[FULL COMMITTEE PRINT]
118TH CONGRESS" HOUSE OF REPRESENTATIVES
2d Session!

REPORT
118–XXX

DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND RELATED AGENCIES APPROPRIATIONS BILL, 2025

llllll, 2024.—Committed to the Committee of the Whole House on the Stateof the Union and ordered to be printed

Mr. ADERHOLT, from the Committee on Appropriations,submitted the following

R E P O R T[To accompany H.R. llllll]

The Committee on Appropriations submits the following report in
explanation of the accompanying bill making appropriations for the
Departments of Labor, Health and Human Services (except the
Food and Drug Administration, the Agency for Toxic Substancesand Disease Registry, and the Indian Health Service), and Education, and the Committee for Purchase from People Who Are
Blind or Severely Disabled, Corporation for National and Community Service, Corporation for Public Broadcasting, Federal Mediation and Conciliation Service, Federal Mine Safety and Health Review Commission, Institute of Museum and Library Services, Medicaid and CHIP Payment and Access Commission, Medicare Payment Advisory Commission, National Council on Disability, National Labor Relations Board, National Mediation Board, Occupational Safety and Health Review Commission, Railroad Retirement
Board, and Social Security Administration for the fiscal year ending September 30, 2025, and for other purposes.
INDEX TO BILL AND REPORTDMWilson on DSKJM0X7X2PROD with HEARINGS

Page number
Bill
ReportSummary of Estimates and Appropriation .............................................. ........
General Summary of the Bill .................................................................... ........
Bill Wide Requirements ............................................................................. ........
Title I—Department of Labor:
Employment and Training Administration .......................................
2
Training and Employment Services ...........................................
2
54–835

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Page number
Bill
ReportJob Corps ......................................................................................
9
Community Service Employment for Older Americans ............ ........
Federal Unemployment Benefits and Allowances .....................
10
State Unemployment Insurance and Employment Service Operations .....................................................................................
11
Advances to the Unemployment Trust Fund and Other Funds
18
Program Administration .............................................................
18
Veterans’ Employment and Training ................................................
18
Employee Benefits Security Administration .....................................
22
Pension Benefit Guaranty Corporation .............................................
22
Office of Workers’ Compensation Programs .....................................
24
Special Benefits ............................................................................
24
Energy Employees Occupational Illness Compensation Fund
26
Special Benefits for Disabled Coal Miners ................................
27
Black Lung Disability Trust Fund .............................................
27
Wage and Hour Division ....................................................................
28
Office of Federal Contract Compliance Programs ............................
28
Office of Labor-Management Standards ...........................................
28
Occupational Safety and Health Administration .............................
29
Mine Safety and Health Administration ...........................................
31
Bureau of Labor Statistics .................................................................
33
Departmental Management ...............................................................
33
Office of Disability Employment Policy .............................................
35
General Provisions ..............................................................................
35
Title II—Department of Health and Human Services:
Health Resources and Services Administration ...............................
53
Primary Health Care ...................................................................
53
Health Workforce .........................................................................
53
Maternal and Child Health .........................................................
57
Ryan White HIV/AIDS Program .................................................
58
Health Systems ............................................................................
58
Rural Health ................................................................................
58
HRSA-Wide Activities and Program Support ............................
59
Vaccine Injury Compensation Program .....................................
60
Covered Countermeasures Process Fund ...................................
60
Centers for Disease Control and Prevention ....................................
60
Immunization and Respiratory Diseases ...................................
60
HIV/AIDS, Viral Hepatitis, Sexually Transmitted Disease,
and Tuberculosis Prevention ...................................................
61
Emerging and Zoonotic Infectious Diseases ..............................
61
Chronic Disease Prevention and Health Promotion .................
61
Birth Defects, Developmental Disabilities, Disabilities and
Health .......................................................................................
62
Public Health Scientific Services ................................................
62
Environmental Health .................................................................
62
Injury Prevention and Control .................................................... ........
National Institute for Occupational Safety and Health ...........
62
Energy Employees Occupational Illness Compensation Program ..........................................................................................
63
Global Health ...............................................................................
63
Public Health Preparedness and Response ...............................
63
CDC-Wide Activities and Program Support ..............................
64
Buildings and Facilities ...............................................................
66
National Institutes of Health .............................................................
67
National Cancer Institute ...........................................................
67
National Institute on Body Systems Research ..........................
67
National Institute on Neuroscience and Brain Research .........
68
National Institute on Infectious Diseases ..................................
68
National Institute on the Immune System and Arthritis ........
68

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Page number
Bill
ReportNational Institute of General Medical Sciences ........................
68
National Institute for Disability Related Research ..................
69
National Institute on Dementia .................................................
69
National Institute on Substance Use .........................................
69
National Institute of Mental Health ..........................................
69
National Institute on Health Sciences Research .......................
70
National Institute on Innovation and Advanced Research ......
70
Office of the Director ...................................................................
70
Buildings and Facilities ...............................................................
72
Substance Abuse and Mental Health Services Administration ......
73
Mental Health ..............................................................................
73
Substance Abuse Treatment .......................................................
74
Substance Abuse Prevention .......................................................
75
Health Surveillance and Program Support ...............................
75
Agency for Healthcare Research and Quality ................................... ........
Centers for Medicare & Medicaid Services .......................................
76
Grants to States for Medicaid .....................................................
76
Payments to the Health Care Trust Funds ...............................
77
Program Management .................................................................
77
Health Care Fraud and Abuse Control Account .......................
79
Administration for Children and Families ........................................
80
Payments to States for Child Support Enforcement and Family Support Programs ...............................................................
80
Low Income Home Energy Assistance .......................................
81
Refugee and Entrant Assistance ................................................
82
Promoting Safe and Stable Families ..........................................
83
Child Care and Development Block Grant ................................
84
Social Services Block Grant ........................................................
85
Children and Families Services Programs ................................
85
Payments for Foster Care and Permanency ..............................
88
Administration for Community Living ..............................................
89
Administration for Strategic Preparedness and Response ..............
92
Research, Development, and Procurement ................................
92
Operations, Preparedness, and Emergency Response ..............
94
Office of the Secretary ........................................................................
94
General Departmental Management ..........................................
94
Office for Civil Rights ..................................................................
96
Office of the National Coordinator for Health Information
Technology ................................................................................
97
Medicare Hearings and Appeals .................................................
97
Office of Inspector General .........................................................
98
General Provisions ..............................................................................
98
Title III—Department of Education:
Office of Elementary and Secondary Education ............................... 126
Education for the Disadvantaged ............................................... 126
Impact Aid .................................................................................... 127
School Improvement Programs ................................................... 128
Safe Schools and Citizenship Education .................................... 130
Indian Education ......................................................................... 130
Innovation and Improvement ..................................................... 131
Office of English Language Acquisition ............................................ ........
Office of Special Education and Rehabilitative Services ................. 132
Special Education ........................................................................ 132
Rehabilitation Services ................................................................ 136
Special Institutions for Persons with Disabilities ..................... 137
American Printing House for the Blind ................................. 137
National Technical Institute for the Deaf .............................. 137
Gallaudet University ................................................................ 137
Office of Career, Technical, and Adult Education ............................ 138

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Page number
Bill
ReportOffice of Postsecondary Education ..................................................... 138
Higher Education ......................................................................... 138
Howard University ...................................................................... 140
College Housing and Academic Facilities Loans ....................... 140
Historically Black College and University Capital Financing
Program Account ...................................................................... 141
Office of Federal Student Aid ..................................................... 141
Student Financial Assistance ..................................................... 141
Student Aid Administration ........................................................ 142
Institute of Education Sciences .......................................................... 143
Departmental Management ............................................................... 144
General Provisions .............................................................................. 145
Title IV—Related Agencies:
Committee for Purchase from People Who Are Blind or Severely
Disabled ............................................................................................ 154
Corporation for National and Community Service ........................... 155
Corporation for Public Broadcasting ................................................. ........
Federal Mediation and Conciliation Service ..................................... 159
Federal Mine Safety and Health Review Commission ..................... 160
Institute of Museum and Library Services ....................................... 160
Medicaid and CHIP Payment and Access Commission ................... 160
Medicare Payment Advisory Commission ......................................... 161
National Council on Disability ........................................................... 161
National Labor Relations Board ........................................................ 161
National Mediation Board .................................................................. 162
Occupational Safety and Health Review Commission ..................... 163
Railroad Retirement Board ................................................................ 163
Social Security Administration .......................................................... 165
Title V—General Provisions ...................................................................... 170
House of Representatives Report Requirements ..................................... ........

227
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246
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260
262

SUMMARY OF ESTIMATES AND APPROPRIATIONS
The following table compares on a summary basis the appropriations, including trust funds for fiscal year 2025, the budget request
for fiscal year 2025, and the Committee recommendation for fiscal
year 2025 in the accompanying bill.
2025 LABOR, HHS, EDUCATION BILL
[Discretionary funding in thousands of dollars]
Fiscal Year—2025 Committee compared to—

Budget Activity

2024
Enacted2025
Budget2025
Committee

2024
Enacted2025
BudgetDepartment of Labor .........................
Department of Health and Human
Services .........................................
Department of Education ..................
Related Agencies ...............................

$13,695,849$14,174,234$10,529,223¥3,166,626¥3,645,011

116,122,958
79,052,238
17,071,955

121,558,671
82,491,976
18,421,516

107,640,959
67,948,452
14,962,530¥8,481,999¥11,103,786¥2,119,425¥13,917,712¥14,543,524¥3,458,986

DMWilson on DSKJM0X7X2PROD with HEARINGS

GENERAL SUMMARY OF THE BILL
For fiscal year 2025, the Committee recommends a total of$185,797,000,000 in current year discretionary funding—the 302(b)allocation—and $201,081,164,000 in overall programmatic funding,including offsets and adjustments. The fiscal year 2025 recommendation is a decrease of $8,637,000,000 below the fiscal year

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2024 enacted level. This amount represents 26 percent of total nondefense spending and 12 percent of total discretionary spending.
The Labor-HHS-Education bill supports some of the nation’s
most critical programs that touch individuals and families throughout their lifespan, from Early Head Start to Social Security.
Federal government discretionary spending of approximately $1.7
trillion represents less than half of mandatory entitlement spending of $3.8 trillion. Mandatory entitlement spending, like Social Security, Medicare, and Medicaid, commands a significant portion of
the budget due to automatic funding mechanisms and eligibility
criteria set by law. Mandatory spending accounts for more than 70
percent of total Federal outlays. Discretionary spending, on theother hand, accounts for just 28 percent of total Federal outlays.
Discretionary spending covers a far broader spectrum of government activities, including the nation’s defense, education, roads
and bridges, and research infrastructure.
Over the past decade, Federal mandatory spending has exhibiteda notable upward trajectory, driven primarily by factors such as demographic shifts, economic conditions, and policy decisions. The rising costs of Federal health care and social insurance programs
have shaped the growth of mandatory spending. Just ten years ago,
mandatory spending was approximately 12 percent of the U.S.
gross domestic product (GDP), and discretionary spending was approximately 8 percent. In one decade, the mandatory amountjumped to nearly 14 percent of GDP and discretionary shrunk toa corresponding 6 percent of GDP. Over the long term, projections
suggest that if current policies remain unchanged, the Federal government could face major fiscal imbalances, primarily due to automatic entitlement spending.

DMWilson on DSKJM0X7X2PROD with HEARINGS

BILL WIDE REQUIREMENTS
In cases where this report directs the submission of a report,that report is to be submitted to the Committee on Appropriationsof the House of Representatives. Where this report refers to theCommittee or the Committee on Appropriations, unless otherwise
noted, this reference is to the House of Representatives Subcommittee on Labor, Health and Human Services, Education, andRelated Agencies.
Each department and agency funded in this Act shall follow thedirectives set forth in this Act and the accompanying report andshall not reallocate resources or reorganize activities except as provided herein. Funds for individual programs and activities are displayed in the detailed table at the end of report accompanying thisAct. Funding levels that are not displayed in the detailed table are
identified within this report. Any action to eliminate or consolidate
programs, projects, and activities should be pursued through a proposal in the President’s Budget so it can be considered by the Committee.
Budget Submission.—As part of the President’s Budget Request,
each Department is directed to provide the Committee in electronic
format a table that corresponds with every program line found in
the detailed table at the end of this report. Such a table shall include a column for the most recently enacted appropriation, thecurrent year, and the budget year, assuming current law. In addition, the Committee continues to expect delivery of all congres-

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6
sional justifications and budget summary documents no later thanthe day of the President’s Budget Appendix publication online. The
Department is directed to notify the Committee 24 hours in advance of any anticipated delay.
Congressional Reports.—Each department or agency is directed
to provide the Committee, within 30 days from the date of enactment of this Act and quarterly thereafter, a summary describing
each requested report to the Committee along with related actions
completed in the current and prior quarters and planned actions to
be completed in future quarters. Such a summary shall be cumulative for all fiscal years for which any report remains outstanding.
Customer Experience.—The Committee continues to support efforts to improve agency customer experience. The Committee urges
all agencies funded by this Act to develop standards to improvecustomer experience and incorporate the standards into the performance plans required under 31 U.S.C. 1115. The Committee requests an update from all agencies funded by this Act to report on
their implementation plans regarding this subject in the fiscal year
2026 congressional justification.
Federal Agency Space Utilization.—The Committee notes withconcern the lack of Federal employees reporting to in person work.
A lack of in office presence is particularly problematic for agencies
whose mission involves direct service to the public. No later than
90 days after enactment of this Act, all executive agencies shall establish and maintain on the homepage of the website of that agency, an accounting of all employees (as defined in 5 U.S.C. 2105)
physically utilizing Washington, DC-metro area Federal agency
space during the previous quarter. Agencies must provide the Committee information detailing what methodology was used to calculate utilization at the time of posting.
Grant Continuation Cost Estimates.—As part of the fiscal year
2026 congressional justification, each department or agency fundedin this Act with discretionary budget authority for competitively
awarded grants shall include the expected cost of continuation
awards for each competitively awarded grant and any amount the
department or agency would seek to issue a new competitive funding opportunity announcement for such grant in fiscal year 2026.
In addition, the department shall include the anticipated numberof awards and average anticipated award for such year.
National Academy of Sciences, Engineering, and Medicine.—The
Committee remains concerned with the lack of objective nonpartisan research methods, including inaccurate references to data
and removal of panel participants, demonstrated by the National
Academy of Sciences, Engineering, and Medicine (NASEM). The
Committee urges agencies to use caution when entering into newagreements with NASEM. Agencies are directed to ensure all contracts are executed with the highest standards of scientific rigor in
an objective, nonpartisan manner. The full spectrum of scientificviews should be represented on a research committee, council, or
panel membership without conflict of interest or ideology.
Performance Reporting.—As part of the congressional justification for fiscal year 2026, each department or agency funded by thisAct is directed to include the percentage of the Senior Executive
Service for each performance level (5—outstanding, 4—exceeds
fully successful, 3—fully successful, 2—minimally satisfactory, or

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1—unsatisfactory). In addition, the department or agency shall include in such justification the total amount spent on performance
awards for the Senior Executive Service for the most recent fiscal
year for which data is available.
Questions for the Record.—The Committee notes the inclusion ofsection 526 of this Act, which requires each Department and agency to provide answers to questions submitted for the record within
45 business days after receipt. The Committee expects each Department and agency to notify the Committees at least 7 days inadvance if they do not anticipate meeting this statutory requirement.
Strengthening Data Capacity and Infrastructure.—The Committee notes that the Office of Management and Budget (OMB) has
revised the Uniform Grants Guidance to clarify that grant funds
may be spent on data, evaluation, and integrated data systems as
direct or indirect costs and on community engagement, which canplay a critical role in data collection and analysis as well as evaluation. To ensure grantees receive consistent guidance from agencies,
the Committee directs the Departments of Education, Labor,
Health and Human Services, and related agencies to coordinate
with OMB to communicate this new guidance and best practices for
implementing it.
Voter Registration.—The Committee notes agencies should remain mission-focused when serving the American public. The Biden
Administration’s relentless expansion and mission creep requiring
agencies to include voting promotion efforts as part of accessing
health care, serving a senior, or helping a student find on campus
employment is a direct attack on the primary focus of these agencies and programs. Efforts to expand the President’s voting basewith taxpayer dollars is a clear violation of executive responsibility.
Whistleblower Protections.—Whistleblowers play a critical role in
the federal government by exposing wrongdoing, fraud, and misconduct. Their willingness to come forward with information helps
maintain transparency, accountability, and integrity within government agencies. Offices of Inspectors General (OIGs) are independent entities responsible for investigating whistleblower complaints at their parent agencies. By thoroughly examining whistleblower reports, OIGs contribute to a healthier and more accountable federal environment. Federal law protects federal employees
from reprisal for whistleblowing. Additionally, under the National
Defense Authorization Act of 2013 (NDAA), it is illegal for employees of Federal contractors, subcontractors, or grantees to face retaliation for making protected whistleblower disclosures. Recently, theDepartment of Justice OIG found a ‘‘chilling effect’’ on employees
hesitant to report wrongdoing due to fear of disciplinary actions.
The Committee requests a briefing from each Department within
120 days of enactment, detailing (1) the number of transmitted
OIG whistleblower reports over the past five years, including thedate of transmittal; (2) actions taken or planned regarding each
OIG transmitted report; (3) any evidence of whistleblower retaliation identified by the OIG; and (4) steps taken to prevent retaliation against whistleblowers reporting wrongdoing.

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TITLE I—DEPARTMENT OF LABOR
Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$13,695,849,000
14,172,234,000
10,529,223,000¥3,166,626,000¥3,643,011,000

This bill provides $10.5 billion in discretionary budget authority
for the Department of Labor, a reduction of 23 percent over fiscal
year 2024 enacted level. The Department of Labor comprises $10.5
billion, or 6 percent of the total 302(b) allocation for this subcommittee.
EMPLOYMENT AND TRAINING ADMINISTRATIONDMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$10,381,341,000
10,644,060,000
7,790,577,000¥2,590,764,000¥2,853,483,000

The Employment and Training Administration (ETA) administers Federal job training grant programs and Trade Adjustment
Assistance and provides funding for the administration and oversight of the State Unemployment Insurance and Employment Service system.
Competitive Grantmaking Transparency.—The Committee is concerned by the Department of Labor’s (DOL) lack of transparency inthe evaluation and awarding of competitive grants. The Committee
directs DOL to provide the Committee with the grant scores foreach applicant for competitive funding evaluated, including all aspects of scoring included in the Funding Opportunity Announcement and in DOL’s award of funds.
Prioritizing High Wage Industries.—The Committee is concernedthat DOL grant making has been ineffective in targeting highwage, high-growth occupations to the detriment of workers and jobseekers. The Committee directs DOL to prioritize grant applications in industries and occupations that exceed the average earnings of a high school graduate based on the Bureau of Labor Statistics (BLS) Occupational Employment and Wage Statistics when
making competitive grant awards and when not inconsistent withthe authorizing statute.
Workforce Development in Innovative Skilled Fields.—The Committee recognizes the growing need for highly-skilled mechanics
and technicians in the automotive field to prepare for advances intechnology. Therefore, the Committee encourages DOL, in collaboration with the Department of Education, to work with industry
partners, workforce groups, and nonprofit experts to better support
pathways for mechanics and technicians in innovative automotive
fields. Specifically, the Committee encourages the Departments to
examine their support for advanced training programs for established career mechanics and to examine needs related to the operation and repair of transportation fleets and motorized equipment.

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TRAINING AND EMPLOYMENT SERVICES

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$4,006,421,000
3,930,587,000
2,083,457,000¥1,922,964,000¥1,847,130,000

Training and Employment Services provides funding for Federal
job training programs authorized primarily by the Workforce Innovation and Opportunity Act of 2014 (WIOA). The Committee recognizes that the House of Representatives has passed bipartisan legislation to reform and improve the workforce development activities
authorized under the now expired WIOA, but the legislation has
yet to be enacted.
Adult Employment and Training Activities
The Committee provides $173,649,000 for adult training, whichis the same as the fiscal year 2024 enacted level and the fiscal year
2025 budget request.
The Committee has included a provision reducing the funding
available for fiscal year 2025 by $712,000,000.
Youth Employment and Training Activities
The Committee provides no funding for Youth Employment andTraining Activities. The Committee notes the absence of evidence
that the program improves employment and educational outcomesfor program participants and that the Department has failed to implement the program in a manner consistent with the changes enacted in the now expired WIOA. This program is largely duplicativeof the Perkins Career and Technical Education, 21st Century Community Learning Centers, and Student Support and Academic Enrichment programs. The Committee further notes that in DOL’s FY
2024 operating plan, DOL transferred $970,000 from youth service
activities to support enforcement activities in the Occupational
Safety and Health Administration.
Dislocated Worker Employment and Training Activities
For Dislocated Worker Employment and Training Activities, theCommittee provides $1,421,412,000. Of the total provided for DislocatedWorker
Employment
andTraining
Activities,$1,095,553,000 is designated for State grants that provide core andintensive services, training, and supportive services for dislocatedworkers. In addition, States use these funds for rapid response assistance to help workers affected by mass layoffs and plant closures. The remaining amount is available for the Dislocated Workers National Reserve (DWNR). DWNR supports national emergency grants, technical assistance, and demonstration projects as
authorized by WIOA. The Committee provides $1,060,000,000 in
advanced appropriations for fiscal year 2026.
Within the total for Dislocated Worker Employment and Training Activities, the Committee provides the following amounts:
DMWilson on DSKJM0X7X2PROD with HEARINGS

Budget Activity

Dislocated Worker Assistance National Reserve .........................................................
Workforce Opportunity for Rural Communities (non-add) .................................
Community College Grants (non-add) ................................................................

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FY 2024
EnactedFY 2025
Committee$300,859,000
50,000,000
65,000,000$325,859,000
55,000,000
65,000,000

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FY 2024
EnactedBudget Activity

DMWilson on DSKJM0X7X2PROD with HEARINGS

Cybersecurity Grants (non-add) .........................................................................
Career Pathways for Youth (non-add) ...............................................................

FY 2025
Committee

10,000,000
20,000,000

25,000,000
10,000,000

Dislocated Worker National Reserve Grantee Performance Reporting.—Consistent with the requirements of section 116(b)(2)(A)(i) of
WIOA (29 U.S.C. 3141), the Committee directs DOL to require thatall grantees receiving awards funded through DWNR report on theemployment, earnings, and credential attainment outcomes of program participants. The Committee further directs DOL to include
program participant outcomes disaggregated by grantee on its
website.
Dislocated Worker National Reserve Disaster Response.—To better ensure DOL is positioned to provide support to communities affected by natural disasters and given the availability of dedicatedfunding for Treatment, Recovery, and Workforce Support within
the Substance Abuse and Mental Health Services Administration,
the Committee provides no funding for the purposes of Training
and Guidance Letter No. 04–18.
Cybersecurity and Software Development Employment Opportunities.—The Committee remains concerned about the high, unmet demand for cybersecurity and software development skills in both the
Department of Defense (DOD) and the private sector and DOL’s
continued lack of attention to these critical and growing industries.
Of the total provided for the DWNR, the Committee directs$25,000,000 for competitive grants to institutions of higher education as defined in sections 101(a) and 101(b) of the Higher Education Act (20 U.S.C. 1001), State Workforce Agencies, local workforce development boards, and employer associations for the purpose of a targeted highly skilled job training grant to help increase
training capacity to meet this demand. For purposes of making
awards under this program, DOL is directed to prioritize applicants
located in States with the greatest number of Federally recognized
Tribes and with preexisting DOD partnerships. DOL is directed toprovide the Committee a briefing on this initiative within 120 daysof the enactment of this Act.
Career Pathways for Youth.—Multiple career pathways should beavailable to young people. The Committee continues to recognize
the need for early workforce readiness, employment, and training
opportunities that help youth develop career-specific skills for employability, such as responsibility, organization, time management,
and workplace safety. The Committee provides $10,000,000 to utilize the demonstration grant authority under DWNR for grants forthis program.
Strengthening Community College Training Grants.—From within the amounts provided for DWNR, the Committee provides$65,000,000 for the Strengthening Community College Training
Grants (SCCT). The Committee directs the Secretary to make individual grants to community colleges of at least $1,500,000, unless
grants are awarded in consortia to community colleges and othereligible institutions of higher education as defined in section 101(a)of the Higher Education Act. In making grant awards, the Committee directs the Secretary to ensure geographic diversity among
grant recipients, to require a plan for third party evaluations in

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DMWilson on DSKJM0X7X2PROD with HEARINGS

each individual grant proposal, and to conduct a national assessment of all grantee proposals once complete. In addition, the Committee directs the Secretary to ensure grantees incorporate a planfor sustainability of funding under the grant proposal. While grants
may be awarded to a consortium of institutions of higher education,
including public and private, nonprofit 4 year institutions, theCommittee directs the Secretary to ensure that the lead grantee inthe consortium is a community college. The Committee directs the
Secretary to brief the Committees 7 days in advance of issuing thefunding opportunity announcement and 7 days in advance of announcing awards.
Degree Apprenticeships.—The Committee encourages DOL tosupport the integration of academic programing and on-the-job
training including paid work experience, related instruction, andindustry involvement.
Immersive Technology Education and Training Programs.—The
Committee encourages the Department to support the utilization
by grantees of immersive technology such as augmented reality,
virtual reality, and mixed reality tools. The use of immersive technologies for training can be cost-efficient and has been found to expedite training processes, increase skills retention, and reduce employee turnover. Immersive technologies can also help expand access to remote training opportunities which is particularly beneficial for individuals living in rural areas or individuals with disabilities that have different access needs.
Workforce Opportunity for Rural Communities.—Within thefunds provided for DWNR, the Committee provides $55,000,000 for
the Workforce Opportunity for Rural Communities (WORC) program, an increase of $5,000,000, to provide enhanced worker training in the Appalachian, Delta, and Northern Border regions. The
Committee directs DOL to ensure that this funding increase isused to support multigenerational workforce training pipelines developed in collaboration with institutions of higher education andworkforce development system partner agencies in regions with a
WORC program.
The WORC program, in coordination with Delta Regional Authority and Appalachian Regional Commission, provides essential
worker training to promote economic recovery in the Delta and Appalachian regions. It is important to bolster workforce programs for
dislocated workers in these underserved areas. The Committee
strongly encourages continued investment in areas with high ratesof unemployment and substance use disorder impacted by the lossof employment in the coal, energy, and telecommunications industries. The energy industry has experienced significant employment
reductions in the past decade resulting in severe economic hardshipconcentrated in specific regions, and sustained investment to transition workers to new industries is needed to offset the challenging
economic conditions.
Native American Programs
For Native American programs, the Committee provides$65,000,000, an increase of $5,000,000, for these programs.

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Migrant and Seasonal Farmworkers
The Committee provides $97,396,000, the same as fiscal year
2024, for this program.
YouthBuild
For the YouthBuild program, the Committee provides$110,000,000, an increase of $5,000,000. WIOA reformed theYouthBuild program to prioritize the employment and educational
outcomes of program participants. While the Committee recognizes
the challenges DOL has had in overseeing grant awards, the Committee notes with concern that in making awards under this program, DOL has prioritized the administrative capacity of new
grantees rather than their demonstrated efficacy in securing employment and earnings outcomes for young adults.
Reintegration of Ex-Offenders
The Committee provides $60,000,000 for training and reintegration activities for individuals with criminal legal histories reentering the community and youth offenders.
The Committee directs DOL to ensure grantees establish formal
partnerships with employers and that program participants receive
industry-recognized credentials and training in fields that preparethem for successful reintegration, including ensuring participantsreceive training and credentials in fields where their record is nota barrier to entry or continued employment. The Committee also
directs DOL to consider the needs of communities that have recently experienced significant unrest. The Committee also continues to set aside $30,000,000 for competitive grants to nationaland regional intermediaries for activities that prepare for employment young adults with criminal legal histories and youth offenders, with a priority for projects serving high-crime, high-poverty
areas. The Committee is aware that reentry programs are an excellent way to help address workforce challenges, including those in
the advanced manufacturing sector.

DMWilson on DSKJM0X7X2PROD with HEARINGS

Workforce Data Quality Initiative
The Committee provides $6,000,000 for the Workforce Data
Quality Initiative.
The Committee notes that Congress has made a significant investment in our workforce development, postsecondary, and career
and technical education systems. As a result of this investment, thenumber of credentials in the U.S. continues to rise. However, theCommittee is aware that many workers and students may facechallenges in navigating an intricate network of diplomas, licenses,
certifications, and badges.
Apprenticeship Programs
The Committee provides $150,000,000 for apprenticeship State
grants. The Committee remains concerned with the modest increases in the number of apprentices generated by considerable andsustained congressional investment. Of the funding made available,
the Committee directs DOL to continue funding State grants at thesame level as fiscal year 2024. The Committee further notes thatin fiscal year 2024, DOL transferred $2,850,000 from this program

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to support enforcement activities in the Occupational Safety and
Health Administration.
No later than 180 days after the enactment of this Act, the Department is directed to publicly disclose on its website grantees receiving funding, the number of apprentices attributable to eachgrantee, and the respective employment and earnings outcomes ofprogram participants as required under section 116(b)(2)(A)(i) of
WIOA. The Committee further directs DOL to provide a briefing on
its implementation of this directive within 90 days of the enactment of this Act.
Cyber Workforce.—The Committee encourages DOL to continue
to prioritize efforts and grants centered on launching, developing,
expanding, and promoting registered apprenticeship programs incybersecurity, as well as related collaboration with cyber industry
and workforce intermediaries.
Parents of Dependent Children.—The Committee encourages
DOL to provide grantees guidance related to coordinating with
community-based providers of wrap around services to support parents of dependent children enrolled in registered apprenticeshipand pre-apprenticeship programs.
Wastewater Apprenticeships.—The Committee directs DOL tomake $20,000,000 in grant funding available to establish, implement, expand, and administer registered apprenticeship programs
consistent with the National Guideline Standards of Apprenticeship for Water and Wastewater System Operations Specialists toaddress nationwide shortages of qualified drinking water andwastewater operators, especially in rural America.
JOB CORPS

DMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$1,760,155,000
1,764,376,000
1,760,155,000–––¥4,221,000

Job Corps is a residential education and vocational training program that helps young people ages 16 through 24 improve thequality of their lives through vocational and academic training. The
Committee continues to be concerned with the administration of
the Job Corps program, including the underutilization of centersrelative to on-board strength, industry-standard training, and performance incentives.
Additionally, the Committee has concerns with the oversight ofjob placement contracts. The DOL Office of Inspector General(OIG) found evidence that contractors helped only 6 percent of thesampled participants find work. The others found jobs on theirown, or there was not enough evidence to show the contractors
helped them. The OIG estimated that nearly $71,000,000 went tocontractors for services they could not show they provided.
Job Corps Programing.—The Committee is concerned that therelative lack of success is due to instructional content that does notreflect job-site best practices or the jobs of today’s economy. To better ensure a variety of high-quality programs are available to Job
Corps students, the Committee directs DOL to limit grants, contracts, or cooperative agreements for purposes of instructional content to no more than $10,000,000.

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Maximizing Employer Partnerships.—The Committee encourages
DOL to fully leverage section 158(f) of WIOA to maximize the resources available to campuses to develop these partnerships andmeet employers’ needs.
Supporting Continuous Campus Improvement.—The Committee
encourages DOL to develop a process involving Job Corps youth
service providers for setting achievable campus performance expectations to more effectively drive continuous improvement in student outcomes.
COMMUNITY SERVICE EMPLOYMENT FOR OLDER AMERICANS

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$405,000,000
405,000,000–––¥405,000,000¥405,000,000

The Committee provides no funding for the Community Service
Employment for Older Americans program, also known as the Senior Community Service Employment Program (SCSEP). The Committee notes that the last comprehensive evaluation of SCSEP
found that the program led to unsubsidized employment for lessthan half of program participants available for employment withworse outcomes for participants with a disability, older adults, andparticipants with lower levels of education. Moreover, the largest
recipients of SCSEP grants are organizations based in the Washington, D.C. area rather than direct service providers.
The Committee further notes that DOL transferred $4,050,000,
the most it is legally allowed, from the SCSEP program in fiscal
year 2024 to enforcement activities in the Occupational Safety and
Health Administration.
FEDERAL UNEMPLOYMENT BENEFITS AND ALLOWANCES

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$30,700,000
33,900,000
33,900,000+3,200,000–––

The Committee provides no funding for the Trade Adjustment
Assistance program in the absence of reauthorization. Funding included under this section is for the administration of benefits to individuals whose petitions were approved before July 1, 2022.
STATE UNEMPLOYMENT INSURANCE AND EMPLOYMENT SERVICEOPERATIONSDMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$4,006,150,000
4,325,429,000
3,740,150,000¥266,000,000¥585,279,000

The total includes $3,656,084,000 from the Employment Security
Administration Account in the Unemployment Trust Fund and$84,066,000 from the General Fund of the Treasury. These funds
are used to support the administration of Federal and State unemployment compensation laws.

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Unemployment Insurance Compensation
In addition, the Committee provides contingency funding for increased workloads that States may face in the administration ofunemployment insurance (UI). The Committee includes bill language so that, during fiscal year 2025, for every 100,000 increasein the total average weekly insured unemployment (AWIU) above
2,124,000, an additional $28,600,000 is made available to Statesfrom the Unemployment Trust Fund.
If additional funds are provided to States under the AWIU contingency authority, the Department is directed to provide notification to the Committee of the current projected AWIU level for the
fiscal year, when funds were provided to States, and how much additional funding was provided in total and to each State within 15
days of funding being provided. If additional funds are provided ona quarterly basis, the Department is directed to provide this information to the Committee on a quarterly basis.
The Committee provides $116,000,000 funding for the Reemployment Services and Eligibility Assessments (RESEA) program. The
Committee supports the intent of the program to provide more intensive services to individuals most likely to use all their unemployment insurance benefits; however, the Committee is concernedthat the program has not achieved the cost savings projected by theCongressional Budget Office (CBO) and does not provide additional
funding pursuant to the Balanced Budget and Emergency Deficit
Control Act. While CBO once estimated that such funding generates reductions in UI benefit exhaustion, the Committee notesthat single State evaluations of the program prior to it being madepermanent in 2018 produced mixed results with some States successfully assisting job seekers to work and others failing to do so.
While a worthy policy objective, the absence of a limitation on
State administrative expenses and inability to effectively target
services to individuals in greatest need of assistance have undermined the ability to achieve the programmatic savings CBO misguidedly predicted.
Unemployment Insurance Integrity Center of Excellence
The Committee provides $9,000,000 for the continued support of
Unemployment Insurance Integrity Center of Excellence.

DMWilson on DSKJM0X7X2PROD with HEARINGS

Unemployment Insurance National Activities
The Committee provides $18,000,000 for UI national activities.
This funding is intended to help modernize information technology
systems and support States in administering the UI program.
Employment Service
The Committee provides $675,052,000 for the Employment Service allotment to States. The Committee also provides $25,000,000
for Employment Service National Activities.
Disability Employment.—The Committee notes the continued
underemployment of individuals with disabilities and encourages
the Department, in consultation with the Social Security Administration, to provide State agencies responsible for reviewing Work
Opportunity Tax Credit certification requests additional information regarding the Ticket to Work program.

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Foreign Labor Certification
The Committee provides $60,528,000 for the Federal administration of the Foreign Labor Certification program and $23,282,000 for
grants to States.
De Minimis Exemption from Adverse Effect Wage Rate.—The
Committee recognizes that the House of Representatives Agriculture Committee’s bipartisan Ag Labor Working Group unanimously supported this change in the wage calculation. The Committee notes that current law requires the highest wage rate to be
paid for all work regardless of how much time a worker may spend
doing the higher rate labor. This overly strict calculation is driving
up costs in the H–2A program and acting as a barrier to entry tothis critical program for employers and employees. As such, theCommittee recommends that DOL adopt a de minimis exemptionthat recognizes the real-world realities of agriculture labor.
U.S. Defense Industrial Base.—The Committee notes that DOL
has not updated the Schedule A Shortage Occupation list to include
more than two occupations since 2005. The Committee encourages
DOL to revise the H–1B program to better prioritize occupations
that are critical to the U.S. defense industrial base.
One-Stop Career Centers/Labor Market Information
The Committee provides $62,653,000 for One-Stop Career Centers and Labor Market Information.
ADVANCES TO THE UNEMPLOYMENT TRUST FUND AND OTHER FUNDSThe Committee recommends such sums as necessary for Advances to the Unemployment Trust Fund and Other Funds. The
funds are made available to accounts authorized under Federal andState unemployment insurance laws and the Black Lung Disability
Trust Fund when the balances in such accounts are insufficient.
PROGRAM ADMINISTRATIONDMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$172,915,000
184,668,000
172,915,000–––¥11,753,000

The Committee provides $118,900,000 from the General Fund of
the Treasury and $54,015,000 from the Employment Security Administration Account in the Unemployment Trust Fund.
Application and Approval Transparency.—The Committee directs
DOL, within 180 days of enactment of this Act, to publicly releasea report on the number of Registered Apprenticeship program applicants, approvals, and the average time between application submittal and approval. The Committee further directs DOL to
disaggregate this data by applicant industry classification; whether
a sponsoring organization is an employer, employer-association, or
an alternative intermediary; and, in the event an application was
not approved, the reason for DOL’s decision.
Office of Apprenticeship.—The Committee notes that for purposesof performance reporting, DOL attributes the total number of Registered Apprenticeships to the Apprenticeship Grants program. The
Committee has concerns regarding the expediency and consistencyof the Office of Apprenticeship’s review of program applications and

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17
that Registered Apprenticeships DOL has attributed to the grant
program are due to private sector investment.
Unemployment Insurance Fraud Detection.—For more than 20
years, the DOL’s Office of Inspector General has reported on DOL’s
challenge to reduce improper payments in the UI program, which
has experienced some of the highest improper payment rates acrossthe Federal government. The Committee is concerned that ETA
currently does not have direct access to State UI claims data, nordoes it have the capability to analyze such data, which would allow
it to better identify fraud and other improper payments as well asother trends or emerging issues, such as timeliness. The Committee notes a report (Report No. 19–23–012–03–315), issued on
September 25, 2023, by the OIG, that recommended the Assistant
Secretary of ETA expedite OIG-related amendments to 20 C.F.R.
603.6(a) to make ongoing disclosures of UI information to DOL–OIG mandatory by expressly adding OIG (including its agents andcontractors) to the list of required disclosures that are necessary forthe proper oversight of the UI program without distinction as topurpose (e.g., audits vs. investigations). The Committee directs
DOL to take such measures as necessary to make ongoing disclosures of UI information available to OIG for purposes of audit ofinvestigation. The Committee directs DOL to provide a briefing on
its implementation of this directive within 90 days of enactment of
this Act.
VETERANS’ EMPLOYMENT AND TRAINING SERVICE

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$335,341,000
337,301,000
335,341,000–––¥1,960,000

The Committee provides $65,500,000 from the General Fund of
the Treasury and $269,841,000 from the Employment Security Administration Account in the Unemployment Trust Fund.
The Veterans Employment and Training (VETS) program serves
America’s veterans and separating service members by preparing
them for meaningful careers, providing employment resources andexpertise, and protecting their employment rights.
Within the total for VETS, the Committee provides the following
amounts:
Budget Activity

DMWilson on DSKJM0X7X2PROD with HEARINGS

Jobs for Veterans State Grants ...................................................................................
Transition Assistance Program ....................................................................................
Federal Administration ................................................................................................
Veterans Employment and Training Institute .............................................................
Homeless Veterans Reintegration Program .................................................................

FY 2024
EnactedFY 2025
Committee$185,000,000
34,379,000
47,048,000
3,414,000
65,500,000$185,000,000
34,379,000
47,048,000
3,414,000
65,500,000

The Transition Assistance Program (TAP) for separating service
members and their spouses provides a mandatory one-day employment workshop, as well as two 2-day career track workshops on
employment preparation and vocational training, as part of TAP toassist service members’ transition to civilian employment. TAP
Employment Workshops are provided on military installations,both domestically and abroad.

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The Committee includes new bill language to allow the Jobs for
Veterans State Grants program to serve the surviving spouses ofindividuals who died while members of the Armed Forces or as aresult of a service-connected disability.
The Committee provides $500,000 to support the Honoring Investments in Recruiting and Employing American Military Veterans Act of 2017 (HIRE Vets) Medallion program.
EMPLOYEE BENEFITS SECURITY ADMINISTRATIONSALARIES AND EXPENSES

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$191,100,000
205,663,000
181,100,000¥10,000,000¥24,563,000

The Employee Benefits Security Administration (EBSA) assures
the security of retirement, health, and other workplace-related benefits of working Americans.
No Suprises Act Implementation.—The Committee encourages
DOL, in collaboration with the Departments of Health and Human
Services and Treasury, to continue conducting random audits of insurers’ qualifying payment amount calculations as mandated by
the No Surprises Act. Additionally, the Committee is concerned
about delays in payment following Independent Dispute Resolution
determinations, despite the No Surprises Act requiring that thesepayments be made within 30 days of the payment determination.
The Committee directs DOL to ensure that Independent Dispute
Resolution entities, payers, and providers provide and receive theappropriate information to complete payments within the required
timeframe. The Committee also urges DOL to use all appropriate
existing authorities to achieve timely payment.
Open Investigations.—The Committee is concerned that prolonged investigations conducted by EBSA have placed tremendous
strain on retirement plan sponsors and have negatively impacted
amounts available for employee benefits. In May 2021, the Government Accountability Office (GAO) found that 17 percent of all investigations opened in 2017 were still open four years later. Within
180 days of enactment of this Act, the Committee directs DOL topublicly release a report on the number of investigations older than
48 months outstanding and the measures taken by DOL to expediently address any violations uncovered by these investigations.
PENSION BENEFIT GUARANTY CORPORATIONPENSION BENEFIT GUARANTY CORPORATION FUND

DMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$512,900,000
514,063,000
514,063,000+1,163,000–––

Congress established the Pension Benefit Guaranty Corporation(PBGC) to insure Americans’ defined-benefit pension plans. It operates a single-employer program and a multiemployer insurance
program, financed through premiums, investment income, and assets from terminated plans.

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Delphi Salaried Plan Employees.—In 2009, the PBGC terminatedcertain Delphi pension plans, including the Delphi Retirement Program for Salaried Employees. The Committee notes that some participants of the Delphi salaried pension plan received less thantheir full benefit. PBGC paid benefits are subject to statutory limitations. The Committee also notes ongoing legislative efforts to restore full benefits to the affected participants.
OFFICE OF WORKERS’ COMPENSATION PROGRAMSSALARIES AND EXPENSES

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$122,705,000
130,545,000
115,705,000¥7,000,000¥14,840,000

The Office of Workers’ Compensation Programs (OWCP) administers the Federal Employees’ Compensation Act, the Longshore
and Harbor Workers’ Compensation Act, the Energy Employees Occupational Illness Compensation Program Act, and the Black Lung
Benefits Act. These programs provide eligible injured and disabledworkers and their survivors with compensation, medical benefits,
and services including rehabilitation, supervision of medical care,and technical and advisory counseling.
The Committee provides $113,500,000 in General Funds from theTreasury and $2,205,000 from the Special Fund established by theLongshore and Harbor Workers’ Compensation Act.
The Committee remains concerned that OWCP has not done
enough to ensure it paid the best price for prescription drugs in theFederal Employees’ Compensation Act (FECA) program. The Committee notes a report (Report No. 03–23–001–04–431) issued on
March 31, 2023, by the DOL–OIG that recommended OWCP implement a process to ensure competitive prices for the FECA program
by regularly evaluating alternate pricing methodologies and othersources—including publicly available benchmark price lists, Statefee schedules, market research, and comparable payers—and updating its pricing methodology as appropriate. The Committee
urges that all DOL–OIG recommendations be sufficiently addressed
to mitigate recurrence of the issues identified and directs DOL toprovide a briefing on agency efforts to implement these recommendations within 90 days of enactment of this Act.
SPECIAL BENEFITSDMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$700,000,000
726,670,000
726,670,000+26,670,000–––

These funds provide mandatory benefits under the Federal Employees’ Compensation Act and the Longshore and Harbor Workers’
Compensation Act.
The Committee is aware that OWCP has a backlog in reimbursing insurance providers for claims under the War Hazards Compensation Act dating back to 2017. Within 180 days of enactmentof this Act, the Committee directs DOL to provide a briefing on its

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work to address the backlog while ensuring only qualified claims
are reimbursed.
ADMINISTRATIVE EXPENSES, ENERGY EMPLOYEES OCCUPATIONAL
ILLNESS COMPENSATION FUND

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$66,532,000
66,966,000
66,966,000+434,000–––

These funds provide mandatory benefits to eligible employees orsurvivors of employees of the Department of Energy (DOE); its contractors and subcontractors; companies that provided beryllium to
DOE; atomic weapons employees who suffer from a radiation-related cancer, beryllium-related disease, or chronic silicosis becauseof their work in producing or testing nuclear weapons; and uranium workers covered under the Radiation Exposure Compensation
Act.
SPECIAL BENEFITS FOR DISABLED COAL MINERS

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$29,890,000
30,367,000
30,367,000+477,000–––

These funds provide mandatory benefits to coal miners disabledby black lung disease, to their survivors and eligible dependents,and for necessary administrative costs.
The Committee provides $6,000,000 as an advance appropriation
for the first quarter of fiscal year 2026. These funds ensure uninterrupted payments to beneficiaries.
BLACK LUNG DISABILITY TRUST FUND

DMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$452,511,000
485,350,000
485,350,000+32,839,000–––

The Black Lung Disability Trust Fund pays black lung compensation, medical and survivor benefits, and administrative expenses when no mine operator can be assigned liability for such
benefits, or when mine employment ceased prior to 1970. The
Black Lung Disability Trust Fund is financed by an excise tax on
coal, reimbursements from responsible mine operators, and shortterm advances from the U.S. Treasury. The Emergency Economic
Stabilization Act of 2008 authorized a restructuring of the Black
Lung Disability Trust Fund debt and required that annual operating surpluses be used to pay down the debt until all remaining
obligations are retired.
Black Lung Benefits Claims Processing.—The Committee is concerned with lengthy delays in the processing of Black Lung Benefits Act claims, particularly where the Department has not yet
identified the liable mine operator or the liable mine operator’sability to pay the claim is in question. Delays impede access to necessary medical care while claims are pending. The Committee supports efforts by the Secretary to resolve these claims expediently to

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21
ensure miners can receive the benefits and medical care they need.
The Committee directs DOL to provide a quarterly report on the
Department’s efforts to improve the speed and quality of black lungclaims processing.
WAGE AND HOUR DIVISIONSALARIES AND EXPENSES

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$260,000,000
294,901,000
235,000,000¥25,000,000¥59,901,000

The Wage and Hour Division (WHD) enforces Federal minimum
wage, overtime pay, recordkeeping, and child labor requirements of
the Fair Labor Standards Act. WHD also has enforcement andother administrative responsibilities related to the Migrant andSeasonal Agricultural Worker Protection Act, the Employee Polygraph Protection Act, the Family and Medical Leave Act, the Davis
Bacon Act, and the Service Contract Act.
The funding level provided by the Committee reflects the significant economic threat posed by aggressive WHD rulemakings which
will adversely affect the ability of workers to provide for their families.
Federal Contractors.—The Committee is concerned that the‘‘Minimum Wage for Federal Contracts’’ notice published by the Department of Labor in the Federal Register on September 30, 2022
(87 Fed. Reg. 59468) disproportionately affects entities operating
seasonal recreational services and equipment rental to the public
on Federal property or lands.
OFFICE OF FEDERAL CONTRACT COMPLIANCE PROGRAMSSALARIES AND EXPENSES

DMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$110,976,000
116,132,000
99,976,000¥11,000,000¥16,156,000

The Office of Federal Contract Compliance Programs (OFCCP)
ensures equal employment opportunity in the Federal contracting
community through enforcement, regulatory work, outreach, andeducation to workers and their advocates.
The Committee notes that 48 C.F.R. 22.101–1 requires that Federal agencies remain impartial concerning labor management disputes and to not undertake the conciliation, mediation, or arbitration of any such dispute. The Committee has concerns that the
Presidential Memorandum Strengthening Support for Federal Contract Labor Practices (M–23–08) proposes that Federal agencies
take a proactive role, consistent with the stated objective of theWhite House Task Force on Worker Organizing and Empowerment,
to unbalance labor-management relations in order to promote
union organizing. The Committee recommendation for OFCCP reflects the Committee’s concerns that the office is promoting and encouraging activities inconsistent with Federal contracting requirements.

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Individuals with Disabilities.—The Committee supports adherence to section 503 of the Rehabilitation Act of 1973, which is dedicated to promoting and advancing the employment of qualified individuals with disabilities.
OFFICE OF LABOR-MANAGEMENT STANDARDSSALARIES AND EXPENSES

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$48,515,000
50,845,000
48,515,000–––¥2,330,000

The Office of Labor Management Standards administers theLabor-Management Reporting and Disclosure Act, which establishes safeguards for union democracy and union financial integrity, and requires public disclosure reporting by unions, union officers, employees of unions, labor relations consultants, employers,
and surety companies.
OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATIONSALARIES AND EXPENSES

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$632,309,000
655,463,000
557,772,000¥74,537,000¥97,691,000

The Occupational Safety and Health Administration (OSHA) administers the Occupational Safety and Health Act of 1970, by setting and enforcing health and safety standards for workplaces andconducting training, outreach, education, and compliance assistance.
Within the total for OSHA, the Committee provides the following
amounts:
Budget Activity

Safety and Health Standards ......................................................................................
Federal Enforcement ....................................................................................................
Whistleblower Programs ..............................................................................................
State Programs ............................................................................................................
Technical Support ........................................................................................................
Federal Compliance Assistance ...................................................................................
State Consultation Grants ...........................................................................................
Training Grants ............................................................................................................
Safety and Health Statistics .......................................................................................
Executive Direction and Administration ......................................................................

FY 2024
EnactedFY 2025
Committee$21,000,000
243,000,000
22,500,000
120,000,000
26,000,000
78,262,000
63,160,000
12,787,000
35,500,000
10,100,000$21,000,000
182,250,000
22,500,000
120,000,000
26,000,000
78,262,000
63,160,000–––
35,500,000
9,100,000

MINE SAFETY AND HEALTH ADMINISTRATIONDMWilson on DSKJM0X7X2PROD with HEARINGSSALARIES AND EXPENSES

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

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E:\HR\OC\A835.XXX$387,816,000
406,538,000
367,816,000¥20,000,000¥38,772,000

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23
The Mine Safety and Health Administration (MSHA) enforces
the Federal Mine Safety and Health Act of 1977 and the Mine Improvement and New Emergency Response Act of 2006 in underground and surface coalmines and metal/non-metal mines.
Within the total for MSHA, the Committee provides the following
amounts:
Budget Activity

Mine Safety and Health Enforcement .........................................................................
Standards and Regulations Development ...................................................................
Assessments ................................................................................................................
Educational Policy and Development ..........................................................................
Technical Support ........................................................................................................
Program Evaluation and Information Resources ........................................................
Program Administration ...............................................................................................

FY 2024
EnactedFY 2025
Committee$265,774,000
5,000,000
7,191,000
39,820,000
36,041,000
17,990,000
16,000,000$245,774,000
5,000,000
7,191,000
39,820,000
36,041,000
17,990,000
16,000,000

Resources and Activities.—The Committee notes significant worker dislocations and mine closures because of economic conditions
throughout the mining industry, and particularly in coal mining.
The Committee reiterates its support for the ongoing effort to bring
MSHA enforcement into proportion by redistributing resources andactivities to the areas where mine production is currently occurring
and where MSHA identifies the most significant safety hazards.
BUREAU OF LABOR STATISTICS
SALARIES AND EXPENSES

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$697,952,000
712,786,000
697,952,000–––¥14,834,000

The Bureau of Labor Statistics is an independent national statistical agency that collects, processes, analyzes, and disseminates essential economic data to the Congress, Federal agencies, State andlocal governments, businesses, and the public. Its principal surveys
include the Consumer Price Index and the monthly unemployment
series.
The Committee recommendation includes $629,952,000 from theGeneral Fund of the Treasury and $68,000,000 from the Employment Security Administration Account in the Unemployment Trust
Fund.
Within the total for BLS, the Committee provides the following
amounts:
Budget Activity

DMWilson on DSKJM0X7X2PROD with HEARINGS

Employment and Unemployment Statistics .................................................................
Labor Market Information ............................................................................................
Prices and Cost of Living ............................................................................................
Compensation and Working Conditions ......................................................................
Productivity and Technology ........................................................................................
Executive Direction and Staff Services .......................................................................

FY 2024
EnactedFY 2025
Committee$243,952,000
68,000,000
246,000,000
91,000,000
12,000,000
37,000,000$247,952,000
68,000,000
241,000,000
91,000,000
12,500,000
37,500,000

Declining Statistical Survey Response Rates.—The Committee
notes a report (Report No. 17–24–001–11–001) issued on October
26, 2023, by the OIG that describes how the BLS addresses challenges posed by declining statistical survey response rates, and the

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24
impact of the declining response rates on the reliability and costsof economic information developed by BLS. The OIG recommended,among other things, that BLS, based on the nonresponse bias study
or imputation assessment, establish, as applicable, a threshold at
which the Consumer Price Index and Import and Export Price
Index must publicly disclose the number of imputations used. The
OIG also recommended that BLS update program policies and procedures to include the established threshold, and document how topublicly disclose when the threshold is met. The Committee remains concerned that BLS may not have guidelines that require a
sufficient degree of transparency and urges that all DOL–OIG recommendations be sufficiently addressed.
Disaggregating Wage Data.—The Committee encourages BLS to
improve its collection and release of data on wages and earnings
by industry of occupation, worker characteristics, and unemployment at the Federal and State levels disaggregated by subpopulations.
Military Spouse Employment.—The Committee recognizes theneed for comprehensive data measuring employment among military spouses over time. The Committee encourages BLS, in collaboration with DOD, to assess the potential for measuring labor market outcomes and characteristics of military spouses with existing
survey data and explore options for modifying such surveys to capture this population.
Nonprofit Data.—BLS is directed to include in the fiscal year
2026 congressional justification an estimate related to the incorporation of nonprofit workforce data into the Quarterly Census of
Employment and Wages program.
Survey on Employer Provided Training.—The Committee directs
BLS to include, as part of the fiscal year 2026 congressional justification, a cost estimate of a survey to better understand the incidence and nature of training provided to employees by employers.
DEPARTMENTAL MANAGEMENTSALARIES AND EXPENSES

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$388,197,000
465,601,000
178,072,000¥210,125,000¥287,529,000

The Departmental Management appropriation provides funds forthe staff responsible for Departmental operations, management,
and policy development.
The Committee recommendation includes $177,764,000 from theGeneral Fund of the Treasury and $308,000 from the Employment
Security Administration Account in the Unemployment Trust
Fund.
Within the total for Departmental Management, the Committee
provides the following amounts:
DMWilson on DSKJM0X7X2PROD with HEARINGS

Budget Activity

Program Direction and Support ...................................................................................
Departmental Evaluation .............................................................................................
Legal Services ..............................................................................................................

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FY 2024
EnactedFY 2025
Committee$32,658,000
4,281,000
131,062,000$25,658,000
3,281,000
86,062,000

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FY 2024
EnactedBudget Activity

DMWilson on DSKJM0X7X2PROD with HEARINGSInternational Labor Affairs ..........................................................................................
Administration and Management ................................................................................
Adjudication .................................................................................................................
Women’s Bureau ..........................................................................................................
Civil Rights Activities ..................................................................................................
Chief Financial Officer ................................................................................................

FY 2025
Committee

116,125,000
30,804,000
37,000,000
23,000,000
7,586,000
5,681,000–––
20,804,000
30,000,000–––
6,586,000
5,681,000

Annual Appropriations.—The Committee notes that the appropriations process is an annual process. The Committee believes if
the Administration is unable to obligate all annual funding for salary and expense accounts, funding should be reduced, not madeavailable for multiple years. The Committee has repeatedly rejected such requests for extended periods of availability and requests information in the fiscal year 2026 congressional justification explaining why funding increases are needed, if the Administration also continues to request annual salaries be available formultiple fiscal years.
Bill Wide Requirements.—The Committee notes the inclusion ofa bill wide requirements section of this report. This section contains requirements which apply to all agencies funded by this Act.
Bureau of International Labor Affairs.—The Committee provides
no funding for the Bureau of International Labor Affairs.
Coronavirus Aid, Relief, and Economic Security Act Program Implementation.—The Committee continues to be concerned that DOL
and States struggled to implement the three key Coronavirus Aid,
Relief, and Economic Security Act UI programs (Pandemic Unemployment Assistance, Pandemic Emergency Unemployment Compensation, and Federal Pandemic Unemployment Compensation),
which received a total of $392 billion as of January 2, 2021. A report (Report No. 19–21–004–03–315) issued on May 28, 2021, by
OIG, found that DOL’s guidance and oversight did not ensure
States implemented the programs and paid benefits promptly; performed required and recommended improper payment detection
and recovery activities; and reported accurate and complete program activities. OIG recommended, among other things, that DOL
continue to work with States to develop, operate, and maintain amodular set of technological capabilities to modernize the deliveryof UI benefits that is sufficient to manage and process sudden
spikes in claims volume during emergencies or high unemployment. The Committee encourages that all OIG recommendations be
sufficiently addressed to mitigate recurrence of the issues identified.
Chief Evaluation Officer.—The Committee notes with concern thelack of program evaluations performed by the Chief Evaluation Officer that evaluate programs based on the employment and labormarket outcomes of program participants.
Collaborations Between Manufacturers and Educational Institutions.—The Committee continues to urge the Department to develop pilot programs that facilitate education and training programs in the field of advanced manufacturing.
Employee Stock Ownership Plans.—The Committee is concerned
about the Department’s implementation of the SECURE 2.0 Act of2022 (26 U.S.C. 1042), specifically a key provision related to employee stock ownership plans (ESOPs). The law directs DOL to

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26
issue formal guidance on the adequate consideration exemption, as
defined in section 407(d)(6) of the Employee Retirement Income Security Act (ERISA). The Committee is aware that this critical regulatory guidance for ESOPs has been neglected since ERISA’s passage in 1974, causing both significant enforcement and investigation issues for decades and a deleterious effect on ESOP formation.
The Committee encourages the Department to prioritize a timely,
formal notice and comment rulemaking on the adequate consideration exemption that ensures taxpayers benefit from stakeholder
input and experience.
Excess Personal Property.—The Committee directs DOL to include in the fiscal year 2026 congressional justification information
the value and recipient of excess personal property provided to apprenticeship programs under section 112 of this Act.
Health Care Professions.—The Committee encourages DOL tosupport efforts that connect unemployed workers with credentials
in health care with employers that have acute workforce needs.
Interstate and Locality Paid Leave Requirements.—The Committee recognizes that the patchwork of State and local paid leave
requirements creates difficulty for employers and employees navigating mandatory paid family and medical leave programs withvarying characteristics and requirements. The Committee directs
DOL to produce and publicly release a report detailing these paid
leave programs, including whether and how they coordinate with
employer-provided leave; the actuarial value of such programs andemployer provided leave, accounting for differences in programmatic features such as eligibility of employees, wage replacement rate, maximum benefit amount, and duration of benefits; andthe comparative equivalence of such programs by jurisdiction. The
Committee directs DOL to provide such report within 180 days ofthe enactment of this Act.
Investments in Impoverished Areas.—The Committee directs DOL
to update the report provided to the Committee in response to a
House Report 117–403 directive to include persistent poverty percentages for competitions in fiscal year 2023 once those data are
available.
Return to Work.—Excessive abuse of telework across the Federal
government must end. For the average American showing up to
work every day is a fact of life; they deserve a government that reflects that reality. Approvals for remote work should be made on
an individual case by case basis and done only to serve the bestinterests of the program and the American public. The agency is
directed to provide to the Committee within 60 days of enactmentof this Act a report detailing the number of full-time employees bysubcomponent who are receiving the Washington D.C. area locality
pay but have not reported to an in person office in the DC area
more than one day a week for the past year. Considering the remote work abuse seen at several agencies, administrative funding
for the Secretary has been reduced accordingly. The Committee
urges the Secretary to bring Federal employees back to the workplace to fulfill the mission of serving the American public.
Skilled Trades Workforce Development Outreach Coordination.—
The Committee encourages DOL to support the development of coordinated State and regional outreach plans to educate young

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27
Americans about the earning potential, career pathways, benefits,
and accessibility of careers in the skilled trades.
Workforce Impacts Related to Vehicles From Foreign Entities ofConcern.—The Committee is concerned about the potential impacts
on U.S. workers from highly subsidized electric vehicles and parts
built by automakers from foreign entities of concern. The Committee is also concerned by potential trade practices inconsistent
with the requirements of U.S.-Mexico-Canada Agreement by these
entities. Therefore, within 180 days of enactment of this Act, theCommittee directs the Department to submit a report analyzing
the potential risks to U.S. workers of highly-subsidized electric vehicles and parts manufactured by automakers from foreign entities
of concern.
IT MODERNIZATION

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$29,269,000
35,286,000
29,269,000–––¥6,017,000

Information Technology (IT) Modernization provides a dedicatedsource of funding for Department-wide IT modernization projects
together with funding through the Department’s Working Capital
Fund.
OFFICE OF INSPECTOR GENERALDMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$97,028,000
106,237,000
99,028,000+2,000,000¥7,209,000

The Office of Inspector General conducts audits of Department
programs and operations to determine that they comply with theapplicable laws and regulations, that they use resources effectively,
and that they are achieving their intended results.
The recommendation includes $93,187,000 from the GeneralFund of the Treasury and $5,841,000 from the Employment Security Administration Account in the Unemployment Trust Fund.
Fraud Reduction.—The Committee continues to recognize theoutstanding UI program oversight work performed by the OIG. The
DOL–OIG has shown that access to UI data is vital to holdfraudsters accountable and perform oversight audits to ensure efficient program operation and the preservation of precious taxpayer
dollars. Between April 1, 2020, and March 31, 2024, the OIG’s efforts to combat UI fraud resulted in more than 1,700 indictments/
initial charges; 1,150 convictions; 26,000 months of incarceration
ordered; and $1,000,000,000 in investigative monetary results. Further, OIG’s audit work resulted in the issuance of 50 audit reports
including 150 recommendations, more than $75,000,000,000 infunds put to better use, and more than $277,000,000 in questioned
costs related to DOL’s pandemic-related programs and operations.
The committee directs DOL to ensure that the OIG has timely access to UI claim and wage data, including access to wage records,
for any authorized purpose under the Inspector General Act of1978. The Committee directs DOL to report to Congress no later
than 180 days after enactment of this Act, on the steps it has taken

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28
to ensure that OIG has access to UI and wage records for all oversight activities authorized by the Inspector General Act of 1978.
OFFICE OF DISABILITY EMPLOYMENT POLICYSALARIES AND EXPENSES

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$43,000,000
44,876,000
43,000,000–––¥1,876,000

The Office of Disability Employment Policy provides policy guidance and leadership to eliminate employment barriers to people
with disabilities.
GENERAL PROVISIONS
Sec. 101. The Committee continues a provision to prohibit theuse of Job Corps funds for the salary of an individual at a rate
more than Executive Level II.
(TRANSFER OF FUNDS)

Sec. 102. The Committee continues a provision regarding transfer authority.
Sec. 103. The Committee continues a prohibition on use of funds
to purchase goods that are in any part produced by indentured children.
Sec. 104. The Committee continues a provision related to grants
made from funds available to the Department under the American
Competitiveness and Workforce Improvement Act.
Sec. 105. The Committee continues a provision to prohibit recipients of funds provided to the Employment and Training Administration from using such funds for the compensation of any individual at a rate more than Executive Level II.
(TRANSFER OF FUNDS)

Sec. 106. The Committee modifies a provision providing the Secretary with the authority to transfer funds made available to the
Employment and Training Administration to Program Administration for technical assistance and program integrity activities.

DMWilson on DSKJM0X7X2PROD with HEARINGS(TRANSFER OF FUNDS)

Sec. 107. The Committee modifies a provision allowing up to 0.75
percent of discretionary appropriations provided in this Act for specific Department of Labor agencies to be used by the Office of the
Chief Evaluation Officer for evaluation purposes consistent withthe terms and conditions in this Act applicable to such office.
Sec. 108. The Committee continues a provision relating to the
Fair Labor Standards Act and certain insurance personnel conducting post-disaster activity.
Sec. 109. The Committee continues a provision relating to flexibility of H–2B nonimmigrant crossings.
Sec. 110. The Committee continues a provision related to the prevailing wage in the H–2B program.

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29
Sec. 111. The Committee continues a provision related to workers
in the H–2B program.
Sec. 112. The Committee modifies a provision relating to surplus
property and apprenticeship programs.
Sec. 113. The Committee modifies a provision relating to the Secretary’s security detail.
Sec. 114. The Committee continues a provision relating to theTreasure Island and Gary Job Corps Centers.
Sec. 115. The Committee continues a provision relating to Job
Corps Civilian Conservation Centers.
(RESCISSION)

Sec. 116. The Committee includes a provision rescinding balances
made available from section 286 of the Immigration and Nationality Act.
Sec. 117. The Committee includes new a provision extending thestatute of limitations for pandemic UI fraud.
Sec. 118. The Committee includes new a provision related to Adverse Effect Wage Rate determination.
Sec. 119. The Committee includes new a provision related to H–
2A rulemaking.
Sec. 120. The Committee includes a new prohibition related to
final rules entitled ‘‘Employee or Independent Contractor Classification Under the Fair Labor Standards Act,’’ and ‘‘Defining andDelimiting the Exemptions for Executive, Administrative, Professional, Outside Sales, and Computer Employees.’’Sec. 121. The Committee includes a new prohibition related to
final rules, ‘‘Prudence and Loyalty in Selecting Plan Investments
and Exercising Shareholder Rights,’’ ‘‘Retirement Security Rules:
Definition on an Investment Advice Fiduciary,’’ ‘‘Amendment to
Prohibited Transaction Exemption 2020–02,’’ ‘‘Amendment to Prohibited Transaction Exemption 84–24,’’ and ‘‘Amendment to Prohibited Transaction Exemptions 75–1, 77–4, 80–83, 83–1, and 86–128.’’
Sec. 122. The Committee includes a new provision related to the
proposed rule ‘‘National Apprenticeship System Enhancements.’’
Sec. 123. The Committee includes a new provision related to thefinal rule ‘‘Lowering Miners’ Exposure to Respirable Crystalline
Silica and Improving Respiratory Protection.’’Sec. 124. The Committee includes a new provision related to thefinal rule ‘‘Worker Walkaround Representative Designation Process.’’
TITLE II—DEPARTMENT OF HEALTH AND HUMANSERVICES

DMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 .............................................
Budget request, fiscal year 2025 ...........................................
Committee Recommendation .................................................
Change from enacted level .............................................
Change from budget request ..........................................

$116,122,958,000
121,548,671,000
107,640,959,000¥8,481,999,000¥13,907,712,000

The Department of Health and Human Services (HHS) anticipates exceeding $1.8 trillion in total spending, constituting over 6
percent of the U.S.’ gross domestic product. Over 90 percent of thisexpenditure is mandatory, with discretionary funding, overseen by
the Committee on Appropriations, comprising only 9 percent. Since
2010, the percentage spent on discretionary programs has actually

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30
decreased, while mandatory program spending has more than doubled. The escalating pace of mandatory entitlement driven spending remains the primary cost driver within the agency.
This bill provides just over $107 billion in discretionary budget
authority for HHS, a reduction of 7 percent over fiscal year 2024
enacted level. HHS comprises 58 percent of the total 302(b) allocation for this subcommittee.
HEALTH RESOURCES AND SERVICES ADMINISTRATION
Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$9,171,787,000
8,530,564,000
7,638,837,000¥1,532,950,000¥891,727,000

The Health Resources and Services Administration (HRSA) supports programs that provide health services to disadvantaged,
medically underserved, and special populations; decrease infantmortality rates; assist in the education of health professionals; andprovide technical assistance regarding the utilization of health resources and facilities.
The
Committee
recommendationfor
HRSA
includes
$7,372,110,000 in discretionary budget authority and $266,727,000
in mandatory funding.
PRIMARY HEALTH CARE

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$1,858,772,000
1,858,772,000
1,858,772,000––––––

Health Centers
Health Centers deliver affordable, accessible, quality, and cost-effective primary health care to millions of people across the country
regardless of their ability to pay. Programs supported by this funding include community health centers, migrant health centers,
health care for the homeless, and public housing health service
grants.
The Committee includes bill language providing up to$120,000,000 for the Federal Tort Claims Act program, the sameas the fiscal year 2024 enacted level and the fiscal year 2025 budget request.
Within the total provided for the Health Centers program, theCommittee provides not less than the following amounts:
FY 2024
EnactedDMWilson on DSKJM0X7X2PROD with HEARINGS

Budget Activity

Addressing Intimate Partner Violence and Project Catalyst .......................................
Alcee L. Hastings Program for Advancing Cancer Screening .....................................
Early Childhood Development ......................................................................................
Native Hawaiian Health Care ......................................................................................
Papa Ola Lokahi (non-add) ................................................................................
School Based Health Centers ......................................................................................
Technical Assistance ...................................................................................................

FY 2025
Committee$2,000,000
10,000,000
30,000,000
27,000,000
10,000,000
55,000,000
2,500,000$2,000,000
10,000,000
30,000,000
27,000,000
10,000,000
55,000,000
2,500,000

Alcee L. Hastings Program for Advanced Cancer Screening in Underserved Communities.—The Committee commends the work of

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31
HRSA in effectively implementing the Alcee L. Hastings Programfor Advanced Cancer Screening in Underserved Communities. This
innovative program focuses on HRSA-funded health centers to leverage Cancer Center trained and supervised outreach specialists
and patient navigators to conduct patient outreach, patient education, case management, and other patient support services in underserved communities served by health centers to promote early
detection and prevention of cancer, connect patients to screening
services, and provide direct assistance with accessing high quality
cancer care and treatment as needed. This program is progressing
as intended with health centers reporting progress toward statedgoals. The grant funding has made it possible for health centers to
improve access to and affordability of cancer screening, referral forcare, and treatment; to enhance patient experience; and to recruit,
train, and engage cancer-focused professionals. Within the total for
health centers, the Committee provides robust funding to continue
supporting screening initiatives in breast, cervical, colorectal, andlung cancer; prioritize new grantees in States where the total number of estimated new cancer cases and deaths due to cancer are
highest; and to support grantees that can expand existing projects
that embrace additional cancers, and that also work to secure appropriate follow up screening and access to care for individuals
with abnormal screening results.
Base Grant Adjustments.—The Committee recognizes that HealthCenter costs have increased significantly and that it has been nearly a decade since the last base grant adjustment. The Committee
encourages HRSA to consider the needs of existing health centersin relation to their current base grants when allocating increased
health center funding.
Expanded Service Grants for Individuals with an Intellectual or
Developmental Disability.—The Committee supports efforts to expand service grants to health centers for the planning and deliveryof services to individuals with an intellectual or developmental disability, including for innovative programs that provide outreachand comprehensive primary health services and additional healthservices as defined in section 330(b) of the Public Health Service(PHS) Act (42 U.S.C. 254b), including dental care.
Federally Qualified Health Center Look Alike Participation.—The
Committee is concerned that certain health centers—and in turn,certain groups of patients—throughout the country are unable torealize the benefits of federal funding for high-quality primary careservices due to Federally Qualified Health Center Look Alike(FQHC LALs) ineligibility to apply for supplemental funding
awards. In many geographic regions, FQHC LALs are ideal candidates for supplemental funding opportunities but are ineligible toapply for them. Given the access to care issues many communities
currently face, widespread healthcare workforce challenges, andthe ability of many FQHC LALs to help meet the country’s current
unmet health care needs, the Committee requests that HRSA provide an update to the committees of jurisdiction on the impacts ofallowing FQHC LALs to apply for Supplemental Funding opportunities under section 330(d) of the PHS Act (42 U.S.C. 254b) within
180 days of enactment of this Act.
Additionally, the Committee requests that HRSA provide a report to the House and Senate Committees on Appropriations; the

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32
House Committee on Energy and Commerce; and the Senate Committee on Health, Education, Labor and Pensions on the ways inwhich FQHC LALs could be better utilized as a pipeline into theSection 330 Health Center program.
Native Hawaiian Health Care.—The Committee continues$27,000,000 for the Native Hawaiian Health Care Program. Of thetotal amount appropriated for the Native Hawaiian Health Care
Program, not less than $10,000,000 shall be provided to Papa Ola
Lokahi for administrative purposes authorized under 42 U.S.C.
11706, including expanded research and surveillance related to thehealth status of Native Hawaiians and strengthening the capacityof the Native Hawaiian Health Care Systems.
Parental Consent.—The Committee directs HRSA to ensure
grantees comply with all Federal and State laws for parental andlegal guardian approval for medical decisions involving minors.
Grantees should not provide materials encouraging health care providers to hide a minor patient’s perceived sexual orientation or any
effort that deviates from the patient’s biological sex from the patient’s parent or guardian. Technical assistance and guidance documentation should be consistent with all Federal and State law regarding parental consent. Moreover, grantees should not be providing any guidance to health care practitioners for ways to bypass
parental consent or how to keep medically relevant informationfrom a patient’s medical record.
School-Based Health Centers.—The Committee continues funding
for school based health centers authorized under section 330 of the
PHS Act (42 U.S.C. 254b).
Sleep Disorders.—The Committee notes delays in diagnosis forsome affected by sleep disorders. Advancements in screening continue to create meaningful opportunities to recognize conditions
and link patients to care, and to mitigate the negative outcomesthat occur when patients, particularly children, endure
undiagnosed and sometimes easily treatable conditions. The Committee supports efforts to explore opportunities to enhance sleep
screening and related awareness tools among frontline health providers and to otherwise work with stakeholders to advance efforts
that quickly recognize sleep disorders and link patients to appropriate care.
Tardive Dyskinesia.—The Committee supports efforts for screening, diagnosing, and treating Tardive Dyskinesia (TD), a persistent,
irreversible, and potentially disabling neurological condition that is
associated with prolonged exposure to antipsychotics and otherdopamine receptor blocking agents. The estimated prevalence of TD
has increased from 500,000 to 600,000 people in the U.S., with only
an estimated 35 percent of people living with this little-known andchallenging movement disorder being diagnosed to date. The Committee supports HRSA’s goal of integrating behavioral health andprimary care.
Testing for Hepatitis C.—The Committee recognizes the value ofpoint of care testing for the hepatitis C virus and supports efforts
by HRSA to adopt practices and policies to test for the hepatitis C
virus. The Committee further encourages HRSA to ensure that
health centers have access to and utilize available point of care diagnostic tests to adequately test the populations they serve.

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DMWilson on DSKJM0X7X2PROD with HEARINGSType 1 Diabetes.—Health centers remain a major source of primary health care for millions of Americans. Therefore, the Committee supports ways to increase type 1 diabetes screenings at
health centers, particularly among high-risk populations. HHS hasreported increased incidents of diabetic ketoacidosis (DKA) at diagnosis, with rates over 40 percent among youth in some years. Further, misdiagnosis with type 2 diabetes is a leading risk factor for
adults entering DKA at diagnosis. A 2020 study from Diabetes
Care showed that charges associated with DKA admissions totaled
over $6,700,000,000 in 2017. HRSA is directed to provide a reportto the Committee 180 days after the enactment of this Act addressing the steps needed to increase screening efforts for type 1 diabetes at health centers and to make such report available on theagency’s website. The report should include the feasibility and costestimate of expanding screening efforts among targeted populations
as well as a plan and timeline to implement such efforts. When developing the report, HRSA should consult with the National Institute of Digestive and Kidney Diseases, patient advocacy organizations, and other type 1 diabetes stakeholders.
Vaccination.—The Committee encourages HRSA to redouble efforts to support health center grantees to adopt the necessary practices and policies to comply with the November 2021 Advisory
Committee on Immunization Practices recommendation that all
adults between 19 and 59 be vaccinated and the March 2023 CDC
recommendation that all adults in the U.S. be screened for hepatitis B. The Committee further encourages HRSA to provide guidance to health centers about screening and immunization for patients in the 19–59 age cohort.
Voting Registrations.—Health centers provide an accessible option for primary health care to millions of people across the country. However, the Committee is concerned with health centers allocating taxpayer funds for uses outside their intended purpose.
HRSA guidance states that, ‘‘Health Center Program grant funding
made available to provide health services to medically underserved
populations under section 330 of the PHS Act cannot be used tosupport voter registration efforts.’’ While the guidance does allow
discretion for health centers to participate in such activities outside
the Health Center program, the Committee is concerned that
health centers’ focus on voter registration activities has grown tosuch an extent that it impairs the purpose of the program. The
Committee requests that the Department include an update in thefiscal year 2026 congressional justification on implementation of
Executive Order 14019 entitled, ‘‘Promoting Access to Voting’’, theuse of health center funding for voter registration, and whether
such use violates requirements laid out in statute or program guidance.
Free Clinics Medical Malpractice
The Committee includes $1,000,000 for carrying out responsibilities under the Federal Tort Claims Act, the same as the fiscal year
2024 enacted level and the fiscal year 2025 budget request. The
program provides medical malpractice coverage to individuals involved in the operation of free clinics to expand access to healthcare services to low-income individuals in medically underserved
areas.

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HEALTH WORKFORCE

DMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$1,404,376,000
1,467,376,000
1,342,011,000¥62,365,000¥125,365,000

The Bureau of Health Workforce supports several health care
workforce programs by providing grants, scholarships, and loan repayment to help communities recruit and retain health care providers.
Community Based Clinical Rotations.—An estimated 80 percent
of patient care is now provided in a range of community-based settings rather than the academic hospital where clinical training has
traditionally occurred. Research shows that providing outpatienttraining opportunities in underserved areas—either in conjunction
with or outside of inpatient training programs—encourages longterm, sustainable physician practice in high-need areas. The Committee recognizes that prioritizing community-based clinical training in rural and underserved areas leads to more physicians staying to practice in these communities. The Committee urges HRSA
to work with medical schools to partner with health centers, rural
health clinics, or other healthcare facilities located in medically underserved communities to increase medical school clinical rotations
in rural and underserved areas.
Health Professional Shortage Areas in Non-Contiguous States.—
The Committee recognizes the significant geographical and transportation challenges faced by patients and health professionals in
non-contiguous States, which lead to difficulties in recruiting andretaining health professionals. The Committee recognizes that according to HRSA’s Report to the Committee pursuant to the joint
explanatory statement which accompanied the Consolidated Appropriations Act, 2021 (P.L. 116–260), HRSA awarded only 83 new National Health Service Corps (NHSC) Loan Repayment ProgramAwards to clinicians completing an NHSC service obligation in noncontiguous States, out of 16,229 nationally. The Committee notesthat the current health professional shortage areas designation criteria may not adequately account for the unique challenges faced
by non-contiguous States.
Health Professions Workforce Enhancement Initiative.—The Committee notes that over the last 30 years, the U.S. has introduced
several programs and initiatives designed to enhance the academic
success of historically underrepresented groups and students fromunderserved areas matriculating into health professions education
programs. The Committee acknowledges the matriculation challenges from these underserved areas demonstrate that no single solution is sufficient and encourages the development of a comprehensive strategy that identifies, prepares, and trains students
in underserved areas or from historically underrepresented groups
for academic success in health professions education programs.
Interstate Licensure.—The Committee recognizes that almost 100
million Americans live in a primary care health professional shortage area and over 156 million—almost half of the U.S. population—
live in a mental health care health professional shortage area.
While efforts continue to support the recruitment and retention of
the healthcare workforce, optimizing the existing workforce is crit-

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35
ical. The Interstate Medical Licensure Compact, created under the
Licensure Portability Grant Program, is a voluntary, expedited
pathway to licensure for qualified health care professionals, including psychologists, to practice in multiple States. Since 2015, thecompact has grown from 7 member States to 37 member States, aswell as Washington, D.C. and Guam. The Committee encourages
HRSA to expand public awareness of these compacts to encouragerobust provider participation.
Natural Procreative Technology Education and Training.—Natural Procreative Technology (NaProTECHNOLOGY), a female specific approach to health, monitors and maintains a woman’s reproductive and gynecological health. The laparoscopic surgical approach of NaProTECHNOLOGY requires specialization in the formof gynecologic surgery. The primary aim of the surgery is to reconstruct the uterus, fallopian tubes, ovaries, and other organ structures so that endometriosis can be eliminated. The excision of endometriosis can alleviate pain and increase the preservation of fertility. At least 7 million women in the U.S. struggle with endometriosis, and there are only about 22 surgeons adequately trainedin
NaProTECHNOLOGY.
Medicaltraining
in
NaProTECHNOLOGY requires an extra fellowship year for surgeons. Addressing this gap in care is crucial, given the rising number of endometriosis diagnoses. The Committee encourages HRSA
to explore scholarship and loan opportunities for medical students
and professionals interested in pursuing this specialty.
Nutrition Education.—The Committee is aware that in the U.S.
today, 42 percent of adults are living with obesity, and 1.5 million
Americans die annually from diet-related diseases such as cardiovascular disease, cancer, and diabetes. Despite this, the average
medical school provides only 19 hours of nutrition education
throughout a student’s four years in medical school, and nutritionrelated competencies are limited or absent from most medical specialties in graduate medical education. Therefore, the Committee
encourages the Department to pursue all opportunities to encourage medical accrediting bodies such as the Accreditation Council
for Graduate Medical Education, the Association of American Medical Colleges, the American Association of Continuing Medical Education (CME), and State CME organizations, to incorporate nutrition competencies into their training requirements. The Committee
requests an update on this topic in the fiscal year 2026 congressional justification.
Real Time Data to Improve U.S. Healthcare Workforce.—The
Committee supports efforts to develop a data dashboard for all
graduate medical education training position participants to include real-time information on residency applications, interviewee
demographics, and residency fulfillment rates. The National Centerfor Health Workforce Analysis has projected shortages across awide range of health care occupations, particularly in rural areas.
As a result, HRSA has increased its focus on rural residency training, including through the Rural Residency Planning and Development program. The Committee recognizes the benefit of using realtime information to assess whether such programs are leading to
improved physician supply in medically underserved areas.
State Based Nursing Workforce Centers.—The Committee notes
interest in State-based nursing workforce centers. Such centers can

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collect local workforce research data, conduct strategic nursing
workforce planning and program development, support programs todecrease workplace violence against nurses, develop programs toincrease the recruitment and retention of nurses, and coordinate
nurse leadership development programs. The Committee requests
an update on the status of State-based nursing workforce centersin the fiscal year 2026 congressional justification.
National Health Service Corps
The Committee includes $130,000,000, which is $1,400,000 above
the fiscal year 2024 enacted level and $4,400,000 above the fiscal
year 2025 budget request, for the National Health Service Corps(NHSC) to support competitive awards to health care providers
dedicated to working in underserved communities in urban, rural,
and Tribal areas.
State Loan Repayment Program.—The Committee appreciatesthat the State Loan Repayment Program (SLRP) program allows
States to determine how to address healthcare provider shortages.
However, the Committee is concerned that many States are not focusing on the full range of healthcare providers in shortage, including in nursing, pharmacy, dentistry, and behavioral healthcare.
The Committee directs HRSA to include in the fiscal year 2026 congressional justification information regarding the process for how
States determine which health professions benefit from the SLRP
with recommendations to improve SLRP access to all professions inshortage in the States.
Tribal Set Aside.—The Committee also includes a set aside of 15
percent within the discretionary total provided for NHSC to support awards to participating individuals that provide health services in Indian Health Service facilities, Tribally-operated healthprograms, and Urban Indian Health programs.
Health Professions Education and Training
The Committee recommends $459,882,000 for the health professions education and training programs authorized under title VIIof the PHS Act, which is $60,422,000 below the fiscal year 2024 enacted level and $115,922,000 below the fiscal year 2025 budget request.
Centers of Excellence and Health Careers Opportunity Program
The Committee does not include funding for these programs.

DMWilson on DSKJM0X7X2PROD with HEARINGS

Faculty Loan Repayment
The Committee includes $2,310,000 for Faculty Loan Repayment,
equal to the fiscal year 2024 enacted level and the fiscal year 2025
budget request. This program provides loan repayment to healthprofessions graduates from disadvantaged backgrounds who serve
as faculty at eligible health professions academic institutions.
Scholarships for Disadvantaged Students
The Committee includes $55,014,000 for Scholarships for Disadvantaged Students (SDS), equal to the fiscal year 2024 enacted
level and the fiscal year 2025 budget request. The SDS programprovides grants to health professions and nursing schools to provide scholarships to students from disadvantaged backgrounds who

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have financial need. The Committee notes the success of the program and encourages HRSA to prioritize institutions with a provenrecord of both training diverse practitioners and placing their practitioners in low-income communities.
Set Aside for Midwifery Training.—Within the total for SDS, theCommittee includes $5,000,000, the same as the fiscal year 2024
enacted level, to continue grants awarded for the purpose of educating midwives to address the national shortage of maternity careproviders. The Committee supports HRSA awarding robust fundingin grants to invest in the maternal and perinatal health nursing
workforce by increasing and diversifying the number of Certified
Nurse Midwives, particularly in rural and underserved communities.
Primary Care Training and Enhancement
The Committee includes $49,924,000, which is the same as the
fiscal year 2024 level and the fiscal year 2025 budget request, forPrimary Care Training and Enhancement programs. These programs address the primary care workforce by supporting enhanced
training for future primary care clinicians and faculty and promoting primary care practice, particularly in rural and underserved areas.
Oral Health Training
The Committee includes $43,673,000 for Oral Health Training,$1,000,000 above the fiscal year 2024 enacted level and the fiscal
year 2025 budget request. The Oral Health Training programs increase access to high-quality dental health services in rural andother underserved communities by increasing the number of oral
health care providers working in underserved areas and improving
training programs for these providers.
Within the funds provided, the Committee includes not less than
$13,500,000 for general dentistry programs and not less than
$13,500,000 for pediatric dentistry programs, and not less than
$15,000,000 for State oral health workforce grants. The Committee
directs HRSA to provide continuation funding for section 748 postdoctoral training grants, predoctoral dental grants, and dental faculty loan repayment grants.
Interdisciplinary Community-Based Linkages

DMWilson on DSKJM0X7X2PROD with HEARINGS

Area Health Education Centers
The Committee includes $47,000,000 for the Area Health Education Centers program, equal to the fiscal year 2024 enacted leveland equal to the fiscal year 2025 budget request. This programlinks university health science centers with community health service delivery systems to provide education and training networks.
Geriatrics Workforce Enhancement Programs
The Committee includes $48,245,000 for Geriatrics Workforce
Enhancement programs, equal to the fiscal year 2024 level and$1,000,000 above the fiscal year 2025 budget request. These programs support training to integrate geriatrics into primary care delivery and develop academic-primary care-community based partnerships to address gaps in health care for older adults.

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Mental and Behavioral Health Programs
The Committee adopts the budget request to consolidate activities funded under Mental and Behavioral Health programs into Behavioral Health Workforce Education and Training.
Behavioral Health Workforce Education and Training
The Committee includes $158,053,000 for the Behavioral Health
Workforce Education and Training (BHWET) program, $1,000,000
above the comparable fiscal year 2024 enacted level and$95,500,000 below the fiscal year 2025 budget request. This program establishes and expands internships or field placement programs in behavioral health, serving populations in rural and medically underserved areas.
Within the total for BHWET, the Committee recommends notless than the following amounts:
Budget Activity

DMWilson on DSKJM0X7X2PROD with HEARINGS

Graduate Psychology Education ..................................................................................
Mental and Substance Use Disorder Workforce Training Demonstration ...................
Addiction Medicine Fellowship (non-add) ..........................................................
Peer Support Specialists .............................................................................................

FY 2024
EnactedFY 2025
Committee$25,000,000
34,700,000
25,000,000
14,000,000$25,000,000
34,700,000
25,000,000
15,000,000

Crisis Service Models.—Crisis service models present opportunities for cost savings and more effective use of the behavioral healthworkforce. By stabilizing individuals experiencing behavioral
health crises in settings that are less intensive and less costly than
traditional acute care, these models align the level of intervention
needed by a client to address a crisis with the level of training andcredentials of a provider. The Committee encourages HRSA to include crisis workforce development, as appropriate, in the BHWET
programs.
Graduate Psychology Education.—The interprofessional Graduate
Psychology Education program increases the number of healthservice psychologists trained to provide integrated services to highneed, underserved populations in rural and urban communities.
The Committee notes new data from CDC demonstrating a rise inmental health issues for youth and adolescents and urges HRSA tostrengthen investments in the training of health service psychologists to help address this population.
Mental and Substance Use Disorder Workforce Training Demonstration.—This program makes grants to institutions, including
but not limited to medical schools and Federally qualified healthcenters, to support training for medical residents and fellows in
psychiatry and addiction medicine, as well as nurse practitioners,
physician assistants, and others, to provide substance use disorder(SUD) treatment in underserved communities. Within the total included for this activity, the Committee directs HRSA to use no lessthan 50 percent of the total funds to award grants to expand thenumber of nurse practitioners, physician assistants, health service
psychologists, counselors, nurses, and social workers trained to provide mental health and substance use disorder services in underserved and rural community-based settings, including such settings
that serve pediatric populations, as authorized under section 760 of
the PHS Act.

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The Addiction Medicine Fellowship program provides fellowships
to train addiction medicine physicians and addiction psychiatrists
who work in underserved, community-based settings that integrate
primary care with mental health disorder and SUD prevention andtreatment services. One major cause of the existing treatment gap
is that physicians in traditional medical settings lack the necessary
training and overall confidence to provide comprehensive assessments of adolescents with SUD and subsequent evidence-based
treatment. The fellowship opportunities funded by this programprovide advanced training opportunities to a wide range of specialists, including those in family medicine, internal medicine, psychiatry, and emergency medicine.
Peer Support Specialists.—The Committee supports community
based experiential training for students preparing to become peer
support specialists and other types of behavioral health-relatedparaprofessionals. The Committee includes a $1,000,000 increase
for this activity.
Youth Behavioral Health Workforce.—The Committee recognizes
the access limitations for child and youth behavioral health services. Some children are impacted by socioeconomic or geographic
factors. The Committee requests an update in the fiscal year 2026
congressional justification outlining funding available for child andadolescent behavioral health workforce development. The updateshould note the type of child and adolescent behavioral health professionals being trained with HHS funding and the number of individuals being trained in each type.
Substance Use Disorder Treatment and Recovery (STAR) Loan
Repayment Program
The Committee includes $40,000,000 for this program, the sameas the fiscal year 2024 enacted level. This program addresses shortages in the SUD workforce by providing for the repayment of education loans for individuals working in a full-time SUD treatment
job that involves direct patient care in either a Mental Health
HPSA or a county where the overdose death rate exceeds the national average.
National Center for Health Workforce Analysis
The Committee includes $5,663,000 for this program, the sameas the fiscal year 2024 enacted level and the fiscal year 2025 budget request. The National Center for Health Workforce Analysis(NCHWA) is the primary Federal entity that collects, analyzes, andreports on data and information regarding the U.S. health workforce. NCHWA also evaluates the effectiveness of HRSA’s workforce
investment programs.

DMWilson on DSKJM0X7X2PROD with HEARINGS

Public Health and Preventive Medicine Training Programs
The Committee does not include funding for these programs.
Nursing Workforce Development
The Committee recommends $287,129,000 for the Nursing Workforce Development programs authorized under title VIII of the PHS
Act, $18,343,000 below the fiscal year 2024 enacted level and$33,343,000 below the fiscal year 2025 budget request.

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Nursing Workforce Programs.—The Committee recognizes theimportant role of hospital-based schools of nursing in preparing ahighly skilled nursing workforce with the clinical experience tomeet the growing demand for nurses to provide care at the bedside.
The Committee encourages HRSA to identify opportunities to increase participation from hospital-based schools of nursing in
HRSA workforce programs.

DMWilson on DSKJM0X7X2PROD with HEARINGS

Advanced Nursing Education
The Committee includes $89,581,000 for Advanced Nursing Education, equal to the fiscal year 2024 enacted level. This programsupports traineeships and faculty and curriculum development toincrease the number of qualified nurses in the primary care workforce.
Certified Nurse Midwives.—The Committee continues $8,000,000
for Certified Nurse Midwives within Advanced Nursing Education.
Sexual Assault Nurse Examiners.—The Committee continues$15,000,000 for this activity. HRSA is encouraged to prioritize
rural, Tribal, and underserved communities, and urban areas without full-time coverage for this program. This program shall provide
training and supervision to nurses with the purpose of increasing
sexual assault forensic nurse capacity in rural areas, and in support of population-specific programs and hospitals including, but
not limited to, underserved or historically underfunded communities. Entities receiving these funds shall promote best practices
in forensic nursing throughout a region, while continuing to research and develop the highest standards of care.
Nursing Education, Practice, Quality, and Retention
The Committee includes $69,413,000 for the Nursing Education,
Practice, Quality, and Retention (NEPQR) programs, an increase of$5,000,000 above the fiscal year 2024 enacted level and equal to
the fiscal year 2025 budget request. These programs support academic, service, and continuing education projects to enhance nursing education, improve the quality of care, increase nurse retention,and strengthen the nursing workforce.
Community Colleges.—The Committee recognizes the importantrole that community colleges play in the education of our healthworkforce, including in nursing. The Committee provides an increase of $5,000,000 above the fiscal year 2024 enacted level to further support community college participation within NEPQR. The
Committee directs HRSA to give priority to applications from community colleges or eligible partnerships that include a community
college with this additional funding.
Experiential Learning.—Nursing schools are facing unprecedented challenges in delivering high quality clinical experiences
necessary for training practice-ready nurses. In-person labs andclinical rotations have been limited, making it challenging to ensure students gain clinical reasoning skills through realistic interactions. And there continues to be a shortage of clinical practicesites, so use of experiential learning can help alleviate the capacity
shortages and enable nursing schools to scale programs. Nursing
schools are eligible to apply for HRSA simulation education training grants and use of simulations will increase the practice readiness of nurses, which can improve retention once nurses enter clin-

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ical practice and reduce stress and burnout. Within the total for
NEPQR, the Committee continues $10,750,000 for grants to enhance nurse education through the expansion of experiential learning opportunities. The grants shall include as an allowable use thepurchase of simulation training equipment.
Nursing Workforce Shortages.—The U.S. Bureau of Labor Statistics projects 203,200 openings for nurses in the U.S. each year
through 2031. With an aging population with greater health careneeds, an aging clinical and faculty workforce, and a decline in thenumber of students in entry-level nursing programs, the Committee believes action must be taken to alleviate this crisis and ensure an ample, well-trained nursing workforce for the future. The
Committee supports efforts to expand the nursing workforce at alllevels to meet the growing health needs of our population. The
Committee encourages efforts to greatly expand the number ofnursing faculty and clinical preceptor sites to educate students at
all levels.
Nurse Practitioner Optional Fellowship Program
The Committee provides $7,000,000, which is $1,000,000 above
the fiscal year 2024 enacted level. This program supports grants toestablish or expand community-based nurse practitioner residency
and fellowship training programs for practicing postgraduate nurse
practitioners in primary care or behavioral health.
Nursing Workforce Diversity
The Committee does not include funding for this program.
Nurse Corps Scholarship and Loan Repayment
The Committee includes $92,635,000 for Nurse Corps, equal to
the fiscal year 2024 enacted level and the fiscal year 2025 budget
request. This program supports scholarships and loan repayment
assistance for nurses and nursing students committed to working
in communities with inadequate access to care.

DMWilson on DSKJM0X7X2PROD with HEARINGS

Nursing Faculty Loan Program
The Committee includes $28,500,000 for the Nursing Faculty
Loan Program, the same as the fiscal year 2024 enacted level andthe fiscal year 2025 budget request. This program supports schoolsof nursing to provide loans to students enrolled in advanced nursing education programs who are committed to becoming nurse faculty.
Nursing School Faculty Shortage Assessment.—The Committee
urges HRSA to make available, to the extent practicable, data on
nursing school teaching faculty and educators in the U.S.
Children’s Hospitals Graduate Medical Education
The Committee includes $395,000,000 for the Children’s Hospitals Graduate Medical Education (GME) program, which is$5,000,000 above the fiscal year 2024 enacted level and$10,000,000 above the fiscal year 2025 budget request. This program helps eligible hospitals maintain GME programs, which support the training of residents to care for the pediatric populationand enhance the supply of primary care and pediatric medical andsurgical subspecialties.

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Medical Student Education
The Committee includes $70,000,000, which is $10,000,000 above
the fiscal year 2024 enacted level to support colleges of medicine
at public universities located in the top quartile of States projected
to have a primary care provider shortage.
The Committee directs HRSA to give priority to applications
from academic institutions located in States with the greatest number of Federally recognized Tribes. The Committee also directs
HRSA to give priority to applications from public universities witha demonstrated public-private partnership.
Pediatric Specialty Loan Repayment Program
The Committee includes $10,000,000, equal to the fiscal year
2024 enacted level and the fiscal year 2025 budget request, for thepediatric specialty loan repayment program authorized by section
775 of the PHS Act.
The Committee is concerned that once again the 2024 application
process does not adequately reflect the way pediatric specialty careis provided nor the Committee’s feedback from the fiscal year 2024
joint explanatory statement. The Committee remains concernedthat pediatric medical specialists, pediatric surgical specialists, andchild and adolescent psychiatrists, were underrepresented in theinitial awards of the program despite the intent of the program.
The Committee strongly urges HRSA to work with stakeholders toensure that the program’s application process includes clinical hourrequirements and site eligibility criteria that are consistent withpediatric specialty practice and reflects the regionalization of pediatric specialty care.
National Practitioner Data BankThe Committee includes $18,814,000 for the National Practitioner Data Bank (NPDB), the same as the fiscal year 2024 enacted
level and the fiscal year 2025 budget request. The NPDB is a workforce tool that collects and discloses information to authorized entities on past adverse actions of health care practitioners, providers,and suppliers to reduce fraud and abuse and improve health carequality.
MATERNAL AND CHILD HEALTH

DMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$1,170,430,000
1,234,944,000
1,018,582,000¥151,848,000¥216,362,000

The mission of the Maternal and Child Health Bureau is to improve the physical and mental health, safety, and well-being of thenation’s women, infants, children, adolescents, and their families.
Nutrition.—The U.S. continues to experience higher rates of maternal morbidity and mortality relative to other nations. Poor nutrition combined with chronic health conditions threatens the healthand wellbeing of mothers and infants alike. The Committee supports efforts by HRSA to work with community-based organizations
to develop interventions for maternal populations at risk of poor
health outcomes due to poor nutrition and other health related risk
factors. Such efforts could target maternal populations in low in-

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come and underserved urban and rural areas and demonstrate improvements in fruit and vegetable intake; health outcomes, such as
gestational weight gain; overall physical and mental health; andwellbeing for a cohort of pregnant women, as well as positive birthoutcomes.

DMWilson on DSKJM0X7X2PROD with HEARINGS

Maternal and Child Health Services Block Grant
The Committee recommends $608,584,000 for the maternal andchild health (MCH) services block grant, which is $5,000,000 above
the fiscal year 2024 enacted level and the fiscal year 2025 budget
request. States use these funds to improve access to care for mothers, children, and their families; reduce infant mortality; provide
pre- and post-natal care; support screening and health assessments
for children; and provide systems of care for children with special
health care needs.
Community Integrated Service Systems.—The Committee recommends $10,276,000 for community integrated service system,
which is the same as the fiscal year 2024 enacted level and the fiscal year 2025 budget request. These grants help States and communities build a comprehensive, integrated system of care to improve access and outcomes for all children, including children withspecial health care needs.
Congenital
Cytomegalovirus.—Congenital
Cytomegalovirus(CCMV) is the most common viral infection infants are born within the U.S. and the leading non-genetic cause of hearing loss. Onein-five of those infected will have serious health complications suchas epilepsy, visual impairment, or developmental delays. Emerging
research has shown that early intervention treatments, such as
anti-viral drugs, may prevent or lessen the severity of hearing loss
in infants born with CCMV. The Committee urges HRSA to expand
efforts to provide CCMV education during pregnancy, ensure infants born with CCMV are identified and provided with opportunities for treatment, hearing screening, and early intervention, andincrease screening and testing for CCMV during pregnancy.
Self-Measured Blood Pressure Monitoring.—The Committee notes
the promise of the Healthy Start blood pressure monitoring pilot,
including the distribution of cuff kits to 15 sites in 12 States. The
Committee would like to see more States benefit from this projectand urges continued support and expansion of this effort to the extent practicable. The self-measured blood pressure monitoring pilot
works to identify preeclampsia at an earlier stage in high-risk communities by distributing blood pressure cuffs and patient information. Preeclampsia, the most dangerous form of hypertension, is apregnancy complication that effects as many as 1 in 12 pregnancies
and can be easily monitored.
MCH Block Grant Special Projects of Regional and National
Significance
The Committee recommends $194,268,000 for the special projectsof regional and national significance (SPRANS), which is$15,848,000 below the fiscal year 2024 enacted level and$33,862,000 below the fiscal year 2025 budget request. The Committee continues bill language identifying a specific amount for
SPRANS. The Committee provides not less than the following within SPRANS:

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Budget Activity

Early Childhood Development Grants ..........................................................................
Fetal Alcohol Syndrome ...............................................................................................
Fetal Infant and Child Death Review .........................................................................
Infant-Toddler Court Teams ........................................................................................
Minority Serving Institutions .......................................................................................
Oral Health ..................................................................................................................
Regional Pediatric Pandemic Network ........................................................................
Sickle Cell Disease ......................................................................................................
State Maternal Health Innovation Grants ...................................................................

FY 2024
EnactedFY 2025
Committee$10,000,000
1,000,000
5,000,000
18,000,000
10,000,000
5,250,000
25,000,000
7,000,000
55,000,000$10,000,000
1,000,000
5,000,000
20,000,000
10,000,000
5,250,000
25,000,000
7,000,000
55,000,000

Infant Toddler Court Teams.—The Committee includes an increase of $2,000,000 for research-based Infant-Toddler Court
Teams to change child welfare practices to improve well-being for
infants, toddlers, and their families. The Committee directs HRSA
to allocate funding to ensure continuation of existing grantees,
technical assistance, and support other expansion activities.
Oral Health and Primary Care Integration.—Within the total
from oral health withing SPRANS, the Committee includes$250,000 to continue demonstration projects to increase the implementation of oral health and primary care practice integration. The
projects should model the core clinical oral health competencies fornon-dental providers that HRSA published and initially tested inits 2014 report Integration of Oral Health and Primary Care Practice. The Committee strongly urges the Chief Dental Officer to continue to direct the design, monitoring, oversight, and implementation of these projects.
Regional Pediatric Pandemic Network.—The pediatric pandemic
network is made up of 10 children’s hospitals that coordinate thedevelopment and dissemination of the best evidence and practices
to pediatric communities across the country. The Network’s major
functions are focused on preparation and mobilization for future
pandemics, other global threats, and other disasters. Preparation
includes emergency preparedness, training, and surveillance in advance of a pandemic. Mobilization includes response, detection,
testing, tracking and recovery planning during a pandemic. Robust
research, innovation, and technology transformation—including
telemedicine—are critical to helping close knowledge and performance gaps.
The Committee does not include funding for the Doula Workforce
or the Addressing Emerging Issues and Social Determinants of Maternal Health as proposed in the fiscal year 2025 budget request.

DMWilson on DSKJM0X7X2PROD with HEARINGS

Sickle Cell Disease Treatment Demonstration Program
The Committee includes $8,205,000 for this program, which isthe same as the fiscal year 2024 enacted level and the fiscal year
2025 budget request. The sickle cell disease treatment demonstration program helps individuals with sickle cell disease (SCD) accessquality, coordinated, comprehensive care by building comprehensive sickle cell disease care teams that extend specialty care from
centrally based SCD experts in hospitals, clinics, or university
health centers to the communities where people live.
Autism and Other Developmental Disabilities
The Committee recommends $57,344,000 for autism and otherdevelopmental disabilities programs, which is $1,000,000 above the

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DMWilson on DSKJM0X7X2PROD with HEARINGS

fiscal year 2024 enacted level and the fiscal year 2025 budget request. These programs seek to improve the health and well-beingof children and adolescents with autism spectrum disorder andother developmental disabilities and to advance best practices forthe early identification and treatment of autism and related developmental disabilities.
Leadership Education in Neurodevelopmental and Related Disabilities.—The Committee provides not less than $38,245,000, thesame as the fiscal year 2024 enacted level, for the Leadership Education in Neurodevelopmental and Related Disabilities (LEND) program to allow the existing 60 LEND sites to maintain their capacity to train interdisciplinary professionals to screen, diagnose, andprovide evidence-based interventions to individuals with autism
spectrum disorder and other developmental disabilities. The LEND
program is essential to increasing the number of professionals withadvanced interdisciplinary training in a broad array of professional
disciplines to train professionals to improve the evaluation, diagnosis, and treatment of people with autism and other developmental disabilities. The funding provides the LENDs with support
needed to address the critical shortage of professionals, increase
the number of trainees, serve underrepresented communities, andfulfill the expanded statutory mandate to serve persons with autism and developmental disabilities across the lifespan.
Heritable Disorders in Newborns and Children
The Committee provides $21,383,000 for the Heritable Disorders
program, which is $500,000 above the fiscal year 2024 enacted
level and the fiscal year 2025 budget request. This program assists
States to improve and expand their newborn screening programsand to promote parental and provider education. HRSA also supports the work of the Advisory Committee on Heritable Disorders
in Newborns and Children, which provides States with a Recommended Uniform Screening Panel (RUSP) to help ensure every
infant is screened for conditions that have a recognized treatment.
Advisory Committee on Heritable Disorders in Newborns andChildren.—The Committee recognizes the authority of Advisory
Committee on Heritable Disorders in Newborns and Children(ACHDNC) to recommend conditions for inclusion in the RUSP. In
March 2023, Duchenne Muscular Dystrophy (DMD) was nominated
for review, but not recommended to be added to the RUSP by
ACHDNC due to concerns with the characteristics of the screening
test, clinical utility, and the diagnostic process. In August 2023,
ACHDNC voted to reconsider DMD and undertake a full evidence
review. As of January 2024, ACHDNC is conducting another literature review to consider DMD as an included condition. With
emerging gene therapies regarding treatment of DMD, newborn
screening may be more impactful regarding early diagnosis andtreatment of DMD. The Committee is encouraged by ACHDNC’s
choice to review DMD as a qualifying condition for the RUSP andencourages a swift and full review of evidence gaps and other barriers to issuing guidance.
Severe Combined Immune Deficiency.—Within the total amountfor Heritable Disorders, the Committee provides $4,500,000, whichis $500,000 above the fiscal year 2024 enacted level, to support
wider implementation, education, and awareness of newborn

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screening and follow-up for Severe Combined Immune Deficiency
and other newborn screening disorders.
Healthy Start
The Committee does not recommend funding for this program.
Funding for these activities is provided by the Maternal, Infant,and Early Childhood Home Visiting (MIECHV) program, also administered by HRSA. For fiscal year 2025, the MIECHV program
received a mandatory appropriation of $600,000,000.
Early Hearing Detection and Intervention
The Committee includes $18,818,000 for the early hearing detection and intervention program, the same as the fiscal year 2024 enacted level and the fiscal year 2025 budget request. This program
awards grants to 53 States and territories to support Statewide
systems of newborn hearing screening and early intervention programs.

DMWilson on DSKJM0X7X2PROD with HEARINGS

Emergency Medical Services for Children
The Committee includes $24,834,000 for emergency medical services for children, an increase of $500,000 from the fiscal year 2024
enacted level and the fiscal year 2025 budget request. Funding isavailable to every State’s emergency medical services office to improve the quality of emergency care for children and to support research on and dissemination of best practices.
Screening and Treatment for Maternal Mental Health andSubstance Use Disorders
The Committee provides $11,500,000, which is $500,000 above
the fiscal year 2024 enacted level and $4,000,000 below the fiscal
year 2025 budget request for the Screening and Treatment for Maternal Mental Health and Substance Use Disorder (MMHSUD) program. The program helps expand health care providers’ capacity toscreen, assess, treat, and refer pregnant and postpartum womenfor maternal mental health and substance use disorders.
The Committee continues to support MMHSUD. According toMaternal Mortality Review Committee data reported to the Centers
for Disease Control and Prevention, suicide and overdose are theleading causes of maternal mortality, accounting for 22 percent ofmaternal deaths. Maternal mental health conditions impact 1 in 5
pregnant or postpartum women, including as many as 1 in 3 inhigh-risk populations including military service members, costing
the U.S. economy $14 billion annually. MMHSUD trains healthcare providers to screen, assess, and treat MMH conditions andprovides specialized psychiatric consultation to health care providers. The Committee encourages HRSA to reduce the administrative burden on current grantees and work to create uniform evaluation metrics across all States with perinatal psychiatric access programs. The Committee urges HRSA to provide guidance for the
MMHSUD and Pediatric Mental Health Care Access program State
grantees to foster collaboration and promote cost efficiencies by integrating the States’ maternal and child psychiatric consultationlines, if applicable. The Committee supports HRSA providing technical assistance to support States that desire to increase collaboration between maternal and child health consultation lines. The

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Committee requests a report within 180 days after the enactmentof this Act detailing the technical assistance HRSA has provided toStates to promote collaboration between maternal and child healthpsychiatric consultation lines; such report shall be made available
on the agency’s website.
Pediatric Mental Health Care Access
The Committee includes $13,000,000 for the pediatric mental
health care access program, which is equal to the fiscal year 2024
enacted level and the fiscal year 2025 budget request. This program supports expanded access to behavioral health services in pediatric primary care by supporting the development of pediatricmental health care telehealth access programs.

DMWilson on DSKJM0X7X2PROD with HEARINGS

Innovation for Maternal Health
The Committee includes $15,300,000 for the Innovation for Maternal Health program, which is the same as the fiscal year 2024
enacted level and $15,000,000 below the fiscal year 2025 budget request. The Innovation for Maternal Health program authorizes theestablishment or continuation of a program to identify, develop, ordisseminate best practices to improve maternal health care quality
and outcomes, improve maternal and infant health, and eliminate
preventable maternal mortality and severe maternal morbidity,
among other activities.
Maternal Mental Health Hotline
The Committee includes $7,500,000 for the Maternal Mental
Health Hotline, which is $500,000 above the fiscal year 2024 enacted level and the fiscal year 2025 budget request. This programprovides 24/7 free, confidential emotional support, information, andreferrals for pregnant or postpartum women and their families.
The Committee continues to support the Maternal Mental HealthHotline. Maternal mental health conditions impact 1 in 5 pregnant
and postpartum women and 1 in 3 female servicemembers andmilitary spouses. The hotline provides 24-hour voice and text maternal mental health support services for pregnant and postpartum
mothers and their families in English and Spanish. Since its
launch on Mother’s Day 2022, the hotline has served more than
30,000 women and families with average response times of lessthan 30 seconds. The average amount of time hotline operators
spend on text conversations is 32 minutes and the average time on
the phone is 17 minutes. The Committee directs HRSA to coordinate with the Department of Veterans Affairs and DOD to increaseawareness and utilization of the hotline by servicemembers, veterans, and military spouses, including promotion at military treatment facilities, hospitals, lactation spaces, and locations frequented
by servicemembers and veterans. The Committee requests a report
within 180 days after the enactment of this Act detailing current
data on hotline usage, caller demographics to include active duty
or veteran status, and the most common reasons for calling the
hotline; such report shall be made available on the agency’s
website.

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Poison Control Centers
The Committee includes $27,846,000 for Poison Control Centers,
which is $1,000,000 above the fiscal year 2024 enacted level andthe fiscal year 2025 budget request. The Poison Control Centers
program supports a national network of centers that prevent andtreat poison exposures by providing cost effective, quality healthcare advice to the public and health care providers.
Integrated Services for Pregnant and Postpartum Women
The Committee includes $10,000,000 for integrated services for
pregnant and postpartum women, the same as the fiscal year 2024
enacted level and the fiscal year 2025 budget request. The Integrated Services for Pregnant and Postpartum Women program
helps States, Indian Tribes, and Tribal organizations establish oroperate innovative programs to effectively deliver care for pregnant
and postpartum women while considering their social, behavioral,
and health care needs.
RYAN WHITE HIV/AIDS PROGRAM

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$2,571,041,000
2,581,041,000
2,381,041,000¥190,000,000¥200,000,000

The Ryan White Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) program funds activities toaddress the care and treatment of persons living with HIV/AIDS
who need assistance to obtain treatment. The program provides
grants to States and eligible metropolitan areas to improve thequality, availability, and coordination of health care and support
services to include access to HIV-related medications; grants toservice providers for early intervention outpatient services; grants
to organizations to provide care to HIV infected women, infants,
children, and youth; and grants to organizations to support theeducation and training of health care providers.
Within the total for the Ryan White HIV/AIDS program, theCommittee provides the following amounts:
Budget Activity

DMWilson on DSKJM0X7X2PROD with HEARINGS

Emergency Assistance .................................................................................................
Comprehensive Care Programs ...................................................................................
AIDS Drug Assistance Program (non-add) .........................................................
Early Intervention Program ..........................................................................................
Children, Youth, Women, and Families .......................................................................
AIDS Dental Services ...................................................................................................
Education and Training Centers .................................................................................
Special Projects of National Significance ...................................................................
Ending the HIV/AIDS Epidemic ....................................................................................

FY 2024
EnactedFY 2025
Committee$680,752,000
1,364,878,000
900,313,000
208,970,000
77,935,000
13,620,000
34,886,000
25,000,000
165,000,000$680,752,000
1,364,878,000
900,313,000
208,970,000
77,935,000
13,620,000
34,886,000––––––

Ryan White Formula Funding.—The Committee is concernedthat the Ryan White Part A funding formula, which is calculated
based on jurisdiction of diagnosis, disadvantages jurisdictions thatexperience increasing population sizes due to incoming new residents. When HRSA last studied this issue in 2019, it found jurisdictions were over- and under-represented in the funding formulaby up to 50 percent. The Committee urges HRSA to renew its anal-

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ysis on discrepancies between where Ryan White patients are diagnosed and where they currently reside. The Committee requests an
update in the fiscal year 2026 congressional justification on thesefindings and potential courses of action and considerations for aresidence-based formula.
HEALTH SYSTEMSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$122,009,000
135,009,000
126,009,000+4,000,000¥9,000,000

The Health Systems Bureau supports national activities that enhance health care delivery in the U.S., including maintaining a national system to allocate and distribute donor organs to individuals
awaiting transplant; building an inventory of cord blood units; andmaintaining a national system for the recruitment of bone marrowdonors.

DMWilson on DSKJM0X7X2PROD with HEARINGS

Organ Transplantation
The Committee includes $58,049,000 for the Organ Transplantation program, which is $4,000,000 above fiscal year 2024 enacted
level and $9,000,000 below the fiscal year 2025 budget request.
Human Cell and Tissue Product Transplant Public AwarenessCampaign.—The Committee includes $1,000,000 for a new program
to develop and disseminate educational materials to inform healthcare professionals and other appropriate stakeholders about organ,
tissue, and eye donation, the availability of any donor screening
tests, and other relevant aspects of organ donation.
Living Organ Donation Reimbursement Program.—The Committee includes an increase of $1,000,000 for the living organ donation reimbursement program. This program reduces financial disincentives to living organ donation by providing reimbursement toliving organ donors up to $6,000 for many expenses related to donating an organ (e.g., travel, lost wages, and child care). Researchsuggests that many of these donors could not have donated without
this program. However, current restrictions (largely due to funding
constraints) severely limit this program’s impact, which in turnlimits the number of donors who can afford to donate a lifesavingorgan. The increase in funding will enable the program to significantly expand income eligibility and total reimbursement levels toallow more donors to qualify.
Modernization Initiative.—The Committee includes an increase of$2,000,000 above the fiscal year 2024 enacted level to support themodernization initiative. The Committee encourages HRSA to promote competition for the Organ Procurement and Transplantation
Network contracts, in line with the Securing the U.S. Organ Procurement and Transplantation Network Act of 2023 (P.L. 118–14).
HRSA is directed to include an update on this effort in the fiscal
year 2026 congressional justification.
National Cord Blood Inventory
The Committee includes $19,266,000 for the national cord bloodinventory (NCBI) program, the same as the fiscal year 2024 enacted level and the same as the fiscal year 2025 budget request.

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The NCBI program supports cord blood banks to build a geneticallyand ethnically diverse inventory of the highest quality cord blood
units for transplantation.
C.W. Bill Young Cell Transplantation
The Committee includes $33,009,000 for the C.W. Bill Young Cell
Transplantation program, the same as the fiscal year 2024 enacted
level and the same as the fiscal year 2025 budget request. This program supports coordinating the procurement of bone marrow andumbilical cord blood units for transplantation.
Hansen’s Disease Program
The Committee includes $13,706,000 for the Hansen’s diseaseprogram, the same as the fiscal year 2024 enacted level and the fiscal year 2025 budget request. The Committee also includes$122,000 for Hansen’s disease buildings and facilities and$1,857,000 for payments to Hawaii for treatment of Hansen’s disease, both of which are the same as the fiscal year 2024 enacted
level and the fiscal year 2025 budget request.
These programs support outpatient and short-term residentialcare, as well as outreach and education, and research in Baton
Rouge, Louisiana; 11 outpatient clinic programs in the continental
U.S. and Puerto Rico; facility-related expenses for the buildings ofthe Gillis W. Long Hansen’s Disease Center; and medical care andtreatment of persons with Hansen’s disease throughout the Hawaiian Islands.
RURAL HEALTH

DMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$364,607,000
352,407,000
400,907,000+36,300,000+48,500,000

The Federal Office of Rural Health Policy’s (FORHP) programs
provide funding to improve access, quality, and coordination of carein rural communities; for research on rural health issues; for technical assistance and recruitment of health care providers; forscreening activities for individuals affected by the mining, transport, and processing of uranium; and for the outreach and treatment of coal miners and others with occupation-related respiratory
and pulmonary impairments.
Cancer Mobile Screening.—Early detection of cancer has beenshown to significantly reduce cancer mortality, especially with lungcancer, making treatments more timely, effective, and cost-efficient.
Mobile screening units can increase access to preventive care andsignificantly reduce disparities in health care access. Mobile units
play a crucial role in reaching populations that are traditionally
underserved, thereby enhancing outcomes in communities often neglected in healthcare. The Committee supports efforts by HRSA to
include cancer mobile screening as appropriate in the rural healthprogram portfolio. The Committee requests an update on implementation in the 2026 congressional justification.
Rural Healthcare.—While current spending for all rural healthdiscretionary programs is relatively small, it plays a critical role insolidifying the fragile healthcare infrastructure in rural commu-

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nities. The Committee supports programs seeking to address thesevere health care crisis escalating in rural America and preventing any additional rural hospitals from closing. Health care
workforce shortages continue to plague rural communities, and,while health care innovations, such as telehealth technologies,
show promise in rural areas, the Committee believes that actionneeds to be taken to address the workforce shortages in rural communities. The Committee continues to support HHS’ efforts to implement programs and policies to improve rural health outcomes,
strengthen care delivery, and address the immediate issues facing
rural communities.
Trauma Care in Rural Areas.—The Committee notes the accesschallenges to trauma care in rural areas. The Committee supports
efforts by HRSA to address this access gap and requests an updateon this topic in the fiscal year 2026 congressional justification.

DMWilson on DSKJM0X7X2PROD with HEARINGS

Rural Health Outreach Programs
The Committee includes $108,975,000 for rural health outreachprograms, an increase of $8,000,000 above the fiscal year 2024 enacted level and $16,000,000 above the fiscal year 2025 budget request. This program supports projects that demonstrate new andinnovative modes of outreach in rural areas, such as integrationand coordination of health services.
Delta States.—The Delta States region consists of Alabama, Arkansas, Illinois, Kentucky, Louisiana, Mississippi, Missouri, andTennessee. The Committee includes an increase of $2,000,000 to
support the Delta States program. The Committee includes nomore than $12,000,000 for the Delta States Rural Development
Network Grant program and not less than $15,000,000 for the
Delta Region Community Health Systems Development program.
Within the total for Delta States, the Committee includes no lessthan the amount provided in fiscal year 2024 for the following activities: community health systems development technical assistance program, rural health workforce training program, health systems implementation program, and the maternal program.
Rural Maternity and Obstetrics Management Strategies.—The
Committee includes no less than $14,000,000 for rural maternity
and obstetrics management strategies (RMOMS), an increase of$2,000,000 above the fiscal year 2024 enacted level. RMOMS supports grants to improve access to and continuity of maternal andobstetrics care in rural communities by increasing the delivery of
and access to preconception, pregnancy, labor and delivery, andpostpartum services, as well as developing sustainable financing
models for the provision of maternal and obstetrics care.
Rural Health Research and Policy Development
The Committee includes $11,576,000 for Rural Health Researchand Policy Development, which is $500,000 above the fiscal year
2024 enacted level and the fiscal year 2025 budget request. Funding supports the Federal Office of Rural Health Policy’s activities
to analyze, advise the Secretary, and provide information to the
public regarding issues that affect the availability, access to, andquality of health care in rural areas.
The Rural Health Research Center Program funds publicly available and policy relevant research on rural health to assist pro-

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viders and Federal, State, and local governments in addressing
challenges faced by rural communities. Access to health services inrural areas is under extreme stress with patients forced to travel
extended distances for even basic health care, while more than 30
percent of rural hospitals are at risk of closing. Additional researchis needed on the significant and pervasive challenges faced by rural
Americans in accessing health care related to mental health, drug
and alcohol use, nutrition and healthy eating, and chronic healthmanagement, among other critical needs. This results in a need for
additional policy research capacity to inform solutions to these important issues. The Committee provides an increase for FORHP tofund additional core research centers to increase the number ofstudies on rural health and support policy solutions that improveaccess to health care, health outcomes, and population health.
Rural Hospital Flexibility Grants
The Committee includes $74,277,000 for Rural Health Flexibility
Grants, $10,000,000 above the fiscal year 2024 enacted level and$10,000,000 above the fiscal year 2025 budget request. These programs help States to assist small and critical access rural hospitals
to remain economically viable and to provide high-quality care.
Within this total, the Committee includes no less than
$5,000,000 for the Rural Emergency Hospitals Technical Assistance
Program and up to $25,942,000 for the Small Rural Hospital Improvement Program.
Rare Disease Education.—The Committee is keenly aware of thesignificant challenges facing emergency care for rare and chronic
disease patients in rural America. Rural emergency medical service
providers have gaps in education that can lead to disparate outcomes for rural rare and chronic disease patients based on delays
in proper care, administration of emergency prescription medications, or unforeseen side effects or drug interactions occurring during medical interventions. Without closing these care gaps, rare
and chronic disease patients face risks to their health and lives inthe event of an emergency, solely because they live in rural America. Therefore, the Committee urges HRSA to support efforts toprovide education for the administration of patient-held drugs forrural rare and chronic disease patients for rural emergency medical
services personnel as an eligible use of funding from the Emergency Services Supplement of the Medicare Rural Hospital Flexibility Grant Program.

DMWilson on DSKJM0X7X2PROD with HEARINGSState Offices of Rural Health
The Committee includes $13,000,000 for State Offices of Rural
Health, $500,000 above the fiscal year 2024 enacted level and thefiscal year 2025 budget request. HRSA supports the establishment
and operation of State offices of rural health to strengthen therural health care delivery system.
Black Lung Clinics
The Committee includes $12,190,000 for Black Lung Clinics,
equal to the fiscal year 2024 enacted level and the same as the fiscal year 2025 budget request. This program funds clinics that treat
respiratory and pulmonary diseases of active and retired coal min-

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ers, steel mill workers, agricultural workers, and others with occupationally related respiratory and pulmonary impairments.
Radiation Exposure Screening and Education Program
The Committee includes $1,889,000 for the radiation exposure
screening and education program, equal to the fiscal year 2024 enacted level and the fiscal year 2025 budget request. This programprovides grants for the education, prevention, and early detectionof radiogenic cancers and diseases resulting from exposure to uranium during mining and milling at nuclear test sites.
Rural Communities Overdose Response Program
The Committee includes $145,000,000, the same as the fiscal
year 2024 enacted level and the fiscal year 2025 budget request, forthis program. Within the funding provided, the Committee includes$10,000,000 to continue the three Rural Centers of Excellence(Centers), as established by P.L. 115–245 and continued throughP.L. 117–328. The Committee recognizes the success of the threeCenters in reducing substance use disorders within rural communities, through various evidence-based treatment and recovery
models. The Committee supports HRSA’s continued investment in
the current Centers and encourages HRSA to consider how theCenters can expand their outreach into other underserved communities.
Rural Residency Planning and Development
The Committee includes $14,000,000 for the rural residency
planning and development program, an increase of $1,300,000
above the fiscal year 2024 enacted level and $1,500,000 above thefiscal year 2025 budget request. This program funds physician residency training programs that support physician workforce expansion in rural areas.
The Committee commends FORHP for their efforts to expand thephysician workforce in rural areas and supports the continuationand expansion of the program to develop new rural residency programs.

DMWilson on DSKJM0X7X2PROD with HEARINGS

Financial and Community Sustainability for At Risk Hospitals
The Committee includes $5,000,000 for this activity as proposedin the fiscal year 2024 budget request. First proposed in fiscal year
2024, this program will target technical assistance to rural hospitals severely at-risk for imminent closure and struggling to maintain health care services.
Small rural hospitals are often the only health care available inrural counties, and populations most affected by hospital closingstend to be poor, minorities, and elderly patients with chronic healthconditions. There have been 143 rural hospital closures from 2010
through January 2023, peaking with a high of 19 in 2020 just as
the pandemic hit. Closures are happening more often in communities of color. Historically, about half of the closures result in acomplete loss of services at those facilities.
Rural Hospital Stabilization Program
The Committee includes $15,000,000, which is an increase of$11,000,000 above the fiscal year 2024 enacted level and

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$15,000,000 above the fiscal year 2025 budget request for this program. Launched in fiscal year 2024, this program provides support
to at-risk rural hospitals to enhance or expand service lines to retain health care services locally and increase service volume andrevenue that will enhance hospitals’ financial viability.
FAMILY PLANNING

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$286,479,000
390,000,000–––¥286,479,000¥390,000,000

The Committee does not recommend funding for the Family
Planning program. The Family Planning program administers Title
X of the PHS Act.
The Committee continues to note its disappointment with the Department’s suspension and termination of Title X grants to projects
serving rural and low-income individuals based on the project’s refusal to refer or counsel for abortion, thereby limiting access toservices provided by such projects. Instead of putting political constituencies first, the Committee urges the Department to work withthe previous grantees to resolve such suspensions and terminations, in accordance with all applicable Federal law to ensure
Title X services are accessible and that no project is discriminatedagainst for refusing to refer or counsel for abortion. The Committee
directs the Department to provide an update on this effort in thefiscal year 2026 congressional justification.
HRSA-WIDE ACTIVITIES AND PROGRAM SUPPORTDMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$1,110,376,000
214,088,000
222,088,000¥888,288,000+8,000,000

This account supports telehealth programs, operation of the 340B
drug pricing program and the cost of Federal staff and related activities to coordinate, direct, and manage the programs of HRSA.
Addressing Health Disparities with Faith-Based and CommunityBased Organizations.—The Committee notes the impact of ongoing
efforts and local partnerships focused on addressing health disparities HRSA is encouraged to support these promising partnerships
to preserve innovative access through houses of worship and community organizations.
Digital Innovation for Rural Healthcare.—The Committee supports efforts to develop digital innovation for rural healthcare. Suchefforts could foster the development and improvement of technologies including telehealth and remote monitoring to bridge thehealth access gap and ensure access to quality, affordable
healthcare, regardless of location.
HRSA Chief Dental Officer.—The Committee notes with strong
concern that despite its directive to have HRSA ensure that theChief Dental Officer (CDO) is functioning at an executive level withresources and staff to lead oral health programs and initiatives
across HRSA, such authority has not been delegated. The Committee urges HRSA to restore this position with authority and resources to oversee and lead oral health dental programs and initia-

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DMWilson on DSKJM0X7X2PROD with HEARINGS

tives across the agency. The CDO is also expected to serve as theagency representative on oral health issues to international, national, State, and/or local government agencies, universities, andoral health stakeholder organizations.
Oral Health Literacy.—The Committee includes $300,000, thesame as the fiscal year 2024 enacted level, to continue the development of an oral health awareness and education campaign acrossrelevant HRSA bureaus, including Health Centers, Health Workforce, Maternal and Child Health, Ryan White HIV/AIDS Program,and Rural Health. The Committee directs HRSA to identify oral
health literacy strategies that are evidence-based and focused onoral health care prevention and education, including prevention oforal disease such as early childhood and other caries, periodontal
disease, and oral cancer. The Committee encourages HRSA to ensure that the Chief Dental Officer plays a key role in the design,monitoring, oversight, and implementation of this project.
Targeted Investments in Impoverished Areas.—The Committee requests an update to the report under this heading in House Report
117–403.
Tribal Engagement.—HRSA’s core mission is to improve healthoutcomes and build the health workforce. HRSA historically has
had lower participation by Indian Tribes in several core program
areas, despite the great Tribal need in all of HRSA’s mission areas.
Within 180 days of enactment of this Act, HRSA shall provide to
the Committee a detailed description of funding provided to Tribal
entities, grants Tribal entities are eligible to apply for, and an action plan by HRSA on how it will provide technical assistance toimprove Tribal participation in HRSA programs. Such report shallbe made available on the agency’s website.
Uninsured Program.—The Committee notes the uninsured program stopped accepting new claims in March and April of 2022 dueto the conclusion of funding provided by supplemental appropriations. The Committee is aware of successfully submitted claims forpayment for COVID-related medical care that were not paid, including claims submitted for care prior to the suspension of the
program. The Committee directs HRSA to provide a report to thecommittees of jurisdiction no later than 180 days after enactmentof this Act that details the number of unpaid claims that were successfully submitted for payment for COVID-related medical services provided prior to suspension of the program. In addition, suchreport should include data detailing any funds returned or recovered as a result of fraudulent claims or improper payments throughthis and other HRSA pandemic relief accounts. Such report shallbe made available on the agency’s website.
Office of Pharmacy Affairs
The Committee includes $12,238,000 for the Office of Pharmacy
Affairs, equal to the fiscal year 2024 enacted level. This office administers the 340B drug discount program, which was designed toenable health care providers that serve low-income and uninsured
patients to purchase drugs at lower costs.
This office administers the 340B drug pricing program, which
was designed to help safety-net providers maintain, improve, andexpand patient access to health care services. The program lowers
the cost of outpatient drugs to health clinics and nonprofit and

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DMWilson on DSKJM0X7X2PROD with HEARINGS

public hospitals that serve a disproportionate share of low-income
and rural patients. The Committee recognizes that 340B is a critical lifeline to safety-net providers, including children’s hospitals,
Ryan White HIV/AIDS clinics, safety-net hospitals, health centers,
and other providers. These covered entities reinvest 340B savings
to reach more patients and provide more services.
The Committee is concerned with some manufacturers who may
not be in full compliance with the 340B statute. Several manufacturers have implemented limits on access to 340B pricing, limiting
the ability of covered entities to access these drugs. The Committee
is pleased that HRSA continues to take steps to enforce the 340B
statute, to refer violations of the statute to the HHS Office of Inspector General, and to appeal litigation in these matters. The
Committee encourages HRSA to continue to use its authority andother appropriate measures to implement the program consistent
with Federal law.
Office for the Advancement of Telehealth
The Committee includes $44,550,000 for the Office for the Advancement of Telehealth, an increase of $2,500,000 above the fiscal
year 2024 enacted level and $6,500,000 above the fiscal year 2025
budget request. Funds for the Office for the Advancement of Telehealth promote the effective use of technologies to improve accessto health services for people who are isolated from health care andto provide distance education for health professionals.
Telehealth Centers of Excellence.—Within the funds provided forTelehealth, the Committee provides $9,000,000 for Telehealth Centers of Excellence, an increase of $500,000 above the fiscal year
2024 enacted level. These Centers identify best practices, serve as
national training resources, and test the efficacy of different telehealth clinical applications. These Centers serve to promote theadoption of telehealth programs across the country by validating
technology, establishing training protocols and by providing a comprehensive template for states to integrate telehealth into theirstate health provider network. Funding should serve to promote
the adoption of telehealth services nationwide and help address theaccess to care issue faced by rural America.
Telehealth Technology Enabled Learning.—The Committee recognizes the significance of telementoring in transforming healthcare
training, education, and delivery. Specifically, the Committee encourages HRSA to integrate and implement a robust telementoring
initiative at an academic medical center with existing Federal support and expertise in the field. This should include technology enabled delivery of evidence-based curricula, offering of practicebased, culturally responsive care, advancing the skill set of healthcare workers, facilitating task shifting, increasing access to specialized care, including for adolescent behavioral health. The Committee further encourages this initiative to increase community
level health literacy that will lead to healthier behaviors and prepare for this telementoring service to be used during public healthemergencies. Telementoring, in partnership with community-basedorganizations, can be rapidly deployed to deliver support and training across a broad cross-section of clinical and non-clinical disciplines. The Committee includes a $2,000,000 increase for this effort.

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VACCINE INJURY COMPENSATION PROGRAM

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$15,200,000
20,200,000
15,700,000+500,000¥4,500,000

The Vaccine Injury Compensation Program provides compensation for individuals with vaccine-associated injuries or deaths. The
Committee also includes $266,727,000 in mandatory funding, thesame as the fiscal year 2025 budget request for claims.
COVERED COUNTERMEASURES PROCESS FUND

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$7,000,000
10,000,000
7,000,000–––¥3,000,000

The countermeasures injury compensation program provides benefits to individuals who are seriously injured because of a vaccination, medication, device, or other item recommended to diagnose,
prevent, or treat a declared pandemic, epidemic, or security threat.
CENTERS FOR DISEASE CONTROL AND PREVENTION
Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$9,222,090,000
9,738,690,000
7,446,058,000¥1,776,032,000¥2,292,632,000

The Committee recommendation for the Centers for Disease Control and Prevention (CDC) program level includes $6,204,500,000
in discretionary budget authority, $55,358,000 in mandatory funds
under the terms of the Energy Employees Occupational Illness
Compensation Program Act, and $1,186,200,000 in transfers fromthe Prevention and Public Health Fund (PPHF).
IMMUNIZATION AND RESPIRATORY DISEASESDMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$919,291,000
969,291,000
919,291,000–––¥50,000,000

The Committee recommendation includes $237,358,000 in discretionary budget authority and $681,933,000 in transfers from PPHF.
Immunization cooperative agreements are awarded to State andlocal public health departments for planning, developing, and conducting childhood, adolescent, and adult immunization programs,
including enhancement of the vaccine delivery infrastructure. CDC
directly maintains a stockpile of vaccines, supports consolidated
purchase of vaccines for State and local health agencies, and conducts surveillance, investigations, and research into the safety andefficacy of new and presently used vaccines.
Within the total for Immunization and Respiratory Diseases, theCommittee recommends the following amounts:

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Budget Activity

Immunization and Other Respiratory Diseases ...........................................................
Budget Authority .................................................................................................
PPHF ....................................................................................................................
Acute Flaccid Myelitis ..................................................................................................
Influenza Planning and Response ...............................................................................

FY 2024
EnactedFY 2025
Committee$681,933,000
262,583,000
419,350,000
6,000,000$231,358,000$681,933,000–––
681,933,000
6,000,000$231,358,000

Decline of Routine Immunizations.—The Committee is concerned
about recent data which shows a significant decline in the rates ofroutine and seasonal childhood and adult immunizations. Seasonal
influenza vaccination declined for the third year in a row and kindergarten vaccinations continue to decline. These declines have already had a measurable impact on public health as demonstrated
by recent outbreaks of measles in Ohio, Illinois, and Pennsylvania.
Therefore, the Committee directs CDC, in consultation with FDA,
ASPR, and NIH, to develop and include in the fiscal year 2026 congressional justification, a comprehensive research agenda to better
understand the decline in routine vaccine uptake and confidence
among Americans and develop a comprehensive strategy to educate
physicians regarding the safety and efficacy of routine vaccines andhow best to communicate with patients and to identify and engage
partners/stakeholders needed to implement the strategies related
to routine vaccinations.
Immunization During Pregnancy.—To increase access to recommended immunizations, the Committee encourages CDC to increase its efforts to educate health care providers about the importance of immunization during pregnancy, which can provide protection for children from 0–6 months from diseases such as flu, pertussis (whooping cough), and respiratory syncytial virus, when thechildren are at their most vulnerable. The Committee also encourages CDC to work with Federal partners to improve awareness andcoordination among Federal partners to increase immunization
during pregnancy.
HIV/AIDS, VIRAL HEPATITIS, SEXUALLY TRANSMITTED DISEASES, AND
TUBERCULOSIS PREVENTION

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$1,391,056,000
1,391,056,000
1,177,135,000¥213,921,000¥213,921,000

DMWilson on DSKJM0X7X2PROD with HEARINGS

CDC provides national leadership and support for HIV/AIDS prevention research and the development, implementation, and evaluation of evidence-based HIV prevention programs serving persons
affected by, or at risk for, HIV infection. Activities include surveillance, epidemiologic and laboratory studies, and prevention activities. CDC provides funds to State, local, and Tribal health departments and community-based organizations to develop and implement integrated community prevention plans.
Within the total for the National Center for HIV/AIDS, Viral
Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention, the Committee provides the following amounts:

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Budget Activity

FY 2024
EnactedDomestic HIV/AIDS Prevention and Research .............................................................

$1,013,712,000

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FY 2025
Committee$793,712,000

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Budget Activity

HIV Prevention by Health Department ................................................................
School Health—HIV BA ......................................................................................
Ending HIV/HIV Initiative ....................................................................................
Viral Hepatitis ..............................................................................................................
Sexually Transmitted Infections ..................................................................................
Tuberculosis (TB) .........................................................................................................
Infectious Diseases and Opioids .................................................................................

FY 2024
EnactedFY 2025
Committee

755,631,000
38,081,000
220,000,000
43,000,000
174,310,000
137,034,000
23,000,000

755,631,000
38,081,000–––
53,000,000
164,310,000
137,034,000
29,079,000

Sexually Transmitted Infections.—The Sexually Transmitted Infections programs included $10,000,000 in both fiscal years 2023
and 2024 to advance the grant period. For fiscal year 2025, theCommittee provides $164,310,000, which will allow the program tooperate at the same fiscal level and grant year as provided for fiscal year 2024.
Viral Hepatitis.—The Committee provides $53,000,000 for Viral
Hepatitis, an increase of $10,000,000 from fiscal year 2024. This increase will support health departments conducting viral hepatitis
outbreak response and surveillance, support viral hepatitis elimination planning and implementation in target jurisdictions, andwork with health clinics and community organizations to promoteawareness and uptake of updated national viral hepatitis testingand vaccination recommendations.
EMERGING AND ZOONOTIC INFECTIOUS DISEASESAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$760,272,000
780,772,000
780,772,000+20,500,000–––

The Committee recommendation includes $728,772,000 in discretionary appropriations and $52,000,000 in transfers from PPHF.
Programs funded under Emerging and Zoonotic Infectious Diseases (EZID) support the prevention and control of infectious diseases through surveillance, outbreak investigation and response,
research, and prevention.
Within the total for EZID, the Committee recommends the following amounts:
Budget Activity

DMWilson on DSKJM0X7X2PROD with HEARINGS

Antimicrobial Resistance Initiative .............................................................................
Vector-Borne Diseases .................................................................................................
Lyme Disease ...............................................................................................................
Prion Disease ...............................................................................................................
Chronic Fatigue Syndrome ...........................................................................................
Emerging Infectious Diseases .....................................................................................
Harmful Algal Blooms .................................................................................................
Food Safety ..................................................................................................................
National Healthcare Safety Network ............................................................................
Quarantine ...................................................................................................................
Advanced Molecular Detection ....................................................................................
Epidemiology and Lab Capacity program (PPHF) .......................................................
Healthcare-Associated Infections (PPHF) ....................................................................

FY 2024
EnactedFY 2025
Committee$197,000,000
63,603,000
27,000,000
8,000,000
5,400,000
213,997,000
3,500,000
72,000,000
24,000,000
53,772,000
40,000,000
40,000,000
12,000,000$197,000,000
63,603,000
27,000,000
8,500,000
5,400,000
228,997,000
3,500,000
72,000,000
24,000,000
58,772,000
40,000,000
40,000,000
12,000,000

Alpha-Gal Syndrome.—The Committee directs CDC, within 180
days of enactment of this Act, to develop a two-year plan (fiscal
years 2025 through 2026) for conducting evaluation reviews of theinformation on its website for tickborne diseases (TBDs), including

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60
any TBD overviews and information on individual TBDs, includingalpha-gal syndrome, the non-infectious allergic disease related to atick bite that is less understood than other allergic conditions, andfor developing educational materials for clinicians and the public
for each TBD and tickborne condition, with priority based on disease burden, determined by prevalence and level of disability.
The CDC is further directed, within 180 days of the enactmentof this Act, to publicly release a report on alpha-gal syndrome, including prevalence, etiology, treatment, outcomes, and prognosis.
Antimicrobial and Antibiotic Resistance.—The Committee notes
the complexities in conducting surveillance of antimicrobial resistance (AMR) and providing treatments across healthcare, veterinary
medicine, and agriculture. In addition to detection, prevention, andcontrol initiatives used to combat the spread of AMR, expanded capacity for monitoring resistance is critical for combating AMR andpreventing the spread of infections. As such, of the amounts allocated for the CDC’s Antimicrobial Resistance Initiative, the Committee encourages CDC to incorporate AMR monitoring into its response efforts.
Chronic Fatigue Syndrome.—The Committee supports CDC’s
work related to provider education and public awareness for postural orthostatic tachycardia syndrome (POTS) and similar formsof dysautonomia, common chronic conditions that impact millionsof Americans and cause severe disability. The Committee is concerned that 28 States do not have a board-certified autonomic specialist resulting in POTS patients facing on average a 5-year diagnostic delay and encourages the CDC to work with patient advocates, clinicians, and researchers to develop an education programfor health care providers to increase access to care for POTS andsimilar dysautonomia patients.
Epidemiology and Laboratory Capacity.—The Committee recognizes the importance of the Epidemiology and Laboratory Capacity(ELC) program, which provides flexibility to State, territorial, andlocal health departments to address gaps not funded by the disease
specific sections of the ELC cooperative agreement. The ELC program provides critical foundational support for these health departments to fund epidemiology, surveillance, laboratory, and data
science staff positions that provide the backbone for public healthprograms. This funding will allow public health departments tobuild their foundational public health workforce and infrastructure
and will better prepare them to respond to emerging infectious disease threats more quickly.
Harmful Algal Blooms.—The Committee notes that harmful algal
blooms (HABs) are on the rise globally, particularly across theGreat Lakes region, and encourages CDC to study the health effects of exposure to cyanotoxins in the air and water, including, but
not limited to, the Great Lakes region. CDC has a unique role inbetter understanding the intersection of public health and environmental impacts of HABs. The Committee encourages CDC to continue building interagency cooperation surrounding health effects
of HABs. The scope of future research may expand to include improving laboratory methods for identifying and quantifying HABrelated toxins in biological specimens, clinical diagnostic methods
to identify HAB-related symptoms and illnesses, optimizing emer-

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61
gency response capacities, and identifying and addressing the impacts of harmful algal toxins to humans.
Lyme Disease—Lyme disease can be found in at least 80 countries around the globe and is endemic in many regions. In the U.S.,
Lyme disease is the most common disease transmitted from animals to humans. After years of uncertainty, CDC continues to notethe number of reported Lyme disease cases in the U.S. is likely far
below the estimated number of actual cases that are diagnosed andtreated annually. According to CDC, in 2022, approximately 63,000
cases of the disease were reported, compared to estimates showingthat more than 475,000 may be diagnosed and treated with Lyme
disease annually in the U.S. The Committee continues to support
CDC’s efforts to improve testing and treatment related to Lymeand other vector-borne diseases and encourages CDC to consider
expanding activities related to the development of more accurate
diagnostic tools and tests for Lyme disease and steps to educate
high risk workers and their employers regarding the occupationalrisks of tickborne diseases.
Maternal Fetal Transmission of Lyme Disease.—Within 180 daysof the enactment of this Act, the Committee directs CDC to provide
a report on its plans to better understand maternal-fetal transmission of Lyme disease and gestational Lyme disease and plans
to improve education for the public and for healthcare providers
about the risks of Lyme disease during pregnancy and adverse
birth outcomes. CDC is encouraged to identify resources required
and potential obstacles to progress.
Mycotic Diseases.—The Committee provides an increase of$15,000,000 in Emerging Infectious Diseases for mycotic diseases,
including, surveillance and prevention, building capacity in theState and local health departments, cooperative agreements, education of the public and healthcare providers, and laboratory support. The Committee continues to support the CDC’s collaboration
with the Valley Fever Institute and the Cocci Study Group. The
Committee requests an update in the fiscal year 2026 congressional
justification on how this funding is being utilized.
Novel Emerging and Dangerous Pathogens.—The Committee
commends CDC for advancing research in the critical area of lethal
bacteria, viruses, and other special pathogens. However, the Committee remains concerned about the increasingly dangerous threat
to public health of emerging and dangerous bacterial and viralpathogens that can be difficult or impossible to grow in laboratory
settings. Further research is required in advanced DNA sequencing
to speed the development of diagnostics, therapeutics, and vaccines.
Therefore, the Committee encourages CDC to prioritize advanced
DNA sequencing and detection of novel emerging and dangerous
pathogens.
Prion Disease.—The Committee is concerned that Chronic wasting disease (CWD), a fatal condition in cervids (deer, elk, andmoose) caused by misfolded prions, has been detected in over 30
States and all four regions of the country. Monitoring the prevalence of prion diseases, including determining a disease’s incidence
and whether it was acquired from animals or other humans, is critical. In light of scientific observations regarding the nationwide
spread of CWD and concerns about the potential for cross-species
transmissions to humans and food production animals, the Com-

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mittee includes $8,500,000 for surveillance efforts of human priondiseases, including Creutzfeldt-Jakob Disease, through the National Prion Disease Pathology Surveillance Center and CDC.
Quarantine.—The Committee provides $58,772,000, an increaseof $5,000,000, to support the Traveler-Based Genomic Surveillance(TGS) program. The Committee is aware of the expansion of the
TGS program to include over 4 core pathogens collected throughair, aircraft wastewater, and nasal swabs from travelers arriving at
9 U.S.-based international airports and recommends the continuation of these activities through resources made available in thisbill and from previous appropriations balances. This capability has
been effective in advancing the nation’s pathogen surveillance capabilities to provide early warning for detection, characterization,
migratory disease origin, and if needed, medical countermeasureresearch and development.
Southern Tick Associated Rash Illness.—The Committee directs
CDC to publicly release a report on Southern Tick Associated Rash
Illness (STARI) including its prevalence, the tick-vector or vectors
causing STARI, and the progress in identifying the causative
pathogen of STARI or any suspected non-infectious disease-causing
mechanism. The Committee directs CDC to provide a briefing to
the Committee on this topic within 180 days of the enactment of
this Act.
Tick Borne Diseases External Engagement.—The Committee
strongly encourages CDC to establish a panel of expert outside
stakeholders to evaluate and review the Lyme disease information
on its website for its inclusion of a balance of scientifically valid
perspectives, primarily regarding the state of the science fordiagnostics and treatments. The stated goals and purposes of thereview and the identity of review participants, including the balanced panel of experts, including experienced TBD clinicians, researchers, and educators, should be fully transparent.
CHRONIC DISEASE PREVENTION AND HEALTH PROMOTIONAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$1,433,914,000
1,559,414,000
1,154,153,000¥279,761,000¥405,261,000

The Committee recommendation includes $912,886,000 in discretionary appropriations and $241,267,000 in transfers from PPHF.
Programs supported within Chronic Disease Prevention and Health
Promotion provide national leadership and support for State, Tribal, and community efforts to promote health and well-being
through the prevention and control of chronic diseases.
Within the total provided, the Committee provides the following
amounts:

DMWilson on DSKJM0X7X2PROD with HEARINGS

Budget Activity

Tobacco ........................................................................................................................
Tobacco ...............................................................................................................
Tobacco (PPHF) ...................................................................................................
Nutrition, Physical Activity, and Obesity .....................................................................
High Obesity Rate Countries (non-add) .............................................................
School Health ...............................................................................................................
Food Allergies (non-add) ....................................................................................

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FY 2024
EnactedFY 2025
Committee$246,500,000
120,650,000
125,850,000
58,420,000
16,500,000
19,400,000
2,000,000

–––
–––
–––
$58,420,000
16,500,000––––––

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Budget Activity

DMWilson on DSKJM0X7X2PROD with HEARINGS

Farm-to-School (non-add) ..................................................................................
Health Promotion .........................................................................................................
Vision and Eye Health ........................................................................................
Alzheimer’s Disease ............................................................................................
Inflammatory Bowel Disease ..............................................................................
Interstitial Cystitis ..............................................................................................
Excessive Alcohol Use .........................................................................................
Chronic Kidney Disease ......................................................................................
Chronic Disease Education and Awareness .......................................................
Prevention Research Centers .......................................................................................
Heart Disease and Stroke ............................................................................................
Heart Disease and Stroke (BA) ..........................................................................
Heart Disease and Stroke (PPHF) .......................................................................
Diabetes .......................................................................................................................
Diabetes (BA) ......................................................................................................
Diabetes (PPHF) ..................................................................................................
National Diabetes Prevention Program .......................................................................
Cancer Prevention and Control ...................................................................................
Oral Health ..................................................................................................................
Safe Motherhood/Infant Health ...................................................................................
Arthritis and Other Chronic Diseases .........................................................................
Arthritis/Other .....................................................................................................
Epilepsy ...............................................................................................................
National Lupus Registry .....................................................................................
Community Grants .......................................................................................................
Racial and Ethnic Approaches to Community Health .......................................
Good Health and Wellness in Indian Country ....................................................
Social Determinants of Health Pilot Program .............................................................
Million Hearts (PPHF) ..................................................................................................
Healthy Weight Task Force Obesity Activities/Early Child Care Collaboration (PPHF)
Hospitals Promoting Breastfeeding (PPHF) .................................................................

FY 2024
EnactedFY 2025
Committee

2,000,000
64,100,000
6,500,000
39,500,000
2,000,000
1,100,000
6,000,000
4,500,000
4,500,000
28,961,000
155,105,000
125,850,000
29,255,000
156,129,000
89,717,000
66,412,000
37,300,000
410,049,000
20,250,000
110,500,000
32,500,000
11,000,000
11,500,000
10,000,000
68,950,000
44,950,000
24,000,000
6,000,000
5,000,000
5,000,000
9,750,000–––
66,200,000
6,500,000
39,500,000
3,000,000
1,200,000
6,000,000
5,500,000
4,500,000–––
155,105,000
44,346,000
110,759,000
156,129,000
45,371,000
110,758,000
37,300,000
417,049,000
22,250,000
110,500,000
42,500,000
11,000,000
11,500,000
20,000,000
68,950,000
38,950,000
30,000,000–––
5,000,000
5,000,000
9,750,000

Breast and Cervical Cancer.—The Committee is concerned withthe decline in screening rates, and the increase in diagnosis of advanced cervical cancers, especially in rural and underserved communities. Provided within the increase, the Committee encourages
the National Breast and Cervical Cancer Early Detection Program
to build on existing programs by finding new and innovative outreach and education strategies to engage women to increase early
screening rates. The use of navigators has proven especially successful in reaching women with low rates of screening. The Committee requests CDC publicly release a report on these activities
within 180 days of enactment of this Act.
The committee recognizes findings that African American women
have twice the odds of being diagnosed with Triple-Negative Breast
Cancers (TNBCs). The Committee therefore directs CDC to issue areport to the Committee on current and planned future efforts topromote awareness of TNBC diagnosis and treatment, including
any findings of best practices for the use of educational or related
tools to increase the uptake of awareness and treatment no later
than 180 days after enactment of this Act.
Cancer Prevention and Control.—The Committee provides$417,049,000 for CDC cancer prevention and control activities, a$7,000,000 increase from the fiscal year 2024 enacted level. The
Committee directs CDC to fund the following activities at not lessthan the fiscal year 2024 enacted level: breast and cervical cancer
including WISEWOMEN, breast cancer awareness for young
women, cancer registries, colorectal cancer, comprehensive cancer
control, Johanna’s Law, ovarian cancer, prostate cancer, skin cancer, and the cancer survivorship resource center. In addition, under

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64
this heading in the fiscal year 2026 congressional justification,
CDC is directed to include a discussion of planned efforts for eachof the areas identified in the preceding sentence. Within theamounts provided, the Committee includes increases of $2,000,000
for Breast and Cervical Cancer programs, $500,000 for Ovarian
Cancer programs, and $500,000 for Johanna’s Law programs.
Chronic Disease Education and Awareness Program.—The Committee notes the progress and opportunities facilitated by the
Chronic Disease Education and Awareness program and has provided $4,500,000 for fiscal year 2025 to support grants for chronic
health conditions, including rare diseases, that lack a specific funding line within the CDC’s budget.
Chronic Kidney Disease.—Chronic kidney disease (CKD) affects
more than 35 million adults in the U.S., with an additional 80 million Americans at risk of developing CKD due to diabetes, cardiovascular disease, or family history. Approximately 25 percent ofMedicare’s annual budget is spent on care for CKD patients, however, CKD is not detected early enough to initiate treatment regimens to reduce death and disability. A public health approach
would contribute toward earlier detection to allow more time forinterventions targeted to improve outcomes. The Committee encourages investments to educate the public about their risk for kidney disease, educate clinical professionals, and spur innovation byentities serving the kidney disease community. By improving surveillance, early detection, and treatment, the progression of kidneydisease can be slowed, and complications can be reduced which will
dramatically improve the quality of life of patients.
Diabetes.—According to CDC’s 2021 data from the National Diabetes Statistics Report, approximately 2 million Americans havetype 1 diabetes (T1D), with 304,000 of these individuals under theage of 20. The incidence of T1D has increased significantly over the
past 20 years. Millions of individuals are at an increased risk of developing T1D because they have a first-degree relative with thecondition, and a subset of these individuals are in the early stagesof T1D. Screening can help improve outcomes for people at risk ofdeveloping T1D, including delaying progression, preventing complications, and reducing the incidence of diabetic ketoacidosis(DKA) at diagnosis. All of these outcomes pose increased morbidity
and mortality risk in the short and long term. The Committee isconcerned that CDC has not adequately focused education andawareness efforts on T1D possible risk factors, screening, and potential avenues to delay onset, including available treatments andclinical trials. The Committee directs CDC to update its website toinclude comprehensive information about screening, risks of DKA
at diagnosis, and information about accessing possible treatments
and clinical trials to delay the onset of T1D. CDC is encouraged toinclude information targeting physicians, school health workers,
parents, and adults regarding screenings; provide information
about populations that should be prioritized for screening; and direct patients to appropriate resources if their screening results indicate that they are at increased risk of developing T1D. CDC isfurther encouraged to enact a process to review the scientific literature on screening for T1D and update information on its website
to reflect new information in a more timely manner.

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65
Early Child Care Collaboratives.—The Committee includes$5,000,000 to enable training of early care and education providers
in the implementation of healthy eating and physical activity bestpractices. The Committee is concerned that consolidation in resource management within the Division of Nutrition, Physical Activity, and Obesity has resulted in less on-the-ground support for
health promotion efforts. The Committee directs that such funds
not only support activities currently funded by the Division but
also support States not currently funded by the Division.
Epilepsy.—The Committee commends CDC for its ongoing leadership of this successful program and effective community collaborations, and encourages further efforts to eliminate stigma, improveawareness and education, and better connect people with epilepsy
to health and community services. The Committee recognizes theimportance of data to accurately understand the incidence, prevalence, and mortality rate of epilepsies, along with individual andsocial risk factors that influence health outcomes. The Committee
appreciates CDC’s ongoing epilepsy-related surveillance and funding of epidemiologic studies on epilepsy. The Committee encourages
CDC to enhance surveillance and epidemiologic studies of
epilepsies to generate data that can guide interventions to improveoutcomes for people with epilepsy.
Heart Disease and Stroke.—The Committee continues to support
heart valve disease education and awareness, encourages CDC tosupport the implementation of the Cardiovascular Advances in Research and Opportunities Legacy Act, and encourages CDC to increase the programmatic emphasis on heart valve disease education and awareness.
High Obesity Rate Counties.—The Committee recognizes the costassociated with diet-related disease and its comorbidities to the
U.S. taxpayer and overall healthcare system and directs that within the amount provided, no less than $5,000,000 is directed to remain available for public institutions with expertise in the fields ofobesity, diabetes, and related chronic diseases in an effort to support the national strategy on nutrition and reducing diet-relateddiseases.
CDC grantees work with State and local public health departments and other partners to support measurable outcomes throughcommunity and population-level, evidenced-based obesity intervention and prevention programs. Projects integrate evidence-based
policy, systems, and environmental approaches to better understand and address the environmental and societal implications ofobesity. The Committee encourages CDC to consider including highchildhood obesity rates in its eligibility criteria for the High Obesity Program as well as the preponderance of obesity by State
based on the CDC Behavioral Risk Factor Surveillance System.
Inflammatory Bowel Diseases.—The Committee provides$3,000,000, an increase of $1,000,000, to support CDC’s work to improve the public health response to Inflammatory Bowel Disease(IBD). The Committee commends CDC’s ongoing efforts to continue
epidemiological studies on Crohn’s disease and ulcerative colitis,known collectively as IBD, and to establish awareness and education activities for patients and healthcare professionals to improve time to diagnosis and disease management, including inmedically underserved populations.

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66
National Lupus Registry.—Guided by the National Public Health
Agenda for Lupus, CDC funds population registries and cohort
studies to increase public health knowledge about lupus as well as
supporting activities to improve awareness of the signs and symptoms of Lupus. The Committee provides $20,000,000 for CDC’s
Lupus activities, an increase of $10,000,000, to support both research and awareness activities.
Oral Health.—The Committee understands the importance of
CDC’s Division of Oral Health and its role in reducing oral disease
rates among vulnerable populations. Therefore, the Committee provides $22,250,000, an increase of $2,000,000, for the Division of
Oral Health. Within the increase for the Division of Oral Health,
the Committee provides funding to evaluate and enhance the nation’s surveillance systems to better identify oral health burden at
the national, State, and local levels. Such enhancements will makedata available more quickly, enable exploration and evaluation of
methods to track adherence to infection prevention, provide information for dental settings to support educational efforts, and increase awareness of the importance of oral health to overall health.
Prostate Cancer.—The Committee is aware of the continued risein prostate cancer deaths and supports the CDC’s work to increase
public awareness of prostate cancer risks, screening and treatment
in high-risk populations.
Psoriatic Disease.—The Committee commends CDC for supporting the development of a national health indicator report on
the burden of psoriasis and psoriatic arthritis in the U.S. This report noted that approximately 8 million Americans are affected bypsoriatic disease and that the systemic inflammation that characterizes psoriatic disease also leads to comorbidities including heartdisease, diabetes, and depression. The Committee also recognizes
CDC for piloting activities to demonstrate the success of publichealth interventions to reduce this burden, particularly among
rural populations and those that are underdiagnosed. The Committee encourages CDC to leverage these evidence-based learnings
into outcomes by partnering with stakeholders to implement promising interventions.
Safe Motherhood and Infant Health.—The Committee includes a
total of $110,500,000 for this portfolio of programs to improve thehealth of pregnant and postpartum women and their infants. The
Committee directs CDC to use the funding increase to support Maternal Mortality Review Committees (MMRCs), Perinatal Quality
Collaboratives, and other programs including the Sudden Unexpected Infant Death and Sudden Death in the Young Case Registry. The Committee encourages CDC to prioritize funding to help
MMRCs build stronger data systems and improve data collection at
the State level to ensure accuracy and completeness in data collection, analysis, and reporting across State MMRCs. This investment
is necessary to provide accurate statistics on U.S. maternal mortality rates and inform data-driven actions to prevent these deaths.
The Committee directs CDC to provide a briefing to the Committees within 180 days of enactment of this Act on barriers to effective and consistent data collection and opportunities to improve coordination among State MMRCs.
Vision and Eye Health.—The Committee provides $6,500,000 for
activities related to vision and eye health including glaucoma, the

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same as fiscal year 2024 enacted level. The Committee supports
national-level surveillance on the prevalence and risk of vision loss
and eye disease in the Vision and Eye Health Surveillance System.
Data on risk of vision loss and existence of vision loss in the U.S.
is necessary to inform State and community partnerships that emphasize early detection and intervention and to address challenges
in access to eye care that can prevent eye disease from progressing
to permanent vision loss.
BIRTH DEFECTS, DEVELOPMENTAL DISABILITIES, DISABILITIES AND
HEALTH

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$206,060,000
205,560,000
206,060,000–––+500,000

This account supports efforts to conduct research on and address
the causes of birth defects and developmental disabilities, as well
as reduce the complications of blood disorders and improve thehealth of people with disabilities.
Within the total, the Committee recommends the following
amounts:
Budget Activity

DMWilson on DSKJM0X7X2PROD with HEARINGSChild Health and Development BA ..............................................................................
Birth Defects .......................................................................................................
Fetal Death .........................................................................................................
Fetal Alcohol Syndrome ......................................................................................
Folic Acid ............................................................................................................
Infant Health ......................................................................................................
Autism .................................................................................................................
Health and Development with Disabilities BA ............................................................
Special Olympics ................................................................................................
Tourette Syndrome ..............................................................................................
Early Hearing Detection and Intervention ..........................................................
Muscular Dystrophy ............................................................................................
Attention Deficit Hyperactivity Disorder .............................................................
Fragile X .............................................................................................................
Spina Bifida ........................................................................................................
Congenital Heart Defects ...................................................................................
Public Health Approach to Blood Disorders ................................................................
Hemophilia Activities ...................................................................................................
Hemophilia Treatment Centers ....................................................................................
Thalassemia .................................................................................................................
Neonatal Abstinence Syndrome ...................................................................................
Surveillance for Emerging Threats to Mothers and Babies ........................................

FY 2024
EnactedFY 2025
Committee$71,300,000
19,000,000
900,000
11,500,000
3,150,000
8,650,000
28,100,000
86,410,000
19,500,000
2,500,000
10,760,000
8,000,000
1,900,000
2,000,000
7,500,000
8,250,000
10,400,000
3,500,000
5,100,000
2,100,000
4,250,000
23,000,000$71,300,000
19,000,000
900,000
11,500,000
3,150,000
8,650,000
28,100,000
86,410,000
19,500,000
2,500,000
10,760,000
8,000,000
1,900,000
2,000,000
7,500,000
8,250,000
10,400,000
3,500,000
5,100,000
2,100,000
4,250,000
23,000,000

Cerebral Palsy.—Cerebral palsy (CP) is the most common, lifelong motor disability caused by an early developmental brain injury. The mechanism and type of injury underlying CP is still not
well understood, which can include perinatal stroke, maternal infection, genetics and/or hypoxic ischemic encephalopathy. The Committee encourages CDC to consider supporting efforts to expand
scientific knowledge on prevalence, risk factors, early detection,and co-morbidities of CP in order to determine if the CP population
is rising, dropping, or staying the same.
Fetal Death.—The Committee provides continued funding to support CDC’s implementation of the recommendations of the Stillbirth Task Force.

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68
Blood Clots.—As part of the fiscal year 2026 congressional justification, the Committee directs CDC to include a cost estimate toexpand its nationwide public awareness campaign to recognize thesymptoms of blood clots.
Fragile X and Fragile X Associated Disorders.—The Committee
commends CDC’s efforts to identify and define the population impacted by Fragile X (FX) and all conditions associated with thegene mutations. The Committee also recommends the National
Center on Birth Defects and Developmental Disabilities (NCBDDD)
work to ensure populations with FX conditions are being properly
diagnosed and made aware of available medical services. Finally,
the Committee recommends the NCBDDD support research acrossthe lifespan of individuals living with FX and the associated conditions and disorders.
Hemophilia Treatment Centers.—The Committee encourages the
CDC to utilize resources to pursue partnerships with additional
community stakeholders to enhance program activities and accessin rural and underserved communities, particularly stakeholders
that have shown success reaching patients who do not have regularaccess to a treatment center.
Muscular Dystrophy.—The Committee includes $8,000,000 to
support Muscular Dystrophy research and monitoring initiatives.
The Committee encourages CDC to continue its efforts through theMuscular Dystrophy Surveillance, Tracking, and Research Network
to provide information and monitoring to better understand theoutcomes for Duchenne and Becker muscular dystrophy treatedboth in and out of Certified Duchenne Care Centers; examine impacts of the condition on bone health, cardiovascular, and cognitive
function; and investigate care and outcomes for adults with
Duchenne and Becker, including those receiving multiple therapies
including gene therapy, and various demographic subpopulations.
Spina Bifida.—The Committee recognizes that Spina Bifida is
the most common permanently disabling congenital disability compatible with life in the U.S., affecting 1,500 babies in the country
each year. While Spina Bifida and related neural tube defects are
sometimes preventable through education and adequate daily folicacid consumption, there are an estimated 166,000 individuals,
more than 65 percent of whom are adults, living with all forms ofthis complex birth defect. The Committee understands that there
is a significant need for support at CDC to address the transitional
and adult care needs of the growing, aging Spina Bifida community, and the Committee requests an update in the fiscal year 2026
congressional justification on efforts to address these needs.
The Committee provides funding for the National Spina Bifida
Program to be used to support the continuation of the Spina Bifida
Clinical Care Monitoring and Tracking program, which works with
the National Spina Bifida Registry to guide the health care community in the best treatment options for people living with Spina
Bifida; and to support the National Spina Bifida Patient Registry
to allow for both the inclusion of more clinics and the examinationof mental health issues in the Spina Bifida community.

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PUBLIC HEALTH SCIENTIFIC SERVICES

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$754,497,000
804,097,000
754,497,000–––¥49,600,000

The Committee recommendation includes $594,497,000 in discretionary appropriations and $160,000,000 in transfers from PPHF.
This account supports programs that provide leadership andtraining for the public health workforce, support infrastructure tomodernize public health surveillance, promote and facilitate science
standards and policies, and improve access to information on disease outbreaks and other threats.
Within the total, the Committee provides the following amounts:
Budget Activity

DMWilson on DSKJM0X7X2PROD with HEARINGS

Health Statistics ..........................................................................................................
Surveillance, Epidemiology, and Informatics ..............................................................
Public Health Data Modernization Initiative ...............................................................
Advancing Laboratory Science .....................................................................................
Public Health Workforce ..............................................................................................

FY 2024
EnactedFY 2025
Committee$187,397,000
298,100,000
175,000,000
23,000,000
71,000,000$187,397,000
298,100,000
175,000,000
23,000,000
71,000,000

Assisted Reproductive Reporting Requirements.—The Committee
recognizes that Congress passed the Fertility Clinic Success Rate
and Certification Act in 1992, which ‘‘mandates that clinics performing assisted reproductive technology annually provide data for
all procedures performed to CDC and sets forth definitions and reporting requirements.’’ The Committee acknowledges the importance of oversight to ensure ethical assisted reproductive technology practices and to address the long-term health outcomes andcomplications for women and children. The Committee directs CDC
to provide and publicly release a report within 180 days of enactment of this Act. This report shall address key outcomes, accrediting information, and the status of consumer education materials
as they relate to infertility treatments.
CDC is further directed to include data related to the number of
fertilized eggs, blastocysts, and embryos created in each cycle of assisted reproductive technology; the number that perish due to natural causes in the course of in vitro fertilization or a related procedure; the number that perish due to preimplantation genetic diagnosis testing in the course of in vitro fertilization or a related procedure; and the number that are intentionally destroyed. In theevent such data are not available, CDC is directed to revise the National Assisted Reproductive Technology Surveillance System toallow their collection and publication in future years.
Data Modernization.—The Committee is pleased to see progress
towards the implementation of CDC’s data modernization efforts
and encourages the agency to continue to invest in the five key pillars of data modernization: (1) electronic case reporting; (2) laboratory information management systems; (3) syndromic surveillance;(4) electronic vital records systems; and (5) the national notifiabledisease surveillance system. The Committee also recognizes CDC’s
efforts to engage with States, Tribes, localities, and territories
through data use agreements for core data sources as well as key
recommendations from the Advisory Committee to the Director

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70
Data and Surveillance Workgroup. The Committee directs CDC,
within 90 days of the enactment of this Act, to provide a report regarding how these efforts are advancing the agency towards the development and implementation of enterprise-level public healthdata systems.
Eating Disorders.—The Committee remains concerned that mental health problems among youth are at an all-time high, with eating disorders-related emergency room admissions for youth doubling during the pandemic. For 23 years, CDC conducted surveillance of the signs and symptoms of eating disorders within theYouth Risk Behavioral Surveillance System (YRBSS), but the
YRBSS coordinators voted to remove the question from the 2015
survey. The resulting gap in data collection has left public healthexperts and researchers with limited data to address current eating
disorders among youth. The Committee directs CDC to include one
standard question on unhealthy weight control practices for eating
disorders for consideration by State directors in the development of
the 2025 YRBSS survey.
Surveillance, Epidemiology, and Informatics
National Neurological Conditions Surveillance System.—The
Committee provides $5,000,000, the same as the fiscal year 2024
enacted level to continue efforts on the two initial conditions multiple sclerosis and Parkinson’s disease.
Primary
Immunodeficiencies.—The
Committee
includes
$3,500,000 for education, awareness, and genetic sequencing surveillance related to primary immunodeficiencies. This program has
proven effective in identifying undiagnosed patients and linking
them to centers of care.
ENVIRONMENTAL HEALTH

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$242,850,000
266,850,000
145,600,000¥97,250,000¥121,250,000

The Committee recommendation includes $94,600,000 in discretionary appropriations and $51,000,000 in transfers from PPHF.
Programs supported within Environmental Health conduct surveillance and data collection to detect and address emerging pathogens and environmental toxins that pose significant challenges topublic health, as well as determine whether and at what level of
exposure these substances are harmful to humans.
Within the total, the Committee provides the following amounts:

DMWilson on DSKJM0X7X2PROD with HEARINGS

Budget Activity

Environmental Health Laboratory ................................................................................
Other Environmental Health Laboratory .............................................................
Newborn Screening Quality Assurance Program ................................................
Newborn Screening/Severe Combined Immunodeficiency Diseases ...................
Environmental Health Activities ..................................................................................
Safe Water ..........................................................................................................
Amyotrophic Lateral Sclerosis (ALS) Registry ....................................................
Trevor’s Law ........................................................................................................
Climate and Health ............................................................................................
All Other Environmental Health ..........................................................................
Environmental and Health Outcome Tracking Network ..............................................

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FY 2024
EnactedFY 2025
Committee$70,750,000
48,500,000
21,000,000
1,250,000
48,600,000
8,600,000
10,000,000
3,000,000
10,000,000
17,000,000
34,000,000$34,500,000
12,000,000
21,000,000
1,500,000
21,600,000
8,600,000
10,000,000
3,000,000
–––
–––
–––

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FY 2024
EnactedBudget Activity

Asthma .........................................................................................................................
Childhood Lead Poisoning (PPHF) ...............................................................................
Lead Exposure Registry ...............................................................................................

FY 2025
Committee

33,500,000
51,000,000
5,000,000

33,500,000
51,000,000
5,000,000

Amyotrophic Lateral Sclerosis.—The Committee provides a funding level of $10,000,000 for the National Amyotrophic Lateral Sclerosis (ALS) Registry and encourages CDC to continue investing inresearch that will reduce incidence of ALS through ALS prevention
and risk mitigation strategies among civilians, active military personnel, and veterans in the U.S. Additionally, the Committee encourages CDC to continue to collaborate with the Departments of
Defense and Veterans Affairs on risk reduction strategies that will
lower the incidence of ALS among active-duty personnel and veterans.
Asthma.—The Committee recognizes the significance of asthma
as a chronic disease with implications for public health, productivity at work and at school, and healthcare utilization. The Committee directs CDC to provide a briefing on the current economic
burden of asthma in the U.S. to help guide public health efforts
and resource allocation within 180 days of the enactment of thisAct. The CDC last published this data in 2018 in a report titled,‘‘The Economic Burden of Asthma in the U.S., 2008–2013.’’ Specifically, the Committee directs CDC to provide a thorough assessmentof the following key aspects: prevalence, medical costs, absenteeism, and mortality.
Pediatric Reference Intervals.—The Committee supports CDC’s
work to ensure the reliable diagnosis and treatment of children ina cost-effective manner. A 2022 CDC study found that many reference intervals used for children do not accurately reflect the biology of child development. The Committee encourages CDC to develop pediatric reference intervals and directs the CDC to include
information on the funding needed for this activity as part of the
fiscal year 2026 congressional justification.
INJURY PREVENTION AND CONTROLDMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$761,379,000
943,379,000–––¥761,379,000¥943,379,000

To restore public confidence and better focus CDC on controllingand preventing communicable diseases, the Committee provides nofunding for the National Center for Injury Prevention and Control(Injury Center). The Committee remains concerned that CDC,
under the Biden Administration, continues to request funding forpolitically-motivated projects at the expense of CDC core preparedness and response activities. While Director Cohen has stated inrelation to pandemic preparedness that CDC must ‘‘be ready to respond, and that is our top priority at CDC,’’ the fiscal year 2025
budget request called for $182,000,000 in additional funding for the
Injury Center, a 24 percent increase above the fiscal year 2023
level and the largest requested funding increase of any CDC center.
The Committee further notes that the activities of the Injury
Center are duplicative of other programs, projects, and activities at

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other agencies, and taxpayers see less services from CDC-funded
activities due to high program support costs. The Department ofJustice’s Office on Violence Against Women is better positioned to
implement Violence Against Women Act programs, the Department
of Health and Human Services’ Administration for Children andFamilies is better positioned to support children and families, and
the Administration on Community Living is better positioned to
implement programs for seniors. Finally, of the $506,079,000 provided for the CDC opioid program in fiscal year 2024,$114,000,000, or 23 percent, has been allocated for administrative
costs. The transfer of this funding to SAMSHA will increase thefunding available to States for prevention, response, and recovery
services by $63,000,000 in reduced Federal administrative expenses
alone.
NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$362,800,000
363,200,000
263,700,000¥99,100,000¥99,500,000

The National Institute for Occupational Safety and Health(NIOSH) conducts applied research, develops criteria for occupational safety and health standards, and provides technical services
to government, labor, and industry, including training for the prevention of work-related diseases and injuries. This appropriation
supports surveillance, health hazard evaluations, intramural andextramural research, instrument and methods development, dissemination, and training grants.
Within the total, the Committee recommends the following
amounts:
Budget Activity

DMWilson on DSKJM0X7X2PROD with HEARINGSNational Occupational Research Agenda ....................................................................
Agricultural, Forestry, and Fishing (non-add) ....................................................
Education and Research Centers ................................................................................
Personal Protective Technology ...................................................................................
Mining Research ..........................................................................................................
National Mesothelioma Registry and Tissue Bank .....................................................
Firefighter Cancer Registry ..........................................................................................
Total Worker Health .....................................................................................................

FY 2024
EnactedFY 2025
Committee$119,500,000
29,000,000
32,000,000
23,000,000
66,500,000
1,200,000
5,500,000
11,800,000$119,500,000
29,000,000
33,500,000
23,000,000
68,000,000
1,200,000
5,500,000
13,000,000

Agricultural, Forestry, and Fishing.—The Committee provides$29,000,000 to protect workers in this sector by providing leadership in applied research, disease and injury surveillance, education,and prevention.
Chronic Obstructive Pulmonary Disease.—The Committee notes
the opportunity for CDC’s implementation of the Chronic Obstructive Pulmonary Disease (COPD) National Action Plan developed by
CDC and the NIH’s National Heart, Lung, and Blood Institute. The
Committee urges CDC and the National Center for Chronic Disease
Prevention and Health Promotion to support surveillance andawareness activities on COPD through existing funding mechanisms.
Health and Safety of Firefighters including Environmental Exposures.—The Committee is aware that firefighting is an inherently

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dangerous and vitally important occupation. In addition to injuries
and deaths in the line of duty, firefighters are also at risk for cancer and other illnesses. Despite a recognition of the risks associatedwith firefighter and first responders’ environmental exposures,
there has been no large-scale, systematic examination of the mechanisms by which the environmental exposures experienced by thesefrontline responders can contribute to cancer risk. The Committee
directs CDC to establish a Total Worker Health Center of Excellence and conduct research to examine the health and safety of
firefighters and first responders, including building upon existingscientific evidence-based research, and to further develop new solutions and best practices for complex occupational safety and healthproblems such as the toxic exposures, higher cancer incidence rates
in this population, personal protective equipment, and wildland firefighting.
Firefighter Cancer Registry.—The Committee recognizes the inherent dangers of firefighting and the corresponding importance ofinvestigating traumatic and medical firefighter line of duty deaths.
The Committee includes $5,500,000 for CDC’s National Firefighter
Registry for Cancer as the registry continues to recruit and enroll
participants.
Mine Health and Safety.—The Committee supports research related to air pollutant exposure risks to miners in metal and nonmetal surface and underground mines. The Committee provides increased funding for CDC to partner with western institutions withdemonstrated expertise in air pollution, familiarity with westernmining challenges, and accredited environmental analytical laboratories to evaluate airborne pollutant exposure risks of miners, develop novel respirable dust and crystalline silica exposure monitoring technologies, work with mine operators to implement exposure monitoring and mitigation measures, train mineworkers to reduce air pollutant exposures, and transfer the knowledge gained toother industries and parts of the country.
ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATIONPROGRAM

DMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$55,358,000
55,358,000
55,358,000––––––

The Energy Employees Occupational Illness Compensation Program provides compensation to employees and survivors of employees of Department of Energy facilities and private contractors who
have been diagnosed with a radiation-related cancer, beryllium-related disease, or chronic silicosis as a result of their work. NIOSH
estimates occupational radiation exposure for cancer cases, considers and issues determinations for adding classes of workers to
the Special Exposure Cohort, and provides administrative support
to the Advisory Board on Radiation and Worker Health.

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GLOBAL HEALTH

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$692,843,000
692,843,000
563,922,000¥128,921,000¥128,921,000

Through its Global Health activities, CDC coordinates, cooperates, participates with, and provides consultation to other nations,
Federal agencies, and international organizations to prevent andcontain diseases and environmental health problems. In cooperation with ministries of health and other appropriate organizations,
CDC tracks and assesses evolving global health issues and identifies and develops activities to apply CDC’s technical expertise.
Within the total, the Committee recommends the following
amounts:
Budget Activity

Global HIV/AIDS Program .............................................................................................
Global Tuberculosis .....................................................................................................
Global Immunization Program .....................................................................................
Polio Eradication .................................................................................................
Measles and Other Vaccine Preventable Diseases ............................................
Parasitic Diseases and Malaria ..................................................................................
Global Public Health Protection ..................................................................................

FY 2024
EnactedFY 2025
Committee$128,921,000
11,722,000
230,000,000
180,000,000
50,000,000
29,000,000
293,200,000–––$11,722,000
230,000,000
180,000,000
50,000,000
29,000,000
293,200,000

Soil Transmitted Helminth and Related Diseases.—The Committee includes funding to extend the currently funded CDC
projects aimed at surveillance, source remediation, and clinical careto reduce soil transmitted helminth infection.
PUBLIC HEALTH PREPAREDNESS AND RESPONSE

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$938,200,000
943,300,000
874,000,000¥64,200,000¥69,300,000

The Public Health Preparedness and Response (PHPR) accountsupports programs that build and strengthen national preparedness for public health emergencies, both naturally occurring and intentional. PHPR supports needs assessments, response planning,training, epidemiology and surveillance, and upgrades for laboratory capacity and communications systems.
Within the total, the Committee recommends the following
amounts:
Budget Activity

DMWilson on DSKJM0X7X2PROD with HEARINGSState and Local Preparedness and Response Capability ...........................................
Public Health Emergency Preparedness Cooperative Agreement .......................
Academic Centers for Public Health Preparedness ...........................................
Ready Response Enterprise Data Integration Platform & Center for Forecasting
Analytics ..................................................................................................................
CDC Preparedness and Response Capability ..............................................................

FY 2024
EnactedFY 2025
Committee$744,200,000
735,000,000
9,200,000$735,000,000
735,000,000–––

55,000,000
139,000,000–––
139,000,000

Emergency Preparedness and Response.—The Committee supports the CDC’s efforts to provide guidance and technical assistance to communities as they prepare for, withstand, and recover

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from emergencies. For example, events such as the Norfolk Southern train derailment in East Palestine, Ohio, demonstrates theneed to provide rural communities support, particularly throughassistance building public health emergency preparedness plans
and understanding response capabilities.
CDC-WIDE ACTIVITIES AND PROGRAM SUPPORTAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$663,570,000
723,570,000
511,570,000¥152,000,000¥212,000,000

This account supports the Office of the Director as well as publichealth leadership and support activities at CDC.
Within the total, the Committee recommends the following
amounts:
Budget Activity

DMWilson on DSKJM0X7X2PROD with HEARINGS

Preventive Health and Health Services Block Grant ...................................................
Office of the Director ...................................................................................................
Office of Rural Health (non-add) .......................................................................
Infectious Disease Rapid Response Reserve Fund .....................................................
Public Health Infrastructure and Capacity .................................................................

FY 2024
EnactedFY 2025
Committee$160,000,000
128,570,000
5,000,000
25,000,000
350,000,000–––$116,570,000
5,000,000
35,000,000
360,000,000

CDC Core Capacities.—The Committee has prioritized funding
for CDC Core Capacities necessary to respond to the threats of infectious disease across 14 accounts. These accounts include Quarantine; Emerging Infectious Diseases; Advanced Molecular Detection; Epi and Lab Capacity; Health Statistics; Public Health Data
Modernization; Public Health Workforce; Advancing Laboratory
Science; Surveillance, Epi, and Informatics; Global Health Protection; Public Health Emergency Preparedness Cooperative Agreements; Buildings and Facilities; the Infectious Diseases Rapid Response Reserve Fund; and Public Health Infrastructure. As part of
the fiscal year 2026 congressional justification, CDC is directed toprovide a breakout table detailing the funding requested for thesecore capacity program lines.
CDC Public Health Loan Repayments.—The Committee recognizes the value of the CDC’s fellowship program in improving thetechnical abilities of public health professionals prior to their permanent placement with State, local, Tribal, or territorial publichealth agencies. The CDC is directed to provide the Committee,
within 180 days of enactment of this Act, a briefing on the numberof CDC fellowships, the cost of the CDC’s fellowship program, andthe placements of CDC fellows and their tenure within relevantpublic health offices.
Congressional Relations.—The Committee is extremely concernedthat the bifurcation of responsibilities related to engagement with
the Committee has degraded the quality and timeliness of information essential to the Committee fulfilling its Constitutional role andis to the detriment of the CDC in its engagement with Congress.
Diet and Health.—In making grants related to diet and health,
the Committee directs CDC to fund projects integrating evidencebased policy, systems, and environmental approaches to better understand and address the environmental and societal implicationsof obesity. CDC is directed to give preference to proposals that are

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led by or conducted in coordination with an academic medical center to ensure that education and outreach efforts are aligned withbest medical practices. The Committee encourages CDC to consider
including high childhood obesity rates in its eligibility criteria.
Disease Modeling.—The Committee encourages CDC to workwith schools of public health and other academic institutions to engage the nation’s expertise in disease modeling, public health data
analysis, research, and training to build workforce capacity in thisemerging field.
Drowning.—The Committee directs CDC to provide information
to States and national organizations to reduce the risk of drowning
for individuals at greater risk of drowning.
Food Allergies.—The Committee recognizes the serious issue offood allergies, which affect approximately 8 percent of children in
the U.S. The Committee includes Chronic Disease Prevention and
Health Promotion funding to support school-based efforts to address food allergies and reduce potentially fatal anaphylactic reactions.
Gender Dysphoria.—The Committee notes the limited medical
evidence of the long-term effects of hormone drugs and surgicalprocedures to alter bodily sex traits. In the United Kingdom, theNational Health Service recently ended social, hormonal, and surgical interventions to look like the opposite sex for minors due tothe limited evidence to support clinical decision making for thispopulation. The Committee directs CDC to conduct a long-term
study on the effects of drugs or surgery used as an intervention forgender dysphoria.
Human Health Risks Posed by Wildlife.—The Committee is concerned by the CDC’s lack of action to implement the GAO recommendation that the agency comprehensively assess the risk thatimported wildlife could introduce zoonotic diseases to the U.S.
Therefore, the Committee directs CDC to develop a comprehensive
risk analysis framework for purposes of evaluating current policies
to determine whether adjustments are required for purposes of assessing zoonotic disease risks related to imported wildlife. The
Committee further directs CDC to provide a briefing on its implementation of this directive within 180 days of the enactment of thisAct.
Importation of Dogs.—The Committee strongly encourages CDC
to modify the final rule entitled, ‘‘Control of Communicable Disease; Foreign Quarantine: Importation of Dogs and Cats’’ in orderto ensure that the transport of dogs into the country by rescue organizations, U.S. employees stationed overseas traveling with theirpets, and professional pet transportation companies licensed as
Class T carriers is not unreasonably inhibited.
Infectious Disease Rapid Response Reserve Fund (Reserve
Fund).—The Committee provides funding for the Reserve Fund toensure that CDC is positioned to respond quickly to an imminent
public health emergency. The Committee directs CDC to provide atable to the Committee each month, which shall include allamounts available in the Reserve Fund for the current fiscal year
and the preceding two fiscal years, including: (1) each individual
obligation above $5,000,000; (2) with respect to each such obligation, the notification to which it relates; and (3) the total amountunobligated in the Reserve Fund.

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Local Health Departments.—Federal funding intended for bothState and local health departments does not consistently reach
local health departments beyond those directly funded by CDC. The
Committee encourages CDC to require States to fund local healthdepartments when programmatically appropriate. The Committee
urges CDC to publicly track and report to the Committee how
funds provided to State health departments are passed through tolocal health departments, including the amount and date funds are
made available, per grant award, by local jurisdiction.
Nicotine.—The Committee encourages CDC to study the psychiatric and physical effect on the body from the use of nicotine.
Obesity.—The Committee recognizes obesity as a serious chronic
disease and public health and economic issue that must be addressed. CDC formally recognizes obesity as a disease and recommends that it be treated as such. Evidence-based therapies, including innovative and highly effective anti-obesity medications(AOMs) are available with others in development. Expanded accessto intensive behavioral therapy and AOMs, in addition to existent
surgical procedures, not only provide significant weight loss reductions but lead to improved outcomes in over 200 obesity-related
health conditions including diabetes, coronary heart disease, andhypertension. The Committee encourages CDC to take a comprehensive approach in treating obesity as a chronic disease andfind ways to improve access to treatment options. The Committee
also encourages CDC to continue to collaborate with other Federal
agencies who are already treating obesity as a chronic disease as
it considers best practices to improve care for people with obesity.
Office of Rural Health.—The Committee is encouraged by efforts
from the agency to establish the CDC Office of Rural Health(ORH). The Committee directs the agency to ensure that the established ORH will guide CDC’s rural health leadership across the entire agency. This includes by developing purposeful public healthguidance for rural health departments, analyzing and developing
initiatives to expand the rural public health workforce, establishinga formal partnership with the Federal Office of Rural Health Policy
under HRSA, and otherwise serving as a resource and technical assistance hub for public health in rural communities. The Committee includes $5,000,000 for the continued efforts of this office.
Overdose Prevention Funding and Naloxone.—The Committee
commends CDC for its leadership in combating opioid drug
overdoses; this funding has been reallocated to SAMHSA to reduce
administrative overhead and expand the resources available toStates and communities to directly respond to substance misuse.
The Committee recognizes that CDC has issued opioid overdose
prevention funding opportunities to States, territories, and certain
localities. The Committee recognizes the delay in implementationand directs CDC to provide a written report on how to consider
opioid overdoes reversal education as a criterion when distributing
opioid overdose prevention funds. The Committee notes that whenan opioid overdose reversal medication, like naloxone, and overdose
education are available to community members, overdose deaths
decrease significantly in those communities.
Public Health Infrastructure.—The Committee notes that the
Public Health Infrastructure (PHI) program is intended, as described in the joint explanatory statement that created it, to sup-VerDate Sep 11 2014

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port public health departments. The Committee includes a newprogram requirement that 10 percent of PHI funding be designatedspecifically for Tribes and Tribal organizations. The provision of astable, disease agnostic funding line will better ensure Tribes andTribal Organizations are better equipped to coordinate together tosave lives. The Committee notes that in the absence of this new requirement, CDC has provided only $5,000,000 to Tribes and Tribalorganizations through the PHI program in fiscal year 2024, whileproviding $255,000,000 to national professional and advocacy organizations. The Committee is concerned that the provision of funds
to national organizations and high programmatic assessment by
the CDC has undermined the ability of the program to effectively
support State, local, Tribal, and territorial public health organizations and again directs that no less than 70 percent of this funding
be awarded to health departments.
Prescription Drug Monitoring Programs.—The Committee understands that nearly all 50 States and U.S. territories’ prescription
drug monitoring programs are connected and securely sharing critical controlled substance information for the purposes of identifying
and preventing abuse, misuse, or diversion of prescription drugs.
The Committee supports the removal of a requirement for States
to connect to a specific data hub solution as a condition of funding.
However, to adhere to Congressional intent and ensure the successand continuity of the program, the Committee encourages CDC tocease any technical requirements that limit the ability of States tooptimize Federal funding and to continue to utilize the prescription
drug monitoring program data hub of their choice.
Reporting.—The Committee is concerned that CDC abortion surveillance reports, published annually in the CDC Morbidity andMortality Weekly Report, lack adequate participation by States including incomplete submissions and even total nonparticipation.
The Committee requests a report on the extent of data inconstancies; steps taken by CDC to improve data completeness; andrecommendations for legislative or regulatory changes to achievecomplete data.
Traumatic Brain Injury Data.—Currently, fewer than half of all
States have developed and manage their own surveillance systems
for individuals living with a traumatic brain injury (TBI). While
the resources provided to individuals living with TBI in thoseStates can be most beneficial, it is difficult to determine resource
allocation when the true burden of the injury is unknown. The
Committee encourages CDC to produce guidance detailing theavailable resources for States interested in establishing State-level
TBI surveillance systems to voluntarily collect information from individuals about their experience living with TBI to inform service
planning and delivery, resources available to such individuals suchas where to seek care, advances in scientific research as well as information about services, therapies, and co-morbidities commonly
experienced by individuals with TBI.
Unapproved Nicotine Devices.—The Committee recognizes therisks posed by nicotine delivery devices from uncertain origins particularly those from foreign entities of concern. The Committee directs CDC, within 180 days of enactment of this Act, to publicly release a report on actions taken by States to improve consumertransparency regarding the risks posed by such devices. The Com-

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mittee encourages CDC to provide funding to States to support theimplementation and enforcement of efforts related to State laws
mandating that manufacturers of electronic nicotine products provide certifications related to compliance with FDA requirements.
Youth Electronic Cigarette Use.—The Committee recognizes thegrowing challenge that schools undergo by increased use of electronic cigarettes and other vaporizing equipment in their facilities.
These concerns often cause schools to lock bathroom doors to prevent their use, but this can also pose a safety risk. The Committee
understands that there are commercially-available off-the-shelfvape detection sensors that can provide detect vape, smoke, THC,
and sound abnormalities in areas where cameras cannot be placed.
The Committee urges CDC to clarify that funds may be used forthis technology and the Committee encourages CDC to work with
States and school districts to increase awareness of this technology.
Youth Sports Injury Prevention Education.—Across the country,
communities continue to recognize the importance of physical activity to maintain health, resulting in rapidly growing youth sports
activities. Research and education are needed to examine sport andrecreation injury across various activities, demographic groups, andhealth care settings, in addition to age related education for prevention and management. The Committee encourages CDC to establish a national public health information and education initiative with States who have legislated child and youth sports injury
education requirements for coaches of non-school organized youth
sports activities. The Committee encourages CDC to coordinate
with respective State departments of public health to develop public service announcements to educate volunteer coaches and parents of children and youth (ages 5–17) on the risks and means toprevent and manage sports related injuries.
BUILDINGS AND FACILITIESAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$40,000,000
40,000,000
40,000,000––––––

This account supports capital projects as well as repairs and improvements to restore, maintain, and improve CDC’s assets and facilities.
The Committee continues language to allow CDC to retain unobligated funds in the Individual Learning Accounts from departed
employees to support the replacement of the underground and surface coal mine safety and health research facility.
NATIONAL INSTITUTES OF HEALTH (NIH)

DMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$48,581,000,000
49,830,482,000
48,581,000,000–––¥1,249,482,000

The mission of NIH is to seek fundamental knowledge about thenature and behavior of living systems and the application of thatknowledge to enhance health, lengthen life, and reduce illness anddisability. NIH conducts and supports research to understand thebasic biology of human health and disease; apply this under-

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standing towards designing new approaches for preventing, diagnosing, and treating disease and disability; and ensure that theseapproaches are widely available.
The Committee recommendation for the NIH program level is$48,581,000,000 including funding for the Advanced Research
Projects Agency for Health (ARPA–H). The Committee provides$47,041,518,000 in discretionary appropriations, $1,412,482,000 in
PHS Act section 241 evaluation set aside transfers, and$127,000,000 as authorized in the 21st Century Cures Act (Cures
Act) (P.L. 114–255).
In coordination with the Committee on Energy and Commerce ofthe House of Representatives, the Committee proposes a reorganization of the National Institutes of Health for the 21st century.
The foundational biomedical science pioneered by NIH does notneed to be spread across 27 various institutes and centers; doing
so creates duplication, the potential for unrecognized gaps, andadded administrative costs. The U.S. has been the world pioneer inbasic science and biomedical research, and as China continues toincrease its spending in this area, it is imperative the U.S. maintain its innovative edge. Maintaining this advantage builds the nation’s economic base and preserves national security interests. As
the threat from foreign nations increases, it is time Congress recognized that a reorganization of the NIH is needed to ensure the nation continues to be a leader in innovation. Several of the proposedchanges to the institutes have been requested by prior Administrations in budget requests or recommended by scientific bodies. The
new structure seeks to encourage a holistic life stage approach to
all research, with the goal of eliminating the demographic- or disease-specific siloed nature of the current structure and ensure each
institute or center is considering the whole individual and all populations across the entire lifespan. The science of today is not accomplished in a silo. The nation’s premier research institution should
not be structured as such either.
The Committee includes specific funding allocations for several
initiatives and activities detailed in the institute- and center-specific sections below. For ease of reference the prior institute andcenter names have been maintained in the report language that
follows. The funding amounts shown for each institute or center,reflect the proposed new structure, and are comparably adjusted tofiscal year 2024, the fiscal year 2025 budget request, or Committee
proposed funding for fiscal year 2025.
NATIONAL CANCER INSTITUTE

DMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$7,224,159,000
7,839,141,000
7,875,289,000+651,130,000+36,148,000

Biliary Tract Cancers.—The Committee encourages the National
Cancer Institute (NCI) to support novel treatment strategies in biliary tract cancers. The Committee supports research on novel cancer vaccines and immunotherapies, including targeting recurrent
cancer neoantigens in these cancers with novel cancer treatment
vaccine in combination with other drugs that work on the humanimmune system.

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Breast Cancer Screening Evidence Gaps.—The U.S. Preventive
Services Task Force (Task Force) breast cancer screening recommendation statement, published in April 2024, identifies several
critical research gaps that restrict the Task Force from making evidence-based recommendations that address multiple important
areas. For example, the Task Force notes that research is needed:
to better understand whether and how the benefits quantitatively
differ for annual vs. biennial breast cancer screening; to help clinicians and patients understand the best strategy for breast cancer
screening in women found to have dense breasts on a screening
mammogram, such as supplemental screening; and to understandand address the higher breast cancer mortality among Black
women. Breast cancer is the second most common cancer among
women in the U.S., and over 40,000 women are expected to diefrom breast cancer in 2024. For the Task Force to fulfill its mission
to improve health through actionable preventive services recommendations, the Committee urges the NIH to continue to support research in the areas outlined in the Evidence Gaps Research
Taxonomy Table from the Task Force’s 2024 Breast Cancer Screening Recommendation Statement to ensure the Task Force has thenecessary evidence to create the strongest evidence-based recommendations for all women and further reduce breast cancer morbidity and mortality, especially among those with the greatest burden of disease. The Committee encourages that these efforts should
continue to prioritize the inclusion of women of all racial and ethnic groups to investigate whether the effectiveness of screening, diagnosis, and treatment vary by group. The Committee requests an
update on this effort in the fiscal year 2026 congressional justification.
Cancer Clinical Trials.—Clinical Cancer trials are pivotal to find
new medications and treatment options for patients. The Committee is concerned that the lack of diversity in cancer clinical
trials is compromising our ability to understand how certain cancers affect populations differently, compounding health disparities,
and hindering future innovative treatment and therapies. Therefore, the Committee provides $3,000,000 for NCI to implement acancer clinical trial patient expense reimbursement program, including the cost of travel, at an extramural NCI designated cancer
center.
Childhood Cancer Data Initiative (CCDI).—The Committee includes no less than $75,000,000 for the CCDI, which is $25,000,000
above the fiscal year 2024 enacted level. Within this total, theCommittee includes no less than $750,000, which is the same as
the fiscal year 2024 enacted level, for enhancement of the CCDI
Molecular Characterization Initiative and other efforts as applicable through continued expansion to focus on ultra-rare tumor types,
such as atypical teratoid rhabdoid tumor and other ultra-rare pediatric tumors with limited therapeutic options. The effort should include comprehensive clinical and molecular data for each patient to
the extent possible. The dataset should include clinical, radiographic, histopathologic, and molecular information to the extent
possible and be stored in a manner that allows for interrogation ofpatient level data. The data collected will be used to identify risk
factors, aid in prognostication and treatment recommendations,

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and assist with the development of novel therapeutics for these diseases.
Childhood Cancer STAR Act.—The Committee includes no lessthan $50,000,000, which is $20,000,000 above the fiscal year 2024
enacted level, for continued implementation of sections of theChildhood Cancer Survivorship, Treatment, Access, and Research(STAR) Act (P.L. 115–180). The funding expands opportunities forchildhood cancer research, improves efforts to identify and trackchildhood cancer incidences, and enhances the quality of life forchildhood cancer survivors. While some progress has been made inpediatric cancer research—leading to a decline in childhood cancer
deaths by almost 70 percent over the last four decades—cancer isstill the leading cause of death by disease past infancy among children in the U.S., according to NCI. And while survival rates forsome forms of childhood cancer like leukemia have increased togreater than 85 percent, the median survival rate for other childhood cancers such as diffuse intrinsic pontine glioma is less than
one year. STAR Act funding goes to critical research infrastructure,
surveillance, and survivorship programs that fundamentallychange the lives of pediatric blood cancer patients and survivors.
For example, the NCI has been able to expand its efforts to collectcancer tissue specimens from children with cancer for which current treatments are least effective, making samples more available
to researchers to develop the next breakthrough. The STAR Act
works to improve the lives of childhood cancer survivors by funding
critical research to further our understanding of the complications
survivors face later in life as well as care models to improve careas survivors transition to primary care.
Deadliest Cancers.—The Recalcitrant Cancer Research Act of2012 (P.L. 112–239) focuses on cancers with a 5-year survival rate
below 50 percent, which account for over 40 percent of all U.S. cancer deaths. While advances in some cancers have made it possible
to reduce the overall rate of cancer deaths over the last several decades, there has been limited progress in reducing mortality forthese diseases. The Committee encourages NCI to continue its
focus on these cancers, which include cancers of the brain (including glioblastoma), esophagus, liver (including cholangiocarcinoma),lung, ovaries, pancreas, stomach, and mesothelioma and requests
an update on research focused on each of these areas in the fiscal
year 2026 congressional justification. Further, given the high mortality rates for these cancers, the Committee is particularly concerned about reports of increased incidence of esophageal, liver,pancreas, and stomach cancer among young adults and urges theNCI to continue to support much needed research to understandthe causes and risk factors leading to these increases, as well as
potential interventions.
Diffuse Intrinsic Pontine Glioma.—The Committee encourages
NCI to continue its research to better understand Diffuse Intrinsic
Pontine Glioma (DIPG) brain tumors and coordinate its research
efforts with other Federal agencies, including the Department of
Defense, as well as private research foundations and advocacy
groups to improve the detection, treatment, and prevention of
DIPG. DIPG is a rare brain tumor that accounts for almost 80 percent of pediatric brainstem gliomas and represents 20 percent of all

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tumors in children. Due to its location and highly aggressive nature, its prognosis is almost always fatal.
Early Detection, Screening, and Prevention for Liver Cancer.—
The Committee commends NCI for seeking input on how best toaddress the need to prioritize early detection, screening, and prevention sciences for primary liver cancer. Primary liver cancer has
a dismal 5-year survival rate of only 22 percent, is the third mostcommon cause of cancer death in the U.S., and unlike most cancers
the rate of liver cancer mortality continues to increase. Therefore,
the Committee urges NCI to use submitted expert feedback to inform a national agenda for early detection, screening, and prevention of primary pancreatic and liver cancers. The Committee commends NCI for its Early Detection of Liver Cancer consortia initiatives as a means of fostering progress and collaboration. The Committee encourages NCI to continue such programs as well as program projects, cooperative research, and broad agency announcements, and other mechanisms. The Committee requests an updateon this effort in the fiscal year 2026 congressional justification.
Esophageal and Gastric Cancer.—The Committee recognizes theimportance of screenings for cancer detection and is encouraged by
the work of NIH in this field. However, the Committee believes
that there is more work to be done, particularly with screening for
gastrointestinal cancers, such as esophageal and gastric, whichhave a low five-year survival rate. The Committee recommends
NIH explore developing, testing, and implementing strategies using
non-endoscopic screening modalities, personalized clinical risk
stratification for screening, and biomarker-based risk stratification
for the surveillance of esophageal adenocarcinoma and gastriccardia adenocarcinoma.
Functional Precision Medicine.—The Committee has a long history of working to address refractory cancers and the lack of treatment options currently available when standard of care has been
exhausted. The Committee is encouraged by the promise of functional precision medicine approaches to identify individualized
treatment options more rapidly for hard-to-treat cancers, in particular with minority populations. Recent data showing the clinicalutility of combining patient-specific drug sensitivity testing andgenomic profiling to treat refractory cancers has proven to be potentially lifesaving. The Committee supports efforts to establish anational center for functional precision medicine and artificial intelligence analysis. Such an effort would serve as the launching
point for large-scale clinical trials needed to demonstrate the realworld clinical impact of guided treatments, and to quickly develop
the datasets needed to optimize standard cancer treatments thatcan be delivered through next generation genomic cancer profiling.
The Committee requests an update on this effort in the fiscal year
2026 congressional justification.
Human Papillomavirus (HPV)-Associated Cancers.—The Committee encourages NCI to expand research related to humanpapillomavirus and HPV-associated cancers.
HPV Screening and Self-Collection.—The Committee recognizes
the impact and potential of the Last Mile Initiative and supports
innovative efforts, such as the emerging network to study
noninvasive self-collection for HPV testing to further improve thedetection and prevention of cervical cancer to address disparate

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health outcomes. NCI is encouraged to work with a variety of
stakeholders and to study various approaches to sustain scientificprogress.
Immunomodulatory Radiopharmaceutical Therapy.—The Committee supports ongoing efforts for immunomodulatory radiopharmaceutical therapy to advance translational research thataims to develop more effective, safe, and potentially curative treatments for patients with potentially any form of metastatic cancer
using combinations of radiopharmaceutical therapies andimmunotherapies.
Improving Native American Cancer Outcomes.—The Committee
continues to be concerned that Native Americans experience overallcancer incidence and mortality rates that are strikingly higher
than non-Native populations. The Committee directs NCI to coordinate with National Institute on Minority Health and Health Disparities (NIMHD) as NIMHD establishes the initiative for Improving Native American Cancer Outcomes.
Medical Imaging Technologies in Cancer Screening Trials.—The
Committee supports the establishment of clinical trials conductedby the NCI to assess the potential role of blood tests to detect cancer in the body. Medical imaging, as a means of conducting diagnostic workup following a positive assay and as a method for disease characterization, is essential to this clinical trial and assessment process. As the Administration aims to reach a 50 percent reduction in overall age-standardized cancer mortality in the U.S. by2047, imaging is a known necessity for a cancer diagnosis andtreatment and should continue to hold a core function in the clinical trial process. The Committee urges NCI to include imaging
technologies and tools in these clinical trials, as they are the essential component of each precise cancer diagnosis and help ensure patients receive the most effective and impactful care.
Metastatic Breast Cancer.—The Committee is aware that clinicalresearch is of utmost importance to those living with metastatic
breast cancer (MBC), which is breast cancer that has spread toother organs and become incurable. An estimated 168,000 Americans live with MBC, and nearly all of the more than 43,000 deaths
from breast cancer are attributed to this late stage of disease.
Given the mortality associated with MBC and the lack of treatment
options, research offers the best possibility of therapeutic advancesand extended life for these patients. MBC is also associated withstartling health disparities, since breast cancer mortality is about
40 percent higher for Black women in the U.S. than Caucasian
women and breast cancer is the second most common cause ofdeath by cancer for Black women. The Committee encourages acontinued emphasis by NCI on research for MBC, to discover better
treatments and a cure for MBC and to address health disparities
in this population. The Committee requests an update on NCI’s activities regarding MBC in the fiscal year 2026 congressional justification, including updates on actions NCI is taking to achieve
representation of the demographics of the U.S. population in clinical trials.
Metastatic Cancers.—The Committee applauds NCI and the Department of Energy for ongoing efforts to modernize the Surveillance, Epidemiology, and End Results registry and bolster data collection, including innovative activities to better capture the preva-

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85
lence and progression of metastatic cancers. The Committee encourages NCI to continue to work with DOE and to provide and update in the fiscal year 2026 congressional justification on ongoingmodernization efforts.
Natural Products Research.—Research shows that derivatives
from natural products have been an important source of clinicallyuseful anti-cancer agents, yet not enough evidence-based researchhas been done to strategically identify those compounds that could
provide potential benefits in cancer treatment. The Committee believes that it is important to fully explore whether and how natural
products could be beneficial to patients in reducing the toxicity oftherapy or by enhancing therapeutic efficacy as a primary or adjunctive therapy. Therefore, the Committee urges NCI to expand
its support of research to evaluate the potential value of natural
products in reducing adverse effects of cancer therapy and in enhancing therapeutic efficacy through basic, translational, and clinical trials research. NCI is encouraged to seek applicants that havea demonstrated expertise in natural products research, can conduct
a holistic review of drugs and disease states, have access to an annotated inventory of natural products, and that are able to test thesafety and efficacy of natural products in communities experiencing
high rates of health care disparities in access to cancer care.
Optimal Timing and Sequencing of Cancer Immunotherapy.—The
Committee recognizes that cancer immunotherapy is improving
outcomes for an increasing number of cancer patients, especiallythose for whom other treatments were ineffective. New researchsuggests that more patients might benefit if immunotherapy wereused earlier in the course of their cancer, or to prevent and intercept cancers before they start. Therefore, the Committee urges NCI
to prioritize research focused on assessing the optimal timing for
the use of cancer immunotherapy in individual patients. Examples
of such research include studying the effectiveness of cancer
immunotherapy in premalignant conditions, early-stage cancer, andas a neoadjuvant therapy, prior to additional treatment such as
surgery, radiation, or chemotherapy.
Patient Access to Clinical Trials.—The Committee recognizes that
local health care provider and patient access to clinical trials is
critical for improving equitable access to research and novel therapies; diversifying the population participating in research; ensuring
the safety and efficacy of new drugs; and accelerating the dissemination and implementation of findings and the adoption of newly
approved therapies. As part of the fiscal year 2026 congressional
justification, the Committee requests an update on the Virtual
Clinical Trials Office (VCTO). In future years, as data from thepilot program become available, the Committee looks forward tofurther updates, including whether the VCTO contributed to increases in local provider and/or patient participation in clinical
trials, especially from rural areas; and challenges and successes inprescreening/screening of potential trial candidates, obtaining informed consents, data abstraction, building protocol-specific treatment plans, and maintaining a repository for quick adoption into
the local sites.
Pediatric Rare Cancer Therapeutic Development.—Childhood cancers are rare and need specialized treatments, rather than justlower-dose treatments than adults receive. Each type of cancer re-

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quires appropriate therapeutic approaches to save a child’s life orsignificantly improve quality of life and extend a child’s lifespan,
yet many types of childhood cancer do not yet have effective curative treatments available. The Committee encourages NIH to continue to examine novel systems for identifying how rare cancers develop and progress, and to continue to support and accelerate development and evaluation of life-saving therapeutics for pediatriccancer patients.
Prostate Cancer.—Prostate cancer is the most common cancer diagnosed in men and is the second leading cause of cancer deaths
among men. 1 in 9 men will be diagnosed in their lifetimes, and3.4 million men are living with a prostate cancer diagnosis today.
The Committee urges continued support of prostate cancer research.
Young Adult Cancer Survivorship Research.—NCI has supported
the Childhood Cancer Survivor Study since 1994. This study, along-term, retrospective cohort study, has dramatically enhanced
our understanding of the side effects of cancer treatment in children and adolescents, supported research to find interventions forchildhood cancer survivors, and improved survival from treatment
side effects. The Committee urges the NCI to conduct a landscapeanalysis of young adult cancer survivorship research and provide
the Committee with an update on this effort in the fiscal year 2026
congressional justification.
NATIONAL INSTITUTE ON BODY SYSTEMS RESEARCH

DMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$6,978,531,000
6,996,774,000
7,101,721,000+123,190,000+104,947,000

The report language that follows includes references to the National Heart, Lung, and Blood Institute (NHLBI), the National Institute of Arthritis and Musculoskeletal and Skin Diseases(NIAMS), and the National Institute of Diabetes and Digestive andKidney Diseases (NIDDK).
Alopecia Areata.—The Committee notes the importance of research into autoimmune skin conditions such as alopecia areata.
NIAMS research has uncovered genetic factors that are associatedwith alopecia areata, many of which have been implicated in otherautoimmune diseases. The Committee encourages NIAMS to explore collaborative opportunities with key stakeholders to advancecritical research projects into causes and treatments. The Committee notes the disproportionate effect of alopecia areata on peopleof color, specifically women. The Committee requests an update in
the fiscal year 2026 congressional justification on collaborative efforts between NIAMS and other relevant NIH institutes and centers and stakeholders in identifying key research areas of concern.
Atopic Dermatitis.—The Committee recognizes NIAMS ongoing
efforts to incorporate community feedback and otherwise craft a
new Strategic Plan for Fiscal Years 2025–2029. The Committee
notes the tremendous opportunity for cross-NIH multidisciplinary
research into atopic dermatitis and other forms of eczema and encourages further efforts to coordinate with other institutes and cen-

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ters to compliment emerging NIAMS activities and to effectively coordinate the overall research portfolio in atopic dermatitis.
Chronic Disease Prevention and Management.—The Committee
commends NIDDK’s accomplishments and ongoing activities to address some of the most common, chronic, costly, and consequential
diseases, including the widespread obesity and diabetes epidemics.
The Committee recognizes that significant health disparities exist
for many NIDDK mission diseases. Such approaches support thepromise of personalized or precision medicine for disease prevention and management and may aid in the prevention and management of other chronic diseases. The Committee requests an updateon these efforts in the fiscal year 2026 congressional justification.
Chronic Kidney Disease.—The Committee notes that approximately 25 percent of Medicare spending is on individuals with achronic kidney disease (CKD) diagnosis, and further that 1 percent
of Medicare beneficiaries have end-stage kidney failure yet accountfor 6.8 percent of spending. Despite the significant toll of CKD on
Medicare spending, funding for kidney disease research has lagged
behind that of NIH overall. Thus, the Committee strongly urges
NIDDK to increase its support for kidney research funding in fiscal
year 2025. The Committee supports recent changes to clinical practice in the diagnosis of kidney disease and concurs with recommendations for new markers for estimating kidney function. The
Committee encourages NIDDK to prioritize research into endogenous filtration markers, activities that spur the adoption of newequations for estimating glomerular filtration rate that do not include race as a modifier, and interventions to eliminate racial andethnic disparities. Finally, the Committee encourages NIDDK toexpand investment in research that bridges existing deficits in
CKD management and treatments to reduce incidence and progression, increases the number of CKD clinical trials and diversity ofparticipants, improves the delivery of evidenced-base care in underrepresented populations, and improves patients’ quality of life. The
Committee requests an update on these priorities in the fiscal year
2026 congressional justification.
Chronic Lung Disease.—Chronic lung diseases are among theleading causes of death and chronic illness in the U.S., including
the over 15 million Americans diagnosed with chronic obstructive
pulmonary disease (COPD) and related diseases. Most chronic lungdisease research to date has focused on later stages of disease
when substantial loss of lung function and damage to lung tissue
have already occurred. There is a need for treatments that whenapplied early in the course of diseases can more effectively slow the
progression and mitigate the lung tissue damage caused by chroniclung diseases. NHLBI supports a wide array of basic andtranslational research in these conditions. Increased funding is urgently needed to improve our understanding of early disease to
identify appropriate targets to modulate disease progression before
the irreversible tissue damage has occurred. NHLBI-funded studies
such as the COPD Gene and SPIROMICS projects are critical tothis objective and have already provided significant insight to begin
to understand the biology of early disease. The Committee encourages NHLBI to increase support for these and other early diseaseresearch in chronic lung disease.

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Diabetes.—The Committee includes an increase of $50,000,000
for diabetes research. The Committee urges NIH to focus efforts on
Type 1 Diabetes.
Duchenne and Becker Muscular Dystrophy.—In light of improvements in care leading to patients living into their third decade, theleading cause of death in Duchenne and Becker Muscular Dystrophy (DBMD) patients is heart failure. The Committee urges
NHLBI to support research that characterizes fibro-fatty replacement of cardiomyocytes in DBMD. The Committee encourages
NHLBI to convene a workshop with research, clinical, and patientorganization leaders to work towards establishing viable cardiac
outcome measures for the development of therapeutic agents todelay or treat heart disease in individuals diagnosed with
Duchenne. There is growing evidence to support that select individuals with DBMD would benefit from ventricular assist device placement or heart transplant. The Committee encourages NHLBI to
support research to further develop criteria for identifying patients
who may benefit from such strategies.
Long COVID.—The Committee notes with concern that themulti-organ syndrome known as long COVID has long-term implications for chronic conditions including pulmonary and cardiovascular complications. The Committee urges NHLBI, in co-leading
researching COVID to enhance recovery, to continue to ensure that
research into the understanding, treatment, and prevention of postCOVID respiratory and cardiovascular conditions in adults andchildren are prioritized.
Mitral Valve Prolapse Workshop.—The Committee urges NHLBI
to convene a workshop composed of subject matter experts andstakeholders to identify research needs and opportunities to develop recommendations for treatment of individuals with mitralvalve prolapse.
National Chronic Obstructive Pulmonary Disease Action.—The
Committee notes NHLBI’s role in crafting the National Chronic
Obstructive Pulmonary Disease Action Plan. NHLBI is encouraged
to continue this important work by supporting additional research
activities and collaborating with other public health service agencies to facilitate implementation of the plan’s recommendations.
National Center on Sleep Disorders Research (NCSDR).—The
Committee commends NCSDR for facilitating sustained progress inadvancing research into sleep, circadian biology, and sleep disorders and recognizes NHLBI for taking steps to refresh the institute’s strategic vision. The Committee encourages NCSDR to continue its focus towards advancing the goals of the NIH Sleep Research Plan to ultimately promote sleep health and improve patient care and treatment for individuals affected by a variety ofsleep and circadian disorders.
Pancreatitis.—The Committee supports the focus on pancreatitis
through the institute’s 2024 Recent Advances and Emerging Opportunities document. The Committee notes the devastating impact ofpancreatitis, the limited treatment options, and challenges related
to health disparities, and encourages sustained scientific progressin this area.
Pulse Oximeters and Health Disparities.—Pulse oximeters are
frequently used in clinics and in homes to measure a person’s pulmonary health, but the devices tend to overestimate blood oxygen

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for some skin types. This discrepancy can have serious consequences, as people with darker tones are nearly three times more
likely to suffer from silent hypoxia, a condition in which the oxygen
saturation level in a person’s blood is dangerously low but goes unnoticed. The Committee encourages NHLBI to support developmentof new noninvasive technologies for monitoring blood oxygen saturation.
Sickle Cell Disease and Sickle Cell Trait.—The Committee encourages NIH to further its clinical research in Sickle Cell Disease(SCD) and Sickle Cell Trait, which includes promising approaches
to eradicate the disease, save lives, and dramatically reduce thesubstantial health care complications and costs associated with
SCD for both children and adults. The NIH is encouraged to consider programs both domestically and globally to evaluate the effectiveness of screening technologies for infants and children with the
sickle cell trait and disease and to develop different innovativetechnologies and medicines to treat and cure SCD.
Valvular Heart Disease Research.—Heart valve disease occurs if
one or more of your heart valves malfunctions. Many people in the
U.S. have heart valve defects or disease but do not have symptoms.
For some, the condition remains the same throughout their lives
and does not cause significant or life-threatening problems. Unfortunately, over 25,000 people die each year in the U.S. from heart
valve disease, primarily due to underdiagnosis and undertreatmentof the condition. The Committee commends the NHLBI for theirwork in advancing treatments for those with valvular heart disease
and encourages the agency to expand these initiatives to include
research that uses advanced technological imaging and precision
medicine to generate data on valvular disease, identifies individuals who are at high risk of sudden cardiac death as a result ofvalvular disease, develops prediction models for high-risk patients,and enables interventions and treatment plans to keep these patients healthy throughout their lives. For these efforts the Committee continues $20,000,000, the same as the fiscal year 2024 enacted level, in funding to the NHLBI for this activity.
Wildland Fire Smoke.—The Committee is concerned that publichealth experts do not yet fully understand the risk posed by exposure to wildland fire smoke particularly acute and chronic smoke
exposure to patients with existing pulmonary and cardiac disease.
The Committee encourages the institute to support research to understand the risk smoke exposure has for patients with underlying
health conditions and any interventions that can be implemented
to mitigate adverse health effects.
NATIONAL INSTITUTE ON NEUROSCIENCE AND BRAIN RESEARCH

DMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$4,020,637,000
4,208,840,000
4,112,805,000+92,168,000¥96,035,000

The report language that follows includes references to the National Institute of Dental and Craniofacial Research (NIDCR), theNational Institute of Neurological Disorders and Stroke (NINDS),
and the National Eye Institute (NEI).

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Alzheimer’s Disease and Alzheimer’s Disease-Related Dementias(AD/ADRD).—The Committee includes an increase of $100,000,000
above the fiscal year 2024 enacted level for AD/ADRD researchacross NIH, split evenly between the National Institute on Dementia and the National Institute on Neuroscience and Brain Research.
Amyotrophic Lateral Sclerosis (ALS) Research.—NIH is the primary federal agency conducting and supporting basic, clinical, andtranslational medical research and is investigating the causes,
treatments, and cures for common and rare diseases. NINDS
makes the largest investment in ALS research. ALS is a rare progressive neurological disease. ALS is a rapidly progressing 100 percent fatal disease, and most people only live for 2–5 years after
symptom onset. There are currently very limited treatment options
that offer only marginal benefit to some people. The Committee
urges NINDS to expand its portfolio of research into ALS.
Angelman Syndrome.—The Committee is aware of the Angelman
syndrome (AS) natural history study supported by NIH from January 2006 to July 2014. The resulting data from over 300 participating American families, along with a later FDA prospective natural history study, provide a critical understanding of the most important symptoms of this serious condition and support the development of specific Angelman syndrome outcome measures. Further,
the recent developments in cell and gene therapies, including a
2023 National Center for Advancing Translational Sciences award
for the application of a CRISPR platform technology, hold significant potential for disease-modifying treatments for rare genetic
brain diseases. To fully support the rapidly increasing array of clinical studies of these and other treatment modalities being developed for Angelman syndrome, the Committee urges NINDS, in cooperation with FDA, to convene relevant research leaders, patientorganizations, and other stakeholders to prepare a roadmap forclinical outcomes measures and biomarkers for this condition.
NINDS shall provide an update on this effort in the fiscal year
2026 congressional justification.
Blepharospasm.—The Committee urges continued support for research into blepharospasm, a form of dystonia, and encourages continued collaborative efforts amongst stakeholders and other institutes and centers.
Brain Research through Advancing Innovative Neurotechnologies(BRAIN) Initiative.—The BRAIN initiative is an ambitious program
to develop and apply new tools and technologies to answer fundamental questions about the brain and ultimately to inspire newtreatments for brain diseases. NINDS and NIMH are leading partners in the initiative, working with eight other NIH Institutes,
Centers, and Offices. The BRAIN Initiative has invested over $3.5
billion in more than 1,500 research projects, engaging scientists
from many areas of expertise as well as mathematicians, engineers,and physicians in individual labs and inter-disciplinary teams. The
BRAIN Initiative will promote scientific advances that provide opportunities to understand the structure and function of the brain
at an unprecedented level of detail, helping bring advanced treatments for brain disorders to clinical use.
Creutzfeldt-Jakob Disease.—The Committee commends the National Alzheimer’s Project Act Advisory Council report from 2023
that acknowledges the scientific connection between prion diseases

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and Alzheimer’s Disease and Related Dementias (ADRDs) and continues to encourage NIH to recognize prion diseases as ADRDs andfund more research for prion diseases, like Creutzfeldt-Jakob disease (CJD). ADRDs have already benefited from prion disease research, and further integration of the fields could lead to beneficial
new treatments and improve our scientific understanding of thesedevastating diseases. CJD is caused by the abnormal folding of theprion protein in the brain, and closely resembles ADRDs. Enhanced
research of CJD, through the BRAIN Initiative and the Alzheimer’s
Disease research portfolio, will be valuable to the study of ADRDs
and vice versa, and further integration will benefit scientific pursuits in both fields with the goal of new treatments forneurodegenerative diseases.
Dystonia.—The Committee requests an update, in the fiscal year
2026 congressional justification, on the implementation of the recommendations from the NINDS workshop Defining Emergent Opportunities in Dystonia Research that was held in 2018 and encourages NINDS to continue to collaborate with stakeholders.
Multiple Sclerosis (MS).—The Committee encourages NINDS tobuild upon its work in the development of the medical understanding of the progression of MS and continue to support researchon prevention strategies, treatments, and cures for MS.
Oral Health Research.—The Committee reaffirms that oral
health care and its maintenance are integral to the medical management of numerous diseases and medical conditions and that thelack of medically necessary oral healthcare heightens the risk of
costly medical complications. The Committee appreciates NIH’s
support for research that has demonstrated that dental care isclosely linked to the clinical success of other covered medical services and urges NIH to fund additional research in this area. Continued research on the causal mechanisms that link untreated oral
microbial infections, oral inflammation, and chronic systemic conditions will provide clinical evidence that can be used to support coverage of medically necessary dental treatment in various benefit
programs.
Parkinson’s Disease.—The Committee commends NINDS for taking critical steps in identifying priority research recommendations
to advance research on Parkinson’s disease, which impacts between
500,000 and 1,500,000 Americans and is the second most prevalentneurodegenerative disease in the U.S. The Committee recognizes
that NINDS is prioritizing public health concerns with severe gaps
in unmet medical needs and supports the research recommendations set forth by the NINDS planning strategy to bring us closer
to better treatments and a cure for Parkinson’s disease.
Parkinson’s Disease and Parkinsonism.—The Committee urges
NIH to support projects studying dementia in Parkinson’s disease
and dementia in atypical parkinsonisms (e.g. progressive
supranuclear palsy). Parkinson’s disease is the second most common and fastest growing neurodegenerative disease and is characterized by the abnormal folding of a protein in the brain. Channeling resources into research could help unlock groundbreaking
discoveries in crucial areas like Parkinson’s disease, atypicalparkinsonisms (e.g. progressive supranuclear palsy), and otherclosely associated neurological disorders.

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Pediatric-Onset Epilepsies Network.—The Committee encourages
NIH to establish a pediatric-onset epilepsies network. Such a network could help coordinate research of pediatric-onset epilepsies
across institutions to maximize the potential for scientific progressin the era of precision medicine. This network could create a collaborative, multidisciplinary research model to enroll patients frommany hospitals in the same system to enable cooperative researchstudies, accelerate the development of knowledge about theepilepsies, and rapidly advance therapeutic options and their implementation to improve treatments and healthcare outcomes.
Pediatric Rare Disease.—The Committee encourages NIH to enhance and prioritize pediatric rare disease research at NINDS.
Such an effort would undertake novel technologies to better diagnose and treat rare diseases such as Tay-Sachs and glioblastoma
in children by using artificial intelligence, precision medicine, andDNA sequencing. Such research can help revolutionize pediatrichealthcare by leveraging cutting-edge technologies and innovative
approaches in genomics research, precision medicine, gene therapy,
human stem cell research, and big data analytics to pave the way
towards developing personalized, targeted treatments and improved patient outcomes for the nation’s pediatric population.
Preventive and Early-Treatment Cognitive and Brain Health Research.—The Committee encourages NIH to give greater attention
to the study of the presymptomatic or preclinical stages of neurological disorders, that is, alterations in cognitive and brain healthbefore the first clinical symptoms of neurological disease when persons typically encounter medical professionals. Learning what happens during these stages may guide the development of measuresfor detection and monitoring earlier in the course of the disease, including sensitive neuropsychological measures and biomarkers,
which could improve early intervention development and testing forneurological disease before it becomes disabling and, ultimately,
prevent diseases like Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, stroke, and epilepsy. Mounting evidence suggeststhat significant pathologies have already accumulated by the time
symptoms appear and early, presymptomatic intervention may leadto more effective care. Such discoveries may also reduce the costs
that neurological diseases pose to our healthcare delivery system.
Retinitis Pigmentosa.—The Committee continues to encourage
NEI to expand research into Retinitis Pigmentosa and requests an
update on collaborative efforts amongst stakeholders and other Institutes and Centers concerning work toward curative treatments
and therapeutics in the fiscal year 2026 congressional justification.
Spinal Muscular Atrophy.—The Committee commends NIH for
its continued support of research in spinal muscular atrophy(SMA), a rare neuromuscular disease. The Committee is aware thatpast NINDS research has led to greater understanding of the nervous system and contributed toward approved SMA treatments thatslow or stop future nerve damage. The Committee also recognizes
that current treatments do not cure the disease or reverse its debilitating symptoms. Without additional SMA research, the Committee is concerned that adults and children with SMA who wereborn after treatments and early diagnosis were available will continue to face chronic health challenges and significant barriers to
independence. Furthermore, it is not yet fully known the extent of

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need among children treated prior to symptom onset. As such, theCommittee encourages NINDS to expand its research in SMA toaddress fatigue, muscle weakness, motor function loss, and otherunmet needs that are pervasive among the largest segment of the
SMA community. Additional research into these common needs
may also benefit individuals with other neuromuscular and rarediseases who face similar challenges.
Stroke Education and Prevention.—Community awareness of thesigns and symptoms of stroke can lead to early intervention andlife-saving emergency treatment. In addition, education about theimportance of healthy eating, weight management, tobacco cessation, physical activity training, stress management, and controlling diabetes and high blood pressure can help prevent stroke andother cardiovascular complications. Awareness and education, bothin person and online, are particularly important in low-resourced
communities, where the prevalence of stroke is significantly higher
than the national average. The Committee, therefore, urges the
NINDS to prioritize funding opportunities in high-risk, vulnerable
populations to reach communities with multiple comorbidities thatlead to stroke.
Undiagnosed Diseases Network.—The Committee recommendation includes $18,000,000 for the Undiagnosed Diseases Network,
the same as the fiscal year 2024 enacted level. The Undiagnosed
Diseases Network (UDN) builds on the success of the Undiagnosed
Diseases Program at the NIH Clinical Center, which is a nationwide network of clinicians and researchers who use basic and clinical research to uncover the underlying disease mechanisms associated with rare and undiagnosed conditions. It is estimated that approximately 25 million Americans suffer from a rare disorder. The
UDN pioneered a new personalized medicine model for helping patients who have historically been the most difficult for the medical
community to diagnose, taking advantage of cutting-edge technologies such as genomic sequencing, metabolomics and assessing
patient variants in model organisms to give clinicians new, powerful information to help understand the cause of extremely rare diseases.
Usher Syndrome.—The Committee strongly encourages NIH toenhance and prioritize Usher syndrome research at NEI. The Committee requests an update in the fiscal year 2026 congressional justification. The update should include efforts to stimulate the field
and to accelerate viable human treatment options for those with
Usher syndrome.
NATIONAL INSTITUTE ON INFECTIOUS DISEASESDMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$3,281,139,500
3,290,645,500
3,315,552,000+34,412,500+24,906,500

The report language that follows includes references to the National Institute of Allergy and Infectious Diseases (NIAID).
Antimicrobial Resistance.—The Committee includes $565,000,000
to support antimicrobial resistance research, the same as the fiscal
year 2024 enacted level. This funding supports NIAID research tocombat antimicrobial resistance (AMR) and the training of new in-

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vestigators to improve AMR research capacity as outlined in the
2020–2025 National Action Plan to Combat Antibiotic ResistantBacteria. The Committee supports the Action Plan’s goal to workwith innovators on therapeutics seeking to establish domestic and/or biomanufacturing-based supply chains, especially for small molecules.
Antimicrobial Stewardship.—The Committee is aware that antibiotic stewardship programs are a key component in preventing the
spread of antibiotic resistance in all healthcare facilities in the U.S.
and across the world. In the 2020 National Action Plan for Combating Antibiotic-Resistant Bacteria (CARB), 2020–2025, one of thefive goals was to Accelerate Basic and Applied Research and Development for New Antibiotics, Other Therapeutics, and Vaccines inorder to improve understanding of the many factors that contributeto the emergence, spread, and persistence of antibiotic resistanceand to support new strategies for preventing and mitigating infections.
Antiviral Drug Discovery Centers.—Researching and developing
new antivirals is essential for combating new viral outbreaks andpreventing them from spreading into pandemics. The Committee
supports the Antiviral Drug Discovery Centers and their mission todevelop antiviral drugs to serve as our first line of defense against
forthcoming viral outbreaks. The Committee is concerned that NIH
reported to the Comptroller General of the U.S. that future funding
for the Antiviral Drug Discovery Centers program has been eliminated. The Committee urges NIH to continue supporting the
Antiviral Drug Discovery Centers to continue the development ofantivirals to mitigate the risk of future viral outbreaks.
Lyme and Other Tick-Borne Diseases.—The Committee includes
not less than $125,000,000 for NIH research into Lyme and Other
Tick-Borne disease research, an increase of $25,000,000 over the
fiscal year 2024 enacted level. NIH is encouraged to support research to better understand the causes of tick-borne diseases, including alpha-gal syndrome and allergic or immune/inflammatory
conditions triggered by tick-borne infections, to support research on
Lyme disease and emerging tick-borne pathogens, and to support
the development of reliable diagnostics and therapies to address
this growing health concern that affects more than 476,000 Americans annually. The Committee encourages NIH to periodically review progress on activity to address tick-borne infection-triggered
chronic illnesses, such as long COVID, long Lyme, Bartonella
henselae, West Nile virus, and multiple sclerosis and to include astatus report in the fiscal year 2026 congressional justification. In
addition, the Committee encourages NIH, in consultation with CDC
and FDA, to consider the potential benefits of establishing a National Network of Academic Research and Clinical Centers of Excellence for Tick-Borne Diseases.
Microbicides.—The Committee recognizes that NIH research has
shown that microbicides and pre-exposure prophylaxis products
work to prevent HIV. The Committee supports NIH efforts to advance microbicide development efforts to produce next generation
solutions for HIV prevention.
Neglected Diseases.—The Committee acknowledges that thegrowing presence of neglected diseases, including Valley fever andother fungal diseases, across the U.S. represents a significant

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health and economic burden, and therefore strongly supports neglected disease research programs at NIAID. NIH is the world’s
single largest funder of neglected disease research and has supported the development of high-impact technologies for healthareas that receive little attention from industry. Many innovation
gaps persist, the Committees urges NIAID to prioritize research
into this area as these diseases expand across the U.S.
In addition, the Committee is aware of the increasing prevalenceof neglected tropical diseases (NTDs) in the U.S. and the staggering global burden of these threats across the globe and is encouraged by the granting of more than 11 priority review vouchers
for new NTD interventions. Considering the magnitude of the NTD
threat, the Committee requests an update in the fiscal year 2026
congressional justification on efforts to address market failures hindering antimicrobial innovation, and what efforts are needed tostimulate NTD research and development.
Regional Biocontainment Laboratories.—The Committee includes$52,000,000 for the 12 regional biocontainment laboratories (RBLs)
to support resources for biosafety level 3 lab containment and resources within the RBL space that promote medical countermeasure development and ability to contribute to NIAID Preclinical
Services. This funding supports research facilities and personnel tobe prepared for any national or regional need related to research
on an emerging biodefense or infectious disease. Of this amount,
the Committee directs that no less than $3,500,000 shall be provided to each of the 12 RBLs for any of the following activities: (1)investments in the research workforce, (2) maintenance or improvement of facilities, or (3) to purchase, service, or maintain equipment, or (4) developing and contributing to an organizational structure to ensure the RBL network is prepared to respond effectively
to national needs. The Committee directs that the remaining funding shall be available for competitive awards for the RBLs and/or
participation in NIAID Preclinical Services, a collection of preclinical resources to support the development of medical countermeasures intended for use in the investigation, control, prevention,and treatment of a wide range of infectious agents.
Swine Resource and Research Centers.—The Committee recognizes the biomedical advances made utilizing swine models ofhuman health and disease and supports the efforts of the swine research centers. These centers support innovative basic andtranslational research on human diseases.
Universal Influenza Vaccine.—The Committee includes no lessthan $270,000,000, the same as the fiscal year 2024 level, for thisactivity. NIAID’s influenza research program is working to develop
a universal flu vaccine, or a vaccine that provides robust, long-lasting protection against multiple subtypes of flu, rather than a selectfew. Such vaccines would provide protection against zoonotic flu
and eliminate the need to update the seasonal flu vaccine eachyear. Universal flu vaccine research includes the improvement of
current vaccines and could provide important foundational work inoutbreak responses. In February 2018, NIAID released its Universal Influenza Vaccine Strategic Plan, which focuses on 3 research areas to broaden knowledge around basic influenza immunity and advance translational research efforts to drive universal
flu vaccine development.

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NATIONAL INSTITUTE ON THE IMMUNE SYSTEM AND ARTHRITISAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$3,281,139,500
3,290,645,500
3,315,552,000+34,412,500+24,906,500

The report language that follows includes references to the National Institute of Allergy and Infectious Diseases (NIAID).
Celiac Disease.—The Committee commends the NIH for issuinga Notice of Special Interest to spur additional research on the
study of celiac disease. Today, the only known treatment for thisdisease is a gluten-free diet; however, recent public and private sector research confirms that such a ‘‘treatment’’ is insufficient for
many who suffer from celiac disease. Therefore, the Committee
supports focused research on the study of celiac disease and encourages the newly created NIH Office of Autoimmune Disease Research (OADR) to work with NIAID and other NIH Institutes to:support new research on celiac disease; to better coordinate existing research; and to focus new research efforts toward causation,
diagnosis, management, treatment, and, ultimately, a cure of thisdisease. The Committee requests NIH to include updates on research, projects, and programs in the fiscal year 2026 congressional
justification for celiac disease.
Consortium for Food Allergy Research.—The Committee recognizes the serious issue of food allergies which affect approximately
8 percent of children and 10 percent of adults in the U.S. The Committee commends the ongoing work of NIAID in supporting a totalof 24 clinical sites for this research, including 7 sites as part of theConsortium of Food Allergy Research (CoFAR). The Committee includes $12,100,000, the same as the fiscal year 2024 enacted level,
for CoFAR to maintain its clinical research network of centers of
excellence in food allergy clinical care and expertise in food allergy
research.
Diagnostics for Primary Immunodeficiency Disease/Inborn Errorsof Immunity.—The Committee recognizes the multiple challenges
that impede access to a timely and accurate diagnosis of primary
immunodeficiency disease/inborn errors of immunity (PID/IEI).
These include needing to improve the interpretation of genetic tests
and the need for identification of biomarkers and other diagnostic
tools to both identify forms of PI and to inform targeted treatments. The Committee urges NIAID to convene a scientific workshop on this topic to identify a research strategy to improve
diagnostics of PID/IEI.
NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES

DMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$4,405,427,000
4,439,831,000
4,451,630,000+46,203,000+11,799,000

The Committee recommendation includes $3,039,148,000 in discretionary appropriations and $1,412,482,000 in PHS Act section
241 evaluation set aside transfers. The report language that follows
includes references to the National Institute of General Medical

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Sciences (NIGMS), the National Human Genome Research Institute (NHGRI), and the National Library of Medicine (NLM).
Biomedical Research Workforce Training.—Training programs at
the NIH provide a quality standard of training for graduate students and postdoctoral fellows in biomedical research. The training
grants that support these programs at research institutions acrossthe country play a vital role in establishing a biomedical researchecosystem and train the next generation of researchers for healthrelated research needs. Despite the success of training programs,
the number of students and postdoctoral scholars supported on
training grants has remained constant over the years. The Committee applauds NIH efforts to increase funding for institutional
development awards (IDeA) States and urges the NIH to also emphasize the importance of supporting training grants in IDeA
states. The Committee directs the NIH to provide a portfolio analysis to the Committee within 60 days of enactment of this Act on
the distribution of T32 training grants among States, including
number of applicants and success rates per State to ensure NIH is
supporting capacity building and a diverse workforce for the future
biomedical research enterprise. In addition to the portfolio analysis,in the fiscal year 2026 congressional justification, NIH is instructedto provide an update on specific actions NIH will take to identify
and remove barriers for applying for training grants in IDeA
States.
Epitranscriptomics Database Standards.—The Committee recognizes the recent release of a NASEM report titled ‘‘Charting a Future for Sequencing RNA and Its Modifications’’ in March 2024.
The Committee notes the report’s recommendation that clear andconsistent standards for data and databases need to be establishedto facilitate data access and sharing. Given that NLM’s National
Center for Biotechnology Information (NCBI) collaborates with thescientific community to support development of standards for databases and biological nomenclature, among other responsibilities,
the Committee urges NCBI to establish data and database standards for epitranscriptomics in collaboration with the scientific community, consistent with the NASEM report recommendation, andinclude an update on this effort in the fiscal year 2026 congressional justification.
Experimental Research.—The Committee recognizes the successof the NIGMS Maximizing Investigators’ Research Award programand encourages the NIH to continue working to expand similar experimental research opportunities to other institutes.
Health Science Analytics.—The Committee supports efforts to address cutting-edge issues at the interface of artificial intelligenceand big data. The Committee supports research that improves
health data security and analyzes claims data to determine wherecare and outcomes can be improved.
Pharmacogenomic
Research.—NHGRI
supports
pharmacogenomic research and programs in a variety of ways including by working to develop community resources. The programsupports a pharmacogenomics knowledge resource that provides
clinical information such as clinical guidelines and drug labels, potentially clinically actionable gene-drug associations, and genotypephenotype relationships, to scientific and healthcare professionals,
which in part informs the work of the clinical pharmacogenetics

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implementation consortium to develop practice guidelines forpharmacogenomics use in clinical care. The Committee encourages
NIH to continue to support this research and similar programs.
Proteomics.—The Committee recognizes the promise of research
into the proteome in the study of biological systems. The ability toanalyze protein patterns and their changes effectively and efficiently over time has potential to provide valuable insights into aperson’s real-time state of health including identifying existing disease, understanding the biological drivers of that disease, predicting near-term health events, and guiding effective therapeuticinterventions. The Committee is encouraged by the value being
demonstrated in population proteomics research but is concernedthat the U.S. is not matching the significant investment being
made by other nations. The Committee urges NHGRI to utilize existing resources to engage with academia and U.S. industry partners and laboratories to expand its research and advance American
leadership in this cutting-edge field.
Institutional Development Awards
The Committee provides $445,956,000 for IDeA, $15,000,000
above the fiscal year 2024 enacted level. The IDeA program increases our Nation’s biomedical research capability by improving
research capacity in States that have historically had lower levels
of NIH biomedical research funding. IDeA supports competitive
basic, clinical, and translational research, faculty development, andinfrastructure improvements. The IDeA program aims to strengthen states’ and institutions’ abilities to support biomedical research,enhance the competitiveness of investigators in securing researchfunding, and enable clinical and translational research that addresses the needs of medically underserved communities.
NATIONAL INSTITUTE FOR DISABILITY RELATED RESEARCH

DMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$2,293,411,000
2,302,344,000
2,317,464,000+24,053,000+15,120,000

The report language that follows includes references to the Eunice Kennedy Shriver National Institute of Child Health andHuman Development (NICHD) and the National Institute on Deafness and Other Communication Disorders (NIDCD).
Centers of Excellence to Reduce Maternal Morbidity and Mortality.—The Committee is aware that NICHD’s current Maternal
Health Research Centers provide a platform to further both research and clinical care in battling maternal morbidity and mortality. However, the Committee remains concerned that too few
Centers exist in areas of the country that see the highest rate of
both. Therefore, the Committee encourages NICHD to expand its
current Centers of Excellence with a particular emphasis on establishing new ones in regions of greatest need.
Cerebral Palsy.—The Committee encourages NIH to continue toprioritize and invest in research on Cerebral Palsy (CP) to significantly strengthen and accelerate CP research priorities across thelifespan. The Committee encourages NIH to focus on basic andtranslational discoveries, as well as implementation, observational,

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and clinical studies aimed at early detection and intervention, comparative effectiveness, functional outcomes, and mental health.
Endometriosis.—The Committee urges NICHD to continue expanding basic, clinical, and translational research into the mechanisms of endometriosis, including root causes of the disease andnew treatment methods. The Committee encourages research on
the genetic and immune system components of endometriosis. The
Committee further encourages NIH to devote more resources tosupport targeted research of endocrine disrupting chemicals inendometriosis, the relationship of endometriosis and cancer, prenatal, and epigenetic influences on the risk for endometriosis. The
Committee also encourages research on non-invasive diagnostics ofendometriosis to reduce diagnosis delay and improve treatment.
The Committee encourages research on the growth of endometriosis
and endometriosis recurrence post-surgical procedures. The Committee further encourages NIH to devote additional resources tosupport targeted endometriosis research on the role of endocrinedisrupting chemicals, the relationship of endometriosis and cancer,
prenatal and epigenetic influences on the risk for endometriosis,
and in developing new and innovative treatment methods andtherapeutics.
Impact of Technology and Digital Media Use Among Infants,
Children, and Teens.—The Committee remains concerned about the
impacts of technology use and media consumption on infant, child,and adolescent development. The Committee appreciates NIH’s ongoing engagement on this important topic and urges expanded support for research into the cognitive, physical, and mental health impacts of young people’s use of technologies as well as long-term developmental effects on children’s social, communication, and creative skills. The Committee also encourages NIH to study the repercussions of increased use of digital media and technologies onsuicidal thoughts and ideation among children. The Committee
asks NIH to consider different forms of digital media and technologies including mobile devices, smart phones, tablets, computers, and virtual reality tools, as well as social media content,
video games, and television programming.
Infertility.—The Committee remains concerned about the rate ofinfertility suffered by couples trying to conceive. In the U.S., 1 in
4 women of reproductive age have difficulty getting pregnant or
carrying a pregnancy to term. The Committee urges NICHD to research female reproductive conditions, specifically adenomyosis,
uterine fibroids, endometriosis, polycystic ovary syndrome, and interstitial cystitis. This research could include diagnostic testing,causes of the conditions, and treatment options, especially nonpharmacological intervention. Since there is a gap in the knowledge of how to diagnose and treat male infertility, the Committee
also urges NICHD to continue to support research on male mechanisms of infertility.
Learning Disabilities Research Centers and Learning Disabilities
Innovation Hubs.—The Committee is increasingly concerned withthe decline in achievement for students with disabilities and recognizes the need for continued research and improved interventions.
The Committee recognizes the importance of NICHD’s funding of
Learning Disabilities Research Centers and Learning Disabilities
Innovation Hubs, which are the only source of Federal funding

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available to researchers interested in exploring child development
and learning disabilities to conduct randomized control trials andexplore the relationships between different variables at work.
While learning disabilities do influence an individual’s education
and academic achievement, these disorders are brain-based and soclinical research using the latest technology and advances in neuroscience is essential.
Maternal-Fetal Medicine Units Network.—The Maternal-Fetal
Medicine Units Network is a network of 12 centers across the country that conduct clinical studies to improve maternal, fetal, andneonatal health that ultimately improves the clinical practice of obstetrics. Broadly, 24 of 27 institutes and centers at NIH support at
least one grant or project related to pregnancy which will further
improve maternal and infant health outcomes and address maternal mortality. The Committee commends the work of the maternalfetal medicine units and supports robust funding for this activity.
Pelvic Organ Prolapse.—Pelvic Organ Prolapse (POP) occurs
when the pelvic floor muscles and connective tissue supporting thepelvic organs fail, causing one or more of the pelvic organs to fall
downward, protruding out of the body. POP is a common problem,with one out of eight women undergoing surgery for prolapse atsome point in their life. Symptomatic POP is associated with urinary incontinence, depression, anxiety, sleep disturbance, deteriorating physical function, and diminished socialization. The Committee encourages the NICHD to convene a workshop to design
prospective studies that can be added on to existing maternal-morbidity research, including research studies being conducted in underserved areas, to assess preventative strategies for POP, including ways to decrease pelvic floor trauma or denervation during delivery, with the goal of reducing the risk of subsequent POP and
its complications. The Committee requests an update on this workshop and on research activities to advance POP prevention andtreatment in the fiscal year 2026 congressional justification.
Population Research.—The Committee has consistently commended NICHD for supporting prospective, population representative longitudinal studies, including the Panel Study of Income Dynamics Child Development Supplement, Future of Families andChild Wellbeing Study, and National Longitudinal Survey ofYouth. Data from these studies are public goods used widely to inform research and training activities conducted by thousands of scientists at universities nationwide, including underserved institutions, and are heavily used by new and early-stage investigators.
In addition, these studies are the only nationally representative
data scientists may use to analyze, for example, how parental andgrandparental characteristics affect children’s outcomes and theimpact of adverse childhood experiences over the life course. The
Committee is concerned to learn that NICHD is proposing dramatic
funding reductions to these surveys, which will result in the permanent loss of invaluable data that could be used to assess andtrack long-term health and wellbeing outcomes in infants, children,
and adolescents. NICHD is strongly encouraged to prioritize funding for these surveys. The Committee requests an update on this
topic in the fiscal year 2026 congressional justification.
Pregnant and Lactating Women.—The Committee remains concerned about the lack of pregnant and lactating women in clinical

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research. Women with chronic health conditions lack access to appropriate treatments during pregnancy, putting both them andtheir infants at risk. Despite 90 percent of pregnant women taking
prescription medication, only 5 percent of medications have data on
the impact of the medications during pregnancy. The Committee
urges NICHD to conduct priority research projects on existing
medications and therapeutics prescribed to pregnant and lactating
women. NICHD is urged to prioritize research applications in thefollowing areas as it relates to pregnant and lactating women: an
unmet medical need or gap in treatment, severity and prevalenceof a specific disease or condition, and cost and availability of treatment or alternate treatments. The Committee requests an updatein the fiscal year 2026 congressional justification on this effort.
Severe Maternal Morbidity.—The Committee is concerned that
despite the high rate of severe maternal morbidity for all pregnancy outcomes (live birth, stillbirth, spontaneous abortion, induced abortion, ectopic pregnancy, and molar pregnancy) in the
U.S., there is not a uniform definition of severe maternal morbidity. Having a uniform definition would help Federal, State andlocal agencies and research institutions establish standardized andinteroperable processes for billing, surveillance, data collection, andresearch. The collected data could then inform the development
and deployment of targeted, evidence-based prevention and treatment programs to reduce the incidence of severe maternal morbidity for all pregnancy outcomes (live birth, stillbirth, spontaneousabortion, induced abortion, ectopic pregnancy, and molar pregnancy). The Committee encourages the Eunice Kennedy Shriver
National Institute of Child Health and Human Development tohold a formal convening of subject matter experts and organizational representatives, including representatives from the Centers
for Disease Control and Prevention, Health Resources and Services
Administration, National Institutes of Health, Eunice Kennedy
Shriver National Institute of Child Health and Human Development, the Office of the National Coordinator for Health Information Technology, the Food and Drug Administration, and public
stakeholders, to determine a uniform definition of severe maternal
morbidity for all pregnancy outcomes (live birth, stillbirth, spontaneous abortion, induced abortion, ectopic pregnancy, and molar
pregnancy). The Committee requests NICHD provide a report in
the fiscal year 2026 congressional justification on the proceedingsof the convening, including a formal definition for ‘‘severe maternal
morbidity’’ for all pregnancy outcomes (live birth, spontaneousabortion, induced abortion, ectopic pregnancy, and molar pregnancy).
Spasmodic Dysphonia or Laryngeal Dystonia.—The Committee
notes the research NIDCD continues to facilitate on spasmodic
dysphonia and collaborative efforts with relevant institutes andcenters and other stakeholders. The Committee continues to encourage sustained collaboration with key stakeholders and agencies.

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NATIONAL INSTITUTE ON DEMENTIA

DMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$4,507,623,000
4,425,295,000
4,604,899,000+97,276,000+179,604,000

The report language that follows includes references to the National Institute on Aging (NIA).
Alzheimer’s Disease and Alzheimer’s Disease-Related Dementias(AD/ADRD).—The Committee includes an increase of $100,000,000
above the fiscal year 2024 enacted level for AD/ADRD researchacross NIH, split evenly between the National Institute on Dementia and the National Institute on Neuroscience and Brain Research.
Digital Innovation for Aging in Place.—The Committee strongly
encourages NIA to fund research that designs and develops digital
innovations that improve health and medical treatment. Such efforts could include establishing a smart living environment
leveraging technologies to improve health and medical treatment,
equipping homes to enable varying levels of remote care and improved diagnosis and treatment, and encouraging medical facilities
to adopt health technologies, including artificial intelligence andmachine learning, to expand to the home space enabling older
adults to age in place.
Geroscience Research.—Recent advances in geroscience suggest it
may be possible to prevent or treat a wide range of adult-onset
health concerns, including functional declines such as frailty andlost resilience, and overt diseases such as Alzheimer’s disease, cancer, cardiovascular diseases and many others. This could beachieved by slowing or reversing certain genetic, molecular and cellular hallmarks of aging discovered through research on the basic
biology of aging. The Committee strongly encourages NIA toprioritize funding for geroscience research. The Committee also understands that the enormous promise of this field is limited by ashortage of investigators with expertise in the biology of aging andthe clinical translation of basic research findings. Therefore, theCommittee encourages increased support for early career investigators, especially postdoctoral researchers and junior faculty, to help
attract, retain, and develop top talent in the field of geroscience. Finally, the Committee encourages NIA to increase funding for basic
and translational research in aging to provide more options andtest more treatments as quickly as possible.
Project Expanding Capacity for Health Outcomes.—The Committee supports efforts to implement section 330N of the PHS Act
to continue the use of technology-enabled collaborative learningand capacity building models and to expand, create, and support
dementia expanding capacity for health outcomes (ECHO) hubs.
These innovative education models, often referred to as Project
ECHO, use a hub-and-spoke approach by linking expert specialist
teams at a ‘‘hub’’ with the ‘‘spokes’’ of health providers in local communities to increase on-the-ground expertise. Using case-basedlearning, Project ECHO models can improve the capacity of providers, especially those in rural and underserved areas, on how tobest meet the needs of people living with many chronic conditions,
including Alzheimer’s and other dementias.

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NATIONAL INSTITUTE ON SUBSTANCE USE

DMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$2,258,013,000
2,267,246,000
2,281,695,000+23,682,000+14,449,000

The report language that follows includes references to the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the
National Institute on Drug Abuse (NIDA).
Cocaine Overdose Reversal Antidote.—The Committee is aware of
NIH’s investment into countermeasures for overdoses attributed toother stimulants such as cocaine. The Committee remains supportive of NIDA funding targeting the surge in overdose deaths involving cocaine and is aware of the current lack of FDA approved
cocaine overdose reversal medications to address the increase in fatalities. The Committee understands there is ongoing research anddevelopment of treatments, which the NIH contributes, which can
rapidly reverse cocaine toxicity and reduce mortality rates. Therefore, the Committee urges NIDA to continue to prioritize and fundresearch to advance a life-saving treatment for overdoses caused bycocaine.
Fetal Alcohol Spectrum Disorders.—The Committee supports
NIAAA’s efforts to accelerate fetal alcohol spectrum disorders(FASD) basic, prevention, diagnosis, and treatment research. The
Committee encourages NIAAA to continue efforts to support innovative research and to disseminate research findings to the public
to inform the efforts of States, Tribes, and provider and nonprofit
organizations in increasing FASD diagnostic capacity, enhancing
FASD prevention programs, developing resources for systems ofcare, and training services providers and professionals.
Marijuana Research.—The Committee is concerned that development of a drug-impairment standard for marijuana remains unlikely in the near-term and encourages NIH to continue supportinga full range of research on the health effects of marijuana and its
components, including research to understand how marijuana policies affect public health issues such as drug-impaired driving. The
Committee is aware that the majority of Federal research has been
limited to marijuana from a single source and encourages NIH toundertake research that strives to encompass the diversity, quality,and potency of commonly available cannabis strains within the current constraints of law. Additionally, the Committee continues tosupport the development of an objective standard to measure marijuana impairment and a related objective field sobriety test to ensure highway safety.
Methamphetamines and Other Stimulants.—The Committee isconcerned that, according to predicted provisional data released by
CDC, over 26,000 overdose deaths involved cocaine and over 33,000
involved drugs in the category that includes methamphetamine in
the 12-month period ending in August 2022, an increase of 35 and
50 percent respectively in just two years. The sharp increase has
led some to refer to stimulant overdoses as the ‘‘fourth wave’’ of thecurrent drug addiction crisis in America following the rise of opioidrelated deaths involving prescription opioids, heroin, and fentanylrelated substances. No FDA approved medications are available fortreating methamphetamine, cocaine, and other stimulant use dis-

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104
orders. The Committee continues to support NIDA’s efforts to address the opioid crisis, has provided continued funding for the
Helping to End Addiction Long-term (HEAL) Initiative, and supports NIDA’s efforts to combat the growing problem of
methamphetamines and other stimulant use disorders and related
deaths.
Opioid Initiative.—The Committee continues to be concerned
about the high mortality rate due to the overdose epidemic and appreciates the important role that research plays in the various Federal initiatives aimed at this crisis. Approximately 295 people dieeach day in this country from drug overdose (over 220 of those are
directly from opioids), making it one of the most common causes of
non-disease-related deaths for adolescents and young adults. The
Committee is also aware of increases in opioid deaths from 2020 to2021, with the primary driver being the increased overdose deaths
involving synthetic opioids, primarily fentanyl. More research isneeded to find new and better agents to prevent or reverse the effects caused by this class of chemicals and to provide improved access to treatments for those with addiction to these drugs. To combat this crisis, the Committee has provided within NIDA’s budget
no less than the fiscal year 2024 enacted level for the institute’s
management of its share of the HEAL Initiative and in response
to rising rates of stimulant use and overdose. The Committee encourages NIDA to support research on the development of safe andeffective medications and new formulations to treat substance use
disorders and prevent or reverse overdose, and to support researchon comprehensive care models in communities nationwide to prevent opioid misuse, expand treatment capacity, enhance access to
overdose reversal medications, and enhance prescriber practice;
test interventions in justice system settings to expand the uptakeof medications for opioid use diorder and methods to scale up theseinterventions; and develop evidence based strategies to integrate
screening and treatment for opioid use disorders in emergency department and primary care settings. The Committee has included
language expanding the allowable use of these funds to include research related to stimulant use and addiction. Recognizing the increasing severity of the national opioid crisis and the need to betterour options for responding to, treating, and preventing overdoses,
the Committee encourages NIDA to prioritize research to expedite
treatments for and prevention of overdose from fentanyl and related analogs.
Pain Management and Addiction.—The Committee urges NIDA
to continue and expand efforts to educate physicians and othermedical professionals on safe prescribing for pain and managing
patients who misuse prescription opioids, as well as best practices
for incorporating substance misuse and addiction screening andtreatment into their clinical practices.
Raising Awareness and Engaging the Medical Community in
Drug Misuse and Addiction Prevention and Treatment.—Education
is a critical component of any effort to curb drug use and addiction,and it must target every segment of society, including healthcare
providers (doctors, nurses, dentists, and pharmacists), patients,and families. Medical professionals must be in the forefront of efforts to curb the opioid crisis. The Committee continues to bepleased with the NIDAMED initiative, targeting physicians-in-

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training, including medical students and resident physicians in primary care specialties (e.g., internal medicine, family practice, emergency medicine, and pediatrics). The Committee urges NIDA tocontinue its efforts in this area, providing physicians and othermedical professionals with the tools and skills needed to incorporate substance use and misuse screening and treatment into
their clinical practices.
Wastewater Drug Testing.—The Committee supports NIH’s National Institute on Drug Abuse (NIDA) research of testing wastewater to detect and understand trends in drug substances. Wastewater-based drug testing is a technique where wastewater samples
are taken from the sewer system and tested for specific targets.
Wastewater-based testing is intended to be complementary to othermore traditional methods of monitoring drug use patterns, with thepotential to detect such patterns near real time and in hard-toreach populations. The Committee recognizes that wastewater drug
testing can be proactive and may allow agencies and related stakeholders to respond appropriately when spikes or new trends are
identified in certain areas or of particular drugs. The Committee
encourages NIDA to report data collection and analysis of trends
and drugs from this research so that the field can improved andvalidate wastewater testing methods, and ultimately enable local
governments to target support and reduce overdose deaths.
NATIONAL INSTITUTE OF MENTAL HEALTH

DMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$2,187,843,000
2,503,162,000
2,210,789,000+22,946,000¥292,373,000

Autism Spectrum Disorder.—The Committee strongly encourages
NIH to support greater investment in research related to autism,
particularly in areas outlined in the Interagency Autism Coordinating Committee (IACC) Strategic Plan for Autism Spectrum Disorder (ASD). The Committee requests the National Institute of
Mental Health (NIMH) partner with other Institutes that serve on
the IACC to provide an update in the fiscal year 2026 congressional
justification on the level of research investment of each of the priority areas outlined in the IACC Strategic Plan for ASD. Progresshas been made in understanding autism, but there is more to do
to improve outcomes and access to services for people with autism
throughout their lifetime. Research has shown that autistic individuals have higher rates of some co-occurring physical and mental
health conditions, which can affect quality of life and increase useof medical services and costs. There are also unaddressed racial,ethnic, and socioeconomic health challenges that autistic individuals and their families experience. The Committee encourages
NIMH to collaborate with NIMHD to support research on such
health disparities associated with autism spectrum disorder, and tocollaborate with other institutes, including NIA, NIEHS and
NINDS, to support research on understanding the impact of socialand environmental factors leading to such co-occurring health conditions.
Impact of Social Media Use on Child and Adolescent Mental
Health.—The Committee remains concerned about the impacts of

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106
social and digital media on youth mental health and developmentof mental health-related challenges. The Committee appreciates
NIH’s ongoing engagement on this important topic and encourages
NIMH to prioritize research into the behavioral and psychosocial
impacts of young people’s use of social media including its impact
on developing or worsening signs of suicidality, anxiety, depression,
disordered eating, sleep disorders, and isolation.
Mental Health Research.—The Committee supports the highquality basic research on serious mental illnesses being conducted
at NIMH. The Committee requests an update in the fiscal year
2026 congressional justification on the funding allocations at NIMH
detailing the percentage of funds spent on basic, translational, andclinical research.
Peer Support for Youth.—The Committee understands that many
youths who are struggling with their mental health seek out peer
support services, often because they are not ready to engage or do
not have access to clinical health care. But while numerous studies
have shown that peer support increases help-seeking behavior andreduces social isolation in adults, research on youth peer support
services and peer-to-peer counseling programs is limited. Therefore,
the Committee encourages NIMH to prioritize research in theseareas, including how to scale up such services and programs effectively. In addition, the Committee encourages NIMH to continue toregularly hear from young people to inform its future research priorities through its Advisory Council, strategic planning process,focus groups or similar leadership methods. The Committee supports the agency’s youth-informed activities and encourages additional efforts to grow youth engagement in setting its research priorities.
Physician Suicide.—The Committee notes that physician suicide
rates are on a rise and the COVID pandemic has only exacerbatedthe spike in suicide rates throughout the nation. The Committee
acknowledges the need to provide resources to help identify andsupport at-risk physicians, respond to suicide risk, and respondcompassionately and effectively on the organizational level after
suicide occurs. The Committee encourages the institute to workwith key stakeholders to support research and resource development aimed at understanding this connection and opportunities forinnovative discovery.
Reducing Mental Health Disparities in Youth.—The Committee
notes with alarm new CDC data on depression and trauma among
adolescents and acknowledges the NIMH strategic framework foraddressing mental health among underserved and underrepresented youth, including those in rural communities, by 2031. The
Committee recognizes ongoing collaborative work with NICHD and
NIMHD to execute this framework through research, workforce development, and stakeholder engagement. The rise in youth mental
health issues will not be resolved without significant new investments in research to guide recovery.
Study on the Cost of Serious Mental Illness.—The Committee directs NIH to conduct a thorough study of the cost impact of serious
mental illnesses in the U.S. This study shall take a multi-systemic
approach examining the fiscal implications of untreated or poorly
managed schizophrenia and other severe mental illnesses on thehealth care system, criminal courts, penal facilities including coun-

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ty jails, housing programs, and nursing facilities. The Committee
encourages NIH to collaborate or consult outside entities with experience in serious mental illness and conduct extensive studies ofgovernment and nongovernmental entities.
Suicide Prevention.—Suicide is complex, and multiple factors—
biological, psychological, social, and environmental—play a role.
The Committee encourages NIMH to provide additional attention
to suicide prevention research across all of these areas, as well as
the application of novel measurement techniques, statistical analysis, digital initiatives, and information systems. The Committee
also encourages NIMH to promote greater collaboration with other
NIH institutes and centers with expertise in research areas thatcan contribute to suicide prevention, especially NIA, NICHD,NHGRI, NIAAA and NIDA.
NATIONAL INSTITUTE ON HEALTH SCIENCES RESEARCH

DMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$1,911,613,000
1,908,073,000
1,931,662,000+20,049,000+23,589,000

The report language that follows includes references to the National Institute of Environmental Health Sciences (NIEHS), theNational Institute on Minority Health and Health Disparities(NIMHD), the National Center for Complementary and Integrative
Health (NCCIH), the National Institute of Nursing Research(NINR), and the John E. Fogarty International Center (FIC).
Alopecia Areata.—The Committees notes the disproportionate effect of alopecia areata on people of color, specifically women. The
Committee requests an update in the fiscal year 2026 congressional
justification on collaborative efforts between NIAMS and other relevant NIH institutes and centers and stakeholders in identifying
key research areas of concern.
Disparities in Digital Health Readiness.—The COVID pandemic
facilitated unprecedented growth in the use of telehealth, but not
all populations benefited equally. For some individuals and communities, barriers include factors such as trust, acceptance, relevanceof telehealth as a means of receiving care. Overcoming such barriers is essential to promoting equitable access to and uptake ofhealth care. Therefore, the Committee urges NIMHD to support
funding opportunities that are focused on identifying digital healthbarriers and developing individually tailored approaches to addressing them.
Improving Native American Cancer Outcomes.—The Committee
continues to be concerned that Native Americans experience overallcancer incidence and mortality rates that are strikingly higher
than non-Native populations. The Committee includes $15,000,000,
which is an increase of $9,000,000 above the fiscal year 2024 enacted level, to continue an initiative for Improving Native American Cancer Outcomes to support efforts including research, education, outreach, and clinical access related to cancer in Native
American populations. The Committee further directs NIMHD towork with NCI to locate this initiative at an NCI-designated cancer
center demonstrating partnerships with Indian Tribes and Tribalorganizations to improve the screening, diagnosis, and treatment of

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108
cancers among Native Americans, particularly those living in ruralcommunities.
Interagency Coordinating Committee on the Validation of Alternative Methods (ICCVAM).—ICCVAM is a committee of NIEHS
under the National Toxicology Program Interagency Center for the
Evaluation of Alternative Toxicology Methods (NICEATM). The primary mission of ICCVAM is to coordinate Federal agency collaboration of new, revised, and alternative test methods, including the development of non-animal testing methods. The Committee urges robust support for ICCVAM and NICEAM to facilitate inter-agency
efforts on the development and utilization of non-animal testing
methods, and to reduce, refine, and replace animal use in Federal
research when feasible.
Microplastics.—The Committee recommends that NIH review
primary chemicals in the life cycle analysis of plastic materials thatare negatively impacting the environment and human health. The
Committee urges NIH to research the presence of microplastics andnanoplastics in the human body, including in organs and biospecimens and how such presence impacts human health.
Multiple Chronic Disease Research Centers.—The Committee isaware and strongly supports the regional chronic disease centersestablished by NIMHD. To further the promotion of their mission,
the Committee encourages NIMHD to establish a disseminationand implementation hub, where investigators could obtain expert
guidance on pragmatic trial design, and dissemination and implementation frameworks to assist in evaluating promising interventions in reducing chronic disease disparities. The Committee
strongly urges NIMHD to establish a hub at one of the regional
chronic disease centers aimed at reducing disparities in diabetes
and hypertension.
Native Hawaiian/Pacific Islander Health Research Office.—The
Committee provides $5,000,000, which is an increase of $1,000,000
above the fiscal year 2024 enacted level, for the Native Hawaiian/
Pacific Islander Health Research Office (NHPIHRO) with a focus
on both addressing Native Hawaiian and Pacific Islander (NHPI)
health disparities, as well as supporting the pathway and researchof NHPI investigators. The Committee encourages NHPIHRO todevelop partnerships with academic institutions with a proventrack record of working closely with NHPI communities and NHPIserving organizations located in states with significant NHPI populations to support the development of future researchers from thesesame communities.
Obstetric Fistula Research.—The Committee notes that an estimated 500,000 women and girls worldwide live with obstetric fistula—with thousands of additional cases occurring annually. Obstetric fistula occurs disproportionately among impoverished, vulnerable, and marginalized women and girls. It can be prevented byskilled health personnel at birth and emergency obstetric and newborn care. The Committee is concerned that fistula repairs were
widely halted or slowed down due to COVID, as they were deemed
non-urgent and unsafe during the pandemic. This may have resulted in an increased backlog of fistula cases. The Committee requests a report in the fiscal year 2026 congressional justification on
the annual funding level for this training over the preceding 5 fis-

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109
cal years, including the types of grants supported during this period.
Primary Care Research.—The Center for Primary Care Research
conducts vital studies that can lead to significant improvements in
how primary care is delivered and financed. By focusing on innovative care models, the integration of technology, and the development of a resilient and well-supported primary care workforce, thisresearch aims to transform primary care into a more patient-centered, efficient, and equitable component of the healthcare system.
Investing in primary care research is not only an investment in thehealth of individuals but also in the overall well-being and economic stability of communities nationwide. Enhanced primary careservices lead to better health outcomes, reduced healthcare costs,
and decreased hospitalizations and emergency department visits.
Research Endowment Program.—The Committee includes$12,000,000 for the Research Endowment Program, the same as
the fiscal year 2024 enacted level. The Committee is pleased with
NIMHD’s reinvigoration of the Research Endowment Program andhas continued funding for fiscal year 2025. The Committee supports effort that seek to supplement the funding available to existing grantees and continue to expand the number of statutorily eligible institutions receiving grants through a competitive process.
Research Centers at Minority Institutions (RCMI) Program.—The
Committee notes that NIMHD’s budget has experienced significant
growth during the last decade but funding for the RCMI program
has not kept pace despite being a flagship program. The Committee
urges NIMHD to revisit its policies related to growth in the RCMI
program.
State Wide Surgical Quality Collaboratives.—The Committee isaware that several States have moved to combine the knowledge,
skills, and resources of diverse hospitals across the State with theexpertise of foundations, hospitals associations, and other outside
stakeholders to identify and disseminate best practices in surgicalcare. The goals of these collaboratives are to improve surgical outcomes, improve the value of surgical care, and decrease disparities
in care. The Committee urges NIH to support States’ developmentof such collaborations including their expansion to include more
hospitals, telehealth, and mobile solutions in higher-value care.
Wildfire Smoke Health Research.—The lack of data about thehealth impacts of wildland fire smoke and wildfire management
strategies is a major gap in our firefighting arsenal. The Committee encourages NIEHS to help fill this gap by pursuing research
to evaluate smoke health impacts for communities experiencing different times of wildfire and to develop datasets linking wildfire
smoke to health impacts.
John E. Fogarty International Center
The Committee includes $95,162,000 for this center, the same as
the fiscal year 2024 enacted level.

DMWilson on DSKJM0X7X2PROD with HEARINGSNATIONAL INSTITUTE ON INNOVATION AND ADVANCED RESEARCH

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

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3,590,431,000
2,568,004,000¥973,347,000¥1,022,427,000

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DMWilson on DSKJM0X7X2PROD with HEARINGS

The report language that follows includes references to the National Institute of Biomedical Imaging and Bioengineering (NIBIB),
the National Center for Advancing Translational Sciences(NCATS), and the Advanced Research Projects Agency for Health(ARPA–H).
Diagnostic Technology Development.—The Committee is pleased
with the success of the Rapid Acceleration of Diagnostics programin accelerating the innovation and commercialization of diagnostic
technologies. The Committee commends NIBIB’s initial efforts toapply the innovation funnel model beyond COVID testing to address other critical unmet needs in diagnostic testing and encourages NIBIB to continue these efforts in fiscal year 2025 in partnership with other institutes and centers, including NICHD, NIA,NINDS, and NIMH. The Committee further requests NIBIB provide an update in the fiscal year 2026 congressional justification onthese efforts.
National Clinical Cohort Collaborative.—The Committee urges
strong support for the National Clinical Cohort Collaborative’s(N3C) open-science, privacy-preserved data-sharing platform to accelerate biomedical research and discovery. Supported by the Clinical and Translational Science Awards program, N3C combines
electronic health record data with other types of data such as imaging, mortality, and Medicare and Medicaid data from CMS to answer key research questions on a variety of diseases, with 2 diseases being piloted. The Committee supports the continuation of
N3C and encourages NCATS to coordinate with other HHS agencies to make N3C available as an underlying common real-world
data platform to drive faster discovery across a range of diseases.
The Committee encourages NCATS to formulate a public-private
strategy on the viability of N3C in the challenging diagnostic odyssey of rare disease research, to be detailed in a report to the Committee within 1 year of enactment of this Act and made available
on the agency’s website.
Rare Disease Research.—The Committee encourages NCATS toleverage the investments made in NCATS rare disease research toaccelerate the development of new treatments for the over 95 percent of 10,000+ rare diseases with no FDA approved treatment, tostrengthen the innovation of diagnostics to shorten the average 6.3
yearlong diagnostic odyssey, and to lower the nearly $1 trillion annual economic burden of rare diseases. The Committee urges
NCATS to increase its support for rare disease research.
Advanced Research Projects Agency for Health (ARPA–H)
The Committee includes $500,000,000 for this activity, which is$1,000,000,000 below the fiscal year 2024 enacted level.
ARPANET–H Network.—The Committee appreciates ARPA–H’sefforts to ensure that communities across the country have input
into and benefit from the agency’s innovations. The ARPANET–H
health innovation network brings together stakeholders from every
state from the earliest stages of program development to the transition to the private market. The Customer Experience hub facilitates input from patients, providers, and other partners to ensure
ARPA–H develops technologies that meet their needs and are accessible to all. The Investor Catalyst hub works with investors andindustry so that solutions developed by ARPA–H thrive after gov-

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111
ernment contracts have concluded. The Committee requests a report within 90 days of the date of enactment of this Act on the
ARPANET–H network, including the number of spokes and a summary of the geographic distribution and types of organizations participating, as well as descriptions of each activity held by the huband-spoke network.
Artificial Organs.—The Committee recognizes that more than
100,000 Americans across the country are on the organ transplant
waiting list, with more than four in five suffering from kidney failure requiring grueling and expensive dialysis treatments. Thoughsome can receive a transplant, 17 Americans die every day waiting
for an organ transplant, with 13 per day dying due to kidney failure. Medicare spends more than $50,000,000,000 annually managing kidney failure, which affects more than 800,000 Americans
in total. KidneyX, a public-private partnership in its 5th year focused on accelerating innovation in the diagnosis, prevention, andtreatment of kidney disease, has accelerated investment in an underfunded area of innovation, leading to a variety of promising newtechnologies in biotechnology and tissue engineering with an eye
toward the artificial kidney. Given the significant cost of kidney
failure to the Federal government, the promising state of science,and the need for better and more available organ transplant options for patients, the Committee encourages ARPA–H to prioritize
research focused on the development of artificial organs, including
kidneys, building on the progress of KidneyX.
Commercialization Network.—Speeding the translation of innovative health technologies to market is essential for the success of
ARPA–H. This acceleration depends on meaningful collaboration
between researchers, entrepreneurs, and investors across sectors
and geographic areas. The Committee supports the establishmentof the Investor Catalyst Hub in the ARPANET–H hub-and-spoke
network and appreciates its initial efforts to build a diverse, wideranging network of experts to advance innovation and commercialization of medical technologies.
Lyme and Other Tick-Borne Diseases (TBD).—The Committee
recognizes the value of and encourages ARPA–H to evaluate thepotential benefits of supporting research and development programs and projects related to TBD. Examples of potential researchand development activities may include research related to TBD
diagnostics and Bartonella unit.
MATRIX Program.—The Committee urges ARPA–H to continue
the Machine Learning/Artificial Intelligence-Aided Therapeutic
Repurposing In eXtended uses (MATRIX) project. The Committee
recognizes the impact of this program to help the 30 million Americans currently facing a rare disease through the project’s ability todetermine if a currently approved drug is suitable to use against
other rare diseases, such as Lowe syndrome, Leigh syndrome, andFabry disease.
Mental Health Research.—The Committee urges ARPA–H to support mental health research, including diagnosis and treatment ofsevere mental illness to address widespread behavioral healthissues, and to focus as well on developing treatments and cures fordementia, given the prevalence and immense burden of this diseaseon society, as well as the potential for such an investment to spurindustry developments and new academic partnerships.

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Nanovaccine Research.—The Committee recognizes the importance to invest in vaccine research at U.S. universities to improveupon existing vaccines such as room temperature stable nanovaccines that can be rapidly designed, tested, and deployed. The Committee urges ARPA–H to support funding to academic researchers
working on nanovaccines.
Retinitis Pigmentosa.—ARPA–H plays a unique role in the development of high-impact research to deliver transformative advancesin health solutions that strengthen U.S. science and technology capacity, competitiveness, and leadership. Given the significant toll
Retinitis Pigmentosa exacts on the health care system every year
and the lack of curative therapies currently available to help thesepatients, the Committee urges ARPA–H to identify and invest in
high-risk, high-reward biopharmaceutical research projects thatshow demonstrated potential to transform health care and improve
public health. The Committee requests an update from ARPA–H in
the fiscal year 2026 budget request on work related to this topic.
Clinical and Translational Science Awards
The Committee includes $629,560,000 for this activity, the sameas the fiscal year 2024 enacted level.
Cures Acceleration Network
The Committee includes $75,000,000 for this activity, the sameas the fiscal year 2024 enacted level.
OFFICE OF THE DIRECTOR

DMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$1,933,113,000
2,291,054,000
2,013,267,000+80,154,000¥277,787,000

The items below include issues and programs specific to the Office of the Director as well as those that involve multiple institutes
and centers.
ACT for Amyotrophic Lateral Sclerosis Expanded Access.—In addition encouraging more research broadly for Amyotrophic Lateral
Sclerosis (ALS), the Committee includes $75,000,000, the same as
the fiscal year 2024 enacted level, to support expanded accessgrants as authorized in the Accelerating Access to Critical Therapies for ALS Act (P.L. 117–79). The Committee continues to direct
NIH to handle this funding as separate from, not competitive with,other funding for research on ALS. The Committee encourages
NINDS and OD to continue to strengthen the expanded accessgrant application process as discussed in the joint explanatory
statement which accompanied the fiscal year 2023 consolidated appropriations Act. The Committee commends efforts by NINDS toengage stakeholders and grow the sustainability of this program.
Furthermore, after the review and award of meritorious applications under Section 2, the Committee recommends NIH apply any
unused funds to programs authorized under ACT for ALS including
Section 3 public-private research partnership and Section 5 Rare
Neurodegenerative Disease Grant Program at FDA, as well as the
NIH ALS Strategic Priorities.

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Adult Cellular Therapies.—To support collaborative evidence development, the agreement encourages HHS—in coordination with
FDA, NIH, and HRSA—to continue efforts to enhance transparency
regarding outcomes from adult (somatic) cellular therapies that are
FDA approved or being administered under FDA Investigational
New Drug or Investigational Device Exemption protocols by ensuring that results are submitted to appropriate databases such as theStem Cell Therapeutic Outcomes Database and ClinicalTrials.gov.
Advancing Gene and Cell Based Therapies.—The Committee recognizes that cell-based therapies hold promise for a broad range ofconditions, including neurological conditions, musculoskeletal conditions, cancer, radiation damage, cardiovascular disease, diabetes,
blindness, skin diseases, wound healing, and autoimmune and immune-medicated disease. The Committee supports the development
and launch of a coordinated program to support research, development, and specific activities related to manufacturing of somatic(adult) gene and cell-based therapies for patients with serious andlife-threatening conditions. Such funding could support large-scale,randomized, controlled clinical trials or other innovative clinical
trial designs exploring the use of somatic gene and cell-based
therapies for serious and life-threatening conditions; development,characterization, optimization, and scaling of manufacturing ofgene and cell-based therapies; a clinical trials network to support
sharing of best practices and lessons learned; workforce development activities; and collaborative, evidence development, including
the development and operation of an outcomes database. The Committee encourages support for cell-based therapies to be guided by
a committee of outside experts, including researchers who haveconducted multiple clinical trials involving cell-based therapies. Initial areas of focus for the program could include neurological conditions, musculoskeletal conditions, cancer, radiation damage,
immunological disease, and cardiovascular disease.
All of Us.—The Committee includes $36,000,000 from the Cures
Act for the All of Us Research program. The Committee continues
to support the work on this program to allow for continued participant enrollment from historically underrepresented populations
and to continue its efforts to enroll participants from rural communities, including pediatric enrollment.
Alternatives to Animal Testing.—The Committee supports theComplement Animal Research In Experimentation (ComplementARIE) Program, intended to spur the development, standardization
and use of new approach methodologies (NAMs) intended to moreaccurately model human biology. The Committee also encourages
NIH, in new announcements and other indications of funding opportunities, to prioritize consideration of NAMs as the preferred option for areas of preclinical research when it is not appropriate touse human participants.
Amyotrophic Lateral Sclerosis Research.—The Committee believes it is critically important that NIH continue to increase its investment in ALS research and grow the research workforce, inorder to find new treatments and a cure for the disease. Increasing
support for ALS research will benefit people living with ALS now
and those diagnosed in the future. The Committee continues tostrongly encourage NIH to increase support for research, including

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the Transforming Research Award program for ALS, that will leadto measurable changes in the lives of people with ALS.
Atopic Dermatitis.—The committee is encouraged that recent scientific breakthroughs have led to progress in patient care and thedevelopment of innovative therapies for atopic dermatitis and otherforms of eczema. The committee recognizes emerging potential in
NIH multidisciplinary research and community engagement for
atopic dermatitis to address new opportunities in a variety of collaborative areas.
Cancer Vaccines.—While much progress has been made in the
study of mRNA cancer vaccines and the mRNA vaccine platform
continues to hold potential, additional advances from ongoing research are needed to hasten the development of effective personalized cancer therapies based on mRNA technology. Findings fromthe ongoing NCI-supported research will continue to inform
progress in this promising field. The Committee urges NIH to continue to provide robust funding to support research that moves thefield forward for mRNA vaccines in cancer, collaborating closelywith academic medical centers and cancer centers. Areas of particular scientific opportunity include focus on enhancing immune
recognition of solid tumors, overcoming suppression in the tumor
microenvironment, and personalization of mRNA vaccines. Together, these strategies have high potential for increasing the effectiveness for cancer immunotherapy treatment and prevention.
Childhood Post Infectious Neuroimmune Disorders, PediatricAcute-Onset Neuropsychiatric Syndrome and Pediatric Autoimmune
Neuropsychiatric Disorders Associated with Streptococcus.—The
Committee supports efforts to advance scientific research related tothe devastating diseases of Pediatric Acute-Onset NeuropsychiatricSyndrome (PANS) & Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS). Although the NIH
has undertaken research in this area, significantly more needs tobe done. Understanding the causes, diagnosis, and treatment ofthese life-threatening diseases is essential to expedite early identification and intervention, thereby reducing the risk of chronic illness and associated costs to families, school systems, health caresystems, and insurers. PANS/PANDAS research also would further
the understanding of the critical link between neuropsychiatric illness and COVID and other infections. The Committee urges NIH
to continue to prioritize research on PANS/PANDAS and related to
autoimmune encephalitic conditions.
Crohn’s Disease.—The Committee is aware of the strategic goal
within the Strategic Plan for NIH Nutrition Research focused on
improving the use of food as medicine and is interested in how certain foods, which are prescribed to support management of a specific condition and administered under physician supervision, impact the lives of patients, for example those with digestive diseases
including Crohn’s disease and ulcerative colitis. The Committee
urges NIH to support research on the efficacy of food as medicine
strategies to treat various diseases and condition, such as Crohn’s
Disease for pediatric patients.
Collaborations with the Department of Energy.—The Committee
supports collaborations between the NIH and the Department ofEnergy (DOE) to strategically leverage NIH’s research needs incancer research, brain mapping, drug development that requires

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DOE’s high frequency imaging, supercomputing, instrumentation,materials, modeling simulation, and data science. Increased andmore effective coordination could be instrumental to assist in thedevelopment of the nation’s health, security, biomedical technologies, and in the development of more strategic enabling technologies. The Committee requests an update from NIH regarding
their current and projected collaborations with DOE, including theidentification of future opportunities for continued partnership
growth as part of the fiscal year 2026 congressional justification.
Common Data Elements.—The Committee commends the Officeof Data Science Strategy for issuing a request for information (RFI)
to stakeholders focused on development of common data elements(CDEs) and for convening a workshop on this topic. The Committee
recognizes the importance of CDEs in facilitating research activities and fostering collaboration amongst the research andhealthcare communities. Specifically, CDEs are instrumental instandardizing data collection, enhancing data quality, and enabling
more effective data sharing and analysis, particularly in complex
areas such as autoimmune and immune-mediated diseases. The
Committee encourages NIH to build upon the RFI and workshop
and to develop a plan to work with stakeholders, particularly in the
autoimmune and immune-mediate communities, to develop CDEs
and best research practices for these conditions.
Debarment Policies.—The Committee supports NIH in its ongoing work focused on changing the culture of sexual harassmentthat is pervasive throughout its biomedical research laboratories.
However, the Committee believes NIH should do more to ensurethat proven bad actors are no longer eligible for Federal funding.
In addition, the Committee is concerned that current regulations do
not allow NIH to act quickly and independently to suspend or
debar award recipients that demonstrate serious or frequent noncompliance and scientists supported through their institutions by
NIH who have engaged in serious forms of professional misconduct.
The Committee urges NIH to issue regulations implementing Executive Order 12549 and Executive Order 12689. Such regulations
would provide NIH with the authority to issue a government-wide
debarment, thereby preventing individuals or entities from participating in any government contracts, subcontracts, loans, grants,
and other assistance programs for a specified period.
Diet and Chronic Disease Research.—The Committee supports
NIH, including the Office of Nutrition Research and NIAID, formoving ahead with a scientific workshop focused on the role foodand diet play in developing mucosal immunity for conditions such
as Crohn’s disease, ulcerative colitis, and other digestive and autoimmune or immune-mediated diseases. This workshop is anticipated to provide crucial insights to inform future Inflammatory
Bowel Disease and larger diet and nutrition research and publichealth activities. The Committee urges NIH to promptly disseminate the proceedings of this workshop, particularly recommendations to inform future research funding priorities.
Dog and Cat Research.—For over half a century, Congress has
expressed concerns about the harmful use of dogs and cats in biomedical research. The Committee remains concerned about thisissue and is aware of various promising Federal initiatives in recent years to refine, reduce and replace the use of dogs and cats

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in research with alternative species and technologies. The Committee directs NIH to submit a report to the Committee no later
than 180 days of enactment of this Act that includes an explanation of NIH efforts for the reduction and replacement of the useof dogs and cats in NIH-funded intramural and extramural research classified in pain category D or E as defined by the Department of Agriculture (USDA), including objective performance
metrics to assess progress. The content of the final report shall bemade publicly available on the agency’s website.
Female Aging Research.—The Committee acknowledges the NIH
for its pioneering efforts in geroscience and underscores the importance of investigating female reproductive aging, a critical yet
understudied aspect of women’s health and longevity. For example,
aging of the female ovary occurs at a more accelerated pace compared to other tissues and organs, posing significant implications
for fertility, reproductive health, and overall well-being. This distinct aging process highlights the need for a deeper understandingof the cellular, molecular, genetic, and epigenetic factors driving
early onset of female reproductive aging. To ensure progress in thispivotal research area, the Committee encourages NIH to convene
a workshop with experts from across NIH, other relevant Federal
agencies, academic institutions, and the private sector to explore
the mechanisms that influence female reproductive aging, its impact on women’s health, and the development of strategies andinterventions to mitigate negative effects.
Focused Ultrasound.—The Committee understands focusedultrasound is a non-invasive, non-pharmacological, safe, and costeffective alternative or complement to conventional surgery, radiation therapy, or drug-based treatments. Focused ultrasound is apromising intervention for patients suffering from serious conditions like Parkinson’s disease, essential tremor, prostate cancer,
and uterine fibroids, and is currently being explored for more than
180 other indications. The Committee encourages NIH to continue
to engage with the focused ultrasound stakeholder community.
Further, the Committee encourages NIH to explore existing focusedultrasound research group and ensure research coordination acrossthe institutes and centers. The Committee requests an update in
the fiscal year 2026 congressional justification, including an NIHwide overview of the grants awarded to support focused ultrasoundresearch and research opportunities for advancing cross-cutting focused ultrasound research across the institutes and centers to benefit patients.
Firearm Injury and Mortality Prevention Research.—The Committee does not include funding for this activity.
Fragile X.—The Committee notes the importance of expanding
the base of researchers and clinicians who are familiar with andtrained in Fragile X-associated disorders and promoting collaboration between basic scientists and clinicians to enable researchers tobetter understand phenotypes, document variations in how the disorder presents itself, identify potential biomarkers and outcome
measures, and develop new interventions. The Committee commends the NIH for recognizing the ethical, legal, and social issues
in premutation screening and testing and encourages to NIH tolook at existing pilot studies that are looking at innovative ways
to screen newborns, study Fragile X across the lifespan, and coordi-

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nate efforts and research with the CDC as they look at screening
solutions for FMR1-related conditions.
Functional
Genomics
toImprove
Outcomesin
Neurodevelopmental and Neurodegenerative Diseases.—The Committee urges NIH to expand efforts in this area. Additional funding
would allow for the integration of worldwide data and discoveries
using cutting edge tools through the lens of genomics which could
accelerate the discovery of new genetic variants associated withneurodegenerative and neurodevelopmental disorders. Such discoveries are instrumental to understanding risk factors, detecting thedisease earlier, monitoring the effectiveness of clinical trials, anddefining pathways for new drug development.
Gabriella Miller Kids First Pediatric Research Program.—The
Committee includes $12,600,000 to support pediatric research as
authorized by the Gabriella Miller Kids First Research program,which is the same as the fiscal year 2024 enacted level.
Gene Expression.—The Committee notes recent precision medicine developments focused on commercialized blood/biopsy tests
that provide clinical decision support by analyzing gene expression,for example RNA, to determine disease status, identify abnormalities in drug targets, and predicting drug options. The benefits ofthis technology include the ability to stretch clinical trial resources
efficiently to address patient needs. If properly implemented during
the drug development process, the Committee acknowledges thistechnology could increases the likelihood that a drug will be approved by the FDA and that, after approval, it will reach patients
who desperately need the drug to improve their condition. The
Committee requests an update in the fiscal year 2026 congressional
justification on efforts and progress made to implement clinical decision support that incorporates genomic information.
INCLUDE Down Syndrome Research Initiative.—The Committee
includes no less than $125,000,000, a $35,000,000 increase above
the fiscal year 2024 enacted level, within OD for the INCLUDE Initiative. With the Committee’s support, NIH launched the INCLUDE Initiative in June 2018. The Committee remains pleased
with a focus on large cohort studies across the lifespan, novel clinical trials, and multi-year, trans-NIH research driving important
advances in understanding immune system dysregulation, Alzheimer’s disease, and leukemia that is contributing to improvements in the health outcomes and quality of life of individuals with
Down syndrome as well as millions of typical individuals. The Committee directs NIH to provide an updated plan within 60 days ofenactment of this Act that includes a timeline and description ofpotential grant opportunities and deadlines for all expected funding
opportunities so that young investigators and new research institutions may be further encouraged to explore research in this space.
This plan should also incorporate and increase pipeline research
initiatives specific to Down syndrome and be made available on theagency’s website.
Infection Associated Chronic Conditions and Illnesses (IACCIs).—
These are a related family of diseases with many overlapping similarities and commonalities. Currently, there is limited coordination
at NIH among these various conditions leading to duplication, inefficiency, and redundancies. The Committee encourages NIH to

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streamline, coordinate, and synergize research for IACCIs acrossthe NIH institutes, centers, and offices.
Interagency Framework for Considering the Exercise of March In
Rights.—The Committee notes with strong concern the Administration’s proposed ‘‘Draft Interagency Guidance Framework for Considering the Exercise of March-in Rights,’’ (Framework) which reviews factors, include price, that a Federal agency may consider
when deciding whether to exercise march-in authority as provided
in the Bayh-Dole Act. The Committee believes that if implemented
by Federal agencies, particularly the National Institutes of Health,the Framework may adversely impact America’s global leadershipin pharmaceutical innovation. The Committee notes that since theinception of the Bayh-Dole Act over 40 years ago, the U.S. has
never exercised its march-in rights authority. This has empowered
U.S. investment and technology communities, universities, and research institutions to take risks and efforts needed to bring new
ideas to the pharmaceutical marketplace. In 2022 alone, 850 newcommercial products utilizing inventions developed by U.S. universities and research institutions became available to the public in
2022 thanks in large part to the Bayh-Dole Act. If the Framework
is finalized and implemented, the Committee is concerned that it
would have serious negative effects on current and future scientificadvancements in hundreds of promising new therapies under development to treat cancer, immune disorders, and other chronic
conditions, and would threaten the U.S.’ global leadership in pharmaceuticals.
Lyme and Other Tick-Borne Diseases.—The Committee encourages the Office of the Secretary to work with the Director of NIH
to evaluate the potential benefits of expanding the TBD portfolio toother institutes and centers in addition to NIAID. Because of the
profound neurologic involvement of TBD, such as Lyme disease,
NINDS and NIMH may make major contributions to the study of
TBD, such as developing novel treatments for neurologic symptoms, including severe neurologic symptoms in children. Because of
the severe impacts of TBD on children, NICHD may also greatly
enhance NIH accomplishments in developing tools to manage pediatric cases of TBD.
Menopause Research.—The Committee is concerned that there isa significant and unmet need with respect to: basic research intoand knowledge and understanding of menopause andperimenopause; new treatments for menopause-related symptoms;
and evaluation of the safety and effectiveness of treatments formenopause-related symptoms. The Committee believes the lack ofattention and investment into these health conditions has contributed to a lower quality of life and poorer health outcomes for thenation’s middle aged and older women. The Committee urges NIH
to undertake and fund additional research related to early menopause (<45 years old), menopause, perimenopause, and mid-life
women’s health, including research concerning symptoms andtreatments for menopause, perimenopause, and other related midlife women’s health issues and a multidisciplinary study of the effects of hormonal treatment for menopausal symptoms. As part of
the fiscal year 2026 congressional justification, the Committee requests the historical information on research related to menopause,
perimenopause, or mid-life women’s health over the preceding 5 fis-

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cal years and an overview of: completed research related to menopause, perimenopause, and mid-life women’s health; status of ongoing Federally-funded such research; and the safety and effectiveness of treatments for menopause-related symptoms and recommendations.
Mental Health, Addiction, and Resilience Research.—Diseases ofthe mind and brain can develop early in life, contribute to the burden of overall health and daily life function, and contribute to thepersistent and rising rates of deaths of despair from mental illness
and addiction. The Committee encourages NIH to support collaborative research efforts to uncover the root causes, risk, and resilience/protective factors of mental health and addiction. These efforts could include leveraging existing longitudinal research to examine the biological, psychological, and social factors and theirinteractions across multiple layers of analysis that put people atrisk for addiction and mental illness including patterns of intergenerational transmission of mental illness, discover ways to better
prepare and respond to stress, trauma and adversity, and informand guide new strategies for prevention, recovery, and resilience.
Microplastics.—The Committee notes that research has identified
microplastics and nanoplastics in water, food, and air, and in thehuman body. The Committee recommends that NIH review primary chemicals in the life cycle analysis of plastic materials andpotential impacts on human health. The Committee also requests
that NIH research the presence of microplastics and nanoplastics
in the human body and the impacts on health.
Mitochondrial Disease.—The Committee recognizes the need for
the NIH to prioritize research on primary and secondary
mitochondrial disease. A constellation of rare diseases linked to impaired mitochondrial function needs further research while potentially promising interventions work through the FDA approval
process. At the same time, research continues to validate the substantial connections between mitochondrial function and major conditions such as Alzheimer’s, Parkinson’s, ALS, Muscular Dystrophy, heart failure, and long COVID. The Committee strongly encourages NIH to advance primary mitochondrial disease research,continue its ongoing outreach and collaboration with the FDA related to research that may lead to future mitochondrial disease-related drug approvals, ensure that support for long COVID research
includes opportunities for studies to explore the role ofmitochondrial impairment, and ensure that opportunities remain
available to support collaborative research on mitochondrial disease
to centralize a critical mass of research, clinical care, and provider
education.
Mucopolysaccharidoses and Mucolipidosis.—The Committee recognizes the severity of Mucopolysaccharidoses and Mucolipidosis(MPS/ML) diseases and the need for additional research in orderto improve life expectancy and quality of life for patients.
National Primate Research Centers and Caribbean Primate Research Center.—The Committee does not include funding for thisactivity.
Neuroarts Research.—The Committee notes the contribution of
NIH to the burgeoning field of neuroarts, which shows great promise in advancing health and wellbeing for all.

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Neurofibromatosis.—The Committee supports efforts to increase
funding and resources for Neurofibromatosis (NF) research andtreatment at multiple Institutes, including NCI, NINDS, NIDCD,NHLBI, NICHD, NIMH, NCATS, and NEI. Children and adults
with NF are at elevated risk for the development of many formsof cancer, deafness, blindness, developmental delays, and autism.
The Committee encourages NCI to continue to support a robust NF
research portfolio in fundamental laboratory science, patient directed research, and clinical trials focused on NF-associated benign
and malignant cancers. The Committee also encourages NCI to
support preclinical research and clinical trials. Because NF cancause blindness, pain, and hearing loss, the Committee urges NEI,NINDS and NIDCD to continue to support fundamental basic
science research on NF relevant to restoring normal nerve function.
Based on emerging findings from numerous researchers worldwide
demonstrating that children with NF have a higher chance of developing autism, learning disabilities, motor delays, and attention
deficits, the Committee encourages NINDS, NIMH, and NICHD tocontinue their support of research investigations in these areas.
Since NF2 accounts for some genetic forms of deafness, the Committee encourages NIDCD to expand its investment in NF2-related
research. NF1 can cause vision loss due to optic gliomas. The Committee encourages NIH to expand its investment in NF1-focused research on optic gliomas and vision restoration.
Non-Human Primates.—The Committee recognizes the criticalrole of non-human primate research in virtually all areas of biomedical research. Research with these unique models makes irreplaceable contributions to understanding the biological processes
that cause diseases. These models are essential in the discovery
and evaluation of new therapeutics before they go to clinical trials.
As the U.S. population ages, and millions of Americans suffer fromchronic and degenerative diseases, including those that affect thenervous system such as Alzheimer’s and Parkinson’s disease, nonhuman primate research will continue be vital to understanding
both the underlying mechanisms and potential cures for these diseases. Non-human primate research remains critical to understandthe causes of age-related degenerative diseases and to improve theeffectiveness of new compounds and non-pharmaceutical treatments such as deep brain stimulation, neuromodulation, cancer,
chronic pain, and metabolic disorders. The Committee encourages
NIH to award funding to meritorious research proposals to study
these degenerative disorders, including studies that utilize nonhuman primates.
Office of AIDS Research.—While great advancements have been
made in HIV prevention, health care, and treatment over the last
30 years, more must be done to improve the lives of the more than
one million people with HIV in the U.S. and prevent the more than
31,000 new infections each year. The targeted HIV/AIDS researchfunding at the NIH is needed to develop improved access to healthcare and services for those with HIV, better prevention for at-risk
populations from transmission, more effective treatments, and ultimately a cure for HIV.
Office of Communications and Public Liaison.—The Committee
notes with strong concern the lack of adherence to scientific terminology and industry-recognized reference standards in the NIH

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Style Guide. The promotion and use of politicized and polarizing
language by the nation’s premier scientific institution is a disappointment and serves as yet another example of the lack of scientific rigor now used across NIH.
Office of the Chief Officer for Scientific Workforce Diversity.—The
Committee does not include funding for this activity.
Office for Research on Women’s Health.—The Committee provides$100,000,000 for the Office of Research on Women’s Health, whichis $23,520,000 above the fiscal year 2024 enacted level and$53,909,000 below the fiscal year 2025 budget request. The Committee recognizes research into conditions that disproportionately
or differently affect women will increases positive health outcomes.
Based on an analysis of NIH extramural grants awarded in fiscal
year 2019, doubling research focused on women-focused funding injust four conditions, coronary artery disease, lung cancer, Alzheimer’s disease, and rheumatoid arthritis could provide a $14 billion economic return. Despite progress made, opportunities to enhance NIH efforts focused on the health of women across the lifespan could bridge gaps in knowledge about diseases that affectwomen differently or disproportionately. Additional NIH-wide investments in research addressing pressing conditions and diseases
which negatively impact the health of women could produce significant economic returns. The Committee urges NIH to focus women’s
health research on these areas.
Open Access Genetic Sequence Data Repositories.—The Committee is concerned NIH may not have sufficient safeguards inplace for open access databases with human genetic data. The
Committee directs NIH to submit a report within 180 days of enactment of this Act on the authentication protocols in place to restrict the ability for foreign adversary entities to access such a
database.
Osteopathic Medical Schools.—Osteopathic medicine represents a
vibrant portion of the medical student education and health systems ecosystem. However, the Committee remains concerned withthe historic disparity in NIH funding and representation for Colleges of Osteopathic Medicine (COMs), as well as NIH’s failure to
respond to requests to create an action plan to address the agency’s
chronic underfunding of osteopathic research and underrepresentation of osteopathic scientists on NIH National Advisory Councils
and study sections. Additionally, the Committee is concerned that
NIH continues to associate osteopathic medicine most strongly with
the National Center for Complementary and Integrative Health(NCCIH). The Committee encourages the NIH to expand funding
opportunities and representation across NIH Institutes and Centers, outside of NCCIH. Further, the Committee requests NIH include in the fiscal year 2026 congressional justifications information on the representation of COMs in NIH applications andawards.
Parkinson’s Progression Markers Initiative.—The Committee supports the significant recent advances in Parkinson’s disease (PD)research through public-private partnerships like the Accelerating
Medicines Partnership for PD (AMP–PD) that is a collaboration between NIH, nonprofit organizations, and industry. The work of theMichael J. Fox Foundation for Parkinson’s Research PPMI program, one of the cohorts contributing to AMP–PD, recently inde-

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pendently replicated a potential diagnostic biomarker for Parkinson’s disease. The Committee encourages NIH and NINDS to continue participation in such public-private partnership opportunities
with patient advocacy groups and build on these discoveries to accelerate Parkinson’s and atypical parkinsonism disorders (e.g. progressive supranuclear palsy) research advances.
Pediatric Lyme Disease.—As part of the fiscal year 2026 congressional justification, the Committee requests an update on the agency’s plans to advance research on pediatric Lyme disease, including
the impact on children who are infected in utero. The Committee
encourages NIH, including NIAID, NINDS and NIMH, to increase
study of neurologic symptoms of Lyme disease, including in children, increasing surveillance of neurologic symptoms and investigating novel treatments of neurologic symptoms.
Pelvic Floor Disorders.—Pelvic floor disorders (PFDs) are common conditions that can significantly affect a woman’s quality oflife. Approximately 25 percent of women experience at least one
PFD and this condition becomes more common with age. Unfortunately, health disparities in the care of pelvic floor disorders are aprevalent issue, especially impacting patients in underserved areas,
areas with limited access to health care, barriers to healthcare andcare-seeking behaviors regarding the treatment/management of
PFDs. Therefore, the Committee urges NIH to support research tobetter understand disparities in care for diverse patients, which
may include identifying risk factor clusters in geographic regions
and within these diverse populations that suffer from PFDs. The
Committee requests an update on this effort in the fiscal year 2026
congressional justification.
Physician Scientist Workforce.—The Committee urges the NIH toinvest in new incentives for physician-scientists to pursue biomedical research opportunities. The number of physicians who opt
for academic career paths in biomedical research has dropped in recent years, and the Committee is concerned that this troubling
trend may inhibit innovation that might otherwise contribute to
the next generation of cures. New incentives are critically needed
to replenish physician-scientists’ ranks. More specifically, the Committee encourages the NIH to continue support for research-oriented career development grants with mentorship activities, continue supporting postdoctoral trainees, and empower researchers to
independently pursue new fields of research, including high-risk/
high-reward projects. It is vital that the NIH build on the findingsof its Physician-Scientist Workforce Working Group Report (June2014) a decade ago, which concluded that physician-scientists may
face pressures from institutions to see patients rather than conduct
research.
Polycystic Ovary Syndrome.—The Committee commends OD forincorporating Polycystic Ovary Syndrome (PCOS) into the NIH Research, Condition, and Disease Categories (RCDC) reporting, which
provides specificity regarding research projects focused on PCOS.
Despite this progress, the discrepancy between PCOS’s profound
impact on 10 percent of women and its annual economic burden ofover $15 billion in the U.S., compared to the $10 million in research projects supported in 2023 as per RCDC, is pronounced. The
Committee recognizes the significant and pervasive health and economic burden of PCOS, which has metabolic, cardiovascular, repro-

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ductive, maternal health, and mental health manifestations. Moreover, the Committee recognizes that there are no FDA approved
treatments specifically for PCOS. To bridge the significant funding
gap and to improve health outcomes for women while reducing
healthcare costs, the Committee strongly urges increased funding
for PCOS research at NIH. The Committee encourages increased
investments into research on the metabolic, cardiovascular, psychosocial, maternal-fetal, oncologic, pediatric, dermatologic, neurologic,
and reproductive aspects of PCOS. The Committee encourages the
NIH to increase its PCOS research portfolio to invest in fundamental laboratory science, patient-oriented research, clinical trials,
and longitudinal studies focused on the cardiometabolic featuresand endocrinopathy of PCOS throughout the lifespan. Areas of interest include closing knowledge gaps in PCOS, researching novel
diagnostics and treatments, exploring the research opportunities
identified from the NHLBI report based on its 2021 NIH workshop
on cardiovascular risks across the lifespan in PCOS, and applying
insights from the PCOS Externally-Led Patient-Focused Drug Development Meeting and Voice of the Patient Report to address patients’ unmet needs and to align with their treatment priorities.
Sexual and Gender Minority Research Office.—The Committee
does not include funding for this activity.
Spina Bifida Research.—The Committee encourages NIH to
study the causes and care of the neurogenic bladder to improve thequality of life of children and adults with spina bifida; to support
research to address issues related to the treatment and management of spina bifida and associated secondary conditions, such ashydrocephalus and sudden death in the adult spina bifida population; and to invest in understanding the myriad co-morbid conditions experienced by individuals with spina bifida, including those
associated with both paralysis and developmental delay. The Committee requests an update in the fiscal year 2026 congressional justification on research findings on spina bifida and issues related toit. The Committee supports the specific efforts of NICHD to understand early human development; set the foundation for a healthy
pregnancy, and lifelong wellness of women and children; and promote the gynecological, andrological and reproductive health forpeople with spina bifida. Additionally, NIH is encouraged to support research to identify sensitive time periods to optimize healthinterventions; improve health during transition from adolescence toadulthood and ensure safe and effective therapeutics and devices
for adults as well as children.
Staffing Report.—The Director shall submit to the Committee,
within 90 days of enactment of this Act, a staffing report detailingthe number of Senior Executive Service (SES) employees and Title
42 public health service excepted employees broken down by theemploying institute or center. These reports shall include the total
number of employees broken down by SES or Title 42 exempted
status and total compensation for each, including pay, and any
awards such as bonuses.
Success Rates.—No later than 180 days after enactment of thisAct, the Agency is directed to publicly post and maintain on theagency’s website a listing of all grant success rates by institute orcenter, grant mechanism, and fiscal year. Such website information
shall be easily accessible and include options to export into an elec-

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tronic data format. Initial information should include the last 10
years, to the extent practicable, and be maintained on the website
indefinitely.
Ultra Processed Foods.—The Committee recognizes more research is required to better understand the health impacts of ultraprocessed foods, and how to best define ultra-processed foods. The
Committee encourages NIH, in coordination with CDC and FDA, tosupport research on ultra-processed foods.
Von Hippel Lindau Disease.—The Committee appreciates NIH’s
support for research on von Hippel-Lindau (VHL) disease, which
has led to the development of new treatments for not only VHL but
also more prevalent cancers. While significant research has focusedon the role between the VHL Gene and Hypoxia-Inducible Factor
2 Alpha, the Committee encourages NIH to continue to support research to identify additional molecular targets. The Committee requests an update on this research in the fiscal year 2026 congressional justification.
BUILDINGS AND FACILITIESAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$350,000,000
350,000,000
353,671,000+3,671,000+3,671,000

NIH INNOVATION ACCOUNT

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$407,000,000
127,000,000
127,000,000¥280,000,000–––

This account supports NIH programs authorized in the Cures
Act. The Committee recommendation includes funding for initiatives authorized by the Cures Act; $36,000,000 for the All of Us
precision medicine initiative within the Office of the Director and$91,000,000 for the BRAIN initiative split equally between NIMH
and NINDS.
SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATIONDMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$7,446,396,000
7,715,556,000
7,542,067,000+95,671,000¥173,489,000

The Committee recommendation for the Substance Abuse andMental Health Services Administration (SAMHSA) program level
includes $7,398,400,000 in discretionary budget authority,$131,667,000 in PHS Evaluation Tap Funding, and $12,000,000 intransfers from the Prevention and Public Health Fund (PPHF).
SAMHSA is the agency within HHS that leads public health efforts to reduce the impact of substance use and mental illness on
America’s communities. The Committee continues to include billlanguage that exempts the Mental Health Services Block Grant(MHSBG) and the Substance Use Prevention, Treatment, and Recovery Services Block Grant (SUPTRS) as a source for the PHS Act
section 241 evaluation set aside in fiscal year 2025.

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125
Eligible Grantees.—Where permitted in the authorizing statute,
the Committee directs SAMHSA, when issuing new funding opportunity announcements, to include as an eligible applicant States,
political subdivisions of States (including local governments, communities, and municipalities), Tribes or Tribal organizations, otherpublic or nonprofit entities, and faith-based organizations. The
Committee encourages SAMHSA to provide outreach and technicalassistance to ensure the maximum level of awareness and participation in new grant announcements to ensure robust competition.
Female Adolescent Mental Health.—The Committee notes withconcern the findings in a February 2023 report on the high rates
of mental health challenges and suicidal ideation among adolescentfemales. The Committee directs the Secretary of HHS, through
SAMHSA, to work across HHS, and in consultation with other Departments as appropriate, to develop a comprehensive interagency
coordinating plan to improve adolescent mental health, with afocus on the unique challenges facing female adolescents. The Committee requests a briefing outlining these efforts within 180 daysof enactment of this Act.
Gambling.—The Committee understands that the annual national cost of problem gambling is estimated to be $7,000,000,000
per year. As part of the fiscal year 2026 congressional justification,
the Secretary is encouraged to include how agency resources can bebetter utilized to provide and facilitate gambling addiction prevention and treatment services.
Harm Reduction.—The Committee is concerned that SAMHSA
has confused the normalization of illegal drug use with its mission
to support prevention and recovery in relation to substance use disorder. The Committee continues to support the availability andprovision of naloxone to reduce overdose deaths; however, the Committee provides no funding to support harm-reduction activities related to supporting the continued misuse of controlled substances.
Homelessness.—The Committee directs SAMHSA to include in
the fiscal year 2026 congressional justification information on how
the agency currently prioritizes substance use and mental healthprograms specifically related to populations that are at high riskof becoming homeless, evaluates the efficacy of current policies, andconsiders new policies that lead toward better outcomes. The Committee also encourages SAMHSA to prioritize programs that require treatment, accountability, and a path to self-sufficiency.
Hair Testing Guidance.—The Committee recognizes that section
5402 of the Fixing America’s Surface Transportation (FAST) Act(P.L. 114–94) required the Secretary to ‘‘issue scientific and technical guidelines for hair testing as a method of detecting the useof a controlled substance for purposes of section 31306 of title 49,
U.S. Code’’, which is the drug and alcohol testing program for operators of commercial motor vehicles. While more than 7 years havepassed since the enactment of the FAST Act, the Committee notesthat HHS is currently considering hair testing as an alternative
method of drug testing and issued proposed mandatory guidelines
relating to hair testing in September 2020, but has not issued final
guidelines, as required by the FAST Act.
The Committee also recognizes that since the FAST Act was
signed into law, our nation has experienced a crippling substanceuse epidemic—particularly from opioids and synthetic opioids—and

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126
Federal inaction to recognize hair testing as a viable alternative tourinalysis has denied Americans a legitimate tool to stem the crisis. This is a glaring reminder that drug-impaired driving remains
a serious issue and poses a tremendous risk to the safety of the
motoring public. Therefore, the Committee directs HHS to produce
guidelines for the use of hair testing as an alternative drug testing
method for commercial motor vehicle operators, in accordance withsection 5402 of the FAST Act. The Committee requests an updateon this effort in the fiscal year 2026 congressional justification.
National Substance Use and Mental Health Services Survey.—
The Committee encourages SAMHSA to partner with an academic
institution to expand the efforts of the National Substance Use andMental Health Services Survey and support the development andimplementation of a dashboard that provides a comprehensive,interactive snapshot of progress toward reversing the opioid epidemic. The dashboard should be designed to support real-time monitoring of prevention, treatment access and quality, and overdose
response capacity, in addition to existing metrics.
Right to Bear Arms.—The Committee recognizes that firearmownership is a constitutionally guaranteed right recognized by the
U.S. Supreme Court. SAMHSA should issue no guidance, nor makea requirement of any recipient of Federal funding, that seeks to restrict, limit, hinder, or further diminish this fundamental right.
Rural Health.—The Committee recognizes the unique challenges
faced by those who live in rural and frontier areas to access regularmental health and substance use services. These challenges arefurther complicated when individuals need timely substance use
disorder and mental health crisis services led by behavioral healthprofessionals in these areas. Providers in rural areas also faceunique obstacles. They may lack the full staff or resources to faithfully implement evidence-based practices or meet requirements for
grant funding. Given these challenges, the Committee directs theAssistant Secretary of Mental Health and Substance Use in coordination with the Assistant Secretary for Planning and Evaluationand the Administrator of HRSA to submit a joint report to theCommittee providing details on what strategies these agencies are
implementing to address the unique concerns of those in rural communities. The report should address what resources are needed to
improve and sustain access to prevention, treatment, and recoveryoriented services, including crisis response services, and to recruit,
train, and sustain sufficient workforce in rural and frontier settings
within 180 days after enactment of this Act. Such report should bemade available on the agency’s website.
Rural Opioid Technical Assistance Regional Centers.—The Committee is gravely concerned with SAMHSA’s proposal to consolidate
funding for the Rural Opioid Technical Assistance Regional Centers
into a single State Opioid Response Technical Assistance Center. If
implemented, the proposed consolidation would have a deleterious
effect on the provision of localized technical assistance to SAMHSA
grantees in regions such as Florida, Wisconsin, Oklahoma, andWashington that host such centers given the variation in regional
and local substance misuse patterns. The Committee, therefore, directs SAMHSA to maintain funding for the Rural Opioid Technical
Assistance Regional Centers at not less than the fiscal year 2024

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127
level and further directs SAMHSA to provide a briefing on this
topic within 90 days of enactment of this Act.
Suicide Prevention.—The Committee recognizes that suicide is aserious public health problem requiring strategic suicide prevention
solutions, especially among disproportionately impacted populations. The Committee further recognizes that suicide prevention
requires a strategic public health approach that addresses multiple
risk factors at the individual, community, and societal levels.
States, Tribes, and territories are most suited to lead a comprehensive public health approach to suicide prevention, which demands
effectively coordinating with multisector partners to take a datadriven, evidence-based process that addresses the broad range ofrisk and protective factors associated with suicide.
MENTAL HEALTH

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$2,808,546,000
3,112,046,000
2,676,107,000¥132,439,000¥435,939,000

Behavioral Health Integration.—The Committee encourages
SAMHSA to develop school-based and evidence-based best practices
addressing behavioral health intervention training to support practices that assist children and youth with behavioral health needs,
including behavioral intervention teams, a team of qualified mental
health professionals who are responsible for identifying, screening,
and assessing behaviors of concern and facilitating the implementation of evidence-based interventions.

DMWilson on DSKJM0X7X2PROD with HEARINGS

Mental Health Services Block Grant
The Committee provides $1,022,571,000 for the Mental HealthServices Block Grant (MHBG) which is $15,000,000 above the fiscal
year 2024 enacted program level and $20,000,000 below the fiscal
year 2025 budget request. The MHBG provides funds to States tosupport mental illness prevention, treatment, and rehabilitation
services. Funds are allocated according to a statutory formula
among the States that have submitted approved annual plans. The
Committee continues the 10 percent set aside within the MHBG for
evidence-based programs that address the needs of individuals withearly serious mental illness, including psychotic disorders and the
5 percent set aside for crises-based services. The Committee notes
that, consistent with State plans, communities may choose to direct
additional funding to crises stabilization programs.
Certified Community Behavioral Health Clinics
The Committee provides $385,000,000, the same as the fiscal
year 2024, for Certified Community Behavioral Health Clinics(CCBHCs). CCBHCs are designed to ensure access to coordinatedcomprehensive behavioral health care by providing care for mental
health or substance use to all who request such services regardlessof their age or ability to pay. CCBHCs provide access to crises services around the clock, support outpatient mental health and substance use services, and community-based mental health care forveterans.

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Children’s Mental Health Services
The Committee provides $130,000,000 for Children’s Mental
Health Services, which is the same as the fiscal year 2024 enacted
program level and $50,000,000 below the fiscal year 2025 budget
request, to fund grants and technical assistance for communitybased services for children and adolescents with serious emotional,
behavioral, or mental disorders, and assists States and local jurisdictions in developing integrated systems of community care.
Protection and Advocacy for Individuals with Mental Illness
The Committee provides $40,000,000 for the Protection and Advocacy for Individuals with Mental Illness program, which is thesame as the fiscal year 2024 enacted program level and the fiscal
year 2025 budget request, to support legal-based advocacy services
to ensure the rights of individuals with mental illness, protect andadvocate for these rights, and investigate incident of abuse and/or
neglect.
Projects for Assistance in Transition from Homelessness
The Committee provides $66,635,000 for the Projects for Assistance in Transition from Homelessness program, which is the sameas the fiscal year 2024 enacted program level and the fiscal year
2025 budget request, to provide grants to States and territories forassistance to individuals suffering from severe mental illness and/or substance use disorders and who are experiencing homelessness
or are at imminent risk of becoming homeless. Grants may be used
for outreach, screening and diagnostic treatment services, rehabilitation services, community mental health services, alcohol or drug
treatment services, training, case management services, supportiveand supervisory services in residential settings, and a limited setof housing services.

DMWilson on DSKJM0X7X2PROD with HEARINGSNational Child Traumatic Stress Initiative
The Committee provides $100,887,000 for the National Child
Traumatic Stress Initiative, which is a $2,000,000 increase above
the fiscal year 2024 enacted program level and $7,000,000 above
the fiscal year 2025 budget request, to increase access to effective
trauma and grief focused treatment and services systems for children, adolescents, and their families, who experience traumatic
events.
988 Suicide & Crisis Lifeline
The Committee provides $519,618,000 for the 988 Suicide & Crisis Lifeline, which is the same as the fiscal year 2024 enacted program level, to support the national suicide hotline to continue tosupport State and local suicide prevention call centers as well asa national network of backup call centers and the national coordination of such centers.
Program Integrity.—The Committee remains concerned that suicide is a leading cause of death in the U.S., with particular concern
regarding the suicide rates among youth and young adults. The
Committee recognizes the vital work of the 988 Lifeline service andthe important role of State partners in suicide prevention and behavioral health. As States establish and develop 988 programs, theCommittee directs SAMHSA to maintain State choice in their tech-

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nology platform. States should have the flexibility to utilize a platform that best facilities a seamless coordination with local crisisand emergency response teams, accommodates a connection to follow-up and community resources, and ensures that sensitive user
data is being safeguarded and protected. In addition, the Committee requests a briefing within 90 days of enactment of this Act
on SAMHSA’s 988 program integrity activities, including with respect to safeguarding 988 user data and responding to feedback
from States and other 988 program partners.
Program Transparency.—The Committee recognizes the work of
SAMHSA to implement the expansion of the 988 Suicide & Crises
Lifeline in fiscal year 2023. The Committee, however, remains concerned that the use of a sole source cooperative agreement limits
the contractual remedies available to ensure effective implementation. The Committee is extremely concerned that SAMSHA’s decision to limit eligible entities in implementing the fiscal year 2021
National Suicide Prevention Lifeline and Disaster Destress
Helpline artificially necessitated the use of an expanded sole sourcecooperative agreement. The Committee directs SAMHSA, 180 days
prior to any extension of the current or an amended cooperative
agreement or request for proposal for a sole source contract, to provide the committees of jurisdiction a description of the services required to meet agency needs, a demonstration of any potential recipients unique qualifications, SAMHSA’s assessment of other entities ability to provide the required services, a description of themarket research conducted and the result of such research, andplanned activities to ensure that offers are solicited from as manypotential sources as practicable.
Within the total provided for Mental Health Programs of Regional and National Significance, the Committee includes the following amounts:

DMWilson on DSKJM0X7X2PROD with HEARINGS

Budget Activity

Capacity:
Seclusion and Restraint .....................................................................................
Project AWARE ....................................................................................................
Tribal Set Aside .........................................................................................
Mental Health Awareness Training ....................................................................
Healthy Transitions .............................................................................................
Infant and Early Childhood Mental Health ........................................................
Children and Family Programs ...........................................................................
Consumer and Family Network Grants ...............................................................
Project LAUNCH ...................................................................................................
Mental Health System Transformation ...............................................................
Primary and Behavioral Health Care Integration ...............................................
Mental Health Crisis Response Grants ..............................................................
National Strategy for Suicide Prevention ...........................................................
Zero Suicide ...............................................................................................
American Indian and Alaska Native Set Aside ................................
Garrett Lee Smith-Youth Suicide Prevention
State Grants ..............................................................................................
Campus Grants ..........................................................................................
American Indian and Alaska Native Suicide Prevention ...................................
Tribal Behavioral Health Grants .........................................................................
Homeless Prevention Programs ..........................................................................
Minority AIDS ......................................................................................................
Criminal and Juvenile Justice Programs ............................................................
Assisted Outpatient Treatment ...........................................................................
Assertive Community Treatment for Individuals with Serious Mental Illness ...
Interagency Task Force on Trauma-Informed Care ............................................

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FY 2024
EnactedFY 2025
Committee$1,147,000
140,001,000–––
27,963,000
28,451,000
15,000,000
7,229,000
4,954,000
23,605,000
3,779,000
55,877,000
20,000,000
28,200,000
26,200,000
3,400,000$1,147,000
120,501,000
10,000,000––––––
15,000,000
8,229,000
4,954,000–––
3,779,000
55,877,000–––
29,200,000
27,200,000
4,400,000

43,806,000
8,488,000
3,931,000
22,750,000
33,696,000
9,224,000
11,269,000
21,420,000
9,000,000
2,000,000

43,806,000
8,488,000
4,931,000
27,750,000––––––
11,269,000
21,420,000
9,000,000
2,000,000

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FY 2024
EnactedBudget Activity

DMWilson on DSKJM0X7X2PROD with HEARINGS

Science and Service:
Garrett Lee Smith-Suicide Prevention Resource Center .....................................
Practice Improvement and Training ...................................................................
Consumer and Consumer Support Technical Assistance Centers .....................
Primary and Behavioral Health Care Integration Technical Assistance ............
Minority Fellowship Program ..............................................................................
Disaster Response ..............................................................................................
Homelessness .....................................................................................................
Eating Disorder Identification, Treatment, and Recovery ..................................

FY 2025
Committee

11,000,000
7,828,000
1,918,000
2,991,000
11,059,000
1,953,000
2,296,000–––

11,000,000
7,828,000
1,918,000
2,991,000
11,059,000
1,953,000
2,296,000
5,000,000

Capacity:
Seclusion and Restraint.—The Committee provides $1,147,000,
which is the same as the fiscal year 2024 enacted program level,
to reduce the inappropriate use of seclusion and restraint practices
through the provision of technical assistance and the promotion ofalternatives to restraint, seclusion, and other coercive practices.
Project AWARE.—The Committee provides $120,501,000 for
Project AWARE State and Tribal grants to implement mental
health related promotion, awareness, prevention, intervention, andresilience activities to ensure that school-aged youth have accessand are connected to appropriate and effective behavioral healthservices. The Committee notes the Bipartisan Safer Communities
Act (P.L. 117–159) provided $60,000,000 for fiscal year 2025 forthis program in addition to resources in this Act and therefore provides no funding for the civil unrest or school-based programs.
Tribal Set Aside.—Of the funds made available for Project
AWARE, the Committee directs that $10,000,000 be made available
for Tribes and Tribal Organizations.
Mental Health Awareness Training.—The Committee provides nofunding for the Mental Health Awareness Training to better ensurethat SMAHSA prioritizes services and programing for individuals
with severe mental illness. The Committee notes the Bipartisan
Safer Communities Act (P.L. 117–159) provided $120,000,000 for
fiscal year 2025 for this program.
Healthy Transitions.—The Committee provides no dedicatedfunding for the Healthy Transitions program. The Committee notesthat to 10 percent of the amounts made available to carry out theChildren’s Mental Health Services program may be used to carryout demonstration grants or contracts for early interventions withpersons not more than 25 years of age at clinical high risk of developing a first episode of psychosis.
Infant and Early Childhood Mental Health.—The Committee provides $15,000,000, which is the same as the fiscal year 2024 enacted program level, for the Infant and Early Childhood Mental
Health program, for grants to human service agencies and nonprofit organizations to provide age-appropriate mental health promotion and early intervention or treatment for children with orwith significant risk of developing mental illness including throughdirect services, assessments, and trainings for clinicians and education providers.
Children and Family Programs.—The Committee provides$8,229,000, an increase of $1,000,000, for the Children and Family
program, to provide grants to Tribes for community-based services

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131
and supports for children and youth, with or at risk for mental illness.
Consumer and Family Network Grants.—The Committee provides $4,954,000, which is the same as the fiscal year 2024 enacted
program level, for Consumer and Family Network grants. Consumer grants support Statewide organizations run by adults withserious mental illness or serious emotional disturbance to integrate
consumer voice into State mental health and allied systems. Family grants provide education and training to family organizations toimprove their capacity for policy and service development.
Project Launch.—The Committee provides no funding for Project
Launch. The Committee notes that this program is duplicative of
programs in the Department of Education, the Administration forChildren and Families, and the Centers for Disease Control andPrevention.
Mental Health System Transformation.—The Committee provides$3,779,000, which is the same as the fiscal year 2024 enacted program level, for the Mental Health System Transformation program.
The program provides State and community capacity building
grants for supported employment for individuals with serious mental illness or serious emotional disturbance.
Primary and Behavioral Health Care Integration.—The Committee provides $55,877,000, which is the same as the fiscal year
2024 enacted program level, for the Primary and Behavioral HealthCare Integration program to promote full integration and collaboration in clinical practice between behavioral healthcare and primary/
physical healthcare. The key goal of this program is to improve patient access to integrated health care services which requires bilateral cooperation between physicians and technical assistance centers.
The Committee notes that integration of primary and behavioral
health has been found to increase access to mental health and substance use recovery services for communities, including rural communities, that lack access to such services and encourages
SAMHSA in making awards to prioritize such communities.
Mental Health Crisis Response Partnership Pilot Program.—The
Committee provides no funding for this program and notes that the
Edward Byrne Memorial Justice Assistance Grant program, under
the Department of Justice, provides funding for State crisis intervention programs.
National Strategy for Suicide Prevention.—The Committee provides $29,200,000, an increase of $1,000,000 from the fiscal year
2024 enacted program level, for the implementation of the National
Strategy for Suicide Prevention including $22,800,000, the same as
fiscal year 2024, for grants to screen adults for suicide risks andprovide referral services, the implementation of evidence-based
practices to provide services to adults at-risk, or to raise awarenessof such risks. Of the funding provided, $4,400,000 is reserved for
grants to American Indian and Alaska Native health systems.
Garrett Lee Smith Youth Suicide Prevention.—The Committee
provides $52,294,000, which is the same as the fiscal year 2024 enacted program level, for Garrett Lee Smith Youth Suicide Prevention, this program supports grants to States and Tribes or theirdesignees for youth suicide prevention activities and services and

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DMWilson on DSKJM0X7X2PROD with HEARINGS

grants to institutions of higher education for services for students
with mental health or substance use disorders.
The Committee recognizes the importance of addressing mental
health and suicide prevention on college campuses, including at institutions of higher education that are traditionally underresourced and serve large proportions of minority populations. To
help meet these growing needs in access to mental health services,
the Committee directs the Secretary to waive the requirement ofmatching funds for minority-serving institutions and community
colleges as defined by the Higher Education Act of 1965.
American Indian/Alaska Native Suicide Prevention Initiative.—
The Committee provides $4,931,000, a $1,000,000 increase from thefiscal year 2024 enacted program level, for the Tribal Training andTechnical Assistance Center to facilitate the development and implementation of comprehensive and collaborative community-based
prevention plans to reduce suicide among American Indians/Alaska
Natives (AI/AN), prevent substance misuse, and reduce substancemisuse among AI/AN communities.
Tribal Behavioral Grants.—The Committee provides $27,750,000,
a $5,000,000 increase from the fiscal year 2024 enacted programlevel, to prevent and reduce suicidal behavior and substance use,
reduce the impact of trauma, and promote mental health among
AI/AN youth, through age 24.
Homelessness Prevention Programs.—The Committee provides nofunding for the Homelessness Prevention Program noting that the
program is duplicative of the Projects for Assistance in Transition
from Homelessness program.
Criminal and Juvenile Justice Activities.—The Committee provides $11,269,000, which is the same as the fiscal year 2024 enacted program level, for grants to States, political subdivisions ofStates, and Tribes or Tribal organizations, to develop and implement programs to divert individuals with mental illness from thecriminal justice system.
Assisted Outpatient Treatment.—The Committee provides$21,420,000, which is the same as the fiscal year 2024 enacted program level, for grants to deliver outpatient treatment under a civil
court order to adults with a serious mental illness who meet State
civil commitment assisted outpatient treatment criteria.
Assertive Community Treatment for Individuals with Serious
Mental Illness.—The Committee provides $9,000,000, which is thesame as the fiscal year 2024 enacted program level, for Assertive
Community Treatment programs, which include a multi-disciplinary service-delivery approach for individuals with severe functional impairments associated with a serious mental illness.
Interagency Task Force on Trauma Informed Care.—The Committee provides $2,000,000 for the Interagency Task Force on Trauma-Informed Care.
Science and Service:
Garrett Lee Smith Suicide Prevention Resource Center.—The
Committee provides $11,000,000, which is the same as the fiscal
year 2024 enacted program level, for the Garrett Lee Smith-Suicide
Prevention Resource Center to build national capacity for preventing suicide by providing technical assistance, training, and re-

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sources to assist States, Tribes, organizations, and SAMHSA grantees to develop suicide-prevention strategies.
Practice Improvement and Training.—The Committee provides$7,828,000, which is the same as the fiscal year 2024 enacted program level, to support the dissemination of key information to themental health delivery system.
Consumer and Consumer Support Technical Assistance Centers.—The Committee provides $1,918,000, which is the same as
the fiscal year 2024 enacted program level, to facilitate quality improvement of the mental health system by the specific promotionof consumer-directed approaches for adults with serious mental illness.
Primary and Behavioral Health Care Integration Technical Assistance.—The Committee provides $2,991,000, which is the sameas the fiscal year 2024 enacted program level, to provide technicalassistance to Primary and Behavioral Health Care Integration
grantees. Of the funds provided, the Committee directs that
$1,000,000 be allocated to the Technical Assistance activities authorized under section 1301(g) of P.L. 117–328 to implement thepsychiatric collaborative care model in primary care practices/systems. Pursuant to such law, these technical assistance centers may
be funded through cooperative agreements.
Minority Fellowship Program.—The Committee provides$11,059,000, which is the same as the fiscal year 2024 enacted program level, to increase behavioral health practitioners’ knowledgeof issues related to prevention, treatment, and recovery support formental illness and addiction among minority populations.
Disaster Response.—The Committee provides $1,953,000, whichis the same as the fiscal year 2024 enacted program level, to support the Disaster Distress Helpline, the Crisis Counseling Assistance and Training Program, and the Disaster Technical AssistanceCenter.
Eating Disorders.—The Committee provides $5,000,000 to improve the availability of health care providers to respond to theneeds of individuals with eating disorders including the work of the
National Center of Excellence for Eating Disorders to increase engagement with primary care providers, including pediatricians, toprovide specialized advice and consultation related to the treatment of eating disorders. The Committee provides additional funding to support the development, in coordination with the departments of Defense and Veterans Affairs, of a Screening, Brief Intervention and Referral to Treatment model for service members, veterans, and their families.
SUBSTANCE ABUSE TREATMENT

DMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$4,159,298,000
4,194,048,000
4,516,463,000+357,165,000+322,415,000

Substance Use Prevention, Treatment, and Recovery Services Block
Grant
The Committee includes $2,508,079,000, which is a $500,000,000
increase to the fiscal year 2024 enacted program level, for the Substance Use Prevention, Treatment, and Recovery Services

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DMWilson on DSKJM0X7X2PROD with HEARINGS

134(SUPTRS) Block Grant. The SUPTRS Block Grant is a critical component of each State’s publicly funded substance use disorder system designed to address all substance use disorders—including
those related to alcohol. SUPTRS Block Grant funds may support
initiatives related to alcohol in settings such as emergency rooms
and primary care offices. In addition, States utilize SUPTRS Block
Grant funds to support alcohol use disorder treatment services in
outpatient, intensive outpatient, and residential programs. Further,
the Committee is also aware that SUPTRS Block Grant funds may
be allocated to support medications for the treatment of alcohol use
disorders, an important tool that should be available to those in
need. The Committee also understands SUPTRS Block Grant funds
are utilized by States to support recovery community organizations
to provide recovery support for those with alcohol use disorders.
The Committee recognizes the critical role the block grant plays
in State and Territory systems across the country, giving States
and Territories the flexibility to direct resources to address themost pressing needs of their communities. The Committee also recognizes that the 20 percent prevention set aside within the
SUPTRS Block Grant is a vital source of funding for primary prevention. The Committee further notes that the transfer of opioid
overdose prevention and surveillance funding from CDC to the
SUPTRS Block Grant will increase the availability of treatment
and recovery services given the dramatic differences in administrative overhead costs assessed by the respective agencies.
The SUPTRS funding level reflects a transfer of $500,000,000
from the CDC to SAMHSA. Of the $506,079,000 provide for the
CDC program in fiscal year 2024, $114,000,000, or 23 percent,
went to administrative costs. The transfer of State program funding from CDC to SAMHA should increase the funding available toStates for these activities by more than $63,000,000 in reduced
Federal administration expenses alone.
No Cost Extension.—The Committee directs SAMHSA to allow
States to apply for a one-year no-cost extension to September 2026
for the allocation of supplemental funds to the SUPTRS Block
Grant as provided in P.L. 117–2. States are concerned about theimpending fiscal cliff. An extension as described allows certain
States to work with their providers to implement spending plans
in a more strategic, predictable, and efficient manner.
Opioid Use Disorder in Rural Communities.—The Committee isaware that the opioid use disorder crisis continues to pose uniquechallenges for rural America, which suffers from problems related
to limited access to both appropriate care and health professionals
critical to identifying, diagnosing, and treating patients along withsupporting recovery from substance use disorders. The Committee
recognizes that the COVID pandemic exacerbated many of rural
America’s unique challenges and resulting needs, creating added
isolation for many, and an increasing number of individuals in crisis. These issues further emphasize the urgency of a comprehensive
approach including training to provide care for diverse populations;the use of technologies to ensure improved access to medically underserved areas; and workforce and skill development including
peer recovery specialist training and other initiatives to increase effective responsiveness to unique rural challenges. The Committee
encourages SAMHSA to support initiatives to advance opioid use

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DMWilson on DSKJM0X7X2PROD with HEARINGS

disorder objectives in rural areas, specifically focusing on addressing the needs of individuals with substance use disorders in ruraland medically underserved areas, and programs that stress a comprehensive community-based approach involving academic institutions, health care providers, and local criminal justice systems.
Prevention Activities.—The SUPTRS Block Grant’s prevention set
aside requires States to allocate at least 20 percent of Block Grant
funds to primary prevention. States may use these prevention set
aside funds to support initiatives aimed at addressing underagedrinking; such efforts can reduce access to alcohol, reduce risk factors, and increase protective factors.
Opioid Use Disorder Relapse and Overdose Prevention.—The
Committee is concerned that relapse following opioid detoxification
is a contributing factor to the overdose crisis. The Committee notes
SAMHSA’s efforts to address this within the Federal grant population and encourages SAMHSA to continue these programs in all
settings where detoxification is offered, including opioid treatment
programs, rehabilitation centers, and criminal justice settings.
Preventing Prescription Drug and Opioid Overdoses.—The Committee notes strong concerns about the increasing number of overdose deaths attributable to opioids, including synthetic opioids.
SAMHSA is encouraged to take steps to support the use of
SUPTRS Block Grant funds for opioid safety education and training, including initiatives that improve access for licensed
healthcare professionals, including paramedics, to emergency devices used to rapidly reverse the effects of opioid overdoses. Suchinitiatives should incorporate robust evidence-based intervention
training and facilitate linkage to treatment and recovery services.
State Opioid Response Grants
The Committee includes $1,575,000,000, which is the same as
the fiscal year 2024 enacted program level, for State Opioid Response (SOR) grants. The Committee supports efforts fromSAMHSA through SOR grants to expand access to SUD treatments
in rural and underserved communities, including through funding
and technical assistance. Within the amount provided, the Committee includes a set aside for Indian Tribes and Tribal organizations of 4 percent.
The Committee continues to support the continuum of prevention, treatment, and recovery support services within SOR for individuals with opioid or stimulant use disorder including co-occurring
addictions such as alcohol addiction. The Committee encourages
SAMHSA to increase awareness of grantees regarding the availability of SOR funding to support treatment and support for co-occurring additions, including alcohol use disorder.
FDA Approved Medications.—SAMHSA is directed to include as
an allowable use of funds all FDA approved medications for opioid
use disorder and overdose reversal and other clinically appropriate
services to treat opioid use disorder.
Opioid Use Disorder Recurrence.—The Committee is concernedthat relapse following opioid withdrawal management for opioid
use disorder is a contributing factor to the overdose crisis. The
Committee appreciates SAMHSA’s efforts to address this within
the Federal grant population by emphasizing the potential benefitsof opioid detoxification followed by medication to prevent recur-

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rence and encourages SAMHSA to disseminate and implement thisapproach in all settings where detoxification is offered, including
opioid treatment programs, rehabilitation centers, and criminal justice settings.
Technical Assistance.—The Committee provides no funding for
Notice of Funding Opportunity Number TI–24–012. The Committee
directs SAMHSA to continue funding technical assistance within
the administrative portion of the appropriated amounts for SOR
grants, to provide locally based technical assistance teams as has
been done through the Opioid Response Network. The Committee
recognizes the importance and essential work currently being doneby the Opioid Response Network in delivering technical assistanceto State and territorial SOR grantees, sub-recipients, and others
addressing opioid use disorder and stimulant use disorder in theircommunities.
Within the total provided for Programs of Regional and National
Significance, the Committee recommends the following amounts:
Budget Activity

DMWilson on DSKJM0X7X2PROD with HEARINGSCapacity:
Opioid Treatment Programs and Regulatory Activities ......................................
Screening, Brief Intervention, Referral to Treatment .........................................
PHS Evaluation Funds ...............................................................................
Targeted Capacity Expansion—General .............................................................
Medication-Assisted Treatment for Prescription Drug and Opioid
Addiction ...............................................................................................
Tribal Set Aside .....................................................................................
Grants to Prevent Prescription Drug Opioid Overdose .......................................
First Responder Training ....................................................................................
Rural Emergency Medical Services Training Grants (non-add) ................
Pregnant and Postpartum Women .....................................................................
Recovery Community Services Program .............................................................
Children and Families ........................................................................................
Treatment Systems for the Homeless ................................................................
Minority AIDS ......................................................................................................
Criminal Justice Activities ..................................................................................
Drug Courts (non-add) ..............................................................................
Improving Access to Overdose Treatment ..........................................................
Building Communities of Recovery ....................................................................
Peer Support Technical Assistance Center ........................................................
Comprehensive Opioid Recovery Centers ...........................................................
Emergency Department Alternatives to Opioids .................................................
Treatment, Recovery, and Workforce Support ....................................................
Youth Prevention and Recovery Initiative ..........................................................
Science and Service:
Addiction Technology Transfer Centers ..............................................................
Minority Fellowship Program ..............................................................................

FY 2024
EnactedFY 2025
Committee$10,724,000
33,840,000
2,000,000
122,416,000$10,724,000––––––
129,416,000

111,000,000
14,500,000
16,000,000
57,000,000
32,000,000
38,931,000
4,434,000
30,197,000
37,144,000
66,881,000
94,000,000
74,000,000
1,500,000
17,000,000
2,000,000
6,000,000
8,000,000
12,000,000
2,000,000

118,000,000
16,500,000
16,000,000
58,000,000
33,000,000
38,931,000
4,434,000
30,197,000––––––
74,000,000
74,000,000
1,500,000
17,000,000
2,000,000
6,000,000
15,000,000
12,000,000
2,000,000

9,046,000
7,136,000

9,046,000
7,136,000

Eligible Grantees.—The Committee directs the Secretary to expand eligibility for grants under SAMHSA Prevention Programs ofRegional and National Significance and the corresponding services
provided by the Center for the Application of Prevention Technologies to private, nonprofit, regional organizations, including
faith-based organizations. The broad coalitions orchestrated bythese regional organizations are uniquely positioned to supplement
the work already being done by the State, Tribal, and community
organizations currently eligible for such grants.

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137
Capacity:
Opioid Treatment Programs and Regulatory Activities.—The
Committee provides $10,724,000, which is the same as the fiscal
year 2024 enacted program level, to support access to FDA approved medications for opioid use disorder through opioid treatment programs and to approve organizations that accredit opioid
treatment programs.
Screening, Brief Intervention, and Referral to Treatment.—The
Committee provides no funding for the Screening, Brief Intervention, and Referral to Treatment program. The Committee notesthat SAMHSA has labeled the program as supporting ‘‘harm reduction’’ activities. The Committee further notes that following the decriminalization of drugs for personal use in Oregon in 2021, overdose deaths increased almost 50 percent.
Targeted Capacity Expansion.—The Committee provides$129,416,000, an increase of $7,000,000 from the fiscal year 2024
enacted program level, for the Targeted Capacity Expansion program including the Medication-Assisted Treatment for Prescription
Drug and Opioid Addition program (MAT–PDOA). These programs
support State and local governments, Tribes, nonprofit organizations, and health facilities respond to treatment and capacity gaps
for purposes of providing services to individuals with opioid use
disorder. MAT–PDOA provides access to FDA approved medications for opioid use disorders to reduce opioid use and related
deaths. The Committee directs SAMHSA to use the increase tosupport nonprofit treatment facilities engaged in community enhancement projects to improve the provision of services to ruralcommunities in surrounding regions. Better access to care mitigates community safety risks while expanding treatment services
and recovery support programs for patients and their families.
SAMHSA is further directed to include all FDA approved medications for opioid use disorder as an allowable use to achieve andmaintain remission and recovery.
Grants to Prevent Prescription Drug/Opioid Overdose.—The
Committee provides $16,000,000 for Grants to Prevent Prescription
Drug/Opioid Overdose Deaths (PDO), which is the same as the fiscal year 2024 program level. The PDO program trains first responders and other community providers on the prevention of prescription drug/opioid overdose-related deaths including through thepurchase and distribution of naloxone.
First Responder Training.—The Committee provides $58,000,000
for First Responder Training. This amount includes $33,00,000, an
increase of $1,000,000 from the fiscal year 2024 enacted programlevel, for Rural Emergency Medical Services Training Grants,
which provide funding to recruit and train emergency medical services personnel in rural areas with a focus on addressing substanceuse disorders and co-occurring mental health conditions.
Pregnant and Postpartum Women.—The Committee provides$38,931,000 for the Pregnant and Postpartum Women program
which is the same as the fiscal year 2024 program level. The Pregnant and Postpartum Women program supports comprehensive residential substance use disorder treatment, prevention, and recovery
support services for pregnant and postpartum women, their minor
children, and other family members.

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138
Recovery Community Services Program.—The Committee provides $4,434,000 for the Recovery Community Services Program,which is the same as the fiscal year 2024 program level; this program provides grants to develop, expand, and enhance communityand statewide recovery support services.
Children and Families Program.—The Committee provides$30,197,000, which is the same as the fiscal year 2024 programlevel, to support early identification and services to children, adolescents, and young adults at risk of substance use disorders, andtreatment for such populations with co-occurring mental illnesses.
Drug Courts.—The Committee provides $74,000,000 for
SAMSHA’s Drug Court initiative. The Committee continues to direct SAMHSA to ensure that all funding appropriated for drug
treatment courts is allocated to serve people diagnosed with a substance use disorder as their primary condition. The Committee directs SAMHSA to ensure that all drug treatment court grant recipients work directly with the corresponding State substance use
agency in the planning, implementation, and evaluation of the
grant. The Committee further directs SAMHSA to expand training
and technical assistance to drug treatment court grant recipientsto ensure evidence-based practices are fully implemented.
Improving Access to Opioid Treatment.—The Committee provides$1,500,000, which is the same as fiscal year 2024 program level, tosupport awards to expand access to FDA approved drugs or devices
for emergency treatment of known or suspected opioid overdose.
Building Communities of Recovery.—The Committee provides$17,000,000, which is the same as the fiscal year 2024 programlevel, to enable the development, expansion, and enhancement ofrecovery community organizations.
Peer Support Technical Assistance Center.—The Committee provides $2,000,000, which is the same as the fiscal year 2024 program level, to provide technical assistance to recovery community
organizations and peer support networks.
Comprehensive Opioid Recovery Centers.—The Committee provides $6,000,000 for Comprehensive Opioid Recovery Centers,
which is the same as the fiscal year 2024 program level, as authorized by section 7121 of the SUPPORT Act (P.L. 115–271).
Emergency Department Alternatives to Opioids.—The Committee
provides $15,000,000, an increase of $7,000,000, for Emergency Department Alternatives to Opioids, as authorized by section 7091 of
the SUPPORT Act (P.L. 115–271). This program provides funding
to hospitals and emergency departments to develop and implement
alternative pain management protocols and treatments that limit
the prescribing of opioids in emergency departments.
Treatment, Recovery, and Workforce Support.—The Committee
provides $12,000,000, which is the same as the fiscal year 2024
program level, for grants to entities that offers treatment or recovery services for individuals with SUDs to support individuals in
SUDs treatment and recovery live independently and participate in
the workforce.
Youth Prevention and Recovery Initiative.—The Committee provides $2,000,000, which is the same as the fiscal year 2024 program level, for the for the Youth Prevention and Recovery Initiative to support early identification and services to children, adolescents, and young adults at risk of SUDs, and treatment for such

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139
populations including those with co-occurring mental illnesses, as
authorized by the SUPPORT Act (P.L. 115–271).
Science and Services:
Minority Fellowship Program.—The Committee provides$7,136,000, which is the same as the fiscal year 2024 programlevel, to increase behavioral health practitioners’ knowledge ofissues related to prevention, treatment, and recovery support formental illness and addiction among minority populations.
Substance Use Disorder Treatment.—The Committee encourages
SAMHSA to expand the availability of treatment services tailoredto adolescents, pregnant women, and parents.
SUBSTANCE ABUSE PREVENTION

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$236,879,000
236,879,000
203,174,000¥33,705,000¥33,705,000

Within the total provided for Programs of Regional and National
Significance, the Committee provides the following amounts:
Budget Activity

DMWilson on DSKJM0X7X2PROD with HEARINGSCapacity:
Strategic Prevention Framework .........................................................................
Federal Drug-Free Workplace ..............................................................................
Minority AIDS ......................................................................................................
Sober Truth on Preventing Underage Drinking ..................................................
National Adult-Oriented Media Public Service Campaign ........................
Community Based Coalition Enhancement Grants ...................................
Interagency Coordinating Committee to Prevent Underage Drinking .......
Tribal Behavioral Health Grants .........................................................................
Science and Service:
Center for the Application of Prevention Technologies ......................................
Science and Service Program Coordination .......................................................
Minority Fellowship Program ..............................................................................

FY 2024
EnactedFY 2025
Committee$135,484,000
5,139,000
43,205,000
14,500,000
2,500,000
11,000,000
1,000,000
23,665,000$140,484,000
5,139,000–––
14,000,000
2,500,000
11,000,000
500,000
28,665,000

9,493,000
4,072,000
1,321,000

9,493,000
4,072,000
1,321,000

Capacity:
Strategic Prevention Framework.—The Committee provides$140,484,000, an increase of $5,000,000, for the Strategic Prevention Framework (SPF). SPF provides grants to States, Tribes, andlocal governmental organizations to prevent substance misuse. The
Committee provides no funding for SPF Rx in recognition of thecontinually evolving nature of substance addiction and misuse. The
Committee strongly believes that investing in prevention is essential to ending the substance abuse crisis, and supports the core
SPF program, which is designed to prevent the onset of substancemisuse, while strengthening prevention capacity and infrastructure. The Committee intends that this program supports comprehensive, multi-sector substance use prevention strategies to stopor delay the age of initiation of each State or local applicant’s mostpressing substance use issues, as determined by the State and/or
local epidemiological data.
The additional funding for core the SPF program is based on theCommittee’s recognition that substance use prevention is underutilized relative to its ability to prevent and delay substance use initiation as well as slow the pathways to addiction and overdose, andVerDate Sep 11 2014

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DMWilson on DSKJM0X7X2PROD with HEARINGS

that demand for community-based primary prevention resources
far outpaces available funding. The Committee directs that the additional funding be split evenly between States and communities.
Federal Drug Free Workplace.—The Committee provides$5,139,000, the same as the fiscal year 2024 program level, for Federal Drug-Free Workplace Programs (DFWP). DFWP ensures employees in national security, public health, and public safety positions are tested for the use of illegal drugs and the misuse of prescription drugs and ensures the laboratories that perform this regulated drug testing are inspected and certified by HHS.
Sober Truth on Preventing Underage Drinking Act.—The Committee provides $14,000,000 for the Sober Truth on Preventing Underage Drinking (STOP) Act. The STOP Act supports an adult-oriented national media campaign to provide parents and caregiversof youth under the age of 21 with information and resources to discuss the issue of alcohol with their children, funds the Interagency
Coordinating Committee on the Prevention of Underage Drinking(ICPUD), and provides grants to prevent and reduce alcohol use
among youth under the age of 21.
The Committee is concerned that funding for the ICPUD may
have been diverted for purposes unrelated to underage drinking
and reiterates that the ICPUD is to focus exclusively on preventing
underage drinking. The Committee further directs SAMHSA to ensure that no funds provided by this Act are directed for the purposeof input into the Dietary Guidelines.
Tribal Behavioral Grants.—The Committee provides $28,665,000,
an increase of $5,000,000 from fiscal year 2024, to address the highincidence of substance misuse and suicide among the AI/AN population.
Fentanyl and Prescription Drug Misuse Prevention.—The Committee supports efforts to better educate the public on the potential
lethality of fentanyl and prescription drug misuse.
Science and Service:
Center for the Application of Prevention Technologies.—The Committee provides $9,493,000, the same as the fiscal year 2024 program level, for the Center for the Application of Prevention Technologies to improve implementation and delivery of effective substance use prevention interventions and provide training and technical assistance services to the substance use prevention field.
The Committee applauds the Center for Substance Abuse Prevention and the Prevention Technology Transfer Centers for theirwork implementing the Prevention Fellowship Program. This program supported 16 early career prevention fellows throughout each
HHS region where they gained hands on experience working inState alcohol and drug agencies. Fellows, coached by mentors, developed leadership skills; received training in professional development; acquired proficiency in core competencies to prepare for certified prevention specialist exams; and prepared for employment
opportunities in the substance use prevention field. The Committee
directs the Secretary to expand eligibility for Center for the Application of Prevention Technologies to private, nonprofit, regional organizations, including faith-based organizations. The broad coalitions orchestrated by these regional organizations are uniquely positioned to supplement the work already being done by the State,

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Tribal, and community organizations currently authorized for suchgrants.
Minority Fellowship Program.—The Committee provides$1,321,000, the same as the fiscal year 2024 program level, to provide stipends to increase the number of SUD and mental healthprofessionals who teach, administer, conduct services research, andprovide direct mental health or substance use disorder treatment
services for minority populations.
The Committee directs SAMHSA to ensure that Center for Substance Abuse Prevention funded fellowships focus on substance use
disorder prevention related activities.
HEALTH SURVEILLANCE AND PROGRAM SUPPORTAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$241,673,000
172,583,000
146,323,000¥93,350,000¥26,260,000

The Committee provides the following amounts for Health Surveillance and Program Support:
Budget Activity

Health Surveillance ......................................................................................................
PHS Evaluation Funds ........................................................................................
Program Support ..........................................................................................................
Performance and Quality.
Information Systems ...........................................................................................
Drug Abuse Warning Network ......................................................................................
Behavioral Health Workforce .......................................................................................
PHS Evaluation Funds ........................................................................................

FY 2024
EnactedFY 2025
Committee$50,623,000
30,428,000
84,500,000$50,623,000
30,428,000
84,500,000

10,200,000
10,000,000
1,000,000
1,000,000

10,200,000–––
1,000,000
1,000,000

AGENCY FOR HEALTHCARE RESEARCH AND QUALITYHEALTHCARE RESEARCH AND QUALITY

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$369,000,000
387,345,000–––¥369,000,000¥387,345,000

The Committee provides no funding for the Agency for
Healthcare Research and Quality (AHRQ). Similar work is done by
several agencies funded in this bill, including the National Institutes of Health, the Centers for Disease Control and Prevention,and the Office of the Assistant Secretary for Health.
CENTERS FOR MEDICARE & MEDICAID SERVICESGRANTS TO STATES FOR MEDICAID

DMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 ...................................
Budget request, fiscal year 2025 .................................
Committee Recommendation .......................................
Change from enacted level ...................................
Change from budget request ................................

$406,956,850,000
383,609,399,000
383,609,399,000¥23,347,451,000–––

Medicaid provides health coverage to eligible populations, including eligible low-income adults, children, pregnant women, elderly
adults, and people with disabilities. Medicaid is administered by

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States, according to Federal requirements. The program is funded
jointly by States and the Federal government.
This amount does not include $245,580,414,000, which was provided as advance funding for the first quarter of fiscal year 2025.
In addition, the Committee recommends an advance appropriationof $261,063,820,000 for program costs in the first quarter of fiscal
year 2026, to remain available until expended.
The Committee continues bill language providing indefinite
budget authority for unanticipated costs in fiscal year 2025. Federal Medicaid grants reimburse States for a portion of their expenditures in providing health care for individuals whose income
and resources fall below specified levels. Subject to certain minimum requirements, States are provided certain limited authority
within the law to set eligibility, coverage, and payment levels.
PAYMENTS TO THE HEALTH CARE TRUST FUNDS

Appropriation, fiscal year 2024 ...................................
Budget request, fiscal year 2025 .................................
Committee Recommendation .......................................
Change from enacted level ...................................
Change from budget request ................................

$476,725,000,000
521,757,000,000
521,757,000,000+45,032,000,000–––

This account includes the general fund subsidy to the Federal
Supplementary Medical Insurance Trust Fund for Medicare Part B
benefits, and Medicare drug benefits and administration, as well asother reimbursements to the Federal Hospital Insurance TrustFund for benefits and related administrative costs, which have notbeen financed by payroll taxes or premium contributions. The Committee continues bill language providing indefinite authority to pay
the general revenue portion of the Medicare Part B premium matchand providing resources for the Medicare Part D drug benefit program if the annual appropriation is insufficient.
PROGRAM MANAGEMENTDMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 ...................................
Budget request, fiscal year 2025 .................................
Committee Recommendation .......................................
Change from enacted level ...................................
Change from budget request ................................

$3,669,744,000
4,329,000,000
3,454,690,000¥215,054,000¥874,310,000

Program Operations
The Committee includes $2,379,823,000 for Program Operations,which is $100,000,000 below the fiscal year 2024 enacted level and$599,228,000 below the fiscal year 2025 budget request. This officeadministers the programs under the Centers for Medicare & Medicaid Services (CMS), funds beneficiary outreach and education,
maintains information technology infrastructure needed to support
various claims processing systems, and supports other programmatic improvements.
Acute Care Mobility.—The Committee is aware that CMS proposed in the FY 2025 Inpatient Prospective Payment System proposed rule to adopt a new geriatric hospital measure, the Age
Friendly Hospital Measure, as part of the Inpatient Quality Reporting (IQR) program that includes mobility screening to ensure thatappropriate management plans are in place to promote and maintain mobility for acute critical care hospital patients. No mobilityspecific measures in CMS quality reporting programs apply to

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143
acute care in hospitals. Evidence suggests that mobilization mitigates critical care’s physical, cognitive, and psychological complications in hospitalized patients and has been linked to decreased
days on a mechanical ventilator, reduced hospital length of stay,and improved functional outcomes. The Committee requests that
CMS include an update in the fiscal year 2026 congressional justification on the agency’s progress in adopting the Age Friendly
Hospital Measure or a similar mobility-focused measure as part of
the IQR program.
Affordable Care Act Surcharge.—The Patient Protection and Affordable Care Act (42 U.S.C. 18023) specifies that qualified healthplans that include abortion coverage in circumstances other thanrape, incest, or to save the life of the mother must collect a ‘‘separate payment’’ for such coverage from the enrollee and deposit that‘‘separate payment’’ of at least $1 per enrollee per month into a‘‘separate allocation account’’ from which such abortions are funded. The Committee is concerned that the department may not beadequately enforcing this requirement. The Committee directs
HHS to provide a report, within 30 days of enactment of this Act,detailing all oversight and investigation activities conducted by
HHS to ensure compliance with this requirement for the prior 4
years. Such report shall also include detailed information regarding: (1) how ‘‘separate payments’’ are collected by qualified healthplans generally; (2) what the department has done to determine
whether qualified health plans have complied with the requirementof collecting at least $1 per enrollee per month and whether suchrequirement is being followed; and (3) how qualified health planscollect the ‘‘separate payment’’ in the case of an enrollee who qualifies for fully subsidized premiums and zero cost sharing.
Algorithm Based Health Services.—Algorithm-based healthcare
services are provided through medical devices cleared by the FDA
that rely on artificial intelligence, machine learning, or other similar software to produce quantitative and/or qualitative clinical information for use in the diagnosis or treatment of a patient’s condition. These services have the potential to improve care delivery andpatient outcomes by providing clinicians with new or additional information. However, the Committee is concerned there is not a stable payment pathway for these services, resulting in low adoption
and reduced access to these services. To best support innovation,
adoption, and access, the Committee encourages CMS to evaluate
a formalized payment pathway for algorithm-based healthcare
services as part of its previous statements regarding Software asa Service. The Committee further encourages CMS to ensure thatthe payment pathway provides the stability and consistency necessary to support provider adoption and patient access to these
services.
Area Wage Index.—The Committee notes the significant disparities in Medicare reimbursement created by the current wage index
system and that the prior Administration sought to account forsome of these imbalances. These disparities create financial andoperational disadvantages between hospitals, endangering criticalaccess to care for communities served by the lowest paid providers,often rural and underserved areas. The Committee strongly urges
CMS to implement a wage index reclassification mechanism for
hospitals in the lowest quartile of wage indexes. Such a mechanism

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144
would ensure that hospitals located near a higher wage index labormarket would be able to reclassify and receive the same wage
index as that paid to hospitals located in the same geographicalarea.
Artificial Intelligence in Prior Authorization.—The Committee acknowledges the use of artificial intelligence (AI) in the prior authorization process within Federal health insurance programs suchas Medicare, Medicaid, Tricare, and the Federal Employees Health
Benefits Program. The Committee directs GAO to provide a preliminary briefing to the Committees on Appropriations, Ways andMeans, and Energy and Commerce of the House of Representatives
no later than 12 months following the enactment of this Act witha report to follow on the current and planned use of AI as part ofprior authorization processes within a subset of plans across these
programs. The study should examine how the Federal government
evaluates the sources of and updates data used to generate priorauthorization decisions drawn from AI applications, the extent of
human oversight, the accountability measures ensuring quality ofcare, and privacy safeguards in place.
Breast Reconstruction.—Breast or chest wall reconstruction has
evolved significantly in the nearly 25 years since the passage of the
Women’s Health and Cancer Rights Act. Autologous perforator flap
reconstruction access is particularly important for patients diagnosed with more advanced diseases and disease that requires radiation, as implants are less safe in these populations. The Committee is concerned that, although access to breast or chest wall reconstruction has improved, gaps may exist for women who seek
autologous perforator flap reconstruction. The Committee requests
an analysis of patient access to perforator flap breast reconstruction in the fiscal year 2026 congressional justification.
Breast Reconstruction, Sensory Restoration.—After breast cancer
surgery, nearly 80 percent of women suffer from pain or numbness.
The Committee is aware of research demonstrating that numbness
after mastectomy can lead to functional impairment and quality oflife issues for breast cancer survivors. The Committee is also awarethat significant technological procedure advancements are now
available to shift the focus of reconstructive breast surgery beyond
cosmetic-only results to include the restoration of typical breast
functions, such as sensation. Sensory restoration as a part of breastreconstruction can ultimately improve functional impairment, physical safety, and quality of life for breast cancer survivors. The Committee requests that CMS, in collaboration with other relevant
HHS agencies, investigate gaps in insurance coverage to address
numbness as a functional impairment after mastectomy. The Committee requests an update in the fiscal year 2026 congressional justification on this issue.
Cancer Care Planning for Medicare Beneficiaries.—The Committee notes that chronic care management billing codes, which areintended to encourage the planning and management of care for
Medicare beneficiaries with chronic conditions, are underutilized by
Medicare providers. The Committee urges CMS to evaluate utilization of chronic care management billing codes, including an evaluation of the reasons for poor utilization of these codes by Medicare
providers.

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Cancer Survivorship Alternative Payment Model.—The Oncology
Care Model ended in 2022 after a five-year test, and the successor
Enhancing Oncology Model was launched in 2023. The trigger foran episode of care in these models is the initiation of cancer drug
therapy. However, these delivery experiments exclude a populationof cancer patients who might benefit from the patient-centered careoffered in care models, such as cancer survivors who have completed active treatment and are entering a period of long-term survivorship. The Committee encourages CMS to consider appropriate
options for survivors.
Certified Registered Nurse Anesthetists.—The Committee isaware of challenges surrounding patient access to anesthesia services, particularly in rural areas. Therefore, the Committee supports
CMS in its continued consideration of the benefits of Certified Registered Nurse Anesthetists performing services.
Chronic Kidney Disease.—The Committee is committed to ensuring that patients with Chronic Kidney Disease (CKD) have accessto the most clinically appropriate treatments. More effective diagnosis and care can help reduce the rates of kidney failure and cardiovascular complications for patients and generate substantial
savings to the Federal government. Therefore, the Committee recommends that CMS work to ensure the Medicare benefit guidelines
reflect the most recent clinical CKD guidelines and increase accessto early screening utilizing both estimated glomerular filtration
rate and urine albumin-creatinine ratio testing, diagnosis, andtreatment for high-risk populations for CKD.
Clarifying Organ Recovery Reimbursement.—The Committee
notes that Organ Procurement Organization (OPO) Recovery Centers can increase the number of organs available for transplantation and intensive care unit bed capacity for living patients. The
Committee is concerned that the current reimbursement guidance
pertaining to Certified Transplant Center organ recovery and reimbursement is opaque and serves as a financial disincentive to effectively utilize OPO Recovery Centers. Therefore, the Committee encourages CMS to consider revising Medicare provider guidance regarding ‘‘Medicare usable organs’’.
Colorectal Cancer Screening Continuum of Care.—The Committee appreciates CMS’s efforts to reduce barriers to colorectal
cancer screening. However, the Committee remains concerned
about increases in colon cancer incidence and death rates, especially among individuals younger than 50. The Committee highlights the recommendation of the U.S. Multi-Society Task Force on
Colorectal Cancer that after the initial screening, asymptomatic individuals with a personal history of polyps should receive more frequent colonoscopy exams given the increased risk of new polyps.
The Committee encourages CMS to support updated clinical evidence for colorectal cancer screenings.
Comprehensive Kidney Care.—The Committee urges CMS to reevaluate the impact of the Retrospective Trend Adjustments (RTA)
within the Comprehensive Kidney Care Contracting model for the
End-Stage Renal Disease (ESRD) population for Medicare ESDR
Beneficiaries, considering in particular the differences between thecalculated RTA for Medicare ESDR Beneficiaries and the calculated RTA for Medicare Parts A and B Beneficiaries for each performance year.

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Contract Center Operations Contract.—The Committee notes withconcern ongoing efforts by the Department to issue a new solicitation for the CMS Contact Center Operations contract; such actions
appear to be solely for the purpose of including a labor harmony
agreement in the contract. The Committee does not support suchblatant political activism for health program operations. The Administration cites the need to address potential disruptions of service as justification for this action despite any previous disruptionof service under the current contract or threat of future disruption.
The Committee questions the need to incur new costs associatedwith a new competition prior to the current contract ending. Additionally, the Committee is concerned that a rushed competition
could threaten current levels of service. The Committee does notsupport this effort and directs CMS to provide a report detailing:a cost/benefit analysis, the costs and resources needed to perform
a rebid, any cost savings expected to be derived, what evidence exists of past or potential disruption, and a performance review of thecurrent contract.
Convenient Access Standards for Medicare Part D Beneficiaries.—
The Committee is concerned that existing convenient access standards for Medicare Part D beneficiaries based on geographic distance do not take into consideration true access to life-saving medications, including those that are less common or facing shortages.
The Committee supports efforts by CMS to limit barriers to medication and pharmacist access for Medicare patients and make, as
appropriate, updates to the Medicare Part D pharmacy accessstandards to improve patient access to pharmacy services offeredby pharmacies not affiliated with a Pharmacy Benefit Manager.
The Committee urges CMS to consider what updates to Part D network adequacy standards, including those that do not rely on physical distance, could improve patient access to drugs and the expertise of pharmacists.
Digital Mammography Coverage Analysis.—The Committee recognizes the importance of access to mammography screening forearly detection of breast cancer. Digital Breast Tomosynthesis, or
3D mammography, offers clinical benefits to women with dense
breasts, detects more invasive cancers, improves accuracy, reduces
patient recalls for additional testing, and provides rapid and reliable results and storage of images. The Committee directs the GAO
to study any coverage and copay gaps across States and different
forms of private and public health insurance, as well as trends inusage for 3D mammography screening.
Direct Deposit Fees.—The Committee is aware that health insurers and third-party vendors charge fees for medical practices to receive reimbursement electronically via direct deposit. Understanding that these fees increase costs for medical practices, theCommittee requests a report on electronic payment options available to clinicians, such as commercially available electronic payment options and the Federal Reserve’s FedNow Payment System,and the cost of such options to clinicians.
Drug Quality.—The Committee continues to be concerned about
the discovery of dangerous levels of carcinogens in frequently prescribed medications, including angiotensin II receptor blockers likelosartan and valsartan, ranitidine, and metformin.

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Emergency Medical Services Treat In Place Model.—The Committee is disappointed by CMS’s decision not to pursue a State-specific emergency medical services demonstration project or Innovation Center model. The Committee urges CMS to reconsider thisdecision to allow for improved access to emergency care in rural
areas, as well as savings for Medicare through the reduction of unnecessary emergency room visits.
Enabling Radiologist Assistant Care.—The Committee notes thatRadiologist Assistants are advanced-level Radiographers who are
critically important members of the Radiologist-led team. Radiologist Assistants work strictly under the supervision of a Radiologist
to promote high standards of patient care by assisting Radiologists
in performing diagnostic and interventional image-guided radiology
services, as permitted by State law. The Committee remains concerned about persistent radiology workforce shortages and is awarethat barriers to care provided by Radiologist Assistants exist within the Medicare program. As such, CMS should consider how it
may remove barriers to care rendered by Radiologist Assistants topromote efficiency, improve patient outcomes, and ensure patient
safety. The Committee encourages CMS to establish effective policies to enable patient access to Radiologist Assistant care under thesupervision of a Radiologist, as permitted by State law. In developing such policies, CMS is urged to consult with stakeholders.
Genetically Targeted Technologies.—Genetically targeted drugs,
defined for the first time in the 21st Century Cures Act (P.L. 114–255), include a set of complex small molecule products that target
predominantly rare, genetic-based diseases, but can also target
broader populations in novel ways. These genetically targeted technologies are in the infancy of their commercialization and subjecting these highly complex drugs to a negotiation timeline intended for simpler drugs so early in their commercialization will
disproportionally impact these innovative ways to treat diseases
with high unmet medical need. The Committee encourages CMS towork with Congress to align the timeline for which drugs madewith genetically targeted technologies are eligible for negotiations,equivalent to that of large molecules.
Home Infusion.—The Committee notes the critical role that home
infusion services can play in improving health outcomes and quality of life for patients who require infusion of medications for complex conditions, including patients who would otherwise need totravel significant distances to receive drug infusions at a hospitalor freestanding infusion center. The Committee is concerned by the
low levels of utilization of home infusion therapy among beneficiaries in traditional Medicare Fee-for-Service as compared tomore robust use of home infusion in commercial insurance andacross other payers. The Committee encourages CMS to examine
options that could help ensure that Medicare Fee-for-Service beneficiaries have better access to drug infusion from the comfort andsafety of their homes.
Hospitals in the U.S. Virgin Islands.—The Committee notes that
Medicare payments for hospitals in the U.S. Virgin Islands are calculated using out-of-date payment data and formulas under theTax Equity and Fiscal Responsibility Act of 1982. The two hospitals
in the U.S. Virgin Islands are reimbursed based on 1982 and 1996
costs. As a result, hospitals do not receive sufficient payment and

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patients must travel outside the territory for necessary services, including total joint replacements and chemotherapy, often at great
expense and personal hardship.
Improving Diagnostic Testing for Neurodegenerative Diseases.—
The Committee supports efforts to prevent and effectively treat
neurodegenerative diseases, including Parkinson’s disease, Lewy
body dementia, and other related disorders. The Committee also
recognizes that early detection is imperative to improving healthoutcomes and patient quality of life by delaying or halting the progression of such diseases. To improve the ability of health care providers to diagnose and treat neurodegenerative diseases at an earlier onset, the Committee encourages HHS to work withhealthcare-related entities, manufacturers, and developers, as appropriate, to promote the awareness and research of novel diagnostic testing, including tests that detect and visualize protein
markers using the skin, for neurodegenerative diseases.
Improving Veterans Enrollment into Medicare Coverage.—The
Committee is aware that information gaps exist for some veterans
related to the differences between the hospital care and medical
services available in the Veterans Affairs (VA) system versus coverage provided under Medicare. The Committee encourages the department to work with the Department of Veterans Affairs to ensure that veterans have complete information regarding the differences between the VA system and Medicare coverage, including
for prescription drugs.
Language Access in Telehealth.—The Committee requests an update in the fiscal year 2026 congressional justification on access tohealth care services, in particular behavioral health services, via
telehealth for individuals with limited English proficiency under
the Medicare program.
Medicaid Best Price Rule.—The Committee is concerned that
CMS has exceeded its statutory authority in developing the latest
Medicaid Drug Rebate Program (MDRP) Proposed Rule (Medicaid
Program; Misclassification of Drugs, Program Administration and
Program Integrity Updates Under the Medicaid Drug Rebate Program (88 Fed. Reg. 34238)). While the Committee is pleased theAdministration has announced that it will not advance the socalled ‘‘stacking proposal,’’ the Committee remains concerned withthe proposed price ‘‘verification’’ survey, which goes beyond its purported purpose and agency authority and targets innovative celland gene therapies. The Committee urges CMS to not finalize or
implement this MDRP Proposed Rule until the agency adequately
addresses the wide spectrum of stakeholder concerns.
Medicaid Dental Audits.—The Committee has previously raised
concerns that failure to use professional guidelines or establish
State Medicaid manual parameters in the auditing process can result in inaccurate Medicaid dental audits, negatively impacting
dentist participation in the program and impeding patient accessto care. While State Medicaid Agencies (SMAs) have significant responsibility in managing provider audits, CMS also has responsibility for oversight of the Medicaid program. Therefore, it is appropriate for CMS to issue guidance to SMAs concerning best practices
in dental audits and offer training in such practices. The Committee again strongly urges CMS to develop such guidance for
SMAs.

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Medicaid Reimbursement Impact on Rural Maternal HealthCare.—The Committee recognizes the importance of rural hospitals
in providing maternal health care services, educating patients, andensuring postpartum safety. The Committee is concerned that insufficient reimbursement and payments, increasing costs of operation, and narrowing profit margins threatens the viability of hospitals in rural areas. The Committee is aware that Medicaid payment rates are often insufficient in the costs of labor and delivery
for rural hospitals, leading to the closures of labor and delivery departments and increased maternal health deserts. The Committee
requests a report within one year from the date of enactment of
this Act that reviews State-by-State payment rates at rural healthcare facilities and evaluates if increased payment rates would help
sustain the ability for rural health care providers to continue maternal health care services. The report should include, to the extent
practicable, how payment rates impact care options, including how
the rates may impact the utilization of new treatment pathways
and devices for birth complications.
Medical Devices.—The U.S.’ manufacturing capacity for medical
devices is at risk due to organized efforts by Chinese manufacturers to enter the U.S. market. The current shift toward purchasing
Chinese-made medical devices could leave U.S. hospitals dependent
on Chinese supplied devices. The Committee recommends CMS advance payment policies to support provider procurement of domestic sources of essential medical supplies. The Committee requests
CMS include in the fiscal year 2026 congressional justification thepercentage of Chinese made devices that hospitals and their grouppurchasing organizations purchase from Chinese manufacturers forthe 96 device medical countermeasures published by the FDA in
2020. If such information is unavailable, the Committee directs
CMS to include what would be necessary for CMS to have this datacollected in the future.
Medicare Coverage for Mobility Assistive Equipment in the Community.—The Committee notes that Title II of the Americans with
Disabilities Act requires public entities to administer services, programs, and activities in the most integrated setting appropriate to
the needs of qualified individuals with disabilities.
Medicare Prescription Payment Plan.—The Committee directs
CMS to provide a report to Congress and post on a publicly available website: (1) the number of beneficiaries who have taken up thesmoothing option and the total number of beneficiaries categorizedas ‘‘likely to benefit’’ by the Part D plan sponsor; (2) informationon the methods that CMS is utilizing to encourage participation,such as the use of Medicare.gov, the Medicare and You handbook,
1–800–MEDICARE, and provider focused communications such as
the Medicare Learning Network; and (3) additional outreach efforts
that CMS is conducting with other stakeholders, including provider
associations and societies, patient and consumer advocacy groups,
and pharmacy benefit managers. Additionally, CMS shall report on
the status of operationalizing point-of-sale enrollment for the program until such functionality is available for all Medicare beneficiaries.
Medicare Secondary Payer.—The Committee continues to be supportive of modernizing the Medicare Secondary Payer Program andinterested in understanding the impacts of the program on bene-

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ficiary access to treatment. In February 2024, CMS released its low
dollar reporting and recovery threshold of $750. The Committee isparticularly concerned that in this calculation CMS uses as the denominator the total number of demand letters when, going back to
as early as 2000, GAO has found that only a fraction of demand
letters result in recoveries.
Medicare Telehealth Provider Privacy.—The Committee has concerns with how CMS plans to ensure the safety of Medicare providers’ personal information. Since the beginning of the COVID–19
pandemic, CMS has allowed Medicare providers who render telehealth services from their home or other location to list a practiceaddress rather than their home address on Medicare enrollment
and billing forms. The flexibility has been extended through theend of calendar year 2024. CMS is urged to implement a permanent policy solution that is not administratively or operationallyburdensome for health care systems and ensures provider safety
and privacy. This policy solution should also prioritize program integrity and allow for monitoring of potential fraud, waste, andabuse. CMS is encouraged to implement a permanent solution priorto December 31, 2024, or extend the current flexibility until suchtime that a permanent solution is reached.
Money Follows the Person Demonstration Grant.—The Committee
notes that it is not the intent of the Money Follows the Person
Demonstration Grant (MFP) to eliminate the option of institutionalcare. MFP funds may not be used for the wholesale transfer of residents from certified care facilities to finance facility closures ordownsizing. MFP is a voluntary program established to facilitate
individual transitions to community settings initiated by the beneficiary at the beneficiary’s choice and request. The Committee requests: (1) mortality data on those who transfer under the MFP
program from certified facilities, and (2) data by category of disability (developmental disabilities, mental illness, age, physical disabilities) for sentinel events (emergency room visits) for MFP participants.
No Surprises Act Timely Payment.—The Committee recognizes
that the Departments of the Treasury, Health and Human Services, and Labor are obligated to continue conducting random audits
of insurers’ qualifying payment amount calculations as mandated
by the No Surprises Act. Additionally, the Committee is concerned
that, despite being statutorily required to submit a report to Congress on such audits in 2022, Congress has only received a perfunctory report detailing the Departments’ failure to complete theiraudit obligations. The Committee directs the Secretary to immediately finish such audits, provide a comprehensive report to Congress, and post such report publicly on the agency’s website; anduse all existing authorities, including PHS Act noncompliance civil
monetary penalties, to enforce timely payments following payment
determinations by Independent Dispute Resolution Entities.
Non-Healing Severe Wound Payment.—Non-healing severe
wounds, such as pressure sores, diabetic ulcers, and surgical incisions, are a major healthcare concern in Medicare. Current Medicare payment policies may create incentives for health professionals to provide care that is suboptimal for wound treatment, resulting in longer treatment and recovery times and higher costs.
Medicare should explore innovative options for wound care to help

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address this healthcare problem. CMS should include an update on
this topic in the fiscal year 2026 congressional justification.
Non-Opioid Pain Medicine.—The Committee believes in the importance of providing access to non-opioid pain medicine to patientscovered by Medicare and Medicaid. The Committee requests a report, within 180 days of the enactment of this Act, addressing uptake and utilization of non-opioid pain medicine.
Nuclear Diagnostics.—Nuclear medicine scans are often both themost clinically appropriate and cost-effective way to diagnose certain diseases, like Alzheimer’s and Parkinson’s diseases, as well as
prostate, breast, and neuroendocrine cancers. Initially classified as
stand-alone ‘‘drugs,’’ radiopharmaceuticals were paid separatelyfrom the nuclear medicine procedure. However, CMS began packaging payments in 2008, which results in underpayment of diagnostic radiopharmaceuticals, serves to disincentivize hospitals fromusing newer diagnostic radiopharmaceuticals in scans, and limits
patients’ access as documented in a 2021 GAO report. The Committee appreciates the recent request for information on different
options to address this issue as part of the calendar year 2024
Medicare Hospital Outpatient Prospective Payment System (OPPS)
proposed rule. The Committee urges CMS to take action to
unpackage Medicare’s OPPS payment for diagnostic radiopharmaceuticals from the OPPS payment for the accompanying procedureor scan.
Obesity.—The Committee continues to encourage CMS to work toensure beneficiary access to care for obesity if determined as clinically appropriate by the patient’s physician and consistent withstatutory and regulatory authority.
Ongoing Responsibility for Medicals.—The Committee continues
to be supportive of modernizing the Medicare Secondary Payer(MSP) program and interested in understanding the impacts of the
program on beneficiary access to treatment. The Ongoing Responsibility for Medicals (ORM) program has been problematic given thatmany providers refuse any treatment of Medicare beneficiaries due
to an ORM flag on the file, even if the treatment is unrelated tothe accident or injury giving rise to the MSP report. Section 111
of the MSP Act requires the reporting of the assumption of ORM,
and CMS requires the reporting of all cases with claims above$25,000. The committee is concerned that this number has not kept
pace with medical inflation and does not fairly reflect an appropriate threshold for ORM reporting. The Committee urges CMS to
submit a report to the committees of jurisdiction on the impact ofadjusting this threshold to medical inflation.
Organ Procurement Organization.—The Committee is aware thatin 2020, CMS issued a final rule to update the Conditions for Coverage for Organ Procurement Organizations (OPOs), which established a process to decertify any OPO falling below median performance on two specified metrics based on 2024 data. Current preliminary data suggests that 42 percent of OPOs could face decertification by 2026. The remaining OPOs would undergo competitive
bidding for the decertified OPOs’ service areas or absorb their responsibilities. The Committee urges CMS to expedite the release ofa proposed rule in 2024.
Overestimating Utilization of New Codes in the Fee Schedule.—
The Committee is concerned that CMS estimates for the utilization

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of a new code in the initial calendar year in the Medicare Physician
Fee Schedule are inflated and exceed what is statutorily required.
When adjusting the number of relative value units needed to account for coding changes, new data on relative value components,
or payment for new procedures, the Committee is concerned that
CMS overestimates utilization, and therefore the overall cost ofsuch changes, resulting in substantial resources being unnecessarily deducted from the physician fee schedule required by budget
neutrality. As such, the Committee directs GAO to study the extent
it has overestimated the utilization of new fee schedule codes ineach of the last ten years, including data on related reductions to
the fee schedule for each of those years.
Over the Counter Hearing Aids.—In the calendar year 2023 Physician Fee Schedule Final Rule, CMS finalized a policy to allow direct access to an audiologist for beneficiaries with non-acute hearing conditions. The finalized policy will allow beneficiaries, once
every 12 months, direct access to an audiologist to receive care for
non-acute hearing assessments that are unrelated to disequilibrium, hearing aids, or examinations for the purpose of prescribing,fitting, or changing hearing aids. Over-the-counter (OTC) hearing
aids are often recommended for adults with non-acute, mild-tomoderate hearing loss. The Committee urges CMS to issue a communication to audiologists to provide information on the availability and effectiveness of OTC hearing aids for non-acute mild-tomoderate hearing loss conditions.
Pharmacists and Patient Care Services.—The Committee isaware that certain Medicare Part B services and care frameworks
have provisions to include pharmacists and their patient care services. However, CMS has few mechanisms to identify and evaluate
the contributions of pharmacists to patient care and outcomes or to
identify barriers within current service requirements that prevent
scalable involvement of pharmacists. The Committee encourages
CMS to create a mechanism to provide greater visibility into thescope and outcomes of the Medicare services currently provided bypharmacists.
Physician Work Payments in Rural Areas.—The Committee recognizes that the current Medicare Physician Work Geographic
Practice Cost Index formula inadequately reflects the value of physician work effort in high-cost, geographically rural areas of thecountry, especially the non-contiguous areas. The current formula
uses wage as an indicator for the relative value of a physician’s
work effort, but this may not adequately account for differences in
the cost of living and other factors that negatively impact the relative value of physician work effort in these areas.
Programs of All-Inclusive Care for the Elderly Feasibility Assessment.—The Committee continues to see the importance of the Programs of All-Inclusive Care for the Elderly (PACE), which enables
medically complex older adults with significant long-term careneeds to remain living at home. Given the increasing need forhome and community-based care for this nursing home eligible population, the Secretary was directed to submit a report outlining animplementation plan for PACE-specific model tests seeking to increase access and affordability in Senate Report 118–84. The Committee looks forward to receipt of the report.

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Protecting Medicare Beneficiary Access to Therapy.—The Committee is concerned with the HHS OIG’s findings that payors havedenied or delayed timely Medicare beneficiary access to medicallynecessary medication through the use of ‘‘utilization management’’(including step therapy, prior authorization, limitations on drug refills, changes in formulary tier, co-pay, co-insurance, or deductibles)
and the implications for beneficiaries with the implementation ofPart D benefit redesign. The Committee urges CMS to prioritize
protecting beneficiary access to medication therapy, including enhanced oversight and review of the use of utilization management
by Medicare Part D plan sponsors, ensuring that sufficient safeguards are in place so plans do not use overly restrictive clinicalcriteria, do not request unnecessary documentation, and are timely
in responding to appeals. The Committee requests an update in thefiscal year 2026 congressional justification on actions the agency istaking to protect Medicare beneficiaries by enhancing its oversightof the use of utilization management by Part D plans to ensure no
adverse impacts to beneficiary access to therapies.
Protecting Medicare Program Integrity and Beneficiary Choice.—
The Committee is concerned that CMS’s final rule to redefine compensation for contract year 2025 represents a price control that will
create unnecessary consequences for the health care system. The
Committee is particularly concerned with CMS finalizing the rule
when it admits it ‘‘lacks the data’’ to quantify the rule’s ‘‘economic
effects.’’ Moreover, the final rule states CMS cannot ‘‘accurately
capture’’ the true cost of administrative services based on the information it has available. The Committee requests an update in thefiscal year 2026 congressional justification on the impact such rule
will have on program participants.
Psychosocial Rehabilitation Model.—The Committee recognizes
the high prevalence of loneliness and social isolation among people
with serious mental illness and encourages CMS to address thisissue.
Radiation Oncology.—The Committee remains concerned that efforts to reform the delivery and payment of certain types of radiation therapy may negatively affect patient access and outcomes.
The Committee continues to encourage CMS to work closely withall affected stakeholders to develop reforms that support patient’s
access to high quality, innovative care, and the Medicare trust
funds.
Rate Review.—The Committee strongly urges CMS to conduct a
rate review process through which each issuer shall submit a single
bid for each state and rating area that such issuer plans to offer
a qualified health plan.
Reducing False Positive Sepsis Blood Cultures.—The Committee
is aware that more than 40 percent of blood culture tests used todiagnose bloodstream infections, like sepsis, are false-positive results due to blood culture contaminations from a patient’s skin andnot an actual infection. These false-positive test results lead to serious morbidity and mortality among misdiagnosed patients, significant spending on unnecessary treatment, and the overuse of antibiotics. The Committee urges CMS to prioritize and expedite theadoption of a blood culture contamination rate measure that reduces contaminations.

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Reliance on Death Certificate Data for Performance Management.—The Committee is aware that when establishing the methodology to evaluate organ procurement organization performance,
the agency elected to rely on death certificate data to determine thedenominator of the donation and transplant rates. The Committee
recognizes that death certificate data can be unreliable and urges
CMS to identify alternative data sources such as patient-level hospital data.
Remote Monitoring Devices for Pregnant Women.—The Committee is concerned with the maternal morbidity and mortality
rate, which disproportionately impact the Medicaid population.
Many indicators of potential pregnancy-related complications canbe monitored remotely through devices that check for irregularities
in blood glucose, oxygen saturation, and weight. The Committee encourages CMS to provide guidance to States on coverage of remotephysiologic devices and related services under Medicaid for pregnant and postpartum women. The Committee requests an updateon this effort in the fiscal year 2026 congressional justification.
Robotic Stereotactic Radiosurgery.—The Committee remains concerned that inadequate payment for robotic stereotactic
radiosurgery (SRS) and robotic stereotactic body radiation therapy(SBRT) may threaten patient access to this important treatment
option for many types of cancer in both the hospital and freestanding center setting. If CMS pursues any changes to radiation
therapy coding and payment policies, the Committee urges theagency and contractors administering the Medicare Part B program
to maintain existing codes describing robotic SRS and robotic SBRT
in order to protect Medicare beneficiary access to these services
which safely deliver life-saving and life-changing cancer treatment
in a timely and cost-efficient manner, improving patient complianceand reducing burdens on patients, providers, and the health caresystem. Furthermore, the Committee notes the promise of value
based care for radiation therapy which promises to improve patient
outcomes over volume.
Rural Hospital Closures.—The Committee is concerned by thecrisis of rural hospital closures. Rural populations are often older,sicker, and more likely to use public insurance or be uninsured,leading to unique pressures on rural hospital finances. The Committee appreciates the investments in certain rural hospital designations—such as Critical Access Hospital, Rural Emergency Hospital, or Medicare-Dependent Hospital—but encourage HHS to continue addressing the community need of rural hospitals that continue to face challenges.
Screening for Cervical Cancer with Human Papillomavirus Self
Sampling.—The Committee is pleased that CMS has included its
National Coverage Determination (NCD) for Screening for Cervical
Cancer with HPV Testing on its wait list for reconsideration. Similar to the approval for self-sampling in other countries with organized screening programs, the National Cancer Institute’s ‘‘Last
Mile’’ initiative will also determine the clinical effectiveness of selfcollection-based HPV testing for screening to be considered for additional labeling by FDA after review. The Committee recognizes
that self-sampling has the potential to reach individuals who arenever screened or under-screened for HPV, which makes up about
half of women who get cervical cancer in the U.S. Given the prom-

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ise of HPV self-sampling, the Committee urges CMS to move thisNCD up the wait list to ensure that there is appropriate coveragefor this screening methodology upon FDA approval.
Special Consideration of Vaccines.—The Committee notes uniquecharacteristics of vaccine products, including: (1) the existence, orlack, of any direct financial burden to Medicare beneficiaries in accessing vaccines, including any cost-sharing obligations; (2) the importance of vaccines to national security; (3) the role vaccines playin reducing overall health care spending; (4) the contribution of
vaccines to the national economy and workforce productivity; (5)the role of vaccines in potentially preventing or addressing a global
or national public health emergency; (6) the ability of vaccines toprevent a serious medical condition or address an unmet medical
need; (7) the ability of vaccines to yield savings to Medicare byeradicating, preventing, and reducing the incidence of diseases
thereby reducing associated hospitalizations and overall burden on
the health care system; and (8) the low cost per unit, and the useof vaccines by CMS for quality measures such as the Merit-based
Incentive Payment System (MIPS) and the MIPS value pathways
to promote increased vaccine utilization.
Standardized Health Plans.—The Committee is concerned that
CMS is limiting competition and choice in the individual health insurance market by limiting the number of nongovernment dictated(‘‘standardized’’) plans that issuers may offer. The Committee believes that Americans are best served by the widest variety of competition and choice possible, ensuring that they can pick the healthplan that best works for them. As such, the Committee urges CMS
to apply a non-enforcement policy to the plan limits enacted via
regulation at 45 CFR 156.202 to promote competition and choice.
Stark Law Compliance.—The Committee encourages the agency
to apply the updated definitions of ‘‘commercially reasonable’’ and‘‘fair market value’’ as established in the CMS Final Rule ‘‘Medicare Program; Modernizing and Clarifying the Physician Self-Referral Regulations’’ (published December 2, 2020, and effective January 19, 2021). The Committee is concerned that these key definitions, which are foundational to compliance with the Federal Physician Self-Referral Law (commonly referred to as the ‘‘Stark Law’’),are not being applied during the review of certain hiring practices
by hospitals. If these definitions are not properly applied, arrangements that violate the Stark Law because they are not commercially reasonable and/or not consistent with fair market value willcontinue to go unaddressed, increasing costs to patients and thehealthcare system.
Timely Access to Alzheimer’s Disease Treatment.—The Committee
is encouraged by innovations in diagnostic tools along with treatments for the underlying biology of Alzheimer’s disease and someof its most serious symptoms. The Committee urges CMS to recognize its role in facilitating timely and equitable beneficiary accessto these diagnostic tools and services and encourages continued collaboration between CMS and other Federal agencies in their collective efforts to shift standard of care towards timely and accurate
detection and diagnosis.
Treasury Referrals.—The Committee continues to be supportiveof modernizing the Medicare Secondary Payer (MSP) program andis interested in understanding the impacts of the program on the

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156
Federal government. The Committee understands that CMS refers
the debt of some claims to the Treasury Department for collection
even before the appeal period has expired. This results in potentially misaligned processes and the Committee urges CMS to coordinate with Treasury to review these timeline interactions.
Unified Program Integrity Contractors Audit Improvements.—The
Committee recognizes the importance of using Unified Program Integrity Contractors to suspend Medicare payments for credible allegations of fraud. The Committee urges CMS to assess how theaudit system can be improved to increase communication with providers.
Waiver of 3-Day-Stay COVID Requirement.—The Committee recognizes the impact of the current 3-day-stay requirement on Medicare beneficiaries in need of Skilled Nursing Facilities (SNF) coverage but without a qualifying stay. During the COVID pandemic,
this requirement was waived. The Committee directs CMS to makedata available on the agency website to better understand the impact of the requirement on SNF utilization and Medicare spending.
Such data made available should include: (1) total number of stays
and total amount of Medicare fee-for-service (FFS) spending forcovered SNF stays; (2) total number of stays and total amount ofMedicare FFS spending for covered SNF stays preceded by a hospitalization with less than three consecutive inpatient hospital
midnights; and (3) total number of stays and total amount of Medicare FFS spending for covered SNF stays for beneficiaries whomeet the following waiver criteria: (a) Are covered under Medicare
FFS; (b) Are not attributed to an accountable care organization;and (c) Received covered SNF care within 30 days of a hospitalization of three or more consecutive midnights, with the following scenarios reported separately: (i) a combination of outpatient observation and less than 3 consecutive inpatient midnights; or (ii) exclusively outpatient observation days, and (4) For each of the above
categories, the number or percentage of stays by patients who resided in an SNF prior to the hospital or observation stay that preceded a covered SNF stay.
Whole Child Health.—The Committee is aware that social driversof health influence health outcomes, particularly for children andyouth. The Committee commends CMS for establishing the Integrated Care for Kids Model and for supporting state flexibility toaddress health-related social needs through guidance and waivers.
To build State capacity to address stressors impacting youth healthand wellbeing through sustainable payment and delivery models,the Committee continues to encourage CMS to consider approaches
to designing a whole child health demonstration program centeredin primary care. Such a program could address the mental, developmental, and social factors impacting children served by Medicaid
and CHIP through pediatric value-based care models, with a particular focus on locally driven strategies to align financial incentives and resources across Medicaid and other programs. The Committee looks forward to the update requested on this effort in Senate Report 118–84.
Whole Genome Sequencing for Medicaid and CHIP Programs.—
The Committee understands that there are an estimated 30 million
Americans who have a rare disease—a disease affecting 200,000
people or less—and the majority of these Americans are children.

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The Committee understands that Medicaid is the largest payer oftreatment for rare disease. The Committee understands there is a
growing body of evidence that whole genome sequencing (WGS),
whole exome sequencing (WES), and gene panel testing (GPT) cansave lives and money when used to diagnose infants and children
who are suspected to have a rare genetic disease. The Committee
encourages CMS to examine State Medicaid programs’ current coverage and reimbursement of WGS, WES, and GPT for infants andchildren with rare diseases or suspected genetic disorders.
State Survey and Certification
The Committee provides $402,334,000 for State Survey and Certification activities, which is $5,000,000 above the fiscal year 2024
enacted level and $90,000,000 below the fiscal year 2025 budget request. This program supports certifications of Medicare and Medicaid certified health care facilities to ensure that beneficiaries receive care at facilities that meet health, safety, and quality standards as required by CMS.
Federal Administration
The Committee provides $672,533,000 for Federal Administration
activities related to the Medicare and Medicaid programs, which is$100,000,000 below the fiscal year 2024 enacted level and$185,082,000 below the fiscal year 2025 budget request. Federal
Administration funding supports CMS staff, along with operating
and administrative expenses for information technology, communication, utilities, rent and space requirements, as well as administrative contracts.
Health Insurance Exchange Transparency.—The Committee continues to include bill language requiring CMS to provide cost information for the following categories: Federal Payroll and Other Administrative Costs; Exchange related Information Technology (IT);Non IT Program Costs, including Health Plan Bid Review, Management and Oversight; Payment and Financial Management; Eligibility and Enrollment; Consumer Information and Outreach, including the Call Center, Navigator Grants, and Consumer Education and Outreach; Exchange Quality Review; Small Business
Health Options Program and Employer Activities; and Other Marketplace Activities. Cost information should be provided for eachfiscal year since the enactment of the Patient Protection and Affordable Care Act (P.L. 111–148). CMS is also required to include
the estimated costs for fiscal year 2026.
Quality Improvement Organizations.—The Committee does notinclude the Administration’s request to remove language regarding
how quality improvement organizations are funded.
HEALTH CARE FRAUD AND ABUSE CONTROL ACCOUNTDMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$915,000,000
941,000,000
941,000,000+26,000,000–––

The Health Care Fraud and Abuse Control Account funds support activities conducted by CMS, the HHS OIG, and the Department of Justice (DOJ). This appropriation includes a base amount

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158
of $311,000,000 and an additional $630,000,000 through a discretionary budget cap adjustment provided to meet the terms of legislation establishing fiscal year 2025 budget enforcement in theHouse of Representatives.
This funding is in addition to other mandatory funding provided
through authorizing legislation. The funding will provide resources
to continue efforts for Medicaid program integrity activities, forsafeguarding the Medicare prescription drug benefit and the Medicare Advantage program, and for program integrity efforts related
to these programs carried out by the DOJ.
Senior Medicare Patrol.—The Committee includes bill language
to enable the Secretary to provide a total of $35,000,000 for the
Senior Medicare Patrol program, which is administered by the Administration for Community Living, from either discretionary or
mandatory funds provided to this account.
ADMINISTRATION FOR CHILDREN AND FAMILIESPAYMENTS TO STATES FOR CHILD SUPPORT ENFORCEMENT AND
FAMILY SUPPORT PROGRAMSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$3,309,000,000
3,924,000,000
3,924,000,000+615,000,000–––

The Committee also provides $1,600,000,000 in advance funding,as requested, for the first quarter of fiscal year 2026 to ensure
timely payments for Child Support Enforcement programs. These
formula and incentive grants to States foster parental responsibility and promote family independence, self-sufficiency, and childwell-being through services such as locating noncustodial parents,
establishing and enforcing support orders, and collecting and disbursing child support payments.
LOW INCOME HOME ENERGY ASSISTANCE PROGRAM

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$4,025,000,000
4,111,000,000
4,040,000,000+15,000,000¥71,000,000

The Low Income Home Energy Assistance Program provides formula grants to States to support eligible families and households
through programs providing assistance with energy costs.
The Committee includes bill language that directs an additional$7,500,000 in funding to be distributed under the new formula.
REFUGEE AND ENTRANT ASSISTANCE

DMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$6,327,214,000
9,341,393,000
2,691,955,000¥3,635,259,000¥6,649,438,000

The Office of Refugee Resettlement (ORR) programs are designed
to help refugees, asylees, Cuban and Haitian entrants, and trafficking victims become employed and self-sufficient. These pro-

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grams also provide for the care of unaccompanied alien children inFederal custody and survivors of torture.
The Committee continues to direct ORR to provide monthly updates of arrivals each month by category, including refugees,asylees, Cuban and Haitian entrants, Special Immigrant Visas, andunaccompanied alien children.
Within the total, the Committee includes the following:
Budget Activity

Transitional and Medical Services ..............................................................................
Refugee Support Services ............................................................................................
Victims of Trafficking ..................................................................................................
Unaccompanied Alien Children ...................................................................................
Survivors of Torture .....................................................................................................

FY 2024
EnactedFY 2025
Committee$564,000,000
307,201,000
30,755,000
5,406,258,000
19,000,000$253,700,000
137,500,000
31,755,000
2,250,000,000
19,000,000

DMWilson on DSKJM0X7X2PROD with HEARINGS

Transitional and Medical Services
Consistent with the Refugee Education and Assistance Act of
1980, the Transitional and Medical Services program funds reimbursements and competitive grants to States and nonprofit organizations to provide refugees and other eligible populations with cash
and medical assistance.
Victims of Trafficking
The Victims of Trafficking program funds competitive grants andcontracts for services to foreign victims of trafficking and potential
victims in the U.S.
Within the $31,755,000 provided for Victims of Trafficking, theCommittee includes not less than $6,000,000 for the National
Human Trafficking Hotline, which is an increase of $1,000,000
from the fiscal year 2024 enacted level.
Mandatory Reporting.—The Committee directs HHS to ensure
the National Human Trafficking Hotline (Hotline) is complying
with all Federal, State, and local laws, regulations, or policies, that
require mandatory reporting to law enforcement for investigations
into possible human trafficking. HHS acknowledges that the goals
and operations of the Hotline include referring actionable tips tolaw enforcement. As outlined in the fiscal year 2020 Hotline Noticeof Funding, an objective of the Hotline is to notify law enforcement
agencies of potential cases of human trafficking, as well as instances when a trafficking victim is in imminent danger, and to
document emerging trafficking schemes to assist in the detection
and investigation of trafficking cases.
Moreover, the Committee notes that the Department of Homeland Security (DHS) has launched the Blue Campaign, a national
public awareness campaign designed to educate the public, law enforcement, and other industry partners to recognize the indicatorsof human trafficking, and how to appropriately respond to possible
cases. The Committee directs HHS to consult and coordinate with
the DHS Blue Campaign. The Committee provides a $1,000,000 increase for the Hotline to update all its materials and to support
operational costs to facilitate increased collaboration and tip sharing with law enforcement.

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DMWilson on DSKJM0X7X2PROD with HEARINGS

Refugee Support Services
Consistent with the Refugee Education and Assistance Act of
1980, the Refugee Support Services program provides formula andcompetitive grants to States and nonprofit organizations to provide
services to refugees and other eligible populations.
School Impact Grants.—The Committee directs ORR to include
the amount provided by State for each activity within Refugee Support Services formula grants, including school impact grants, in thefiscal year 2026 budget justification.
Unaccompanied Alien Children
The Unaccompanied Alien Children (UAC) program supports thecare and placement of unaccompanied alien children under the ageof 18 apprehended by the DHS at the Southwest border while attempting to enter the U.S. illegally. The Committee is concerned
this program under the Biden Administration has served as a catalyst for illegal immigration and child labor exploitation. Costs toserve this population have skyrocketed in recent years and remain
on a trajectory that is unsustainable. Numerous legislative proposals have been offered to address this unacceptable humanitarian situation. The Biden Administration is on track to spend
over $500,000,000 taxpayer dollars on a facility in North Carolina
that has never received a single unaccompanied alien child. Suchrampant waste provides another stark example of why this program needs to eprioritize how funding is allocated to address immediate needs. The Committee proposes reduced funding consistent
with the historical needs of the account.
Age Verification.—For the most recent fiscal year for which data
is available, the Committee directs ORR to submit a report to theCommittee no later than 180 days after enactment of this Act, detailing the processes and procedures ORR uses to verify a UAC’s
age, including, but not limited to, the use of birth certificate
verification with consulates, medical exams, and verbal confirmation. The Department shall make such a report available on its
website.
Fair and Open Contracting and Grant Making.—The Committee
directs the agency to conduct all public solicitations for grants orcontracts in a manner that is fair, open, transparent, and free from
ideological bias and conflict of interest. All Federal laws, regulations, and guidelines on communications with outside vendors
should be rigorously adhered to with appropriate internal controls
in place to avoid undue risk of favoritism or other bias in making
selections.
HHS Office of Inspector General Report.—The Committee notes
with concern that the 2024 HHS OIG Report (‘‘Gaps in Sponsor
Screening and Followup Raise Safety Concerns for UnaccompaniedChildren,’’ OEI–07–21–00250) found that in a sample of 342 minors
who were released to sponsors by HHS in March and April 2021,
for 55 minors, or 16 percent, the minor’s case files lacked any documentation indicating that the required sponsor safety checks wereconducted. These important safety checks include criminal publicrecord checks, sex offender registry name checks, and Google address checks. Moreover, 35 percent of children’s case files contained
illegible scans of photo IDs, birth certificates, or legal documents
meant to verify a sponsor’s identity. The OIG recommended that

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DMWilson on DSKJM0X7X2PROD with HEARINGS161
ORR implement additional safeguards to ensure that all safety
checks are conducted and documented within each child’s case fileprior to children’s release to sponsors and that ORR ensure sponsor
records in the UAC portal accurately capture sponsorship history.
The Committee directs ORR to brief the Committee within 30 daysof the enactment of this Act on the timeline and steps it will taketo meet both recommendations.
Home Studies.—The Committee notes that the Trafficking Victims Protection Reauthorization Act requires home studies of potential sponsors when the child is a victim of trafficking, special
needs/disabled, a victim of physical or sexual abuse, or if the sponsor clearly presents a risk of abuse, maltreatment, exploitation, or
trafficking. ORR additionally mandates home studies if a potential
sponsor is seeking to sponsor two or more children and at least oneof the children is unrelated to the potential sponsor, if a potential
sponsor has previously been the sponsor of two or more children
and is now seeking to sponsor an additional child, or if a potential
sponsor is seeking to sponsor an unrelated child who is 12 years
or under. Due to repeated reports of ORR releasing minors into unsafe situations and the concerning findings in the previously mentioned OIG report, the Committee directs ORR to conduct a homestudy for every potential sponsor.
Notification.—The Committee directs ORR to continue to report
the death of any unaccompanied alien child in its custody within
24 hours, including relevant details regarding the circumstances ofthe fatality.
Online Data.—The Committee notes that HHS publishes updated
data on its website on occupancy rates in facilities, average lengthof care in HHS custody, UAC demographics, and releases to sponsors by category.
ORR Employee Vetting.—The Committee notes with concern thatthe HHS OIG found in a May 2023 report (‘‘The Office of Refugee
Resettlement Needs To Improve Its Practices for Background
Checks During Influxes,’’ A–06–21–07003) that for some employees,
ORR’s influx care facilities and emergency intake sites did not conduct or document all required background checks for some employees or did not conduct the checks in a timely manner. In addition,
ORR did not require the transportation services contractor to conduct background checks on employees as required by ORR minimum standards. The Committee directs HHS to brief the Committee no later than 30 days after enactment of this Act on the corrective actions taken by ORR in response to these findings.
Qualified Sponsor Denials.—The Committee notes that ORR currently has no way to track the reasons that sponsor applications
are denied. The Committee directs ORR to begin tracking the reasons for sponsor denials in a reportable format no later than 180
days after enactment of this Act. The Committee then directs ORR
to submit a report to the Committee on the number of sponsors
who completed an application, but for which a child was not referred. ORR shall include information regarding why a child was
not able to be placed with the sponsor who successfully completed
an application, including, but not limited to, voluntary withdrawal;
a prior criminal, domestic violence, or child abuse conviction; orproviding false information to ORR.

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162
Referrals Related to Trafficking.—The Committee directs ORR to
submit quarterly reports to the Committee that includes the number of referrals that ORR has made to the DHS’s Homeland Security Investigations Division.
Report.—The Committee directs ORR to continue to submit biannual reports to the Committee that include the number of UACs
that remain in HHS care for longer than one year and the number
of UACs that HHS has released to sponsors. The report should also
include an explanation of the methods ORR uses to follow-up withunaccompanied children after releasing them to a sponsor, including the follow-up method used and number of attempts made. The
Department shall include the total number of UACs that ORR has
been unable to contact successfully for follow-up for fiscal years
2021–2024 and shall make such a report available on its website.
Spend Plan.—The Committee continues to direct the Secretary of
HHS to submit a comprehensive spend plan to the Committee
every 90 days.
Website Updates.—The Committee directs ORR to include on its
website unaccompanied children released to sponsors by county
where five or more children have been released.
Survivors of Torture
The program funds competitive grants to nonprofit organizations
providing services to refugees, asylees, and asylum seekers to address the effects of torture.
PROMOTING SAFE AND STABLE FAMILIESAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$417,515,000
421,515,000
414,765,000¥2,750,000¥6,750,000

The Committee provides $345,000,000 in mandatory funds and$69,765,000 in discretionary funds for the Promoting Safe and Stable Families program. This program enables each State to operatea coordinated program of family preservation services, communitybased family support services, time-limited reunification services,
and adoption promotion and support services.
The Committee eliminates $2,750,000 in discretionary funding
for the Title IV–E Prevention Services Clearinghouse of evidencebased programs and notes that the Clearinghouse receives$1,000,000 in dedicated mandatory funding. As described in the fiscal year 2020 House Report (House Report 116–62), discretionary
funding for the Clearinghouse was intended to be temporary, while
Kinship Navigator programs eligible for Title IV–E reimbursement
were identified. The Clearinghouse has received $17,750,000 in discretionary funding since fiscal year 2020, and the Committee believes this funding is no longer necessary.

DMWilson on DSKJM0X7X2PROD with HEARINGSPAYMENTS TO STATES FOR THE CHILD CARE AND DEVELOPMENTBLOCK GRANT

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

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8,521,387,000
8,771,387,000+25,000,000+250,000,000

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The childcare and development block grant provides formula
grants to States, territories, and Tribes to provide financial assistance to help low-income working families and families engaged intraining or education activities pay for childcare.
The Committee includes new bill language increasing the Tribal
set aside.
SOCIAL SERVICES BLOCK GRANT

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$1,700,000,000
1,700,000,000
1,700,000,000––––––

The Social Services Block Grant (SSBG) program provides formula grants to the 50 States, the District of Columbia, Puerto Rico,
Guam, American Samoa, the U.S. Virgin Islands, and the Commonwealth of the Northern Mariana Islands. SSBG funding targets a
broad set of goals, including reducing or eliminating poverty,
achieving, or maintaining individual self-sufficiency, preventing or
remedying neglect, abuse, or exploitation of children and adults,
preventing or reducing inappropriate institutional care, and supporting institutional care, when appropriate.
Family Resource Centers.—The Committee recognizes that Family Resource Centers provide direct assistance to families throughparenting support and education, navigation of care and social
services, mental health counseling, early learning and afterschool
activities, family financial planning, and job training. The Committee supports States’ investments in Family Resource Centers.
CHILDREN AND FAMILIES SERVICES PROGRAMSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$14,829,100,000
15,052,128,000
14,709,694,000¥119,406,000¥342,434,000

The Children and Families Services programs fund activities
serving children, youth, families, the developmentally disabled, Native Americans, victims of child abuse and neglect and domestic violence, and other vulnerable populations.
The Committee provides the following amounts:

DMWilson on DSKJM0X7X2PROD with HEARINGS

Budget Activity

Programs for Children, Youth, and Families:
Head Start ..........................................................................................................
Preschool Development Grants ...........................................................................
Runaway and Homeless Youth Program ............................................................
Prevention Grants to Reduce Abuse of Runaway Youth ....................................
Child Abuse State Grants ...................................................................................
Child Abuse Discretionary Activities ..................................................................
Community Based Child Abuse Prevention ........................................................
Child Welfare Services ........................................................................................
Child Welfare Research, Training, and Demonstration ......................................
Adoption Opportunities .......................................................................................
Adoption and Legal Guardianship Incentive Payments .....................................
Social Services Research and Demonstration ....................................................
Native American Programs .................................................................................
Community Services Block Grant Act Programs:
Community Services Block Grant ..............................................................

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FY 2024
EnactedFY 2025
Committee$12,271,820,000
315,000,000
125,283,000
21,000,000
105,091,000
36,000,000
70,660,000
268,735,000
21,984,000
53,000,000
75,000,000
35,012,000
60,500,000$12,296,820,000
250,000,000
125,283,000
21,000,000
105,091,000
32,000,000
70,660,000
268,735,000
21,984,000
54,000,000
75,000,000–––
65,500,000

770,000,000

780,000,000

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Budget Activity

Community Economic Development ...........................................................
Rural Community Facilities .......................................................................
National Domestic Violence Hotline ...................................................................
Family Violence Prevention and Services ...........................................................
Chafee Education and Training Vouchers ..........................................................
Disaster Human Services Case Management ....................................................
Program Direction ...............................................................................................

FY 2024
EnactedFY 2025
Committee

22,383,000
12,000,000
20,500,000
240,000,000
44,257,000
1,864,000
219,000,000–––
13,000,000
20,500,000
245,000,000
44,257,000
1,864,000
219,000,000

Head Start
Head Start and Early Head Start programs fund competitive
grants to promote school readiness of children under 5 from lowincome families through preschool services.
Notice to Congressional Offices.—The Committee directs theagency to notify a congressional office if a current Head Start recipient in its congressional district will be required to re-compete
to continue its grant. The agency is directed to notify the officewhen the grant forecast for the recipient’s service area and funding
is published.
Tribal Colleges and Universities Head Start Partnership Program.—The Committee includes $12,000,000 for the Tribal Collegesand Universities Head Start Partnership program, which is an increase of $4,000,000 from the fiscal year 2024 enacted level.
Preschool Development Grants
The Committee provides $250,000,000 for these competitive
grants to States to improve existing early childhood programs. Thisis a decrease from the fiscal year 2024 enacted level but equal to
the fiscal year 2025 President’s budget request. This funding level
will allow HHS to provide continuation of funding for existing
grantees and fund the States and territories eligible to apply for renewal grants.
Runaway and Homeless Youth ProgramThis program funds competitive grants to provide street outreach, emergency shelters, and longer-term transitional living programs to protect and provide supportive services to runaway andhomeless youth.
Prevention Grants to Reduce Abuse of Runaway YouthThis program funds competitive grants to nonprofit agencies forthe purpose of providing street-based services to runaway, homeless, and street youth who have been subjected to, or are at riskof being subjected to sexual abuse, prostitution, human trafficking,sexual exploitation, or other forms of victimization.

DMWilson on DSKJM0X7X2PROD with HEARINGSChild Abuse State Grants
This program provides Child Abuse Prevention and Treatment
Act formula grants to States to improve their child protective service systems.
Child Abuse Discretionary Activities
This funding supports a variety of competitive grants, including
research and demonstration projects on the causes, prevention,
identification, assessment and treatment of child abuse and ne-

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glect, the development and implementation of evidence-based training programs, and technical assistance to grantees and communities through national resource centers and the Child Welfare Information Gateway.
Child Abuse Hotline.—The Committee supports ongoing efforts toaddress and support youth and families impacted by child abuse
and neglect. Within the total, the Committee continues to provide$2,000,000, which is the same as the fiscal year 2024 enacted level,for broad, ongoing support for the national child abuse hotline inorder to provide resources and intervention through multiple modalities, including chat, text, and call, to respond to the urgent
needs of youth and concerned adults facing these challenges.
The Committee does not provide the $4,000,000 needed for continuation grants for the field-initiated approach to addressing racial bias, inequity, and disparity project.
Community Based Child Abuse Prevention
This program provides formula grants to States that then disburse funds to local community-based organizations to improve
local child abuse prevention and treatment efforts.
Child Welfare Services
This program funds formula grants to State and Tribal child welfare programs for research, monitoring, and special initiatives topromote positive outcomes for children and families involved inchild welfare.

DMWilson on DSKJM0X7X2PROD with HEARINGSChild Welfare Research, Training, and Demonstration Projects
This program funds competitive grants to entities that prepare
personnel for work in the child welfare field and those engaged inresearch around child welfare issues.
Strengthening State Indian Child Welfare Act Compliance.—The
Committee recognizes the important role State child welfare agencies play in ensuring the safety of Indian children who come into
contact with the State child welfare system. The Committee appreciates the work of the Children’s Bureau to support State compliance with the Indian Child Welfare Act through technical assistance and through grants to develop strong working relationships
between States and Tribes. The Committee continues to provide$3,000,000, equal to the fiscal year 2024 enacted level, for StateTribal partnership grants to build collaborations between States
and Tribes to better address the ongoing challenges Tribal communities face. Moreover, the Committee directs the agency to provide
the guidance required in Senate Report 118–84 to the Committee
and make such guidance available on its website.
Adoption Opportunities
This program funds competitive grants and contracts to public
and private organizations to remove barriers to adoption and toprovide permanent homes for children who would benefit fromadoption.
Adoption Agencies.—The Committee encourages HHS to maintain a public list of licensed adoption agencies so that birth mothers can make decisions based on verified and trustworthy informa-

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tion. The list of agencies should include adoption agencies with current State licenses who are in good standing with the State.
Adoption-Sensitive Care Training.—The Committee continues toprovide $1,000,000, the same as the fiscal year 2024 enacted level,
for a competitive grant program to improve access to adoption-sensitive care training for eligible hospital staff as directed in the explanatory statement that accompanied Division D of P.L. 118–47.
Family First Prevention Services Clearinghouse.—The Committee
continues to direct not less than $2,000,000, the same as the fiscal
year 2024 enacted level, for the evaluation of programs to support
adoption arrangements at risk of a disruption or dissolution, as directed in Senate Report 118–84.
National Adoption Competency Mental Health Training
Initiative.—The Committee continues to provide $2,000,000, thesame as the fiscal year 2024 enacted level, for the National Adoption Competency Mental Health Training Initiative.
National Training and Development Curriculum (NTDC).—The
Committee directs HHS to extend the current grant by 12 months
for the NTDC as directed in the explanatory statement that accompanied Division D of P.L. 118–47.
Support for Birth Parents.—The Committee recognizes that birthparents who voluntarily place their children for adoption often benefit from post-adoption counseling, support, and resources. The
Committee provides $1,000,000 for a demonstration program toprovide support groups, resources, and services to birth parents.
Eligible grantees should be adoption-focused, nonprofit organizations with experience working with parents who have placed theirchildren for private domestic adoption. The Committee directs HHS
to brief the Committee no later than 90 days after enactment of
this Act on its plans for carrying out this competition. In addition,
the Committee directs HHS to provide notice to the Committee atleast seven days before awards are announced.
Adoption and Legal Guardianship Incentive Payments
This program provides formula-based incentive payments toStates to encourage them to increase the number of adoptions ofchildren from the foster care system.

DMWilson on DSKJM0X7X2PROD with HEARINGS

Social Services Research and Demonstration
The Committee does not provide any funding for this program.
The Committee notes that statutory intent of this program is tosupport research, evaluation, and demonstration efforts that address the goals of preventing and reducing dependency on government programs. However, the funding for this program has been
directed in recent years to create new, duplicative demonstration
programs.
Native American Programs
These programs fund competitive grants to assist Tribal governments and Native American institutions and organizations in theirefforts to support and develop stable, diversified local economies.
Tribes and nonprofit organizations use funds to develop and implement sustainable community based social and economic programs
and services to improve the wellbeing of Native people.

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Within the total, the Committee provides $15,000,000 for Native
American language preservation activities, including no less than
$6,000,000 for language immersion programs as authorized by section 803C(b)(7)(A)–(C) of the Native American Programs Act, as
amended by the Esther Martinez Native American Language Preservation Act of 2006.
Community Services Block Grant Act Programs
Community Services Block Grant.—This Program provides formula grants to States to alleviate the causes and conditions of poverty in communities.
Rural Community Facilities.—Rural Community Development is
a competitive grant program that works with regional and Tribalorganizations to manage safe water systems in rural communities.
Under this program’s technical assistance authority, grant recipients can provide assistance to residents in unserved and underserved populations, including isolated, unincorporated communities, small, low-income communities that cannot afford loan/grant
financing, and those that lack central systems and are therefore
not regulated under the Clean Water Act or Safe Drinking Water
Act.
Community Economic Development.—Due to budget constraints,
the Committee does not provide funding for these competitive
grants.
National Domestic Violence Hotline
The National Domestic Violence Hotline provides 24-hour, tollfree and confidential services immediately connecting callers to
local service providers.
Religious Communities.—Individuals in religious communities
experience unique challenges in assessing appropriate domestic violence resources and support. The Committee provides $250,000 forthe domestic violence hotline to evaluate and expand its list of resources for contacts from religious communities.

DMWilson on DSKJM0X7X2PROD with HEARINGSFamily Violence Prevention and Services
The Family Violence Prevention and Services Act (FVPSA) programs provide funding to support the prevention of incidents offamily violence, domestic violence, and dating violence, and provide
the immediate shelter and supportive services for adult and youth
victims.
Addressing Domestic Violence in Religious Communities.—The
Committee recognizes the unique challenges experienced by individuals in religious communities, especially populations underserved because of their religious beliefs, in accessing appropriate
domestic violence services and supports. The Committee supports
the work that FVPSA Resource Centers are doing to improve outreach to faith-based communities.
Chaffee Education and Training Vouchers
This program funds formula grants to States to provide vouchers
to youth who are, or were formerly, in foster care for expenses related to post-secondary education assistance, and vocational training.

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Disaster Human Services Case Management
This funding supports work at HHS addressing human service
preparation for, response to, and recovery from, natural disasters.
Program Direction
This funding supports Federal administrative costs associatedwith administering the agency’s programs.
Temporary Assistance for Needy Families Rulemaking.—The
Committee is concerned that HHS’s October 2, 2023, proposed rule(Strengthening Temporary Assistance for Needy Families (TANF)
as a Safety Net and Work Program (88 Fed. Reg. 67697)) threatens
funding for crisis pregnancy centers. The Committee encourages
HHS to ensure continued funding for pregnancy centers in any
final rulemaking. These centers are a critical part of the safety net
for pregnant and parenting women and offer a wide range of services including providing material support free-of-charge, aiding clients in developing critical life skills to gain economic self-sufficiency, providing sexual risk avoidance education and sexual integrity counseling, and offering or referring for both marriage enrichment and relationship counseling.
TANF Pilot Projects.—The Committee directs HHS to provide notice to the committees of jurisdiction of the States selected to participate in the TANF pilot projects authorized under section 302 of
the Fiscal Responsibility Act (P.L. 118–5) at least seven days prior
to public release.
PAYMENTS FOR FOSTER CARE AND PERMANENCY

DMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$8,594,000,000
6,768,000,000
6,768,000,000¥1,826,000,000–––

The Committee also provides an advance appropriation of$3,600,000,000 for the first quarter of fiscal year 2026 to ensure
timely completion of first-quarter grant awards.
Foster Youth and the Pediatric Care System.—The Committee directs the agency to include information in its fiscal year 2026 congressional justification detailing its ongoing inter-agency collaboration with CMS and SSA to ensure that youth aging out of foster
care with medically-complex or special needs undergo a smoothtransition out of the pediatric care system.
Within the total, the Committee provides $4,796,000,000 for the
Foster Care program. This mandatory program provides funds toStates for foster care maintenance payments for children living infoster care. These funds also reimburse States for administrative
costs to manage the program and training for staff and parents.
Within the total, the Committee provides $4,659,000,000 for
Adoption Assistance. This mandatory program provides funds toStates to subsidize families who adopt children with special needs,
such as older children, a member of a minority or sibling group, or
children with physical, mental, and emotional disabilities. In addition, the program provides training for adoptive parents and Stateadministrative staff. This annually appropriated entitlement provides alternatives to long, inappropriate stays in foster care by developing permanent placements with families.

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Within the total, the Committee provides $365,000,000 for the
Kinship Guardianship Assistance program. This mandatory program provides subsidies to a relative taking legal guardianship ofa child for whom being returned home, or adoption are not appropriate permanency options.
Finally, within the total, the Committee provides $143,000,000
for the Independent Living program. This mandatory program assists foster children age 16 or older make successful transitions to
independence. Funds support a variety of services, including educational assistance, career exploration, vocational training, job
placement, life skills training, home management, health services,
substance abuse prevention, preventive health activities, and roomand board. Each State receives funds based on the number of children on whose behalf the State receives Federal Foster Care Payments.
ADMINISTRATION FOR COMMUNITY LIVING
AGING AND DISABILITY SERVICES PROGRAMSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$2,548,042,000
2,634,043,000
2,498,109,000¥49,933,000¥135,934,000

Created in 2012, the Administration for Community Living(ACL) brings together the efforts and achievements of the Administration on Aging, the Administration on Intellectual and Developmental Disabilities, and the HHS Office on Disability to serve as
the Federal agency responsible for increasing access to community
supports, while focusing attention and resources on the uniqueneeds of older Americans and people with disabilities across thelifespan.
The Committee continues to fund the Senior Medicare Patrol
Program through the Health Care Fraud and Abuse Control Account.

DMWilson on DSKJM0X7X2PROD with HEARINGSHome and Community Based Supportive Services
The Committee provides $415,000,000 for Home and CommunityBased Supportive Services, which is an increase of $5,000,000 fromthe fiscal year 2024 enacted level. This program provides formula
grants to States and territories to fund a wide range of social services that enable seniors to remain independent in their homes foras long as possible.
Preventive Health Services
The Committee provides $26,339,000 for Preventive Health Services, which is equal to fiscal year 2024 enacted level. This program
funds formula grants to States to help seniors remain healthy andavoid chronic diseases. Funding supports a variety of healthy aging
programs aimed to reduce disease and prevent injuries, including
evidence-based programs to address the risk of falls, chronic diseases, mental health, and medication management.

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Protection of Vulnerable Older Americans
The Committee provides $26,658,000 for activities to protect vulnerable older Americans, which is equal to the fiscal year 2024 enacted level. These programs provide formula grants to States forprotection of vulnerable older Americans through the Long-TermCare Ombudsman and Prevention of Elder Abuse and Neglect programs.
The Committee continues to provide $21,885,000 for the LongTerm Care Ombudsman program. This program works to improve
the quality of life and care for individuals who reside in long-termcare facilities. Ombudsmen work to ensure residents understandtheir care options and that strong beneficiary support systems arein place in all settings.
Family Caregivers
The Committee provides $210,000,000 for the National Caregiver
Support program, which is an increase of $3,000,000 from the fiscal
year 2024 enacted level. This program offers a range of support
services to family caregivers, including assistance in accessing services such as respite care, counseling, support groups, and caregivertraining.
Native American Caregivers Support
The Committee provides $16,000,000 for the Native American
Caregivers Support program, which is an increase of $4,000,000
from the fiscal year 2024 enacted level. This program provides formula grants to Tribes for the support of American Indian, Alaskan
Native, and Native Hawaiian families caring for older relatives
with chronic illness or disabilities.

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Nutrition
The Committee provides a total of $1,041,684,000 for senior nutrition. This is an overall decrease from the fiscal year 2024 enacted level. Funding for this population is also available from the
Department of Agriculture. The recommendation includes$543,342,000 for Congregate Meals and $366,342,000 for Home Delivered Meals, a decrease from the fiscal year 2024 enacted levels
but equal to the fiscal year 2023 enacted levels, and $132,000,000
for the Nutrition Services Incentives program, an increase of$20,000,000 from the fiscal year 2024 enacted level. These programs provide older Americans with meals and related services ina variety of settings (including congregate facilities such as seniorcenters) and via home delivery to older adults who are homebounddue to illness, disability, or geographic isolation.
Collaboration with the Department of Agriculture.—The Committee encourages ACL to deepen collaborations directly with the
Department of Agriculture’s Senior Farmers Market Nutrition Program to ensure seniors can continue to access locally grown fresh
fruits and vegetables while also assisting local agricultural producers.
Grants for Native Americans
The Committee provides $42,264,000 for Native American Nutrition and Supportive Services, which is an increase of $4,000,000
from the fiscal year 2024 enacted level. This program provides for-

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mula grants to Tribes to promote the delivery of nutrition andhome and community-based supportive services to Native American, Alaskan Native, and Native Hawaiian elders.
Aging Network Support Activities
The Committee provides $21,796,000 for Aging Network Support
Activities, which is a decrease from the fiscal year 2024 enacted
level. This program supports activities that expand public understanding of aging and the aging process.
The Committee does not provide funding for Care Corps, the Direct Care Workforce Demonstration, or the Older Adult Equity Collaborative.
Holocaust Survivor Assistance Program.—The Committee provides $8,500,000, which is equal to the fiscal year 2024 enacted
level, for the Holocaust Survivor Assistance program. This programprovides supportive services for aging Holocaust survivors living in
the U.S.
Interagency Coordinating Committee on Healthy Aging and
Age-Friendly Communities.—The Committee continues to provide$1,000,000 for this effort.
Research, Demonstration, and Evaluation Center for the Aging
Network.—The Committee continues to provide $5,000,000 for the
Research, Demonstration, and Evaluation Center for the Aging
Network.
Alzheimer’s Disease Program
The Committee provides $31,500,000 for the Alzheimer’s diseaseprogram, which is equal to the fiscal year 2024 enacted level. This
program provides competitive matching grants to a limited numberof States to encourage program innovation and coordination of public and private services for people with Alzheimer’s disease andtheir families.
The Committee provides no less than $2,000,000 for the National
Alzheimer’s Call Center.
Lifespan Respite Care
The Committee provides $10,000,000 for Respite Care, which isequal to the fiscal year 2024 enacted level. The program funds competitive grants to ease the burdens of caregiving by providing
grants to eligible State organizations to improve the quality of, andaccess to, respite care for family caregivers.

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Chronic Disease Self-Management Program
The Committee provides $8,000,000 for the Chronic Disease SelfManagement program, which is equal to the fiscal year 2024 enacted level. This program funds competitive grants and cooperative
agreements to support evidence-based prevention models that use
state of the art techniques to help those with chronic conditions address issues related to the management of their disease.
Elder Falls Prevention
The Committee provides $7,500,000 for the Falls Prevention program, which is equal to the fiscal year 2024 enacted level. Falls
prevention competitive grants and cooperative agreements support

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the promotion and dissemination of prevention tools delivered incommunity settings.
White House Conference on Aging.—The Committee recognizes
that falls are the top cause of fatal and non-fatal injury among
adults over 65. The Committee encourages ACL to incorporate thetopic of elderly falls, including risk factors and evidence-based prevention strategies, within the 2025 White House Conference on
Aging, including risk factors, evidence-based prevention strategies,
and the cost effectiveness of policies such as home modification coverage, payments for physicians to conduct comprehensive fall risk
assessments, and community-based fall prevention programs.
Elder Rights Support Activities
The Committee provides $18,874,000 for Elder Rights Support
Activities, which is a decrease from the fiscal year 2024 enacted
level. These programs support efforts that provide information,
training, and technical assistance to legal and aging services organizations working to prevent and detect elder abuse and neglect.
The Committee provides no funding for the State Adult Protective Services formula grant program. This program was first funded in the American Rescue Plan (P.L. 117–2).
Aging and Disability Resource Centers
The Committee provides $8,619,000 for Aging and Disability Resource Centers (ADRCs), which is equal to the fiscal year 2024 enacted level. These centers provide information, counseling, and access for individuals to learn about the services and support options
available to seniors and the disabled so they may retain their independence.
State Health Insurance Assistance Program
The Committee recommends $55,242,000 for the State Health Insurance Assistance Program, which is equal to the fiscal year 2024
enacted level. The State Health Insurance Assistance Program
funds grants to provide Medicare beneficiaries with information,
counseling, and enrollment assistance.

DMWilson on DSKJM0X7X2PROD with HEARINGSParalysis Resource Center
The Committee provides $10,700,000 for the Paralysis Resource
Center, which is equal to the fiscal year 2024 enacted level. The
Paralysis Resource Center offers activities and services aimed atincreasing independent living for people with paralysis and related
mobility impairments, and supporting integration into the physicaland cultural communities in which they live.
Limb Loss Resource Center
The Committee provides $4,200,000 for the Limb Loss Resource
Center, which is equal to the fiscal year 2024 enacted level. The
Limb Loss Resource Center supports a variety of programs andservices for those living with limb loss, including a national peer
support program, educational events, training for consumers andhealthcare professionals, and information and referral services.

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Traumatic Brain Injury
The Committee provides $16,118,000 for the Traumatic Brain Injury program. The Committee provides an increase of $3,000,000
from the fiscal year 2024 enacted level for the State Protection and
Advocacy Systems State formula grants. The program provides
grants to States for the development of a comprehensive, coordinated family and person-centered service system at the State andcommunity level for individuals who sustain a traumatic brain injury.

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Developmental Disabilities State Councils
The Committee provides $81,000,000 for State Councils on Developmental Disabilities, which is equal to the fiscal year 2024 enacted level. This program funds formula grants to States to Developmental Disabilities State Councils, which work to develop, improve, and expand the system of services and supports for people
with developmental disabilities.
The Committee provides not less than $800,000 for technical assistance and training for the State Councils on Developmental Disabilities.
Developmental Disabilities Protection and Advocacy
The Committee provides $45,000,000 for Developmental Disabilities Protection and Advocacy, which is equal to the fiscal year
2024 enacted level. This formula grant program provides funding
to States to establish and maintain protection and advocacy systems to protect the legal rights of persons with developmental disabilities.
The Committee notes that the Supreme Court decision in
Olmstead v. L.C. (1999) held that the Americans with Disabilities
Act (ADA) does not require removing individuals from institutionalsettings when they are unable to handle or benefit from a community-based setting and that the ADA does not require the imposition of community-based treatment on individuals who do not desire it. The Committee notes that actions to undermine and closeintermediate care facilities for individuals with intellectual disabilities may impact some individuals who do not meet the criteria fortransfer to a community-based setting. The Committee encourages
HHS to ensure that programs properly account for the needs anddesires of individuals with disabilities, their families, legal representatives and caregivers, and the importance of affording individuals the proper setting for their care.
The Committee recognizes that the ADA encourages states to administer services for people with Intellectual and Developmental
Disabilities (IDDs) in the most integrated setting appropriate to
the needs of qualified individuals with IDDs. Further, the Committee understands that while center-based work is not appropriate
for every individual with a disability, center-based adult work programs chosen by individuals with severe IDDs and their families
remain a viable choice that can provide dignity and purpose for asignificant percentage of the IDD population. These work and service settings have been determined to be rewarding and appropriateby the individuals and family members directly involved in the decision-making process, and the Committee is concerned that someorganizations receiving funding under the Developmental Disabil-

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ities Assistance and Bill of Rights Act have targeted these setting
for closure. The Committee encourages ACL to encourage stakeholders to coordinate to ensure that individuals with IDDs appropriately suited to participate in center based work programs are
not deprived of the opportunity to do so.
Developmental Disabilities Voting Access for Individuals with
Disabilities
The Committee provides $10,000,000 for Voting Access for Individuals with Disabilities program, which is equal to the fiscal year
2024 enacted level. The Voting Access for Individuals with Disabilities program authorized by the Help America Vote Act provides
formula grants to States ensure full participation in the electoral
process for individuals with disabilities, including registering tovote, accessing polling places, and casting a vote.
Developmental Disabilities Projects of National Significance
The Committee provides $12,250,000 for Developmental Disabilities Projects of National Significance, which is equal to the fiscal
year 2024 enacted level. This program funds grants and contracts
that develop new technologies and demonstrate innovative methods
to support the independence, productivity, and integration of thoseliving with a disability into the community.
University Centers for Excellence in Developmental Disabilities
The Committee provides $43,119,000 for University Centers for
Excellence in Developmental Disabilities, which is equal to the fiscal year 2024 enacted level. The University Centers for Excellencein Developmental Disabilities Education, Research, and Service area nationwide network of independent but interlinked centers, funded via competitive grants, representing a national resource for addressing issues, finding solutions, and advancing research related
to the needs of individuals with developmental disabilities andtheir families.

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Independent Living
The Committee provides $128,183,000 for the Independent Living program, which is equal to the fiscal year 2024 enacted level.
Independent Living programs fund grants to maximize the leadership, empowerment, independence, and productivity of individuals
with disabilities.
National Institute on Disability, Independent Living, andRehabilitation Research
The Committee provides $119,000,000 for the National Instituteon Disability, Independent Living, and Rehabilitation Research(NIDILRR), which is equal to the fiscal year 2024 enacted level.
NIDILRR generates knowledge and promotes its effective use toenhance the abilities of people with disabilities to perform activitiesof their choice in the community and to expand society’s capacity
to provide full opportunities for its citizens with disabilities.
The Committee continues to support the Traumatic Brain Injury
Model Systems National Data and Statistical Center at no lessthan the fiscal year 2024 enacted level.

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Assistive Technology
The Committee provides $40,000,000 for Assistive Technology(AT), which is equal to fiscal year 2024 enacted level. AT supports
programs providing formula grants to States for addressing AT
needs of individuals with disabilities. The goal is to increase awareness of and access to AT devices and services that may help witheducation, employment, daily activities, and inclusion of people
with disabilities in their communities.
The Committee continues to provide $2,000,000 for competitive
grants to support existing and new alternative financing programs
that provide for the purchase of AT devices.
Program Administration
The Committee provides $49,063,000 for Program Administration, which is an increase of $1,000,000 from the fiscal year 2024
enacted level. This funding supports Federal administrative costs
associated with administering ACL’s programs.
ADMINISTRATION FOR STRATEGIC PREPAREDNESS AND RESPONSE

DMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$3,634,606,000
3,768,088,000
3,630,597,000¥4,009,000¥137,491,000

This account supports the activities of the Administration for
Strategic Preparedness and Response (ASPR) to prevent, prepare
for, and respond to the health consequences of chemical, biological,
radiological, and nuclear threats and other public health emergencies, including pandemic influenza. ASPR is responsible for coordinating national policies and plans for medical and public healthpreparedness and for administering a variety of public health preparedness programs.
Active Pharmaceutical Ingredients.—The Committee remains concerned that the U.S. is dependent on foreign sources for criticalraw materials and manufacturing of essential medicines, including
antivirals. The Committee is aware of the need to onshore criticalraw materials and invest in companies through public-private partnerships for domestic manufacturing of essential medicines. Therefore, the Committee encourages ASPR to prioritize funding for companies that are investing in domestic manufacturing of medicines,
especially products dependent on China for sourcing of raw materials. Additionally, within 180 days of enactment of this Act, theCommittee directs ASPR to provide a report to Committee on the
progress of onshoring investments to establish a resilient domestic
supply chain for medicines, including antivirals.
Domestic Antibiotic Manufacturing.—The Committee recognizes
the importance of the domestic pharmaceutical industrial base andthe need to mitigate risks to the U.S. pharmaceutical supply chain,
which is heavily reliant on foreign suppliers for critical drugs andactive pharmaceutical ingredients, including generic antibiotics.
Therefore, the Committee encourages ASPR, in coordination with
the Secretary of Defense, to jointly implement a plan to evaluate
the end-to-end supply chain for the biomanufacturing of fermentation-based essential antibiotics to ensure necessary domestic manufacturing capacity.

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176
Essential Medical Devices.—The Committee supported BARDA’s
investments to accelerate the expansion of domestic manufacturing
capacity for ancillary supplies like needles and syringes during the
COVID pandemic. However, to continue to ensure Americans havethe essential medical devices necessary, the Committee encourages
a more concerted effort to shore up domestic production and the
U.S. supply chain. The Committee encourages the Office of Industrial Base Management and Supply Chain (IBMSC) to advance programs and policies that preserve and protect U.S. based manufacturing for essential medical devices.
Interagency Alignment of Biomedical Countermeasures Researchand Development.—The Committee has prioritized investments inresearch and development of biodefense medical countermeasures
to better prepare our country to detect and respond to biologicalthreats. While funding for such priorities currently is allocated todifferent HHS agencies based on their missions and areas of expertise, the Public Health Emergency Medical Countermeasures Enterprise Advisory Committee (PHEMCE) is responsible for ensuring
the alignment of medical countermeasures requirements, priorities,
and projects across these agencies. To improve alignment and efficiency of research and development activities, the Committee directs ASPR to establish a formal mechanism to identify and track
the alignment of medical countermeasure research and development programs of each relevant agency, while tracking themagainst prioritized national biodefense countermeasure needs to ensure the end-to-end development of needed products, technologies,
or platforms; track previous and future transitions of development
projects between agencies to ensure seamless and properly
resourced end-to-end development programs; and identify areas ofcontinually unmet research and development needs. The Committee encourages ASPR to coordinate with the Departments of Defense, Energy, and Homeland Security regarding similar researchand development programs.
The Committee further encourages ASPR to prioritize researchand development programs that focus on early-stage development
and innovative platform-based technologies that can yield multiple
products to address multiple threats. Finally, the Committee directs ASPR to make public relevant information on HHS-funded research and development programs, including development stages
and target disease area. The Committee directs ASPR to provide areport on the status of this effort within 180 days of enactment of
this Act and to include such information in the fiscal year 2026
congressional justification.
Interagency Coordination.—The Committee encourages ASPR, in
coordination with DOD, to provide technical expertise to FDA’s
Center for Biologics Evaluation and Research, as they further countermeasures for combatting emerging pathogens.
Neglected Tropical Diseases.—The Committee is aware of the increasing prevalence of neglected tropical diseases (NTDs) in the
U.S. and the staggering global burden of these threats across theglobe and is encouraged by the granting of more than 11 priority
review vouchers for new NTDs interventions. Considering the magnitude of the NTD threat, the Committee directs ASPR to provide
a report within 180 days of the enactment of this Act addressing
whether additional incentives to redress market failures hindering

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177
antimicrobial innovation, are needed to stimulate NTD researchand development. Such report shall be made available on the agency’s website.
Multiyear Budget.—The Committee notes that 42 U.S.C. 300hh–
10 requires annual updates to the PHEMCE multiyear budget. The
Committee appreciates the timely delivery of the fiscal year 2025
multiyear budget. The Committee continues to direct ASPR to notify the Committee 14 days in advance of any anticipated delay.
Public Health Emergency Medical Countermeasures Enterprise
Advisory Committee.—The committee recognizes effective publicprivate partnerships are the best way to support our nation’s preparedness and response capabilities, as these private sector partners are the primary developers of critical medical countermeasures (MCMs) such as diagnostics, therapeutics, and vaccines
which have no commercial market. The Committee notes with concern that the PHEMCE, which is chaired by ASPR, has not established an advisory committee incorporating private sector and nonFederal partners and stakeholders despite recommendations from
Congress and NASEM. The Committee encourages ASPR to establish this advisory committee with urgency to ensure timely andtransparent communication with the government’s private sector
partners.
Rapid Detection of Bioterrorism Agents.—The Committee is concerned that the nation is not prepared to rapidly detect biologicalagents, such as anthrax, tularemia, melioidosis, glanders, andplague, even though Biomedical Advanced Research and Development Authority (BARDA) has successfully supported development
of diagnostic technologies that detect such biothreats, in some cases
simultaneously. The Committee encourages ASPR, in coordination
with CDC, to prioritize partnerships with domestic manufacturers
capable of producing rapid diagnostics that can detect such threats
and develop a diagnostic testing preparedness plan for use during
public health emergencies, disasters, and other serious publichealth threats.
Reporting.—The Committee directs ASPR to brief the Committee
monthly regarding activities funded by this Act and other available
appropriations. The agency is directed to notify the Committee atleast 24 hours in advance of any obligation greater than
$25,000,000 from any appropriation available to ASPR. Such notification is directed to include the source of funding, including the applicable legislative citation, and a description of the obligation. In
addition, ASPR is directed to submit a monthly obligation report inelectronic format summarizing the details of these obligations to
the Committee. ASPR is further directed to provide the report nolater than 30 days after the end of each month and it is directed
to be cumulative for the fiscal year with the most recent obligations
listed at the top.
Strengthening Domestic Manufacturing and Production.—The
Committee appreciates efforts by ASPR to expand upon the domestic industrial base to end the reliance on foreign-sourced medical
equipment, personal protective equipment (PPE), diagnostic tests,
medical devices, and to secure the pipeline for critical medicines,
including antibiotics, such as through the National Biopharmaceutical Manufacturing Partnership (BioMaP) and Industrial Base
Expansion. The Committee encourages IBMSC to use available

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funds to continue and expand ongoing work to build and validate
advanced manufacturing processes and facilities capable of storing,producing, and deploying essential medicines in the event of a national health emergency. Further, the Committee encourages
IBMSC to seek opportunities to expand domestic manufacturing facilities with end-to-end capabilities to produce bulk drug substances, support platform technologies for MCMs, and provide fillfinish capacity. The Committee encourages ASPR to use available
funds to support manufacturers in building, expanding, upgrading,modifying, and, if necessary, recommissioning facilities in the U.S.
to increase manufacturing capacity of critical medicines or their active pharmaceutical ingredients.
The Committee directs ASPR to brief the Committees on Appropriations of the House of Representatives and the Senate, the Committee on Energy and Commerce of the House of Representatives,
and the Committee on Health, Education, Labor, and Pensions of
the Senate within 180 days of enactment of this Act, with an update on IBMSC efforts including programs, projects, and activities
underway designed to ensure appropriate domestic supply, including domestic manufacturing, of essential medical equipment, PPE,
diagnostic tests, medical devices, and critical medicines.
Vaccine Manufacturing.—The Committee recognizes the potential
benefits of developing innovative continuous vaccine manufacturing
processes and technology. The Committee encourages ASPR to support research in developing continuous downstream purification
processes including two aqueous two-phase extraction steps as necessary.
RESEARCH, DEVELOPMENT, AND PROCUREMENTDMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$3,135,000,000
3,082,991,000
3,277,991,000+142,991,000+195,000,000

Biomedical Advanced Research and Development Authority
The Committee includes $1,100,000,000 for the Biomedical Advanced Research and Development Authority, which is $85,000,000
above the fiscal year 2024 enacted level and $130,000,000 above
the fiscal year 2025 budget request. BARDA supports the advanced
development of vaccines, therapeutics, diagnostics, and devices forpotential serious public health threats, including chemical, biological, radiological, and nuclear threats, pandemic influenza, andemerging and re-emerging infectious diseases. The Committee supports ASPR’s ongoing work to build and validate advanced manufacturing processes and facilities capable of storing, producing, anddeploying essential medicines in the event of a national healthemergency.
Antifungal Research and Development.—The Committee continues to support the research and development of novel antifungal
therapies, particularly for multi-drug resistant fungal pathogens, tobolster national health security and minimize their impact on public health. Antifungal development faces similar challenges to antibacterial development and BARDA’s Advanced Research and Development program support will be critical to generate additional
antifungal products, including for endemic fungal diseases, like

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179
Valley Fever. In addition, the Committee encourages the Secretary
to update the scope of support for the CARB–X program to include
pathogens listed in the 2019 CDC Antibiotic Resistant Threats report, which includes products that target fungal pathogens. The
Committee requests a report within the 180 days of the date of enactment of this Act on actions taken.
Acceleration of Antibiotic Combination Drug Development.—The
Committee is concerned about the increasing public health threatof antimicrobial resistance and the lack of new antibiotics entering
the market. The Committee is encouraged that BARDA has invested in combination antibiotic drug development for both oral
and intravenous administration. Therefore, the Committee encourages BARDA to continue to prioritize the development of combination drugs, particularly those with activity against CDC urgent
threat pathogens which can offer increased efficacy, reduced costs,
and reduce the emergence of AMR infections.
Antimicrobial Resistance.—The Committee continues to support
advancedresearchanddevelopmentofbroad-spectrum
antimicrobials, particularly for multi-drug resistant pathogens, andnext-generation therapeutics that address the increasing incidenceof antimicrobial resistance, including Combating Antibiotic-Resistant Bacteria Biopharmaceutical Accelerator (CARB–X).
Chemical, Biological, Radiological, and Nuclear Threats.—The
Committee notes with concern the elevated risk posed by chemical,
biological, radiological, and nuclear (CBRN) weapons across theglobe and provides robust funding for BARDA’s core national security mission to protect Americans against these deliberate, manmade threats. The Committee directs ASPR to provide, within 180
days of enactment of this Act, a report on the Rapid Response Partnership Vehicle (RRPV). The Committee encourages ASPR andBARDA to engage more frequently with private sector partners via
the RRPV process to ensure adequate prioritization, timely development of new MCMs and stockpiling of existing MCMs against
CBRN threats.
Drug Resistant Tuberculosis.—Drug resistant TB is identified asa serious threat level pathogen to the U.S. by CARB–X. As drug
resistant TB cases are on the rise globally, the threat to the U.S.
also grows and BARDA’s investment in new TB diagnostics, drugs,
and vaccines is critical. The Committee directs ASPR to provide abriefing on BARDA’s investments in drug resistant diseases including TB within 180 days of the enactment of this Act.
Infectious Disease Outbreaks with Pandemic Potential.—The
Committee supports robust funding for BARDA to engage in publicprivate partnerships to support advanced research and development of innovative platform technologies and medical countermeasure programs focused on vaccines, therapeutics, and othermedical countermeasures for emerging infectious diseases, including novel pathogens and viral families with pandemic potential.
The Committee encourages ASPR to prioritize the identificationand development of promising technologies that can be leveraged
to address a range of future pathogens, including virus families
with significant pandemic potential.
Pathogen Reduction Technologies.—The Committee urges
BARDA to continue investments in red blood cell pathogen reduction technology to ensure the completion of urgently needed nucleic

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acid targeted pathogen reduction technology to significantly improve red blood cell transfusion safety for all blood products in thenation’s blood supply.
Pharmaceutical Platform Technologies.—The Committee encourages BARDA to support the research, development, and facilitationof pharmaceutical platform technologies. The Committee notes that
platform technologies supported by strong data production andcomputer power provide flexible systems for the discovery of novelcures at a much faster rate and a lower cost than traditional pharmaceutical discovery processes across a broad array of disease targets. Furthermore, the Committee recognizes the potential for machine learning, artificial intelligence, and high throughput systems
to improve the development of foundational models. The Committee
encourages BARDA to partner with domestic entities to bolster domestic capacity to respond to a variety of new threats more efficiently in the future.
Radiological and Nuclear Threats.—The Committee supports
BARDA’s effort to develop MCMs effective against radiological andnuclear threats and encourages BARDA to support innovative
radioprotective technologies to enhance the nation’s preparedness
and response capabilities by supporting the advancement of novel
therapeutic agents that mitigate the effects of radiation exposure.
Sustainable Blood Supply and National Blood Response Capability.—The Committee remains concerned regarding the continued
vulnerability of the blood supply after the peak COVID shortages
and receiving the report from the HHS Advisory Committee on
Blood and Tissue Safety and Availability. That report indicatedthat, ‘‘the continued availability of a robust blood supply faces significant threats and challenges in the current environment,’’ andrecommended the ‘‘implementation of new technologies to improve
the safety and reliability of the blood supply.’’ The Committee encourages BARDA to meet its strategic objective of developing next
generation blood products by including products that can be usedregardless of the patient’s blood group, expand availability to all
hospitals, prevent shortages, and are suitable for use throughout
the continuum of care, including first responders. The Committee
encourages ASPR to rapidly expand the development of freezedried hemostatic products, especially platelet-derived products, toinclude a wide range of indications encompassing treatment ofhemorrhagic disease, use in general surgery, obstetrics and trauma.
Strengthening Domestic Supply Chain Resiliency.—The Committee appreciates ASPR taking steps to strengthen our nation’s
medical countermeasure enterprise, including through BioMaP and
BARDA’s Pharmaceutical Countermeasures Infrastructure (PIC)
Division, and supports efforts to expand domestic manufacturing
infrastructure for medical countermeasures. Given the global nature of certain clinical research, development, and manufacturing
activities, it is critical for BARDA to strengthen, expand, and makeprogress in onshoring these programs. Within 180 days of enactment of this Act, ASPR is directed to brief the Committee on
ASPR’s fiscal year 2025 plans to support the onshoring of medical
countermeasure development activities, including actions taken by
BioMAP and PIC.

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DMWilson on DSKJM0X7X2PROD with HEARINGS

Project BioShield
The Committee provides $850,000,000 for Project BioShield,
which is $25,000,000 above the fiscal year 2024 enacted level and$30,000,000 above the fiscal year 2025 budget request. These funds
support the acquisition of promising medical countermeasures developed through BARDA contracts for the most serious publichealth threats.
Strategic National Stockpile
The Committee provides $1,000,000,000 for the Strategic National Stockpile, which is $20,000,000 above the fiscal year 2024
enacted level and $35,000,000 above the fiscal year 2025 budget request.
Addressing
Domestic
Personal
Protective
Equipment
Purchasing.—The Committee recognizes the COVID pandemic
highlighted both the vulnerability and necessity of maintaining arobust domestic supply of PPE. It is critical the U.S. maintain arobust domestic production base. Doing so is vital for both the national security interests and protection of public health in the faceof international infectious disease threats. The Committee strongly
recommends ASPR allocate not less than 10 percent of the budgetof the Strategic National Stockpile (SNS) for the purchase of domestically manufactured personal protective equipment. In addition, the Committee directs ASPR to submit a report within 90
days of enactment of this Act for all PPE purchases for the priorfiscal year and current levels of each type of PPE in the SNS, including expiry dates.
The Committee includes a new provision prohibiting ASPR frompurchasing MCMs from Chinese owned company.
Antimicrobial Resistance Class Review.—The Committee encourages the ASPR, in coordination with FDA and CDC, to implementa review system to regularly assess the safety, efficacy, and vulnerability to antimicrobial resistance of existing SNS assets that could
be used to respond to CBRN and public health threats and to support efforts to maintain an inventory of medical countermeasuresappropriate to respond to the continued evolution of antimicrobial
resistant organisms.
Guidance to States.—The Committee recognizes that SNS focuses
on chemical, biological, radiological, and nuclear threats, and therefore the Committee supports States’ efforts to secure appropriate
drugs, vaccines, and other biological products, medical devices, andother medical supplies necessary to respond to a public healthemergency or a major disaster. The Committee recognizes the importance of guidance to States on how best to establish, expand,procure, replenish, maintain, and manage their own State stockpile, while ensuring appropriate collaboration with the SNS. ASPR
is directed to provide a briefing to the committees of jurisdiction
within 180 days of enactment of this Act on guidance and technicalassistance related to State stockpiles.
Influenza MCM Diversification.—The Committee remains concerned about the perennial threat of pandemic influenza, which
could be exacerbated by expiring antivirals in the Strategic National Stockpile. The Committee strongly urges HHS to diversify
and replenish its stockpile of emergency influenza antivirals to en-

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182
sure the nation has multiple current treatment options in the eventof an influenza pandemic.
Pending Product Expiration.—The Committee directs ASPR toprovide a report within 180 days of enactment of this Act, regarding agency awareness, planning, and utilization of products thathave expired or will expire within 18 months.
Persistent Procurement Challenges.—The Committee is concerned
about the Strategic National Stockpile’s procurement process thathas been mired by successful bid protests, repeated unanswered
sources sought notices, and misuse of sole source awards under
GAO determined faulty pretexts. The Committee has invested inefforts to bolster that nation’s medical countermeasure preparedness against health security threats, especially for those chemical,
biological, radiological, and nuclear countermeasures that lack a
traditional marketplace. The Committee directs ASPR to have an
independent outside audit performed to improve the procurement
process and align strategic preparedness with CBRN threats. The
Committee further directs ASPR to provide a briefing on the implementation of this directive within 180 days of the enactment of thisAct.
Poxvirus Countermeasures.—The Committee notes that Administration decisions, including the decision to ship vaccine oversees,
has depleted medical countermeasures that were previously developed, purchased, and stockpiled for domestic smallpox preparedness. The Committee is concerned there may now be an insufficient
supply of poxvirus vaccine for immunocompromised individuals aswell as poxvirus treatments in the stockpile, especially considering
the continued national security threat of an intentional or accidental release of smallpox. Therefore, the Committee encourages
ASPR to prioritize replenishment of medical countermeasures usedduring the monkey pox outbreak and directs ASPR to provide abriefing within 90 days of the date of enactment of this Act on thestockpiling requirements for poxvirus vaccine.
Shelf-Life Extension Program.—The Committee acknowledges thebenefits of the Shelf-Life Extension Program (SLEP) and takes into
consideration public skepticism of certain countermeasures in the
program. In the annual SNS threat-based review, the Committee
encourages ASPR to include the quantity of each countermeasurethat is beyond 10 years of the initial FDA expiration date and thenumber of these aged products in the SLEP program that have no
industry sponsor.
Security Countermeasures Modeling.—The Committee believes
that robust quantitative modeling tools will help ensure ASPR isaddressing the most significant threats to national security and implementing the most impactful and cost effective solutions. To build
quantitative and economics analytics and modeling capabilities
that effectively evaluate medical countermeasure programs, theCommittee directs ASPR to provide a detailed analysis of the resources required and their potential deployment in the fiscal year
2026 congressional justification.
SNS Requirements.—The Committee notes with concern the
Medical Countermeasure Preparedness Report, submitted to Congress as part of the required annual threat based review of SNS,found that SNS has not maintained adequate supplies of many
medical countermeasures to reflect requirements established by

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PHEMCE. In addition, GAO has recently upheld multiple bid protest decisions evidencing a concerning lack of quality control in thecontract solicitation and review process. Therefore, the Committee
directs ASPR, within 180 days of the enactment of this Act, to provide a report on processes put in place to better ensure adherence
to all Federal contracting requirements.
Thermal Radiation Burns.—The Committee notes ASPR has the
responsibility of developing and procuring MCMs for naturally occurring and intentional threat agents while ensuring that these arequickly available in the event of an emergency, and that thesethreats include nuclear and radiological events. The Committee encourages ASPR to ensure that an appropriate supply of these
MCMs are available.
Warm Base Manufacturing for Diagnostics.—The Committee remains concerned the COVID pandemic has demonstrated the need
for warm base manufacturing to ensure access to necessary
diagnostics in the event of a future pandemic. The Committee encourages ASPR to continue to support the investments for testing,supply chain, and surge capacity for U.S. diagnostic manufacturing
to maintain U.S. readiness and future preparedness. Further, theCommittee encourages ASPR to promote policies for flexible contracting to improve public health.
Pandemic Influenza Preparedness
The Committee includes $327,991,000, for the pandemic influenza preparedness program. This funding supports efforts to modernize influenza research and development of vaccines and preparedness testing and evaluation, as well as critical domestic vaccine manufacturing infrastructure.
The Committee encourages ASPR to support the development ofpandemic influenza therapeutics and vaccines to ensure a robust
pipeline of influenza countermeasures.
OPERATIONS AND EMERGENCY RESPONSE

DMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$499,606,000
685,097,000
352,606,000¥147,000,000¥332,491,000

Office of Administration & Preparedness and Emergency Operations
The Committee includes $80,407,000 for activities within the Assistant Secretary’s Immediate Office; the Office of the Chief Operating Officer; the Office of Acquisitions Management, Contracts,
and Grants; the Office of Financial Planning and Analysis; and for
Preparedness and Emergency Operations. The Preparedness andEmergency Operations account also funds the Office of Emergency
Management, which supports a full spectrum of emergency management responsibilities, including planning, coordination, logistics,
training, and responding to planned events and unplanned incidents.
Addressing Emergency Medical Services Workforce Shortages andReadiness.—The Committee is keenly aware of the significant challenges the emergency medical services (EMS) community faces.
Across the Federal government, there are a host of resources available to assist public, private, and nonprofit EMS agencies. Within

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180 days of enactment of this Act, the Committee directs ASPR, in
consultation with SAMHSA and the National Highway Traffic
Safety Administration, to provide an overview of its resources
available to address EMS readiness and workforce shortages; any
actions taken to address EMS readiness and the workforce shortage; and recommendations on what additional resources and authorities are necessary to support EMS and community access toemergency healthcare services. Such overview shall be made available on the agency’s website.
Healthcare and Public Health Sector Cybersecurity Performance
Goals.—The Committee notes its significant concerns with cybersecurity threats to the healthcare and public health sector and urges
HHS to rapidly roll out its proposed program to support the implementation of essential cybersecurity performance goals.
Supply Chain Control Tower.—The Committee recognizes the potential value of the Supply Chain Control Tower (SCCT) program,a voluntary collaboration between industry partners and ASPR, toprovide end-to-end visibility for supply chain monitoring and readiness. In addition to providing insights for demand and supply forecasting, the Committee encourages ASPR to coordinate with FDA
and CDC to use SCCT to monitor the availability of a broader listof essential health and medical products.

DMWilson on DSKJM0X7X2PROD with HEARINGSNational Disaster Medical System
The Committee provides $76,904,000 for the National Disaster
Medical System (NDMS). NDMS deploys trained medical, mortuary, and veterinarian teams to communities impacted by publichealth and medical emergencies due to natural and manmade incidents. The Committee provides no funding for next generation air
equipment.
Mission Zero.—The Committee provides $4,000,000, for civilian
trauma centers to train and incorporate military trauma care providers and teams into care centers, the same as the fiscal year
2024 enacted level.
Pediatric Disaster Care.—The Committee provides $7,000,000 for
the pediatric disaster care program, the same as the fiscal year
2024 enacted level.
Hospital Preparedness Program
The Committee provides $185,055,000 for the Hospital Preparedness Program (HPP) formula grants, which is $120,000,000 below
the fiscal year 2024 enacted level and $132,000,000 below the fiscal
year 2025 budget request. HPP supports a variety of programs tostrengthen the preparedness and response of the health care sector.
Due to funding constraints, the Committee reduces funding for thisprogram.
Emergency Medical Service Preparedness and Response.—The
Committee encourages ASPR to clarify the extent to which the hospital preparedness program can better integrate emergency medical
service operations, including both governmental and nongovernmental emergency medical services, into regional health care coalitions.
National Special Pathogen System.—The Committee provides$28,500,000 for the National Special Pathogen System which is thesame as the fiscal year 2024 enacted level.

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National Emerging Special Pathogens Training and Education
Center.—The Committee provides $7,500,000 for the National
Emerging Special Pathogens Training and Education Center.
Regional Emerging Special Pathogen Treatment Centers.—The
Committee provides $21,000,000 for Regional Emerging Special
Pathogen Treatment Centers program and Special Pathogen Treatment Centers.
Medical Reserve Corps
The Committee provides $6,240,000 for the Medical Reserve
Corps, which is the same as the fiscal year 2024 enacted level andthe fiscal year 2025 budget request.
Preparedness and Response Innovation
The Committee provides $4,000,000, which is the same as the fiscal year 2024 enacted level and $4,000,000 above the fiscal year
2025 budget request, for a bilateral cooperative program with theGovernment of Israel for the development of health technologies.
In the fiscal year 2026 congressional justification the Committee
requests an update on the investments this funding has produced
since the program’s inception.
OFFICE OF THE SECRETARY
GENERAL DEPARTMENTAL MANAGEMENT (GDM)

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$710,955,000
607,434,000
467,164,000¥223,791,000¥120,270,000

Of the funds provided, $58,028,000 shall be derived from evaluation set aside funds available under section 241 of the PHS Act,
which is $6,800,000 less than fiscal year 2024 enacted level and$16,466,000 below the fiscal year 2025 budget request.
This appropriation supports activities that are associated with
the Secretary’s roles as policy officer and general manager of the
Department of Health and Human Services (HHS). The Office of
the Secretary also implements administration and Congressional
directives, and provides assistance, direction, and coordination to
the headquarters, regions, and field organizations of the department. In addition, this funding supports the Office of the Surgeon
General and several other health promotion and disease prevention
activities that are centrally administered.
Within the total provided for GDM, the Committee provides notless than the following amounts:
FY 2024
EnactedDMWilson on DSKJM0X7X2PROD with HEARINGS

Budget Activity

Children’s Interagency Coordinating Council ..............................................................
Embryo Adoption ..........................................................................................................
Interagency Coordinating Committee on the Promotion of Optimal Birth Outcomes
KidneyX ........................................................................................................................
LymeX ...........................................................................................................................
Stillbirth Working Group ..............................................................................................

FY 2025
Committee$3,000,000
1,000,000
2,000,000
5,000,000
5,000,000
1,750,000$3,000,000
2,000,000
2,000,000
5,000,000
5,000,000
1,750,000

Advisory Council on Alzheimer’s Research, Care, and Services.—
The bipartisan National Alzheimer’s Project Act (P.L. 111–375) re-

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186
quires the Secretary of HHS, in collaboration with the Advisory
Council on Alzheimer’s Research, Care, and Services (Advisory
Council), to create and maintain an annually updated National Alzheimer’s Plan. The Committee supports efforts to establish the Advisory Council as outlined. The Advisory Council, made of bothFederal members and expert non-Federal members, is an integral
part of the planning process as it advises the Secretary in developing the annual National Alzheimer’s Plan, makes recommendations to the Secretary and Congress, and assists in coordinating thework of Federal agencies involved in Alzheimer’s research, care andservices.
Artificial Intelligence Mammography.—The Committee is awareof the growing use of artificial intelligence (AI) in breast cancer
screening and wants to ensure transparency in the use of AI andthat such use of AI does not inadvertently exacerbate health disparities in breast cancer due to algorithms based on narrow data
sets and lack of standardization. The Committee urges HHS toprioritize transparency in the use of AI by ensuring that patientsare notified on their written report if their mammogram is analyzed using AI-assisted technology. The Committee also urges the
NIH to support research to help validate the use, scaling, and outcomes of AI in breast cancer screening. The Committee requests an
update on this topic in the fiscal year 2026 congressional justification.
Bill Wide Requirements.—The Committee notes the inclusion ofa bill wide requirements section of this report. This section contains requirements which apply to all agencies funded by this Act.
Biomarkers.—The Committee is pleased with the progress madein precision medicine with the creation of tests that examine biomarkers to guide clinical decisions. This advancement holds potential for improving clinical trials and speeding up the creation of
new treatments for patients requiring them. The Committee requests HHS to provide an update on the Department’s work towards promoting and incorporating precision medicine tools into
the healthcare system in the fiscal year 2026 congressional justification.
Brain Aneurysms.—The Committee recognizes that although 1 in
50 Americans have a brain aneurysm, there are typically no warning signs or symptoms unless they rupture. Currently, up to 50
percent of patients will not survive such a hemorrhage. Even when
an aneurysm has ruptured, the symptoms are not widely known
among healthcare professionals, such as first responders and emergency room physicians. The Committee reiterates the language provided in fiscal year 2019 (H. Rept. 115–862 and S. Rept. 115–289)
which directed the Secretary, in consultation with appropriate
stakeholders—including healthcare providers (e.g., neurosurgeons,neurologists, neuro-interventional surgeons, emergency physicians),brain aneurysm patient advocacy foundations, brain aneurysm survivors, and caregivers—to facilitate the development of best practices on brain aneurysm detection and rupture for first responders,emergency room physicians, primary care physicians, nurses, andadvanced practice providers. In doing so, the Committee encourages the Secretary to consider incorporating topics including, but
not limited to, the symptoms of brain aneurysms, evidence-basedrisk factors for brain aneurysms, appropriate utilization of medical

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187
testing and diagnostic equipment, and screening recommendations.
The Secretary is urged, in consultation with appropriate stakeholders, to develop a strategy for disseminating information about
the best practices and begin implementation.
Child Cancer Survivorship.—The Committee urges the Secretary
to convene a stakeholder group to develop best practices to improvesurvivorship care as children and adolescents transition from active
oncological care to primary care. The stakeholder group will evaluate the best mechanisms and practices for every childhood cancer
survivor to receive a comprehensive care summary and follow-up
plan, based on guidelines, once they complete their cancer care.
The Committee directs the Secretary to make a report publicly
available online within 180 days of the date of enactment of thisAct based on the stakeholder group’s recommendations.
Children’s Interagency Coordinating Council.—The Committee
continues to include $3,000,000 for the Children’s Interagency Coordinating Council and supports the continued partnership between the Assistant Secretary for Planning and Evaluation and
NASEM.
Cognitive Decline and Dementia.—The Committee encourages the
Department of Health and Human Services to identify and implement a comprehensive set of actions that assesses risk, reserve,
and resilience factors for cognitive decline and dementia, with anemphasis on historically underserved communities. Actions should
include: conducting health risk assessments, such as the detectionof cognitive impairment included as part of the Medicare Annual
Wellness Visit; identifying opportunities to address cognitive
strength and possible risk for cognitive decline and dementia by addressing known factors, including patient and provider education;offering reimbursement incentives to providers to promote cognitiveand brain health; providing payments for prevention and care delivery models that incorporate cognitive and brain health as partof care and treatment of other conditions that may modify dementia risk, reserve, and resilience; and developing and implementing
quality measures specifically related to cognitive and brain health.
Creative Arts Therapies and Mental Health.—The Committee
supports continued collaboration between HHS and the National
Endowment for the Arts to better understand the role of creativearts therapies in addressing mental health, including for youth andother vulnerable populations, drawing on the NEA’s successful Creative Forces program in partnership with the Department of Defense.
Cybersecurity Threats in Grantmaking.—The Committee strongly
urges the Department to adopt more proactive measures tostrengthen its cybersecurity infrastructure against the ever-evolving threat of social engineering attacks. As the custodian of vast repositories of sensitive data, HHS is a prime target for malicious actors seeking to exploit system vulnerabilities. Implementing training programs to educate staff about the tactics employed in social
engineering attacks, as well as bolstering technological defenses,
are crucial steps in safeguarding HHS’ systems. Moreover, HHS isurged to maintain robust communication channels with other Federal grant-making agencies to promptly alert them of cybersecurity
incidents that may put their systems at risk. The Committee urges
an interagency collaborative approach to create a shared defense

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for grant-making agencies and their IT systems, enabling them toshare insights quickly and effectively, and fortifying their defenses
against ongoing cybersecurity threats.
Drug Shortages.—The Committee notes that prescription drug
shortages persist as a pressing issue across various treatment categories. While previous efforts have examined the frequency ofthese shortages, there remains a gap in understanding their full
impact on consumer expenses and the healthcare system. Increased
out-of-pocket expenses, elevated insurance premiums, and compromised health outcomes can result if shortages are not addressed. The Committee urges ASPE to research options to address
drug shortages.
In addition, the Committee notes that certain generic drugs haveconsistently made up most drugs in a shortage, and that the lowest
cost generics are often the most impacted. Additionally, some shortages have lasted for years, and in some cases have risen to theirhighest levels in a decade. The Committee is concerned about these
persistent generic drug shortages, particularly impacting genericsterile injectables, which include cancer drugs, emergency medicines, and anesthesiology medications. Accordingly, the Committee
directs HHS to provide a report to the Committee and to post ona publicly available website no later than 180 days after enactmentof this Act examining how payment policy can impact the supply
chain, including economic dynamics that influence market stability
for generic drugs.
Electric Vehicle.—The Committee does not include funding for a
new electric vehicle program.
Embryo Adoption Awareness Campaign.—The Committee increases funding for the Embryo Adoption Awareness Campaign to
educate Americans about the existence of frozen human embryos(resulting from in-vitro fertilization), which may be available fordonation/adoption to help other couples build their families. The
Committee includes bill language permitting these funds also to be
used to provide medical and administrative services to individuals
adopting embryos, deemed necessary for such adoptions, consistent
with the Code of Federal Regulations.
Federal Poverty Guidelines.—The Committee directs HHS to include in its fiscal year 2026 congressional justification information
on how the agency calculates and determines the Federal poverty
guidelines, most recently published by the Department in the Federal Register on January 19, 2023 (88 Fed. Reg. 3424). Additionally, the Committee directs HHS to make publicly available on its
website no later than 90 days after enactment of this Act, a list of
all Federal means tested public benefit programs, within the jurisdiction of the Department, that utilize such guidelines for eligibility
determination or for purposes of or determining the allocation ofFederal funds to state or local grantees.
Food as Medicine.—The Department developed a Food as Medicine initiative in response to direction from the Committee in fiscal
year 2023. The Committee includes $3,000,000, an increase of$1,000,000 above the fiscal year 2024 enacted level, to continue theFood as Medicine pilot program, an integrative model for
healthcare that uses healthy, nutritious, and affordable foods toprevent, treat, and manage chronic conditions to advance health.
As part of the pilot program, the Department will need to better

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understand challenges and opportunities to advance Food as Medicine models. The Committee urges HHS to include in its annual reports details on how community pharmacies may be able to play a
critical role in the Food as Medicine approach, specifically how they
can help improve nutrition-related outcomes and prevent chronic
diseases. These reports should also be posted on the agency’s
website.
Global Health Research.—The Committee requests an update in
the fiscal year 2026 congressional budget justification on how CDC,
FDA, BARDA, NIH—including the Fogarty International Center—and other agencies jointly coordinate global health research activities with specific metrics to track progress and collaboration toward
agreed upon health goals.
Highly Pathogenic Avian Influenza.—The Committee notes the
Department’s response to the outbreak of avian influenza among
cattle in multiple states including transmission to humans in Texas
and Michigan. Within 30 days of the enactment of this Act, theCommittee directs the Department to publicly release a report on
the Department’s response to the outbreak detailing the Department’s response including State requests for assistance from CDC
and ASPR. The Department is further directed to detail State andcommunity requests for supplies from the strategic national stockpile.
Hospital Acquired Pneumonia.—The Committee notes concern
with the current rate of non-ventilator hospital acquired pneumonia (NVHAP) with a recent study of over six million hospital admissions finding that NVHAP may account for 1 in 14 hospital
deaths. Regular oral care during inpatient stays might help prevent such incidents according to results from the Department of
Veterans Affairs (VA) Hospital-Acquired Pneumonia Prevention by
Engaging Nurses initiative that has been implemented at every VA
medical center in the nation and showed declines in NVHAP of 40
to 60 percent. The Committee urges the Secretary to prioritize theprevention of NVHAP, including by working with CDC and CMS
to review such health system initiatives and, building off CDC’s recently issued Oral Health in Healthcare Settings to Prevent Pneumonia Toolkit, establish a concrete plan to reduce the prevalence
and associated patient harm from this potentially preventable hospital-acquired condition.
Hospital Closures.—The Committee is deeply concerned with theaccelerated rate of community hospital closures and the impact ofclosures on access to health care for vulnerable patient populations.
The Committee directs GAO to conduct a study that identifies hospital closures across the U.S. over the last 10 years, the ownershipmodel of each closure, and the impact these closures have had on
health care outcomes for communities. The study shall be completed within 180 days of enactment of this Act.
Interagency Task Force on Improving Access to Treatment for Myopic Children and Myopic Patients in Underserved Areas.—The
Committee urges HHS to establish a task force to improve accessto treatment for myopic children and other myopic patients in underserved areas. Such a task force could identify, evaluate, andmake recommendations regarding best practices with respect tochildren who have been diagnosed as myopic and have been unable
to get access to treatment and ways in which Federal agencies can

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better coordinate with each other in D.C. and through all regional
offices across the country to inform the public regarding treatment
options that are available through Federal programs to underserved patients.
Joint Funding Arrangement.—The Committee continues to direct
the agency to include all amounts assessed from any operating division and the methodology used to determine such amounts.
Laboratory Biosecurity.—The Committee is committed to ensuring improved and comprehensive laboratory biosecurity. Currently,
laboratory biosafety and biosecurity reporting are fractured acrossdifferent agencies and data recorded is not used to create evidencebased biosafety and biosecurity standards. The rapid advancementof biotechnology necessitates a single comprehensive laboratory incident reporting system that is non-punitive (also referred to as‘‘no-fault’’), and which accommodates privacy considerations. Sucha reporting system would collect information on laboratory accidents and near misses to learn from real-world incidents, generating data to develop evidence-based standards for biosafety andbiocontainment. The Committee directs HHS to conduct a deliberative study in consultation with biosafety officers to determine thedesign of such a laboratory incident reporting system. Further, theFederal Select Agent Program (FSAP) is uniquely positioned topilot the laboratory incident reporting system once the study has
been concluded and prior to any department-wide implementation.
Within 1 year of enactment of this Act, the Committee directs HHS
to report on the study results and deliver an FSAP pilot implementation plan.
Lyme and Other Tick-Borne Diseases.—The Committee strongly
encourages the Secretary to establish within the Office of the Assistant Secretary for Health a TBD coordinating office to track,
monitor and provide technical assistance on TBD activities
throughout HHS, including its operating divisions, and to serve as
an HHS-wide facilitator for TBD activities. The coordinating officewould be able to monitor and report to the Secretary on implementing the ‘‘National Public Health Strategy to Prevent and Control Vector-Borne Diseases in People.’’ The Committee further encourages such office to establish a program for temporary agency/
stakeholder panels or commissions to address a need or gaps related to TBD goals and objectives in an HHS agency or acrossagencies. The agency/stakeholder panels could consist of a range ofstakeholders, similarly to the TBD working groups, except on asmaller scale, to operate for a short period of time, e.g., 120 days,
to address a particular need or gap in the TBD knowledge base or
TBD activity. The overarching purpose is to facilitate transitioning
products to patients, health care practitioners, researchers, academia—including Vector-Borne Diseases (VBD) Centers of Excellence, industry, State, and local governments. In addition, the Committee urges the Office of the Secretary and NIH, in consultation
with CDC and FDA, to enter into discussions on the potential benefits of establishing a National Network of Academic Research andClinical Centers of Excellence for Tick-Borne diseases.
Marijuana Research.—The Committee is concerned about reportsof the mental health hazards of regular use of high-potency marijuana, particularly among youth. The Committee encourages HHS
to support research on high-potency marijuana and its effects on

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the adolescent brain, specifically regarding addiction and mental
illness such as schizophrenia or psychosis.
Medically Tailored Meals.—The Committee notes the use of
medically tailored meals (MTMs) and produce prescription programs. MTMs are home-delivered meals tailored to the nutritionneeds of individuals living with severe, complex, and chronic illness
by a Registered Dietician Nutritionist through a referral from a
medical professional or health care plan. The Committee urges the
Secretary to identify programs that could allow coverage for MTMs.
Produce prescriptions programs are a medical treatment or preventative service for diet-related health risks and are referred bya healthcare provider or health insurance plan. These produce prescriptions are fulfilled through food retail or delivery and enable
patients to access healthy produce at low or no cost to the patient.
The Committee supports efforts to include, where permissible, suchmeals and produce plans as a component of a program.
Nonrecurring Expenses Fund.—The Committee directs HHS toprovide quarterly reports for all ongoing projects. The report shall
include the following for each project: the agency each project isfunded under; a description for each project; the date the project
was notified to the Committee; total obligations to date; obligations
for the prior fiscal year; anticipated obligations for current fiscal
year; and any expected future obligations. For any project ongoingfor more than 3 years, the report should include a narrative describing the cause of delay and steps being taken by the agency toensure prompt completion. In addition, the Committee requests biannual reports on expired balances that are eligible for transfer to
the Nonrecurring Expenses Fund (NEF). Such report shall include
the Treasury Account Fund Symbol, program name, unobligatedbalance, and unexpended balance. Such report shall be transmitted
30 days after the close of the second quarter and within 45 days
after the close of the fourth quarter of the fiscal year. To ensure
appropriate Congressional oversight into use of the NEF, the Committee includes a new provision limiting the amount for additional
notifications for use of the NEF.
Obesity Therapies.—The advent of a new class of anti-obesity
medications, glucagon-like peptide-1 (GLP–1) receptor agonists, hasgiven physicians effective new tools to address the obesity epidemic. Combined with preventative measures, these new medicines
have transformed the treatment of obesity as a disease and could
improve quality of life for individuals with obesity across the country. Emerging research suggests that these drugs may also have apotential benefit for individuals suffering from alcohol and othersubstance use disorders. The Committee urges the Department toevaluate the work being done across agencies on the risks and benefits of GLP–1 agonists, including clinical trials and basic researchthat enhances our understanding of the physiological processes andpathways affected by these drugs, with an appreciation of the potential for sex-specific effects. The Secretary shall provide an update on scientific progress and discoveries, including research opportunities that can be addressed by NIH, FDA, SAMHSA andother agencies as appropriate in the fiscal year 2026 congressional
justification.
Other Transaction Authority.—Congress has authorized HHS andseveral offices within the Department, to use other transaction au-

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thority (OTA). Under this authority, agencies may develop agreements that are not required to follow a standard format or include
terms and conditions that are typically required when using traditional mechanisms. Agreements executed using traditional mechanisms, such as a contract, grant, cooperative agreement, or cooperative research and development agreement, contain terms and conditions to ensure compliance with statutory requirements applicable to those mechanisms (such as the Federal Acquisition Regulation (FAR)). Conversely, OTA agreements are not generally subject
to these requirements, and the terms and conditions of each individual agreement may be tailored to meet the specific situation andneed. The Committee notes, however, that GAO and others havepreviously reported that agencies’ use of OTA has caused reduced
accountability and transparency, in part because other transaction
agreements are usually exempt from the FAR and government costaccounting standards. Recognizing these issues, the Committee directs HHS to submit a consolidated report no later than 120 days
following enactment of this Act, that details a comprehensive narrative of OTA usage within the Department for the most recent fiscal year for which data is available. The report shall include thefollowing for each active OTA award: agency the award is funded
under; the OTA authority cited for the award; the justification forusing OTA authority instead of a traditional acquisition mechanism; a description for each award; the date of award; the anticipated date of completion; and total obligations to date. For any
award ongoing for more than 5 years in excess of $25,000,000, thereport should include a narrative describing the status of the
project.
Patient Advocate Program.—The Committee is concerned aboutbarriers patients face during hospitalization, time of discharge, andthe subsequent coordination of care at and after discharge. Whilesome patients are able to contribute to the decision-making process
regarding healthcare, there are other patients who are unable toaccess the comprehensive coordination of care from acute care or
acute rehabilitation facilities, including access to nurse case managers, social workers, or mental health care providers. Where applicable, the Committee encourages the Secretary to coordinate efforts
across the agency related to this issue.
Primary Care Physician Shortages.—The Committee urges theAssistant Secretary for Planning and Evaluation to conduct a review of trends and factors contributing to the nation’s challenges
with primary care physician recruitment and retention. Such a report could include a review and analysis of challenges recruiting
and retaining primary care physicians; what Federal policies andprograms are effective in recruitment and retention, including increased reimbursement, loan forgiveness and repayment programs,
and training programs serving underserved and diverse patient
populations; and geographic and demographic characteristics ofareas facing the greatest challenges or shortages. The Committee
supports such report being made available on the agency’s website
and to include recommended policies to address primary care physician shortages, improve primary care physician recruitment andretention, and enhance primary care access for all Americans.
Program Support Center.—The Committee is concerned by thestatus of operations at the Program Support Center (PSC). Accord-

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ing to its website, PSC provides more than 40 services and products that support financial management, occupational health, andreal estate, logistics, and operations. The Committee is aware thatmany HHS operating divisions and staff divisions are no longer
using PSC for its services. Rather, these offices are outsourcing fortheir needs, several choosing the Department of Interior. The Committee requests a briefing with PSC and the Assistant Secretaryfor Administration within 120 days of enactment of this Act detailing: (1) the number of HHS operating divisions and staff divisions
where PSC acted as the main service provider for each of the last
5 years; (2) the name and location of each PSC office; (3) the number of full-time staff (including Federal employees and contractors)
at each office; (4) the number of full-time staff (including Federal
employees and contractors) that are fully remote; (4) the numberof outside agencies where PSC acted as the main service provider
for each of the last 5 years; and (5) what efforts PSC is undertaking to ensure HHS and external customers are being provided
a high-level of customer service.
Rare Diseases.—The Committee recognizes that multiple Federal
departments, agencies, and programs exist to address the needs ofpeople impacted by rare diseases and improve the lives of membersof the rare disease community. The Committee would like to seeenhanced coordination and collaboration across the Federal government and urges the Secretary of HHS to develop a framework for
an Interagency Coordinating Committee for Rare Diseases. The coordinating committee should focus on optimizing rare disease activities across the government and produce a report assessing allagency activities concerning rare diseases, including regulatory
flexibilities in rare disease therapy reviews, current and emerging
biomedical research opportunities, current and future rare disease
surveillance and epidemiological activities, programs to support
rare disease patients and caregivers, overall programmatic funding,and other topics to be added by the committee members.
Return to Work.—Excessive abuse of telework across the Federal
government must end. For the average American showing up to
work every day is a fact of life; they deserve a government that reflects that reality. Approvals for remote work should be made on
an individual case by case basis and done only to serve the bestinterests of the program and the American public. The agency is
directed to provide to the Committee within 60 days of enactmentof this Act a report detailing the number of full-time employees bysubcomponent who are receiving the Washington D.C. area locality
pay but have not reported to an in person office in the DC area
more than one day a week for the past year. Considering the remote work abuse seen at several agencies, administrative funding
for the Secretary has been reduced accordingly. The Committee
urges the Secretary to bring Federal employees back to the workplace to fulfill the mission of serving the American public.
Rural News Media and Advertising Campaigns.—The Committee
continues to recognize the critical role that local media plays in delivering lifesaving messages to small and rural communities.
Therefore, the Committee urges the Secretary to ensure that local
media in small and rural markets are a key component in the Department’s public health advertising campaigns which is critical in
improving the delivery of public health messages to these small

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and rural communities. To further this goal the Committee urges
the Secretary, in coordination with the Assistant Secretary for Public Affairs and the Department’s buyer contractors, to utilize local
news media in small and rural areas for public health advertising
campaigns for HHS and its related agencies to reach citizens with
key health messages. Local media includes newspapers, specificallynon-daily newspapers, television, and radio. The Committee directs
the Office of the Secretary within 90 days of enactment of this Act
to provide an update to the Committee on the efforts of the Department in its utilization of local media in small and rural areas aspart of the Department’s public health advertising campaigns forthe most recent fiscal year for which data is available and plans
for subsequent fiscal years. The Committee also directs the Assistant Secretary for Public Affairs in consultation with the CDC’s Office of Rural Health to undertake a review of the use of local media
in small and rural communities in an HHS public Health advertising campaign for the most recent fiscal year for which data isavailable, in several states to better understand their role as a key
delivery system to reach small and rural communities with critically important health messages. The Committee requests an update from the Assistant Secretary for Public Affairs within 180
days of enactment of the Act on the status of this review and requests a final report by the end of the fiscal year.
Safe Patient Handling.—The Committee is concerned that preventable injuries and musculoskeletal disorders related to patient
handling are forcing nurses and nurse assistants to leave the profession, thus exacerbating the nationwide nurse shortage and negatively impacting patient care. The Committee notes that voluntary
national guidelines based on best practices on safe patient handlingand injury prevention that incorporate the use of lift equipment tomove patients may significantly improve workplace safety outcomesin healthcare settings. The Committee encourages the Department
to identify ways to help existing training and nurse education programs adopt the use of safe patient handling equipment and requests an update on these efforts in the fiscal year 2026 congressional justification.
Self-Governance.—For over forty years, Indian Tribes have proven that utilizing self-governance through the Indian Self-Determination and Education Assistance Act in Federal funding is a successful approach for improving program performance. For decades,
Indian Tribes have requested the Department to expand this authority beyond the Indian Health Service to other critical HHS programs serving Tribes. Over twenty years, multiple reports andworkgroups have produced evidence of the feasibility of the expansion of self-determination and self-governance within the Department. The Committee directs HHS to work with Tribal representatives to provide a plan for the expansion of self-governance at HHS
including specific actions the Department can take to advance thisprocess. Such plan is due within 180 days of enactment of this Act.
In addition, the Department shall report to the Committee theamount of funding that is going to Indian Tribes for the 4 largest
block grants administered by HHS within 90 days of enactment of
this Act.
Smoking Cessation.—The Committee acknowledges the Department’s work on smoking cessation but remains concerned that its

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approach does not include a focus on the need for new smoking cessation therapies to help adult smokers be more successful in quitting. The Committee urges the Department to acknowledge the importance of advancing smoking cessation treatment innovation andrequests an update from the Department on how it will incorporatea focus on smoking cessation treatment innovation in the Department’s smoking cessation work in the fiscal year 2026 congressional justification.
Staffing Reports.—The Committee includes a general provision
requiring the Department to submit a biannual staffing report to
the Committee. The Excel table shall include: the names, titles,
grades, agencies, and divisions of all of the political appointees,
special government employees, and detailees that were employedby or assigned to the Department during the previous 180 days.
Stillbirth Working Group.—The Committee includes funding for
the Secretary to prioritize implementation of the Stillbirth Working
Group’s recommendations across the Department and continue toengage in efforts to promote evidence-based stillbirth awarenessand prevention activities. The Committee looks forward to reviewing the Department’s report on its progress, as requested in the
joint explanatory statement which accompanied the Further Consolidated Appropriations Act, 2024 (P.L. 118–47).
Supply Chain.—The Committee directs the Secretary, in consultation with the Secretaries of Defense and Homeland Security
as well as with the Director of the Office of Pandemic Preparedness
and Response Policy, to provide a comprehensive risk assessmentof the pharmaceutical supply chain within 18 months of enactmentof this Act. The assessment shall identify, in coordination with theprivate sector, a list of medicines that: (1) are reasonably likely tobe required to respond to a public health emergency or CBRN
threat; (2) whose shortage would pose a significant threat to the
U.S. health care system or at-risk populations; and (3) whose shortage would pose a risk to national security. The assessment shallalso assess and identify: (1) key starting materials and excipientsused in manufacturing the active pharmaceutical ingredients anddrugs on the essential medicines list; (2) current domestic manufacturing capabilities with respect to drugs, including key starting
materials, excipients, and active pharmaceutical ingredients; (3)critical vulnerabilities, including cybersecurity threats; and (4) any
deficiencies, lack of authorities, or limitations in policy or processthat limit the Departments of Health and Human Services, Defense, or Homeland Security to address vulnerabilities in the pharmaceutical supply chain and how it will mitigate such
vulnerabilities.
Suspension and Debarment.—The Committee notes with concern
the infrequent utilization of suspensions and debarments, as wellas the associated timeliness challenges and the underutilization ofsuspensions prior to debarment, within HHS. These concerns werealso noted in a 2022 report from the Office of Inspector General,
entitled, ‘‘HHS’s Suspension and Debarment Program Helped Safeguard Federal Funding, But Opportunities for Improvement Exist(Report No. OEI–04–19–00570).’’ As the largest grantmaking agency in the Federal government, HHS awarded over $778 billion in
grants during fiscal year 2023. Federal suspension and debarment
programs play a critical role in maintaining the integrity of Federal

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grant programs and ensure that the government conducts businessonly with responsible individuals or entities. If recipients lack honesty, integrity, or satisfactory business performance, they can besuspended or debarred from receiving further Federal grants.
These mechanisms are essential for accountability and proper allocation of taxpayer funds. The Committee requests a report within
120 days of enactment of this Act. Such a report shall include: (1)the number of suspension or debarment referrals received by the
HHS Office of Recipient Integrity Coordination for each of the last
5 years; (2) the number of final decisions issued by the Suspension
and Debarment Official for each of the last 5 years; (3) the numberof referrals and final decisions that were fact-based; (4) the numberof referrals and final decisions that were conviction-based; and (5)the procedures the Department has in place to ensure bad actors
are timely listed as suspended or debarred on SAM.gov.
Test-To-Treat.—The Committee believes the home test-to-treat
model can make treatments for infectious diseases available more
quickly and reduce disease transmission and illness severity. The
availability of accurate diagnostics and the rapid prescription oftreatments is especially critical given the recent co-circulation ofmultiple respiratory diseases during the winter season. The Committee believes the home test-to-treat model should be evaluatedfor the confluence of influenza, COVID, and RSV, given the availability of multiple diagnostic tests and antivirals. The Committee
requests HHS provide an update in the fiscal year 2026 congressional justification on the findings of the NIH Home Test-to-Treatdemonstration for influenza, lessons learned from the COVID Federal Retail Pharmacy Program, and the design of a potential testto-treat demonstration for COVID, influenza, and RSV to serve vulnerable populations.
Tuberculosis.—The Committee remains concerned regarding therepeated instances of TB cases associated with viable bone matrix
material. The repeated contamination of the biologics market andthe failure to implement effective quality control measures cost the
lives of ten Americans. The Committee directs the Secretary, no
later than 90 days following the enactment of this Act, to initiate
an internal review of existing guidance for determining eligibilityof donors of human cell and tissue products, and if necessary, issue
or update any Food and Drug Administration guidance related toreducing the risk of transmission of mycobacterium tuberculosis byhuman cells, tissues, and cellular and tissue-based products. Within 180 days of enactment of this Act, the Secretary is directed toprovide the Committee a briefing on the actions being taken by the
Department to ensure that immunocompromised Americans are notexposed to TB through the biologic supply chain.
Minority HIV/AIDS Fund
The Committee includes $45,000,000 for the Minority HIV/AIDS
Fund (MHAF), which is $15,000,000 below the fiscal year 2024 enacted level and the fiscal year 2025 budget request.
Tribal Set Aside.—The Committee notes that according to the
CDC, HIV-positive status among Native Americans is increasing
and nearly one-in-five HIV-positive Native Americans is unawareof their status. In addition, only three-in-five receive care and lessthan half are virally suppressed. To increase access to HIV/AIDS

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testing, prevention, and treatment, the Committee increases the
Tribal set aside within the MHAF to $6,000,000, which is$1,000,000 above the fiscal year 2024 enacted level.
Office of the Assistant Secretary for Health
Abortion Hotline.—The Committee includes a new provision prohibiting funds for the abortion hotline.
Reproductive Rights.—No funds are provided to support
www.reproductiverights.gov nor any similar website.
Traumatic Brain Injury Data Summit.—The Committee recognizes the need for standardized data collection practices across thecare continuum to capture and integrate real world data on TBI
with data collected for research purposes to improve patients’ identification and outcomes. In 2022, at the request of the U.S. Army
Medical Research and Development Command, NASEM publisheda TBI Roadmap that stated, ‘‘Data cannot be integrated across thecare continuum from prehospital care environments to hospitalbased care, rehabilitation settings, and community services.’’ Further, the report notes the lack of standardized TBI informationfrom electronic health records that limits research, such as comparative effectiveness trials using causal inference methods. The
Committee urges the Office of the Assistant Secretary for Healthto convene a summit of Federal agency staff, including representatives from HHS, the Departments of Defense, Veterans Affairs, andTransportation, and others, and private sector researchers andstakeholders to identify and recommend key data elements andterms that should be collected to improve the consistency of TBI
health data derived from different sources to improve patient outcomes. Additional items that could be addressed at this meeting include: utilizing data from the National Concussion Surveillance
System to determine accurate numbers on national incidence ofTBI; identifying the parameters and elements necessary to conceptualize a national TBI registry; addressing patient privacy and securing patient information; and determining how best to leveragedata from and improve the interoperability with existing national
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Office of Climate Change and Health Equity
No funds are provided for the Office of Climate Change and
Health Equity.
Office of Minority Health
The Committee includes $59,835,000 for the Office of Minority
Health (OMH), which is $15,000,000 below the fiscal year 2024 enacted level and the fiscal year 2025 budget request.
The OMH works with public health service agencies and otheragencies of the Department to address the health status and quality of life for minority populations in the U.S. OMH develops andimplements new policies; partners with States, Tribes, and communities through cooperative agreements; supports research, demonstration, and evaluation projects; and disseminates information.
Within the total provided for OMH, the Committee provides notless than the following amounts:

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FY 2024
EnactedBudget Activity

Achieving Equitable Maternal Health Outcomes .........................................................
Center for Indigenous Innovation and Health Equity .................................................
National Lupus Training, Outreach, and Clinical Trial Education .............................
Promoting Language Access Services .........................................................................

FY 2025
Committee$7,000,000
4,000,000
2,000,000
4,000,000$7,000,000
4,000,000
2,000,000
4,000,000

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Center for Indigenous Innovation and Health Equity.—The Committee continues funding for this center to advance Indigenous solutions for improved health outcomes. The Committee recognizes
the center’s efforts to partner with Tribal nations and institutionsof higher education with a focus on Indigenous health research,education, and policy among American Indians and Alaska Natives,
as well as Native Hawaiian and Pacific Islander organizations andinstitutions of higher education with a focus on Indigenous healthresearch, education, and policy and innovation among Native Hawaiians and Pacific Islanders. The Committee encourages OMH toboth continue and expand these efforts.
Kidney Disease Initiative.—Rates of severe kidney disease are
significantly higher in Black Americans than in other ethnic
groups, with approximately 13 percent of African Americans carrying two APOL1 variants. The Committee encourages OMH to
support activities to reduce genetic kidney disease among populations disproportionally affected by the disease, including a healtheducation program on genetic kidney disease and coordination with
NIH to develop clinical trial education interventions to recruit andretain minority populations affected by the disease.
Language Access and Communications Services for Limited
English Proficient Communities.—The Committee supports efforts
to improve communications, which should include mediums such as
television and radio, to reach limited English proficient (LEP) communities. However, to improve implementation, the Committee encourages the Department to review the communication practices
and create uniform applications across all agencies to strengthencommunication practices to include digital, television, and radio advertising when working with LEP communities. The Committee
further urges agencies under HHS with annual advertising budgets
to include information in the fiscal year 2026 congressional justification on funding allocated to local media advertising to include
digital, television, and radio. The Committee encourages agencies
to support outreach funding to ethnic media outlets that work with
hard-to-reach communities to ensure equal access across all media
outlets.
Office on Women’s Health
The Committee includes $34,140,000 for the Office on Women’s
Health (OWH), which is $10,000,000 below the fiscal year 2024 enacted level and $20,000,000 below the fiscal year 2025 budget request.
OWH provides consultation to the Secretary on women’s healthand establishes short and long-range goals and objectives for women’s health within the Department. OWH monitors activities regarding women’s health and coordinates across the Department on
disease prevention, health promotion, service delivery, research,and public and health care professional education, and other women’s health concerns throughout their lifespan. OWH leads the co-

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ordination of activities to promote women’s health programs andpolicies with the private sector and to share information with the
public. OWH also leads the Coordinating Committee on Women’s
Health and the National Women’s Health Information Center.
Within the total provided for OWH, the Committee provides notless than the following amounts:
Budget Activity

Committee Combatting Violence Against Women .......................................................
Eating Disorders Research ..........................................................................................
Pregnant and Lactating Women’s Advisory Committee ..............................................

FY 2024
EnactedFY 2025
Committee$10,100,000
750,000
200,000$10,100,000
750,000
200,000

Eating Disorders Research.—The Committee remains concernedthat eating disorders have one of the highest fatality rates of any
psychiatric illness, with girls and women at heightened risk for developing an eating disorder during their lifetime. The Committee
recognizes OWH’s efforts to address the rise in eating disorders
amongst adolescent girls. The Committee continues funding andurges focus on early detection and treatment protocols for womenand girls with or at-risk of developing an eating disorder. The Committee encourages OWH to prioritize projects to address the lackof pediatric and adolescent screening in the primary care and pediatrics settings. The Committee urges OWH to coordinate with outside organizations, eating disorders specialists, and other groups asnecessary to identify research needs of eating disorders amongst
women and girls.
Pregnant Women and Lactating Women Advisory Committee.—
The Committee continues funding for the advisory committee tocontinue activities within the 2020 Task Force on Research Specificto Pregnant and Lactating Women (PRGLAC) Implementation
Plan. The Committee requests an update in the fiscal year 2026
congressional justification on progress and Federal activities undertaken to implement the PRGLAC recommendations and recommendations for further implementation of PRGLAC recommendations.
Office of the Assistant Secretary for Administration

DMWilson on DSKJM0X7X2PROD with HEARINGS

Cybersecurity
The Committee provides $100,000,000, the same as the fiscal
year 2024 enacted level and $20,500,000 below the fiscal year 2025
budget request, for information technology cybersecurity in the Office of the Chief Information Officer and HHS-wide to strengthen
the Department’s cybersecurity posture.
In addition, the Committee permits the transfer of $20,000,000
from the Nonrecurring Expenses Fund.
Office of National Security
The Committee provides $9,983,000, which is $1,000,000 above
the fiscal year 2024 enacted level and $5,000,000 below the fiscal
year 2025 budget request, for the Office of National Security tomaintain the security of the Department’s personnel, systems, andcritical infrastructure.

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Office of Global Affairs
The Committee provides $7,009,000, the same as the fiscal year
2024 enacted level and $1,000,000 below the fiscal year 2025 budget request, for the Office of Global Affairs work related to pandemic
influenza.
OFFICE FOR CIVIL RIGHTS

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$39,798,000
56,798,000
39,798,000–––¥17,000,000

The Office for Civil Rights (OCR) is responsible for enforcing civilrights statutes that prohibit discrimination in health and humanservices programs. OCR implements the civil rights laws througha compliance program designed to generate voluntary complianceamong all HHS recipients.
National Council on Disability Recommendations.—The Committee is aware of a National Council on Disability report entitled,‘‘The Danger of Assisted Suicide Laws,’’ which raises concern thatsuch laws could lead to a two-tiered system that results disproportionately in the deaths of people with disabilities. Accordingly, theCommittee strongly encourages the OCR to clarify that all HHS
suicide prevention grants and services must comply with existingdisability rights laws, including the Americans with Disabilities
Act, sections 504 and 508 of the Rehabilitation Act, and section
1557 of the Affordable Care Act, including the provisions requiring
accessible communications, so that all videos, documents, and otherproducts ensure access to persons with disabilities. The Committee
further strongly encourages OCR to clarify that sections 504 and508 of the Rehabilitation Act require physicians to provide people
with disabilities with information on the full array of available clinical treatments and available long-term services and supports andto require that referrals to such treatments and services be given
if requested.
OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH INFORMATIONTECHNOLOGYDMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$69,238,000
86,000,000
69,238,000–––¥16,762,000

The Office of the National Coordinator for Health Information
Technology (ONC) is the principal Federal entity charged with coordinating efforts to implement and use health information technology and exchange electronic health information.
Health Artificial Intelligence.—The Committee appreciates efforts
by HHS—including FDA and ONC—to accelerate adoption of artificial intelligence-based tools to improve patient care, health carepayment, operations, and public health. The Committee is concerned, however, that new policies could duplicate existing authorities and negatively affect U.S. competitiveness in the developmentof artificial intelligence innovations. Within 9 months of enactmentof this Act, the Committee directs the Secretary to submit a report

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201
outlining all existing authorities that could apply to the development and use of artificial intelligence-based tools, including thosethat may either be artificial intelligence as stand-alone and/orinterface with, enabled by, or supplied by medical devices, healthinformation technology, and decision support interventions. The report shall provide an update to the Department’s response to OMB
M–21–06 and explain how existing authorities that were not initially developed for artificial intelligence can still apply to artificial
intelligence-based technologies used in care. The report should
clearly explain what gaps, if any, exist in HHS authorities and proposed approaches to fill those gaps.
Information Blocking.—The Committee recognizes that ONC’srule to implement the interoperability and information blocking
provisions of the 21st Century Cures Act took significant steps forward to give patients greater access to and improve the electronic
flow of electronic health information across care settings. Given thesignificant penalties and other consequences for information blocking, the Committee urges ONC to provide regulated entities andother stakeholders with clear, practical guidance regarding therule, which should include how regulated entities can evaluate
their circumstances and scenarios under the rule, and answer inquiries by covered actors about how ONC interprets its regulations
and how the regulations apply to a specific set of facts. ONC andOIG should only apply standards of conduct that have been publicly stated in a manner that would not cause unfair surprise.
Patient Matching.—The Committee is concerned there is no consistent and accurate way to link patients to their health information as they seek care across the continuum. Health informationmust be accurate, timely, and robust to inform clinical care decisions for every patient. The recommendation includes $3,000,000,
the same as the fiscal year 2024 enacted level, for ONC to workwith industry to develop matching standards that prioritize interoperability, patient safety, and patient privacy.
Standards for Interoperability.—ONC and CMS have publishedfinal rules to implement interoperability provisions contained in
the Cures Act, including the ONC final rule, 21st Century Cures
Act: Interoperability, Information Blocking, and the ONC Health
IT Certification Program and the related CMS final rule, including
the adoption of Fast Healthcare Interoperability Resources (FHIR)
as the foundational standard to support health information sharing
without ‘‘special effort’’ on the part of the user. FHIR-based application programming interfaces are now required for all healthstakeholders that exchange data in compliance with the rules that
support the Act. The Committee’s recommendation includes notless than $5,000,000, the same as the fiscal year 2024 enacted
level, to support interoperability and information sharing efforts related to the implementation of implementation standards.
The Committee urges ONC to ensure that the post-acute Fast
Healthcare Interoperability Resources standard for cognitive statusis implemented in electronic health record systems and should offer
guidance on including fields for cognitive status by default without
configuration being necessary.

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MEDICARE HEARINGS AND APPEALSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$196,000,000
196,000,000
196,000,000––––––

This appropriation supports activities carried out by two Officeof the Secretary Staff Divisions. The Office of Medicare Hearings
and Appeals supports Medicare appeals at the administrative law
judge level, the third level of Medicare claims appeals. The Departmental Appeals Board represents the fourth level of the Medicare
appeals process and provides impartial, independent hearings andappellate reviews.
OFFICE OF INSPECTOR GENERAL

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$87,000,000
97,384,000
87,000,000–––¥10,384,000

The Committee recommends $87,000,000 for OIG, which is thesame as the fiscal year 2024 enacted level and $10,384,000 below
the fiscal year 2025 budget request.
In addition, within the Health Care Fraud and Abuse Control(HCFAC) program discretionary appropriations for fiscal year 2025,
the Committee provides the OIG with $111,508,000, which is$3,773,000 above the fiscal year 2024 enacted level and the sameas the fiscal year 2025 budget request. Mandatory appropriations
for this office are also contained in the HCFAC program and the
Health Insurance Portability and Accountability Act of 1996.
The Committee supports the OIG as an independent and objective entity charged with conducting oversight, preventing waste,fraud and abuse, and promoting economy, efficiency, and effectiveness in the Department’s programs and operations.
Marijuana Scheduling.—The Committee is also concerned about
deviations from established drug scheduling evaluation standards
in the FDA 2023 marijuana scheduling review. The Committee
supports efforts to compile a report on the 2023 marijuana scheduling review including: (1) deviations from the established five-factor currently accepted medical use test, (2) justification for a new,
two-factor currently accepted medical use test and whether thiswill be the standard for all future reviews, (3) use of a limited
number of hand-selected comparator substances, and (4) inclusionof research results that are not statistically significant or inconclusive.

DMWilson on DSKJM0X7X2PROD with HEARINGSRETIREMENT PAY AND MEDICAL BENEFITS FOR COMMISSIONED
OFFICERS

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$792,691,000
894,795,000
894,795,000+102,104,000–––

The Committee provides for retirement pay and medical benefitsof Public Health Service Commissioned Officers, for payments

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203
under the Retired Serviceman’s Family Protection Plan, and for
medical care of dependents and retired personnel.
GENERAL PROVISIONS
Sec. 201. The Committee continues a provision to limit theamount available for official reception and representation expenses.
Sec. 202. The Committee continues a provision to limit the salaryof an individual through an HHS grant or other extramural mechanism to not more than the rate of Executive Level II.
Sec. 203. The Committee continues a provision to prohibit the
Secretary from using evaluation set aside funds until the Committees on Appropriations receive a report detailing the planned useof such funds.
Sec. 204. The Committee continues a provision regarding the useof PHS evaluation set aside.
(TRANSFER OF FUNDS)

Sec. 205. The Committee continues a provision permitting theSecretary of HHS to transfer up to one percent of any discretionary
funds between appropriations, provided that no appropriation is increased by more than three percent by any such transfer to meet
emergency needs. Notification must be provided to the Committees
on Appropriations at the program, project, and activity level in advance of any such transfer.
Sec. 206. The Committee modifies a provision providing 60-day
flexibility for National Health Service Corps contract terminations.
Sec. 207. The Committee continues a provision to prohibit theuse of Title X funds unless the applicant for the award certifies to
the Secretary that it encourages family participation in the decision of minors to seek family planning services and that it provides
counseling to minors on how to resist attempts to coerce minors
into engaging in sexual activities.
Sec. 208. The Committee continues a provision stating that noprovider of services under Title X shall be exempt from any law requiring notification or the reporting of child abuse, child molestation, sexual abuse, rape, or incest.
Sec. 209. The Committee continues a provision related to theMedicare Advantage program.
Sec. 210. The Committee continues a provision prohibiting funds
from being used to advocate or promote gun control.
Sec. 211. The Committee continues a provision limiting the assignment of employees for work with certain organizations.
Sec. 212. The Committee modifies a provision to allow fundingfor HHS international HIV/AIDS and other infectious diseases,
chronic and environmental disease, and other health activities
abroad to be spent under the State Department Basic Authorities
Act of 1956.

DMWilson on DSKJM0X7X2PROD with HEARINGS(TRANSFER OF FUNDS)

Sec. 213. The Committee continues a provision to provide the Director of NIH, jointly with the Director of the Office of AIDS Research, the authority to transfer up to three percent of human immunodeficiency virus funds.

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204
(TRANSFER OF FUNDS)

Sec. 214. The Committee continues a provision that makes NIH
funds for human immunodeficiency virus research available to the
Office of AIDS Research.
Sec. 215. The Committee continues a provision granting authority to the Office of the Director of the NIH to enter directly intotransactions in order to implement the NIH Common Fund for
medical research and permitting the Director to utilize peer review
procedures, as appropriate, to obtain assessments of scientific andtechnical merit.
Sec. 216. The Committee continues a provision clarifying thatfunds appropriated to NIH institutes and centers may be used forminor repairs or improvements to their buildings, up to $5,000,000
per project with a total limit for NIH of $100,000,000.
(TRANSFER OF FUNDS)

Sec. 217. The Committee continues a provision transferring one
percent of the funding made available for National Institutes of
Health National Research Service Awards to the Health Resources
and Services Administration.
Sec. 218. The Committee continues the Biomedical Advanced Research and Development Authority ten-year contract authority.
Sec. 219. The Committee modifies a provision requiring HHS toinclude information regarding full-time Federal employees and contractors working on the Affordable Care Act in the fiscal year 2026
budget request.
Sec. 220. The Committee modifies a provision for a report on
CMS’s Health Insurance Exchange activities in the fiscal year 2026
budget request.
Sec. 221. The Committee continues a provision prohibiting the
CMS Program Management account from being used to support
risk corridor payments.
(TRANSFER OF FUNDS)

Sec. 222. The Committee modifies a provision directing thespending of the Prevention and Public Health Fund.
PREVENTION AND PUBLIC HEALTH FUND

DMWilson on DSKJM0X7X2PROD with HEARINGS

In fiscal year 2025, the level appropriated for the fund is$1,225,900,000 after accounting for sequestration. The Committee
includes bill language in section 222 of this Act that requires thatfunds be transferred within 45 days of enactment of this Act to thefollowing accounts, for the following activities, and in the following
amounts:

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AgencyBudget Activity

ACL ....................
ACL ....................
ACL ....................
CDC ...................
CDC ...................
CDC ...................
CDC ...................
CDC ...................
CDC ...................

Alzheimer’s Disease Program ......................................................
Chronic Disease Self-Management .............................................
Falls Prevention ...........................................................................
Hospitals Promoting Breastfeeding .............................................
Diabetes .......................................................................................
Epidemiology and Laboratory Capacity Grants ...........................
Healthcare Associated Infections ................................................
Heart Disease and Stroke Prevention Program ..........................
Million Hearts Program ...............................................................

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FY 2024
EnactedFY 2025
Committee$14,700,000
8,000,000
5,000,000
9,750,000
66,412,000
40,000,000
12,000,000
29,255,000
5,000,000$14,700,000
8,000,000
5,000,000
9,750,000
110,758,000
40,000,000
12,000,000
110,759,000
5,000,000

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AgencyBudget Activity

CDC ...................
CDC ...................
CDC ...................
CDC ...................
SAMHSA .............

Section 317 Immunization Grants ..............................................
Lead Poisoning Prevention ..........................................................
Public Health Data Modernization ..............................................
Early Care Collaboratives ............................................................
Garrett Lee Smith—Youth Suicide .............................................

FY 2024
EnactedFY 2025
Committee

681,933,000
51,000,000–––
5,000,000
12,000,000

681,933,000
51,000,000
160,000,000
5,000,000
12,000,000

Sec. 223. The Committee modifies a provision related to breast
cancer screening.
(TRANSFER OF FUNDS)

Sec. 224. The Committee continues a provision permitting transfer of funds within NIH, if such funds are related to opioid andpain management research.
Sec. 225. The Committee continues a provision related to certain
Congressional notification requirements.
Sec. 226. The Committee continues a provision related to funding
for the Medicare program.
Sec. 227. The Committee continues a provision related to a reporton staffing.
Sec. 228. The Committee continues a provision allowing HHS tocover travel expenses when necessary for employees to obtain medical care when they are assigned to duty in a location with a publichealth emergency.
Sec. 229. The Committee continues a provision related to donations for unaccompanied alien children.
Sec. 230. The Committee continues a provision related to the notification requirements regarding the use of facilities that are notState licensed for the care of unaccompanied alien children.
Sec. 231. The Committee continues a provision related to Members of Congress and oversight of facilities responsible for the careof unaccompanied alien children.
Sec. 232. The Committee continues a provision requiring monthly
reporting on unaccompanied alien children who were separated
from their parents or legal guardians and transferred to the careof the Office of Refugee Resettlement.
Sec. 233. The Committee continues a provision related to primary and secondary school costs for eligible dependents of personnel stationed in a U.S. territory.
Sec. 234. The Committee includes a new provision modifying theCommunity Services Block Grant Act.

DMWilson on DSKJM0X7X2PROD with HEARINGS(RESCISSION AND INCLUDING TRANSFER OF FUNDS)

Sec. 235. The Committee modifies a provision related to unobligated balances in the Nonrecurring Expenses Fund.
Sec. 236. The Committee includes a new provision related to NIH
and workplace investigations related to a principal investigator or
key personnel.
Sec. 237. The Committee includes a new provision related to facilities and administration costs.
Sec. 238. The Committee includes a new provision related to fetal
tissue.
Sec. 239. The Committee includes a new provision related to physician training for abortions.

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Sec. 240. The Committee includes a new provision restricting
funding to certain health care entities.
Sec. 241. The Committee includes a new provision related to providing information on abortion.
Sec. 242. The Committee includes a new provision related to referral for abortions.
Sec. 243. The Committee includes a new provision related to executive orders addressing reproductive services.
Sec. 244. The Committee includes a new provision limiting funds
for a proposed rule for the Temporary Assistance for Needy Families program.
Sec. 245. The Committee includes a new provision regarding a
CMS rule related to vaccination requirements.
Sec. 246. The Committee includes a new provision regarding Executive Order 13988 (Executive Order on Preventing and Combating Discrimination on the Basis of Gender Identity or Sexual
Orientation).
Sec. 247. The Committee includes a new provision limiting funding for certain elective services.
Sec. 248. The Committee includes a new provision related torulemaking for section 1557 of the Affordable Care Act.
Sec. 249. The Committee includes a new provision related toplacement under Titles IV–E and IV–B of the Social Security Act.
Sec. 250. The Committee includes a new provision related to theunaccompanied alien children foundational rule.
Sec. 251. The Committee includes a new provision related toplacement of unaccompanied alien children.
Sec. 252. The Committee includes a new provision related tonursing home staffing standards.
Sec. 253. The Committee includes a new provision related to a
final rule for short term, limited duration health plans.
Sec. 254. The Committee includes a new provision related to a
proposed rule for the Medicaid program.
Sec. 255. The Committee includes a new provision related to a
public health emergency and a citizen’s Second Amendment rights.
TITLE III—DEPARTMENT OF EDUCATIONDMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 ...................................
Budget request, fiscal year 2025 .................................
Committee Recommendation .......................................
Change from enacted level ...................................
Change from budget request ................................

$79,052,238,000
82,491,976,000
67,948,452,000¥11,103,786,000¥14,543,524,000

The U.S. Department of Education’s (Education) discretionary
spending encompasses the budget allocated to various education
programs, determined through annual appropriations. In 2012,
Education’s discretionary funding stood at approximately $68 billion, while the student loan portfolio balance was $950 billion. By
fiscal year 2024, Education’s discretionary funding had increased tojust under $80 billion; yet, in that same time, the Federal student
loan portfolio exceeded $1.6 trillion, with nearly 43 million borrowers, and 90 percent of the outstanding balances owned by Education. This growth in student loan debt has substantially outpaced
Education’s discretionary spending, reflecting the rapidly increasing cost associated with direct loans for higher education.

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Notably, much of the growth in Education’s student loan balance
is not being driven by undergraduate loans. Instead, it stems fromindividuals pursuing advanced graduate degrees—such as master’s,
doctoral, and professional programs—often facing substantial financial strain to attain such degrees. These graduate students rely
heavily on Federal loans to cover tuition, expenses, and living
costs. Unfortunately, the earnings potential after completing these
degrees often does not align with the debt incurred, leading to asignificant burden on the borrower and the American taxpayer who
financed the direct loan. Consequently, the sustainability and longterm implications of Education overseeing and administering a rapidly growing Federal loan portfolio is in question, as new loans are
disbursed at a faster rate than existing loans are repaid.
This bill provides just under $69 billion in discretionary budget
authority for the Department of Education, a reduction of 13 percent over fiscal year 2024 enacted level. The Department of Education comprises 37 percent of the total 302(b) allocation for thissubcommittee.
OFFICE OF ELEMENTARY AND SECONDARY EDUCATIONEDUCATION FOR THE DISADVANTAGED

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$19,107,790,000
19,287,790,000
14,389,212,000¥4,718,578,000¥4,898,578,000

DMWilson on DSKJM0X7X2PROD with HEARINGSThis appropriation account includes compensatory education programs authorized under title I and subpart 2 of part B of title IIof the Elementary and Secondary Education Act of 1965 (ESEA)
and section 418A of the Higher Education Act (HEA).
Of the total amount available, $4,399,178,000 is appropriated forfiscal year 2025 for obligation on or after July 1, 2025, and$10,841,177,000 is appropriated for fiscal year 2026 for obligation
on or after October 1, 2025.
Grants to Local Educational Agencies
For fiscal year 2025, the Committee provides $14,626,490,000, forTitle I grants to Local Educational Agencies (LEAs or school districts), which is $3,780,312,000 below the fiscal year 2024 enacted
level.
The Committee proposes reduced formula funding for publicschools. The Committee notes that despite annual increases infunding for Title I formula grants, student test scores continue todecline. The latest test scores published by the Department showedthat overall math and reading scores for both fourth and eighth
graders have fallen sharply. Math scores for eighth graders in 2022
fell to a 20-year low. Nationwide, only 36 percent of fourth gradersand 26 percent of eighth graders are proficient in math, and only
33 percent of fourth graders and 31 percent of eighth graders are
proficient in reading. Federal tax dollars have not been shown toresult in meaningful improvement in student achievement. Moreover, the partisan American Rescue Plan (P.L. 117–2) invested
more than $150,000,000,000 into American schools. Despite the un-

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DMWilson on DSKJM0X7X2PROD with HEARINGS

precedented direct Federal support for schools, U.S. student
achievement continues to lag other industrialized nations.
The Committee also notes that traditional public schools werequick to shut down in 2020 at the behest of teachers’ unions andstayed closed for nearly two years, while most private and charterschools reopened. During the pandemic, these public schools failed
their students, and the effects will be felt by an entire generationof students. In December 2023, EdChoice polling showed that nearly two-thirds of American parents feel that K–12 education is on
the wrong track. The same polling showed that 71 percent of parents support charter schools. Predictably, public school enrollment
has been declining and charter school enrollment accelerated during the pandemic. Between 2010 and 2021, according to data fromthe Department of Education, enrollment in public elementary andsecondary schools declined by 3 percent. During this same period,
charter school enrollment more than doubled by nearly 2 million
students. The National Center for Education Statistics projects additional losses of 2.4 million students by 2031. The Committee recognizes this shift in demand for alternatives to traditional publicschools and responds by increasing funding for charter schools inthis bill.
The Committee also notes that both Democrat and Republican
led States are taking advantage of budget surpluses due to Federal
stimulus dollars and high tax revenues and making record investments in their education budgets. South Dakota, Arkansas, andIowa have all passed teacher pay raises this year, and similar efforts are being considered in Alabama, Virginia, South Carolina,
and Missouri this legislative session. According to the National
Education Association, the national average public school teacher
salary in 2022–2023 increased 4.1 percent from the previous year
and is projected to grow a further 3.1 percent in 2023–2024. These
are the largest teacher pay increases in over a decade.
Military Student Identifier.—The Committee notes that the
ESEA recognizes military-connected students as a distinct subgroup of students. More than 80 percent of military-connected children attend public schools. Students with parents or guardians
serving full-time in the military often move and change schools frequently. In addition, they may experience trauma resulting fromseparations from a parent/guardian due to their parents’ service tothe U.S. Military. The Military Student Identifier provides educators, school leaders, and policymakers with critical information topersonalize attention and direct resources to better support military dependent children. Current law directs the Military Student
Identifier toward the children of active-duty families, leaving out
more than half a million children of the reserve component, both
National Guard and Reserves. The Committee supports efforts toaddress the unique needs of children whose parents/guardiansserve in the National Guard and reserve components.
Basic Grants
Of the amounts provided for Title I programs, the Committee
provides $3,614,089,000 for Basic Grants to LEAs, which is$2,845,312,000 below the fiscal year 2024 enacted level. Of thisamount, $763,776,000 is available for fiscal year 2026. Basic grants

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209
are awarded to school districts with at least 10 low-income children
who make up more than 2 percent of the school-age population.
High-Quality Tutoring.—The Committee encourages the Department to promote and provide technical assistance to LEAs and support partnerships between LEAs and education-related community
based organizations to implement evidence-based tutoring models.
Concentration Grants
The Committee provides $1,362,301,000, the same as the fiscal
year 2024 enacted level for Title I Concentration Grants. These
grants target funds to school districts in which the number of lowincome children exceeds 6,500 or 15 percent of the total school-age
population.
Targeted Grants
The Committee provides $4,825,050,000, which is $467,500,000
below the fiscal year 2024 enacted level for Title I Targeted Grants.
Within this amount, $4,357,550,000 is available for fiscal year
2026. Targeted Grants provide higher payments to school districts
with high numbers or percentages of low-income students.
Education Finance Incentive Grants
The Committee provides $4,825,050,000, which is $467,500,000
below the fiscal year 2024 enacted level for Title I Education Finance Incentive Grants (EFIGs). Within this amount,$4,357,550,000 is available for fiscal year 2026. EFIGs are allocated according to one of the four allocation formulas authorizedunder ESEA Title I, Part A for providing Federal education funding to the States for the education of disadvantaged pupils.

DMWilson on DSKJM0X7X2PROD with HEARINGS

Innovative Approaches to Literacy
The Committee provides $30,000,000 for Innovative Approaches
to Literacy, which is the same as the fiscal year 2024 enacted level.
This program provides competitive grants to support school libraries.
The Committee is supportive of efforts to equip educators withcomprehensive literacy resources via a free, website format with a
specific focus on children in kindergarten through sixth grade. The
Committee encourages the Department to build upon existing programs that leverage public partnerships and multidisciplinary tools
and have demonstrated outcomes of success.
Pediatric Literacy Program.—The Committee encourages the Department to support pediatric literacy programs that are provided
during well-child visits by medical providers trained in researchbased methods of early language and literacy.
Comprehensive Literacy Development Grants
The Committee provides $194,000,000 for Comprehensive Literacy Development Grants, which is the same as the fiscal year
2024 enacted level. Competitive grants are awarded to States tosubgrant to school districts and/or early education programs to improve literacy instruction for disadvantaged students.
Science of Reading.—The Committee notes with concern thatmany school districts continue to use reading instruction methods
that have been shown to be ineffective at helping all students, andVerDate Sep 11 2014

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especially struggling readers, learn to read. The Committee isaware of recent reporting which has demonstrated that many
schools in our country continue to use ineffective reading programs
that teach students to guess words rather than to learn how toread words. Neuroscience research has shown that skilled readers
process all of the letters in words when they read them. After several exposures, the word becomes recognizable on sight, through aprocess called orthographic mapping. Even so, many early reading
programs are designed to teach students to make better guesses tolearn words, a process known as three-cueing. This method teaches
children that they don’t need to look at all of the letters that makeup words in order to read them. As they progress in grades and do
not have pictures or other context to learn words, many students
struggle with reading and, as a result, may even be identified asin need of special education services when they may just not havebeen taught to read properly.
The Committee is aware that many teachers may not know thatcueing strategies do not comport with the scientific evidence basearound teaching reading. The Committee intends that funds provided under the comprehensive literacy development grants program be used solely for reading programs that promote sciencebased reading instruction and therefore directs the Department toensure that all grants funded through this program adhere to thehighest evidence-based standards of research for practices forteaching reading, supporting struggling readers, and developing
them into strong readers. Programs must include systematic instruction in phonological awareness, phonics, and fluency andshould be externally validated to show reading success with thelowest-achieving students rather than relying on a proprietary
reading program’s own self-assessment.

DMWilson on DSKJM0X7X2PROD with HEARINGSState Agency Programs: Migrant
The Committee provides $375,626,000 for the State Agency Program for Migrant Education, which is the same as the fiscal year
2024 enacted level. This formula grant program supports special
educational and related services for children of migrant agricultural workers and fishermen, including: (1) supplementary academic education; (2) remedial or compensatory instruction; (3)English for limited English proficient students; (4) testing; (5) guidance counseling; and (6) other activities to promote coordination ofservices across States for migrant children whose education is interrupted by frequent moves.
State Agency Programs: Neglected and Delinquent/High Risk Youth
For the State Agency Program for Neglected and DelinquentChildren, the Committee provides $49,239,000, which is the sameas the fiscal year 2024 enacted level. This formula grant programsupports educational services for children and youth under age 21
in State-run institutions, attending community day programs, andin correctional facilities. A portion of these funds is provided for
projects that support the successful re-entry of youth from thecriminal justice system into postsecondary and vocational programs.

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Special Programs for Migrant Students
The Committee provides $52,123,000 for the Special Programsfor Migrant Students, which is the same as the fiscal year 2024 enacted level. These programs make competitive grants to colleges,
universities, and nonprofit organizations to support educational
programs designed for students who are engaged in migrant andother seasonal farm work. The High School Equivalency Program
recruits migrant students aged 16 and over and provides academic
and support services to help those students obtain a high school
equivalency certificate and subsequently to gain employment or admission to a postsecondary institution or training program. The
College Assistance Migrant Program provides tutoring and counseling services to first-year, undergraduate migrant students andassists those students in obtaining student financial aid for theirremaining undergraduate years.
IMPACT AID

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$1,625,151,000
1,618,112,000
1,630,000,000+4,849,000+11,888,000

This account supports payments to school districts affected byFederal activities, such as those that educate children whose families are connected with the military or who live on Indian land.
Basic Support Payments
The Committee provides $1,477,000,000 for Basic Support Payments to LEAs, which is an increase of $3,000,000 from the fiscal
year 2024 enacted level. Basic Support Payments compensate
school districts for lost tax revenue and are made on behalf of Federally connected children, such as children of members of the uniformed services who live on Federal property.
Special Education Needs at Impact Aid Schools.—In the fiscal
year 2026 congressional justification, the Committee requests data
and analysis on special education needs at Impact Aid schools, including data on the percent of students at Impact Aid schools who
receive special education services compared to the percent of such
students at non-Impact Aid schools.

DMWilson on DSKJM0X7X2PROD with HEARINGS

Payments for Children with Disabilities
The Committee provides $49,000,000 for Payments for Children
with Disabilities, which is an increase of $684,000 from the fiscal
year 2024 enacted level. These payments compensate school districts for the increased costs of serving Federally connected children with disabilities.
Facilities Maintenance
The Committee provides $6,000,000 for Facilities Maintenance,
which is an increase of $1,165,000 from the fiscal year 2024 enacted level. Capital payments are authorized for maintenance of
certain facilities owned by the Department.

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Construction
The Committee provides $19,000,000 for the Construction program, which is the same as the fiscal year 2024 enacted level. This
program provides formula grants for building and renovating
school facilities to school districts that educate Federally connectedstudents or have Federally-owned land.
Payments for Federal Property
The Committee provides $79,000,000 for payments for Federal
property, which is the same as the fiscal year 2024 enacted level.
Funds are awarded to school districts to compensate for lost tax
revenue as the result of Federal acquisition of real property since
1938.
SCHOOL IMPROVEMENT PROGRAMSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$5,776,178,000
5,781,178,000
3,164,523,000¥2,611,655,000¥2,616,655,000

The School Improvement account includes programs authorizedunder Titles I, II, IV, VI, and VII of the ESEA; the McKinneyVento Homeless Assistance Act; Title IV–A of the Civil Rights Act;and section 203 of the Educational Technical Assistance Act of2002.
Supporting Effective Instruction State Grants
The Committee does not provide fiscal year 2025 funding forthese formula grants to States. This funding has not been shown
to improve teacher quality or advance student achievement.
Additionally, the Committee notes that according to the Department’s August 2023 report (‘‘State and District Use of Title II, PartA Funds in 2021–2022’’), professional development was the mostpopular use of Title II–A funds among school districts. Seventy five
percent of districts reported funding professional development forteachers, and 56 percent of districts reported funding professional
development for principals and other school leaders. Among districts that invested Title II–A funds in teacher professional development, 78 percent funded topics related to ‘‘content knowledge.’’
The Committee is concerned that school districts are using theseFederal funds to train teachers in divisive ideologies.
For these reasons, the Committee directs the Department in the
Departmental Management section of this report to submit a reportto the Committee on the specific uses of these funds by school district and schools.

DMWilson on DSKJM0X7X2PROD with HEARINGSState Assessments
The Committee does not provide funding for this program. The
Committee believes that State and local funds should cover these
activities.
Education for Homeless Children and YouthThe Committee provides $129,000,000 for the Education forHomeless Children and Youth program, which is the same as the
fiscal year 2024 enacted level. Formula grants are allocated to

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States in proportion to the total each State receives under the
Title I program.
Training and Advisory Services
The Committee does not provide funding for this program. The
Committee is concerned that this funding is used to push divisive
trainings and ideologies on public school teachers and other officials through training on how to address racial and sexual bias inteaching materials, school discipline policies, and school climates.
Nita M. Lowey 21st Century Community Learning Centers
The Committee provides $1,329,673,000 for Nita M. Lowey 21stCentury Community Learning Centers, which is the same as the
fiscal year 2024 enacted level. This program awards formula grants
to States, which in turn distribute funds on a competitive basis tolocal school districts, nonprofit organizations, and other public entities. Funds may be used to provide activities that complement andreinforce the regular school-day program for participating students
and may also fund local activities that are included as part of an
expanded learning time program.
Student Support and Academic Enrichment Grants
The Committee provides $1,390,000,000 for Student Support andAcademic Enrichment State Grants, which is an increase of$10,000,000 from the fiscal year 2024 enacted level. The Every Student Succeeds Act eliminated several narrowly focused competitive
grant programs and replaced them with this formula grant program. States and school districts have flexibility to focus these resources on locally determined priorities to provide students with access to a well-rounded education, including rigorous coursework,and to improve school conditions and the use of technology.

DMWilson on DSKJM0X7X2PROD with HEARINGS

Rural Education
The Committee provides $225,000,000 for Rural Education programs, which is an increase of $5,000,000 from the fiscal year 2024
enacted level. There are two dedicated programs to assist ruralschool districts with improving teaching and learning in theirschools: the Small, Rural Schools Achievement program, which provides funds to rural districts that serve a small number of students; and the Rural and Low-Income Schools program, which provides funds to rural districts that serve concentrations of poor students, regardless of the number of students served by the district.
Funds appropriated for Rural Education shall be divided equally
between these two programs.
Native Hawaiian Education
The Committee provides $45,897,000 for the Education for Native Hawaiian program, which is the same as the fiscal year 2024
enacted level. These funds are used to provide competitive grants
for supplemental education services to the Native Hawaiian population.
The Committee is supportive of resources to public elementaryand secondary schools that serve Native Hawaiian students, including activities for construction, renovation, and modernization of
any public elementary school, secondary school, or structure related

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to a public elementary school or secondary school, as authorizedunder part B of Title VI. The Committee encourages the Department to prioritize funding to organizations with construction needs
that have experience providing supplemental education services to
Native Hawaiian children and youth. In addition, the Committee
continues to support the Native Hawaiian Education Council.
Alaska Native Education
The Committee provides $44,953,000 for the Alaska Native Education program, which is the same as the fiscal year 2024 level.
These funds are used to provide competitive grants for supplemental education services to the Alaska Native population.
Comprehensive Centers
The Committee does not provide funding for this program. The
Committee is concerned that the Department is providing technicalassistance via comprehensive centers on social and emotional
learning rather than on efforts to improve academic achievement.
SAFE SCHOOLS AND CITIZENSHIP EDUCATION

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$457,000,000
507,000,000
291,000,000¥166,000,000¥216,000,000

This appropriation account includes programs authorized underparts of Title IV of the ESEA.

DMWilson on DSKJM0X7X2PROD with HEARINGS

Promise Neighborhoods
The Committee does not provide funding for these competitive
grants. The Committee notes that this program provides neighborhood social services such as healthcare, counseling, and job training that are duplicative of other free and subsidized government
programs that serve the same population. The Committee believes
the core role of the Department should be to support schools anddistricts in educating children in areas such as reading, writing,and math. The Committee also believes that these initiatives tobroaden the role and influence of schools in a child’s upbringing,in some cases, can present a negative impact on parental rights
and decrease parental responsibility.
School Safety National Activities
The Committee provides $216,000,000 for School Safety National
Activities, which is the same as the fiscal year 2024 enacted level.
The Committee’s recommendation provides up to $10,000,000 for
the Project School Emergency Response to Violence (Project SERV)
program, which is an increase of $5,000,000 from the fiscal year
2024 enacted level. The Project SERV program provides counselingand referral to mental health services as well as other educationrelated services to LEAs and Institutions of Higher Education(IHEs) in which the learning environment has been disrupted bya natural disaster or violent crisis.
Elementary and Secondary School Emergency Relief Funds
Uses.—As the deadline of September 30, 2024, approaches for districts to obligate these funds, the Committee encourages the De-

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215
partment to clarify that the following are eligible uses of Elementary and Secondary School Emergency Relief funds: video surveillance; student monitoring; updated doors, locks, and window panels; universal master key access boxes; mental health training; information technology that is able to transmit a text or video notification; crowd flow security technology; removable, semi-permanent,or permanent barriers or shields; and traffic pattern analytic software.
The Committee also notes that funds made available through the
Bipartisan Safer Communities Act (P.L. 117–159), for the Stronger
Connections Grant program may be used for information technology to improve the safety of the school environment in highneed LEAs. Guidance documentation published by the Department
also includes information regarding other related eligible uses offunds including equipment and minor remodeling.
Grants to Schools for Federal Law Enforcement Training.—The
Committee recognizes that highly trained School Resource Officers(SROs) play a crucial role in ensuring the safety and well-being ofstudents, faculty, and staff within K–12 schools. Their specialized
training equips them with the skills to effectively handle various
situations, including emergencies, conflicts, and other potential
threats. Beyond security, SROs also serve as mentors, mediators,
and positive role models, fostering a sense of trust and community
within schools. However, many K–12 schools do not have the necessary funding available to provide continued training to their
SROs. As such, the Committee provides $20,000,000 for a new competitive grant program for K–12 schools to provide SROs with enhanced training at the Federal Law Enforcement Training Centers(FLETC). The FLETC offers a variety of training that focuses onmaintaining a safe K–12 school environment. These types of specialized trainings are vital in supporting the unique, important,and varied roles that SROs must fulfill to ensure the safety andwell-being of K–12 school communities. The Committee directs the
Department to provide a briefing within 90 days of enactment of
this Act to the Committee on its plans for carrying out these competitive grants. In addition, the Committee directs the Department
to provide notice to the Committees at least seven days before any
notice of funding opportunity is published or any grantee is announced.
Parental Consent.—The Committee encourages the Department
to provide technical assistance and guidance to School-Based Mental Health Services grantees to ensure that they are following all
applicable district, State, and Federal laws and policies regarding
parental consent.
Rural Grant Applications.—The Committee is concerned with thedifficulties that underserved and rural communities face accessing
and applying for Federal school safety grants. The committee encourages the Department to prioritize technical assistance to ruraland underserved grant applicants.
School Infrastructure.—The Committee provides $136,000,000 for
a new competitive grant program to help schools implement bestpractices to improve school safety. This includes several things thatwere recommended in the Department of Justice’s January 18,
2024, report, ‘‘Critical Incident Review: Active Shooter at Robb Elementary School,’’ such as updated doors and locks that can be

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locked from the inside, metal detectors, or other deterrent measures; wi-fi to ensure emergency alerts are received in a timely manner; universal master key access boxes; school resource officers andsecurity personnel; and training and preparedness exercises coordinated between students, school personnel, local law enforcement
and first responders, and local government agencies. The Committee directs the Department to provide a briefing within 90 daysof enactment of this Act to the Committee on its plans for carryingout these competitive grants. In addition, the Committee directs
the Department to provide notice to the Committees at least sevendays before any notice of funding opportunity is published or any
grantees for a new competition are announced.
Student Mental Health Grants.—The Committee provides$25,000,000 for the Mental Health Services Professional Demonstration Grants program. The Committee also provides$25,000,000 for the School-Based Mental Health Services Grants
program with the requirements established in the explanatory
statement accompanying P.L. 116–94, including that no less than
50 percent of grants support LEA recipients, that awards include
a 25 percent match from grantees, and that the awards do not supplant existing mental health funding. The Committee notes thatthe Bipartisan Safer Communities Act (P.L. 117–159) provides$100,000,000 each fiscal year over fiscal years 2022–2026 to support each program. The Department is directed to provide quarterly obligation and expenditure reports to the Committee for eachprogram funded in such Act.
Full Service Community Schools
The Committee provides $75,000,000 for Full-Service Community
Schools, which is a decrease of $75,000,000 from the fiscal year
2024 enacted level. This program makes competitive grants to support school-based comprehensive services for students, families,
and communities, such as mental health and nutrition services.
The Committee believes the core role of the Department should beto support local school districts in educating children in areas suchas reading, writing, and math. Some of the services provided bycommunity schools are duplicative of other free and subsidized government programs that serve the same population.
INDIAN EDUCATION

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$194,746,000
194,746,000
202,246,000+7,500,000+7,500,000

DMWilson on DSKJM0X7X2PROD with HEARINGSThis account supports programs authorized by part A of title VIof the ESEA.
Grants to Local Educational Agencies
The Committee provides $110,381,000 for Grants to Local Educational Agencies, which is the same as the fiscal year 2024 enacted level. This program provides assistance through formula
grants to school districts and schools supported or operated by the
Bureau of Indian Education. The purpose of this program is to improve elementary and secondary school programs that serve Amer-

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ican Indian students, including preschool children. Grantees must
develop a comprehensive plan and ensure that the programs they
carry out will help American Indian students reach the same challenging standards that apply to all students. This program supplements the regular school program to help American Indian children
sharpen their academic skills, bolster their self-confidence, and participate in enrichment activities that would otherwise be unavailable.
Special Programs for Indian Children
The Committee provides $72,000,000 for Special Programs for Indian Children, which is the same as the fiscal year 2024 enacted
level. These programs make competitive grants to improve thequality of education for American Indian students.
Demonstration Grants.—The Committee directs the Department
to award $5,000,000 in new demonstration grants to eligible nonprofits who provide education and related services to students withdisabilities to establish on-site, early intervention, and special education services for K–12 students in Bureau of Indian Education
Resource Centers. The grantees shall design and provide services
for an educational, behavioral, therapeutic, and vocational programfor individuals with special needs from birth to 21 years of age.
National Activities
The Committee provides $19,865,000 for National Activities,
which is an increase of $7,500,000 from the fiscal year 2024 enacted level. Of that amount, $9,800,000 is provided for State-Tribal
Education Partnerships, $7,000,000 is provided for Native Language Immersion Schools and Programs, and $3,065,000 is provided for Native American Language Resource Centers.
Funds under this authority support: (1) research, evaluation, anddata collection to provide information about the educational status
of Indian students and the effectiveness of Indian education programs; (2) grants to support Native language immersion schools
and programs; and (3) grants to Tribes for education administrative planning, development, and coordination.
OFFICE OF INNOVATION AND IMPROVEMENTINNOVATION AND IMPROVEMENT

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$1,115,000,000
1,208,000,000
882,000,000¥233,000,000¥326,000,000

DMWilson on DSKJM0X7X2PROD with HEARINGSThis appropriation account includes programs authorized under
portions of Titles II and IV of the ESEA.
American History and Civics Academies
The Committee provides $3,000,000 for this program, which isthe same as the fiscal year 2024 enacted level. This program supports academies for teachers and high school students to strengthen their knowledge on American history, Civic, and government
education.

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American History and Civics National Activities
The Committee does not provide funding for these competitive
grants. The Committee is concerned that the Department is using
these grants to push divisive ideology onto school children, such as
the widely discredited 1619 project. The Committee notes that themost recent Nation’s Report Card scores found only 13 percent ofeighth graders were proficient in U.S. history and only 22 percent
proficient in civics. This program has become over politicized under
the current Administration and fails to sufficiently address theeducational needs of students.
Teacher and School Leader Incentive Grants
Due to funding constraints, the Committee does not provide
funding for these competitive grants.

DMWilson on DSKJM0X7X2PROD with HEARINGS

Supporting Effective Educator Development
The Committee does not provide funding for these competitive
grants. The Committee is unaware of any findings demonstratingthat these grants have improved teacher quality or student
achievement. Additionally, the Committee is concerned that school
districts are using these Federal funds to train teachers in divisive
ideology.
Charter Schools Grants
The Committee provides $450,000,000 for Charter School Program (CSP) Grants, which is an increase of $10,000,000 from thefiscal year 2024 enacted level.
The Charter Schools Grants program awards competitive grants
to State Educational Agencies (SEAs) or, if a State’s SEA chooses
not to participate, to charter school developers to support the development and initial implementation of public charter schools. State
Facilities Incentive Grants and Credit Enhancement for Charter
School Facilities awards help charter schools obtain adequate
school facilities. These programs work in tandem to support the development and operation of charter schools.
The Committee believes, in contrast to the Department’s flawed
justification in its fiscal year 2025 budget proposal for cutting thisprogram, that increased funding for CSP is strongly supported byrecent research and data on charter school performance and increasing demand for charter schools, despite efforts by the Administration to decrease the amount of successful grant applicants
through burdensome regulations and inadequately staffing the program office. For example, the office at the Department that oversees social and emotional learning, mental health, trauma, andschool climate has 40 percent more staff than the charter school
program office but oversees less competitive grant funding.
The Committee notes that high-quality charter schools continue
to yield strong academic results, especially for students from lowincome families and students of color. A 2020 Harvard study(‘‘Changes in the Performance of Students in Charter and District
Sectors of U.S. Education: An Analysis of Nationwide Trends’’)
found greater academic gains for students in charter schools, withthe difference amounting to almost an additional half year of learning for students in charter schools over the course of the study, andthe most significant gains found for Black and low-income stu-

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dents. Additionally, a 2021 meta-analysis of three decades of research, conducted by the National Institute of Economic Research(‘‘Charter Schools’ Effectiveness, Mechanisms, and Competitive Influence’’), found that charter schools located in urban areas boost
student test scores, particularly those of Black, Hispanic, and lowincome students, that charter school attendance is associated withincreases in college enrollment and voter turnout, and that thepresence of a charter school can have a beneficial influence onneighboring public schools. Recognizing these impacts, the Congressional Black Caucus Institute’s 21st Century Council 2023 Annual
Report supports the CSP’s effectiveness in leveling the playing field
for public charter schools, including through equal treatment ofpublic charter schools as public schools and expanding access topublic charter schools.
The Committee also notes that parents’ support for charterschools is strong, and charter school enrollment continues to climb,
while district public school enrollment falls. A 2022 Harris pollfound that three in four parents support expanding the number ofslots in charter schools in their communities, and the same percentage said that they would consider sending their child to a charter school if one were available. Further, 84 percent of parents responding to the poll stated that charter schools should be an available option for parents and students. The Committee also notesthat the Department’s 2023 Report on the Condition of Education
found that between fall 2019 and fall 2020, while traditional public-school enrollment decreased by 4 percent, public charter school
enrollment increased by 7 percent. Moreover, from the 2021–2022
to the 2022–2023 school year, charter school enrollment increased
again by 72,241 students (2 percent) while enrollment remained
flat for traditional public schools.
Facilities Grants.—The Committee provides an increase of$5,000,000 for State Charter School Facilities Incentive Grants andthe Credit Enhancement for Charter School Facilities Program.
The Committee is supportive of construction and renovation ofcharter school facilities, including storm shelters, safe rooms, andother infrastructure improvements such as fortified roof and wallconstruction to improve windstorm, tornado, and hurricane resilience.

DMWilson on DSKJM0X7X2PROD with HEARINGS

Magnet Schools Assistance
The Committee provides $139,000,000 for this program, which isthe same as the fiscal year 2024 enacted level. This program makes
competitive grants to support the establishment and operation ofmagnet schools that are a part of a court-ordered or Federally-approved voluntary desegregation plan.
Ready to Learn Television Programming
The Committee provides $31,000,000 for this program, which isthe same as the fiscal year 2024 enacted level. This program supports the development and distribution of educational video programming for preschool and elementary school children and theirparents, caregivers, and teachers.

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Arts in Education
The Committee does not provide funding for these competitive
grants. The Committee believes that considering the continued decline of public-school performance and student achievement acrossthe country, funding provided by the Department should be focusedon core education such as reading, writing, and math.
Javits Gifted and Talented Education
The Committee does not provide funding for these competitive
grants. The Committee is concerned that the Department’s focus onequity within the gifted and talented program further divides
American students and leaves them less prepared to compete in achallenging global economy. The Committee believes this program
should be merit based.

DMWilson on DSKJM0X7X2PROD with HEARINGSStatewide Family Engagement Centers
The Committee does not provide funding for these competitive
grants. The Committee is concerned that despite the millions ofdollars appropriated for these grants in recent years, there is noevidence that the grants have fostered trusting relationships between families and schools. In fact, the country witnessed the deterioration of that relationship during and in the aftermath of the
COVID pandemic for reasons these grants are not designed to address.
Education Innovation and Research
The Committee provides $259,000,000 for the Education Innovation and Research (EIR) program, which is the same as the fiscal
year 2024 enacted level. This program makes competitive grants to
support the replication and scaling-up of evidence-based education
innovations.
Grant Priorities.—The Committee notes there is significant demand from the field to test many types of strategies and to examine promising techniques that can be scaled up in different settings. The Committee encourages the Department to continue tosupport diverse and field-initiated interventions, rather than a single nationwide program or award focused solely on one area of educational innovation.
Publicizing Research Findings.—The Committee continues to besupportive of efforts by the Department to publicize research findings from the EIR program as described in House Report 117–96.
The Committee encourages the Department to take additional
steps to publicly release, widely publicize, and support the use of
research findings from this critical program and its predecessor,
the Investing in Innovation program, to stakeholders at the Federal, State, and local levels. The Committee specifically encourages
the Department to showcase those programs that have demonstrated, through rigorous research as required by the ESEA, that
their innovations show specific evidence of achievement in educational outcomes. The Committee directs the Department to submit a report to the Committee no later than 120 days after enactment of this Act, with an update on the Department’s goals, outcome measures, and corrective measures for achieving the widest
possible dissemination and use of this information in SEA and LEA
decision making.

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Rural Set Aside.—The Committee supports the required 25 percent set aside within the EIR program for rural areas and encourages the Department to invest in rural, high-need communities by
ensuring grants are awarded to a diverse set of institutions, affecting varied geographic locations, including areas with substantial
minority students, which have submitted high-quality applications
meeting EIR program requirements.
School Readiness.—The Committee encourages the Department
to support EIR awards that promote evidence-based school readiness programming in preschool, elementary, and secondary education.
STEM and Computer Science Grants.—In addition, within the
total for EIR, the Committee provides $87,000,000 for STEM education, including computer science, the same as the fiscal year 2024
enacted level.
Tutoring.—The Committee notes the importance of high-dosage
tutoring in accelerating student learning and supporting student
success. As States and districts are implementing and scaling up
tutoring programs aligned with research-based components, theCommittee encourages the Department to support high-dosage tutoring through new EIR awards.
OFFICE OF ENGLISH LANGUAGE ACQUISITIONENGLISH LANGUAGE ACQUISITION

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$890,000,000
940,000,000–––¥890,000,000¥940,000,000

Due to funding constraints, the Committee does not provide
funding for these formula and competitive grants.
OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES
SPECIAL EDUCATIONDMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$15,467,264,000
15,673,264,000
15,497,264,000+30,000,000¥176,000,000

These grants help States and localities pay for a free, appropriate
education for students with disabilities aged 3 through 21.
Teachers of Blind or Visually Impaired Children.—The Committee encourages the Department to support continuing education
opportunities for teachers of blind or visually impaired children,enrichment projects to improve the capacity of blind or visually impaired children to learn and live independently, programs within
institutions of higher education for the preparation of teachers ofchildren who are blind or visually impaired, and facilitate cooperation with nonprofit organizations with expertise and experience
serving children who are blind or visually impaired.
Intervener Services.—The Committee encourages the Department
to make technical assistance available to SEAs and LEAs in matters related to supporting students who are deafblind to address
the unique needs of these students. In addition, the Committee en-

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courages the Department to assist SEAs and LEAs seeking to facilitate the availability of intervener services at State and local levels, so students who are deafblind have access to information, communication, and interaction in educational environments.
Grants to States
The Committee provides $14,238,704,000 for Part B Grants toStates, which is an increase of $25,000,000 from the fiscal year
2024 enacted level. This program provides formula grants to assist
States in meeting the costs of providing special education and related services to children with disabilities. States generally transfer
most of the funds to LEAs; however, they can reserve some funds
for program monitoring, technical assistance, and other related activities. In order to be eligible for funds, States must make free appropriate public education available to all children with disabilities.
Preschool Grants
The Committee provides $420,000,000 for Preschool Grants,
which is the same as the fiscal year 2024 enacted level. These
funds provide additional assistance to States to help them makefree, appropriate public education available to children with disabilities ages 3 through 5.

DMWilson on DSKJM0X7X2PROD with HEARINGS

Grants for Infants and Families
The Committee provides $540,000,000 for Grants for Infants andFamilies, which is the same as the fiscal year 2024 enacted level.
These funds provide additional assistance to States to help themmake free, appropriate public education available to children withdisabilities from birth through age 2. The Committee continues billlanguage to promote the continuity of services for eligible infants
and their families.
IDEA National Activities
The Committee provides $257,560,000 for IDEA National Activities, which is the same as the fiscal year 2024 enacted level. The
IDEA National Activities programs support State efforts to improveearly intervention and education results for children with disabilities.
State Personnel Development.—The Committee provides$38,630,000 for State Personnel Development, which is the same as
the fiscal year 2024 enacted level. This program supports grants toStates to assist with improving personnel preparation and professional development related to early intervention and educational
and transition services that improve outcomes for students withdisabilities.
Technical Assistance and Dissemination.—The Committee provides $39,345,000 for Technical Assistance and Dissemination,
which is the same as the fiscal year 2024 enacted level. Funding
supports technical assistance, demonstration projects, and information dissemination. These funds support efforts by State and local
educational agencies, IHEs, and other entities to build State andlocal capacity to improve results for children with disabilities.
Personnel Preparation.—The Committee provides $115,000,000
for Personnel Preparation, which is the same as the fiscal year
2024 enacted level. This program supports competitive grants to

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help address State-identified needs for qualified personnel to workwith children with disabilities, and to ensure that those personnel
have the necessary skills and knowledge to serve children with special needs. Awards focus on addressing the need for leadership andpersonnel to serve low-incidence populations.
ParentInformation
Centers.—The
Committee
provides$33,152,000 for Parent Information Centers, which is the same as
the fiscal year 2024 enacted level. This program makes awards toparent organizations to support Parent Training and Information
Centers, including community parent resource centers. These centers provide training and information to meet the needs of parentsof children with disabilities living in the areas served by the centers, particularly underserved parents and parents of children who
may be inappropriately identified. Technical assistance is also provided under this program for developing, assisting, and coordinating centers receiving assistance under this program.
Educational Technology, Media, and Materials.—The Committee
provides $31,433,000 for Educational Technology, Media, and Materials, which is the same as the fiscal year 2024 enacted level. This
program makes competitive grants to support the development,
demonstration, and use of technology and educational media activities of educational value to children with disabilities. The Committee encourages the Department to expand this program’s reachto students with disabilities in higher education, given the valuethat exists to both K–12 and higher education through educational
technology improvements and the importance of providing seamless
pathways for students with disabilities to improve their completionof postsecondary education.
Special Olympics Education Programs
The Committee provides $41,000,000 for Special Olympics Education Programs, which is an increase of $5,000,000 from the fiscal
year 2024 level, to support activities authorized by the Special
Olympics Sport and Empowerment Act. This funding supports efforts to expand Special Olympics programs and the design and implementation of Special Olympics education programs that can be
integrated into classroom instruction and are consistent with academic content standards.
REHABILITATION SERVICES

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$4,110,241,000
4,118,156,000
4,118,156,000+7,915,000–––

DMWilson on DSKJM0X7X2PROD with HEARINGSThe programs in this account are authorized by the Rehabilitation Act of 1973 and the Helen Keller National Center Act.
Vocational Rehabilitation State Grants
This program supports vocational rehabilitation services throughformula grants to States. These grants support a wide range ofservices designed to help persons with physical and mental disabilities prepare for and engage in gainful employment to the extent
of their capabilities. Emphasis is placed on providing vocational re-

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habilitation services to persons with the most significant disabilities.
Randolph-Sheppard Program.—The Committee directs the Department to provide participants in the Randolph-Sheppard program with technical assistance and support in applying for funding
opportunities available under the Office of Special Education andRehabilitative Services. In the fiscal year 2026 congressional justification, the Committee requests an update on such efforts fromfiscal year 2024 and planned efforts in fiscal years 2025 and 2026.
Client Assistance State Grants
The Committee provides $13,000,000 for Client Assistance State
Grants, which is the same as the fiscal year 2024 enacted level.
Client Assistance State Grants support services for eligible individuals and applicants of the vocational rehabilitation State Grants
program, and other programs, projects, and services funded under
the Rehabilitation Act. These formula grants are used to help persons with disabilities overcome problems with the service delivery
system and improve their understanding of services available tothem under the Rehabilitation Act.
Training
The Committee provides $29,388,000 for the Training program,which is the same as the fiscal year 2024 enacted level. The program supports long-term and short-term training, in-service personnel training, and training of interpreters for deaf persons.
Projects in a broad array of disciplines are funded to ensure thatskilled personnel are available to serve the vocational needs of persons with disabilities.
Demonstration and Training Programs
The Committee provides $5,796,000 for Demonstration andTraining Programs, which is the same as the fiscal year 2024 enacted level. These programs authorize competitive grants to public
and private organizations to support demonstrations, direct services, and related activities for persons with disabilities.

DMWilson on DSKJM0X7X2PROD with HEARINGS

Protection and Advocacy of Individual Rights
The Committee provides $20,150,000 for Protection and Advocacy
of Individual Rights, which is the same as the fiscal year 2024 enacted level. Grants are awarded to entities that have the authority
to pursue legal, administrative, and other appropriate remedies toprotect and advocate for the rights of persons with disabilities.
Supported Employment State Grants
The Committee provides $22,548,000 for Supported Employment
State Grants, which is the same as the fiscal year 2024 enacted
level. These formula grants assist States in developing collaborative programs with public agencies and nonprofit agencies fortraining and post-employment services leading to supported employment. In supported employment programs, persons with themost significant disabilities are given special supervision and assistance to enable them to work in integrated settings.

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Services for Older Blind Individuals
The Committee provides $33,317,000 for Services for Older Blind
Individuals, which is the same as the fiscal year 2024 enacted
level. Funds are distributed to States according to a formula basedon the population of individuals who are 55 or older and provide
support for services to persons 55 or over whose severe visual impairment makes gainful employment extremely difficult to obtain,
but for whom independent living goals are feasible.
Helen Keller National Center
The Committee provides $19,000,000 for the Helen Keller National Center for Deafblind Youth and Adults, which is the sameas the fiscal year 2024 enacted level. These funds are used for theoperation of a national center that provides intensive services for
deafblind individuals and their families at Sands Point, New York,and a network of ten regional offices that provide referral, counseling, transition services, and technical assistance to service providers.
SPECIAL INSTITUTIONS FOR PERSONS WITH DISABILITIESAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$303,292,000
301,292,000
305,792,000+2,500,000+4,500,000

AMERICAN PRINTING HOUSE FOR THE BLIND

DMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$43,431,000
43,431,000
44,431,000+1,000,000+1,000,000

This funding subsidizes the production of educational materials
for legally blind persons enrolled in pre-college programs. The
American Printing House for the Blind (Printing House), which is
chartered by the Commonwealth of Kentucky, manufactures, andmaintains an inventory of educational materials in accessible formats that are distributed free of charge to schools and States basedon the number of blind students in each State. The Printing Housealso conducts research and field activities to inform educators
about the availability of materials and how to use them.
The Committee provides $44,431,000 to meet the resources necessary to develop and distribute assistive technologies, books in accessible formats and specially designed educational aids that willallow students who are blind or visually impaired to fully participate in and benefit from education programs. In addition, withinamounts provided for the Printing House, the Committee includes
up to $6,000,000, which is an increase of $1,000,000 from fiscal
year 2024 enacted level, to support additional field testing and initial production and distribution of an innovative braille and tactile
display products developed by the Printing House and its partners.
Center for Assistive Technology Training.—The Committee includes $6,000,000, which is equal to the fiscal year 2024 enacted
level, to continue the current Center for Assistive Technology regional partnership.

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NATIONAL TECHNICAL INSTITUTE FOR THE DEAF

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$92,500,000
92,500,000
93,000,000+500,000+500,000Congress established the National Technical Institute for theDeaf (Institute) in 1965 to provide a residential facility for postsecondary technical training and education for deaf persons with the
purpose of promoting the employment of these individuals. The Institute also conducts applied research and provides training related
to various aspects of deafness. The Secretary of Education administers these activities through a contract with the Rochester Institute of Technology in Rochester, New York.
Regional STEM Center.—The Committee includes $9,500,000,
which is equal to the fiscal year 2024 enacted level, to continue
NTID’s current Regional STEM Center partnership.
GALLAUDET UNIVERSITY

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$167,361,000
165,361,000
168,361,000+1,000,000+3,000,000

Gallaudet University is a private, nonprofit educational institution Federally chartered in 1864 providing elementary, secondary,undergraduate, and continuing education for deaf persons. In addition, the University offers graduate programs in fields related todeafness for deaf and hearing students, conducts research on deafness, and provides public service programs for deaf persons.
Early Learning Acquisition Project.—The Committee includes$9,000,000, which is an increase of $500,000 from the fiscal year
2024 enacted level, to continue the current regional partnership
through the Early Learning Acquisition Project with the current
partner as the lead agent for program expansion.
OFFICE OF CAREER, TECHNICAL, AND ADULT EDUCATIONCAREER, TECHNICAL, AND ADULT EDUCATION

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$2,181,436,000
2,268,436,000
2,186,436,000+5,000,000¥82,000,000

DMWilson on DSKJM0X7X2PROD with HEARINGSThis account includes vocational education programs authorized
by the Carl D. Perkins Career and Technical Education Act of2006, as recently reauthorized by the Strengthening Career andTechnical Education for the 21st Century Act, and the Adult Education and Family Literacy Act.
Career and Technical Education: State Grants
The Committee provides $1,449,848,000 for Career and Technical
Education (CTE) State Grants, which is an increase of $10,000,000
from the fiscal year 2024 enacted level.
State Grants support a variety of career and technical education
programs developed in accordance with a State’s submitted plan.

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This program focuses Federal resources on institutions with highconcentrations of low-income students. The populations assisted by
State Grants range from secondary students in prevocationalcourses to adults who need retraining to adapt to changing technological and labor markets.
Upcoming Regulatory Actions.—The Committee is concerned
about the Department’s recently announced plans to regulate theCarl D. Perkins Career and Technical Education Act (Perkins V).
The Committee notes that Congress included a provision in the2018 Strengthening Career and Technical Education for the 21stCentury Act, section 218, which specifically limits the issuance ofregulations under this Act unless it is necessary to administer andensure compliance with the specific requirements of Perkins V. The
Committee encourages the Department to explicitly, and expeditiously, clarify the scope and content of these forthcoming regulations.
Career and Technical Education: National Programs
The Committee provides $7,421,000 for National Programs,
which is a decrease of $5,000,000 from the fiscal year 2024 enacted
level. This program supports the conduct and dissemination of research in career and technical education.
Adult Education State Grants
The Committee provides $715,455,000 for Adult Basic and Literacy Education State Grants, which is the same as the fiscal year
2024 enacted level. State formula grants, authorized under the
AEFLA, support programs to enable adults to acquire basic literacy
skills, to enable those who so desire to complete secondary education, and to make available to adults the means to become more
employable, productive, and responsible citizens.
Adult Education National Leadership Activities
The Committee provides $13,712,000 for National Leadership Activities, which is the same as the fiscal year 2024 enacted level.
This program supports applied research, development, dissemination, evaluation, and program improvement efforts to strengthen
the quality of adult education services.
The Committee recognizes the potential that innovative technologies have in addressing adult literacy challenges and directs noless than $2,000,000 to the Department to partner with an institution of higher education that specializes in high performance computing to develop a pilot program utilizing innovative technologies
including artificial intelligence and machine learning to develop apersonalized literacy program for adults.
OFFICE OF POSTSECONDARY EDUCATIONDMWilson on DSKJM0X7X2PROD with HEARINGSHIGHER EDUCATION

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

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3,343,247,000
2,849,272,000¥434,024,000¥493,975,000

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Aid for Institutional Development
Strengthening Institution
The Strengthening Institutions program under Part A of title IIIof the Higher Education Act supports competitive grants for general operating subsidies to institutions with below average educational and general expenditures per student and significant percentages of low-income students. Funds may be used for faculty
and academic program development, management, joint use of libraries and laboratories, acquisition of equipment, and student
services.
The Committee provides $117,070,000 for the Strengthening Institutions program, which is $5,000,000 above the fiscal year 2024
enacted level and $22,930,000 below the fiscal year 2025 budget request.
The Committee directs the Department to establish a competitive
preference priority for eligible institutions with needs for developing and improving academic programs or construction, maintenance, and related improvements in classrooms, laboratories, andother instructional facilities, that are within the geographic area of
the Delta Regional Authority (7 U.S.C. 2009aa et seq.), the Northern Border Regional Commission (40 U.S.C. 15101 et seq.), or the
Appalachian Regional Commission (40 U.S.C. 14101 et seq.). The
Committee further directs the Department to prioritize grants foracademic programs that address workforce shortages in thehealthcare and aviation fields.
Developing Hispanic-Serving Institutions
The Committee provides $232,890,000 for the Developing Hispanic-Serving Institutions (HSI) program, which is $4,000,000
above the fiscal year 2024 enacted level and $13,657,000 below the
fiscal year 2025 budget request.
The Developing HSIs program provides operating subsidies toschools that serve at least 25 percent Hispanic students. Funds
may be used for faculty and academic program development, management, joint use of libraries and laboratories, acquisition ofequipment, and student services.
New Hispanic-Serving Institutions.—The Committee recognizes
the importance of supporting HSIs, particularly those that have recently received this designation. The Committee encourages the
Department to provide technical assistance to newly designated
HSIs on all Federal resources and grants available to them.

DMWilson on DSKJM0X7X2PROD with HEARINGS

Promoting Postbaccalaureate Opportunities for Hispanic Americans
The Committee provides $27,451,000 for the Promoting
Postbaccalaureate Opportunities for Hispanic Americans program,the same as the fiscal year 2024 enacted level. This program provides expanded postbaccalaureate educational opportunities for theacademic attainment of Hispanic and low-income students. In addition, it expands academic offerings and enhances program quality
at IHEs educating the majority of Hispanic college students.
Strengthening Historically Black Colleges and Universities
The Committee provides $407,966,000 for Strengthening Historically Black Colleges and Universities (HBCUs), which is $7,000,000

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more than the fiscal year 2024 enacted level. This program provides operating subsidies to accredited HBCUs that were established prior to 1964, with the principal mission of educating Black
Americans. Funds are distributed through a formula grant basedon the enrollment of Pell Grant recipients, number of graduates,
and the number of graduates entering graduate or professional
schools in which Black students are underrepresented.
The Committee recognizes that many students’ postsecondary
education and career goals are well-supported by two-year programs offered by Historically Black Community Colleges and seeks
to further support educational opportunities for students at theseschools. The Committee continues language and funding for thisprogram, dedicating this increased funding for supplemental
awards to junior or community colleges that are eligible under theHistorically Black Colleges and Universities program.
Strengthening Historically Black Graduate Institutions
The Committee provides $101,286,000 for the Strengthening Historically Black Graduate Institutions program, which is the sameas the fiscal year 2024 enacted level. The program provides fiveyear grants to postsecondary institutions that are specified in section 326(e)(1) of the HEA. Institutions may use funds to build endowments, provide scholarships and fellowships, and to assist students with the enrollment and completion of postbaccalaureate andprofessional degrees.
Strengthening Predominantly Black Institutions
The Committee provides $22,412,000 for the Strengthening Predominantly Black Institutions (PBIs) program, which is the sameas the fiscal year 2024 enacted level. This program provides grants
to PBIs to increase their capacity to serve the academic needs ofstudents.

DMWilson on DSKJM0X7X2PROD with HEARINGS

Strengthening Asian American and Native American Pacific-Islander-Serving Institutions
The Committee provides $18,682,000 for the Strengthening Asian
American and Native American Pacific-Islander-Serving Institutions program, which is the same as the fiscal year 2024 enacted
level. This program provides grants to undergraduate institutions
that have an undergraduate student enrollment of at least 10 percent Asian American or Native American Pacific Islander.
Strengthening Alaska Native and Native Hawaiian-Serving Institutions
The Committee provides $24,555,000 for the Strengthening Alaska Native and Native Hawaiian-Serving Institutions program,which is the same as the fiscal year 2024 enacted level. Throughthe Strengthening Alaska Native and Native Hawaiian-Serving Institutions program, the Department provides grants to assist institutions of higher education in serving Alaska Native and Native
Hawaiian students.

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Strengthening
NativeAmericanServing
Non-Tribal
Institutions
The Committee provides $14,462,000 for the Native American
Serving Non-Tribal Institutions program, which is $3,000,000 morethan the fiscal year 2024 enacted level. This program makes grants
to IHEs at which enrollment is at least 10 percent Native American students and that are not Tribally Controlled Colleges or Universities.
Strengthening Tribally Controlled Colleges and Universities
The Committee provides $55,807,000 for the Strengthening Tribally Controlled Colleges and Universities (TCCUs) program, whichis $4,000,000 more than the fiscal year 2024 enacted level. This
program makes grants to TCCUs to increase their capacity to serve
the academic needs of students.
Strengthening HBCU Masters Program
The Committee provides $20,037,000 for the Strengthening
HBCU Masters Programs, which is the same as the fiscal year
2024 enacted level. This program provides grants to specified colleges and universities making a substantial contribution to graduate education opportunities at the Master’s level in mathematics,
engineering, the physical or natural sciences, computer science, information technology, nursing, allied health, or other scientific disciplines.
International Education and Foreign Language Studies
Authorized by Title VI of the HEA, these programs include National resource centers, foreign language and area studies fellowships, undergraduate international studies and foreign language
programs, international research and studies projects, business andinternational education projects, international business education
centers, language resource centers, American overseas research
centers, and technological innovation and cooperation for foreign
information access.
Domestic Programs
The Committee provides $73,282,000 for the Domestic Programsof the International Education and Foreign Languages Studies program, which is $2,071,000 less than the fiscal year 2024 enacted
level.

DMWilson on DSKJM0X7X2PROD with HEARINGS

Overseas Programs
The Committee provides $8,249,000 for the Overseas Programs,
which is $2,062,000 less than the fiscal year 2024 enacted level andthe same as the budget request.
Model Comprehensive Transition and Postsecondary Programs forStudents with Intellectual Disabilities
The Committee provides $13,800,000 for the Model Comprehensive Transition and Postsecondary Programs for Students with Intellectual Disabilities (TPSID) program, which is the same as the
fiscal year 2024 enacted level. TPSID supports grants to createmodel transition programs into postsecondary education for students with intellectual disabilities.

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Minority Science and Engineering Improvement
The Committee provides $16,370,000 for the Minority Scienceand Engineering Improvement Program, which is the same as the
fiscal year 2024 enacted level. This program awards grants to improve mathematics, science, and engineering programs at institutions serving primarily minority students and to increase the number of minority students who pursue advanced degrees and careers
in those fields.
Tribally Controlled Postsecondary Career and TechnicalInstitutions
The Committee provides $15,953,000 for the Tribally Controlled
Postsecondary Career and Technical Institutions program, which is$4,000,000 more than the fiscal year 2024 enacted level. This program awards competitive grants to Tribally controlled postsecondary career and technical institutions to provide career and technical education to Native American students.
Federal TRIO Programs
The Committee provides $1,191,000,000 for TRIO programs,
which is the same as the fiscal year 2024 enacted level. The TRIO
programs provide a variety of outreach and support services to encourage low-income, first-generation college students and individuals with disabilities to enter and complete college. Discretionary
grants of up to four or five years are awarded competitively to
IHEs and other nonprofit organizations. At least two thirds of theeligible participants in TRIO must be low-income, first-generationcollege students.

DMWilson on DSKJM0X7X2PROD with HEARINGS

Gaining Early Awareness and Readiness for Undergraduate
Programs
The Committee provides $388,000,000 for Gaining Early Awareness and Readiness for Undergraduate Programs (GEAR UP),
which is the same as the fiscal year 2024 enacted level. GEAR UP
provides grants to States and partnerships of low-income middle
and high schools, IHEs, and community organizations to target entire grades of students and give them skills, encouragement, andscholarships successfully to pursue postsecondary education.
The Committee continues bill language allowing the Department
to maintain the GEAR UP evaluation set aside at 1.5 percent towork with the GEAR UP community and grantees to standardize
data collection, including through the use of third-party data systems. Additionally, the Committee continues to direct the Department to ensure that no request from a State Grant applicant to receive an exception to the GEAR UP scholarship (as described in
section 404E(b)(2) of the HEA) shall be denied on the basis of 34
CFR 694.14(c)(3).
Graduate Assistance in Areas of National Need
The Committee does not provide funding for the Graduate Assistance in Areas of National Need program. This program funds fellowships for students pursuing a doctoral degree or the highest degree in the field available at their institution, and who are studying in areas considered to be of national need. The Committee recognizes that institutions of higher education or non-Federal sources

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of postsecondary funding could more appropriately support such
graduate fellowships. The Committee is concerned that the program performance is not meeting its targets. The target completion
rate for fellows to finish their degree is only 65 percent, but the actual completion rate in 2021 was 63 percent. Additionally, the program’s cost per PhD and for students who pass preliminary exams
exceeded the target of $68,000 in both 2020 and 2021, for whichdata is most recently available.
Teacher Quality Partnership Grants
The Committee does not provide funding for the Teacher Quality
Partnerships program. The Committee notes this program’s purpose duplicates those of other Federal programs related to teacher
preparation and development. The Committee recognizes that K–12
education is inherently local in nature, and therefore States anddistricts can be most responsive to needs regarding teacher recruitment and development in local schools. Therefore, they are best positioned to make funding decisions for such activities.
Child Care Access Means Parents in School
The Committee does not provide funding for the Child Care Access Means Parents in School program. The Committee notes that
this program has a duplicative function of the Child Care and Development Block Grant, which supports childcare for low-income
families and for which the Committee has provided resources.
Fund for the Improvement of Postsecondary Education
The Committee recommendation includes $100,000,000 for theFund for the Improvement of Postsecondary Education, which is$71,000,000 less than the fiscal year 2024 enacted level and$162,000,000 below the fiscal year 2025 budget request.
Within the total provided, the Committee includes the following
amounts:
FY 2024
EnactedBudget Activity

DMWilson on DSKJM0X7X2PROD with HEARINGS

Basic Needs Grants .....................................................................................................
Centers of Excellence for Veteran Student Success Program ....................................
HBCU, TCU, and MSI Research and Development Infrastructure Grants ...................
HSI and LEA Partnerships ...........................................................................................
Increasing Hispanic PhDs Pilot ...................................................................................
Open Textbook Pilot .....................................................................................................
Postsecondary Student Success Grants ......................................................................
Rural Postsecondary and Economic Development Grant Program .............................
Transitioning Gang-Involved Youth to Higher Education ............................................

FY 2025
Committee$10,000,000
9,000,000
50,000,000––––––
7,000,000
45,000,000
45,000,000
5,000,005

–––
–––
–––
$2,500,000
2,500,000–––
45,000,000
50,000,000–––

Hispanic-Serving Institutions and Local Educational Agencies
Partnerships.—The Committee includes $2,500,000 for grants topromote and support collaboration between Hispanic-Serving Institutions and local educational agencies that serve a significant number or percentage of Hispanic or Latino students for the purposeof improving educational attainment, including increasing highschool graduation rates and postsecondary enrollment, transfer andcompletion rates among Hispanic or Latino students, such as bystrengthening pathways to postsecondary and workforce development programs. The Department shall also ensure such funds areused to improve educational outcomes for English learners served

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DMWilson on DSKJM0X7X2PROD with HEARINGS

by such local educational agencies, including recently arrived
English learners and long-term English learners.
Increasing Hispanic-Serving Institutions PhDs Pilot.—The Committee recognizes that Hispanic professionals are underrepresented
in postsecondary education. The Committee includes $2,500,000 forcompetitive grants to HSIs or consortiums of HSIs that award
PhDs. The Department is directed to make awards to at least four
institutions of higher education, as defined by section 101 of the
HEA, to support programs that seek to bolster PhD attainment.
Grant priority will go to institutions with 25 percent or higher Pell
enrollment, and HSIs located in areas with 25 percent or higher
Hispanic or Latino population. Funding should be used to develop
and test new models of cross-institutional partnerships that facilitate mutually reinforcing activities such as resource-sharing learning communities, mentorship programs for PhD students, graduate
research experiences, faculty mentor capacity-building, and otherassociated uses.
Postsecondary Student Success Grants.—The Committee provides$45,000,000, which is the same as the fiscal year 2024 enacted
level, for grants to support evidence-based activities to improve
postsecondary retention and completion rates, including criticalpersistence benchmarks. Eligible applicants may include institutions of higher education, a consortium of institutions of higher
education, Statewide systems of higher education, a nonprofit organization, or any of the preceding entities in partnership with a nonprofit or business.
Rural Postsecondary and Economic Development Grants.—The
Committee provides $50,000,000, which is $5,000,000 above the fiscal year 2024 enacted level, for the Rural Postsecondary and Economic Development Grants (RPED) program. The Committee isaware that although rural students graduate from high school at
rates that may exceed their urban and suburban peers, they arealso significantly less likely than their peers in other areas to attend post-secondary education opportunities. The Committee recognizes that rural-serving institutions and communities face uniquechallenges and barriers when compared to their urban and suburban counterparts. Smaller, rural-serving colleges, universities, andnonprofit organizations may have significantly fewer staff, and lessexperience, in preparing to respond to Federal grant opportunities.
The Committee encourages the Department of Education to consider ways to better support rural applicants by recognizing theunique challenges facing rural communities, including but not limited to providing greater flexibility, longer application timelines,
and targeted technical assistance for RPED grants and other funding opportunities across the Department.
Augustus F. Hawkins Centers of Excellence
The Committee does not provide funding for the Hawkins Centers of Excellence program, recognizing there are duplicative Federal programs related to improving and expanding the availabilityof teachers. The Committee instead prioritizes resources for otherprograms providing aid to institutions of higher education and aidthat goes directly to students, such as Pell Grants.

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HOWARD UNIVERSITY

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$304,018,000
297,018,000
253,928,000¥50,090,000¥43,090,000

The Committee provides $253,928,000 for Howard University,
which is $50,090,000 less than the fiscal year 2024 enacted level.
Howard University is a leading research university located in theDistrict of Columbia and provides undergraduate liberal arts, graduate, and professional instruction to students. Of the amounts provided, the Committee recommendation includes no less than
$3,405,000 for the matching endowment grant, which is the sameas the fiscal year 2024 enacted level and the fiscal year 2025 budget request.
Howard University Hospital.—Within the funds provided forHoward University, the Committee recommends $70,235,000 for
the Howard University Hospital. Of this amount, $27,235,000 is forongoing hospital operations, the same as the fiscal year 2024 enacted level. The Committee also includes new language in section
311 providing legislative authority for the Secretary to transfer up
to $43,000,000 in unobligated amounts from the Department of
Education’s Nonrecurring Expenses Fund to Howard University forcompletion of the construction of the new Howard University Hospital. This funding follows the $257,000,000 for hospital construction that Congress has provided since fiscal year 2021. This funding will complete the University’s request of $300,000,000.
COLLEGE HOUSING AND ACADEMIC FACILITIES LOANS PROGRAM

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$298,000
328,000
298,000–––¥30,000

Previously, these programs helped to ensure that postsecondary
institutions were able to make necessary capital improvements tomaintain and increase their ability to provide a high-quality education. Since 1994, no new loans have been made, and the Department’s role has been to manage the outstanding loans.
HISTORICALLY BLACK COLLEGE AND UNIVERSITY CAPITAL FINANCINGPROGRAM ACCOUNTDMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$20,678,000
20,731,000
20,678,000–––¥53,000

The Committee provides $20,678,000 for the HBCU Capital Financing program, which is the same as the fiscal year 2024 enacted
level. This program is authorized under part D of Title III of the
HEA and makes capital available for repair and renovation of facilities at HBCUs.
Within the total provided for this program, the Committee recommendation includes $528,000 for the administrative expenses tocarry out the program and $20,150,000 for loan subsidy costs.

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DMWilson on DSKJM0X7X2PROD with HEARINGSOFFICE OF FEDERAL STUDENT AID (FSA)
90/10 Rule.—The 90/10 rule under the HEA requires proprietary
institutions of higher education to derive at least 10 percent of
their tuition and fee revenue from non-Title IV sources. In October
2022, the Department updated the rule to include other Federal
education assistance funds from other Federal agencies, not justTitle IV funds, as required by P.L. 117–2. The rule is effective July
1, 2023, for institutional fiscal years that begin on or after January
1, 2023, such that some institutions were required to comply starting January 1. The Committee is aware that some commentersraised questions about this timing and asked for clarification on
the statutory authority the Department used to determine the timing. Others questioned the rule’s requirement that institutions cannot count as non-Federal revenue the funds they get from distancelearning programs that are ineligible for Title IV funds, for calculating 90/10 compliance. They noted that distance learning is a valuable form of education. The Committee continues to be concernedwith the Department’s use of preamble language to regulate distance education. Given the complexities of the rule and its significant effects on proprietary institutions and students, the Committee urges the Department to ensure it provides clear communication and information on these regulations.
Collective Adjudication of Borrower Defense Claims.—The Committee acknowledges concerns regarding the recent expansion ofborrower defense that allows the Department to collectively apply
an adjudicated decision of an individual claim for borrower defense
to another group of borrowers, including groups formed by thirdparty requestors, rather than adjudicating individual claims separately. The Committee is concerned that such ‘‘group’’ processing ofborrower claims may result in the inadvertent approval of
meritless claims solely based on their grouping with legitimate
claims. The Committee directs the Department to ensure that the
adjudication and review process for borrower defense claims involving groups of borrowers, including those formed by third-party requestors, shall be conducted on an individual basis, and reviewed
for materiality. The Department is encouraged to establish clear
criteria for assessing the materiality and reliability of third-party
submitted claims and is directed to report to the Committee within
180 days of enactment of this Act on the implementation of theseprocedures and any additional measures taken to mitigate the riskof improper claim approvals.
Public Service Loan Forgiveness.—The Committee remains concerned about the fiscal and distributional impact associated with
the Public Service Loan Forgiveness (PSLF) program, particularly
considering executive actions and new regulations issued by the
Department. The Committee requests a report be provided to theCommittee and the Committee on Education and the Workforce ofthe House of Representatives, the Committee on Health, Education, Labor, and Pensions and the Committee on Appropriationsof the Senate within 90 days of enactment of this Act and published on the Department’s website describing the distributional
impact of the PSLF program. The report shall include informationon the amounts forgiven under PSLF based on borrower characteristics, including, type of employment, household income, highest

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level of degree obtained, and amount borrowed. The Secretary shalldevelop employment categories for purposes of meeting this requirement, which may include using information from the Department’s eligible employer database, aligning categories with the Bureau of Labor Statistics standard occupation classification system,or other methods.
Responsiveness to GAO Information Requests.—The Committee
notes that the Department of Education has unreasonably and unnecessarily delayed the routine production of information to GAO
in response to GAO information requests regarding ongoing reviews of the rollout of the simplified Free Application for Federal
Student Aid (FAFSA) (engagement code 107407) and the FAFSA
processing system launch (engagement code 107396). Such information requested by GAO is necessary for GAO to complete its work.
The Committee directs FSA to immediately comply with all ongoing
GAO information requests related to the two FAFSA reviews andto comply fully with all future GAO information requests related
to the two FAFSA reviews no later than 7 calendar days after each
GAO request or such other timeframe as GAO may specify. GAO
has well-established statutory authority to access agency records
under 31 U.S.C. 716(a), and there is no question that the information GAO has requested from the Department for its reviews falls
squarely within GAO’s authority. The Committee further directs
GAO to provide the Committee periodic updates on the Department’s responsiveness to GAO’s information requests on the two
FAFSA reviews. The Department shall include in the fiscal year
2026 congressional justification the status of any outstanding recommendation, not fully implemented, from any prior GAO publication.
Student Loan Debt Relief.—The Committee expresses growing
concern about the fiscal and distributional impact associated with
the Department’s student debt relief efforts. The Department’s
stated total debt relief provided as of May 21, 2024, through various waivers, executive actions, and new regulations is $167 billion,
and hundreds of billions more is expected to be realized over the
next decade. The Committee requests a report be provided to theCommittee and the Committee on Education and the Workforce ofthe House of Representatives, and the Committee on Health, Education, Labor, and Pensions and the Committee on Appropriationsof the Senate within 30 days of enactment of this Act and published on the Department’s website. This report shall describe the
distributional impact of the Department’s debt relief efforts. The
report shall include the amounts cancelled, waived, or otherwise
discharged through each of the Administration’s debt relief actions
carried out under the Higher Education Act of 1965 and the Higher
Education Relief Opportunities Act of 2003 and cover actions undertaken since January 1, 2021. In addition, such information shallbe disaggregated by household income, highest level of degree obtained, and amount borrowed.

DMWilson on DSKJM0X7X2PROD with HEARINGSSTUDENT FINANCIAL ASSISTANCE

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

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26,716,352,000
23,545,352,000¥1,070,000,000¥3,171,000,000

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Pell Grants
The Committee provides $22,475,352,000 in discretionary funding for the Pell Grant program, the same as the fiscal year 2024
enacted level. These funds will support Pell Grants to students forthe 2025–2026 award year.
The Committee recommendation includes $6,335 for the discretionary portion of the maximum Pell grant award, the same as the
fiscal year 2024 enacted level. Combined with mandatory fundingof $1,060, this would provide a total maximum award of $7,395 forthe 2025–2026 award year.
Pell Grants are the foundation of Federal postsecondary student
aid programs. Pell Grants increase access to educational and economic opportunities for low- and middle-income students by providing need-based financial assistance. Grants are determined according to a statutory formula, which considers income, assets,household size, and the number of family members in college,
among other factors.
Federal Supplemental Educational Opportunity Grants
The Federal Supplemental Educational Opportunity Grant program provides need-based grant aid to eligible undergraduate students to help reduce financial barriers to postsecondary education.
Federal funding allocations are awarded to qualifying postsecondary institutions under a statutory formula. The Committee provides $455,000,000, which is $455,000,000 below the fiscal year
2024 enacted level and the fiscal year 2025 budget request.
Federal Work Study
The Federal work study (FWS) program provides funds for parttime employment to help low income students to finance the costsof postsecondary education. Students can receive FWS funds at approximately 3,400 participating postsecondary institutions. The
Committee provides $615,000,000, which is $615,000,000 below the
fiscal year 2024 enacted level and the fiscal year 2025 budget request.
STUDENT AID ADMINISTRATION

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$2,058,943,000
2,659,126,000
1,529,472,000¥529,471,000¥1,129,654,000

DMWilson on DSKJM0X7X2PROD with HEARINGS

Programs administered under the Student Aid Administration(SAA) include Pell Grants, campus-based aid programs, Teacher
Education Assistance for College and Higher Education grants, andFederal student loan programs.
Salaries and Expenses
Within the total provided for SAA, the Committee provides$529,472,000 for salaries and expenses, which is $529,471,000 lessthan the fiscal year 2024 enacted level and $805,271,000 below the
fiscal year 2025 budget request.

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238
Servicing Activities
Within the total provided for SAA, the Committee provides$1,000,000,000 for Loan Servicing Activities, which is the same as
the fiscal year 2024 enacted level, and $324,383,000 below thebudget request. The Committee notes that in fiscal year 2024, SAA
received a $25,000,000 increase in funding specifically designatedfor the continuation of student loan servicing activities, including
supporting borrowers reentering repayment. The Committee underscores the importance of prioritizing loan servicing and assisting
borrowers in repaying their loans. The Committee urges the Department to abandon its unfair and fiscally irresponsible student
loan forgiveness schemes.
Enforcement.—The Committee expresses growing concern about
the escalating frequency of targeted enforcement actions against
specific categories of postsecondary institutions. Objective, unbiased oversight, devoid of ideology and conflicts of interest, is essential. Any punitive measures, fines, or penalties must be impartiallyassessed based on neutral criteria. The department has repeatedly
conducted specific investigations into individual colleges and universities, certain types of institutions, and companies in the education sector, often based on unfounded claims, a de minimis basis
for opening an investigation, or sheer political motives. The failure
to adhere to professional audit, oversight, and enforcement standards negatively impacts the institution and undermines service
provisions. As part of the Administration’s announcement to modernize the Office of Federal Student Aid, the Committee strongly
recommends increased caution and a thorough evaluation of ongoing, and any planned future, investigations to ensure objective andunbiased results.
In 2021, the Department established an Enforcement Office within FSA. The Committee is aware of concerns that the Enforcement
Office is targeting proprietary schools, rather than investigating all
institutions of higher education. The Committee directs the Department to provide the Committees with a briefing on the Office’s investigations work, particularly its targeted, proactive investigations
and the resources allocated for such activities, including across different sectors of higher education, within 90 days of enactment of
this Act. Such briefing should include information on the Office’s
methods for prioritizing investigations. Additionally, the Committee
requests that the Department include, in the fiscal year 2026 congressional justification, information on the number of staff in the
Enforcement Office as of the end of each fiscal year since it wasestablished.
Free Application for Federal Student Aid.—The Committee notes
the myriad problems with the implementation of the 2024–2025
FAFSA. This chaotic rollout has caused repeated delays in the Department sending completed FAFSA information to college financial aid administrators, in turn delaying when students and theirfamilies can receive information on their financial aid eligibility. It
has caused tremendous frustration and confusion among students
and their families. The Committee is concerned that the Department prioritized resources for its repeated student loan forgivenessefforts at the expense of adequately preparing for the FAFSA implementation. The Committee requests an update in the fiscal year
2026 congressional justification on the estimated resources, both

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239
monetary and employees and contractors, the Department spent on
FAFSA and the various loan cancellation initiatives. The Committee notes the Department’s regular communications regarding
the FAFSA implementation and strongly encourages it to continue
this practice, especially as it relates to the anticipated timeline forthe 2025–2026 FAFSA release.
Quarterly Briefings.—The Department is directed to provide
quarterly briefings to the Committee on the implementation of the
Unified Servicing and Data Solution.
Reprogramming of Funds.—Any reallocation of funds between
administrative costs and servicing activities within this accountshould be treated as a reprogramming of funds, and the Department is directed to notify the Committee in advance of any suchchanges, pursuant to section 514 of this Act.
Spend Plans.—No later than 45 days after enactment of this act,
the Committee directs the Department to provide a detailed spendplan of anticipated uses of funds made available in this account for
fiscal year 2025 and provide quarterly updates on this plan (including contracts awarded, change orders, bonuses paid to staff, reorganization costs, and any other activity carried out using amounts
provided under this heading for fiscal year 2025). The Department
is expected to conduct briefings with appropriate subject matter experts to answer questions on these topics to limit the need for follow up information after the briefing.
Student Loan Forgiveness.—The Committee is deeply disappointed by the Department’s continued partisan effort to cancel
student loans, rather than focus taxpayer resources on ensuring a
successful return to repayment for borrowers. This massive accumulation of loan forgiveness is on top of the income-based repayment plan, called SAVE or Saving on a Valuable Education, thatthe Department created through regulatory action. It is the mostgenerous income-based repayment plan ever, and the Congressional Budget Office estimates it will cost taxpayers more than$150,000,000,000. The plan makes more borrowers eligible to have
$0 monthly payments, and for borrowers who still must pay someamount, it cuts their monthly payments in half. Additionally, theDepartment announced even more loan cancellation efforts it will
pursue through regulation, including waiving potentially thousandsof dollars in accrued interest per borrower regardless of their income. Another concerning aspect of this new scheme is a proposal
for the Secretary of Education to be able to cancel debt for borrowers that the Department ‘‘predicts’’ will be in default within a
specified time frame. Despite the Supreme Court’s decision to overturn the Department’s blanket student loan cancellation plan, theDepartment has demonstrated its obstinate determination to cancel
as much in student loans as possible incrementally. The Administration’s repeated promises of future loan cancellation further
weakens any message it gives borrowers about reentering repayment and paying back their loans. Such mixed messages create thewrong incentives for future students, who may make borrowing decisions based on assumptions that little if any of their loans will
have to be repaid. The Committee includes legislative language tostop the taxpayer funded bailout of student loans.

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INSTITUTE OF EDUCATION SCIENCES
Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$793,106,000
815,455,000
740,373,000¥52,733,000¥75,082,000

This account supports education research, statistics, dissemination, evaluation, and assessment activities.
Research, Development, and Dissemination
The Committee provides $245,000,000 for Research, Development, and Dissemination, which is the same as the fiscal year 2024
enacted level. This account supports research, development, andnational dissemination activities that are aimed at expanding fundamental knowledge of education and promoting the use of research and development findings in the design of efforts to improveeducation.

DMWilson on DSKJM0X7X2PROD with HEARINGS

Statistics
The Committee provides $122,500,000 for the activities of the
National Center for Education Statistics (NCES), which is$1,000,000 above the fiscal year 2024 enacted level. Statistics activities are authorized under Title I of the Education Sciences Reform Act of 2002. NCES collects, analyzes, and reports statistics on
all levels of education in the U.S. Activities are carried out directly
and through grants and contracts and include projections of enrollments, teacher supply and demand, and educational expenditures.
NCES also provides technical assistance to State and local educational agencies and postsecondary institutions.
Civics Assessment.—The Committee requests an update from
NCES and the National Assessment Governing Board on the plans,budgetary requirements, and timeline for the National Assessmentof Educational Progress Civics Assessment in the fiscal year 2026
congressional justification.
School Phone Usage.—The Committee directs NCES to study andissue a report on cell phone use in schools and any policies that
limit cell phone use in K–12 schools, and any correlation between
phone use and student academic achievement. The Committee provides an increase of $1,000,000 for this purpose.
Regional Educational Laboratories
The Committee does not provide funding for this program. The
Regional Education Laboratories support dissemination and technical assistance activities that are duplicative of existing investments in areas of training, technical assistance, and professional
development to build State capacity to provide high-quality education. States can use Title I funds to pay for these services directly. States may reserve funds under Title I that may be used toobtain needed technical assistance, and LEAs are not limited in theamount of Title I funds that may be used for reasonable and necessary technical assistance services related to the effective implementation of Title I program requirements.

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Research in Special Education
The Committee provides $64,255,000 for Research in Special
Education, which is the same as the fiscal year 2024 enacted level.
This program supports competitive grants to produce and advancethe use of knowledge to improve services and results for children
with disabilities. The program focuses on producing new knowledge, integrating research and practice, and improving the use ofknowledge.
Special Education Studies and Evaluations
The Committee provides $13,318,000 for Special Education Studies and Evaluations, which is the same as the fiscal year 2024 enacted level. This program awards competitive grants, contracts,
and cooperative agreements to assess the implementation of the
IDEA and the effectiveness of State and local efforts to provide special education and early intervention programs and services to infants, toddlers, and children with disabilities.
Statewide Longitudinal Data Systems
The Committee provides $28,500,000 for this program, which isthe same as the fiscal year 2024 enacted level. These competitive
grants are awarded to States to design and maintain longitudinal
data systems.
Assessment
The Committee provides $193,300,000 for Assessment, which isthe same as the fiscal year 2024 enacted level. This amount includes $8,300,000 for the National Assessment Governing Board(NAGB), the same as the fiscal year 2024 enacted level. The National Assessment of Educational Progress (NAEP) is the only nationally representative and continuing survey of educational ability
and achievement of students in the U.S. The primary goal of theassessment is to determine and report the status and trends of theknowledge and skills of students, subject by subject. Subject areas
assessed in the past have included reading, writing, mathematics,
science, history, citizenship, literature, art, and music. The NAEP
is operated by contractors through competitive grants made by the
NCES. The NAGB formulates the policy guidelines for the program.
Program Administration
The Committee provides $73,500,000 for Program Administration, which is the same as the fiscal year 2024 enacted level.
Operating Plan.—The Committee directs the Director to submit
an operating plan within 90 days of enactment of this Act to theCommittees detailing how IES plans to allocate funding available
to the Institute for research, evaluation, statistics, administration,and other activities.

DMWilson on DSKJM0X7X2PROD with HEARINGSDEPARTMENTAL MANAGEMENT
Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

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716,702,000
418,407,000¥209,000,000¥298,295,000

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PROGRAM ADMINISTRATIONDMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$419,907,000
476,846,000
210,907,000¥209,000,000¥265,939,000

The Committee recommends $210,907,000 for Program Administration, which is $209,000,000 less than the fiscal year 2024 enacted level and $265,939,000 below the fiscal year 2025 budget request. These funds are used for expenses related to staff and othercosts of administering programs and activities at the Department.
Such expenses include personnel compensation, health, retirement,
and other benefits, as well as travel, rent, telephones, utilities,
postage fees, data processing, printing, equipment, supplies, technology training, consultants, and other contractual services.
Bill-Wide Requirements.—The Committee notes the inclusion of abill-wide requirements section of this report. This section contains
requirements which apply to all agencies funded by this Act.
Chronic Absenteeism.—The Committee is concerned about therise in chronic student absenteeism across the country and the effectiveness of efforts at the Federal level to address it. Therefore,
the Committee directs the GAO to review (1) how the Departmentof Education assesses States’ efforts to improve chronic absenteeism for States that include it as an indicator in their Statewide accountability systems, and (2) any opportunities to improve Federal
oversight of these efforts. GAO should begin this work no later
than September 30, 2024, and issue a final report on a date thereafter as agreed between GAO and the Committee.
Cost Savings of Inclusive Access Programs Study.—The Committee is concerned the Department’s proposed changes to the CashManagement regulations related to Books and Supplies for Title IVfunds could unintentionally increase prices and limit first-day access for students receiving Federal financial aid. The Committee directs GAO to report on the potential cost savings and accessibilityof ‘‘Inclusive Access’’ and other ‘‘first-day’’ programs that provide
students with books and materials at below market rates by the
first day of class. The report shall consider the potential impact of‘‘Inclusive Access’’ and other ‘‘first-day’’ programs on access and affordability for students receiving Federal financial aid, as well asother topics GAO determines appropriate.
Credit Transfer.—The Committee is aware that students facechallenges when seeking to transfer credits to institutions of higher
education, and this can result in the loss of credit. The Committee
is also aware of barriers to students in obtaining college credit, certification, or advanced standing toward further education throughlearning outside the traditional academic environment. The Committee emphasizes that credit for prior learning can be beneficial
to students, by helping them accelerate their program completion,saving them time and money.
Cybersecurity Training.—The Committee recognizes the rapidchanges and costs of cybersecurity training and urges the Department of Education to recognize and support public, private, andproprietary institutions of higher education that have accelerated
their programs within the field of training cybersecurity profes-

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sionals for the emerging national need demonstrated by the estimated 700,000 open public and private cybersecurity jobs.
Nonrecurring Expenses Fund.—The Committee directs the Department to provide quarterly reports for all ongoing projects. The
report shall include the following for each project: agency project isfunded under; a description for each project; the date the project
was notified to the Committees; total obligations to date; obligations for the prior fiscal year; anticipated obligations for current
fiscal year; and any expected future obligations. For any project ongoing for more than 3 years, the report should include a narrativedescribing the cause for delay and steps being taken by the agency
to ensure prompt completion. In addition, the Committee requests
biannual reports on expired balances that are eligible for transfer
to the Nonrecurring Expenses Fund (NEF). Such report shall include the Treasury Account Fund Symbol, program name, unobligated balance, and unexpended balance. Such report shall be transmitted 30 days after the close of the second quarter and within 45
days after the close of the fourth quarter of the fiscal year. To ensure appropriate Congressional oversight into use of the NEF, theCommittee includes a new provision limiting the amount for additional notifications for use of the NEF.
Opioid Overdose Reversal Agents.—The U.S. continues to see arise in known or suspected opioid overdoses at educational institutions to include both colleges and universities. The Committee commends the Department of Education for preparing for opioid-related emergencies for K–12 Schools and institutions of higher education. However, the Committee remains concerned that schools
have inconsistent policies and may have uncertainty around thepurchasing and use of overdose reversal medication to respond toa student or employee emergency. The Committee supports efforts
to ensure schools and institutions of higher education have accessto overdose reversal medication in the event of an emergency.
Therefore, the Committee also supports efforts to train employees
on overdose reversal as appropriate.
Office of Communications and Outreach.—The Department is reminded of the statutory anti-lobbying restrictions in place in 18
U.S.C. 1913, which prohibits lobbying by Federal agencies. The
Secretary is directed to ensure compliance with these laws on all
public statements, and to make all central office based employees
receive training on the Hatch Act and its application to ensure official Department resources are being used in a nonpartisan manner.
Program Administration.—The Committee remains concerned
about the Department’s prioritization of staff resources in the Program Administration account. The fiscal year 2023 agreement directed the Department to begin rebalancing the agency’s ratio ofcareer staff to non-career staff, to prioritize career staff for executing core programs at the Department, and not to expand its
non-career staff on board above the December 2022 levels. Despite
the clear Congressional directive, the level of non-career staff remained above the December 2022 level for all fiscal year 2023. For
this reason, the fiscal year 2024 bill included new language prohibiting funds from being used on or after August 15, 2024, to support
a non-career employee number that is above the number of non-career employees as of December 31, 2022. The Committee continues
bill language prohibiting funds from being used to support a num-

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244
ber of non-career employees that is above the number of non-career
employees as of December 31, 2022 for fiscal year 2025.
Reports to Congress.—The Department is directed to provide 5
business days’ notice to the Committees before release of any congressionally directed report.
Responsiveness to GAO.—The Committee notes that there havebeen prior engagements where the Department of Education unnecessarily delayed in providing GAO with timely and complete information in response to GAO requests. The Committee directs the
Department to provide timely and complete information to GAO on
its engagements within timeframes as GAO may specify. The Committee further directs GAO to develop timeliness criteria to measure the Department of Education’s responsiveness to GAO requests
for information. GAO activities are crucial to Congressional oversight, and the development of such criteria will assist GAO in thetimely completion of work. GAO should consult with the Department, as GAO determines appropriate, in developing such criteria.
Return to Work.—Excessive abuse of telework across the Federal
government must end. For the average American showing up to
work every day is a fact of life; they deserve a government that reflects that reality. Approvals for remote work should be made on
an individual case by case basis and done only to serve the bestinterests of the program and the American public. The agency is
directed to provide to the Committee within 60 days of enactmentof this Act a report detailing the number of full-time employees bysubcomponent who are receiving the Washington D.C. area locality
pay but have not reported to an in person office in the D.C. area
more than one day a week for the past year. Considering the remote work abuse seen at several agencies, administrative funding
for the Secretary has been reduced accordingly. The Committee
urges the Secretary to bring Federal employees back to the workplace to fulfill the mission of serving the American public.
Staffing Report.—Consistent with the fiscal year 2024 explanatory statement, the Committee continues to request, no later than
30 days after enactment of this Act, an operating plan identifying
the total full time equivalent (FTE) and non-personnel allocations
supported by the program administration appropriation in total for
the Department, and FTE and non-personnel allocations for eachprogram office supported by the program administration appropriation provided by this Act. In addition, the Department shall provide
monthly the number of on-board staff, attrition, approved hires not
yet on-board and projected full-year FTE usage, including approved
hires, and actual non-personnel expenses, for each program officesupported by, and in total for, the program administration appropriation provided by this Act. The monthly reports should be detailed by career and non-career staff. In addition, the Department
shall separately identify in such plans and reports total FTE allocations supported by other funding sources. The Department shallalso provide the Committee on a biannual basis an excel file which
includes the names, titles, grades, program office, and date of hireof all political appointees employed by the Department for the previous 180 days.
Title II–A Funds.—The Department is directed to provide theCommittee, within 180 days from the date of enactment of this Act,a report that lists any use of this funding for the most recent year

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245
data is available, by schools or school districts to pay outside consultants or firms for the purposes of teacher and/or school leader
training or professional development. The report shall include thespecific names of any applicable consultants or firms who were
paid using Title II–A funds and where possible a description of the
training or other materials provided.
Transparency about Foreign Influence in American Postsecondary
Education.—The Committee remains concerned about the ongoingrisks associated with malign foreign influence in American postsecondary education, as well as the Department’s limited enforcementof section 117 of the Higher Education Act. The Committee requests a report be provided to the Committee and the Committeeon Education and the Workforce of the House of Representatives
and the Committee on Health, Education, Labor, and Pensions andthe Committee on Appropriations of the Senate no later than 60days after enactment of this Act and published on the Department’s website describing how the Department is enforcing section
117. This report shall include staffing levels for enforcement, enforcement actions taken, section 117 compliance reviews opened
and closed for the most recent fiscal year for which data is available, how the Department verifies data submitted by institutions,and a description of how the Department shares information withother Federal agencies. The report shall also include totals of disclosed foreign contributions reported by postsecondary institutions
by type of contribution and country of origin, year to year comparisons by type of contribution and country of origin, and the numberof disclosures submitted anonymously.
The Department is urged to modernize its College Foreign Gift
and Contract Report website to allow disclosed information to be
individually identified and compared and searchable and sortableby date received, type, date filed, and country of origin. The Department is urged to implement technical improvements to its public database, including improving upload functionality by allowing
institutions to batch upload one file with all required information.
The Department is further encouraged to publish a database users
guide, including information on how to edit an entry and how toreport errors.
Women’s Health Education and Training on Reproductive Conditions.—The Committee recognizes the importance of empowering
women with a medically sound knowledge of their reproductive system, fertility window, tracking their monthly cycle, the health risks
related to hormonal birth control and medically induced menopausal medication, medical and non-medical approaches to reproductive conditions excluding abortion, and what symptoms to consider as it relates to hormonal imbalances, endometriosis, polycystic ovary syndrome, adenomyosis, uterine fibroids, interstitial
cystitis, and irregular menstrual cycles. To ensure that women receive such information, they need to give informed consent. This includes age-appropriate coursework and resources. Materials thatshould be taught (or available) in both middle school and highschool sex education courses. Teacher licensing requirements forsex education courses should also include training and educationmaterials to prepare teachers to cover these topics. The Committee
encourages the Department of Education to explore funding opportunities for these educational trainings and resources.

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OFFICE FOR CIVIL RIGHTS

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$140,000,000
162,359,000
140,000,000–––¥22,359,000

The Office for Civil Rights (OCR) is responsible for enforcing
laws that prohibit discrimination on the basis of race, color, national origin, sex, disability, and age in all programs and institutions that receive funds from the Department. These laws extend
to SEAs, LEAs, and IHEs, including proprietary schools. They also
extend to State rehabilitation agencies, libraries, museums, andother institutions receiving Federal funds.
The Committee supports efforts by the Office for Civil Rights toprovide technical assistance regarding antisemitism on campus andto complete pending investigations of complaints relating to antisemitism under Title VI of the Civil Rights Act of 1964.
Antisemitism Investigations.—The Committee is concerned by the
explosion of antisemitism at IHEs across the U.S. following the terrorist attack on Israel and the subsequent failure of many IHEs toaddress antisemitic conduct on their campuses. It is unclear what
actions OCR has taken to date in response to the numerous complaints received. The Committee requests that OCR produce aquarterly report on the status of OCR shared ancestry investigations and provide an initial report to the Committee and the Committee on Education and the Workforce of the House of Representatives and the Committee on Health, Education, Labor, and Pensions and the Committee on Appropriations of the Senate no later
than 30 days after enactment of this Act. Such report should include a brief overview, including timeline, status of the investigation, and any actions taken by the Department.
OFFICE OF INSPECTOR GENERAL

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$67,500,000
77,497,000
67,500,000–––¥9,997,000

The Office of Inspector General has authority to inquire into all
program and administrative activities of the Department, as well
as related activities of grant and contract recipients. It conducts
audits and investigations to determine compliance with applicablelaws and regulations, to check alleged fraud and abuse, efficiency
of operations, and effectiveness of results.
GENERAL PROVISIONSDMWilson on DSKJM0X7X2PROD with HEARINGS

Sec. 301. The Committee continues a provision related to the implementation of programs of voluntary prayer and meditation in
public schools.
(TRANSFER OF FUNDS)

Sec. 302. The Committee continues a provision regarding transfer authority.

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Sec. 303. The Committee modifies a provision allowing ESEA
funds consolidated for evaluation purposes to be available from
July 1, 2025 through September 30, 2026.
Sec. 304. The Committee modifies a provision allowing certain institutions to continue to use endowment income for student scholarships.
Sec. 305. The Committee modifies a provision extending the authorization of the National Advisory Committee on Institutional
Quality and Integrity.
Sec. 306. The Committee modifies a provision extending the authority to provide account maintenance fees to guaranty agencies
for Federal student loans.
Sec. 307. The Committee continues a provision allowing administrative funds to cover outstanding Perkins loans servicing costs.
Sec. 308. The Committee modifies a provision allowing up to 0.5
percent of funds appropriated in this Act for programs authorizedunder the HEA, except for the Pell Grant program, to be used forevaluation of any HEA program.
(INCLUDING TRANSFER OF FUNDS)

Sec. 309. The Committee continues a provision regarding centralized support costs for the Institute of Education Sciences.
(RESCISSION)

Sec. 310. The Committee includes a new provision rescinding
various unobligated balances.
(RESCISSION AND INCLUDING TRANSFER OF FUNDS)

Sec. 311. The Committee includes a new provision rescinding
amounts from the Nonrecurring Expenses Fund and transferring
funds to Howard University.
Sec. 312. The Committee includes a new provision regarding participation in athletic programs.
Sec. 313. The Committee includes a new provision prohibiting
certain rules regarding Title IX of the Education Amendments of
1972.
Sec. 314. The Committee includes a new provision regarding protection for religious student groups at institutions of higher education.
Sec. 315. The Committee includes a new provision prohibiting
certain Federal student loan cancellations, and rules related to income-driven repayment, borrower defense to repayment, 90/10, andgainful employment.
TITLE IV—RELATED AGENCIESDMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$17,081,955,000
18,421,516,000
14,962,530,000¥2,119,425,000¥3,458,986,000

This bill provides just under $15 billion in discretionary budget
authority for the title IV Related Agencies, a reduction of 12 percent over fiscal year 2024 enacted level. The agencies within title

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248
IV comprise 8 percent of the total 302(b) allocation for this subcommittee.
COMMITTEE FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR
SEVERELY DISABLED
SALARIES AND EXPENSES

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$13,124,000
14,800,000
13,124,000–––¥1,676,000

The Committee for Purchase from People Who Are Blind or Severely Disabled, an independent Federal agency, oversees and manages the AbilityOne Program, which uses the purchasing power of
the Federal government to buy products and services from participating, community-based nonprofit agencies nationwide dedicatedto training and employing individuals with disabilities.
Office of Inspector General.—The Committee provides not lessthan $3,150,000 for the Office of Inspector General, the same as
the fiscal year 2024 enacted level.
CORPORATION FOR NATIONAL AND COMMUNITY SERVICEOPERATING EXPENSES

DMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$975,525,000
1,046,276,000
361,158,000¥614,367,000¥685,118,000

The Corporation for National and Community Service (CNCS)
funds various service and volunteer programs.
Data Collection.—The Committee directs CNCS to clearly communicate with grantees involved in any data collection, whether
the information being collected is optional for reporting or required
information as part of a grant.
The Committee is concerned that several audits have found theagency does not conduct proper oversight of its grants:• 2016: Major AmeriCorps Grantee Allowed Members to Provide Abortion-Related Services Prohibited by Law (OIG–2016–003)• 2017: Grants Management: Monitoring Efforts by Corporation for National and Community Service Could Be Improved(GAO–17–90)• 2017: Grants Management: Corporation for National andCommunity Service’s Grant Monitoring Process Could Be Improved (GAO–17–528T)• 2017: Information Technology Modernization: Corporation
for National and Community Service Needs to Develop a System That Supports Grant Monitoring (GAO–17–267)• 2024: Grants: AmeriCorps Should Take Multiple Actions to
Better Manage Fraud Risks (GAO–24–106564)• 2024: Performance Audit of AmeriCorps Grants Awarded
to YouthBuild USA (OIG–AR–24–05)
Due to the lack of oversight and financial management necessary
for Federal funding, the Committee does not provide funding for

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several programs. Given the agency’s longstanding inability toproperly manage its grants, CNCS should focus on oversight of existing grantees and improved program operations and management. Instead, the agency is dedicating significant attention, staff
time, and resources to the newly launched American Climate
Corps.
Domestic Volunteer Service Programs
The Committee includes $103,285,000 for Volunteers in Service
to America, which is the same as the fiscal year 2024 enacted level
and $33,232,000 below the fiscal year 2025 budget request.
National Senior Volunteer Corps
The funding breakout by program is as follows:
Budget Activity

National Senior Volunteer Corps:
Foster Grandparents Program ............................................................................
Senior Companion Program ................................................................................
Retired Senior Volunteer Program ......................................................................

FY 2024
EnactedFY 2025
Committee

125,363,000
56,449,000
55,105,000$125,363,000
56,449,000
55,105,000

The Retired Senior Volunteer Program provides grants to organizations to engage Americans aged 55 years and older in volunteer
service.

DMWilson on DSKJM0X7X2PROD with HEARINGSNational and Community Service Programs
The Committee does not include funding for AmeriCorps State
and National grants, which is $557,094,000 below the fiscal year
2024 enacted level and $591,336,000 below the fiscal year 2025
budget request.
The Committee does include $14,706,000 for innovation, assistance, and other activities, which is the same as the fiscal year 2024
enacted level and the fiscal year 2025 budget request.
The Committee does include $6,250,000 for evaluation, which isthe same as the fiscal year 2024 enacted level and the fiscal year
2025 budget request.
The Committee does not include funding for the National Civilian Community Corps, which is $37,735,000 below the fiscal year
2024 enacted level and $42,491,000 below the fiscal year 2025
budget request.
The Committee does not include funding for the State Commission Support grants, which is $19,538,000 below both the fiscal
year 2024 enacted level and the fiscal year 2025 budget request.
Innovation, Assistance, and Other Activities
National Days of Service.—The Committee continues to support
the September 11 National Day of Service and Remembrance andthe Martin Luther King, Jr. National Day of Service—two important national events. The Committee encourages CNCS toprioritize eligible organizations with expertise in representing families of victims of the September 11, 2001, terrorist attacks andother impacted constituencies when planning for the September 11
National Day of Service and Remembrance.

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PAYMENT TO THE NATIONAL SERVICE TRUSTAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$180,000,000
159,951,000–––¥180,000,000¥159,951,000

The National Service Trust makes payments for Segal education
awards, pays interest that accrues on qualified student loans for
AmeriCorps participants during terms of service in approved national service positions, and makes other payments entitled tomembers who serve in the programs of the Corporation for National and Community Service.
The Committee rescinds $140,000,000 from the National Service
Trust.
SALARIES AND EXPENSES

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$99,686,000
127,104,000
79,686,000¥20,000,000¥47,418,000

OFFICE OF INSPECTOR GENERAL

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$7,595,000
8,762,000
8,595,000+1,000,000¥167,000ADMINISTRATIVE PROVISIONS

Sec. 401. The Committee modifies a provision requiring the agency to make any significant changes to program requirements or policy through rulemaking.
Sec. 402. The Committee continues a provision related to National Service Trust minimum share requirements.
Sec. 403. The Committee continues a provision related to donations.
Sec. 404. The Committee continues a provision related to veterans.
Sec. 405. The Committee continues a provision related to criminal history background checks.
Sec. 406. The Committee continues a provision related to 1,200
hours of service positions.
Sec. 407. The Committee continues a provision related to Volunteers in Service to America members’ education awards.
(RESCISSION)

Sec. 408. The Committee includes a new provision rescinding unobligated balances.

DMWilson on DSKJM0X7X2PROD with HEARINGSCORPORATION FOR PUBLIC BROADCASTING
Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level (for FY 2025) ..................................
Change from budget request ......................................................

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655,000,000–––¥60,000,000¥655,000,000

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The Committee continues $535,000,000 in funding for the Corporation of Public Broadcasting (CPB) for fiscal year 2025.
The Committee does not believe CPB should receive a two-year
advance appropriation and does not provide the fiscal year 2027 advance request of $595,000,000. The Committee does not provide
funding for the interconnection system, which is $60,000,000 below
the fiscal year 2024 enacted level and the fiscal year 2025 budget
request.
FEDERAL MEDIATION AND CONCILIATION SERVICESALARIES AND EXPENSES

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$53,705,000
53,705,000
53,705,000––––––

The Federal Mediation and Conciliation Service promotes labormanagement cooperation through mediation and conflict resolution
services to industry, government agencies, and communities.
FEDERAL MINE SAFETY AND HEALTH REVIEW COMMISSIONSALARIES AND EXPENSES

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$18,012,000
17,572,000
18,012,000–––+440,000

The Federal Mine Safety and Health Review Commission is anindependent adjudicative agency that provides administrative trial
and appellate review of legal disputes arising under the Federal
Mine Safety and Health Act of 1977.
INSTITUTE OF MUSEUM AND LIBRARY SERVICES
OFFICE OF MUSEUM AND LIBRARY SERVICES: GRANTS AND
ADMINISTRATION

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$294,800,000
280,000,000
249,515,000¥45,285,000¥30,485,000

Within the total for the Institute of Museum and Library Services (IMLS), the Committee provides the following amounts:

DMWilson on DSKJM0X7X2PROD with HEARINGS

Budget Activity

Library Services Technology Act:
Grants to States .................................................................................................
Native American Library Services .......................................................................
National Leadership: Libraries ...........................................................................
Laura Bush 21st Century Librarian ...................................................................
Museum Services Act:
Museums for America .........................................................................................
Native American/Hawaiian Museum Service ......................................................
National Leadership: Museums ..........................................................................
African American History and Culture Act:
Museum Grants for African American History and Culture ...............................

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FY 2024
EnactedFY 2025
Committee$180,000,000
5,763,000
15,287,000
10,000,000$180,000,000
5,763,000––––––

30,330,000
3,772,000
9,348,000

30,330,000
3,772,000–––

6,000,000

6,000,000

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FY 2024
EnactedBudget Activity

National Museum of the American Latino Act:
Museum Grants for American Latino History and Culture ................................
Museum and Library Services Act General Provisions:
Research, Analysis and Data Collection ............................................................
Program Administration ...............................................................................................

FY 2025
Committee

6,000,000

6,000,000

5,650,000
22,650,000–––
17,650,000

America250.—The Committee recognizes IMLS’s commitment to
the 250th Anniversary of the U.S. IMLS has a key role in supporting existing activities and new projects at the State and local
levels that enhance civic engagement, innovation, and community
collaboration in preparation for the 250th Anniversary. The Committee fully funds IMLS library formula grants to States and museums for America formula grants to States to support local libraries
and museums interested in hosting historical programming aheadof the celebration.
Grant Decision Making.—The Committee encourages IMLS in its
grant review process to consider the full scope of an organization’s
work or activities before awarding grants, regardless of whether
the IMLS grant will directly fund such work or activities.
MEDICAID AND CHIP PAYMENT AND ACCESS COMMISSIONSALARIES AND EXPENSES

DMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$9,405,000
10,698,000
9,405,000–––¥1,293,000

The Medicaid and CHIP Payment and Access Commission(MACPAC) is an independent agency tasked with advising the Congress on issues affecting Medicaid and the State Children’s Health
Insurance Program (CHIP). MACPAC conducts policy and data
analysis on Medicaid and CHIP to support policymakers and support program accountability.
The Committee supports the role played by MACPAC in providing nonpartisan policy recommendations and data analysis on awide array of issues affecting Medicaid and CHIP. The Medicaid
program is at a unique juncture. Growing costs for the program,driven by the maldistribution of resources away from the nation’s
most vulnerable towards individuals who qualify for other forms ofcoverage or are otherwise ineligible for the program, threaten toundermine access in the State budgets to afford reimbursement
rate increases for providers or an expansion of new services. As the
program continues to navigate these uncertain times, the Committee encourages MACPAC to include in their policy recommendations additional specific recommended policy changes to the program that can result in savings to help improve access to care forbeneficiaries or accompany any policy changes that may entail additional costs to offset those proposed increases in spending. Additionally, the Committee encourages MACPAC to include more detailed cost estimates and actuarial analyses for costs that would beincurred by the Federal government and the States to better understand the actual implications of the Commission’s recommendations.

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MEDICARE PAYMENT ADVISORY COMMISSIONSALARIES AND EXPENSES

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$13,824,000
14,477,000
14,477,000+653,000–––

The Medicare Payment Advisory Commission (MedPAC) is anindependent agency tasked with advising the Congress on issues
affecting the Medicare program. In addition to advising on payments to private health plans participating in Medicare and providers in Medicare’s traditional fee-for-service (FFS) program,
MedPAC is also responsible for providing analysis on access tocare, quality of care, and other issues affecting Medicare.
Differential Coding in Medicare Fee For Service.—The Committee
is aware of the dynamic noted in MedPAC’s 2024 Report to theCongress that FFS Medicare claims offer little incentive to record
all relevant diagnoses of FFS patients. The Committee directs
MedPAC to, within 12 months of enactment of this Act, issue a report estimating the extent to which this incentive results in different relative rates of diagnostic coding for Medicare Advantage
and FFS beneficiaries and the extent to which such coding differences may result in payment differentials between Medicare Advantage and FFS.
Medicare Beneficiaries’ Access to Care.—The Committee is concerned that despite MedPAC’s conclusion in its March 2024 Reportto the Congress, Medicare and Medicare Advantage patients report
longer wait times for routine health care appointments than patients with private health insurance plans. The Committee requests a report on Medicare beneficiaries’ access to care, including
the share of primary care providers that refuse to accept or limit
the acceptance of new Medicare patients and data on Medicare patients’ wait times for visits with new primary care providers.
NATIONAL COUNCIL ON DISABILITYSALARIES AND EXPENSES

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$3,850,000
4,000,000
3,850,000–––¥150,000

DMWilson on DSKJM0X7X2PROD with HEARINGSThe National Council on Disability (NCD) is an independent Federal agency charged with advising the President, Congress, andother Federal agencies regarding policies, programs, practices, andprocedures that affect people with disabilities. NCD is comprised ofa team of Presidential and Congressional appointees, an Executive
Director appointed by the Chair, and a full-time professional staff.

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NATIONAL LABOR RELATIONS BOARD
SALARIES AND EXPENSES

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$299,224,000
320,002,000
200,000,000¥99,224,000¥120,002,000

The National Labor Relations Board (NLRB) is responsible for
enforcing U.S. labor law related to collective bargaining and unfair
labor practices, including the National Labor Relations Act of 1935.
The Committee notes with significant concern that NLRB resources are being used to support regulatory and enforcement actions inconsistent with the National Labor Relations Act. These actions include:• General Counsel Memo 22–04 asserting that employer discussions of statutory labor rights are ‘‘inherently’’ unlawful incontradiction of NLRB v. Agents’ Int’l Union, Chamber of Commerce v. Brown, and Thomas v. Collins;• Denying employees the privacy of the voting booth and disregarding the outcomes of secret-ballot elections established in
Gissel Packing Co. v. NLRB and Linden Lumber v. NLRB;• Proposing an employment status test rejected by the U.S.
Court of Appeals for the D.C. Circuit in FedEx Home Delivery
v. NLRB;• General Council Memo 21–04 asserting that the NLRB has
enforcement powers in contradiction of H. K. Porter Co. v.
NLRB.
The Committee further notes that the allocation of staff time andresources to curtail employer rights protected under the First
Amendment, circumvents due process, and undermines civil rights
laws. Moreover, such actions contradict the agency’s claims that
additional resources are necessary to perform core functions in amanner consistent with its authorized responsibilities. Given suchpronouncements, the Committee directs the Board to include caseintake statistics at the regional level disaggregated by unfair labor
practice and representation in the NLRB’s fiscal year 2026 congressional justification. The Committee further directs the NLRB to include information detailing the number of full-time equivalent staff
assigned to each regional office.
ADMINISTRATIVE PROVISIONS

Sec. 409. The Committee continues language restricting the useof electronic voting.
Sec. 410. The Committee includes a new provision related to joint
employer status.
NATIONAL MEDIATION BOARD

DMWilson on DSKJM0X7X2PROD with HEARINGSSALARIES AND EXPENSES

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

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15,113,000
15,113,000
–––
–––

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The National Mediation Board coordinates labor-management relations within the U.S. railroads and airlines industries.
OCCUPATIONAL SAFETY AND HEALTH REVIEW COMMISSIONSALARIES AND EXPENSES

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$15,449,000
16,278,000
15,449,000–––¥829,000The Occupational Safety and Health Review Commission provides administrative trial and appellate review related to contestsof citations or penalties resulting from Occupational Safety and
Health Administration (OSHA) inspections of American workplaces.
RAILROAD RETIREMENT BOARD
DUAL BENEFITS PAYMENTS ACCOUNTDMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$8,000,000
7,000,000
7,000,000¥1,000,000–––

This appropriation is authorized by the Railroad Retirement Act
of 1974 to fund vested dual benefits received by railroad retirees
who, under prior law, would have become covered by both the railroad retirement system and the Social Security system because
railroad retirement was not fully coordinated with Social Security
from 1937 to 1974.
The Committee is concerned that the Railroad Retirement Board(RRB) has yet to implement and integrate an enterprise risk management (ERM) system including a lack of measurable goals andimplementation timeline. The Committee notes that the RRB’s pervasive challenges in risk management extend to program integrity,
as evidenced by persistent findings of material weaknesses in financial reporting that the RRB’s Office of Inspector General (OIG)
has identified. The Committee also notes that the RRB has not had
its current internal assessment substantiated by the OIG or an
independent auditor or contractor. The Committee, therefore, notesthat the RRB’s ERM process merits further evaluation.
The Committee also notes that in prior years, the OIG issued adisclaimer of opinion for the RRB’s overall financial statements.
RMA Associates, an independent public accounting firm, audited
the RRB’s fiscal year 2022 financial statements. RMA identified 9
material weaknesses and 1 non-compliance with laws and regulations, and it made 15 recommendations to address the material
weaknesses identified. RMA did not make recommendations for two
findings, because they were repeated from prior OIG reports andremain open. The Committee is concerned that the RRB non-concurred with the RMA findings.
Additionally, the Committee notes that RMA did not express an
opinion on the fiscal year 2022 financial statements. RMA did not
express an opinion on the effectiveness of the RRB’s internal control over financial reporting, and RRB could not provide sufficient

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appropriate evidential matter to support its internal control over financial reporting due to inadequate process, controls, and records.
The RRB is directed to provide the Committee with a corrective
action plan explaining how the RRB will address these areas ofconcern, within 120 days of enactment of this Act. Additionally, the
RRB’s Audit Compliance Section (ACS) does not provide adequate
audit coverage of railroad employees. Such a deficiency is troubling,
and therefore the RRB is directed to brief the Committee within
120 days of enactment of this Act on the ACS and how it plans toprovide adequate coverage in this area.
FEDERAL PAYMENT TO THE RAILROAD RETIREMENT ACCOUNTS

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$150,000
150,000
150,000––––––

LIMITATION ON ADMINISTRATION

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$126,000,000
134,000,000
100,000,000¥26,000,000¥34,000,000

LIMITATION ON THE OFFICE OF INSPECTOR GENERAL

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$14,000,000
14,600,000
14,000,000–––¥600,000

SOCIAL SECURITY ADMINISTRATION
In fiscal year 2024, the Social Security Administration (SSA) anticipates exceeding $1.5 trillion in total spending on social security
retirement, disability insurance, and supplemental security income(SSI) payments. SSA’s total outlays have grown a staggering 145
percent since 2008 as mandatory entitlement programs continue togrow on autopilot. The SSA Old-Age and Survivors Insurance TrustFund, which funds retirement and survivor benefit payments, isprojected to be depleted in 2033, at which time, Americans will see
a 21 percent cut to their benefits. SSA’s discretionary budget authority for fiscal year 2024, which funds the agency’s administrative expenses, totals $14 billion, an increase of only 42 percent
since 2008. The escalating pace of mandatory entitlement-driven
spending remains the primary cost driver within SSA.

DMWilson on DSKJM0X7X2PROD with HEARINGSPAYMENTS TO SOCIAL SECURITY TRUST FUNDS

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$10,000,000
15,000,000
15,000,000+5,000,000–––

This appropriation provides reimbursement to the Social Security
trust funds for non-trust fund activities.

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SUPPLEMENTAL SECURITY INCOME PROGRAM

Appropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$45,365,042,000
46,555,635,000
46,159,083,000+794,041,000¥396,552,000

The Committee provides $22,100,000,000 in advance funding forthe first quarter of fiscal year 2026, as requested.
Research and Demonstration
Section 1110 of the Social Security Act provides authority to theSocial Security Administration for conducting research and demonstration projects related to SSA’s programs. Within the appropriation for Supplemental Security Income, the Committee provides$91,000,000 for research and demonstration activities.
Administration
Within the appropriation for SSI, the Committee provides$4,516,083,000. This funding is for payment to the Social Security
trust funds for SSI’s share of the administrative expenses of SSA.
LIMITATION ON ADMINISTRATIVE EXPENSES

DMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$14,225,978,000
15,400,924,000
13,824,776,000¥401,202,000¥1,576,148,000

The Limitation on Administrative Expenses (LAE) funds the administrative and operational costs for administering the Old Ageand Survivors Insurance, Disability Insurance, and Supplemental
Security Income (SSI) programs, and associated costs for support to
the Centers for Medicare and Medicaid Services in administering
their programs.
Within the total for LAE, the Committee provides not less than
$1,450,000,000 for Information Technology and not less than
$4,050,000,000 for field offices, equal to fiscal year 2024 levels.
The Committee notes that SSA’s budget for fiscal year 2024 allocates close to $3,000,000,000 or 20 percent, of agency costs to theBaltimore and Washington, D.C. offices, including automatic pay
increases and career ladder promotions. However, of the 5,900 employees across these offices, only 39 percent are reporting to workin the office at least three days a week.
Moreover, the Committee is disappointed by the agency’s decision
to provide all SSA employees with administrative leave and close
all SSA offices on the afternoons of Friday, May 10, 2024, and Friday, May 24, 2024, with less than 48 hours advance notice to the
public. Each day, approximately 170,000 Americans visit and
250,000 call one of SSA’s 1,200 field offices nationwide for various
reasons, such as to file disability claims, ask questions, or update
their information. Americans who had appointments at SSA field
offices for those afternoons had to wait longer, and those without
appointments or who picked up the phone to call found offices
closed with no explanation. This shortsighted decision, especiallyduring a customer service crisis, was a disservice to those Americans who rely on SSA services.

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DMWilson on DSKJM0X7X2PROD with HEARINGS

258
Given SSA’s bloated budget for the Baltimore and Washington,
D.C. offices, including excessive use of telework, and the agency’s
disappointing decision to close all SSA offices with limited notice,
the Committee proposes reduced funding for SSA. For the average
American showing up to work every day is a fact of life; they deserve a government that reflects that reality. Approvals for remote
work should be made on an individual case by case basis and done
only to serve the best interests of the program and the American
public. The Committee urges the Commissioner to bring Federal
employees back to the workplace to fulfill the mission of serving
the American public and directs the agency to provide to the Committee within 60 days of enactment of this Act a report detailingthe number of full-time employees by subcomponent who are receiving the Washington D.C. area locality pay but have not reported to an in person office in the Baltimore or D.C. area morethan one day a week for the past year.
Bill Wide Requirements.—The Committee notes the inclusion ofa bill wide requirements section of this report. This section contains requirements which apply to all agencies funded by this Act.
Disability Backlogs.—The Committee continues to direct SSA to
submit to the Committee quarterly reports on disability hearings
backlogs until SSA has eliminated the hearings backlog andachieved its monthly average processing time goal.
Hiring and Retention.—The Committee continues to direct SSA
to provide a quarterly staffing report to the Committee detailingfull-time equivalents and new hires by component and retention
rates of new hires by component.
Information Technology (IT).—The Committee is concerned that
the SSA’s antiquated IT service management system is adversely
impacting agency staff’s ability to deliver the value, service, and efficiency that the public expects and deserves. The Committee recognizes that the SSA began modernizing its IT Service Management
tools in fiscal year 2021 and directs SSA to continue working on
IT solutions to improve customer service, ensure high availability
and service continuity, optimize operational efficiency, and maximize enterprise productivity.
Occupational Information System (OIS).—The Committee continues to direct SSA to include information in its congressional justifications detailing efforts to fully implement the OIS project, including the status of implementation and timeline for transitioning
entirely to OIS, an action plan to accomplish said timeline, and thecosts associated with the project.
Report on LAE Expenditures.—The Committee continues to request that the data referenced under this heading in House Report
114–699 be included in future congressional justifications. In addition, the Committee requests the fiscal year 2026 congressional justification include a historical table of costs and fiscal year 2026 requests for personnel and benefits, by major SSA component to include Operations (field offices, teleservice centers, processing centers, and regional offices); Office of Hearings Operations; Systems;
Office of Analytics, Review, and Oversight; and Headquarters.
SSI Income Support and Maintenance (ISM).—The Committee
directs SSA to complete an assessment and submit to the committees of jurisdiction a report within 120 days of enactment of thisAct on the effects that omitting food from the ISM calculation

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would have on supplemental State program financing and administration. Additionally, the Committee directs the agency to makesuch information publicly available on its website.
Work Incentives Planning and Assistance and Protection and Advocacy for Beneficiaries of Social Security.—The recommendation
includes $23,000,000 for Work Incentives Planning and Assistancegrants and $10,000,000 for Protection and Advocacy for Beneficiaries of Social Security.
Continuing Disability Reviews, Redeterminations, and Program
Integrity Activities
The Committee provides $1,903,000,000 for program integrity activities as authorized by section 251 of the Balanced Budget andEmergency Deficit Control Act of 1985.
The bill includes language transferring up to $20,000,000 to the
OIG for the cost of jointly operating co-operative disability investigation units.
Social Security Advisory Board
The Committee provides $2,700,000 for the Social Security Advisory Board, which is the same as the fiscal year 2024 enacted level.
User Fees
In addition to the other amounts provided, the Committee provides $171,000,000 for administrative activities funded from user
fees. Of this amount, $170,000,000 is derived from fees collectedfrom States that request SSA to administer State SSI supplementary payments. The remaining $1,000,000 is derived from fees
charged to non-attorneys who apply for certification to represent
claimants under titles II and XVI of the Social Security Act.
OFFICE OF THE INSPECTOR GENERALDMWilson on DSKJM0X7X2PROD with HEARINGSAppropriation, fiscal year 2024 .........................................................
Budget request, fiscal year 2025 .......................................................
Committee Recommendation .............................................................
Change from enacted level .........................................................
Change from budget request ......................................................

$114,665,000
121,254,000
114,665,000–––¥6,589,000

The Office of the Inspector General is responsible for meeting thestatutory mission of promoting economy, efficiency, and effectiveness in the administration of SSA programs and operations and toprevent and detect fraud, waste, abuse, and mismanagement insuch programs and operations. To accomplish this mission, the OIG
directs, conducts, and supervises audits, evaluations, and investigations. In addition, the OIG searches for and reports on systemic
weaknesses in SSA programs and operations and makes recommendations for needed improvements and corrective actions.
Nonwork Social Security Numbers.—The Committee encourages
the OIG to update its 2020 audit report, ‘‘Assignment of Nonwork
Social Security Numbers’’ (A–08–18–50500) that examined whether
SSA appropriately assigned Social Security numbers to noncitizens
with a valid nonwork reason.

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TITLE V—GENERAL PROVISIONSDMWilson on DSKJM0X7X2PROD with HEARINGS(TRANSFER OF FUNDS)

Sec. 501. The Committee continues a provision allowing the Secretaries of Labor, Health and Human Services, and Education totransfer unexpended balances of prior appropriations to accounts
corresponding to current appropriations to be used for the same
purposes and for the same periods of time for which they wereoriginally appropriated.
Sec. 502. The Committee continues a provision prohibiting theobligation of funds beyond the current fiscal year unless expressly
so provided.
Sec. 503. The Committee continues a provision prohibiting funds
from being used to support or defeat legislation.
Sec. 504. The Committee continues a provision limiting theamount available for official reception and representation expenses
for the Secretaries of Labor and Education, the Director of the Federal Mediation and Conciliation Service, and the Chairman of the
National Mediation Board.
Sec. 505. The Committee continues a provision requiring grantees receiving Federal funds to clearly state the percentage of thetotal cost of the program or project that will be financed with Federal money.
Sec. 506. The Committee continues a provision prohibiting theuse of funds for any abortion.
Sec. 507. The Committee continues a provision providing exceptions to section 506 and a provision prohibiting funds from being
made available to a Federal agency or program, or to a State or
local government, if such agency, program, or government discriminates against institutional or individual health care entities because they do not provide, pay for, provide coverage of, or refer for
abortions.
Sec. 508. The Committee continues a provision prohibiting use offunds for certain research involving human embryos.
Sec. 509. The Committee continues a provision prohibiting use offunds for any activity that promotes the legalization of any drug or
substance included in schedule I of the schedules of controlled substances.
Sec. 510. The Committee continues a provision prohibiting use offunds to promulgate or adopt any final standard providing for aunique health identifier until legislation is enacted specifically approving the standard.
Sec. 511. The Committee continues a provision related to annual
reports to the Secretary of Labor.
Sec. 512. The Committee continues a provision prohibiting transfer of funds made available in this Act except by authority provided
in this Act or another appropriations Act.
Sec. 513. The Committee continues a provision to limit funds inthe bill for public libraries to those that comply with the requirements of the Children’s Internet Protection Act.
Sec. 514. The Committee modifies a provision regarding procedures for reprogramming of funds.
Sec. 515. The Committee continues a provision pertaining to appointments to scientific advisory committees.

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Sec. 516. The Committee modifies a provision requiring each department and related agency funded through this Act to submit anoperating plan within 45 days of enactment, detailing any funding
allocations that are different than those specified in this Act, theaccompanying detailed table, or budget request.
Sec. 517. The Committee modifies a provision requiring the Secretaries of Labor, Health and Human Services, and Education tosubmit a quarterly report to the Committees on Appropriations
containing certain information on noncompetitive contracts, grants,
and cooperative agreements exceeding $500,000 in value.
Sec. 518. The Committee continues a provision prohibiting theuse of funds to process claims for credit for quarters of coveragebased on work performed under a Social Security number that was
not the claimant’s number, where the performance of such work
under such number has formed the basis for a conviction of theclaimant of a violation of section 208(a)(6) or (7) of the Social Security Act.
Sec. 519. The Committee continues a provision prohibiting theuse of funds to implement a Social Security totalization agreementwith Mexico.
Sec. 520. The Committee continues a provision prohibiting theuse of funds for the downloading or exchanging of pornography.
Sec. 521. The Committee continues a provision related to reporting requirements for conference expenditures.
Sec. 522. The Committee continues a provision related to disclosure of U.S. taxpayer funding for programs used in advertising.
Sec. 523. The Committee modifies a provision requesting quarterly reports on the status of balances of appropriations from the
Departments of Labor, Health and Human Services and Education.
Sec. 524. The Committee continues a provision related to grant
notifications.
Sec. 525. The Committee modifies a provision related to needle
exchange.
Sec. 526. The Committee continues a provision related to questions for the record.
Sec. 527. The Committee modifies a provision related to researchand evaluation funding flexibility.
Sec. 528. The Committee modifies a provision to make funds
from the Child Enrollment Contingency Fund unavailable for obligation in fiscal year 2025.

DMWilson on DSKJM0X7X2PROD with HEARINGS(RESCISSION)

Sec. 529. The Committee includes a new provision rescinding unobligated balances from the American Rescue Plan.
Sec. 530. The Committee includes a new provision prohibiting
certain actions related to a sincerely held religious belief.
Sec. 531. The Committee includes a new provision related to thedisplay of flags over Federal facilities.
Sec. 532. The Committee includes a new provision related to executive orders related to climate change.
Sec. 533. The Committee includes a new provision related to certain executive orders related to diversity, equity, and inclusion.
Sec. 534. The Committee includes a new provision related to diversity, equity, and inclusion.

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Sec. 535. The Committee includes a new provision related toCritical Race Theory.
Sec. 536. The Committee includes a new provision related toteaching and training activities.
Sec. 537. The Committee includes a new provision related toantisemitism.
Sec. 538. The Committee includes a new provision related to gainof function research in certain countries.
Sec. 539. The Committee includes a new provision related to
COVID mask and vaccine mandates.
Sec. 540. The Committee includes a new provision related to certain actions with specific entities or subsidiaries.
SPENDING REDUCTION ACCOUNT

Sec. 541. The Committee includes a Spending Reduction Account.
HOUSE OF REPRESENTATIVES REPORT REQUIREMENTS
The following materials are submitted in accordance with various
requirements of the Rules of the House of Representatives:
STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES
Pursuant to clause 3(c)(4) of rule XIII of the Rules of the Houseof Representatives, the following is a statement of general performance goals and objectives for which this measure authorizes funding:
The Committee on Appropriations considers program performance, including a program’s success in developing and attaining outcome-related goals and objectives, in developing
funding recommendations.
PROGRAM DUPLICATION
No provision of this bill establishes or reauthorizes a program of
the Federal Government known to be duplicative of another Federal program, a program that was included in any report from theGovernment Accountability Office to Congress pursuant to section
21 of Public Law111–139, or a program related to a program identified in the most recent Catalog of Federal Domestic Assistance.
TRANSFERS OF FUNDS
Pursuant to clause 3(f)(2) of rule XIII of the Rules of the Houseof Representatives, the following list includes the transfers included in the accompanying bill:
TITLE I—DEPARTMENT OF LABOROFFICE OF DISABILITY EMPLOYMENT POLICYDMWilson on DSKJM0X7X2PROD with HEARINGS

Language is included under ‘‘Office of Disability Employment
Policy’’ which provides for the transfer of funds to the ‘‘State Unemployment Insurance and Employment Service Operations.’’
SPECIAL BENEFITS

Language is included under ‘‘Special Benefits’’ which provides forthe transfer of funds from the ‘‘Postal Service’’ account.

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BLACK LUNG DISABILITY TRUST FUND

Language is included under ‘‘Black Lung Disability Trust Fund’’
which provides for the transfer of funds to the ‘‘Office of Workers’
Compensation Programs,’’ ‘‘Departmental Management,’’ and ‘‘Office of Inspector General’’ salaries and expenses accounts and tothe ‘‘Department of the Treasury, Miscellaneous Expenses’’ account.
OFFICE OF DISABILITY EMPLOYMENT POLICY

Language is included under ‘‘Office of Disability Employment
Policy’’ which provides for the transfer of funds to ‘‘State Unemployment Insurance and Employment Service Operations.’’
GENERAL PROVISIONS

A general provision is included permitting up to one percent ofany discretionary appropriation to be transferred between an existing program, project, or activity of the Department of Labor, provided that no program, project, or activity is increased by morethan three percent by any such transfer.
A general provision is included permitting the transfer of ‘‘Employment and Training Administration’’ funds for technical assistance to ‘‘Program Administration’’ when such activities would be
more effectively performed by Federal employees. The provisionalso authorizes the transfer of 0.5 percent of ‘‘Employment andTraining Administration’’ discretionary grants to ‘‘Program Administration’’ for purposes of program integrity activities.
A general provision is included that allows for the transfer of up
to 0.75 of funds under the ‘‘Training and Employment Services,’’State Unemployment Insurance and Employment Service Operations,’’ Employee Benefits Security Administration,’’ Office ofWorkers Compensation Services,’’ Wage and Hour Division,’’ Officeof Federal Contract Compliance Programs,’’ ‘‘Office of Labor Management Standards,’’ Occupational Safety and Health Administration,’’ ‘‘Mine Safety and Health Administration,’’ Office of Disability
Employment Policy,’’ and ‘‘Veterans’ Employment and Training’’ accounts to ‘‘Departmental Management’’ for purposes of evaluating
programs or activities funded under such accounts.
TITLE II—DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR DISEASE CONTROL AND PREVENTION

DMWilson on DSKJM0X7X2PROD with HEARINGS

Language is included under ‘‘Centers for Disease Control andPrevention, Buildings and Facilities’’ that directs that prior-year
unobligated balances from individual learning accounts for former
employees be credited and merged with the amounts made available for the replacement of the mine safety research facility.
Language is included under ‘‘Centers for Disease Control andPrevention, CDC-Wide Activities and Program Support’’ for funds
to be transferred to and merged with the Infectious Diseases Rapid
Response Reserve Fund.
NATIONAL INSTITUTES OF HEALTH

Language is included under the ‘‘National Institutes of Health,Innovation Account’’ to allow the transfer of funds to other Insti-

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tutes and Centers to support activities authorized in the 21st Century Cures Act (P.L. 114–255).
ADMINISTRATION FOR COMMUNITY LIVING

Language is included under the ‘‘Administration for Community
Living, Aging and Disability Services Programs’’ for the transfer tothe Secretary of Agriculture to carry out section 311 of the Older
Americans Act of 1965.
GENERAL PROVISIONS

A general provision that allows up to one percent of any discretionary funds to be transferred between existing appropriations accounts of the ‘‘Department of Health and Human Services,’’ provided that no appropriation account is increased by more than
three percent by such transfer.
A general provision is included that allows the transfer of up to
3 precent among the institutes and centers of the ‘‘National Institutes of Health’’ from amounts identified as funding research pertaining to the human immunodeficiency virus.
A general provision is included that allows for the transfer offunding determined to be related to the human immunodeficiency
virus to the ‘‘Office of AIDS Research.’’A general provision is included that transfers 1 percent of theamounts made available for the ‘‘National Research Service
Awards’’ to the ‘‘Health Resources and Services Administration.’’A general provision is included to direct the transfer of the ‘‘Prevention and Public Health Fund’’ as specified in the committee report accompanying the Act.
A general provision is included that allows the transfer of funds
related to research on opioid addiction, opioid alternatives, stimulant misuse and addiction, pain management, and addiction treatment between the institutes and centers of the ‘‘National Institutesof Health.’’TITLE III—DEPARTMENT OF EDUCATIONGENERAL PROVISIONS

A general provision is included that allows not to exceed one percent of any discretionary funds to be transferred between existing
appropriations accounts of the Department of Educations, provided
that not appropriation accounts is increased by more than three
percent by such transfer.
A general provision is included that allows up to $20,000,000,000
of funding made available for ‘‘Institute of Education Sciences’’ tobe available for the Secretary of Education to provides support
services to the Institute of Education Sciences.
TITLE IV—RELATED AGENCIESDMWilson on DSKJM0X7X2PROD with HEARINGSSOCIAL SECURITY ADMINISTRATION

A provision is included under ‘‘Social Security Administration,
Limitation on Administrative Expenses’’ allowing for the transfer ofunobligated balances to be available until expended for information
technology and telecommunications hardware and software infrastructure.

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A provision is included under ‘‘Social Security Administration’’allowing for the transfer of up to $20,000,000 to the ‘‘Social Security Administration, Office of Inspector General,’’ for the costs ofjointly operated-co-operative disability investigation units.
TITLE V—BILL-WIDE GENERAL PROVISIONS

A general provision is included that allows the Secretaries ofLabor, Health and Human Services, and Education to transfer balances of prior appropriations to accounts corresponding to current
appropriations.
RESCISSIONS

Pursuant to clause 3(f)(2) of rule XIII of the Rules of the Houseof Representatives, the following lists the rescissions included in
the accompanying bill:
Program or Activity

AmountDepartment of Labor
Training and Employment Services, H–1B Fees .....................................................................................
Adult Training FY 2024 Advance ............................................................................................................
Department of Health and Human Services
Nonrecurring Expenses Fund ...................................................................................................................
Department of Education
Institute of Education Sciences ..............................................................................................................
Nonrecurring Expenses Fund ...................................................................................................................
Education for the Disadvantaged FY 2025 Advance ..............................................................................
Supporting Effective Instruction State Grants FY 2025 Advance ..........................................................
Rehabilitation Services ............................................................................................................................
Corporation for National and Community Service
National Service Trust .............................................................................................................................
Title V—General Provisions
American Rescue Plan ............................................................................................................................

$217,000,000
712,000,000
2,352,000,000
25,000,000
76,000,000
147,266,000
1,681,441,000
415,000,000
140,000,000
245,000,000

COMPLIANCE WITH RULE XIII, CL. 3(d) (RAMSEYER RULE)
In compliance with clause 3(e) of rule XIII of the Rules of theHouse of Representatives, changes in existing law made by the bill,as reported, are shown as follows (existing law proposed to be omitted is enclosed in black brackets, new matter is printed in italics,
existing law in which no change is proposed is shown in roman):[TO BE PROVIDED]CHANGES IN THE APPLICATION OF EXISTING LAW
Pursuant to clause 3(f)(1)(A) of rule XIII of the Rules of theHouse of Representatives, the following statements are submitted
describing the effect of provisions in the accompanying bill that directly or indirectly change the application of existing law.
The bill includes provisions which place limitations on the use offunds in the bill or change existing limitations and that might,
under some circumstances, be construed as changing the application of existing law:
DMWilson on DSKJM0X7X2PROD with HEARINGS

TITLE I—DEPARTMENT OF LABOR

Language is included under ‘‘Employment and Training Administration’’ providing that allotments to outlying areas are not required to be made through the Pacific Region Educational Labora-

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266
tory as provided by section 127 of the Workforce Innovation andOpportunity Act (WIOA).
Language is included under ‘‘Employment and Training Administration’’ providing that outlying areas may submit a single application for consolidated grant awards and may use the funds for anyof the programs and activities authorized under subtitle B of title
I of WIOA.
Language is included under ‘‘Employment and Training Administration’’ providing amounts made available for dislocated workers
may be used for State activities or across multiple local areas
where workers remain dislocated.
Language is included under ‘‘Employment and Training Administration’’ providing that technical assistance and demonstration
projects may provide assistance to new entrants in the workforce
and incumbent workers.
Language is included under ‘‘Employment and Training Administration’’ providing that the Secretary may reserve a higher percentage of funds for technical assistance than what is provided in section 168(b) of the WIOA.
Language is included under ‘‘Employment and Training Administration’’ providing that the Department of Labor may take no action to limit the number or proportion of eligible applicants receiving related assistance services in the migrant and seasonal farmworkers programs.
Language is included under ‘‘Employment and Training Administration’’ providing that an individual may qualify as an ‘‘eligible
seasonal farmworker’’ under section 167(i)(3) of the WIOA if suchindividual is a member of a family with a total family income equal
to or less than 150 percent of the poverty line.
Language is included under ‘‘State Unemployment Insurance and
Employment Service Operations’’ providing for reemployment services and eligibility assessments.
Language is included under ‘‘State Unemployment Insurance and
Employment Service Operations’’ providing that funds available for
integrated Unemployment Insurance and Employment Service automation may be used by States notwithstanding cost allocation
principles prescribed under the Office of Management and Budget‘‘Uniform Administrative Requirements, Cost Principles, and Audit
Requirements for Federal Awards.’’
Language is included under ‘‘State Unemployment Insurance and
Employment Service Operations’’ providing that the Department ofLabor may reallot funds among States participating in a consortium.
Language is included under ‘‘State Unemployment Insurance and
Employment Service Operations’’ allowing the Secretary to collectfees for the costs associated with additional data collection, analyses, and reporting services related to the National Agricultural
Workers Survey.
Language is included under ‘‘Veterans’ Employment and Training’’ providing that funds may be used for support specialists providing intensive services to wounded service members, spouses orother family caregivers of the service member, and to surviving
spouses of individuals who died while members of the Armed
Forces.

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267
Language is included under ‘‘Veterans’ Employment and Training’’ related to consultation requirements under section 2023 of
Title 38 U.S. Code.
Language is included under ‘‘Veterans’ Employment and Training’’ related to eligibility under sections 2002(a)(1) and 2023 of
Title 38 U.S. Code.
Language is included under ‘‘Veterans’ Employment and Training’’ providing that data systems and contract support may be provided directly or through grant or contract.
Language is included under ‘‘Veterans’ Employment and Training’’ related to HIRE Vets Medallion Award Program eligibility.
Language is included under ‘‘Special Benefits’’ providing that the
Department of Labor may use authority to reimburse an employer
who is not the employer at the time of injury for portions of thesalary of a re-employed, disabled beneficiary.
Language is included under ‘‘Special Benefits’’ providing thatfunds shall be transferred to the appropriation from entities required under 5 U.S.C. 8147(c) as determined by the Department ofLabor.
Language is included under ‘‘Special Benefits’’ providing that the
Secretary may prescribe regulations requiring identification for thefiling of benefit claims.
Language is included under ‘‘Administrative Expenses, Energy
Employees Occupational Illness Compensation Fund’’ providingthat the Secretary may prescribe regulations for identification for
the filing of benefit claims.
Language is included under ‘‘Occupational Safety and Health Administration’’ providing that up to a certain amount of fees collected from the training institute may be retained and used for related training and education.
Language is included under ‘‘Occupational Safety and Health Administration’’ providing that fees collected from Nationally Recognized Testing Laboratories may be used to administer laboratory
recognition programs that ensure safety of equipment used in theworkplace.
Language is included under ‘‘Mine Safety and Health Administration’’ providing that a specific amount may be collected by the
National Mine Health and Safety Academy and made available formine safety and health education and training.
Language is included under ‘‘Mine Safety and Health Administration’’ providing that a specific amount may be collected from theapproval and certification of equipment and materials and madeavailable for other such activities.
Language is included under ‘‘Mine Safety and Health Administration’’ providing that the Department of Labor may accept lands,
buildings, equipment, and other contributions from public and private sources for cooperative projects.
Language is included under ‘‘Mine Safety and Health Administration’’ providing that the Department of Labor may recognize theJoseph A. Holmes Safety Association as the principal safety association and may provide funds or personnel as officers in local
chapters or the national organization.
Language is included under ‘‘General Provisions’’ prohibiting theuse of any funds appropriated for grants under section 414(c) of theAmerican Competitiveness and Workforce Improvement Act of

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1998, for purposes other than competitive grants for training individuals over the age of 16 who are not currently enrolled in schoolin the occupations and industries for which employers are using H–
1B visa to hire foreign workers.
Language is included under ‘‘General Provisions’’ related to theimplementation of the Fair Labor Standards Act.
Language is included under ‘‘General Provisions’’ modifying certain authorities related to the Secretary’s security detail.
Language is included under ‘‘General Provisions’’ allowing theSecretary to furnish a certain amount of excess personal property
to apprenticeship programs through grants, contracts, and otherarrangements.
Language is included under ‘‘General Provisions’’ modifying certain authorities related to the Secretary’s security detail.
Language is included under ‘‘General Provisions’’ providing that
the Secretary may dispose or divest of certain Job Corps center
property and use the proceeds to carry out the program in thesame geographic location.
Language is included under ‘‘General Provisions’’ modifying certain authorities related to the Inspector General.

DMWilson on DSKJM0X7X2PROD with HEARINGS

TITLE II—DEPARTMENT OF HEALTH AND HUMAN SERVICES

Language is included under ‘‘Health Resources and Services Administration—Health Workforce’’ overriding the proportional funding requirements in the Public Health Service Act for sections 751
and 756.
Language is included under ‘‘Health Resources and Services Administration—Health Workforce’’ providing permissive authority to
the Secretary to waive requirements for entities awarded funds
from sections 751(d)(2)(A) and 751(d)(2)(B).
Language is included under ‘‘Health Resources and Services Administration—Health Workforce’’ allowing funds for the Nurse
Corps and National Health Service Corps Scholarship and Loan
programs to be used to make prior year adjustments.
Language is included under ‘‘Health Resources and Services Administration—Health Workforce’’ providing funding under the National Health Service Corps Loan Repayment Program for substance use disorder counselors and placement in Indian HealthService facilities.
Language is included under ‘‘Centers for Disease Control andPrevention—CDC-Wide’’ permitting CDC to operate and maintainan aircraft.
Language is included under ‘‘Centers for Disease Control andPrevention—CDC-Wide’’ permitting CDC to exclude CDC and Public Health Service employees on overseas assignments or detailed
to States, municipalities, or other organizations to be treated as
non-federal employees.
Language is included under ‘‘Centers for Disease Control andPrevention—Buildings and Facilities’’ providing funds from former
employees with existing Individual Learning Accounts unobligatedto be available to support acquisition, renovation, or replacement,of the National Institute for Occupational Safety and Health’s underground and surface coal mining research capacity.
Language is included under ‘‘Substance Use And Mental HealthServices Administration—Mental Health’’ requiring that 5 percent

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269
of the Mental Health Block Grant funding be available to support
evidence-based crisis systems.
Language is included under ‘‘Substance Use And Mental HealthServices Administration—Mental Health’’ allowing up to 10 percentof the amounts made available to carry out the Children’s Mental
Health Services program may be used to carry out demonstration
grants or contracts for early interventions for people 25 years andyounger at high risk of developing a first episode of psychosis.
Language is included under ‘‘Substance Use And Mental HealthServices Administration—Mental Health’’ exempting the Mental
Health Block Grant from the evaluation set-aside in section 241 of
the Public Health Service Act.
Language is included under Substance Use And Mental HealthServices Administration—Substance Use Services’’ requiring that 4
percent of State Opioid Response grant funding be made available
for Indian Tribes or tribal organizations.
Language is included under ‘‘Substance Use And Mental HealthServices Administration—Substance Use Services’’ exempting theSubstance Use Prevention and Treatment Block Grant and State
Opioid Response grants from the evaluation set-aside in section
241 of the Public Health Service Act.
Language is included under ‘‘Centers for Medicare and Medicaid
Services—Program Management’’ limiting the amount of funding
available under that heading for quality improvement organizations.
Language is included under ‘‘Centers for Medicare and Medicaid
Services—Health Care Fraud and Abuse Control Account’’ providing funds to support the cost of the Senior Medicare Patrol program.
Language is included under ‘‘Administration for Children andFamilies—Low Income Home Energy Assistance’’ modifying the formula distribution of funds.
Language is included under ‘‘Administration for Children andFamilies—Refugee and Entrant Assistance’’ to exempt the matching requirements of certain funds as required in section
235(c)(6)(C)(iii) of the William Wilberforce Trafficking Victims Protection Reauthorization Act of 2008.
Language is included under ‘‘Administration for Children andFamilies—Payments to States for the Child Care and Development
Block Grant’’ increasing the tribal set-aside.
Language is included under ‘‘Administration for Children andFamilies—Children and Families Services Programs’’ related to thecalculation of base grants, the Tribal Colleges and Universities
Head Start Partnership program, and selection criteria for Head
Start programs operated by Indian tribes.
Language is included under Administration for Community Living to allow funding provided for adult protective services grants
under section 2042 of title XX of the Social Security Act to be setaside for Tribes and Tribal organizations.
Language is included under Administration for Community Living continuing an assistive technology alternative financing program.
Language is included under Administration for Community Living prohibiting the use of the funds provided in the bill to pursue
legal action on behalf of a protection and advocacy system de-

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270
scribed in section 103 of the Protection and Advocacy for Individuals with Mental Illness Act unless public notice has been provided
within 90 days of instituting action to the named person or theirlegal guardian.
Language is included under Administration for Community Living waiving the public notice requirement for individuals without
a guardian, who are not competent to consent, who are wards of
the State or subject to public guardianship.
Language is included increasing the percentage of appropriations
available for this section to 2.5 percent.
Language is included modifying the timeframe when a contract
may be terminated.
Language is included requiring that providers of Title X services
adhere to state laws requiring notification or the reporting of childabuse, child molestation, sexual abuse, rape, or incest.
Language is included prohibiting the Secretary from denying
participation in the Medicare Advantage program to entities who
do not provide coverage or referrals for abortion services.
Language is included prohibiting funds from being used to advocate or promote gun control.
Language is included limiting assignments of Public HealthService staff to assist in child survival activities to not more than
60 employees.
Language is included permitting funding for HHS international
HIV/AIDS and other infectious disease, chronic and environmental
disease, and other health activities abroad to be spent under theState Department Basic Authorities Act of 1956.
Language is included granting authority to the Office of the Director of the NIH to enter directly into transactions in order to implement the NIH Common Fund for medical research and permitting the Director to utilize peer review procedures as the Director
deems appropriate.
Language is included providing the Biomedical Advanced Research and Development Authority ten-year contract authority.
Language is included directing the Secretary to consider current
recommendations of the United State Preventive Services Task
Force with respect to breast cancer screening, mammography, andprevention as if such recommendations were a reference to such
recommendations issued before 2009.
Language is included allowing HHS to cover travel expenses
when necessary for employees to obtain medical care when they are
assigned to duty in a location in response to a public health emergency.
Language is included allowing HHS to accept donations in certain circumstances.
Language is included limiting the circumstances when the Secretary may enter into a contract or agreement related to the housing of unaccompanied alien children in any facility that is not state
licensed.
Language is included related to the use of intangible assets in
the Community Services Block Grant.
Language is included limiting the use NIH funding for buildings
and facilities.

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Language is included prohibiting the provision of funds to organizations described in section 501(c)(3) of the Internal Revenue Codeof 1986 that provides abortions except in certain circumstances.
Language is included to prohibit funding for social transitioning.

DMWilson on DSKJM0X7X2PROD with HEARINGS

TITLE III—DEPARTMENT OF EDUCATION

Language is included under ‘‘Impact Aid’’ allowing continued eligibility for students affected by the deployment or death of theirmilitary parent so long as the children attend school in the same
local education agency they attended prior to the parent’s death or
deployment.
Language is included under ‘‘Special Education’’ clarifying theamounts required to be transferred to the Department of the Interior under the Grants to States program.
Language is included under ‘‘Special Education’’ outlining procedures for reducing a State’s award because of a failure to meet themaintenance of State financial support requirements of the Individuals with Disabilities Education Act.
Language is included under ‘‘Special Education’’ authorizing the
Department to use certain funds to provide technical assistanceand support to States to improve data collection capacity.
Language is included under ‘‘Special Education’’ authorizing the
Department to use funds appropriated for the State Personnel Development Grants program to evaluate program performance.
Language is included under ‘‘Special Education’’ permitting
States to subgrant funds that they reserve for ‘‘Other State-Level
Activities’’ under the Grants to States, Preschool Grants to States,
and Grants for Infants and Families programs.
Language is included under ‘‘Special Education’’ allowing the Department to provide all States that apply for the State Incentive
Grants program, in years in which five or fewer States apply forfunding, 20 percent of the funds reserved for the program.
Language is included under ‘‘Special Education’’ to promote continuity of services for eligible infants and their families.
Language is included under ‘‘Special Education’’ to increase access for infants and families who have been traditionally underrepresented in the Grants for Infants and Families program, eliminate
out-of-pocket costs for participating families, and conduct certain
activities with individuals expecting to become parents of infants or
toddlers with disabilities.
Language is included under ‘‘Special Institutions for Persons
with Disabilities’’ allowing the National Technical Institute for theDeaf to use, at its discretion, funds for the endowment program as
authorized under section 207 of the Education of the Deaf Act of1986.
Language is included under ‘‘Special Institutions for Persons
with Disabilities’’ allowing Gallaudet University to use, at its discretion, funds for the endowment program as authorized under section 207 of the Education of the Deaf Act of 1986.
Language is included under ‘‘Higher Education’’ allowing funds
to carry out Title VI of the Higher Education Act to be used to support visits and study in foreign countries for participants in advanced foreign countries by individuals who are participating in advanced foreign language training and international studies in areasthat are vital to U.S. national security and who plan to apply their

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language skills and knowledge of these countries in the fields ofgovernment, the professions, or international development.
Language is included under ‘‘Higher Education’’ stating the section 313(d) of the Higher Education Act does not apply to an institution of higher education that is eligible to receive funding under
section 318 of such Act.
Language is included under ‘‘Higher Education’’ related to loans
to HBCUs.
Language is included under ‘‘General Provisions’’ allowing certain institutions to continue to use endowment income for student
scholarships.
Language is included under ‘‘General Provisions’’ related to the
National Advisory Committee on Institutional Quality and Integrity.
TITLE IV—RELATED AGENCIES

Language is included under ‘‘The Committee for Purchase from
People Who are Blind or Severely Disabled’’ requiring that writtenagreements, with certain oversight provisions, be in place in order
for authorized fees to be charged by certified nonprofit agencies.
Language is included under ‘‘Corporation for National and Community Service’’ requiring the Corporation to make awards on acompetitive basis pursuant to section 501(a)(4)(F) of the 1990 Act,section 198B notwithstanding.
Language is included under ‘‘Corporation for National and Community Service’’ allowing the requirements of section 112(c)(1)(D)
to be met through a determination of need by the local community.
Language is included under ‘‘Corporation for National and Community Service’’ regarding changes to program requirements or policy through rulemaking.
Language is included under ‘‘Corporation for National and Community Service’’ limiting the use of an educational award under
section 148(a)(4) to individuals who are veterans.
Language is included under ‘‘Corporation for National and Community Service’’ related to criminal background checks.
Language is included under ‘‘Corporation for National and Community Service’’ related to 1,200 hour service positions.
Language is included under ‘‘Federal Mediation and Conciliation
Service—Salaries and Expenses’’ providing that fees charged forspecial training and other services and be retained and used for authorized purposes, that fees for arbitration services may only be
used for training agency personnel, and that the Director may accept gifts and services in aid of any projects under the Director’s
jurisdiction.

DMWilson on DSKJM0X7X2PROD with HEARINGS

TITLE V—GENERAL PROVISIONS

Language is included requiring receiving Federal funds to clearlystate the percentage of the total cost of the program or project thatwill be financed with Federal money.
Language is included limiting ability for trust funds receiving
funding appropriated by this act to fund health benefits coveragethat includes abortion.
Language is included limiting the availability for obligation offunds deposited in the Child Enrollment Contingency Fund.

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Language is included prohibiting discriminatory action being
taken against a person on the basis of their sincerely held religious
beliefs.
Language is included prohibiting the provision of funding to particular institutions.
APPROPRIATIONS NOT AUTHORIZED BY LAW
Pursuant to clause 3(f)(1)(B) of rule XIII of the Rules of theHouse of Representatives, the following table lists the appropriations in the accompanying bill which are not authorized by law for
the period concerned:

DMWilson on DSKJM0X7X2PROD with HEARINGS

Agency Program

DEPARTMENT OF LABOR ETA
Adult Training .................
Dislocated Worker Employment and Training
Activities.
Native Americans ............
Migrant and Seasonal
Farmworker programs.
YouthBuild .......................
Job Corps .........................
Reintegration of Ex-Offenders.
Apprenticeship Grants .....
One-Stop Career Centers/
Labor Market Information.
DEPARTMENT OF HEALTH AND
HUMAN SERVICES HRSA
Nurse Practitioner Optional Fellowship Program.
Medical Student Education.
Heritable Disorders ..........
Emergency Relief—Part A
Comprehensive Care—Part B.
Early Intervention—PartC.
Coordinated Services andAccess to Research for
Women, Infants, Children and Youth—PartD.
AIDS Dental Services—
Part F.
Educ. & Training Centers—Part F.
Organ Transplantation ....
Rural Hospital Flexibility
Grants.
CDC
Sexually Transmitted Infections.
National Center for
Health Statistics.
WISEWOMAN ....................
National Cancer Registries.
Asthma Surveillance &Grants.

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Last Year of
Authorization

Authorization Level

Appropriations in Last
Year of Authorization

FY2020 ................
FY2020 ................

$899,987,000 .............
1,436,137,000 ............

$885,649,000 .............
1,052,053,000 ............

$885,649,000
1,421,412,000

FY2020 ................
FY2020 ................

54,137,000 .................
96,211,000 .................

55,000,000 .................
91,896,000 .................

65,000,000
97,396,000

FY2020 ................
FY2020 ................
N/A .......................

91,087,000 .................
1,983,236,000 ............
N/A .............................

94,534,000 .................
1,743,655,000 ............
N/A .............................

110,000,000
1,760,155,000
60,000,000

N/A .......................
FY2020 ................

N/A .............................
70,667,000 .................

N/A .............................
62,653,000 .................

150,000,000
62,653,000

N/A .......................

N/A .............................

N/A .............................

7,000,000

N/A .......................

N/A .............................

N/A .............................

70,000,000

FY 2019 ...............
FY 2013 ...............
FY 2013 ...............

19,900,000 .................
789,471,000 ...............
1,562,169,000 ............

18,883,000 .................
649,373,000 ...............
1,314,446,000 ............

21,383,000
680,752,000
1,364,878,000

FY 2013 ...............

285,766,000 ...............

205,544,000 ...............

208,970,000

FY 2013 ...............

87,273,000 .................

75,088,000 .................

77,935,000

FY 2013 ...............

15,802,000 .................

12,991,000 .................

13,620,000

FY 2013 ...............

42,178,000 .................

33,275,000 .................

34,886,000

FY 1993 ...............
FY 2012 ...............

Such Sums .................
Such Sums .................

2,767,000 ...................
41,040,000 .................

58,049,000
74,277,000

FY 1998 ...............

Such Sums .................

112,117,000 ...............

164,310,000

FY 2003 ...............

Such Sums .................

125,899,000 ...............

187,397,000

FY 2003 ...............
FY 2003 ...............

Such Sums .................
Such Sums .................

12,419,000 .................
N/A .............................

34,620,000
53,440,000

FY 2005 ...............

Such Sums .................

32,422,000 .................

33,500,000

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Last Year of
Authorization

Authorization Level

Appropriations in Last
Year of Authorization

Folic Acid .........................
Oral Health Promotion .....
Screening, Referrals, and
Education Regarding
Lead Poisoning.
Birth Defects, Developmental Disability, Disability and Health.
Breast and Cervical Cancer.
Public Health Workforce ..
National Diabetes Prevention Program.
Johanna’s Law .................
Section 317 Immunization
Young Women’s Breast
Health Awareness andSupport of Young
Women Diagnosed with
Breast Cancer (PHSA
399NN).
Preventive Health Measures with regard to
Prostate Cancer.
Combating Antimicrobial
Resistance.
National Strategy for
Combating and Eliminating Tuberculosis.
Newborn Screening Quality Assurance.
Early Hearing Detection
and Intervention.
Firefighter Cancer Registry.

FY 2005 ...............
FY 2005 ...............
FY 2005 ...............

Such Sums .................
Such Sums .................
40,000,000 .................

2,188,000 ...................
11,204,000 .................
36,474,000 .................

3,150,000
22,250,000
51,000,000

FY 2007 ...............

Such Sums .................

122,242,000 ...............

205,560,000

FY 2012 ...............

275,000,000 ...............

204,779,000 ...............

237,500,000

FY 2013 ...............
FY 2014 ...............

39,500,000 .................
Such Sums .................

64,000,000 .................
10,000,000 .................

71,000,000
37,300,000

FY 2014 ...............
FY 2014 ...............
FY 2019 ...............

18,000,000 .................
Such Sums .................
4,900,000 ...................

4,972,000 ...................
610,847,000 ...............
4,960,000 ...................

12,000,000
681,993,000
6,960,000

FY 2004 ...............

Such Sums .................

14,091,000 .................

15,205,000

FY 2006 ...............

Such Sums .................

17,443,000 .................

197,000,000

FY 2013 ...............

243,101,000 ...............

132,997,000 ...............

137,034,000

FY 2019 ...............

8,000,000 ...................

17,250,000 .................

21,000,000

FY 2022 ...............

11,852,000 .................

10,760,000 .................

10,760,000

FY 2022 ...............

2,500,000 ...................

2,500,000 ...................

5,500,000

National Institutes of
Health.
SAMHSA
Protection and Advocacy
for Individuals with
Mental Illness.
ACF
Low Income Home Energy
Assistance Program.
Child Care and Development Block Grant.
Children and Families
Services Programs.
Adoption and Legal
Guardianship Incentive
Payments.
Native American Programs.
Community Services
Block Grant.
Rural Community Development.
Head Start .......................
Runaway and Homeless
Youth Programs.
CAPTA programs ..............
Family Violence Programs
National Domestic Violence Hotline.
Child Welfare Services ....

FY 2020 ...............

36,472,442,775 ..........

40,954,400,000 ..........

47,168,518,000

FY 2003 ...............

19,500,000 .................

36,146,000 .................

40,000,000

FY 2007 ...............

5,100,000,000 ............

2,161,170,000 ............

4,040,000,000

FY 2020 ...............

2,748,591,018 ............

5,826,000,000 ............

8,771,387,000..............................

....................................

....................................

FY 2016 ...............

43,000,000 .................

37,943,000 .................

75,000,000

FY 2002 ...............

Such Sums .................

45,826,000 .................

65,500,000

FY 2003 ...............

Such Sums .................

645,762,000 ...............

778,000,000

FY 2003 ...............

Such Sums .................

7,203,000 ...................

13,000,000

FY 2012 ...............
FY 2013 ...............

Such Sums .................
Such Sums .................

7,968,544,000 ............
107,852,000 ...............

12,296,820,000
146,283,000

FY 2015 ...............
FY 2015 ...............
FY 2015 ...............

Such Sums .................
178,500,000 ...............
Such Sums .................

143,981,000 ...............
139,500,000 ...............
4,500,000 ...................

105,091,000
245,000,000
20,500,000

FY 2016 ...............

325,000,000 ...............

268,735,000 ...............

268,735,000

Agency Program

Appropriationsin this Bill

DMWilson on DSKJM0X7X2PROD with HEARINGS

NIH

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275
Agency Program

Refugee and Entrant Assistance Programs.
Refugee Support Services
Transitional and Medical
Services.
Survivors of Torture .........
Anti-Trafficking in Persons Programs.

Last Year of
Authorization

Authorization Level

Appropriations in Last
Year of Authorization

Appropriationsin this Bill..............................

....................................

....................................

FY 2002 ...............
FY 2002 ...............

Such Sums .................
Such Sums .................

212,912,000 ...............
227,243,000 ...............

137,500,000
253,700,000

FY 2007 ...............
FY2021 ................

25,000,000 .................
28,755,000 .................

9,817,000 ...................
28,755,000 .................

19,000,000
31,755,000

FY 2011 ...............
FY 1996 ...............

94,810,000 .................
10,000,000 .................

2,495,000 ...................
N/A .............................

10,000,000
55,242,000

FY 2007 ...............

Such Sums .................

155,115,000 ...............

191,369,000

FY 2005 ...............

17,410,000 .................

13,879,000 .................

10,000,000

FY 2010 ...............
FY 2019 ...............
FY 2011 ...............
N/A .......................
FY 2020 ...............

Such Sums .................
8,600,000 ...................
25,000,000 .................
N/A .............................
214,135,000 ...............

25,000,000 .................
11,321,000 .................
6,352,000 ...................
N/A .............................
228,153,000 ...............

40,000,000
16,118,000
10,700,000
4,200,000
247,183,000

FY 2020 ...............
FY 2020 ...............

16,309,802,000 ..........
27,000,000 .................

14,626,490,000
30,000,000

192,000,000 ...............

194,000,000

FY 2020 ...............
FY 2020 ...............

16,182,345,000 ..........
180,014,000 (for IAL
and CLSD).
180,014 (for IAL and
CLSD).
374,751,000 ...............
47,614,000 .................

375,626,000 ...............
47,614,000 .................

375,626,000
49,239,000

FY 2020 ...............
FY 2020 ...............

1,388,603,000 ............
1,100,000,000 ............

1,486,112,000 ............
1,249,673,000 ............

1,630,000,000
1,329,673,000

FY 2020 ...............

85,000,00 ...................

101,500,000 ...............

129,000,000

FY 2020 ...............

32,397,000 .................

36,897,000 .................

44,897,000

FY 2020 ...............

31,453,000 .................

35,953,000 .................

44,953,000

FY 2020 ...............
FY 2020 ...............

169,840,000 ...............
1,600,000,000 ............

185,840,000 ...............
1,210,000,000 ............

225,000,000
1,390,000,000

FY 2020 ...............

106,525,000 ...............

105,381,000 ...............

110,381,000

FY 2020 ...............

17,993,000 .................

67,993,000 .................

72,000,000

FY 2020 ...............

5,565,000 ...................

7,365,000 ...................

19,865,000

FY 2020 ...............

90,611,000 .................

190,000,000 ...............

259,000,000

FY 2020 ...............
FY 2020 ...............

300,000,000 ...............
5,000,000 ...................

440,000,000 ...............
105,000,000 ...............

450,000,000
216,000,000

FY 2021 ...............

3,675,021,000 ............

3,675,021,000 ............

4,389,957,000

FY 2021 ...............

14,098,000 .................

13,000,000 .................

13,000,000

DMWilson on DSKJM0X7X2PROD with HEARINGS

ACL
Lifespan Respite Care .....
State Health Insurance
Assistance Program.
Developmental Disabilities.
Voting Access for People
with Disabilities.
Assistive Technology .......
Traumatic Brain Injury ....
Paralysis Resource Center
Limb Loss ........................
Independent Living and
the National Instituteon Disability, Independent Living andRehabilitation Research.
DEPARTMENT OF EDUCATION
Title I Grants to LEAs .....
Innovative Approaches to
Literacy (IAL).
Comprehensive Literacy
Development (CLSD).
Migrant ............................
Neglected and Delinquent/High Risk Youth.
Impact Aid .......................
Nita M. Lowey 21st Century Community Learning Centers.
Education for HomelessChildren and Youth.
Education for Native Hawaiians.
Alaska Native Education
Equity.
Rural Education ..............
Student Support andAcademic Enrichment
Grants.
Indian Education Grants
to Local Educational
Agencies.
Special Programs for Indian Children.
Indian Education National
Activities.
Education Innovation andResearch.
Charter Schools Grants ...
School Safety National
Activities.
Vocational Rehabilitation
State Grants.
Client Assistance State
Grants.

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276
Agency Program

Last Year of
Authorization

Authorization Level

Appropriations in Last
Year of Authorization

Appropriationsin this Bill

Supported Employment
State Grants.
Training ...........................
Demonstration and Training Programs.
Services for Older Blind
Individuals.
Protection and Advocacy
of Individual Rights.
Helen Keller National
Center for Deaf-Blind
Youths and Adults.
National Technical Institute for the Deaf.
Gallaudet University ........
Adult Basic and Literacy
Education State Grants.
Adult Education National
Leadership Activities.
Aid for Institutional Development.
Aid for Hispanic-Serving
Institutions.
International Education
And Foreign Language.
Federal TRIO Programs ...
IDEA National Activities ..
IDEA Grants for Infantsand Families.
Special Programs for Migrant Students.
RELATED AGENCIES
Corporation for Nationaland Community Service.

FY 2021 ...............

32,363,000 .................

22,548,000 .................

22,548,000

FY 2021 ...............
FY 2021 ...............

39,540,000 .................
6,809,000 ...................

29,388,000 .................
5,796,000 ...................

29,388,000
5,796,000

FY 2021 ...............

39,141,000 .................

33,317,000 .................

33,317,000

FY 2021 ...............

20,735,000 .................

18,150,000 .................

21,150,000

FY 2004 ...............

Such Sums .................

8,666,000 ...................

19,000,000

FY 2015 ...............

Such Sums .................

67,016,000 .................

93,000,000

FY 2015 ...............
FY 2021 ...............

Such Sums .................
665,067,000 ...............

120,275,000 ...............
674,955,000 ...............

168,361,000
715,455,000

FY 2021 ...............

13,573,000 .................

13,712,000 .................

13,712,000

FY 2015 ...............

Such Sums .................

429,762,000 ...............

1,042,618,000

FY 2015 ...............

Such Sums .................

109,223,000 ...............

232,890,000

FY 2015 ...............

Such Sums .................

72,164,000 .................

81,531,000

FY 2015 ...............
FY 2010 ...............
FY 2010 ...............

Such Sums .................
Such Sums .................
Such Sums .................

839,752,000 ...............
260,203,000 ...............
439,427,000 ...............

1,191,000,000
257,560,000
540,000,000

FY 2015 ...............

Such Sums .................

37,474,000 .................

52,123,000

FY 2014 ...............

Such Sums .................

1,049,954,000 ............

309,349,000

BUDGETARY IMPACT OF THE DEPARTMENTS OF LABOR, HEALTH AND
HUMAN SERVICES, AND EDUCATION, AND RELATED AGENCIES APPROPRIATIONS BILL, 2025, PREPARED IN CONSULTATION WITH THE
CONGRESSIONAL BUDGET OFFICE PURSUANT TO SECTION 308(a) OF
THE CONGRESSIONAL BUDGET ACT OF 1974

[In Millions of Dollars]
COMPARISON WITH BUDGET RESOLUTION

Pursuant to clause 3(c)(2) of rule XIII of the Rules of the Houseof Representatives and section 308(a)(1)(A) of the Congressional
Budget Act of 1974, the following table compares the levels of new
budget authority provided in the bill with the appropriate allocation under section 302(b) of the Budget Act:[In millions of dollars]
302(b) Allocation

DMWilson on DSKJM0X7X2PROD with HEARINGS

BudgetAuthority

Comparison of amounts in the bill with Committee allocations to its subcommittees: Subcommittee on
Labor, Health and Human Services, and Education,
and Related Agencies
Discretionary ..........................................................

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This Bill
BudgetAuthority

OutlaysOutlays

$X,X

$X,X

$X,X

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1 $X,X

277[In millions of dollars]
302(b) Allocation
BudgetAuthority

Mandatory ..............................................................

This Bill
BudgetAuthority

Outlays

X,X

X,X

Outlays
1 X,X

X,X

1 Includes outlays from prior-year budget authority.

FIVE-YEAR OUTLAY PROJECTIONS

Pursuant to clause 3(c)(2) of rule XIII and section 308(a)(1)(A) of
the Congressional Budget Act of 1974, the following table contains
five-year projections associated with the budget authority provided
in the accompanying bill as provided to the Committee by the Congressional Budget Office:[In millions of dollars]
Outlays

Projection of outlays associated with the recommendation:
2025 ......................................................................................................................................................
2026 ......................................................................................................................................................
2027 ......................................................................................................................................................
2028 ......................................................................................................................................................
2029 and future years ..........................................................................................................................

1 $X

X
X
X
X

1 Excludes outlays from prior-year budget authority.

FINANCIAL ASSISTANCE TO STATE AND LOCAL GOVERNMENTS

Pursuant to clause 3(c)(2) of rule XIII and section 308(a)(1)(A) of
the Congressional Budget Act of 1974, the Congressional Budget
Office has provided the following estimates of new budget authority
and outlays provided by the accompanying bill for financial assistance to State and local governments:[In millions of dollars]
BudgetAuthority

Financial Assistance to State and local governments for 2025 ................................

Outlays

1 $X,X

1 $X,X

1 Excludes outlays from prior-year budget authority.

DMWilson on DSKJM0X7X2PROD with HEARINGSCOMMITTEE HEARINGS
Pursuant to clause 3(c)(6) of rule XIII of the Rules of the Houseof Representatives, the following hearings were used to develop or
consider the Labor, Health and Human Services, and Education,
and Related Agencies Appropriations Bill, 2025:
The Subcommittee on Labor, Health and Human Services, Education, and Related Agencies held a budget hearing on March 20,
2024, entitled ‘‘Fiscal Year 2025 Request for the Department of
Health and Human Services.’’ The Subcommittee received testimony from:The Honorable Xavier Becerra, Secretary, Department of
Health and Human Services
The Subcommittee on Labor, Health and Human Services, and
Education, and Related Agencies held a budget hearing on April
10, 2024, entitled ‘‘Fiscal Year 2025 Request for the Department of
Education.’’ The Subcommittee received testimony from:The Honorable Miguel Cardona, Secretary, Department of
Education

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The Subcommittee on Labor, Health and Human Services, and
Education, and Related Agencies held a budget hearing on April
17, 2024, entitled ‘‘Fiscal Year 2025 Request for the Department ofLabor.’’ The Subcommittee received testimony from:The Honorable Julie Su, Acting Secretary, Department ofLabor
The Subcommittee on Labor, Health and Human Services, and
Education, and Related Agencies held a hearing on April 30, 2024,
entitled ‘‘Fiscal Year 2025 Member Day.’’ The Subcommittee received testimony from:James McGovern, Member of Congress, andRaul Ruiz, Member of Congress.
DISCLOSURE OF EARMARKS AND CONGRESSIONALLY DIRECTEDSPENDING ITEMS
Pursuant to clause 9 of rule XXI of the Rules of the House ofRepresentatives, neither the bill nor this report contains any congressional earmarks, limited tax benefits, or limited tariff benefits
as defined in clause 9 of rule XXI of the Rules of the House of Representatives.
COMPARATIVE STATEMENT OF BUDGET AUTHORITY[TO BE PROVIDED]FULL COMMITTEE VOTES
Pursuant to the provisions of clause 3(b) of rule XIII of the Houseof Representatives, the results of each roll call vote on an amendment or on the motion to report, together with the names of thosevoting for and those against, are printed below:
FULL COMMITTEE VOTES[TO BE PROVIDED]
DISSENTING VIEWSDMWilson on DSKJM0X7X2PROD with HEARINGS[TO BE PROVIDED]

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