26–688 PDF 

Calendar No. 215 

115TH CONGRESS REPORT " ! SENATE 1st Session 115–150 

DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND RELATED AGENCIES APPROPRIATION BILL, 2018 

SEPTEMBER 7, 2017.—Ordered to be printed 

Mr. BLUNT, from the Committee on Appropriations, 

submitted the following 

R E P O R T 

[To accompany S. 1771] 

The Committee on Appropriations reports the bill (S. 1771) making appropriations for Departments of Labor, Health and Human 

Services, and Education, and related agencies for the fiscal year 

ending September 30, 2018, and for other purposes, reports favorably thereon without amendment and recommends that the bill do 

pass. 

Amounts to new budget authority 

Total of bill as reported to the Senate ....................$991,867,000,000 

Amount of 2017 appropriations ............................... 933,945,868,000 

Amount of 2018 budget estimate ............................ 964,663,824,000 

Bill as recommended to Senate compared to: 

2017 appropriations .......................................... ∂57,921,132,000 

2018 budget estimate ........................................ ∂27,203,176,000 
(2) 

C O N T E N T S 

Page 

List of Abbreviations ............................................................................................... 4 

Summary of Budget Estimates and Committee Recommendations .................... 8 

Overview ............................................................................................................ 8 

National Institutes of Health .......................................................................... 8 

Combating Opioid Abuse ................................................................................. 9 

Promoting College Affordability and Completion .......................................... 10 

Improving Fiscal Accountability ...................................................................... 11 

Increasing the Efficiency and Cost Effectiveness of Government ................ 12 

Guidance Documents ........................................................................................ 13 

Bill-Wide Directives .......................................................................................... 14 

Other Highlights of the Bill ............................................................................. 15 

Title I: Department of Labor: 

Employment and Training Administration .................................................... 18 

Employee Benefits Security Administration .................................................. 28 

Pension Benefit Guaranty Corporation .......................................................... 28 

Wage and Hour Division .................................................................................. 29 

Office of Labor-Management Standards ......................................................... 30 

Office of Federal Contract Compliance Programs .......................................... 30 

Office of Workers’ Compensation Programs ................................................... 30 

Occupational Safety and Health Administration ........................................... 33 

Mine Safety and Health Administration ........................................................ 35 

Bureau of Labor Statistics ............................................................................... 35 

Office of Disability Employment Policy .......................................................... 36 

Departmental Management ............................................................................. 36 

General Provisions ........................................................................................... 39 

Title II: Department of Health and Human Services: 

Health Resources and Services Administration ............................................. 41 

Centers for Disease Control and Prevention .................................................. 57 

National Institutes of Health .......................................................................... 79 

National Institute for Research on Safety and Quality ................................ 105 

Substance Abuse and Mental Health Services Administration .................... 115 

Agency for Healthcare Research and Quality ................................................ 124 

Centers for Medicare and Medicaid Services ................................................. 126 

Administration for Children and Families ..................................................... 133 

Administration for Community Living ........................................................... 142 

Office of the Secretary ...................................................................................... 149 

General Provisions ........................................................................................... 160 

Title III: Department of Education: 

Education for the Disadvantaged .................................................................... 162 

Impact Aid ......................................................................................................... 164 

School Improvement Programs ........................................................................ 165 

Indian Education .............................................................................................. 168 

Innovation and Improvement .......................................................................... 170 

Safe Schools and Citizenship Education ......................................................... 173 

English Language Acquisition ......................................................................... 174 

Special Education ............................................................................................. 175 

Rehabilitation Services .................................................................................... 177 

Special Institutions for Persons With Disabilities: 

American Printing House for the Blind ................................................... 178 

National Technical Institute for the Deaf ............................................... 179 

Gallaudet University ................................................................................. 179 

Career, Technical, and Adult Education ........................................................ 179 

Student Financial Assistance .......................................................................... 180 

Student Aid Administration ............................................................................ 181 
Page

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Title III—Continued 

Higher Education ............................................................................................. 185 

Howard University ........................................................................................... 190 

College Housing and Academic Facilities Loans Program ............................ 190 

Historically Black College and University Capital Financing Program 

Account .......................................................................................................... 191 

Institute of Education Sciences ....................................................................... 191 

Departmental Management: 

Program Administration ........................................................................... 193 

Office for Civil Rights ............................................................................... 194 

Office of the Inspector General ................................................................ 195 

General Provisions ........................................................................................... 195 

Title IV: Related Agencies: 

Committee for Purchase From People Who Are Blind or Severely Disabled ............................................................................................................... 197 

Corporation for National and Community Service ........................................ 197 

Corporation for Public Broadcasting ............................................................... 200 

Federal Mediation and Conciliation Service .................................................. 201 

Federal Mine Safety and Health Review Commission .................................. 201 

Institute of Museum and Library Services ..................................................... 202 

Medicaid and CHIP Payment and Access Commission ................................. 202 

Medicare Payment Advisory Commission ...................................................... 203 

National Council on Disability ........................................................................ 203 

National Labor Relations Board ...................................................................... 203 

National Mediation Board ............................................................................... 203 

Occupational Safety and Health Review Commission ................................... 204 

Railroad Retirement Board .............................................................................. 204 

Social Security Administration ........................................................................ 205 

Title V: General Provisions ..................................................................................... 209 

Compliance With Paragraph 7, Rule XVI of the Standing Rules of the Senate .......................................................................................................................... 211 

Compliance With Paragraph 7(c), Rule XXVI of the Standing Rules of the 

Senate ................................................................................................................... 211 

Compliance With Paragraph 12, Rule XXVI of the Standing Rules of the 

Senate ................................................................................................................... 212 

Budgetary Impact of Bill ......................................................................................... 216 

Comparative Statement of New Budget Authority ............................................... 217 
(4) 

LIST OF ABBREVIATIONS 

ACA—Patient Protection and Affordable Care Act 

ACL—Administration for Community Living 

ADAP—AIDS Drug Assistance Program 

AHEC—Area Health Education Center 

AHRQ—Agency for Healthcare Research and Quality 

AP—Advanced Placement 

APH—American Printing House for the Blind 

ASH—Assistant Secretary for Health 

ASPR—Assistant Secretary for Preparedness and Response 

BARDA—Biomedical Advanced Research and Development Authority 

BCA—Budget Control Act of 2011 

BLS—Bureau of Labor Statistics 

CAN—Cures Acceleration Network 

CCAMPIS—Child Care Access Means Parents in School 

CCDBG—Child Care and Development Block Grant 

CDC—Centers for Disease Control and Prevention 

CHAFL—College Housing and Academic Facilities Loans 

CHC—Community Health Center 

CHGME—Children’s Hospitals Graduate Medical Education 

CJ—Congressional Justification of Estimates for Appropriations 

Committees 

CMS—Centers for Medicare and Medicaid Services 

CNCS—Corporation for National and Community Service 

CPB—Corporation for Public Broadcasting 

CSAP—Center for Substance Abuse Prevention 

CSAT—Center for Substance Abuse Treatment 

CSBG—Community Services Block Grant 

CSEOA—Community Service Employment for Older Americans 

DOD—Department of Defense 

DOL—Department of Labor 

DRA—Delta Regional Authority 

EBSA—Employee Benefits Security Administration 

EEOICPA—Energy Employees Occupational Illness Compensation Program Act 

ERISA—Employee Retirement Income Security Act of 1974 

ESEA—Elementary and Secondary Education Act 

ETA—Employment and Training Administration 

FDA—Food and Drug Administration 

FEMA—Federal Emergency Management Agency 

FIC—Fogarty International Center 

FIE—Fund for the Improvement of Education 

FIPSE—Fund for the Improvement of Postsecondary Education 

FMCS—Federal Mediation and Coalition Service 

FMSHRC—Federal Mine Safety and Health Review Commission 

FTE—full-time equivalent 
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FWS—Federal Work Study 

GAANN—Graduate Assistance in Areas of National Need 

GAO—Government Accountability Office 

GEAR UP—Gaining Early Awareness and Readiness for Undergraduate Programs 

HBCUs—Historically Black Colleges and Universities 

HCFAC—Health Care Fraud and Abuse Control 

HEA—Higher Education Act 

HELP—Health, Education, Labor, and Pensions 

HHS—Health and Human Services 

HRSA—Health Resources and Services Administration 

IC—Institute and Center 

IDeA—Institutional Development Award 

IDEA—Individuals with Disabilities Education Act 

IES—Institute of Education Sciences 

IMLS—Institute of Museum and Library Services 

IOM—Institute of Medicine 

LEA—local educational agency 

LIHEAP—Low Income Home Energy Assistance Program 

MACPAC—Medicaid and CHIP Payment and Access Commission 

MCH—Maternal and Child Health 

MedPAC—Medicare Payment Advisory Commission 

MSHA—Mine Safety and Health Administration 

NAEP—National Assessment of Educational Progress 

NAGB—National Assessment Governing Board 

NCATS—National Center for Advancing Transitional Sciences 

NCBDDD—National Center on Birth Defects and Developmental 

Disabilities 

NCES—National Center for Education Statistics 

NCHS—National Center for Health Statistics 

NCI—National Cancer Institute 

NEI—National Eye Institute 

NHGRI—National Human Genome Research Institute 

NHLBI—National Heart, Lung, and Blood Institute 

NIA—National Institute on Aging 

NIAAA—National Institute on Alcohol Abuse and Alcoholism 

NIAID—National Institute of Allergy and Infectious Disease 

NIAMS—National Institute of Arthritis and Musculoskeletal and 

Skin Diseases 

NIBIB—National Institute of Biomedical Imaging and Bioengineering 

NICHD—Eunice Kennedy Shriver National Institute of Child 

Health and Human Development 

NIDA—National Institute on Drug Abuse 

NIDCD—National Institute on Deafness and Other Communication Disorders 

NIDCR—National Institute of Dental and Craniofacial Research 

NIDDK—National Institute of Diabetes and Digestive and Kidney Disease 

NIDRR—National Institute on Disability and Rehabilitation Research 

NIEHS—National Institute of Environmental Health Sciences 

NIGMS—National Institute of General Medical Sciences 

NIH—National Institutes of Health 
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NIMH—National Institute of Mental Health 

NIMHD—National Institute on Minority Health and Health Disparities 

NINDS—National Institute of Neurological Disorders and Stroke 

NINR—National Institute of Nursing Research 

NLM—National Library of Medicine 

NLRB—National Labor Relations Board 

NSF—National Science Foundation 

NSIP—Nutrition Services Incentives Program 

NTID—National Technical Institute for the Deaf 

NFP—Not-for-Profit 

OAR—Office of AIDS Research 

OCR—Office for Civil Rights 

ODEP—Office of Disability Employment Policy 

OFCCP—Office of Federal Contract Compliance Programs 

OIG—Office of the Inspector General 

OLMS—Office of Labor-Management Standards 

OMB—Office of Management and Budget 

OMH—Office of Minority Health 

OMHA—Office of Medicare Hearings and Appeals 

ONC—Office of the National Coordinator for Health Information 

Technology 

ORR—Office of Refugee Resettlement 

ORWH—Office of Research on Women’s Health 

OSEP—Office of Special Education Programs 

OSHA—Occupational Safety and Health Administration 

OWCP—Office of Workers’ Compensation Programs 

OWH—Office of Women’s Health 

PAIMI—protection and advocacy for individuals with mental illness 

PATH—Projects for Assistance in Transition From Homelessness 

PBGC—Pension Benefit Guaranty Corporation 

PHS—Public Health Service 

PPH Fund—Prevention and Public Health Fund 

PRNS—Programs of Regional and National Significance 

PROMISE—Promoting School Readiness of Minors in SSI 

RSA—Rehabilitation Services Administration 

SAMHSA—Substance Abuse and Mental Health Services Administration 

SAPT—Substance Abuse Prevention and Treatment 

SEA—State educational agency 

SEOG—Supplemental Educational Opportunity Grant 

SIG—School Improvement Grants 

SPRANS—Special Projects of Regional and National Significance 

SSA—Social Security Administration 

SSBG—Social Services Block Grant 

SSI—Supplemental Security Income 

STEM—science, technology, engineering, and mathematics 

TB—tuberculosis 

TBI—traumatic brain injury 

TIF—Teacher Incentive Fund 

TIVAS—Title IV Additional Servicers 

UAC—unaccompanied alien children 
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UCEDD—University Center for Excellence in Developmental 

Disabilities 

UI—unemployment insurance 

USAID—U.S. Agency for International Development 

VETS—Veterans’ Employment and Training Services 

VISTA—Volunteers in Service to America 

VR—Vocational Rehabilitation 

WANTO—Women in Apprenticeship and Non-Traditional Occupations 

WHD—Wage and Hour Division 

WIA—Workforce Investment Act 

WIOA—Workforce Innovation and Opportunity Act 

WIF—Workforce Innovation Fund 

WISEWOMAN—Well-Integrated Screening and Evaluation for 

Women Across the Nation 
(8) 

SUMMARY OF BUDGET ESTIMATES AND COMMITTEE 

RECOMMENDATIONS 

For fiscal year 2018, the Committee recommends total budget au- thority of $969,052,391,000 for the Departments of Labor, Health 

and Human Services, and Education, and Related Agencies. This 

amount includes $164,066,000,000 in current year discretionary 

funding subject to discretionary spending caps and $1,896,000,000 

in cap adjustments for healthcare fraud and abuse control and for 

program integrity at the Social Security Administration, in accordance with the allocation for this bill. 

Fiscal year 2017 levels cited in this report reflect the enacted 

amounts in Public Law 115–31, the Consolidated Appropriations 

Act, 2017, adjusted for comparability where noted. 

OVERVIEW

The Labor, Health and Human Services, and Education, and Related Agencies [Labor-HHS-Education] appropriations bill constitutes the largest share of non-defense discretionary spending, 32 

percent of the total in fiscal year 2018. Total spending in this bill 

subject to discretionary spending caps is $3,041,000,000 above the 

comparable fiscal year 2017 level. In addition, the bill includes 

$4,393,000,000 in spending offset by savings from changes in mandatory programs, $3,831,900,000 less than the fiscal year 2017 

level. This decreased funding level has required the Committee to 

make difficult funding decisions and consider the appropriate role 

and jurisdiction of Federal programs. The priorities and considerations of the Committee in developing this bill are summarized in 

the section below: 

NATIONAL INSTITUTES OF HEALTH

The Committee recommendation includes $36,084,000,000 for the 

NIH, an increase of $2,000,000,000. Even in a difficult funding environment, the Committee believes it is critical to prioritize funding 

for NIH and build on the last 2 years of funding increases in a predictable and consistent way. Without continued investment in the 

NIH, we jeopardize our current scientific progress, risk losing a 

generation of scientists, and stunt our Nation’s global competitiveness. 

The Committee rejects the Administration’s proposal to cap Facilities & Administrative [F&A] costs for NIH grantees at 10 percent. While the Committee understands the desire to identify budget and administrative savings, F&A costs are not optional; they are 

a fundamental part of doing research. The Committee also disagrees with the proposal to eliminate the John E. Fogarty International Center and provides funding to maintain the Center at 

NIH. Disease knows no borders. It is critical to ensure that NIH 

continues to have the resources to build scientific expertise in de-
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veloping countries and, as we saw with the Zika virus, continue its 

strong partnerships internationally to protect the health and safety 

of Americans. 

Finally, the Committee recommendation allocates funding to 

areas holding the most promise of scientific advancement, while allowing NIH to maintain flexibility to pursue unplanned scientific 

opportunities and address unforeseen public health needs. The 

Committee recommendation is estimated to support over 10,600 

new and competing grants in fiscal year 2018. 

Alzheimer’s Disease.—In 2017, Medicare and Medicaid will spend an estimated $175,000,000,000 caring for those with Alzheimer’s 

and other dementias, 68 percent of total costs. It is the most expensive disease in America. Without a medical breakthrough to prevent, slow, or stop the disease, by 2050 the combined Medicare and 

Medicaid spending on people with Alzheimer’s disease will more 

than quadruple. The Committee recommendation includes an increase of $414,000,000 for Alzheimer’s disease research, bringing 

the total available in fiscal year 2018 to approximately 

$1,828,000,000, a 29.3 percent increase above fiscal year 2017. 

Over the last three years, specific funding for Alzheimer’s disease 

research has increased $1,239,000,000, a 210 percent increase. 

Brain Research through Advancing Innovative Neurotechnologies 

[BRAIN].—The Committee continues to strongly support the 

BRAIN Initiative and provides $400,000,000 in fiscal year 2018. 

This is an increase of $140,000,000 above fiscal year 2017. The 

BRAIN Initiative is developing a more complete understanding of 

brain function and has the possibility of helping millions of people 

who suffer from a wide variety of neurological and psychiatric disorders such as Parkinson’s disease, schizophrenia, Alzheimer’s disease and dementia, depression, and traumatic brain injury. 

Combating Antibiotic Resistant Bacteria [CARB].—The Committee supports efforts to develop new antibiotics and rapid diagnostic tests. Given the threat posed by the spread of antibiotic resistant bacteria, the recommendation includes $513,000,000, an increase of $50,000,000 above fiscal year 2017. 

Precision Medicine.—The Committee provides $370,000,000, an increase of $70,000,000 above fiscal year 2017, for the Precision 

Medicine Initiative. This includes $80,000,000 for the National 

Cancer Institute’s precision medicine initiative that applies advances in cancer genomics and precision oncology to allow physicians to individualize cancer treatments to a patient. In addition, 

$290,000,000 is provided for the All of Us study. 

COMBATING OPIOID ABUSE

Nearly 2 million American adults have an opioid use disorder related to prescription pain relievers, and almost 600,000 have an 

opioid use disorder related to heroin. According to the Centers for 

Disease Control and Prevention [CDC], the amount of opioids prescribed per person was three times higher in 2015 than in 1999, 

and drug overdose deaths have nearly tripled in the last 15 years. 

Even more troubling, prescription opioid abuse is a risk factor for 

heroin use, another form of opioids. Approximately 3 out of 4 new 

heroin users abused prescription opioids before switching to heroin. 

To stop the spread of further opioid abuse, the bill provides 
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$816,210,000, an increase of $665,000,000, or 440 percent, since fiscal year 2016, in discretionary funding to fight both prescription 

opioid and heroin abuse: 

State Targeted Response to the Opioid Abuse Crisis Grants.—The 

Committee continues to provide $500,000,000 for State responses to 

opioid abuse, for a total of $1,000,000,000 in the past two fiscal 

years. The Committee strongly encourages the U.S. Department of 

Health and Human Services [HHS] and the Substance Abuse and 

Mental Health Services Administration [SAMHSA] not to change 

requirements that would require States and Territories to reapply 

for the second year of State grant funding. By doing so, States 

could reduce administrative burdens and the Department could 

focus on promoting effective implementation of the already approved plans. The Department is directed to brief the Committee 

on any planned changes for fiscal year 2018 at least 30 days prior 

to any public announcement of such changes. Further, the Department is directed to brief the Committee quarterly on implementation of the program, including detailing obligation of such funding. 

Community Health Centers.—The Committee continues 

$50,000,000 from the prior year for grants to expand services for 

the treatment, prevention, and awareness of opioid abuse. This 

funding will help health centers support 220,000 patients with accessing substance abuse services. 

Opioid Prevention Grant.—The Committee includes a new 

$15,000,000 opioid prevention grant targeted to communities and 

community coalitions. The Committee directs SAMHSA to develop 

and distribute evidence-based practices to prevent opioid abuse. 

In total, the Department is expected to spend $910,210,000 in 

discretionary and mandatory funding for targeted efforts to combat 

opioid abuse in fiscal year 2018. In addition, States have access to 

the Substance Abuse Prevention and Treatment Block Grant, funded at $1,858,079,000 in fiscal year 2018. Finally, the National Institute on Drug Abuse [NIDA] continues its efforts to understand 

addiction, fund research on medications to alleviate pain, support 

efforts to better understand the long-term effects of prescription 

opioid use, and research alternative ways to treat pain. NIDA receives an increase of $1,113,442,000 in this act. 

PROMOTING COLLEGE AFFORDABILITY AND COMPLETION

The Committee recommendation includes a 1.7 percent increase 

in the maximum Pell grant, from a total maximum award of $5,920 

in the 2017–18 academic year, to $6,020 for the 2018–19 academic 

year. This represents the first discretionary increase in the maximum Pell grant award in over a decade. The maximum Pell grant 

has increased each year since the 2007–08 award year, and automatically each year since 2013–14 based on increases in the Consumer Price Index, paid for with mandatory funding. The automatic increase in the ‘‘mandatory add-on’’ expires this year and the 

Committee recommendation ensures the maximum Pell grant will 

continue to increase for the 2018–19 award year, helping students 

keep up with rising costs and reducing the need for student loans. 

In addition, the Committee recommendation includes more than 

sufficient funding to continue Year-Round Pell, a permanent law 

change included in the Consolidated Appropriations Act, 2017. The 
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2018–19 academic year will be the first full year of implementation 

of Year-Round Pell, which will allow students who have exhausted 

their traditional Pell grant award for a given academic year, to receive an additional Pell grant if they enroll in coursework for an 

additional term during the same academic year, traditionally the 

summer. This is expected to provide over 900,000 students an additional award of over $1,600 for the 2018–19 school year, which will 

help them complete their program faster, enter or re-enter the 

workforce sooner, and graduate with less debt. 

The Committee recommendation also includes new bill language 

restoring the eligibility period for Pell grants for those students defrauded by institutions of higher education and report language directing the Secretary to take additional actions to provide relief 

from fraudulently issued Federal loan debt, including by contacting 

potentially eligible borrowers. 

IMPROVING FISCAL ACCOUNTABILITY

The Committee has an obligation to promote fiscal accountability 

and the effective use of U.S. taxpayer funds. The annual appropriations process affords Congress the opportunity to continuously improve and refine how Government works. Appropriations bills provide oversight of every discretionary program, every year, which 

gives these bills the unique ability to react to changing needs and 

unintended consequences in the intervening years of an authorization bill. 

Taxpayer Transparency.—U.S. taxpayers have a right to know 

how the Federal Government is spending their hard-earned taxpayer dollars—especially when that money is being spent on advertising Federal programs. The Committee recommendation continues a provision to promote Government transparency and accountability by requiring Federal agencies funded in this act to include disclaimers when advertising materials are paid for with 

Federal funds. The Committee expects each agency to include in 

their fiscal year 2019 CJ information detailing how much funding 

was spent on advertising in fiscal year 2018. 

Federal Vehicle Fleet Management.—The General Services Administration [GSA] issues guidance on Federal fleet management, 

but the Federal vehicle fleet is decentralized, with each agency 

maintaining flexibility to manage vehicle utilization as appropriate. 

To provide greater transparency and accountability of funding for 

Federal vehicles, the Committee directs agencies funded in this bill 

to conduct an annual review of fleet utilization during the third 

quarter of each fiscal year. Agencies are directed to provide their 

Offices of Inspectors General [OIGs] with supporting documentation on the method used for determining optimal fleet inventories 

and justification for any deviation from GSA’s Federal Property 

Management Regulations. OIGs shall be responsible for conducting 

annual audits of fleet management practices and making the subsequent results publicly available. 

Public Health Services Act [PHS] Evaluation Transfer.—The 

Committee recommendation continues to ensure that in fiscal year 

2018, no funds will leave NIH via the transfer required by section 

241 of the PHS Act. 
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INCREASING THE EFFICIENCY AND COST EFFECTIVENESS OF

GOVERNMENT

The Committee provides funding for a variety of activities aimed 

at reducing fraud, waste, and abuse of taxpayer dollars. These program integrity initiatives have proven to be a wise Federal investment, resulting in billions of dollars of savings each year. In addition, the Committee recommendation provides direction to the Departments on opportunities to take action where Federal programs 

are fragmented or duplicative. The bill advocates that longstanding 

priority by reforming and transforming government in many small 

ways, and several initiatives to increase the efficiency and cost effectiveness of Government, including: 

Fighting Healthcare Fraud and Abuse.—The Committee includes 

$745,000,000 for the Health Care Fraud and Abuse Control program at CMS. The Committee notes that the latest data demonstrates for every new $1 spent on fraud and abuse, $2 is recovered by the U.S. Treasury. 

Inspectors General.—The Committee recommendation provides 

$350,477,000 for the Inspectors General funded in this act to conduct additional audits and investigations of possible waste and 

fraud in Government programs. The Committee appreciates the 

strong working relationships between the Inspectors General and 

the agencies they work with under this Committee’s jurisdiction. 

The Committee reiterates the strong expectation that Inspectors 

General have timely and independent access to all records, reports, 

audits, reviews, documents, papers, recommendations, data and 

data systems, or other materials related to their responsibilities 

under this act and under the Inspector General Act of 1978. Further, the Committee also expects that all agencies funded by this 

act treat electronic data, records, and systems no differently than 

paper-based records and files with respect to access by OIGs unless 

particular electronic systems are clearly and explicitly protected 

from Inspectors General access by statute. 

Preventing Improper Social Security Payments.—The Committee 

recommendation includes $1,735,000,000 for the Social Security 

Administration [SSA] to conduct continuing disability reviews and 

SSI program redeterminations of non-medical eligibility and for 

other program integrity efforts. Combined, these activities are estimated to save approximately $9,828,000,000 over 10 years in taxpayer dollars by reducing waste, fraud, abuse, and improper payments in the Social Security, Medicare, and Medicaid programs. 

Taxpayer Accountability.—In recent years, GAO has published 

reports showing as many as 249 areas of potential duplication and 

overlap. Since 2011, GAO has identified 724 actions to reduce, 

eliminate, or better manage fragmentation, overlap, or duplication; 

achieve costs savings; or enhance revenue. While GAO has noted 

that the Nation has achieved $136,000,000,000 in savings based on 

these reports, many more efficiencies may be realized. The Committee directs each agency funded in this bill to report to the Committee, within 1 year of enactment of this act, on all efforts made 

to address the duplication identified by the annual GAO reports 

along with identifying substantive challenges and legal barriers to 

implementing GAO’s recommendations, as well as suggested legis-
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lative recommendations that could help the agency to further reduce duplication. Given the current fiscal environment, it is imperative for Government agencies to increase efficiencies to maximize 

the effectiveness of agency programs. 

Tribal Coordination.—The Committee directs all Departments 

with American Indian and Alaskan Native specific programs or 

grants to coordinate with the Department of the Interior when possible to ensure there is no overlap or duplication of funding or services and to enhance the programs’ effectiveness. 

Unemployment Insurance Trust Fund Integrity.—The Committee 

provides $130,000,000 for Reemployment Services and Eligibility 

Assessments [RESEA] for fiscal year 2018. The RESEA program 

provides for intensive, in-person attention from specialists in the 

One-Stop career center system for individuals most likely to exhaust unemployment compensation benefits, those with particular 

barriers to reemployment, and others who have been difficult to 

place. RESEA has significantly reduced the time participating individuals must rely on unemployment compensation payments and 

reduced the total amount of benefits paid from the Unemployment 

Insurance Trust Fund. The program has also shown the benefit of 

reducing improper payments to ineligible claimants, thus helping 

protect the fiscal solvency of the trust fund. 

GUIDANCE DOCUMENTS

The Committee continues to note that executive branch agencies 

may, as authorized by the Administrative Procedures Act, issue a 

variety of types of interpretive guidance documents that are exempt from the public notice and comment process. However, some 

have raised concerns under the last Administration about the use 

of guidance documents because, while such documents are not legally binding, regulated entities may interpret them as imposing 

new legally binding requirements. Further, the GAO has found 

that executive branch agencies could improve procedures for approving, disseminating, and periodically reviewing guidance documents. For example, after a sub-agency in the Department of Labor 

reviewed its guidance to determine if it was relevant and current, 

the sub-agency was able to reduce its guidance by 85 percent. 

Consistent with GAO recommendations, the Committee believes 

Departments and agencies funded in this act need to make more 

progress in adhering to and implementing OMB’s 2007 ‘‘Final Bulletin for Agency Good Guidance Practices,’’ which establishes policies and procedures for the development, issuance, and use of significant guidance documents by executive branch departments and 

agencies. 

The Committee recommends that guidance documents include a 

statement explaining why the agency believes it is appropriate to 

issue guidance about a matter instead of proposing a regulation 

and the specific statutory provisions or regulation(s) the guidance 

is interpreting. The Committee further recommends all guidance 

documents be posted in one place on its Web site as well as on the 

relevant sub-agency Web page. This information should be easily 

accessible for the public to comment on guidance. Finally, when appropriate, guidance should be sent to the Office of Management 

and Budget for review if it is significant. 
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BILL-WIDE DIRECTIVES

Children Exposed to Trauma.—The Committee encourages the 

Departments and agencies funded in this bill to enhance coordination on activities that address child trauma, including data collection and awarding grants. The Committee encourages the Departments and agencies to examine practices already supported by Federal agencies and solicit public feedback in order to identify, recommend, and disseminate best practices for the identification, referral, and implementation of trauma-informed interventions in 

child and youth-serving settings. The Committee further encourages the Departments and agencies to promote programs that incorporate trauma-informed best practices, including twogenerational interventions, integration or co-location of mental 

health services, or training front-line service providers in understanding trauma and implementing appropriate responses. 

Further, the Committee is interested in the expansion of Performance Partnerships to identify strategies to improve the effectiveness of and increase opportunities for collaboration in Federal 

programs serving children exposed to trauma. The Committee requests that the GAO issue a report to explore the potential opportunities for such pilots in this area, including identifying significant Federal programs that are commonly used to provide services 

to children exposed to trauma; identifying overlapping but varying 

eligibility rules, allowable uses of funds, and other requirements, 

including reporting requirements, in such programs; and identifying barriers or challenges commonly faced by organizations receiving funding from multiple Federal programs to serve children 

exposed to trauma. 

Congressional Budget Justifications.—Congressional justifications are the primary tool used for the Committee to evaluate 

budget requests and resource requirements. The Committee expects the fiscal year 2019 congressional justifications to include sufficient detail to justify all programs, projects, and activities contained in each department, agency, board, corporation, or commission’s budget request. The justifications shall include a sufficient 

level of detailed data, exhibits, and explanatory statements to support the appropriations requests, including tables that outline each 

agency’s programs, projects, and activities for fiscal years 2018 and 

2019. Specifically, every bill and report number included in either 

the House of Representatives or Senate Appropriations bill or report or the final appropriations bill or explanatory statement of the 

fiscal year should be reflected within these justifications. 

The Committee directs the chief financial officer of each department, agency, board, corporation, or commission funded in this 

act’s jurisdiction to ensure that adequate justification is given to 

support each increase, decrease, and staffing change proposed in 

the fiscal year 2019 budget. When requesting additional resources, 

reduced funding, or eliminations of programs, changes should be 

outlined with an adequate justification. Should the final fiscal year 

2018 appropriations bill be enacted within a timeframe that does 

not allow it to be reflected within the congressional justifications 

for fiscal year 2019, the Committee directs each department, agency, board, corporation, or commission funded in this act to submit 
15 

within 30 days of enactment updated information to the Committee 

on funding comparisons to fiscal year 2018. 

Two Generation Approaches to Poverty Reduction.—The Committee is also interested in the expansion of Performance Partnerships to identify strategies to increase opportunities for collaboration in Federal programs to carry out two-generational approaches 

to poverty reduction. The Committee requests that GAO issue a report to explore the potential for pilots in this area, including identifying significant Federal programs that could be used for twogenerational approaches to poverty reduction; identifying potential 

opportunities for collaboration between such programs; identifying 

overlapping but varying eligibility rules, allowable uses of funds, 

and other requirements, including reporting requirements, in such 

programs; and identifying barriers or challenges commonly faced, 

or potentially faced, by organizations receiving funding from multiple Federal programs in implementing two-generation approaches 

to poverty reduction. 

OTHER HIGHLIGHTS OF THE BILL

Children’s Hospitals Graduate Medical Education [CHGME].— The Committee recommendation includes $305,000,000 for 

CHGME, an increase of $5,000,000 above fiscal year 2017. This 

funding supports freestanding children’s teaching hospitals to provide Graduate Medical Education for physicians. 

Community Health Centers [CHC].—The Committee recommendation includes $1,491,522,000 for CHC’s, level with fiscal 

year 2017. The Committee’s recommendation is projected to support 26 million patients and continues quality improvement activities for more than 1,400 health centers operating over 10,400 primary sites. 

Corporation for Public Broadcasting.—The bill continues advance 

funding in the amount of $445,000,000 for the Corporation for Public Broadcasting [CPB] and an additional $20,000,000 to continue 

the interconnection project. 

Corporation for National and Community Service.—The Committee recommendation includes $386,010,000 for AmeriCorps 

State and National Grants, $30,000,000 for NCCC, $92,364,000 for 

VISTA, and $202,117,000 for Senior Corps, all the same as the fiscal year 2017 funding levels. 

Domestic Violence and Sexual Assault Programs.—The bill includes $5,000,000 for a new initiative to support clinical training 

of sexual assault nurse examiners (including registered nurses, 

nurse practitioners, and nurse midwives) to administer medical forensic examinations and treatments to victims of sexual assault in 

hospitals, health centers, and other emergency healthcare settings. 

The bill also includes an additional $5,000,000, a 30 percent increase, in the tribal set-aside for Family Violence Prevention and 

Services programs, as well as an increase of $5,000,000 to CDC’s 

Rape Prevention and Education program. Finally, the bill provides 

an increase of $2,000,000 to the Victims of Trafficking program, 

which provides a variety of services to victims of commercial sex 

and forced labor trafficking. 

Institute for Museum and Library Services [IMLS].—The Committee recommendation includes $235,000,000 for IMLS, an in-
16 

crease of $4,000,000 above fiscal year 2017. This funding supports 

123,000 libraries and 35,000 museums, ensuring that all Americans have access to essential museum, library, and information 

services. 

Medicare Appeals Backlog.—The Committee continues to be concerned that the Office of Medicare Hearing and Appeals [OMHA] 

has a current case backlog of approximately 600,000 cases. The bill 

directs $10,000,000 in Recovery Audit Contractor [RAC] funds be 

available to OMHA and the Departmental Appeals Board to process RAC-related appeals. 

Rural Health and Telehealth.—The Committee continues to 

prioritize funding for telehealth and the impact it is having on access to care for medically underserved and rural populations. The 

Committee recommendation includes $160,560,000 for Rural 

Health programs, an increase of $4,500,000 above fiscal year 2017. 

Included in that amount is $21,000,000 for the Office for the Advancement of Telehealth [OAT], an increase of $2,500,000 above 

fiscal year 2017. 

Supporting Local Control in Elementary and Secondary Education.—The Committee continues to prioritize funding for elementary and secondary education programs that provide the most flexibility for states, school districts, schools, and parents to make education decisions impacting students and families. —$15,485,210,000, an increase of $25,408,000 for title I grants to 

LEAs 

—$450,000,000, an increase of $50,000,000 for title IV Student 

Support and Academic Enrichment Grants —$1,340,112,000, an increase of $11,509,000 for Impact Aid 

—$367,172,000, an increase of $25,000,000 for the Charter 

Schools Program 

Training Assistance to Appalachian Regional Commission [ARC] 

and Delta Regional Authority [DRA] regions.—The bill broadens 

and adapts an initiative within the Dislocated Worker National Reserve from the last two fiscal years. The initiative is intended to 

ensure reemployment and training assistance is provided to workers dislocated in rural areas of the country hit hardest by the recession and recovering more slowly. The bill devotes $30,000,000 to 

assist unemployed workers from any industry within the ARC and 

DRA regions to adapt existing skills and learn new ones demanded 

by growing industries. 

Veterans Employment and Training Service.—The Committee includes $284,041,000, an increase of $5,000,000. This amount includes funding to expand transition assistance for separating service members and to implement the Honoring Investments in Recruiting and Employing [HIRE] American Military Veterans Act of 

2017. 

WIOA State Grants.—The bill includes $2,709,832,000 for employment training grants distributed by formula to States under 

the Workforce Innovation and Opportunity Act. These grants, 

which provide tremendous flexibility to State and local governments to meet their own unique job training needs, form the bedrock of the Federal workforce development effort. 

The Committee recommendation maintains funding for several 

other important programs including: 
17 

—$86,125,000 for the Bureau of International Labor Affairs 

—$2,318,781,000 for Ryan White AIDS Programs 

—$660,000,000 Public Health Emergency Preparedness Cooperative Agreement —$562,571,000 for Mental Health Block Grant 

—$3,390,304,000 for the Low Income Home Energy Assistance 

Program [LIHEAP] —$2,856,000,000 for the Child Care and Development Block 

Grant 

—$9,253,095,000 for Head Start 

—$837,753,000 for Nutrition programs, including Meals on 

Wheels programs —$47,115,000 for the State Health Insurance Program 

—$254,555,000 Hospital Preparedness Program 

—$511,700,000 for Biomedical Advanced Research and Development Authority —$510,000,000 for Project BioShield 

—$12,002,848,000 for IDEA Grants to States (Part B, Section 

611) 

—$1,191,673,000 for 21st Century Community Learning Centers 

—$2,055,830,000 for Supporting Effective Instruction State 

Grants 

—$1,117,598,000 for Career and Technical Education State 

Grants 

—$733,130,000 for Supplemental Educational Opportunity 

Grants 

—$989,728,000 for Federal Work Study 

—$274,224,000 for National Labor Relations Board 
(18) 

TITLE I 

DEPARTMENT OF LABOR 

EMPLOYMENT AND TRAINING ADMINISTRATION

TRAINING AND EMPLOYMENT SERVICES

Appropriations, 2017 ............................................................................. $3,338,699,000 

Budget estimate, 2018 ........................................................................... 2,053,766,000 

Committee recommendation ................................................................. 3,335,199,000 

The Training and Employment Services account provides funding 

primarily for activities under the Workforce Innovation and Opportunity Act [WIOA], and is a decentralized, integrated system of 

skill training and related services designed to enhance the employment and earnings of economically disadvantaged and dislocated 

workers. Funds provided for many training programs for fiscal year 

2018 will support the program from July 1, 2018, through June 30, 

2019. A portion of this account’s funding, $1,772,000,000, is available on October 1, 2018, for the 2018 program year. 

Any references in this title of the report to the ‘‘Secretary’’ or the 

‘‘Department’’ shall be interpreted to mean the Secretary of Labor 

or the Department of Labor, respectively, unless otherwise noted. 

The Committee strongly encourages the Department to continue 

to work with other Federal agencies to align and streamline employment and training services. In cases where legislation would be 

required to achieve these goals, the President’s budget request 

should include recommendations and specific proposals for consolidation of programs. 

The Committee urges the Department to continue and expand its 

efforts in preparing workers for in-demand occupations through a 

coordinated Federal, State, and local strategy. This strategy should 

include close engagement with employers by all levels of the workforce development system to ensure that provided training services 

align with the demands of those who would hire program participants. 

The Committee encourages the Employment and Training Administration [ETA] to expand its collaborative work with the Institute for Museum and Library Services to assist in the implementation of WIOA to assist States and local boards in integrating the 

education, employment, and training services provided by public libraries into the workforce investment system. The Committee also 

encourages ETA to continue to invest in building and strengthening partnerships between the one-stop system and public libraries by encouraging applicants for competitive grant opportunities to 

collaborate with public libraries. 

The Committee continues to believe that the Pay for Performance 

authority under WIOA is a promising, innovative approach to using 

data, evidence, and evaluation to improve workforce development 
19 

outcomes for the most vulnerable citizens. The Committee encourages the Department to continue to provide technical assistance to 

States and localities to help them utilize Pay for Performance strategies. 

The Committee has been made aware of concerns about shortages nationwide of well-trained drinking water and wastewater 

management professionals. Safe and effective water utility management is in the national interest. The Committee strongly urges the 

Department to evaluate these concerns and to consider innovative 

ways to address the shortage of trained water system management 

professionals through the WIOA system. 

Grants to States 

The Committee recommends $2,709,832,000 for Training and 

Employment Services Grants to States. 

Under WIOA, a local board is given up to 100 percent transfer 

authority between Adult and Dislocated Worker activities upon approval of the Governor. 

The Committee recommendation is consistent with the WIOA authorization regarding the amount of WIOA State grant funding 

that may be reserved by Governors. 

Adult Employment and Training.—For adult employment and training activities, the Committee recommends $815,556,000. 

Formula funding is provided to States and further distributed to 

local workforce investment areas through one-stop centers. The 

program provides employment and training services to disadvantaged, low-skilled, unemployed, and underemployed adults, including veterans. 

Funds are made available in this bill for adult employment and 

training activities in program year 2018, which occurs from July 1, 

2018, through June 30, 2019. The bill provides that $103,556,000 

is available for obligation on July 1, 2018, and that $712,000,000 

is available on October 1, 2018. Both categories of funding are 

available for obligation through June 30, 2019. 

Youth Training.—For youth training activities, the Committee 

recommends $873,416,000. 

The purpose of this program is to provide low-income youth facing barriers to employment with services that prepare them to succeed in the knowledge-based economy. Funds are made available 

for youth training activities in program year 2018, which occurs 

from April 1, 2018, through June 30, 2019. 

The Department is directed to carry out an evaluation of the use 

of Youth Activities funds under WIOA to support youth in areas 

with high crime rates. This evaluation should include a description 

of the activities carried out by local workforce development boards 

in high crime areas and the number of youth being served in these 

areas. In addition, it should identify successful models for youth 

workforce development in high crime areas. The Department is encouraged to continue pilot or demonstration programs that have 

been demonstrated to be effective. 

Dislocated Worker Assistance.—For dislocated worker assistance, 

the Committee recommends $1,020,860,000. 

This program is a State-operated effort that provides training 

services and support to help permanently separated workers return 
20 

to productive unsubsidized employment. In addition, States must 

use State-wide reserve funds for rapid response assistance to help 

workers affected by mass layoffs and plant closures. States must 

also use these funds to carry out additional State-wide employment 

and training activities such as providing technical assistance to 

certain low-performing local areas, evaluating State programs, and 

assisting with the operation of one-stop delivery systems. States 

may also use funds for implementing innovative training programs. 

Funds made available in this bill support activities in program 

year 2018, which occurs from July 1, 2018, through June 30, 2019. 

The bill provides that $160,860,000 is available for obligation on 

July 1, 2018, and that $860,000,000 is available on October 1, 

2018. Both categories of funding are available for obligation 

through June 30, 2019. 

Federally Administered Programs 

Dislocated Worker Assistance National Reserve.—The Committee 

recommends $220,859,000 for the Dislocated Worker Assistance 

National Reserve, which is available to the Secretary for activities 

such as responding to mass layoffs, plant and/or military base closings, and natural disasters that cannot be otherwise anticipated, as 

well as for technical assistance, training, and demonstration 

projects. 

Funds made available for the National Reserve in this bill support activities in program year 2018. The bill provides that 

$20,859,000 is available for obligation on July 1, 2018, and that 

$200,000,000 is available on October 1, 2018. Both categories of 

funding are available for obligation through September 30, 2019. The Committee bill makes $30,000,000 available for obligation on 

October 1, 2017, through September 30, 2019, to provide enhanced 

dislocated worker training to promote economic recovery in the Appalachian and Delta regions. The bill rescinds $30,000,000 from fiscal year 2018 Dislocated Worker National Reserve advances appropriated in the fiscal year 2017 act and reappropriates it for this 

purpose. 

The initiative will include projects for dislocated workers within 

the Delta Regional Authority [DRA] and Appalachian Regional 

Commission [ARC] areas. These regions have been particularly 

hard hit by industrial downsizing and closures, and funding is provided to target these underserved areas. The Department is strongly urged to engage proactively with Workforce Development Boards 

and other appropriate entities at the State and local levels, including those typically involved in applying for and administering National Dislocated Worker Grants to ensure that they are aware of 

the availability of the targeted funds so they will be sought and 

utilized promptly and effectively to assist workers in areas hardest 

hit by job loss. The Department, DRA, and ARC are directed to 

jointly brief the Committee not later than 90 days after enactment 

of this Act on an operating plan, community engagement, and 

progress made on this program and shall update the Committee 

quarterly thereafter until all funds are expended. 

The Committee recognizes Federal infrastructure investment and 

reorganization, such as the relocation of an agency headquarters, 

can lead to major construction projects in local areas. Such projects 
21 

result in positive regional employment opportunities as well as 

challenges to prepare new workers and dislocated workers to fill 

these jobs. This surge in need for job training does not arise from 

a negative incident like a natural disaster or a major industrial 

layoff, but it results in similar workforce preparation needs. In 

light of these ongoing Federal infrastructure investments, the Secretary is urged to find innovative ways to enhance workforce training capabilities in areas that have the opportunity to train and retrain local workforces to meet the construction needs related to 

new Federal investments. 

Indian and Native American Programs.—The Committee recommends $50,000,000 for Indian and Native American Programs. 

These programs are designed to improve the academic, occupational, and literacy skills of Native Americans, Alaskan Natives, 

and Native Hawaiians to aid the participants in securing permanent, unsubsidized employment. Allowable training services include 

adult basic education, GED attainment, literacy training, English 

language training, as well as the establishment of linkages with remedial education. 

The Committee directs the Department to obligate funding at the 

authorized levels for activities pursuant to section 166(k) of subtitle 

D of title I of the WIOA. 

Migrant and Seasonal Farmworker Programs.—The Committee 

recommends $81,896,000 for migrant and seasonal farmworkers 

programs, which serve members of economically disadvantaged 

families whose principal livelihood is derived from migratory and 

other forms of seasonal farm work, fishing, or logging activities. 

Enrollees and their families are provided with employment, training, and related services intended to prepare them for stable, yearround employment within and outside of the agriculture industry. The Committee recommendation provides that $75,885,000 be 

used for State service area grants. The Committee recommendation 

also includes bill language directing that $5,517,000 be used for migrant and seasonal farmworker housing grants, of which not less 

than 70 percent shall be for permanent housing. The principal purpose of these funds is to continue the network of local farmworker 

housing organizations working on permanent housing solutions for 

migrant and seasonal farmworkers. The Committee recommendation also includes $494,000 to be used for section 167 training, 

technical assistance, and related activities, including funds for migrant rest center activities. 

The Committee is concerned by continued labor shortages in the 

agricultural sector. The Committee directs the Department to ensure that agricultural worker training programs funded under section 167 of WIOA prioritize the development of additional and enhanced skills specifically relevant to continued agricultural work. 

YouthBuild.—The Committee strongly supports the YouthBuild 

program and recommends $84,534,000 to support its work to target 

at-risk high school dropouts and prepare them with the skills and 

knowledge they need to succeed in a knowledge-based economy. 

YouthBuild helps low-income young people learn valuable, marketable job skills by combining educational resources, a supportive environment, and real construction experience with the successful 

completion of more than 30,000 units of affordable housing for low- 
22 

income communities since 1994. There are currently over 220 

YouthBuild programs across the country serving more than 6,000 

youth per year. 

National Activities 

Reintegration of Ex-Offenders.—The Committee recommends 

$88,078,000 for the Reintegration of Ex-Offenders program. The 

Reintegration of Ex-Offenders program helps prepare and assist 

adult ex-offenders return to their communities through pre-release 

services, mentoring, and case management. The program also provides support, opportunities, education, and training to youth who 

are involved in court and on probation, in aftercare, on parole, or 

who would benefit from alternatives to incarceration or diversion 

from formal judicial proceedings. Programs are carried out directly 

through State and local governmental entities and community 

based organizations, as well as indirectly through intermediary organizations. States are encouraged to continue to support reintegration efforts for ex-offenders with resources available through 

the comprehensive workforce development investment system. The 

Committee directs the Department to use funding to support efforts 

in high-crime, high-poverty areas and, in particular, communities 

that are seeking to address relevant impacts and root causes of 

civil unrest and high levels of community violence. The Committee 

directs the Department to require grantees to offer training and industry-recognized credentials that meet the needs of local, high-demand industries and to establish formal partnerships and jobplacement services with industry employers. 

Evaluation.—The bill continues to use a set-aside funding mechanism to support the evaluation of employment and training programs. Instead of directly providing funds for evaluation, the Committee recommendation supports evaluation activities through a 

0.75 percent set-aside on all training and employment programs, 

including the WIOA formula programs, Job Corps, Community 

Service Employment for Older Americans, the Employment Service, 

and others. The set-aside approach ensures that sufficient funding 

is available to carry out comprehensive evaluation and applied research activities. 

ETA will continue to conduct evaluation and applied research activities in consultation with the Department’s chief evaluation officer, who oversees the evaluation program. Results will inform policy, advance the Department’s mission, and improve its performance-based management initiatives. 

Workforce Data Quality Initiative.—The Committee recommends 

$5,000,000 for the Workforce Data Quality Initiative. Funds are 

used to assist States with incorporating comprehensive workforce 

information into longitudinal data systems being developed in part 

with the support of funding provided by the Department of Education. The initiative is also intended to help improve the quality 

and accessibility of performance data being produced by training 

providers. 

Apprenticeship Grants.—The recommendation includes 

$95,000,000 for continued support for the apprenticeship program 

that the Committee created in fiscal year 2016. This funding shall 

be for making competitive contracts and to continue funding grants 
23 

to States and industry partnerships. The Department is directed to 

ensure approval of apprenticeship opportunities that engage, recruit, and serve women and other under-represented populations 

and local communities that have high rates of unemployment and 

high levels of community violence. The Committee also directs the 

Department to collaborate with the Delta Regional Authority to develop a targeted apprenticeship and job training program to meet 

the unique needs of underserved rural communities in this region. 

The Committee recognizes the role that sector partnerships play in 

organizing key stakeholders in an industry cluster to address the 

shared goals and human resources needs of the industry cluster. 

The Committee supports the funding and development of industry 

or sector partnerships as a means of closing the skills gap and expanding apprenticeships in in-demand industries. The Department 

is encouraged to develop a nationally-recognized apprenticeship 

standard to enhance the skills and workforce opportunities for 

water utility related jobs. The Committee also notes the Department’s proposal to use $100,000,000 in high-tech job training funds 

available under the authority of the American Competitiveness and 

Workforce Improvement Act to further expand the program. The 

Committee encourages the Secretary to ensure approval of apprenticeship opportunities that are already effective and substantially 

widespread, including, but not limited to, programs certified by the 

National Center for Construction Education and Research 

[NCCER] as Industry-Recognized Apprenticeships. 

JOB CORPS

Appropriations, 2017 ............................................................................. $1,704,155,000 

Budget estimate, 2018 ........................................................................... 1,448,444,000 

Committee recommendation ................................................................. 1,699,155,000 

The recommendation for operations of Job Corps centers is $1,699,155,000, a decrease of $5,000,000 from fiscal year 2017. 

The Committee remains deeply concerned about the issue of student safety on Job Corps campuses across the country as well as 

findings by the Department’s Office of Inspector General [OIG] regarding the enforcement of Job Corps’ disciplinary policies, potentially exposing students to unsafe environments. The Committee 

recognizes the Department has taken important steps toward addressing these issues and strongly urges the Department to take 

fully corrective actions to ensure the safety of students and staff. 

The Committee recommendation for administrative costs is 

$32,330,000. 

The Committee also recommends a total of $79,500,000 in construction, renovation, and acquisition [CRA] funds, a decrease of 

$5,000,000 from fiscal year 2017. This amount is available from 

July 1, 2018, to June 30, 2020. The Committee continues bill language allowing the Secretary to transfer up to 15 percent of CRA 

funds, if necessary, to meet the operational needs of Job Corps centers or to achieve administrative efficiencies. The bill continues to 

require the Secretary to notify the House and Senate Committees 

on Appropriations at least 15 days in advance of any transfer. The 

Committee expects any notification to include a justification. 

While most Job Corps centers meet or exceed program standards, 

there are some centers that are chronically low-performing and 
24 

have remained so despite significant and long-term Departmental 

intervention. The Committee expects the Department to use WIOA 

performance measures as the key component for developing its 

methodology for identifying centers for closure and to adhere to the 

process for closing a Job Corps center as described in section 159 

of WIOA, which includes advance announcement to the general 

public of the proposed closure; 30 day comment period for interested parties to submit written comments to the Secretary; and notification to the Members of Congress who represent the district or 

State in which such center is located. Further, the Committee 

strongly encourages the Department to provide Job Corps students 

enrolled in a closing low-performing center the opportunity to 

transfer to another higher-performing Job Corps center. Finally, 

the Committee requests a detailed description of the Department’s 

plan for identifying centers for closure, including a definition of a 

‘‘low-performing center,’’ the methodology used for identifying those 

centers, and a timeline for the closure process. The Committee expects to receive this information no later than 180 days after the 

enactment of this act or at least 30 days prior to any public notice 

published in the Federal Register. 

The Job Corps program provides disconnected youth with the 

education and job training necessary to successfully enter the 

workforce and earn a living wage. The Committee urges the Office 

of Job Corps to increase recruitment efforts, particularly in areas 

experiencing increased levels of community violence. 

Technological limitations can hinder students’ preparation for the 

high-tech 21st century college and work environment. Therefore, 

the Committee encourages the Department to utilize available 

funds for upgrading the telecommunications infrastructure of Job 

Corps centers to provide students access to online learning and job 

search tools in appropriate campus buildings. 

The Committee urges the Secretary to ensure that Job Corps 

center operators are providing effective professional development 

for their staff. Without consistent and on-going training, the quality of services, as well as the safety and security of the students 

and staff, can be compromised. The Secretary is encouraged to ensure that adequate contract funds, as direct contract allowable 

costs, are available for center instructor training and related travel 

costs to maintain a high level of staff qualifications and student 

work-based learning opportunities. The Department is requested to 

report within 120 days of the enactment of this Act, on how professional development is provided to center staff by the Office of Job 

Corps and center operators, especially in the areas of safety, security, education, and training. Further, the Department is requested 

to report to Congress on the competitiveness of Job Corps teacher 

and instructor salaries, as well as staff retention and vacancy 

rates. 

Funds should not be used to award a new contract for operation 

of a Job Corps center, unless ETA ensures that each of the factors 

listed in section 147(a)(3) of WIOA are applied to the procurement 

process to award a new contract to operate a Job Corps center as 

well as to any decision to restrict competition. 

Gulfport Job Corps Center.—The Committee continues to be encouraged by the progress made toward rebuilding the Gulfport Job 
25 

Corps Center, including the Memorandum of Agreement signed by 

the Department and the City of Gulfport. The Committee expects 

the Department to complete the Section 106 process, complete the 

design of the new Center, and open request for contracts as quickly 

as possible. Despite transition to a new Administration, the Committee expects the Department to remain diligently committed to 

ensuring that the Center is rebuilt and able to return to serving 

the number of young people that it once served while, in the meantime, reserving sufficient funds for the restoration of the facility 

consistent with the expectations of the Committee. Given that Congress provided emergency appropriations for this purpose shortly 

after the damage caused by Hurricane Katrina, the Committee continues to direct the Department to prioritize the Gulfport Job Corps 

Center among pending construction cases in the CRA. The Committee requests to be updated every 30 days regarding progress on 

this project. 

COMMUNITY SERVICE EMPLOYMENT FOR OLDER AMERICANS

Appropriations, 2017 ............................................................................. $400,000,000 

Budget estimate, 2018 ........................................................................... ........................... 

Committee recommendation ................................................................. 400,000,000 

Community Service Employment for Older Americans [CSEOA] 

provides part-time employment in community service activities for 

unemployed, low-income persons aged 55 and older. The Committee 

recommendation includes $400,000,000 for CSEOA. 

FEDERAL UNEMPLOYMENT BENEFITS AND ALLOWANCES

Appropriations, 2017 ............................................................................. $849,000,000 

Budget estimate, 2018 ........................................................................... 790,000,000 

Committee recommendation ................................................................. 790,000,000 

The Committee recommendation includes mandatory funds for 

the Federal unemployment benefits and allowances program that 

assists trade-impacted workers with benefits and services to upgrade skills and retrain in new careers. These benefits and services 

are designed to help participants find a path back into middle-class 

jobs, improve earnings, and increase credential and education 

rates. The Committee recommendation provides for the full operation of the Trade Adjustment Act program in fiscal year 2018 consistent with current law. 

The Trade Adjustment Assistance [TAA] program provides assistance to workers who have been adversely affected by international trade. TAA provides benefits and services to those who 

qualify, to include: job training, job search and relocation allowances, and wage supplements for workers age 50 and older. 

STATE UNEMPLOYMENT INSURANCE AND EMPLOYMENT SERVICE

OPERATIONS

Appropriations, 2017 ............................................................................. $3,523,691,000 

Budget estimate, 2018 ........................................................................... 3,213,159,000 

Committee recommendation ................................................................. 3,462,691,000 

The Committee recommendation includes $3,378,625,000 authorized to be drawn from the Employment Security Administration ac-
26 

count of the Unemployment Trust Fund and $84,066,000 to be provided from the general fund of the Treasury. 

The funds in this account are used to provide administrative 

grants and assistance to State agencies that administer Federal 

and State unemployment compensation laws and operate the public 

employment service. The account is workload based, and due to the 

improving economy, fewer unemployment applications are being 

processed. Therefore less funding is required for this purpose as reflected in the bill. 

The Committee recommends a total of $2,651,497,000 for UI activities. For UI State operations, the Committee recommends 

$2,637,600,000. Of these funds, the Committee includes 

$130,000,000, an increase of $15,000,000, to expand intensive, individualized reemployment assistance and to help address and prevent long-term unemployment and reduce improper payments 

through the Reemployment Services and Eligibility Assessments 

[RESEA] initiative. 

As State consortia continue work to modernize their UI information technology systems with newly-appropriated fiscal year 2017 

funds, the Committee expects the Department to closely support 

and oversee the consortia’s efforts and to keep the Committee on 

Appropriations informed on how new funds are utilized and 

progress on system development. The Committee recommendation includes $6,000,000 for the UI 

Integrity Center of Excellence, including supporting an integrated 

data hub, training modules, and data analytics capacity to help 

States reduce fraud. 

The Committee recommendation provides for a contingency reserve amount should the unemployment workload exceed an average weekly insured claims volume of 2,246,000. The Committee recommends $13,897,000 for UI national activities, which will support activities that benefit the entire FederalState UI system, including supporting the continuation of IT upgrades and technical assistance. 

For the Employment Service allotments to States, the Committee 

recommends $666,413,000. This amount includes $21,413,000 in 

general funds together with an authorization to spend 

$645,000,000 from the Employment Security Administration account of the Unemployment Trust Fund. 

The Committee also recommends $19,818,000 for Employment 

Service national activities. The administration of the work opportunity tax credit program accounts for $18,485,000 of the recommended amount; the remainder is for technical assistance and 

training to States. 

For carrying out the Department’s responsibilities related to foreign labor certification activities, the Committee recommends 

$48,028,000. In addition, 5 percent of the revenue from H–1B fees 

is available to the Department for costs associated with processing 

H–1B alien labor certification applications, and $14,282,000, the 

same as the fiscal year 2017 enacted level, is available for related 

State grants. 

The Committee remains concerned about efficient, effective management of the H–2B and H–2A programs. Unacceptable processing delays in the past two years have degraded the effectiveness 
27 

of the programs for those who depend on them for meeting shortterm, seasonal surges in demand. Authority was included in fiscal 

year 2017 to utilize H–1B fee receipts through fiscal year 2018 to 

augment processing capacity. This short-term authority was intended to prevent excessive labor certification and wage determination delays while the Department develops improved administrative procedures for the longer term. The Committee expects the Department to provide timely updates about the use of the fee authority and Department’s longer-term plans to improve the efficiency of 

these programs. 

In the determination of prevailing wage for the purposes of the 

H–2B program, the Secretary shall accept private wage surveys 

even in instances where Occupational Employment Statistics [OES] 

survey data are available unless the Secretary determines that the 

methodology and data in the provided survey are not statistically 

supported. The bill continues general provisions related to enforcement of H–2B regulations. 

Additionally, the Committee has been informed of instances in 

which certain job duties related to seafood processing have been 

categorized by the Department into OES wage rate categories that 

may not accurately reflect the work being performed by workers 

normally placed in that category, resulting in inaccurate prevailing 

wage determinations for many seafood workers. Therefore, the 

Committee strongly urges the Department to establish an OES 

wage rate category for seafood processing. 

For one-stop career centers and labor market information, the 

Committee recommends $62,653,000. The Committee includes 

$2,500,000 to finalize the work of the collaborative effort with 

States to reduce unnecessary occupational licensing barriers. The 

Committee included $15,000,000 over the past two fiscal years to 

establish occupational licensing grants for State consortia to identify, explore, and address areas where licensing requirements create an unnecessary barrier to labor market entry or labor mobility 

across State lines. The Committee appreciates the Secretary’s support of pursing cooperative approaches to enhance reciprocity or 

portability of occupational licenses across State lines. Such agreements would significantly ease barriers to opportunity and reemployment for thousands of Americans, especially for military 

spouses, dislocated workers, and transitioning service members. 

The Committee directs the Department to report, within 60 days 

of enactment of this Act, on progress and outcomes of the occupational licensing portability initiative funded in fiscal year 2016 and 

fiscal year 2017. 

These funds also support system capacity building efforts which 

allow the American Job Center network to respond to the needs of 

the job seekers and businesses in the current economy, including 

the Disability Employment Initiative. When reviewing investment 

alternatives for the Disability Employment Initiative in fiscal year 

2018, the Committee directs that the Department strongly consider 

needs in rural, underserved States especially in cases where meaningful applicant partnerships exist with institutions of higher 

learning and the workforce investment system. 
28 

ADVANCES TO THE UNEMPLOYMENT TRUST FUND AND OTHER FUNDS

The Committee bill continues language providing such sums as 

necessary in mandatory funds for this account. The appropriation 

is available to provide advances to several accounts for purposes 

authorized under various Federal and State unemployment compensation laws and the Black Lung Disability Trust Fund, whenever balances in such accounts prove insufficient. 

PROGRAM ADMINISTRATION

Appropriations, 2017 ............................................................................. $158,656,000 

Budget estimate, 2018 ........................................................................... 154,265,000 

Committee recommendation ................................................................. 158,656,000 

The Committee recommendation of $158,656,000 for program ad- ministration includes $108,674,000 in general funds and 

$49,982,000 from the Employment Security Administration account 

of the Unemployment Trust Fund. 

General funds in this account pay for the Federal staff needed 

to administer employment and training programs under WIOA, 

OAA, the Trade Act of 1974, and the National Apprenticeship Act. 

Trust funds provide for the Federal administration of employment 

security, training and employment, and executive direction functions. 

EMPLOYEE BENEFITS SECURITY ADMINISTRATION

SALARIES AND EXPENSES

Appropriations, 2017 ............................................................................. $181,000,000 

Budget estimate, 2018 ........................................................................... 183,926,000 

Committee recommendation ................................................................. 181,000,000 

The Committee recommends $181,000,000 for the Employee Benefits Security Administration [EBSA]. EBSA is responsible for the 

enforcement of title I of ERISA in both civil and criminal areas and 

for enforcement of sections 8477 and 8478 of the Federal Employees’ Retirement Security Act of 1986. EBSA administers an integrated program of regulation, compliance assistance and education, 

civil and criminal enforcement, and research and analysis. New authority is provided, as requested, making $3,000,000 available 

through September 30, 2019. These funds may be used to facilitate 

procurement of expert outside witnesses for enforcement litigation. 

The authority will be useful in situations where services may be 

needed for cases extending beyond the end of the fiscal year. 

PENSION BENEFIT GUARANTY CORPORATION

The Pension Benefit Guaranty Corporation’s [PBGC’s] estimated 

obligations for fiscal year 2018 include single-employer benefit payments of $6,770,000,000, multi-employer financial assistance of 

$169,000,000, and consolidated administrative expenses of 

$522,917,000. Administrative expenses are comprised of three activities: pension insurance activities, pension plan termination expenses, and operational support. These expenditures are financed 

by permanent authority. Previously, the Committee accepted the 

PBGC’s proposal to reform the previous administrative apportionment classifications from three budget activities to one budget ac-
29 

tivity to make operations more efficient and improve stewardship 

of resources. That consolidated approach for the three activities is 

continued, but PBGC is directed to continue providing detail every 

year on the three activities in its annual congressional budget justification. 

Funding requested by PBGC in fiscal year 2017 to consolidate 

three separate headquarters facilities into one combined location 

was provided in full. Therefore requested funds are not included for 

that purpose in fiscal year 2018. 

The PBGC is a wholly owned Government corporation established by ERISA. The law places it within DOL and makes the Secretary the chair of its board of directors. The Corporation receives 

its income primarily from insurance premiums collected from covered pension plans, assets of terminated pension plans, collection 

of employer liabilities imposed by the act, and investment earnings. 

The primary purpose of the PBGC is to guarantee the payment of 

pension plan benefits to participants if covered defined benefit 

plans fail or go out of existence. 

The bill continues authority for a contingency fund for the PBGC 

that provides additional administrative resources when the number 

of participants in terminated plans exceeds 100,000. When the trigger is reached, an additional $9,200,000 becomes available through 

September 30, 2019, for every 20,000 additional participants in terminated plans. The Committee bill also continues authority allowing the PBGC additional obligation authority for unforeseen and 

extraordinary pre-termination expenses, after approval by OMB 

and notification of the Committees on Appropriations of the House 

of Representatives and the Senate. 

The Committee recognizes PBGC’s ‘‘Smaller Asset Managers 

Pilot Program’’ to ensure that smaller and more diverse investment 

management entities more effectively compete for investment allocations. The project, announced in 2015 and now underway, provided access to smaller allocations ranging from $50,000,000 to 

$250,000,000, creating new opportunities for smaller asset managers to participate. Similarly, several States have established programs to encourage greater participation by smaller and diverse 

asset management entities, and studies have found that women 

and minority-owned firms have achieved at least comparable performance, both in terms of absolute returns and risk-adjusted returns, as the rest of the market. The Committee directs the PBGC 

to provide by December 31, 2017, an interim update on the performance of the pilot program, as well as a written account of additional steps that can be explored to expand opportunities for smaller and diverse asset management entities. 

WAGE AND HOUR DIVISION

SALARIES AND EXPENSES

Appropriations, 2017 ............................................................................. $227,500,000 

Budget estimate, 2018 ........................................................................... 230,068,000 

Committee recommendation ................................................................. 227,500,000 

The Committee recommends $227,500,000 for the Wage and 

Hour Division [WHD]. 
30 

WHD is responsible for administering and enforcing laws that 

provide minimum standards for wages and working conditions in 

the United States. The Fair Labor Standards Act [FLSA], employment rights under the Family and Medical Leave Act [FMLA], and 

the Migrant and Seasonal Agricultural Worker Protection Act are 

several of the important laws that WHD is charged with administering and/or enforcing. 

OFFICE OF LABOR-MANAGEMENT STANDARDS

SALARIES AND EXPENSES

Appropriations, 2017 ............................................................................. $38,187,000 

Budget estimate, 2018 ........................................................................... 46,634,000 

Committee recommendation ................................................................. 40,187,000 

The Committee recommends $40,187,000 for the Office of LaborManagement Standards [OLMS]. 

OLMS administers the Labor-Management Reporting and Disclosure Act of 1959 [LMRDA] and related laws. These laws establish 

safeguards for union democracy and financial integrity. They also 

require public disclosure by unions, union officers, employers, and 

others. In addition, the Office administers employee protections 

under federally sponsored transportation programs. 

OFFICE OF FEDERAL CONTRACT COMPLIANCE PROGRAMS

SALARIES AND EXPENSES

Appropriations, 2017 ............................................................................. $104,476,000 

Budget estimate, 2018 ........................................................................... 88,000,000 

Committee recommendation ................................................................. 103,476,000 

The Committee recommends $103,476,000 for the Office of Federal Contract Compliance Programs [OFCCP]. 

This Office protects workers and potential employees of Federal 

contractors from employment discrimination prohibited under Executive Order 11246, section 503 of the Rehabilitation Act of 1973, 

and the Vietnam Era Veterans’ Readjustment Assistance Act of 

1974. 

The Committee rejects the budget’s proposal to begin plans to 

merge the OFCCP with the Equal Employment Opportunity Commission. The Committee strongly urges OFCCP to find efficiencies 

and cost savings, including the consolidation of offices, within its 

current budget structure. This should include a review of the current OFCCP office locations and infrastructure across the country 

and whether these offices align with current workload needs. 

OFCCP is directed to report to the Committee with an inventory 

of current infrastructure and a plan to consolidate and right-size 

the agency 180 days after enactment of this Act. 

OFFICE OF WORKERS’ COMPENSATION PROGRAMS

SALARIES AND EXPENSES

Appropriations, 2017 ............................................................................. $117,601,000 

Budget estimate, 2018 ........................................................................... 115,282,000 

Committee recommendation ................................................................. 117,601,000 
31 

The Committee recommends $117,601,000 for the Office of Workers’ Compensation [OWCP]. The bill provides authority to expend 

$2,177,000 from the special fund established by the Longshore and 

Harbor Workers’ Compensation Act. 

OWCP administers four distinct compensation programs: the 

Federal Employees’ Compensation Act [FECA], the Longshore and 

Harbor Workers’ Compensation Act, the Black Lung Benefits programs, and the Energy Employees Occupational Illness Compensation Program. In addition, OWCP houses the Division of Information Technology Management and Services. 

SPECIAL BENEFITS

Appropriations, 2017 ............................................................................. $220,000,000 

Budget estimate, 2018 ........................................................................... 220,000,000 

Committee recommendation ................................................................. 220,000,000 

The Committee recommends $220,000,000 for this account. This 

mandatory appropriation, which is administered by OWCP, primarily provides benefits under FECA. 

The Committee recommends continuation of appropriations language to provide authority to require disclosure of Social Security 

numbers by individuals filing claims under FECA or the Longshore 

and Harbor Workers’ Compensation Act and its extensions. 

The Committee continues appropriations language that provides 

authority to use FECA funds to reimburse a new employer for a 

portion of the salary of a newly reemployed injured Federal worker. 

FECA funds will be used to reimburse new employers during the 

first 3 years of employment, not to exceed 75 percent of salary in 

the worker’s first year, and declining thereafter. 

The Committee continues language that allows carryover of unobligated balances to be used in the following year and that provides authority to draw such sums as are needed after August 15 

to pay current beneficiaries. Such funds are charged to the subsequent year appropriation. 

The Committee recommends continuation of appropriations language to provide authority to deposit into the special benefits account of the employees’ compensation fund those funds that the 

Postal Service, the Tennessee Valley Authority, and other entities 

are required to pay to cover their fair share of the costs of administering the claims filed by their employees under FECA. 

Finally, the Committee maintains language consistent with longstanding interpretations and implementation of this appropriation 

stating that, along with the other compensation statutes already 

specifically enumerated, the appropriation is used to pay obligations that arise under the War Hazards Compensation Act, and the 

appropriation is deposited in the Employees’ Compensation Fund 

and assumes its attributes, namely availability without time limit 

as provided by 5 U.S.C. section 8147. 

SPECIAL BENEFITS FOR DISABLED COAL MINERS

Appropriations, 2017 ............................................................................. $61,319,000 

Budget estimate, 2018 ........................................................................... 54,319,000 

Committee recommendation ................................................................. 54,319,000 

The Committee recommends a mandatory appropriation of 

$54,319,000 in fiscal year 2018 for special benefits for disabled coal 
32 

miners. This is in addition to the $16,000,000 appropriated last 

year as an advance for the first quarter of fiscal year 2018, for a 

total program level of $70,319,000 in fiscal year 2018. The decrease 

in this account below the fiscal year 2017 level reflects a declining 

beneficiary population. 

These mandatory funds are used to provide monthly benefits to 

coal miners disabled by black lung disease and their widows and 

certain other dependents, as well as to pay related administrative 

costs. 

The Committee also recommends an advance appropriation of 

$15,000,000 for the first quarter of fiscal year 2019. These funds 

will ensure uninterrupted benefit payments to coal miners, their 

widows, and dependents. 

DIVISION OF ENERGY EMPLOYEES OCCUPATIONAL ILLNESS

COMPENSATION

SALARIES AND EXPENSES

Appropriations, 2017 ............................................................................. $59,846,000 

Budget estimate, 2018 ........................................................................... 59,846,000 

Committee recommendation ................................................................. 59,846,000 

The Committee recommends $59,846,000 for the Division of Energy Employees Occupational Illness Compensation. This is a mandatory appropriation. 

The Division administers the Energy Employees Occupational Illness Compensation Program Act [EEOICPA], which provides benefits to eligible employees and former employees of the Department 

of Energy [DOE], its contractors and subcontractors, or to certain 

survivors of such individuals. The mission also includes delivering 

benefits to certain beneficiaries of the Radiation Exposure Compensation Act. The Division is part of OWCP. 

In fiscal year 2018, the volume of incoming claims under part B 

of EEOICPA is estimated at about 4,977 from DOE employees or 

survivors and private companies under contract with DOE, who 

suffer from a radiation-related cancer, beryllium-related disease, or 

chronic silicosis as a result of their work in producing or testing 

nuclear weapons. 

Under part E, approximately 4,754 new claims will be received 

during fiscal year 2018. Under this authority, the Department provides benefits to eligible DOE contractor employees who were found 

to have work-related occupational illnesses due to exposure to a 

toxic substance at a DOE facility, or to the employees’ survivors. 

The Committee is disturbed by reports that a DOL whistleblower 

charged that DOL’s Division of Energy Employees Compensation 

Program thwarted workers’ attempts to seek compensation by 

‘‘writing regulations that made qualification much more stringent 

than Congress intended, failing to disclose all the application rules, 

changing eligibility rules midstream, and delaying compensation 

for years until the sick workers died.’’ Outside groups also have 

raised concerns about implementation of the program. Therefore, 

the Secretary shall implement changes to assist current and former 

workers navigate the EEOICPA program. The Committee expects 

these steps to be strongly considered: establishing a 1–800 number 

for current and former workers to receive information on the 
33 

EEOICPA claims process, including next steps after a claims is accepted or denied, and assistance with completing the Occupational 

Health Questionnaire; developing literature on EEOICPA and the 

claims process, such as frequently asked questions; providing current and former workers with a copy of their entire claims file upon 

request in electronic or paper form; allowing Industrial Hygienists 

to contact current or former workers regarding their claim; and extending the timeline for current or former workers to file an appeal 

in U.S. District Court from 60 days to 180 days when a claim is 

denied. 

BLACK LUNG DISABILITY TRUST FUND

Appropriations, 2017 ............................................................................. $373,041,000 

Budget estimate, 2018 ........................................................................... 415,162,000 

Committee recommendation ................................................................. 415,162,000 

The Committee bill provides an estimated $415,162,000 as requested for this mandatory appropriations account. This estimate 

is comprised of $69,527,000 for administrative expenses and an estimated $345,635,000 for benefit payment and interest costs. 

The Committee bill continues to provide indefinite authority for 

the Black Lung Disability Trust Fund to provide for benefit payments. In addition, the bill provides for transfers from the trust 

fund for administrative expenses for the following Department 

agencies as requested: up to $38,246,000 for the part C costs of the 

Division of Coal Mine Workers’ Compensation Programs; up to 

$30,595,000 for Departmental Management, Salaries and Expenses; and up to $330,000 for Departmental Management, Inspector General. The bill also allows a transfer of up to $356,000 for 

the Department of the Treasury. 

The Trust Fund pays all black lung compensation/medical and 

survivor benefit expenses when no responsible mine operation can 

be assigned liability for such benefits or when coal mine employment ceased prior to 1970, as well as all administrative costs that 

are incurred in administering the benefits program and operating 

the trust fund. 

OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION

SALARIES AND EXPENSES

Appropriations, 2017 ............................................................................. $552,787,000 

Budget estimate, 2018 ........................................................................... 543,257,000 

Committee recommendation ................................................................. 552,787,000 

The Committee recommends $552,787,000 for the Occupational 

Safety and Health Administration [OSHA], which is responsible for 

enforcing the Occupational Safety and Health Act of 1970 in the 

Nation’s workplaces. 

The Committee continues bill language to allow OSHA to retain 

course tuition and fees for training institute courses used for occupational safety and health training and education activities in the 

private sector. The cap established by the bill is $499,000, the same 

as current law. 

The bill retains language that continues to exempt farms employing 10 or fewer people from the provisions of the act with the exception of those farms having a temporary labor camp. The bill also 
34 

retains language exempting small firms in industry classifications 

having a lost workday injury rate less than the national average 

from general schedule safety inspections. 

The exemption of small farming operations from OSHA regulation has been in place since 1976. OSHA clarified the limits of its 

authority to conduct enforcement on small farms in July 2014, particularly regarding post-harvest activities of a farming operation. 

The continued exemption for small farms and recognition of limits 

of the OSHA regulatory authority are critical for family farms. It 

is also important the Department of Agriculture be consulted in 

any future attempts by OSHA to redefine or modify any aspect of 

the small farm exemption. The Committee recommends $100,850,000 for grants to States 

under section 23(g) of the Occupational Safety and Health Act. 

These funds primarily are provided to States that have taken responsibility for administering their own occupational safety and 

health programs for the private sector and/or the public sector. 

State plans must be at least as effective as the Federal program 

and are monitored by OSHA. The Committee bill continues language that allows OSHA to provide grants of up to 50 percent for 

the costs of State plans approved by the agency. 

The Committee believes that OSHA’s compliance assistance activities are a critical and underutilized component of a comprehensive approach to worker protection. This approach includes grants 

made to various types of organizations representing employers and 

labor organizations for direct training of workers on occupational 

safety and health. OSHA is urged to enhance its industry-specific 

compliance assistance efforts, including but not limited to increased 

informational publications and training materials available 

through its website and enhanced consultation services. OSHA is 

also urged to take additional proactive steps to make small businesses and contractors more aware of the types of health and safety compliance assistance and consultation available from OSHA. 

The Committee recommendation includes $10,537,000 for the 

OSHA Susan Harwood Training Grant Program and directs OSHA 

to dedicate no less than $3,500,000 per year for the purpose of administering the Voluntary Protection Program [VPP] in its Federal 

Compliance Assistance budget. OSHA shall not reduce funding levels or the number of employees administering the VPP, the Safety 

and Health Achievement Recognition Program [SHARP], or Federal 

Compliance Assistance, and shall not collect any monies from participants for the purpose of administering these programs. 

The Committee has created a new capacity-building setaside 

within the Susan Harwood training grant program to improve safety training efforts. The Committee directs OSHA to work with 

grantees and applicants under this subsection of the program to develop and implement a plan to achieve self-sufficiency as required 

by the cited, previous application notice. Nothing in this provision 

should be construed to prohibit periodic recompetition of grants. 

The Committee recognizes that fewer injuries mean safer, more 

productive workers and lower worker compensation and healthcare 

costs. Statistical evidence for VPP success is impressive. The average VPP worksite has a Days Away Restricted or Transferred 

[DART] case rate of 52 percent below the average for its industry. 
35 

These sites typically do not start out with such low rates. Reductions in injuries and illnesses begin when the site commits to the 

VPP approach to safety and health management and the challenging VPP application process. 

MINE SAFETY AND HEALTH ADMINISTRATION

SALARIES AND EXPENSES

Appropriations, 2017 ............................................................................. $373,816,000 

Budget estimate, 2018 ........................................................................... 375,172,000 

Committee recommendation ................................................................. 373,816,000 

The Committee recommendation includes $373,816,000 for the 

Mine Safety and Health Administration [MSHA]. 

MSHA enforces the Federal Mine Safety and Health Act by conducting inspections and special investigations of mine operations, 

promulgating mandatory safety and health standards, cooperating 

with the States in developing effective State programs, and improving training in conjunction with States and the mining industry. 

The bill continues language authorizing MSHA to use up to 

$2,000,000 for mine rescue and recovery activities. It also retains 

the provision allowing the Secretary to use any funds available to 

the Department to provide for the costs of mine rescue and survival 

operations in the event of a major disaster. To prepare properly for 

an actual emergency, the Committee also directs MSHA to continue 

to devote sufficient resources toward a competitive grant activity 

for effective emergency response and recovery training in various 

types of mine conditions. 

In addition, bill language is included to allow the National Mine 

Health and Safety Academy to collect not more than $750,000 for 

room, board, tuition, and the sale of training materials to be available for mine safety and health education and training activities. 

Bill language also allows MSHA to retain up to $2,499,000 from 

fees collected for the approval and certification of equipment, materials, and explosives for use in mines, and to utilize such sums for 

these activities. 

The Committee supports the significant advances MSHA has 

achieved in mine rescue and communications capabilities. To prepare properly for an actual mine rescue emergency, the Committee 

directs MSHA to continue to devote sufficient resources towards 

mine rescue technology by fully equipping and maintaining the existing MSHA mine rescue stations. Considering changes in economic conditions throughout the mining industry in recent years, 

the Committee urges MSHA to provide all necessary technical advice regarding mine rescue communications to State and private 

mine rescue teams and to ensure that all relevant MSHA grant 

programs prioritize mine rescue communications technology. 

BUREAU OF LABOR STATISTICS

SALARIES AND EXPENSES

Appropriations, 2017 ............................................................................. $609,000,000 

Budget estimate, 2018 ........................................................................... 607,842,000 

Committee recommendation ................................................................. 609,000,000 
36 

The Committee recommends $609,000,000 for the Bureau of 

Labor Statistics [BLS]. This amount includes $65,000,000 from the 

Employment Security Administration account of the Unemployment Trust Fund and $544,000,000 in Federal funds. 

BLS is the principal fact finding agency in the Federal Government in the broad field of labor economics. The Committee recognizes that the Nation requires current, accurate, detailed workforce 

statistics for Federal and non-Federal data users as provided by 

BLS. 

The Committee urges BLS to take steps to improve information 

it collects and reports related to education occupations in career 

and technical fields. This should include expanded sample size, survey question refinement, and enhanced analytical capacity for the 

annual supplement to the Current Population Survey [CPS], so it 

produces better information about occupational credentials. The 

Committee requests BLS to provide a report not later than 90 days 

after enactment of this act on the cost and design options for a new 

survey on employer-provided training. 

OFFICE OF DISABILITY EMPLOYMENT POLICY

Appropriations, 2017 ............................................................................. $38,203,000 

Budget estimate, 2018 ........................................................................... 27,203,000 

Committee recommendation ................................................................. 38,203,000 

The Committee recommends $38,203,000, the same as fiscal year 

2017, for the Office of Disability Employment Policy to provide 

leadership, develop policy and initiatives, and award grants furthering the objective of eliminating physical and programmatic barriers to the training and employment of people with disabilities and 

to design and implement research and technical assistance grants 

and contracts to develop policy that reduces barriers to competitive, 

integrated employment for youth and adults with disabilities. 

DEPARTMENTAL MANAGEMENT

SALARIES AND EXPENSES

Appropriations, 2017 ............................................................................. $334,844,000 

Budget estimate, 2018 ........................................................................... 259,858,000 

Committee recommendation ................................................................. 336,844,000 

The Committee recommendation includes $336,844,000 for the 

Departmental Management account. Of this amount, $336,536,000 

is available from general funds and $308,000 is available by transfer from the Employment Security account of the Unemployment 

Trust Fund. In addition, $30,595,000 is available by transfer from 

the Black Lung Disability Trust Fund. 

The Departmental Management appropriation pays the salaries 

and related expenses of staff responsible for formulating and overseeing the implementation of departmental policy and management 

activities in support of that goal. In addition, this appropriation includes a variety of operating programs and activities that are not 

involved in departmental management functions, but for which 

other appropriations for salaries and expenses are not suitable. 

The Committee recommendation includes $86,125,000 for the Bureau of International Labor Affairs [ILAB], of which $59,825,000 is 

available for obligation through December 31, 2018. ILAB’s appro-
37 

priation is available to help improve working conditions and labor 

standards for workers around the world by carrying out ILAB’s 

statutory mandates and international responsibilities including in 

promoting the elimination of child labor and forced labor. ILAB will 

continue to oversee 61 active grant projects totaling over 

$316,000,000 in 67 countries around the world in fiscal year 2018 

in addition to new grants appropriated in fiscal year 2017 which 

have not yet been awarded. 

ILAB will also continue to publish its annual List of Goods Produced by Child or Forced Labor that helps to identify global sectors 

where human trafficking has occurred. Funding for international 

programming to eliminate the worst forms of child labor should 

prioritize comprehensive and sustainable initiatives that address 

the root causes of the problem, including lack of education and vocational training opportunities; household poverty; lack of data and 

awareness of the scope and impact of the worst forms of child 

labor; gaps in social protection services; and weak enforcement of 

labor laws, which increase the vulnerability of households to the 

worst forms of child labor. ILAB plays an important role in identifying and addressing labor violations in U.S. trade agreements, and 

its work leads to greater worker rights and protections globally, 

which helps to ensure that U.S. workers compete on a level playing 

field. 

The Committee recommendation provides $8,040,000 for program 

evaluation and allows these funds to be available for obligation 

through September 30, 2019. The Committee bill also continues the 

authority of the Secretary to transfer these funds to any other account in the Department for evaluation purposes. The Committee 

bill continues authority to use up to 0.75 percent of certain Department appropriations for evaluation activities identified by the chief 

evaluation officer. The Committee expects to be notified of the 

planned uses of funds derived from this authority. The recommendation includes $23,534,000 for the Office of the 

Assistant Secretary for Administration and Management. The reduction reflects the transfer of the Departmental Budget Center to 

the Office of the Chief Financial Officer as requested. The recommendation includes $35,000,000 for the Adjudication 

activity, level with fiscal year 2017. The Committee recommendation provides $12,530,000 for the 

Women’s Bureau. The Committee continues bill language allowing 

the Bureau to award grants. 

VETERANS EMPLOYMENT AND TRAINING

Appropriations, 2017 ............................................................................. $279,041,000 

Budget estimate, 2018 ........................................................................... 279,595,000 

Committee recommendation ................................................................. 284,041,000 

The Committee recommendation of $284,041,000 for the Veterans Employment and Training Service [VETS] includes 

$45,000,000 in general revenue funding and $239,041,000 to be expended from the Employment Security Administration account of 

the Unemployment Trust Fund. 

This account provides resources for VETS to maximize employment opportunities for veterans and transitioning service members, 

including protecting their employment rights. VETS carries out its 
38 

mission through a combination of grants to States, competitive 

grants, and Federal enforcement and oversight. The Committee provides $175,000,000 for the Jobs for Veterans 

State Grants [JVSG] program. This funding will enable Disabled 

Veterans’ Outreach Program specialists and Local Veterans’ Employment Representatives to continue providing intensive employment services to veterans and eligible spouses; transitioning service 

members early in their separation from military service; wounded 

warriors recuperating in military treatment facilities or transition 

units; and, spouses and family caregivers to help ensure the family 

has income to provide sufficient support. The Committee maintains 

language providing authority for JVSG funding to be used for data 

systems and contract support to allow for the tracking of participant and performance information. The Committee provides $18,500,000 for the Transition Assist- ance Program [TAP], an increase of $3,900,000 over fiscal year 

2017 to support employment workshops at military installations 

and in virtual classrooms worldwide for exiting service members 

and spouses. The Committee recommendation includes $42,127,000 for Federal 

administration costs. This funding level will support oversight and 

administration of the VETS grant programs, TAP employment 

workshops, and compliance and enforcement activities. The Committee recommends $45,000,000 for the Homeless Veterans’ Reintegration Program [HVRP], level with fiscal year 2017, 

to help homeless veterans attain the skills they need to gain meaningful employment. This funding will allow DOL to provide HVRP 

services to over 18,000 homeless veterans nationwide, including 

homeless women veterans. The bill allows Incarcerated Veterans’ 

Transition funds to be awarded through September 30, 2018, and 

to serve veterans who have recently been released from incarceration but are at-risk of homelessness. 

The Committee recommendation includes $3,414,000 for the National Veterans’ Training Institute, which provides training to Federal staff and veteran service providers. The Committee includes 

funding and new authority to facilitate the Department’s implementation of the Honoring Investments in Recruiting and Employing American Military Veterans Act of 2017. 

INFORMATION TECHNOLOGY MODERNIZATION

Appropriations, 2017 ............................................................................. $18,778,000 

Budget estimate, 2018 ........................................................................... 29,722,000 

Committee recommendation ................................................................. 18,778,000 

The Committee recommends $18,778,000 for the IT Modernization account. Funds available in this account have been used for 

two primary activities. The first is departmental support systems, 

for which $4,898,000 is provided as requested. The second activity, 

IT Infrastructure Modernization, supports necessary activities associated with the Federal Data Center Consolidation Initiative. 

OFFICE OF THE INSPECTOR GENERAL

Appropriations, 2017 ............................................................................. $87,721,000 

Budget estimate, 2018 ........................................................................... 86,136,000 

Committee recommendation ................................................................. 87,721,000 
39 

The Committee recommends $87,721,000 for the DOL OIG. The 

bill includes $82,061,000 in general funds and authority to transfer 

$5,660,000 from the Employment Security Administration account 

of the Unemployment Trust Fund. In addition, an amount of 

$330,000 is available by transfer from the Black Lung Disability 

Trust Fund. 

Through a comprehensive program of audits, investigations, inspections, and program evaluations, OIG attempts to reduce the incidence of fraud, waste, abuse, and mismanagement, and to promote economy, efficiency, and effectiveness. 

The Department has reported improper payments, including 

fraud, in the UI and Employee Compensation programs totaling approximately $3,850,000,000 and $106,300,000 respectively for fiscal 

year 2016. The Committee strongly supports and commends the efforts of the OIG to identify and prosecute those who defraud the 

Department’s worker benefit programs and to help protect the solvency of these important programs. 

The Committee is disturbed by reports that a DOL whistleblower 

charged that DOL’s Division of Energy Employees Compensation 

Program sought to thwart workers’ attempts to seek compensation. 

Outside groups also have raised concerns about implementation of 

the program. Therefore, the Office of Inspector General shall conduct a comprehensive review of DOL’s Division of Energy Employees Compensation Program [DEEOIC] to determine the impact of 

policy changes in the past two years under the Energy Employees 

Occupational Illness Compensation Program Act [EEOICPA] on 

workers and the fulfilling of the program’s statutory mission. 

GENERAL PROVISIONS

Section 101. The bill continues a provision limiting the use of Job 

Corps funding for compensation of an individual that is not a Federal employee at a rate not to exceed Executive Level II. 

Section 102. The bill continues a provision providing for general 

transfer authority. 

Section 103. The bill continues a provision prohibiting funding 

for the procurement of goods and services utilizing forced or indentured child labor in industries and host countries already identified 

by the Department in accordance with Executive Order 13126. 

Section 104. The bill continues a provision requiring that funds 

available under section 414(c) of the American Competitiveness 

and Workforce Innovation and Opportunity Act may only be used 

for competitive grants that train individuals over the age of 16 who 

are not enrolled in school, in occupations and industries for which 

employers are using H–1B visas to hire foreign workers. 

Section 105. The bill continues a provision limiting the use of 

ETA funds by a recipient or subrecipient for compensation of an individual at a rate not to exceed Executive Level II. 

Section 106. The bill amends a provision providing the ETA with 

authority to transfer funds provided for technical assistance services to grantees to ‘‘Program Administration’’ when it is determined 

that those services will be more efficiently performed by Federal 

employees. The provision does not apply to section 171 of the 

WIOA. In addition, authority is provided for program integrity-related activities as requested by the administration. 
40 

Section 107. The bill continues a provision allowing up to 0.75 

percent of discretionary appropriations provided in this act for all 

Department agencies to be used by the Office of the Chief Evaluation Officer for evaluation purposes consistent with the terms and 

conditions in this act applicable to such office. 

Section 108. The bill continues a longstanding provision regarding the application of the Fair Labor Standards Act after the occurrence of a major disaster. 

Section 109. The Committee continues a provision rescinding advance appropriations in the Dislocated Workers’ National Reserve 

account. 

Section 110. The bill continues a provision that provides flexibility with respect to the crossing of H–2B nonimmigrants. 

Section 111. The bill continues a provision related to the wage 

methodology under the H–2B program. 

Section 112. The bill continues a provision regarding the threefourths guarantee and definitions of corresponding employment 

and temporary need for purposes of the H–2B program. 

Section 113. The bill includes a new provision providing authority related to the disposition of excess property related to the training of apprentices. 

Section 114. The bill includes a new provision providing enhanced dislocated worker training resources to support economic 

recovery in the Appalachian and the Delta regions. 

Section 115. The bill includes a new provision related to funds 

available to State Unemployment Insurance information technology 

consortia. 
(41) 

TITLE II 

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Any references in this title of the report to the ‘‘Secretary’’ or the 

‘‘Department’’ shall be interpreted to mean the Secretary of HHS 

or the Department of HHS, respectively, unless otherwise noted. 

HEALTH RESOURCES AND SERVICES ADMINISTRATION

HRSA activities support programs to provide healthcare services 

for mothers and infants; the underserved, elderly, and homeless; 

rural residents; and disadvantaged minorities. This agency supports cooperative programs in maternal and child health, AIDS 

care, healthcare provider training, and healthcare delivery systems 

and facilities. 

BUREAU OF PRIMARY HEALTH CARE

Appropriations, 2017 ............................................................................. $1,491,522,000 

Budget estimate, 2018 ........................................................................... 1,488,687,000 

Committee recommendation ................................................................. 1,491,522,000 

The Committee recommendation for the activities of the Bureau 

of Primary Health Care is $1,491,522,000. 

Community Health Centers 

The Committee provides $1,491,522,000 in this bill for Community Health Centers, equal to the amount provided last year. 

Programs supported by this funding include community health 

centers, migrant health centers, healthcare for the homeless, 

school-based, and public housing health service grants. The Committee continues to support the ongoing effort to increase the number of people who have access to medical services at health centers. 

Health centers play a vital role in ensuring access to primary care 

in underserved areas of the country, including urban, rural, and 

frontier areas. 

The Committee is supportive of ongoing efforts to expand the capacity of community health centers to offer a comprehensive, integrated range of services, through strategic investment in behavioral health, substance abuse, oral health, and other services and 

capacity. The Committee also recognizes the need for capital resources at community health centers to meet increased demand 

and upgrade facilities. 

The Committee believes that enhanced funding for the technical 

assistance and networking functions available for health centers 

through national and State cooperative agreements and grants is 

critical to the successful operation and expansion of the health centers program. Funds are available within the amount provided to 

enhance technical assistance and training activities, further quality 

improvement initiatives, and continue the development of and sup-
42 

port for health center-controlled networks so that new and existing 

centers can improve patient access to quality health services. 

In addition, within the amount provided, the Committee provides up to $99,893,000 under the Federal Tort Claims Act [FTCA], 

available until expended. These funds are used to pay judgments 

and settlements, occasional witness fees and expenses, and related 

administrative costs. The Committee intends FTCA coverage funded through this bill to be inclusive of all providers, activities, and 

services included within the health centers’ federally approved 

scope of project. 

Native Hawaiian Health Care.—The Committee expects that no less than $14,400,000 be provided for the Native Hawaiian Health 

Care Program. 

Perinatal Transmission of Hepatitis B.—The Committee appreciates that HRSA has agreed to fund an evaluation of intervention 

strategies to eliminate the perinatal transmission of Hepatitis B. 

This is consistent with the urgings of the Committee for the last 

four fiscal years. The Committee recognizes that a full evaluation 

of intervention strategies will require the training of health care 

professionals, followed by service delivery, and data collection. The 

Committee directs that HRSA’s funding plans accommodate these 

components and this necessary sequence of activities in order to accommodate a full evaluation of the recommended intervention 

strategies. 

Free Clinics Medical Malpractice Coverage 

The Committee provides $1,000,000 for payments of claims under 

the FTCA to be made available for free clinic health professionals 

as authorized by section 224(o) of the PHS Act. 

This appropriation extends FTCA coverage to medical volunteers 

in free clinics to expand access to healthcare services to low-income 

individuals in medically underserved areas. 

BUREAU OF HEALTH PROFESSIONS

Appropriations, 2017 ............................................................................. $838,695,000 

Budget estimate, 2018 ........................................................................... 382,631,000 

Committee recommendation ................................................................. 856,195,000 

The Committee recommendation for the activities of the Bureau 

of Health Professions is $856,195,000. 

The Bureau of Health Professions provides policy leadership and 

grant support for health professions workforce development. The 

mission of the Bureau is to identify shortage areas while working 

to make them obsolete. Its programs are intended to ensure that 

the Nation has the right clinicians, with the right skills, working 

where they are needed. 

National Health Service Corps 

The Committee recommendation does not include discretionary 

funding for the National Health Service Corps [Corps]. The Committee strongly supports the Corps’ long and successful record of 

supporting qualified healthcare providers that are dedicated to 

working in underserved areas with limited access to healthcare. 

Nearly 3-in-4 Corps members choose to stay in the area in which 

they serve upon completion of their service, and it is essential to 
43 

ensure that the Committee is supporting the creation and development of health care professionals in rural areas. 

The Committee recognizes that the Corps is an essential tool for 

recruitment and retention of health professionals at community 

health centers, especially given recent expansions of the program. 

The Committee encourages HRSA to increase the proportion of clinicians serving at health centers to improve alignment between 

these two programs and to best leverage investments in Corps 

health professionals. The Committee recognizes that the Secretary 

retains the authority to include additional disciplines in the Corps. 

As such, the Committee urges the Secretary to include pharmacists 

and pediatric subspecialists as eligible recipients of scholarships 

and loan repayments through the program. 

The Committee recognizes the importance of the Corps scholarship and loan-repayment programs with Corps members in all 50 

States. The Committee encourages HRSA to ensure that States 

with fewer than ten Corps awardees in the most recent fiscal year, 

will receive at least five awards in that State this fiscal year, 

prioritizing awards to individuals for whom that is their home 

State or to those that received their education in that State. 

The Committee continues to include section 206 of this act to 

modify the rules governing the Corps to allow every Corps member 

60 days to cancel their contract. 

Training for Diversity 

Minorities in Health Professions.—The Committee understands 

that there is a concern about the supply of underrepresented minorities [URM] in health professions. The Committee supports 

more attention be focused on ways to better address URM in areas 

such as pharmacy, medicine, and behavioral health and encourages 

HRSA to emphasize the importance of adequate industrial training 

space with better secured/controlled access, bacteria free environment and temperature/humidity control as a means to enhance the 

academic performance, support faculty development and facilitate 

research. 

Centers of Excellence 

The Committee recommends $21,711,000 for the Centers of Excellence [COE] Program. 

The Committee recognizes that the COE Program increases the 

supply and competencies of URM in health professions. Funds support programs of excellence that enhance the academic performance 

of URM students, support URM faculty development, and facilitate 

research on minority health issues. 

Health Careers Opportunity Program 

The Committee provides $14,189,000 for the Health Careers Opportunity Program. This program provides individuals from disadvantaged backgrounds who desire to pursue a health professions 

career an opportunity to develop the skills needed to successfully 

compete for, enter, and graduate from schools of health professions 

or allied health professions. 
44 

Faculty Loan Repayment 

The Committee provides $1,190,000 for the Faculty Loan Repayment Program. This amount is the same as the fiscal year 2017 enacted level. 

Scholarships for Disadvantaged Students 

The Committee provides $45,970,000 for Scholarships for Disadvantaged Students, equal to the fiscal year 2017 level. The Committee supports diversity among health professionals. This program 

provides grants to eligible health professions and nursing schools 

to award scholarships to students from disadvantaged backgrounds 

who have financial need. 

Primary Care Training and Enhancement 

The Committee provides $38,924,000 for Primary Care Training 

and Enhancement programs, which support the expansion of training in internal medicine, family medicine, pediatrics, and physician 

assistance. Funds may be used for developing training programs or 

providing direct financial assistance to students and residents. 

Training in Oral Health Care 

The Committee provides $36,673,000 for Training in Oral Health Care programs, which includes not less than $10,000,000 each for 

general and pediatric dentistry. Funds may be used to expand 

training in general dentistry, pediatric dentistry, public health dentistry, dental hygiene, and other oral health access programs. 

Funds may also be used to plan and operate training programs, as 

well as to provide financial assistance to students and residents. 

The Committee is pleased that HRSA has restored the position 

of Chief Dental Office [CDO] and looks forward to learning how the 

agency has ensured that the CDO is functioning at an executive 

level authority with resources to oversee and lead HRSA oral 

health programs and initiatives. The Committee directs HRSA to 

provide an update on how the CDO is serving as the agency representative on oral health issues to international, national, State, 

and local government agencies, universities, and oral health stakeholder organizations in the fiscal year 2019 CJ. 

The Nation continues to confront an oral health access crisis, 

which will not be ameliorated without better utilization of existing 

dental providers and exploration of new types of licensed dental 

providers. The Committee urges HRSA to convene a stakeholder 

meeting in order to determine how best to create new entry points 

into the oral health care delivery system for rural and other underserved populations, better utilization of existing dental personnel, 

and exploration of new types of dental providers. 

The agency is directed to provide continuation funding for 

predoctoral and postdoctoral training grants initially awarded in 

fiscal year 2015, and for Section 748 Dental Faculty Loan Program 

grants initially awarded in fiscal year 2016 with preference for pediatric dentistry faculty supervising dental students or residents 

and providing clinical services in dental clinics located in dental 

schools, hospitals, and community-based affiliated sites. 

The Committee continues long-standing bill language that prohibits funding for section 340G–1 of the PHS Act. 
45 

Interdisciplinary, Community-Based Linkages 

Area Health Education Centers 

The Committee provides $32,750,000, an increase of $2,500,000 

for Area Health Education Centers [AHEC]. The Committee does 

not support the administration’s proposed elimination of AHEC 

funding. 

The program links university health science centers with community health service delivery systems to provide training sites for 

students, faculty, and practitioners. The program supports three 

types of projects: core grants to plan and implement programs; special initiative funding for schools that have previously received 

AHEC grants; and model programs to extend AHEC programs with 

50 percent Federal funding. The AHEC community training model 

provides a uniquely appropriate opportunity to bring the training 

of community health workers to scale. HRSA is encouraged to provide technical assistance on and disseminate best practices for 

training community health workers to existing AHECs. The Committee is pleased with AHEC’s efforts to improve access to quality 

healthcare in America’s rural and underserved areas by increasing 

the number of primary healthcare professionals who practice in 

those areas. 

Geriatric Programs 

The Committee provides $38,737,000 for Geriatric Programs. 

The Committee recognizes the importance of geriatric training 

programs incorporating culturally sensitive training programs and 

encourages HRSA to work to ensure training programs are collaborative, interdisciplinary, and culturally competent. 

Behavioral Health Workforce Education and Training Program 

The Committee provides $50,000,000 for Behavioral Health 

Workforce Education and Training Program [BHWET]. The 

BHWET Program is focused on developing and expanding the mental health and substance abuse workforce serving populations 

across the lifespan. HRSA will continue to leverage SAMHSA’s subject matter expertise in formatting new investments in fiscal year 

2018. 

The Committee supports the broadened target populations of 

people to be served by the BHWET program. The Committee continues to direct that eligible entities for this program shall include, 

but is not limited to, accredited programs that train masters and 

clinical doctoral level social workers, psychologists, counselors, 

marriage and family therapists, psychiatric mental health nurse 

practitioners, occupational therapists; psychology interns; and behavioral health paraprofessionals. 

Mental and Behavioral Health Education Training Programs 

The Committee provides $9,916,000 for Mental and Behavioral 

Health Education Training Programs. The programs provide grants 

to higher education institutions and accredited training programs 

to recruit and train professionals and faculty in the fields of social 

work, psychology, psychiatry, marriage and family therapy, sub-
46 

stance abuse prevention and treatment, and other areas of mental 

and behavioral health. 

Graduate Psychology Education Program [GPE].—The Committee recognizes the growing need for highly trained behavioral 

health professionals to deliver evidence-based services to vulnerable populations, including the elderly, returning military veterans, 

and those suffering from trauma. The GPE program is the main 

Federal initiative dedicated to the education and training of psychologists. The Committee urges HRSA to explore evidence-based 

approaches to leverage workforce capacity through this program, to 

invest in geropsychology training programs, and to help integrate 

health service psychology trainees at Federally Qualified Health 

Centers. 

Screening and Treatment for Maternal Depression 

The Committee provides $5,000,000 for a new Screening and 

Treatment for Maternal Depression program as authorized in Section 10005 of the 21st Century Cures Act (Public Law 114–255). 

HRSA is directed to make grants to States to establish, improve, 

or maintain programs to train professionals to screen, assess, and 

treat for maternal depression in women who are pregnant or who 

have given birth within the preceding 12 months. 

Health Professions Workforce Information and Analysis 

The Committee provides $4,663,000 for health professions workforce information and analysis. The program provides for the collection and analysis of targeted information on the Nation’s 

healthcare workforce, research on high-priority workforce questions, the development of analytic and research infrastructure, and 

program evaluation and assessment. 

Public Health Workforce Development 

The Committee provides $17,000,000 for Public Health Workforce 

Development. This program line, also called Public Health and Preventive Medicine, funds programs that are authorized in titles III 

and VII of the PHS Act and support awards to schools of medicine, 

osteopathic medicine, public health, and integrative medicine programs. 

Nursing Workforce Development Programs 

The Committee provides $234,472,000 for Nursing Workforce Development programs. These programs provide funding to address 

all aspects of nursing workforce demand, including education, practice, recruitment, and retention. 

Advanced Education Nursing 

The Committee recommends $69,581,000 for the Advanced Education Nursing programs, which increases the number of qualified 

nurses in the workforce by improving nursing education through 

curriculum and faculty development. 

The Committee notes that in 2015, approximately 400,000 individuals age 12 or older were reported victims of sexual assault according to the Bureau of Justice Statistics. Studies have shown 

that exams performed by sexual assault forensic examiners—med-
47 

ical providers trained in collecting and preserving forensic evidence—may result in better physical and mental health care for 

victims, better evidence collection, and higher prosecution rates. 

The Committee is concerned that a recent GAO report identified 

major gaps in access to sexual assault examinations at hospitals 

nationwide, including a lack of trained sexual assault nurse examiners, or SANEs, whose job is to provide uninterrupted compassionate care and to collect the evidence critical to successful prosecutions. As such, the Committee provides an increase of 

$5,000,000 to award grants for the clinical training of sexual assault nurse examiners to administer medical forensic examinations 

and treatments to victims of sexual assault in hospitals, health 

centers, and other emergency health care service provider settings, 

including Federally qualified health centers, clinics receiving funding under title X, and other health care providers as determined 

appropriate by the Secretary. 

Children’s Hospitals Graduate Medical Education 

The Committee provides $305,000,000, an increase of $5,000,000, 

for the Children’s Hospitals Graduate Medical Education [CHGME] 

program. The Committee strongly supports the CHGME program 

which provides support for graduate medical education training 

programs in both ambulatory and in-patient settings within freestanding children’s teaching hospitals. CHGME payments are determined by a per-resident formula that includes an amount for direct training costs added to a payment for indirect costs. Payments 

support training of resident physicians as defined by Medicare in 

both ambulatory and inpatient settings. 

The Committee recognizes changes made to the program that 

have increased the number of children’s teaching hospitals eligible 

to apply for funding. The Committee notes the Secretary’s use of 

the authority provided under the current authorization to make 

funding available for hospitals previously ineligible for the program, and urges the Secretary to continue to make such funding 

available in future CHGME application and funding cycles. The 

Committee encourages HRSA to continue its work with the Children’s Hospitals on the development and collection of enhanced 

program performance measures. 

National Practitioner Data Bank 

The Committee provides $18,814,000 for the National Practitioner Data Bank. As mandated by the Health Care Quality Improvement Act, the National Practitioner Data Bank does not receive appropriated funds, but instead is financed by the collection 

of user fees. 

The National Practitioner Data Bank collects certain adverse information, medical malpractice payment history, and information 

related to healthcare fraud and abuse. The data bank is open to 

healthcare agencies and organizations that make licensing and employment decisions. 
48 

MATERNAL AND CHILD HEALTH

Appropriations, 2017 ............................................................................. $848,617,000 

Budget estimate, 2018 ........................................................................... 795,290,000 

Committee recommendation ................................................................. 848,617,000 

The Committee recommendation for the Maternal and Child 

Health [MCH] Bureau is $848,617,000. The mission of the Bureau 

is to improve the physical and mental health, safety, and wellbeing of the Nation’s women, infants, children, adolescents, and 

their families. This population includes fathers and children with 

special healthcare needs. 

Virtual Pediatric Trauma Center.—The Committee recognizes the 

importance of a Virtual Pediatric Trauma Center, which would provide 24/7 virtual access to critical pediatric acute trauma care resources for providers in the United States and around the world, 

for civilian and military purposes. When trauma strikes a child, 

most of them will receive care from a surgeon, physician, nurse, or 

physician-extender with limited pediatric trauma experience or be 

distant from necessary, pediatric subspecialties such as pediatric 

surgery. The Committee acknowledges the work that HRSA has 

undertaken with the Uniformed Services University of the Health 

Sciences to cooperatively introduce and develop the concept of a 

Virtual Pediatric Trauma Center. Recognizing the value of the concept and the established conceptual framework, the Committee requests that HRSA provide an update on the status of the Virtual 

Pediatric Trauma Center model in the fiscal year 2019 CJ. 

Maternal and Child Health Block Grant 

The Committee provides $641,700,000 for the MCH Block Grant, 

which provides a flexible source of funding that allows States to 

target their most urgent maternal and child health needs. The program supports a broad range of activities including: providing prenatal care, well child services, and immunizations; reducing infant 

mortality; preventing injury and violence; expanding access to oral 

healthcare; addressing racial and ethnic disparities; and providing 

comprehensive care through clinics, home visits, and school-based 

health programs. 

Children’s Health and Development.—Evidence shows that experiences in early childhood have long-term health consequences over 

the course of a person’s life. These experiences are critical for a 

child’s educational, social, physical, and economic well-being. Children living in States with persistently high child poverty rates experience more negative health outcomes than their peers elsewhere. Therefore, the Committee provides $3,500,000 within the 

Special Projects of Regional and National Significance program for 

the HRSA-funded study focused on improving child health through 

a statewide system of early childhood developmental screenings 

and interventions. This funding shall be used to extend the currently-funded project for another year. 

Maternal Mortality.—The Committee is aware that many women 

in the United States suffer from maternal morbidity and the maternal mortality rate in the United States has more than doubled 

between 1987 and 2013. The Committee directs the Maternal and 

Child Health Bureau to submit a report to the Committee, no later 
49 

than 180 days after the enactment of this act, on recommendations 

to reduce maternal mortality and morbidity rates in the United 

States. The report should include information and insights from 

States gathered through the Alliance for Innovation on Maternal 

Health program and other sources. 

Maternal, Infant and Early Childhood Home Visiting Program.— 

The Committee encourages HRSA and the Administration for Children and Families to continue their collaboration and partnerships 

to improve health and development outcomes for at-risk pregnant 

women, parents, and young children through evidence-based home 

visiting programs. 

Sickle Cell Anemia 

The Committee provides $4,455,000 for grants and contracts to 

help coordinate service delivery for individuals with sickle cell disease, including genetic counseling and testing; training of health 

professionals; and coordination of education, treatment, and continuity of care programs. 

Autism and Other Developmental Disorders 

The Committee provides $47,099,000 for the Autism and Other 

Developmental Disorders program. The program supports surveillance, early detection, education, and intervention activities on autism and other developmental disorders, as authorized in the Combating Autism Act of 2006. 

Leadership Education in Neurodevelopmental and Related Disabilities [LEND] Programs.—The Committee provides $28,990,000 

for the LEND program to maintain capacity and expand the number of sites to train professionals to diagnose, treat, and provide 

interventions to individuals with autism spectrum disorder authorized by the Combating Autism Act. This funding will help these 

programs initiate or expand their work in the area of interdisciplinary leadership training to meet the needs of children with Autism 

Spectrum Disorders and related developmental disabilities. This 

funding will also enable the LEND network to assist in ongoing developmental monitoring, especially for children exposed to lead and 

other environmental toxins and for infants exposed to the Zika 

virus with its resulting complications. In addition, the funding will 

allow these programs to develop innovative strategies to integrate 

and enhance existing investments, including translating research 

findings on interventions, guidelines, tools and systems management approaches to training settings, communities and into practice; and promote life-course considerations, from developmental 

screening in early childhood to transition to adulthood issues. 

Newborn Screening for Heritable Disorders 

The Committee provides $13,883,000 for the Newborn Heritable 

Disorders Screening program, as described in section 1109 of the 

Newborn Screening Saves Lives Act of 2008. This program provides 

funding to improve States’ ability to provide newborn and child 

screening for heritable disorders. Newborn screening provides early 

identification and follow-up for treatment of infants affected by certain genetic, metabolic, hormonal, and/or functional conditions. 
50 

Healthy Start 

The Committee provides $103,500,000 for the Healthy Start infant mortality initiative. The primary purpose of Healthy Start is 

to reduce infant mortality and generally improve maternal and infant health in at-risk communities. Grants are awarded to State 

and local health departments and nonprofit organizations to conduct an infant mortality review, develop a package of innovative 

health and social services for pregnant women and infants, and 

evaluate these efforts. 

Universal Newborn Hearing Screening and Early Intervention 

The Committee provides $17,818,000 for universal newborn hearing screening and early intervention activities. This program 

awards grants to 53 States and territories that support Statewide 

systems of newborn hearing screening, audiologic diagnostic testing 

before 3 months of age, and enrollment in early intervention programs before the age of 6 months. 

Emergency Medical Services for Children 

The Committee provides $20,162,000 for the Emergency Medical 

Services for Children program which focuses on improving the pediatric components of the emergency medical services system and 

improving the quality of care provided to children in the pre-hospital setting. Funding is available to every State emergency medical services office to improve the quality of emergency care for 

children and to pay for research and dissemination of best practices. 

HIV/AIDS BUREAU

Appropriations, 2017 ............................................................................. $2,318,781,000 

Budget estimate, 2018 ........................................................................... 2,260,008,000 

Committee recommendation ................................................................. 2,318,781,000 

The Committee recommendation includes $2,318,781,000 for the 

HIV/AIDS Bureau. 

The mission of the Bureau is to address the unmet care and 

treatment needs of persons living with HIV/AIDS. The Bureau administers the Ryan White Care Act, which provides a wide range 

of community-based services, including primary and home 

healthcare, case management, substance abuse treatment, mental 

health, and nutritional services. 

Screening for Sexually Transmitted Diseases [STDs].—The Committee continues to support HRSA’s efforts to include screening and 

treatment for all STDs as a part of the comprehensive clinical care 

provided to HIV infected individuals. The Committee encourages 

HRSA to continue to work with CDC’s Division of STD Prevention 

to establish appropriate protocols and standards to assure that 

these screenings are fully integrated into grant recipients comprehensive clinical care plan. 

Emergency Assistance 

The Committee provides $655,876,000 for emergency assistance 

grants to eligible metropolitan areas disproportionately affected by 

the HIV/AIDS epidemic. 
51 

Grants are provided to metropolitan areas meeting certain criteria. Two-thirds of the funds are awarded by formula, and the remainder is awarded through supplemental competitive grants. 

Comprehensive Care Programs 

The Committee provides $1,315,005,000 for HIV healthcare and 

support services. 

Funds are awarded to States to support HIV service delivery consortia, the provision of home- and community-based care services 

for individuals with HIV disease, continuation of health insurance 

coverage for low-income persons with HIV disease, and support for 

State AIDS drug assistance programs [ADAP]. The Committee provides $900,313,000 for AIDS medications in ADAP. 

Early Intervention Services 

The Committee provides $201,079,000 for early intervention 

grants. These funds are awarded competitively to primary 

healthcare providers to enhance healthcare services available to 

people at risk of HIV and AIDS. Funds are used for comprehensive 

primary care, including counseling, testing, diagnostic, and therapeutic services. 

Children, Youth, Women, and Families 

The Committee provides $75,088,000 for grants for coordinated 

services to women, infants, children, and youth. 

Funds are awarded to a variety of providers, including community health centers, comprehensive hemophilia centers, county and 

municipal health departments, and other nonprofit communitybased programs that provide comprehensive primary healthcare 

services to populations with or at risk for HIV. 

AIDS Dental Services 

The Committee provides $13,122,000 for the AIDS Dental Services program. This program provides grants to dental schools, dental hygiene schools, and postdoctoral dental education programs to 

assist with the cost of providing unreimbursed oral healthcare to 

patients with HIV. 

The Ryan White Part F program provides for the Dental Reimbursement Program [DRP] which covers the unreimbursed costs of 

providing dental care to persons living with HIV/AIDS. Programs 

qualifying for reimbursement are dental schools, hospitals with 

postdoctoral dental education programs, and colleges with dental 

hygiene programs. 

AIDS Education and Training Centers 

The Committee provides $33,611,000 for AIDS Education and 

Training Centers [AETCs]. AETCs train healthcare practitioners, 

faculty, and students who care for AIDS patients outside of the traditional health professions education venues and support curriculum development on the diagnosis and treatment of HIV infection for health professions schools and training organizations. 
52 

Special Projects of National Significance 

The Committee provides $25,000,000 for the Special Projects of 

National Significance program. This program supports the development, evaluation and dissemination of innovative models of HIV 

care to improve the retention and health outcomes of Ryan White 

HIV/AIDS Program clients. 

HEALTH CARE SYSTEMS

Appropriations, 2017 ............................................................................. $104,193,000 

Budget estimate, 2018 ........................................................................... 99,351,000 

Committee recommendation ................................................................. 101,640,000 

The Committee recommendation for the Health Care Systems 

Bureau is $101,640,000. 

The Health Care Systems Bureau protects the public health and 

improves the health of individuals through efforts to support and 

enhance the systems by which healthcare is delivered in America. 

Organ Donation and Transplantation 

The Committee provides $23,549,000 for organ donation and 

transplantation activities. 

Funds support a scientific registry of organ transplant recipients 

and the National Organ Procurement and Transplantation Network to match donors and potential recipients of organs. A portion 

of the appropriated funds may be used to educate the public and 

health professionals about organ donations and transplants and to 

support clearinghouse and technical assistance functions. 

Liver Transplant.—The Committee understands that HRSA is 

considering a new proposal to address liver distribution by the end 

of the year. The Committee encourages UNOS and HRSA to proceed carefully, taking into consideration all regional concerns and 

available analyses. The Committee directs HRSA, in consultation 

with UNOS, to submit a report the Committee no later than 180 

days after enactment of this act on the following: costs to transplant programs and to liver recipients, transportation of livers, and 

health disparities, with a particular focus on its effects among vulnerable populations. The report should examine whether these effects vary due to a donor or patient’s socioeconomic status or rural 

location. 

National Cord Blood Inventory 

The Committee provides $12,266,000 for the National Cord Blood 

Inventory. The purpose of this program is to provide funds to cord 

blood banks to build an inventory of the highest quality cord blood 

units for transplantation. 

C.W. Bill Young Cell Transplantation Program 

The Committee provides $22,109,000 for the C.W. Bill Young 

Cell Transplantation Program. 

The Committee continues to support cell transplantation through 

the use of cord blood, bone marrow, peripheral blood stem cells, 

and other sources of stem cells that may be available in the future. 

The Committee appreciates HRSA’s efforts to increase the diversity 

of the registry and the program’s research efforts to improve the 
53 

availability, efficiency, safety, and cost of transplants and the effectiveness of program operations. 

Office of Pharmacy Affairs 

The Committee provides $10,238,000 for the Office of Pharmacy 

Affairs [OPA]. OPA administers the 340B drug pricing program, 

which requires drug manufacturers to provide discounts or rebates 

to a set of programs and hospitals that serve a disproportionate 

share of low-income patients. 

The Committee is aware that the 340B statute requires HRSA to 

make 340B ceiling prices available to covered entities through a secure Web site and continues to be concerned that OPA has failed 

to meet deadlines to complete work on the secure Web site. The 

Committee urges OPA to complete the development of a transparent system to verify the accuracy of the 340B discount or ceiling 

prices. 

Poison Control Centers 

The Committee provides $19,846,000, an increase of $1,000,000 

from fiscal year 2017, for poison control activities. The Poison Control Centers [PCCs] program is a national network of 55 PCCs that 

prevent and treat poison exposures by providing cost effective, 

quality healthcare advice to the general public and healthcare providers. 

The Committee continues to recognize the role PCCs have played 

in the opioid crisis through management of opioid overdoses by assisting first responders and hospital personnel through the National Poison Help Line. 

National Hansen’s Disease Program 

The Committee includes $11,653,000 for the National Hansen’s 

Disease program. The program consists of inpatient, outpatient, 

long-term care as well as training and research in Baton Rouge, 

Louisiana; a residential facility at Carville, Louisiana; and 11 outpatient clinic sites in the continental United States and Puerto 

Rico. The decrease in this account below the fiscal year 2017 level 

reflects a declining beneficiary population. 

National Hansen’s Disease Program Buildings and Facilities 

The Committee provides $122,000 for the repair and maintenance of buildings at the Gillis W. Long Hansen’s Disease Center. 

Payment to Hawaii for Hansen’s Disease Treatment 

The Committee provides $1,857,000 to Hawaii for Hansen’s Disease treatment. Payments are made to the State of Hawaii for the 

medical care and treatment of persons with Hansen’s disease in 

hospital and clinic facilities at Kalaupapa, Molokai, and Honolulu. 

Expenses above the level of appropriated funds are borne by the 

State of Hawaii. 

RURAL HEALTH

Appropriations, 2017 ............................................................................. $156,060,000 

Budget estimate, 2018 ........................................................................... 74,395,000 

Committee recommendation ................................................................. 160,560,000 
54 

The Committee recommendation for Rural Health programs is $160,560,000, an increase of $4,500,000 above the fiscal year 2017 

level. 

The Office of Rural Health Policy [ORHP] administers HHS rural 

health programs, coordinates activities related to rural healthcare 

within HHS, and analyzes the possible effects of policy on the more 

than 42 million residents of rural communities. ORHP advises the 

Secretary on the effects of Medicare and Medicaid on rural citizens’ 

access to care, the viability of rural hospitals, and the availability 

of physicians and other health professionals. 

Rural Health Outreach 

The Committee provides $67,500,000 for the Rural Health Out- reach program, $2,000,000 above the fiscal year 2017 level. 

This program supports projects that demonstrate new and innovative modes of outreach in rural areas, such as integration and coordination of health services. The Committee recommendation provides not more than $12,514,000 for Outreach Service Grants; not 

more than $15,000,000 for Rural Network Development Grants; not 

less than $14,000,000 for Delta States Network Grant Program; not 

more than $2,200,000 for Network Planning Grants; and not less 

than $6,500,000 for Small Healthcare Provider Quality Improvement Grants. 

Delta States Rural Development Network Grant Program.—The 

Committee encourages HRSA to continue to consult with the Delta 

Regional Authority [DRA] on the awarding, implementing, administering, and monitoring grants under the Delta States Network 

Grant Program in fiscal year 2018. The Committee continues to encourage HRSA to align its awards as closely as possible with the 

DRA’s strategic plan and with DRA economic and community development plans. In addition, of the funds provided, the Committee 

provides $4,000,000 to support HRSA’s collaboration with the DRA 

to continue DRA’s program to help underserved rural communities 

identify and better address their health care needs and to help 

small rural hospitals improve their financial and operational performance. Finally, the Committee encourages HRSA to participate 

and collaborate on DRA’s Next Health strategic plan for the Delta 

Region. The Committee believes that the information the DRA collects in the development of that plan will be of substantial value 

to HRSA, and encourages HRSA to provide support to DRA for the 

provision of that information. Within 90 days of enactment of this 

act, the Committee directs HRSA and DRA to jointly brief the 

Committee on this program’s progress. 

Expanding Capacity for Health Outcomes.—The Committee notes 

the passage of Public Law 114–270 supporting Project ECHO and 

the efforts to deliver high-quality, professional care to rural and 

underserved communities. The Committee notes there is increasing 

demand for technical training on Project ECHO and encourages 

HRSA to support a national resource center focused on Project 

ECHO technical training. 

Rural Health Research 

The Committee provides $9,351,000 for the Rural Health Research program. Funds are used for rural health research centers, 
55 

the National Advisory Committee on Rural Health, and a reference 

and information service. Supported activities focus on improving 

the delivery of health services to rural communities and populations. 

Rural Hospital Flexibility Grants 

The Committee provides $43,609,000 for Rural Hospital Flexibility grants and the Small Hospital Improvement Program. Under 

these grant programs, HRSA works with States to provide support 

and technical assistance to critical access hospitals to focus on 

quality and performance improvement and to integrate emergency 

medical services. 

The Committee continues to recognize the importance of supporting hospitals located in rural or underserved communities and 

recommends HRSA give preference in grant awards to Critical Access Hospitals serving rural communities that create community 

health teams to better coordinate care among rural populations to 

create better outcomes in chronic disease management. 

State Offices of Rural Health 

The Committee provides $10,000,000 for State Offices of Rural 

Health. These offices help States strengthen rural healthcare delivery systems by enabling them to coordinate care and improve support and outreach in rural areas. 

Black Lung Clinics 

The Committee provides $7,266,000 for the Black Lung Clinics 

program. This program funds clinics that treat respiratory and pulmonary diseases of active and retired coal miners, steel mill workers, agricultural workers, and others with occupationally related 

respiratory and pulmonary impairments. These clinics reduce the 

incidence of high-cost inpatient treatment for these conditions. 

The Committee continues to direct the Secretary to evaluate 

funding levels for applicants based on the needs of the populations 

those applicants will serve and the ability of those applicants to 

provide health care services to miners with respiratory illnesses, 

with preference given to State agency applications over other applicants in that State, without regard to the funding tiers and overall 

per-applicant funding cap established by the Secretary in fiscal 

year 2014. 

Radiation and Exposure Screening and Education Program 

The Committee provides $1,834,000 for activities authorized by 

the Radiation Exposure Compensation Act. This program provides 

grants for the education, prevention, and early detection of 

radiogenic cancers and diseases resulting from exposure to uranium during mining and milling at nuclear test sites. 

Telehealth 

The Committee provides $21,000,000, an increase of $2,500,000 

above the fiscal year 2017 level, for the Office for the Advancement 

of Telehealth [OAT], which promotes the effective use of technologies to improve access to health services for people who are iso-
56 

lated from healthcare and to provide distance education for health 

professionals. 

The Committee strongly supports OAT and their mission to expand high quality medical care to rural communities that do not 

have adequate access to medical providers including many medical 

specialties. 

Telehealth Center of Excellence [COE].—The Committee commends HRSA’s OAT for providing the requested report to Congress 

and for awarding the Telehealth COE grant during fiscal year 

2017. Within the funds provided for OAT activities, the Committee 

includes $4,000,000 for a second year of funding for the Telehealth 

COE awarded site. This site is responsible for testing the efficacy 

of telehealth services in various sites and models, providing research and coordination efforts across the Federal Government, developing best practices for telehealth, collecting data, and providing 

relevant telehealth training. 

Telehealth Network Grant Program.—The Committee remains 

encouraged by the ability of telehealth services to provide access to 

vital care for patients in underserved areas. One very promising 

area for the expansion of telemedicine is in stroke treatment, 

where patients without access to specialty neurological care can 

significantly improve their standard of care through telehealth. 

Stroke is a leading cause of death but remains the major cause of 

long-term disability, and the speedy access to appropriate care is 

the key factor in determining patient mortality and recovery. The 

Committee encourages HRSA to support telestroke initiatives in 

the Telehealth Network Grant Program. 

Telehealth Resource Centers Grant Program.—The Committee 

recognizes the vital role of existing Telehealth Resource Centers 

across the United States to provide support to healthcare organizations, providers, and networks. In addition, these current centers 

are an important part of the telehealth infrastructure; helping to 

improve access to healthcare and ultimately improve outcomes for 

underserved populations. The Committee recommends that part of 

OAT funding should be used to support increased outreach to providers and communities regarding the benefits of telehealth and 

the availability of technical assistance to support its further adoption. The Committee supports continued funding of the current 12 

regional centers and two National centers in fiscal year 2018. 

FAMILY PLANNING

Appropriations, 2017 ............................................................................. $286,479,000 

Budget estimate, 2018 ........................................................................... 286,479,000 

Committee recommendation ................................................................. 286,479,000 

The Committee provides $286,479,000 for the title X Family 

Planning program. This program supports preventive and primary 

healthcare services at clinics nationwide. 

PROGRAM MANAGEMENT

Appropriations, 2017 ............................................................................. $154,000,000 

Budget estimate, 2018 ........................................................................... 151,993,000 

Committee recommendation ................................................................. 154,000,000 

The Committee provides $154,000,000 for program management 

activities. 
57 

VACCINE INJURY COMPENSATION PROGRAM TRUST FUND

Appropriations, 2017 ............................................................................. $247,750,000 

Budget estimate, 2018 ........................................................................... 277,200,000 

Committee recommendation ................................................................. 247,750,000 

The Committee provides that $247,750,000 be released from the 

Vaccine Injury Compensation Trust Fund in fiscal year 2018. Of 

that amount, $7,750,000 is for administrative costs. 

The National Vaccine Injury Compensation program provides 

compensation for individuals with vaccine-associated injuries or 

deaths. Funds are awarded to reimburse medical expenses, lost 

earnings, pain and suffering, legal expenses, and death benefits. 

The Vaccine Injury Compensation Trust Fund is funded by excise 

taxes on certain childhood vaccines. 

CENTERS FOR DISEASE CONTROL AND PREVENTION

The Committee recommendation provides a program level of 

$7,175,211,000 in this bill for the Centers for Disease Control and 

Prevention [CDC], which includes $55,358,000 in mandatory funds 

under the terms of the Energy Employees Occupational Illness 

Compensation Program Act [EEOICPA], and $800,900,000 in transfers from the Prevention and Public Health [PPH] Fund. 

The activities of CDC focus on several major priorities: providing 

core public health functions; responding to urgent health threats; 

monitoring the Nation’s health using sound scientific methods; assuring the Nation’s preparedness for emerging infectious diseases 

and potential pandemics; and providing leadership in the implementation of nationwide prevention strategies that are conducive to 

improving and maintaining health. 

IMMUNIZATION AND RESPIRATORY DISEASES

Appropriations, 2017 ............................................................................. $794,350,000 

Budget estimate, 2018 ........................................................................... 700,828,000 

Committee recommendation ................................................................. 794,350,000 

The Committee recommendation for the activities of the National 

Center for Immunization and Respiratory Diseases is $794,350,000, 

which includes $324,350,000 in transfers from the PPH Fund. 

The mission of the National Center for Immunization and Respiratory Diseases is the prevention of disease, disability, and death 

through immunization and by control of respiratory and related 

diseases. 

The Committee recommendation includes funding for the following activities in the following amounts: 

[In thousands of dollars] 

Budget activity Fiscal year 2017 

appropriation 

Fiscal year 2018 

request 

Committee 

recommendation 

Section 317 Immunization Program .............................................. 606,792 520,828 606,792 

National Immunization Survey (non-add) ............................. 12,864 ............................ 12,864 

Influenza Planning and Response ................................................. 187,558 180,000 187,558 

Cost Estimates.—The Committee looks forward to reviewing the 

fiscal year 2018 report on estimated funding needs of the Section 
58 

317 Immunization Program and requests that the report be updated and submitted not later than February 1, 2018, to reflect fiscal year 2019 cost estimates. The updated report should also include an estimate of optimum State and local operations funding, 

as well as a discussion of the evolving role of the 317 program as 

expanded coverage for vaccination becomes available from private 

and public sources over the next several years. 

Immunizations.—The Committee does not support the proposed 

reduction to the Section 317 Immunization Program by the Administration and provides funding at last year’s level. The Committee 

believes a strong public health immunization infrastructure is critical for ensuring high vaccination coverage levels, preventing vaccine-preventable diseases, and responding to outbreaks. The Committee acknowledges that immunization program investments in 

Immunization Information Systems [IIS] improve data exchange 

security standards and enhance the interface with electronic health 

records [EHRs] and other health information technology systems. 

IISs inform providers and support clinical decision making in terms 

of a patient’s immunization status as well as help to identify recommended vaccines the patient may not have received, which guide 

public health strategies to reduce vaccine-preventable diseases. 

During the 2015 multi-State measles outbreak and the ongoing, 

multi-State mumps outbreaks, funds from this program supported 

State and local health departments in rapid response, public health 

communication, community outreach and education, data gathering, and laboratory testing. 

HIV, VIRAL HEPATITIS, SEXUALLY TRANSMITTED DISEASES, AND

TUBERCULOSIS PREVENTION

Appropriations, 2017 ............................................................................. $1,117,278,000 

Budget estimate, 2018 ........................................................................... 934,000,000 

Committee recommendation ................................................................. 1,117,278,000 

The Committee recommendation for the activities of the National 

Center for HIV, Viral Hepatitis, Sexually Transmitted Diseases 

[STDs], and TB Prevention is $1,117,278,000. 

The Center administers CDC’s activities on HIV/AIDS, viral hepatitis, STDs, and TB, with the exception of the Global AIDS program, which is housed in the Center on Global Health. 

The Committee recommends funding for the following activities 

in the following amounts: 

[In thousands of dollars] 

Budget activity Fiscal year 2017 

appropriation 

Fiscal year 2018 

request 

Committee 

recommendation 

Domestic HIV/AIDS Prevention and Research ................................ 788,712 640,065 788,712 

HIV Prevention by Health Department .................................. 397,161 N/A 397,161 

HIV Surveillance .................................................................... 119,861 N/A 119,861 

Activities to Improve Program Effectiveness ........................ 103,208 N/A 103,208 

National, Regional, Local, Community & Other Organizations .................................................................................. 135,401 N/A 135,401 

School Health ........................................................................ 33,081 N/A 33,081 

Viral Hepatitis ................................................................................ 34,000 33,935 34,000 

Sexually Transmitted Infections ..................................................... 152,310 130,000 152,310 

Tuberculosis ................................................................................... 142,256 130,000 142,256 
59 

Hepatitis B.—The Committee is concerned that even with a Hepatitis B vaccine that is 95 percent effective, CDC estimates that 

there are at least 850,000 Americans infected with Hepatitis B, 

with an estimated 21,900 infections occurring in 2015. The Committee notes that as a result of the opioid epidemic, infections are 

on the rise, with significant spikes in those areas that suffer from 

widespread opioid abuse. Additionally, the Committee highlights 

that the link between hepatitis B infection and primary liver cancer is well established with up to 15 percent of liver cancer cases 

in the United States caused by HBV. Many of these liver cancer 

cases are preventable with early detection, treatment, and vaccination. The Committee encourages CDC to prioritize the acceleration 

of Hepatitis B interventions within its Viral Hepatitis program 

commensurate with its disease burden. 

Hepatitis C.—The Committee recognizes the rising rates of hepatitis C virus [HCV] infection among American Indians [AI] and 

Alaska Natives [AN], which surpasses many other populations. The 

Committee encourages CDC to work in collaboration with the Indian Health Service to support increased prevention, HCV screening, and access to treatment for AI and AN tribes. 

HIV Screening.—The Committee continues to support CDC grant 

programs that work to improve awareness of HIV status and linkage to care. The Committee requests an update in the fiscal year 

2019 CJ on CDC action to improve testing rates and reduce late 

stage diagnosis in States that scored low on these measures of effectiveness. 

Sexually Transmitted Infections [STIs].—The Committee encourages CDC to sustain public health infrastructure, support surveillance, and continue initiatives to address STI elimination with a 

special focus on congenital syphilis, gonorrhea disease reduction, 

and the use of technology to reach at-risk populations. 

Viral Hepatitis Screening.—The Committee continues to support 

hepatitis screening activities and encourages CDC to prioritize 

screening programs in medically-underserved and minority communities. Point-of-care testing allows for utilization of effective and innovative screening technology in a variety of health care settings. 

EMERGING AND ZOONOTIC INFECTIOUS DISEASES

Appropriations, 2017 ............................................................................. $584,922,000 

Budget estimate, 2018 ........................................................................... 514,000,000 

Committee recommendation ................................................................. 584,922,000 

The Committee recommendation for the activities of the National 

Center for Emerging and Zoonotic Diseases is $584,922,000, which 

includes $52,000,000 in transfers from PPH Fund. 

The National Center for Emerging and Zoonotic Infectious Diseases aims to detect, prevent, and control infectious diseases from 

spreading, whether they are naturally occurring, unintentional, or 

the result of terrorism. 

The Committee recommendation includes funding for the following activities in the following amounts: 
60 

[In thousands of dollars] 

Budget activity Fiscal year 2017 

appropriation 

Fiscal year 2018 

request 

Committee recommendation 

Core Infectious Diseases ............................................................... 396,350 379,684 396,350 

Antibiotic Resistance Initiative ............................................. 163,000 137,000 163,000 

Lab Safety and Quality ......................................................... 8,000 7,985 8,000 

Vector-borne Diseases .......................................................... 26,410 38,816 26,410 

Lyme Disease ........................................................................ 10,700 10,643 10,700 

Prion Disease ........................................................................ 6,000 ............................ 6,000 

Chronic Fatigue Syndrome .................................................... 5,400 ............................ 5,400 

Emerging Infectious Diseases .............................................. 147,000 155,457 147,000 

All Other Infectious Diseases ............................................... 29,840 29,783 29,840 

Food Safety .................................................................................... 54,000 51,901 54,000 

National HealthCare Safety Network ............................................. 21,000 20,960 21,000 

Quarantine ..................................................................................... 31,572 31,512 31,572 

Advanced Molecular Detection ....................................................... 30,000 29,943 30,000 

Epidemiology and Lab Capacity Program ..................................... 40,000 ............................ 40,000 

Healthcare-Associated Infections .................................................. 12,000 ............................ 12,000 

Catheter Associated Urinary Tract Infections.—Each year, hospital-acquired, catheter-associated urinary tract infections 

[CAUTIs] result in the death of 15,000 patients. When CDC’s 

Healthcare Infection Control Practices Advisory Committee last updated its guidelines for prevention of CAUTIs in 2009, it recommended additional research on the use of urinary stents to reduce infection. The Committee encourages CDC to examine existing 

evidence regarding the use of stents to address CAUTIs and issue 

appropriate communications to hospitals, up to and including an 

update to its 2009 Guidelines. 

Combating Antibiotic Resistant Bacteria [CARB].—The Committee continues to support the CARB initiative and provides 

$163,000,000 for this effort. The Committee recognizes the importance of addressing antibiotic-resistant bacteria through a ‘‘One 

Health’’ approach, simultaneously combating antibiotic resistance 

in human, animal, and environmental settings. The Committee encourages CDC to competitively award research activities that address aspects of antibiotic resistance related to ‘‘One Health’’ 

among entities, including public academic medical centers, veterinary schools with agricultural extension services, and State public 

health departments whose proposals are in line with CDC’s strategy for addressing antibiotic resistant bacteria. CDC shall include 

an update on these efforts in the fiscal year 2019 CJ. 

Healthcare-Associated Infections [HAIs].—The Committee acknowledges CDC has made significant progress on HAIs prevention 

and data collection at acute-care hospitals, but gaps in data collection and reporting on HAIs persist across outpatient, post-acute, 

and long-term care facilities. The Committee recognizes that voluntary participation in the National Healthcare Safety Network 

continues to grow among dialysis facilities, nursing homes, and ambulatory surgical centers, and encourages CDC to continue to expand its data collection efforts to these healthcare providers. 

Lyme Disease and Related Tick-Borne Illnesses.—The Committee 

encourages CDC to support surveillance and prevention of Lyme 

disease and other high-consequence tick-borne diseases in endemic 

areas as well as areas not yet considered endemic. CDC should 

work closely with States to advance the use of Integrated Pest 
61 

Management for prevention and control of tick-borne diseases. The 

Committee encourages CDC to coordinate with NIH, NIMH, and 

NINDS on publishing reports that assess diagnostic advancements, 

methods for prevention, the state of treatment, and links between 

tick-borne disease and psychiatric illnesses. Further, the Committee is concerned by reports that cases of Lyme disease are 

under-reported and encourages CDC to re-evaluate surveillance criteria used to track cases of the disease while assisting States to 

more accurately evaluate prevalence. The Committee requests a report within 180 days of enactment of this act on how CDC is examining the potential misuse of the Lyme disease case definition. The 

report should also include updates on the implementation of the 

Lyme disease program, including advancing more sensitive diagnostic tests and details of how Lyme disease funds were spent in 

fiscal year 2017. 

Responding to Emerging Threats.—The Committee maintains 

funding for the Epidemiology and Laboratory Capacity [ELC] Infectious Diseases Program which strengthens the epidemiologic and 

laboratory capacity in 50 States, six local health departments, and 

eight territories. This funding provides critical support to epidemiologists and laboratory scientists who are instrumental in discovering and responding to various food and vector-borne outbreaks. The Committee provides funding for ELC grants to sustain 

core surveillance capacity and ensure that State and local epidemiologists are equipped to respond rapidly to emerging threats 

including antimicrobial resistant superbugs and the Zika virus. 

Sepsis.—The Committee is encouraged that CDC has addressed 

sepsis as a priority within the CARB initiative and has also improved its online sepsis awareness and prevention resources. The 

Committee supports CDC’s goals to scale up the evaluation of sepsis surveillance to help track national sepsis rates, assess the impact of prevention and treatment initiatives, and enable comparisons between health care facilities to identify problem areas. In addition, the Committee encourages CDC to continue to monitor the 

effectiveness of State-based sepsis prevention and treatment protocols. 

Urinary Tract Infections.—The Committee notes that UTIs are 

one of the most common diagnoses leading to antibiotic prescriptions. Since recent research indicates that E. coli and other leading 

causes of UTIs are becoming resistant to many antibiotics, the 

Committee encourages CDC to examine the role that nutrientdense food products, such as cranberries, may play in reducing the 

risk of illness and recurrent infections. The Committee also requests that CDC provide an update on this effort and actions to address antibiotic resistant pathogens linked to UTI in its fiscal year 

2019 CJ. 

Vector-Borne Diseases.—The Committee requests a report 180 

days after enactment of this act that details how CDC worked and 

is continuing to work with the States most vulnerable to Zika and 

other vector-borne diseases. Further, the Committee encourages 

CDC to provide a progress update in the fiscal year 2019 CJ on 

meeting goals and performance indicators to prevent new infections, improve health outcomes, and reduce disease-related disparities. 
62 

Zika Virus.—The Committee continues to support CDC’s preparedness and response efforts to control outbreaks of Zika virus 

infection. The Committee encourages CDC to examine innovative 

vector control technologies to enhance current vector-borne disease 

control efforts. CDC should continue to work closely with the vector 

control unit in Puerto Rico and the most vulnerable States to address not only basic surveillance and research but also the use of 

new approaches to limit the spread of infected mosquitoes through 

innovative vector control technologies which can be effective in environments and locations not amenable to traditional pesticides. 

CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION

Appropriations, 2017 ............................................................................. $1,115,596,000 

Budget estimate, 2018 ........................................................................... 952,250,000 

Committee recommendation ................................................................. 1,065,146,000 

The Committee recommendation for the activities of the National 

Center for Chronic Disease Prevention and Health Promotion is 

$1,065,146,000, which includes $247,550,000 in transfers from the 

PPH Fund. 

The mission of the National Center for Chronic Disease Prevention is to provide national leadership in promoting health and wellbeing through prevention and control of chronic diseases. Nearly 

one-half of all American adults have at least one chronic illness; 

such diseases account for nearly 70 percent of all U.S. deaths and 

three-quarters of all healthcare costs in the United States. 

The Committee does not include the administration’s proposal to 

create a new block grant and instead maintains the existing program line items, including funding mechanisms as they existed in 

fiscal year 2017. The Committee believes the existing funding 

structure allows for the greatest transparency, accountability, and 

measured outcomes for Congress and the taxpayer. Chronic diseases, such as arthritis, cancer, diabetes, heart disease, stroke, and 

obesity are the leading causes of death and disability in the United 

States and account for 86 cents of every dollar spent on health 

care. Therefore, a robust investment in the prevention and control 

of chronic diseases, including chronic conditions like Alzheimer’s 

disease, epilepsy, lupus, and colorectal, prostate, and skin cancers 

is essential to curb health spending and improve health and quality 

of life for millions of Americans. 

Within the total provided for the National Center for Chronic 

Disease Prevention and Health Promotion, the following amounts 

are available for the following categories of funding: 

[In thousands of dollars] 

Budget activity Fiscal year 2017 

appropriation 

Fiscal year 2018 

request 

Committee 

recommendation 

Tobacco .......................................................................................... 205,000 ............................ 205,000 

Nutrition, Physical Activity and Obesity ........................................ 49,920 ............................ 49,920 

High Obesity Rate Counties (non-add) ................................ 10,000 ............................ 10,000 

School Health ................................................................................. 15,400 15,371 15,400 

Health Promotion ........................................................................... 14,025 3,493 14,025 

Glaucoma .............................................................................. 3,300 ............................ 3,300 

Visual Screening Education .................................................. 525 ............................ 525 

Alzheimer’s Disease .............................................................. 3,500 3,493 3,500 
63 

[In thousands of dollars] 

Budget activity Fiscal year 2017 

appropriation 

Fiscal year 2018 

request 

Committee recommendation 

Inflammatory Bowel Disease ................................................ 750 ............................ 750 

Interstitial Cystitis ................................................................ 850 ............................ 850 

Excessive Alcohol Use ........................................................... 3,000 ............................ 3,000 

Chronic Kidney Disease ........................................................ 2,100 ............................ 2,100 

Prevention Research Centers ......................................................... 25,461 ............................ 25,461 

Heart Disease and Stroke .............................................................. 130,037 ............................ 130,037 

Diabetes ......................................................................................... 140,129 ............................ 140,129 

National Diabetes Prevention Program .......................................... 22,500 19,962 22,500 

Cancer Prevention and Control ...................................................... 356,674 337,424 356,674 

Breast and Cervical Cancer ................................................. 210,000 210,000 210,000 

WISEWOMAN (non-add) ................................................ 21,120 21,120 21,120 

Breast Cancer Awareness for Young Women ....................... 4,960 4,960 4,960 

Cancer Registries .................................................................. 49,440 49,346 49,440 

Colorectal Cancer .................................................................. 43,294 ............................ 43,294 

Comprehensive Cancer ......................................................... 19,675 67,143 19,675 

Johanna’s Law ...................................................................... 5,500 5,500 5,500 

Ovarian Cancer ..................................................................... 8,000 ............................ 8,000 

Prostate Cancer .................................................................... 13,205 ............................ 13,205 

Skin Cancer ........................................................................... 2,125 ............................ 2,125 

Cancer Survivorship Resource Center .................................. 475 475 475 

Oral Health ..................................................................................... 18,000 17,000 18,000 

Safe Motherhood/Infant Health ...................................................... 46,000 46,000 46,000 

Arthritis and Other Chronic Disease ............................................. 25,500 13,000 26,000 

Arthritis ................................................................................. 11,000 N/A 11,000 

Epilepsy ................................................................................. 8,500 N/A 8,500 

National Lupus Registry ....................................................... 6,000 N/A 6,500 

Racial and Ethnic Approach to Community Health ...................... 50,950 ............................ ............................

Million Hearts ................................................................................. 4,000 ............................ 4,000 

National Early Child Care Collaboratives ...................................... 4,000 ............................ 4,000 

Hospitals Promoting Breastfeeding ............................................... 8,000 ............................ 8,000 

America’s Health Block Grant ....................................................... ............................ 500,000 ............................

Alzheimer’s and Healthy Aging.—The Committee includes 

$3,500,000 for activities related to Alzheimer’s disease and commends the Healthy Brain Initiative for its leadership in bringing 

attention to the public health crisis of Alzheimer’s disease. The 

Committee encourages CDC to continue implementing the action 

steps listed in the updated Road Map, including working towards 

a consensus on the mortality burden of the disease. 

Breast and Cervical Cancer Screening.—The Committee encourages CDC to continue to strengthen access to preventive screenings 

for women who are uninsured or underinsured and at high risk for 

breast and cervical cancer through the Breast and Cervical Cancer 

program. Of women aged 21–64, 5,700,000 or 14.6 percent, will remain eligible for cervical cancer screening through this program. 

Cancer Survivorship.—Recognizing there are nearly 15 million 

cancer survivors in the United States, the Committee encourages 

CDC to invest in evidence-based physical activity and wellness programs for cancer survivors. Evidence-based physical activity programs have been shown to improve survivors’ overall quality of life, 

increase cardiovascular endurance, decrease cancer-related fatigue, 

and help them meet or exceed recommended amounts of physical 

activity. 

Children in Adversity.—The Committee recognizes that CDC is a 

key implementing partner of the United States Government Action 

Plan on Children in Adversity’s three principle objectives. The 
64 

Committee fully supports the use of funds provided to CDC 

through this act for activities that the agency has identified as 

being necessary to link representative data to effective, sustainable, and scalable action and thus ensure that: (1) the percentage 

of children achieving age-appropriate growth and developmental 

milestones is increased; (2) the percentage of children living outside 

of family care is reduced; and (3) the percentage of children experiencing violence, exploitation, abuse, and neglect is reduced. The 

Committee continues to direct CDC to collaborate with USAID, 

PEPFAR, and the Department of Labor to ensure monitoring and 

evaluation is aligned for all of the Action Plan’s objectives. The 

Committee asks that the annual Public Law 109–95 report to Congress display the amount of funding by objective to the Action Plan 

on Children in Adversity. 

Chronic Fatigue Syndrome.—The Committee applauds CDC’s efforts to collaborate with disease experts in its multi-site study to 

resolve the case definition issues and urges CDC to complete that 

effort. The Committee encourages CDC to partner with other HHS 

agencies, disease experts, and key medical societies to implement 

a proactive dissemination plan that counters medical misinformation and stigma and addresses other key barriers to clinical care. 

Chronic Pain.—The Committee commends CDC for including 

chronic pain in the Healthy People 2020 initiative. The Committee 

encourages CDC to analyze data collected from the chronic pain 

questions included in the 2017 National Health Interview Survey 

and to clarify the incidence and prevalence of various pain syndromes differentiated by patient age, comorbidities, socioeconomic 

status, race, and gender. The Committee further encourages CDC 

to collect data on direct and indirect costs of pain treatment and 

effectiveness of evidence-based treatment approaches and include 

this information in the fiscal year 2019 CJ. 

Diabetes Prevention Program.—The Committee recommendation 

includes $22,500,000, level with fiscal year 2017, for the Diabetes 

Prevention Program. This program promoting lifestyle interventions has proven to reduce the risk of developing diabetes by 58 

percent in individuals at high risk. 

Division of Diabetes Translation [DDT].—The Committee recognizes the work of CDC’s DDT to address the diabetes epidemic and 

encourages CDC to continue to ensure that the prevention needs of 

those Americans with, and at risk for, diabetes and prediabetes are 

met. The Committee believes these activities must include clear 

outcomes and ensure transparency and accountability that demonstrate how funding was used to support diabetes prevention and 

specifically how diabetes funding reached State and local communities. Additionally, the Committee encourages CDC to support the 

translation of research into better prevention, care, and surveillance. The Committee encourages CDC to explore opportunities to 

expand virtual delivery of the National Diabetes Prevention Program’s lifestyle change program in rural areas where patients have 

provider care access challenges. 

Early Child Care Collaboratives.—The Committee recognizes 

that the early care and education setting is important for promoting healthy habits in young children. The Committee provides 

$4,000,000 to the National Early Child Care Collaboratives to en-
65 

able training of early care and education providers in implementation of healthy eating and physical activity best practices, including 

strategies for engaging families. Funds will also support technical 

assistance for integration of healthy eating and physical activity 

best practices into existing State and local professional development systems’ early care and education settings, and health initiatives. The Committee also encourages the program to serve a mix 

of rural, suburban and urban areas, including areas with high 

childhood obesity rates. 

Electronic Cigarettes.—The Committee notes a rise in usage of 

electronic cigarettes, or e-cigarettes, among U.S. middle and high 

school students. The Committee is aware of an ongoing NAM study 

on the health effects from e-cigarettes that is due out at the end 

of 2017, which will include recommendations for future federally 

funded research. The Committee encourages CDC to examine the 

recommendations from the NAM study and report to the Committee on opportunities that may exist for further research. 

Epilepsy in Rural Areas.—The Committee encourages CDC to 

continue telehealth and educational training programs for rural 

and underserved areas that reach school nurses, child care personnel, first responders, and care providers for seniors in order to 

recognize and respond appropriately to seizures caused by epilepsy 

or resulting from trauma and other acute chronic illness. 

Heart Disease and Stroke Prevention.—While largely preventable, 

cardiovascular disease, including heart disease and stroke, continues to inflict the highest burden on our Nation’s long-term 

health and economic stability. The Committee continues funding to 

support, strengthen, and expand heart disease and stroke prevention and control activities within State, local, and tribal public 

health departments and to enhance surveillance and research to 

target high burden populations and guide public health strategies. 

The Committee encourages CDC to prioritize these funds to communities with the highest disease burden of heart disease and 

stroke to identify and disseminate novel and innovative evidencebased strategies, including scientifically valid risk factor reduction 

measures, through competitive awards. 

Heart Valve Disease.—The Committee understands that heart 

valve disease can be debilitating and if not treated properly can result in heart failure, sudden cardiac arrest, and death. The Committee encourages CDC to include information on valve disease on 

its website and to help bring public awareness to this disease. The 

Committee encourages CDC to engage with patient and research 

organizations to explore collaborative ways to integrate information 

about the warning signs, symptoms, and risk factors of valve disease into CDC’s existing programs. 

High Obesity Rate Counties.—The Committee remains concerned 

about the growing body of evidence suggesting that obesity is one 

of the most significant challenges facing the public health system. 

If this epidemic continues unabated, obesity and the many complications it causes will increase the disease burden among Americans, particularly youth. The Committee continues to include 

$10,000,000 to support the rural extension and outreach services 

grants for rural counties with an obesity prevalence of over 40 percent. The Committee expects CDC to work with State and local 
66 

public health departments to support measurable outcomes 

through evidenced-based obesity research, intervention, and prevention programs. Grants should combine basic, clinical, and population research to better understand and treat the metabolic, medical, surgical, environmental, and societal implications of obesity in 

cooperation with partners that have existing outreach capacity to 

develop and implement educational and intervention programs. 

Preference should be given to States where at least 10 percent of 

counties meet the requirements of this program. In addition, CDC 

shall focus its efforts in areas of the country with the highest burden of obesity and with the comorbidities of hypertension, cardiac 

disease, and diabetes from county level data in the Behavioral Risk 

Factor Surveillance System. The Committee encourages CDC to 

support only activities that are supported by scientific evidence. 

Inflammatory Bowel Diseases [IBD].—The Committee commends 

CDC for its commitment to the study of IBD epidemiology and is 

concerned by the results of the recent Morbidity and Mortality 

Weekly Report which demonstrates that IBD affects 3,300,000 

Americans, almost three times the number of adults previously estimated to have IBD. The Committee is particularly concerned that 

IBD is increasingly recognized in minority and underserved communities and encourages CDC to complement its existing epidemiological study with a focus on these populations. 

Interstitial Cystitis [IC].—The Committee recommendation for IC 

activities provides support for the ongoing epidemiology study, as 

well as education, outreach, and public awareness activities. 

Lupus Registry.—The Committee continues to support research 

efforts under the National Lupus Patient Registry program, but acknowledges that challenges still remain. Burden of illness studies 

are needed to better understand and evaluate issues such as the 

disease impact on quality of life, productivity, frequency of clinical 

events, natural history, and the direct and indirect costs associated 

with lupus. The Committee encourages CDC to support the lupus 

cohort and burden of illness studies. 

Million Hearts 2022.—The Committee supports Million Hearts 

2022 and encourages CDC to capitalize on the solid foundation, 

best practices, evidence, shared tools, and progress made on this 

public-private initiative to prevent heart attacks and strokes. Continued funding will allow implementation of evidence-based interventions to prevent heart disease and stroke in areas with the 

highest burden by implementing the ABCS: aspirin when appropriate, blood pressure control, cholesterol management, and smoking cessation; supporting innovative strategies to increase physical 

activity; using cardiac rehabilitation; and developing innovative, 

scalable approaches to improve cardiovascular health. 

Mississippi Delta Health Collaborative [MDHC].—The Committee 

commends CDC’s ongoing efforts to support the MDHC. The program has developed key partnerships at the local level and has implemented team-based approaches designed to link communities 

with clinical care. Within the funds provided for Chronic Disease 

Prevention and Health Promotion, the Committee encourages CDC 

to build on its longstanding investment in MDHC by working to 

replicate the work in additional sites while maintaining the current 

strategy. As it has in past years, CDC shall consider using lifestyle 
67 

change intervention models like the Diabetes Prevention Program; 

utilizing local pharmacy schools with existing community-based research programs that could focus on screenings, medication reviews, medication therapy management, comprehensive medication 

management, and disseminating prevention strategies; and working with communities to establish health networks to better coordinate and manage community based health initiatives. To reach the 

target population, the Committee encourages CDC to take advantage of rapidly evolving healthcare technology by leveraging the resources of States with recognized leadership in areas of electronic 

medical records, telehealth, and innovative delivery of education 

tools. CDC shall provide an update on these activities in the fiscal 

year 2019 CJ. 

Psoriasis and Psoriatic Arthritis.—The Committee recognizes the 

growing body of evidence linking psoriatic disease, which impacts 

more than 8,000,000 Americans, to other comorbidities such as cardiovascular disease, mental health and substance abuse challenges, 

kidney disease, and other conditions. The Committee encourages 

CDC to develop an action plan not later than 6 months after the 

enactment of this act as to how it can leverage existing programs 

and resources to build upon the agency’s Public Health Agenda for 

Psoriasis and Psoriatic Arthritis. 

Pulmonary Hypertension [PH].—The Committee understands 

that PH causes heart failure and death. CDC is encouraged to support education, outreach, and awareness activities that promote 

early and accurate diagnosis of PH. 

Racial and Ethnic Approach to Community Health [REACH].— The Committee eliminates the REACH program due to funding 

constraints. Funding continues to be provided to other programs 

that conduct outreach to reduce ethnic disparities in health status. 

Safe Motherhood Initiative.—Preterm birth affects more than 

500,000 babies each year in the United States and is the leading 

cause of neonatal mortality. The Committee commends CDC for 

funding State-based perinatal collaboratives that focus on improving birth outcomes using known preventative strategies such as reducing early elective deliveries. 

Skin Cancer Education and Prevention.—The Committee is concerned with the growing number of people diagnosed with preventable forms of skin cancer, which is now the most commonly diagnosed cancer in the United States. Every year in the United States, 

nearly 5,000,000 people are treated for skin cancer. Melanoma 

causes more deaths than any other type of skin cancer, resulting 

in over 9,000 deaths each year. The Committee encourages CDC to 

provide increased collaboration and partnership with local governments, business, health, education, community, nonprofit and faithbased sectors in this effort. 

Sleep Surveillance.—The Committee is pleased by CDC’s work on 

a national public health awareness campaign for sleep. The Committee encourages CDC to ensure that funding for surveillance activities on sleep disorders and sleep health is maintained in addition to these awareness efforts. 

Stroke Prevention.—States in the Stroke Belt have age-adjusted 

stroke mortality rates that are significantly higher than the national average. The Committee encourages the Division to further 
68 

focus its resources in the Stroke Belt, including the development of 

a comprehensive strategy to address stroke mortality and morbidity in the region. CDC shall provide an update on these efforts 

in the fiscal year 2019 CJ. 

WISEWOMAN.—The Committee lauds the WISEWOMAN program that helps uninsured and under-insured low-income women 

ages 40 to 64 decrease, prevent, or control heart disease and stroke 

by providing preventive health services, referrals to local health 

care providers, lifestyle programs, and health counseling services 

tailored to identified risk factors to promote lasting, healthy behavior change. Between July 2013 and June 2016, WISEWOMAN provided an estimated 74,000 health behavioral support services and 

51,000 blood pressure screenings. The Committee recognizes the 

critical role screening and referral programs play in reducing cardiovascular disease and directs CDC to explore innovative approaches to expand the number of women served through 

WISEWOMAN and report the results to the Committee no later 

than September 30, 2018. 

NATIONAL CENTER ON BIRTH DEFECTS, DEVELOPMENTAL

DISABILITIES, DISABILITY AND HEALTH

Appropriations, 2017 ............................................................................. $137,560,000 

Budget estimate, 2018 ........................................................................... 100,000,000 

Committee recommendation ................................................................. 139,560,000 

The Committee recommendation for the activities of the National 

Center on Birth Defects and Developmental Disabilities [NCBDDD] 

is $139,560,000. 

This Center improves the health of children and adults by preventing birth defects, developmental disabilities, and complications 

of heredity blood disorders and by promoting optimal child development and health and wellness among children and adults living 

with disabilities. 

Within the total provided, the following amounts are provided for 

the following categories of funding: 

[In thousands of dollars] 

Budget activity Fiscal year 2017 

appropriation 

Fiscal year 2018 

request 

Committee recommendation 

Total Birth Defects ......................................................................... 137,560 100,000 139,560 

Child Health and Development ............................................. 65,800 N/A 65,800 

Other Birth Defects ...................................................... 19,000 N/A 19,000 

Fetal Death .................................................................. 900 N/A 900 

Fetal Alcohol Syndrome ................................................ 11,000 N/A 11,000 

Folic Acid ..................................................................... 3,150 N/A 3,150 

Infant Health ................................................................ 8,650 N/A 8,650 

Autism .......................................................................... 23,100 N/A 23,100 

Health and Development with Disabilities ........................... 56,660 N/A 58,660 

Disability and Health ................................................... 24,000 N/A 26,000 

Tourette Syndrome ....................................................... 2,000 N/A 2,000 

Early Hearing Detection and Intervention ................... 10,760 N/A 10,760 

Muscular Dystrophy ...................................................... 6,000 N/A 6,000 

Attention Deficit Hyperactivity Disorder ....................... 1,900 N/A 1,900 

Fragile X ....................................................................... 2,000 N/A 2,000 

Spina Bifida ................................................................. 6,000 N/A 6,000 

Congenital Heart Defects ............................................. 4,000 N/A 4,000 

Public Health Approach to Blood Disorders ......................... 4,400 N/A 4,400 
69 

[In thousands of dollars] 

Budget activity Fiscal year 2017 

appropriation 

Fiscal year 2018 

request 

Committee recommendation 

Hemophilia CDC Activities .................................................... 3,500 N/A 3,500 

Hemophilia Treatment Centers ............................................. 5,100 N/A 5,100 

Thalassemia .......................................................................... 2,100 N/A 2,100 

Blood Safety Monitoring.—Facing an increase in infectious diseases that have a known or potential risk of transmission via blood 

transfusion, patients with thalassemia, anemia, and other diseases 

that impact blood production often face a lack of information about 

transmission modes and rates of infectious diseases, including new 

or emerging viruses like the Zika virus. The Committee encourages 

CDC to provide specific information to assist blood centers in responding to emerging infectious diseases that may be transmitted 

by blood transfusion. 

Cerebral Palsy [CP].—The Committee encourages CDC to build 

upon existing surveillance and research applications of CP surveillance within the established 11 Autism and Developmental Disabilities Monitoring Network surveillance sites. The Committee recognizes and supports CDC’s efforts to include CP surveillance in 

three existing sites and encourage CDC to expand this effort within 

current resources to additional sites allowing for a more nationally 

representative sample. 

Congenital Heart Disease [CHD].—CHD is the number one category of birth defects in the United States. The Committee notes 

that children and adults with CHD require ongoing, specialized 

cardiac care, and there remain gaps in data as children and adolescents transition to adult care. The Committee commends NCBDDD 

for its leadership in addressing CHD and adult CHD surveillance 

efforts and requests a report in the fiscal year 2019 CJ on CDC 

surveillance and research efforts regarding CHD across the lifespan, age-specific prevalence, and factors associated with those patients who may have dropped out of appropriate specialty care. 

Disability and Health Officer.—The Committee encourages CDC 

to re-appoint a Chief Disability and Health Officer and re-establish 

the Disability and Health Work Group to provide leadership, coordination, and collaboration among Centers in order to expand 

and improve efforts to enhance the health of individuals with disabilities. 

Fragile X and Associated Disorders.—The Committee commends 

CDC’s efforts to identify and define the population impacted by FX 

and FXD with the goal of understanding the public health impact 

of these conditions. The Committee acknowledges significant 

progress made by the NCBDDD Fragile X Clinical and Research 

Consortium in growing its FORWARD Database and its Patient 

Registry. CDC is encouraged to continue this effort. The Committee 

also supports the public-private partnership which resulted in the 

‘‘Future of Fragile X: Setting the Public Health Research Agenda’’ 

meeting in 2014 and the resulting Funding Opportunity Announcement which seeks to use longitudinal data to characterize the natural history of Fragile X to improve services and outcomes. The 

Committee encourages the NCBDDD to continue data-driven public 
70 

health research to reduce the public health burden of both FX and 

autism. 

Health and Development for Those With Disabilities.—The Committee supports CDC awards under the National Centers on Health 

Promotion for People with Disabilities and its goal of promoting 

better health for adults and children with disabilities. By mobilizing national networks to provide technical assistance, provide 

community leaders and community organizations with health promotion training, and by disseminating effective strategies and tools 

for disability service providers, these awards play an important 

role in encouraging a healthier lifestyle for Americans with disabilities. 

Hemophilia.—The Committee has included sufficient funding to 

maintain the Center’s hemophilia programs, which provide critical 

information to better understand risk factors for complications and 

identify high-risk populations for prevention measures. The Committee recognizes the importance of CDC’s research on inhibitors 

and recommends that CDC enhance the inhibitor surveillance program and further prevention and eradication activities. The Committee encourages CDC, working with stakeholders and the network of hemophilia treatment centers, to implement inhibitor testing across the United States and support further research to better 

understand inhibitors and how they can be prevented. 

Improving the Health of People With Intellectual Disabilities 

Through Physical Activity.—People with disabilities have a high 

risk of poor health outcomes such as obesity, hypertension, and 

mood disorders such as depression. Therefore, the Committee includes $8,700,000 for the Healthy Athletes program. 

Marfan Syndrome.—The Committee remains concerned that 

structural cardiovascular disorders, such as Marfan syndrome, continue to claim the lives of high school athletes across the country 

who received a sports physical prior to competition. CDC is encouraged to work with patient and professional stakeholders to develop 

minimum screening guidelines that ensure all young athletes are 

appropriately screened for potentially life-threatening structural 

cardiovascular disorders. 

Muscular Dystrophy Surveillance.—The Committee is aware of 

CDC’s established surveillance efforts through the Muscular Dystrophy Surveillance, Tracking, and Research Network [MD 

STARnet] and encourages CDC to continue its work to enhance the 

quality and quantity of the data being collected through MD 

STARnet. Additionally, the Committee is interested in CDC’s plans 

to disseminate and implement the updated care standards, including for adults with Duchenne and for other forms of muscular dystrophy. The Committee also supports CDC’s engagement of multiple Divisions and Centers in the development of a Duchenne newborn screening program along with the refinement of an International Classification of Disease code for Duchenne and Becker 

Muscular Dystrophy. 

Sickle Cell Disease [SCD].—SCD is a lifelong inherited blood disorder affecting nearly 100,000 Americans who are unable to access 

specialized quality care and effective treatment options. The Committee encourages CDC to continue and expand its SCD surveillance program to better understand and address long term health 
71 

outcomes, complications, and unmet health care access and to initiate a public health awareness campaign for people with SCD and 

a sickle cell trait. 

Spina Bifida.—While spina bifida and related neural tube defects 

are highly preventable through education and adequate daily folic 

acid consumption, they are the most common permanently disabling birth defect in the United States. The Committee supports 

the continuation of the Spina Bifida Clinical Care Monitoring and 

Tracking program and commends the National Spina Bifida Program in serving as a model for programs assisting other individuals living with similar complex conditions. The Committee encourages CDC to continue the dissemination of information to clinicians, parents, and families living with spina bifida. 

Tuberous Sclerosis Complex [TSC].—The Committee encourages 

CDC to take into consideration all the major manifestations of TSC 

in its surveillance network. 

PUBLIC HEALTH SCIENTIFIC SERVICES

Appropriations, 2017 ............................................................................. $489,397,000 

Budget estimate, 2018 ........................................................................... 460,000,000 

Committee recommendation ................................................................. 489,397,000 

The Committee recommendation for Public Health Scientific 

Services is $489,397,000. 

This funding supports the work of all of the CDC Centers by 

compiling statistical information to inform public health policy. In 

particular, these activities assure the accuracy and reliability of 

laboratory tests; apply digital information technology to help detect 

and manage diseases, injuries, and syndromes; and develop and inform the public health community on sound public health surveillance, laboratory protocols, and epidemiological practices. 

The Committee recommendation includes funding for the following activities in the following amounts: 

[In thousands of dollars] 

Budget activity Fiscal year 2017 

appropriation 

Fiscal year 2018 

request 

Committee recommendation 

Health Statistics ............................................................................ 160,397 155,000 160,397 

Surveillance, Epidemiology, and PH Informatics ........................... 279,000 260,000 279,000 

Public Health Workforce ................................................................. 50,000 45,000 50,000 

Alzheimer’s Disease and Dementia.—The Committee is aware of 

recent peer-reviewed studies suggesting that more than 500,000 

U.S. deaths each year are attributable to Alzheimer’s disease and 

dementia, far in excess of the deaths reported by the Center each 

year. Such statistics would elevate Alzheimer’s disease from the 

sixth leading cause of death to the third leading cause of death. 

The Committee looks forward to receiving CDC recommendations 

on ways to ensure the accuracy and completeness of measurements 

of the Alzheimer’s disease and dementia death rate and to develop 

a consensus on the mortality burden of the disease. 

Digital Bridge.—The Committee remains interested in an integrated public health surveillance strategy to improve real-time surveillance and situational awareness. The Committee is encouraged 
72 

by efforts underway at CDC and by public-private partnerships 

such as the Digital Bridge initiative that connect the health care 

system, electronic health record vendors, and public health authorities at all levels to reduce reporting burden and scientific, administrative, and fiscal inefficiencies. 

Modernizing Vital Statistics Collection.—While most States have 

or will soon have operational electronic birth and death registration 

systems, many do not have the resources to maximize electronic 

death reporting or to modernize their systems to keep pace with 

new technology. The Committee encourages CDC to support States 

in upgrading antiquated systems and improving the quality and accuracy of vital statistics reporting. 

ENVIRONMENTAL HEALTH

Appropriations, 2017 ............................................................................. $215,750,000 

Budget estimate, 2018 ........................................................................... 157,000,000 

Committee recommendation ................................................................. 180,750,000 

The Committee recommendation for the National Center for Environmental Health is $180,750,000. The Committee recommendation includes $17,000,000 in transfers from the PPH Fund. This 

does not include $35,000,000 in one-time multi-year lead poisoning 

prevention and registry funding for Flint, Michigan provided in fiscal year 2017. 

The National Center for Environmental Health addresses emerging pathogens and environmental toxins that pose significant challenges to public health. The Center conducts surveillance and data 

collection to determine which substances in the environment are 

found in people and to what degree. The Center also determines 

whether and at what level of exposure these substances are harmful to humans. 

The Committee recommendation includes funding for the following activities: 

[In thousands of dollars] 

Budget activity Fiscal year 2017 

appropriation 

Fiscal year 2018 

request 

Committee 

recommendation 

Environmental Health Laboratory .................................................. 56,150 55,894 56,150 

Newborn Screening Quality Assurance Program .................. 8,400 N/A 8,400 

Newborn Screening for SCID ................................................. 1,250 N/A 1,250 

Other Environmental Health ................................................. 46,500 N/A 46,500 

Environmental Health Activities .................................................... 44,600 34,106 44,600 

Safe Water ............................................................................ 8,600 N/A 8,600 

Amyotrophic Lateral Sclerosis Registry ................................ 10,000 N/A 10,000 

Climate Change .................................................................... 10,000 N/A 10,000 

All Other Environmental Health ............................................ 16,000 N/A 16,000 

Environmental and Health Outcome Tracking Network ................. 34,000 25,000 34,000 

Asthma ........................................................................................... 29,000 25,000 29,000 

Childhood Lead Poisoning ............................................................. 17,000 17,000 17,000 

Lead Poisoning Prevention ............................................................. 15,000 ............................ ............................

Lead Exposure Registry .................................................................. 20,000 ............................ ............................

Amyotrophic Lateral Sclerosis [ALS] Registry.—The Committee 

continues to support the purpose of the National ALS Registry and 

seeks to understand how to build upon current efforts to improve 

data collection. The Committee directs CDC to review the ALS reg-
73 

istry and submit a report to the Committees on Appropriations of 

the House of Representatives and Senate within one year of enactment of this act to determine the compliance of the ALS registry 

with Congressional intent as laid out in Public Law 110–373. The 

report should include the cost of maintaining the registry, a review 

of how the National ALS registry interacts with State, local, and 

Federal registries to build upon existing data, and recommendations on how to improve the surveillance quality of the registry. 

Asthma.—The Committee continues to support the work of the 

National Asthma Control Program, recognizing that asthma is one 

of the most common and costly health conditions in the United 

States. The Committee understands that better coordination of 

public health and health systems interventions are necessary to reduce the burden caused by asthma and encourages CDC to continue its collaboration with payers and health systems. 

Environmental Health Activities.—The Committee is concerned 

about the increasing health effects on people with asthma, cardiovascular disease, and other chronic diseases caused by increased 

spread of vector-borne disease, air pollution, extreme weather 

events, and longer allergy seasons. The Committee directs CDC to 

continue to help state and local health departments plan for these 

public health threats and to focus on protecting the most vulnerable individuals and communities. 

Hormone Standardization.—The Committee is encouraged by the 

work CDC’s Environmental Health Laboratory has done to date to 

help ensure the accuracy and reliability of testing for certain hormones through its standardization program. The Committee recognizes that gaps still remain in hormone standardization to ensure 

reliable and actionable results. The Committee requests a report in 

the fiscal year 2019 CJ outlining what is necessary for the agency 

to increase the standardization of clinical laboratory testing to help 

prevent misdiagnoses and reduce unnecessary health expenses. 

Lead Poisoning.—The Committee notes that the fiscal year 2017 Omnibus provided an additional $35,000,000 in multi-year lead poisoning prevention efforts for a lead exposure registry and an advisory committee. CDC is directed to provide a status update on 

these activities in the fiscal year 2019 CJ. 

Newborn Screening.—The Committee requests CDC provide an 

update in the fiscal year 2019 CJ on actions planned and on-going 

to work with States on ways to ensure screening of infants for diseases for which there is a preventable and/or effective treatment. 

Further, the update should note what steps can be taken to encourage States to adopt and implement new Recommended Uniform 

Screening Panel conditions within one year of their addition. 

INJURY PREVENTION AND CONTROL

Appropriations, 2017 ............................................................................. $286,059,000 

Budget estimate, 2018 ........................................................................... 216,165,000 

Committee recommendation ................................................................. 291,059,000 

The Committee recommendation for the National Center for Injury Prevention and Control is $291,059,000. 

CDC is the lead Federal agency for injury prevention and control. 

Programs are designed to prevent premature death and disability 

and reduce human suffering and medical costs caused by fires and 
74 

burns, poisoning, drowning, violence, and traffic accidents. The national injury control program at CDC encompasses non-occupational injury and applied research in acute care and rehabilitation 

of the injured. 

The Committee recommendation includes funding for the following activities: 

[In thousands of dollars] 

Budget activity Fiscal year 2017 

appropriation 

Fiscal year 2018 

request 

Committee 

recommendation 

Intentional Injury ............................................................................ 97,730 97,730 102,730 

Domestic Violence and Sexual Violence ............................... 32,700 32,700 32,700 

Child Maltreatment ...................................................... 7,250 7,250 7,250 

Youth Violence Prevention .................................................... 15,100 15,100 15,100 

Domestic Violence Community Projects ................................ 5,500 5,500 5,500 

Rape Prevention .................................................................... 44,430 44,430 49,430 

National Violent Death Reporting System ..................................... 16,000 15,970 16,000 

Unintentional Injury ....................................................................... 8,800 6,737 8,800 

Traumatic Brain Injury .......................................................... 6,750 N/A 6,750 

Elderly Falls .......................................................................... 2,050 N/A 2,050 

Injury Prevention Activities ............................................................ 28,950 20,293 28,950 

Prescription Drug Overdose ........................................................... 112,000 75,435 112,000 

Illicit Opioid Use Risk Factors ....................................................... 13,579 ............................ 13,579

Injury Control Research Centers .................................................... 9,000 ............................ 9,000 

Biosurveillance Program.—The Committee continues to be very 

concerned about the high rate of opioid abuse and understands 

data can facilitate forecasting of overdose risk by geographic region. Therefore, the Committee instructs CDC to begin using data 

from the Enhanced State Surveillance of Opioid-Involved Morbidity 

and Mortality program to provide such forecasts that public health 

officials can use to intervene and prevent overdoses. CDC should 

focus on States experiencing the highest rates of opioid related 

overdosing then expand into a national system. 

Combating Opioid Abuse.—CDC Prescription Drug Overdose Prevention [PDO] activities fund critical work in all 50 States and 

Washington, DC. Activities support rigorous monitoring, evaluation, and improvements in data quality at a national level, including data collection and analysis on heroin-related overdose deaths. 

These funds provide States with the greatest burden of opioid 

abuse the ability to implement prevention activities and improve 

interventions that monitor prescribing and dispensing practices. 

This includes maximizing the use of State-based Prescription Drug 

Monitoring Programs [PDMPs] as a public health tool to assist in 

clinical decision-making and in conducting surveillance. The Committee expects CDC to continue to expand and evaluate an innovative model to coordinate care for high-risk opioid patients to ensure 

safer, more effective care. Further the Committee strongly encourages CDC to support local prevention activity to determine the effectiveness of naltrexone in treating heroin and prescription drug 

abuse and reducing diversion of buprenorphine for illicit purposes 

Concussion Surveillance.—The 2013 NAS study ‘‘Sports-Related 

Concussions in Youth: Improving the Science, Changing the Culture’’ recommended that CDC establish and oversee a national surveillance system to accurately determine the incidence of sports-re-
75 

lated concussions, including youth ages 5 to 21. The Committee is 

aware of the promising progress CDC has made in creating a comprehensive survey instrument which the agency will be piloting in 

the coming months to prepare for a national survey in the future. 

The Committee supports CDC’s work in this area and urges the 

agency to increase its efforts. 

Opioid Prescribing Guidelines.—The Committee commends CDC 

for building awareness about responsible opioid prescribing practices by publishing the Guideline for Prescribing Opioids for Chronic Pain. The Committee notes that opioid prescribing for acute pain 

remains a significant driver of initial opioid prescriptions, especially for youth. The Committee encourages CDC to continue its 

leadership in prevention of the opioid epidemic by developing prescribing guidelines for acute pain, including those which are applicable to emergency physicians, surgeons, and dentists. CDC is encouraged to coordinate with the Office of the National Coordinator 

for Health Information Technology to develop and disseminate clinical decision support tools derived from the opioid prescribing 

guidelines. CDC is also urged to work with the VA and the DOD 

on implementing these guidelines to ensure consistent, high-quality 

care standards across the Federal Government. 

Pain Reporting.—The Committee notes that pain is a public 

health problem that causes tremendous burden on the health care 

system. The Committee notes CDC’s prior reports focusing on pain, 

but recognizes that more complete and comprehensive epidemiological data is needed. CDC is urged to investigate the collection of 

data that clarifies the incidence and prevalence of various pain syndromes differentiated by patient age, comorbidities, socio-economic 

status, profession, race and gender. 

Rape Prevention.—The Committee recognizes that 25 percent of 

rape prevention programs currently have a wait time of over a 

month. The Committee therefore has provided an increase of 

$5,000,000 for CDC’s rape prevention and education program and 

directs that at least 75 percent of the program’s funds go to States 

for State and local prevention activities. 

Trauma Surveillance.—The Committee commends CDC for providing funding to States to conduct surveillance on youth and adult 

behavioral risk factors. The Committee encourages CDC to 

prioritize collection and reporting of data on adverse childhood experiences, including exposure to violence. The Committee also encourages CDC to report on the prevalence of adverse childhood experiences across geography, race and ethnicity, and socioeconomic 

status and to examine ways to target such areas or populations 

with high rates of measured adverse childhood experiences. 

OCCUPATIONAL SAFETY AND HEALTH

Appropriations, 2017 ............................................................................. $335,200,000 

Budget estimate, 2018 ........................................................................... 200,000,000 

Committee recommendation ................................................................. 335,200,000 

The Committee recommendation for National Institute for Occupational Safety and Health [NIOSH] programs is $335,200,000. 

NIOSH is the only Federal agency responsible for conducting research and making recommendations for the prevention of work-related illness and injury. The NIOSH mission is implemented by 
76 

conducting basic and applied scientific research and translating the 

knowledge gained into products and services that impact workers 

in settings from corporate offices to construction sites to coal mines. 

Total Worker Health.—The Committee commends CDC’s Total 

Worker Health Program, which aims to promote and protect the 

health and productivity of the American workforce through research and dissemination of innovative and cost-effective tools and 

interventions for American businesses. The Committee commends 

CDC’s work in this area and encourages CDC to continue dissemination of these tools. 

The Committee recommendation includes funding for the following activities at the following amounts: 

[In thousands of dollars] 

Budget activity Fiscal year 2017 

appropriation 

Fiscal year 2018 

request 

Committee 

recommendation 

Total NIOSH .................................................................................... 335,200 200,000 335,200 

National Occupational Research Agenda ............................. 116,000 N/A 116,000 

Agriculture, Forestry, Fishing (non-add) ...................... 25,500 N/A 25,500 

Education and Research Centers ......................................... 29,000 N/A 29,000 

Personal Protective Technology ............................................. 20,000 N/A 20,000 

Mining Research ................................................................... 59,500 N/A 59,500 

National Mesothelioma Registry and Tissue Bank ............... 1,100 N/A 1,100 

Other Occupational Safety and Health Research ................. 109,600 N/A 109,600 

ENERGY EMPLOYEES OCCUPATIONAL INJURY COMPENSATION ACT

Appropriations, 2017 ............................................................................. $55,358,000 

Budget estimate, 2018 ........................................................................... 55,358,000 

Committee recommendation ................................................................. 55,358,000 

The Committee recommendation for the Energy Employees Occupational Illness Compensation Program Act [EEOICPA] is 

$55,358,000. This mandatory funding supports NIOSH scientists 

who reconstruct radiation dose levels to inform compensation decisions. 

GLOBAL HEALTH

Appropriations, 2017 ............................................................................. $435,121,000 

Budget estimate, 2018 ........................................................................... 350,000,000 

Committee recommendation ................................................................. 433,621,000 

The Committee recommends $433,621,000 for global health-related activities at CDC. 

The Center for Global Health leads international programs and 

coordinates CDC’s global efforts with the goal of promoting health 

and preventing disease in the United States and abroad. The Center has a particular focus on ensuring rapid detection and response 

to emerging health threats. 

The Committee recommendation includes funding for the following activities in the following amounts: 
77 

[In thousands of dollars] 

Budget activity Fiscal year 2017 

appropriation 

Fiscal year 2018 

request 

Committee 

recommendation 

Global HIV/AIDS Program ............................................................... 128,421 69,547 128,421 

Global Immunization Program ....................................................... 224,000 206,000 224,000 

Polio Eradication ................................................................... 174,000 165,000 174,000 

Measles and Other Vaccine Preventable Diseases .............. 50,000 N/A 50,000 

Parasitic Diseases and Malaria. ................................................... 24,500 24,453 26,000 

Global Public Health Protection ..................................................... 58,200 50,000 55,200 

Global Disease Detection and Emergency Response ........... 48,400 N/A 45,400 

Global Public Health Capacity Development ........................ 9,800 N/A 9,800 

CDC Global Health Security and Global Health Research.—The 

Committee supports CDC’s work to protect American and global 

health security through the Center for Global Health, the National 

Center for Emerging and Zoonotic Infectious Diseases, and other 

programs that detect, prevent, and respond to infectious disease 

and other health threats. The Committee supports continued work 

in health research, innovation, capacity building for disease research, detection, and surveillance, and robust monitoring and 

evaluation systems at home and abroad. 

Malaria and Parasitic Diseases.—The Committee recognizes the 

important role the Center for Global Health plays in the fight 

against malaria and parasitic diseases. CDC’s crucial monitoring 

and surveillance of transmission, evaluation of interventions for effectiveness and impact, and testing of tools in a real world setting 

are critical to understanding how to scale up global health programs and ensure that our global health investments are smarter, 

better, and not wasteful. The Committee encourages CDC to continue to research, monitor, and evaluate efforts for malaria and 

parasitic disease in collaboration with other divisions and agencies. 

Polio.—CDC is the lead U.S. agency in the global effort to eradicate polio and currently works with various organizations by providing expertise in training, vaccines, epidemiology, laboratory capacity, and surveillance. Currently, polio is endemic in only three 

countries, Nigeria, Afghanistan, and Pakistan. The Committee 

commends these efforts to help eradicate this disease. 

Soil Transmitted Helminth and Related ‘‘Diseases of Poverty’’ 

[STH].—STH infections when found in the United States are most 

frequently seen in poverty stricken, rural populations. Surveillance 

studies through school-based clinics have been successful in providing safe treatments and public health interventions to reduce infection burden, but in some areas with high STH-infection, there 

is no surveillance or remediation effort underway. Therefore, within the funds provided, the Committee includes $1,500,000 to CDC 

for surveillance, source remediation, and clinical care aimed at reducing STH-infection in an area not being addressed by current 

CDC outreach. The clinical care effort shall be led by an academic 

medical center with collaboration from State health agencies, universities, and public health entities and shall be located in a rural, 

agrarian area with high incidence of STH-infection, poverty, and 

chronic disease, especially among children. 
78 

PUBLIC HEALTH PREPAREDNESS AND RESPONSE

Appropriations, 2017 ............................................................................. $1,405,000,000 

Budget estimate, 2018 ........................................................................... 1,266,000,000 

Committee recommendation ................................................................. 1,405,000,000 

The Committee recommendation for the Office of Public Health 

Preparedness and Response [PHPR] is $1,405,000,000. 

The mission of PHPR is to build and strengthen national preparedness for public health emergencies including natural, biological, chemical, radiological, and nuclear incidents. PHPR administers national response programs and assets, as well as grants to 

States and localities to enhance preparedness efforts across the 

country. 

The Committee recommendation includes funding for the following activities in the following amounts: 

[In thousands of dollars] 

Budget activity Fiscal year 2017 

appropriation 

Fiscal year 2018 

request 

Committee 

recommendation 

Public Health Emergency Preparedness Cooperative Agreement .. 660,000 551,000 660,000 

Academic Centers for Public Health Preparedness ....................... 8,200 ............................ 8,200 

BioSense ......................................................................................... 23,000 N/A 23,000 

All Other CDC Preparedness .......................................................... 138,800 140,000 138,800 

Strategic National Stockpile .......................................................... 575,000 575,000 575,000 

Emergency Preparedness.—The Committee recognizes the importance of the Public Health Emergency Preparedness program 

[PHEP] in helping States and territories strengthen their public 

health system capacity. In doing so, the Committee does not include the proposed cut to the program and instead provides the 

same level of funding as fiscal year 2017. The Committee continues 

to request detailed information on how PHEP funding is distributed at the local level by States. CDC is encouraged to provide in 

the fiscal year 2019 CJ an update on how much of the Federal 

PHEP funding is being allocated to local health departments and 

what basis or formula each State is using to make such allocations. 

Strategic National Stockpile.—The Committee encourages CDC 

to evaluate the latest approved advances in influenza prevention 

and antiviral treatment for inclusion in the SNS in preparation for 

pandemic influenza. Further, the Committee encourages BARDA 

and CDC to better coordinate the handoff of new countermeasures 

being purchased for the Strategic National Stockpile and, as appropriate, maintain BARDA involvement to negotiate technical details 

of future procurement. The Committee requests a report within 90 

days of enactment of this act detailing the number of potential 

FDA-approved MCMs that will be needed in the SNS over the next 

3 fiscal years (including new products or products currently in the 

SNS that will require replenishment), and the anticipated costs to 

purchase these products while maintaining current SNS products. 

BUILDINGS AND FACILTIIES

Appropriations, 2017 ............................................................................. $10,000,000 

Budget estimate, 2018 ........................................................................... 20,000,000 

Committee recommendation ................................................................. 10,000,000 
79 

The Committee recommendation for Buildings and Facilities is $10,000,000. 

NIOSH Facility.—The Committee is aware that CDC plans to 

consolidate the NIOSH Cincinnati research facilities, which are 

more than 50 years old, into one modern laboratory in order to reduce operational costs and strengthen scientific collaboration. The 

Committee understands that CDC plans to support this facility replacement through the Department’s Nonrecurring Expense Fund. 

The Secretary and CDC are directed to prioritize obligations for 

this facility and obligate such funds as quickly as possible in fiscal 

year 2018. 

Replacement of the Lake Lynn Experimental Mine and Laboratory.—The Secretary is directed to provide quarterly reports to the 

Committees on Appropriations of the House of Representatives and 

Senate detailing activities to replace the Lake Lynn Laboratory. 

The Committee continues to support CDC efforts to find a replacement facility. 

CDC-WIDE ACTIVITIES

Appropriations, 2017 ............................................................................. $273,570,000 

Budget estimate, 2018 ........................................................................... 105,000,000 

Committee recommendation ................................................................. 273,570,000 

The Committee provides $273,570,000 for public health leadership and support activities at CDC. 

The recommendation includes $160,000,000 in transfers from the 

PPH Fund. 

The Committee recommendation includes funding for the following activities in the following amounts: 

[In thousands of dollars] 

Budget activity Fiscal year 2017 

appropriation 

Fiscal year 2018 

request 

Committee 

recommendation 

Preventive Health and Health Services Block Grant ..................... 160,000 ............................ 160,000 

Public Health Leadership and Support ......................................... 113,570 105,000 113,570 

Preventative Health and Health Services Block Grant.—The Committee continues to oppose this administration’s and the previous 

administration’s proposal to eliminate this program. The Committee provides $160,000,000, the same level as in fiscal year 2017. 

These grants are crucial for States because they provide enough 

flexibility necessary to resolve any emerging health issues at the 

local level while tailoring those activities to best address the diverse, complex, and constantly changing local community. 

The Committee does not include bill language requested by the 

administration to provide additional transfer authority to the Director beyond that which is already provided to the Secretary. 

NATIONAL INSTITUTES OF HEALTH

The National Institutes of Health [NIH] is the global leader in 

medical research and the Committee provides an increase of 

$2,000,000,000 for a third year in a row after a decade of stagnant 

funding. The Committee provides $36,084,000,000 for NIH activi-
80 

ties within the jurisdiction of this bill, an increase of 5.9 percent 

above fiscal year 2017. This includes $1,074,443,000 in transfers 

available under section 241 of the PHS Act. The Committee continues a reform to section 241 allocations such that no NIH funding 

will be removed from NIH under this authority. This reform ensures that section 241 transfers are a benefit to NIH rather than 

a liability. In addition, it improves the transparency of NIH’s budget, so that the enacted total is truly the amount the Committee expects to be used for biomedical research. 

The Committee continues its commitment to funding research on Alzheimer’s disease and increases funding by $414,000,000 to a 

total of approximately $1,828,000,000 in fiscal year 2018; increases 

funding for the Precision Medicine Initiative by $10,000,000; increases funding for antibiotic resistance research by $50,000,000; 

and increases funding for the BRAIN Initiative by $140,000,000. In 

addition, funding is provided to ensure that every Institute and 

Center receives an increase above fiscal year 2017 to continue investments in innovative research that will advance the fundamental knowledge and speed the development of new therapies, 

diagnostics, and preventive measures to improve the health of all 

Americans. Revolutionary discoveries often come from unexpected, 

untargeted research. The Committee continues to support these 

basic advances as well as the clinical and translational research 

that moves basic discoveries from ‘‘bench-to-bedside.’’ 

The Committee rejects the administration’s proposals to: cap Facilities and Administrative costs; eliminate the John E. Fogarty 

International Center; and create the National Institute for Research on Safety and Quality. 

NATIONAL CANCER INSTITUTE

Appropriations, 2017 ............................................................................. $5,671,926,000 

Budget estimate, 2018 ........................................................................... 4,474,222,000 

Committee recommendation ................................................................. 5,858,270,000 

The Committee recommendation includes $5,858,270,000 for the 

National Cancer Institute [NCI], including $300,000,000 appropriated from the NIH Innovation Account. Of this amount, 

$30,000,000 is available for repairs and improvements to the NCI 

facility in Frederick, Maryland. 

Cancer Kinome.—The Committee is aware that research into the 

role of kinases—enzymes in the human genome that regulate an 

immense variety of cellular function—holds the promise to drive 

the development of new treatments and cures for a variety of cancers, including ovarian cancer. The challenge today is to collectively 

investigate the role of the kinome in triggering cancer and gaining 

a better understanding of which kinases play a role in cancer development in particular patients, and how kinome ‘‘reprogramming’’ contributes to resistance to anti-cancer drugs. NCI is asked 

to support this type of promising personalized medicine research. 

Cancer and Mitochondria.—The Committee commends the NCI 

for its work in establishing a Mitochondrial Model Organisms and 

Cellular Systems Working Group and for its work to identify needs, 

barriers, and opportunities pertaining to mitochondrial biology relevant to addressing mechanistic questions in cancer. The Committee encourages the NCI to continue to support qualified re-
81 

search studies that examine the mechanisms by which cancer cells 

utilize oxidative stress in stromal cells to fuel their growth. 

Deadliest Cancers.—The Committee remains concerned that 

while more effective screening methods and treatments have lowered overall cancer incidence and death rates, some forms of cancer 

remain extremely difficult to diagnose and treat. Defined in statute 

as ‘‘recalcitrant cancers’’—those whose 5-year survival rate is below 

50 percent—they account for nearly half of all cancer deaths in the 

U.S. and include cancers of the pancreas, liver, ovary, brain, stomach, esophagus, and lung. Given the toll these types of cancer exact 

on society, the Committee urges NIH and NCI to continue to support research with an emphasis on developing improved screening 

and early detection tools and more effective treatments. The Committee expects to receive an update in the fiscal year 2019 CJ of 

how NCI is advancing these goals. 

Gastric Cancer.—The Committee continues to be concerned about 

the deadly outcomes of gastric cancer, particularly among young 

adults. The 5-year survival rate for stomach cancer is 30 percent. 

The Committee notes that research on gastric cancer is less advanced than that of many other cancers. The lack of research funding makes it difficult to attract researchers to the field and make 

progress toward curative treatments. The Committee therefore encourages NCI to consider developing a scientific framework, as 

specified by the Recalcitrant Cancer Research Act of 2012 (Public 

Law 112–239, section 1083), for advancing stomach cancer research. 

Gynecologic Cancer Clinical Trials.—Clinical trials have significantly improved survival for women with gynecologic cancers, including ovarian, endometrial, cervical, and vulvar cancers. The 

Committee urges the NCI to continue to work with stakeholders 

through the NCI National Clinical Trials Network Gynecologic 

Cancers Steering Committee to address priorities for the 

gynecologic oncology clinical trials scientific agenda, including increasing the availability of trials for these patients. The Committee 

requests that NCI provide an update to the Committee in the fiscal 

year 2019 CJ. 

IDeA States and Cancer Clinical Trials.—The Committee recognizes that NCI supports clinical trials across the country through 

its National Clinical Trials Network [NCTN] and the NCI Community Oncology Research Program [NCORP]. The Committee understands that there are more than 270 NCORP component sites and 

14 NCORP awardees across the country located in IDeA States, 

and that NCI supports several NCI-designated cancer centers in 

IDeA States. At the same time, the Committee recognizes that 

there are still opportunities for academic medical centers in IDeA 

States to become more engaged in these networks. Therefore, the 

Committee encourages NCI to coordinate with NIGMS in helping 

Clinical and Translational Research award sites in IDeA States 

that do not currently have NCORP or NCTN awards build capacity 

in these regions to conduct cancer clinical trials. The Committee 

also encourages NCI to continue to support NCORP in its mission 

to increase diversity among patients participating in NCI clinical 

trials, especially with regard to rural and minority populations. Finally, the Committee urges NCI, in consultation with NIGMS, to 
82 

encourage collaboration between IDeA awardees and existing NCI 

designated cancer centers, NCTN lead sites, and NCORP sites. 

Immunotherapy.—NCI-funded research on the immune system’s 

ability to find and destroy tumors has led to a new wave of promising treatments for many forms of cancer. Yet much remains unknown about how immunotherapy works on a cellular level, and especially why such treatments are successful for some patients but 

not for others. Without a better understanding of the immune system’s response to cancer and knowing how cancer escapes immunebased therapy, further advances in this field will be slowed. Therefore, the Committee urges NCI to continue to prioritize basic research on the mechanisms of action involved in immunotherapy, including a focus on tumor resistance to immunotherapy. The Committee also recognizes the need for more basic and clinical researchers who have the necessary education to develop new breakthroughs in immunotherapy. The Committee encourages NCI to 

continue to support fellowships and T32 training awards for both 

young and mid-career researchers interested in immunotherapy. 

Liver Cancer.—The Committee notes that in the U.S. liver cancer 

is the second deadliest cancer, with a 5-year survival rate of less 

than 15 percent, and according to the CDC, unlike many other cancers, the rates of liver cancer deaths and incidence are rising. In 

spite of its growing mortality, research spending focused on liver 

cancer is not even among the 20 largest NCI cancers research programs; NCI has few liver cancer-oriented grants in its portfolio, 

and it does not have a Specialized Program of Research Excellence 

[SPORE] for liver cancer. To increase the 5-year survivability of 

liver cancer, the Committee urges that NCI support liver cancer research across its portfolio using a variety of methods to stimulate 

research proposals. The Committee also notes that the link between hepatitis B infection and primary liver cancer is well established with up to 60 percent of global liver cancer cases caused by 

the hepatitis B virus [HBV] and, therefore, urges close collaboration with NIAID and NIDDK on issues related to HBV research. 

Lung Cancer.—The Committee encourages NCI to continue to 

prioritize support for meritorious research for lung cancer generally, as well as for research specifically related to early detection 

and continued advances in treatment with personalized medicine, 

immunotherapy, and other innovative treatments. The Committee 

requests an update in the fiscal year 2019 CJ on these efforts. 

Metastatic Brain Tumor Research.—Metastatic brain tumors are 

the most common brain tumor in adults. While the exact incidence 

of metastatic brain tumors is not known, it is estimated at between 

200,000 and 300,000 people per year. The Cancer Moonshot Initiative has helped to raise awareness of this often neglected form of 

cancer, and the Committee urges NCI to continue working with 

stakeholder organizations to advance research into improving brain 

imaging technologies and developing treatments to increase survivorship. 

Neuroblastoma.—The Committee encourages NCI to expand its 

support for research on high-risk neuroblastoma, including the detection and treatment of central nervous system metastases. The 

Committee requests an update on these activities in the fiscal year 

2019 CJ. 
83 

Pancreatic Cancer.—In 2016, pancreatic cancer rose to become 

the third-leading cause of cancer-related death in the U.S., claiming the lives of nearly 42,000 Americans. Despite progress in combating other forms of cancer, pancreatic cancer remains the only 

major cancer with a 5-year survival rate in the single digits, at 

nine percent, in large part because there are no reliable early detection methods nor effective treatment options. To help turn the 

tide against this deadly cancer, Congress in 2012 passed the Recalcitrant Cancer Research Act (Public Law 112–239), calling for the 

development of scientific frameworks for certain cancers. The Committee requests an update on pancreatic cancer in the fiscal year 

2019 CJ. 

Pediatric Cancer.—The Committee remains concerned about the 

lack of child-specific solutions for pediatric cancer patients and the 

consistent overall rise in rate of incidence (35 percent increase 

since 1975). The Committee acknowledges that the needs of pediatric cancer patients are unique and different from the needs of 

adults with cancer. The majority of cancers in children are not seen 

in the adult population, but the vast majority of solutions continue 

to be adopted and adapted from adult cancer drugs for use in children, despite the toxicity of the drugs for their small developing 

bodies. The consequences continue to leave two-thirds of childhood 

cancer survivors with serious lifelong complications and one-third 

of childhood cancer survivors dead by the age of 36. As a result, 

cancer continues to kill more children than all other diseases combined. The Committee notes that childhood cancer is unique from 

adult cancer and should be approached from a child-specific perspective. Accordingly, the Committee urges the NCI to continue to 

support research that addresses the unique characteristics of childhood cancers and the unique needs of childhood survivors. There 

are some encouraging efforts currently focusing on child-specific solutions, and there should continue to be parallel efforts to determine the efficacy of adult research and treatments for childhood 

cancer; however, they should not be the primary focus. Just as 

adult research hopes to benefit children, it is more likely childhood 

cancer research may benefit adults. Therefore, the Committee encourages the continuation of important pediatric oncology research, 

including clinical trials for children with brain tumors and preclinical testing program evaluating new agents for treating pediatric malignancies. Within the additional resources provided for 

cancer research, the Committee requests a report within 120 days 

after enactment of this act on how the NCI is focusing on the 

unique needs of children. The Committee also encourages NCI to 

continue its investments in the novel pediatric Molecular Analysis 

for Therapy Choice [MATCH] study. The Committee requests an 

update on the progress of MATCH implementation for children 

with cancer, with specific information on issues such as accrual, 

participating institutions, and the scope and progress of the trials 

in the fiscal year 2019 CJ. 

Precision Medicine Initiative [PMI].—The Committee continues 

its strong support of NCI PMI and provides no less than 

$80,000,000 to continue its efforts to develop individualized treatments for cancer patients. The Committee recognizes the potential 

for significant advancements in cancer treatments from the NCI 
84 

MATCH trial. It remains the central pillar of the precision medicine research focused on oncology for cancers that are unresponsive 

to standard interventions. The Committee urges NCI to continue to 

expand precision oncology trials. NCI should also continue to focus 

on launching the important pediatric MATCH trial as pediatric oncology mechanisms are very different from mutations seen in 

adults. Further, the Committee continues to believe in the necessity of NCI-funded clinical trials in the area of immuno-oncology, 

where a patient’s engineered T-cells are used in combination with 

the immune system to fight late stage disease and commends NCI 

for its continued leadership in this area. Of particular interest is 

the use of precision medicine to develop therapies for late stage 

cancers and for those forms of the disease for which meaningful 

conventional treatments have proved largely ineffective for long 

term survival of the patients. NCI shall provide an update on these 

activities in the fiscal year 2019 CJ. 

Prostate Cancer.—The Committee is aware of NCI’s ongoing investment in prostate cancer research and is concerned that prostate cancer lacks treatments for men with advancing disease as 

well as adequate diagnostic and imaging methodologies common in 

other hormone-driven cancers with similar disease burden. To ensure Federal resources are leveraged to the greatest extent possible, the Committee encourages NCI to continue to coordinate its 

response to these needs with other Federal agencies, including 

DOD, as well as private research foundations and advocacy groups. 

Psycho-Social Distress Complications.—According to the Institute 

of Medicine, nearly 50 percent of all cancer patients experience distress. Further, studies suggest that distress in cancer patients 

leads to higher healthcare costs, less compliance with treatment 

pathways, and poorer health outcomes. While significant advancements have been made in biomedical treatments in cancer care, the 

Committee is concerned that the unaddressed psycho-social needs 

of patients are adversely impacting the effectiveness and cost of 

care, as well as the individuals’ overall well-being. The Committee 

encourages NCI to continue to implement distress screenings in the 

NIH Clinical Center and in NCI-funded clinical trials as appropriate, coordinate and share information on this effort with the 

FDA, and provide an update on such activities in the fiscal year 

2019 CJ. 

Research Initiative on Ethnic and Racial Diversity in Cancer.— 

The Committee recognizes that the NIH’s Cancer Moonshot initiative aims to accelerate the discovery of new ways to cure cancers, 

including through an understanding and application of cancer genetic information to the prevention and treatment of cancer. The 

Committee urges the NIH, through the NIMHD and NCI, to continue to support research on the cause, prevention, and treatment 

of cancer in populations with diverse cultural, racial, and ethnic 

composition. To further support such collaborations, the NCI is encouraged to consider research expertise in ethnic and racial diversity and its impact on cancer development and outcomes in evaluating applications for NCI-designated cancer centers. 

Sleep Health and Cancer.—The Committee understands the complex intersection between sleep health and cancer development, 

cancer progression, and remission. The Committee encourages NCI 
85 

to continue to explore the role of sleep health in cancer development and progression. 

Translational Research Program.—The Committee notes the 

SPORE program is NCI’s cornerstone effort to promote collaborative, interdisciplinary translational cancer research. The Committee continues robust support for the SPORE grant program as 

it works to bring basic research into practical treatments. The 

Committee requests an update in the fiscal year 2019 CJ on the 

SPORE program. 

Translational Science of Natural Products for Cancer.—The Committee has recognized the importance of moving natural products 

and their derivatives through development and testing, with the 

goal of accelerating the designation of Investigational New Drug to 

promising natural products that can treat cancer. The Committee 

directs NCI to continue to support this work. 

NATIONAL HEART, LUNG, AND BLOOD INSTITUTE

Appropriations, 2017 ............................................................................. $3,217,081,000 

Budget estimate, 2018 ........................................................................... 2,534,803,000 

Committee recommendation ................................................................. 3,322,774,000 

The Committee recommendation includes $3,322,774,000 for the 

National Heart, Lung, and Blood Institute [NHLBI]. 

Alzheimer’s Disease and Vascular Dementia.—The Committee 

recognizes the importance of well characterized, longitudinal, population-based cohort studies in providing insights into risk factors 

related to dementia, with special focus on minority populations 

where disease burden is greatest. As the participants in these studies have aged, much has been learned about cognitive decline and 

the role of mid-life risk factors, but key challenges remain, particularly in the identification of biomarkers and in understanding the 

role of environmental versus genetic factors. Therefore, within the 

provided funds, the Committee directs NHLBI to recruit and examine the subsequent generations of such cohorts, as studying the 

adult children of these extensively characterized cohort members 

may provide new insights into risk identification and accelerated 

prevention efforts. The project shall conduct clinical examinations, 

including brain imaging, of this second generation of participants. 

Asthma.—The Committee notes with concern the evidence suggesting a causal link between air pollution and the development of 

asthma. The Committee urges NHLBI and the NIEHS to explore 

this potential causal link and any interventions necessary to prevent the development of asthma. 

Congenital Heart Disease [CHD].—The Committee commends 

NHLBI for its continued work to better understand causation and 

appropriate treatments for those with the most life threatening 

congenital heart defects through its biomedical research program 

‘Bench to Bassinet’ and the critical multi-centered infrastructure of 

the Pediatric Heart Network. NHLBI should also explore how the 

new adult CHD accreditation program, that advances and sets 

quality standards for care, can inform its work in this area. The 

Committee urges NHLBI to continue its work with other Federal 

agencies and professional and patient organizations to expand collaborative activities targeted toward prevention and treatment of 

the diverse lifelong needs of children and adults living with CHD. 
86 

The Committee requests a report on these efforts in the fiscal year 

2019 CJ. 

Cystic Fibrosis [CF].—The Committee applauds the work of NIH 

to support translational research tools that spur the development 

of new therapies for rare diseases like cystic fibrosis. Animal models are critical tools for understanding disease progression and 

identifying potential new treatments. The National Swine Resource 

and Research Center [NSRRC], funded by the NIH and hosted at 

the University of Missouri, provides services to develop swine models of many genetic conditions, like cystic fibrosis, to facilitate research and drug development for these diseases. The Committee 

encourages the continuation of jointly funded clinical research programs occurring at CF care centers in Missouri and across the 

country. One such project, the OPTIMIZE study, has brought together hospital systems in nearly 30 States to compare treatments 

for lung infections in those with CF to determine if a commonly 

used combination of antibiotics is safe and effective. Real world 

clinical trials such as this one are often only supported by NIH and 

non-profit organizations, and they may significantly improve care 

and treatment for people with serious, life-threatening diseases 

such as cystic fibrosis. 

Fibrotic Diseases.—The Committee encourages NIH to continue 

to vigorously support research into fibrotic diseases affecting different organs, including the lungs, liver, kidneys, heart, skin, and 

bones and to ensure enhanced coordination among its Institutes as 

they conduct necessary, expanded single organ or cross-organ fibrotic disease research to save lives and reduce healthcare expenses in future years. The Committee also encourages NIH to explore naturally occurring fibrotic disease in domestic animals to investigate opportunities to improve human and animal lives. Since 

many fibrotic diseases are individually rare diseases, a strategy 

that provides collaboration across disease and organ areas is recommended. Furthermore, the Committee encourages NIH to continue to provide oversight and direction through coordinated multiinstitute activities to improve research efforts and avoid redundancy. The Committee requests a report on the current NIH Fibrosis Interest Group and its progress, which brings together key 

stakeholders at the NIH and elsewhere, to evaluate current research efforts and develop strategic paths forward to maximize efforts in fibrotic disease research. The Committee also directs NIH 

to include an update in its fiscal year 2019 CJ on its work relating 

to idiopathic pulmonary fibrosis following the November 2012 

NHLBI workshop, ‘‘Strategic Planning for Idiopathic Pulmonary Fibrosis’’. 

Heart Disease.—The Committee is concerned that heart disease 

continues to impose an enormous burden on our Nation’s long-term 

health and economic stability and directs an NIH-wide 

prioritization of heart research to significantly increase, expand, intensify, and stimulate its investment commensurate with the impact on public health, the economy, and innovative scientific opportunities. The Committee commends NHLBI for its leadership in 

launching a Strategic Vision and directs the Institute to accelerate 

the implementation of the heart research recommendations and 

priorities, including heart failure and cardiac rehabilitation. 
87 

Hemophilia.—The Committee encourages NHLBI to bring together leading hemophilia researchers and clinicians, as well as its 

Federal partners from CDC, FDA, and HRSA to create a national 

scientific agenda for clinical and translational research for the prevention and eradication of inhibitors, a costly complication affecting 

people with hemophilia. 

Longitudinal Study of Cardiovascular Health in African Americans.—The Committee commends NHLBI for accomplishments 

made by its longitudinal study of cardiovascular health in African 

Americans. This 16-year study has provided new insights into and 

better understanding of the burden of cardiovascular disease 

among African Americans in the United States. With this increased 

understanding comes knowledge of the gaps in a number of other 

health conditions that affect African Americans disproportionally, 

such as obesity, diabetes, hypertension, chronic kidney disease, and 

heart failure. Additionally, research has revealed that some of 

these chronic conditions may have an impact on healthy aging, including cognition and risk of dementia and may have 

transgenerational effects. Therefore, the Committee encourages 

NHLBI to continue to follow-up with all current study participants, 

conduct broader examinations for these participants, and explore 

enrollment of a new group of participants, including children and 

grandchildren of current study participants. An expanded study 

will provide researchers more information about the roles of familial factors and shared environments in the development and progression of cardiovascular disease and other conditions. The new 

round of examinations should include measurements that utilize 

the latest technology, such as Magnetic Resonance Imaging, to assess the status of the heart, muscles, and adiposity and to evaluate 

structural brain changes that may be related to hypertension, diabetes, and other chronic disorders. 

National Center on Sleep Disorders Research [NSCDR].—The 

Committee commends NHLBI and NSCDR for recent efforts to reinvigorate collaborations on important research in sleep, sleep disorders, and circadian rhythms. NHLBI and NSCDR are encouraged 

to continue to show leadership in this area and further incorporate 

sleep into relevant research activities across NIH Institutes and 

Centers. 

Postural Orthostatic Tachycardia Syndrome [POTS].—With an 

estimated 1,000,000 to 3,000,000 Americans suffering from POTS, 

a neurological disorder that affects mostly adolescent and adult 

women, there are no effective treatments to address this often 

misdiagnosed and debilitating condition. The level of disability resulting from POTS can be similar to that occurring in multiple 

sclerosis and congestive heart failure, but little research funding 

has been dedicated to date to improving understanding of POTS. 

Due to the lack of effective treatments, many patients are unable 

to attend school or work, resulting in significant impacts to the 

U.S. economy. The World Health Organization recently approved 

the first unique ICD code for POTS, which when implemented, will 

hopefully enable more precise epidemiological research on the disease. The Committee expects NHLBI and NINDS to work with 

stakeholders to stimulate the field and develop strategies that will 
88 

increase our understanding of POTS and lead to effective treatments. 

Pulmonary Hypertension [PH].—The Committee applauds 

NHLBI for identifying the study of underlying mechanisms of disease of PH as one of its areas of focus within its recent strategic 

vision plan for research. The Committee encourages NHLBI to continue its focus in this area, particularly on idiopathic pulmonary 

arterial hypertension, so that additional gains can be made that 

benefit patient outcomes and further improve survivability for affected individuals. 

Sickle Cell Disease.—The Committee encourages NHLBI to 

prioritize the study of sickle cell disease. Academic medical centers 

located in States with significant populations of sickle cell patients 

have made progress in treating the disease through NIH sponsored 

clinical trials and through blood and marrow transplantation for 

sickle cell disease, which is currently the only therapy that can 

cure the disease. However, more research dollars are needed to 

augment the limited treatment options available if we are to have 

a real impact on sickle cell disease. 

Sleep Phenotypes.—The health consequences of sleep disorders 

such as obstructive sleep apnea and insomnia include increased 

risk of hypertension, cardiovascular disease and obesity. The Committee is encouraged by the Institute’s efforts to improve our understanding of sleep disorders and urges the Institute to partner 

with other NIH Institutes to continue advancing research for sleep 

phenotypes and biomarkers that further explore health disparities 

and the intersection between chronic diseases and sleep. 

Thoracic Aortic Disease.—The Committee is concerned about sudden, preventable death caused by thoracic aortic aneurysm and dissection attributed to structural cardiovascular disorders, such as 

Marfan syndrome, and encourages NHLBI to further study the 

mechanisms of disease and opportunities to improve patient health. 

NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL RESEARCH

Appropriations, 2017 ............................................................................. $425,751,000 

Budget estimate, 2018 ........................................................................... 320,749,000 

Committee recommendation ................................................................. 439,738,000 

The Committee recommendation includes $439,738,000 for the 

National Institute of Dental and Craniofacial Research [NIDCR]. 

Temporomandibular Disorder [TMD].—The Committee recognizes NIDCR’s leadership in TMD pain research, which has led to 

establishing TMD as a multisystem disorder with overlapping pain 

and non-pain conditions. The Committee encourages NIDCR to continue its leadership as a critical member of the Trans-NIH Working 

Group on Chronic Overlapping Pain Conditions by promoting and 

advancing integrated research on these conditions. In addition, as 

the oral disability associated with TMD affects a patient’s nutritional health status, the Committee encourages NIDCR to improve 

research on orofacial function relevant to the nutritional implications of TMD. Finally, the Committee is aware of the scientific 

meetings on an integrated systems approach of precision medicine 

related to cellular-molecular-genetic-epigenetic mechanisms related 

to diagnosis and treatment of TMD and its comorbid conditions. In 

2013, several Institutes co-sponsored a workshop on the topic of the 
89 

temporomandibular joint. The Committee requests an update on 

initiatives that resulted from the recommendations that came forth 

from these meetings in the fiscal year 2019 CJ. 

NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY

DISEASES

Appropriations, 2017 ............................................................................. $1,874,028,000 

Budget estimate, 2018 ........................................................................... 1,449,534,000 

Committee recommendation ................................................................. 1,935,597,000 

The Committee recommendation includes $1,935,597,000 for the 

National Institute of Diabetes and Digestive and Kidney Diseases 

[NIDDK]. 

Biomarkers.—The Committee encourages NIDDK to accelerate 

the discovery and validation of biomarkers to aid in designing and 

conducting clinical trials to prevent, treat, and cure type 1 diabetes. The Committee also encourages NIDDK to work with NIAID 

to develop biomarkers specifically related to immune interventions 

for multiple autoimmune diseases, including type 1 diabetes. 

Diabetes.—The Committee recognizes the important work of 

NIDDK, the lead Federal agency conducting research to find a cure 

for diabetes and improve diabetes care. Individuals with and at 

risk for diabetes benefit from life-sustaining advancements in preventing and treating diabetes that result from NIDDK studies. The 

Committee also recognizes the success of the NIDDK-supported research in the development of essential tools to manage diabetes, including insulin pumps and blood glucose monitors, ongoing development of artificial pancreas technologies, and new and better medications to treat diabetes. The Committee urges NIDDK to commit 

resources commensurate with the severity and escalating costs of 

the epidemic to further diabetes research that will build upon these 

past successes, improve prevention and treatment, and bring the 

Nation closer to a cure. 

Drug-Induced Liver Injury Network [DILIN].—The Committee 

commends NIDDK for including analyses of liver injury caused by 

alternative medicines, such as herbal products and supplements, 

within its DILIN. However, the Committee is concerned with the 

limited scope of the current work. Therefore, the Committee directs 

NIDDK to work to expand to a broader sample of herbal products 

and supplements associated with liver injury cases to ascertain 

with greater certainty the causal agents and their prevalence. 

These samples exist within the DILIN Repository and afford an opportunity to analyze products for unlabeled ingredients, along with 

current analyses. This work can help generate a database to help 

identify signals to prevent future liver injury. The Committee requests that NIDDK provide an update to the Committee in the fiscal year 2019 CJ. 

Glomerular Diseases.—The Committee encourages continued support for the Cure Glomeruloneuropathy initiative which has enrolled over 1,500 clinical research participants to further the understanding of rare forms of kidney diseases. 

Inflammatory Bowel Diseases [IBD].—The Committee is pleased 

by NIDDK’s support of research into inflammatory bowel diseases. 

The Committee urges NIDDK to respond to these findings by providing additional support for research on IBD. Research should in-
90 

clude a focus on the environmental triggers and epigenetics of IBD 

as well as interventions for the rising prevalence of IBD. The research should also be targeted at both pediatric and adult patients. 

Interstitial Cystitis.—The Committee is pleased with the evolving 

research on interstitial cystitis and encourages NIDDK to work 

with stakeholders on a comprehensive scientific conference to examine mechanisms for scientific opportunity. 

Multidisciplinary Approach to the Study of Chronic Pelvic Pain 

[MAPP].—The Committee is pleased with the progress of the 

MAPP Research Network and encourages collaborations with 

stakeholders to ensure proper dissemination of information. 

National Commission on Digestive Disease Research.—The Committee continues to value and support the implementation of the 

2009 National Commission on Digestive Disease Research report 

entitled ‘‘Opportunities & Challenges in Digestive Diseases.’’ The 

Committee requests an update on the implementation of the recommendations of the National Commission. 

NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE

Appropriations, 2017 ............................................................................. $1,782,582,000 

Budget estimate, 2018 ........................................................................... 1,355,998,000 

Committee recommendation ................................................................. 1,904,666,000 

The Committee recommendation includes $1,904,666,000 for the 

National Institute of Neurological Disorders and Stroke [NINDS], 

including $43,000,000 appropriated from the NIH Innovation Account. 

Brain Aneurysm Research.—The Committee is concerned that an 

estimated 1 out of every 50 individuals in the United States has 

a brain aneurysm and an estimated 30,000 Americans suffer a 

brain aneurysm rupture each year, with little to no warning. Ruptured brain aneurysms are fatal in about 40 percent of cases. Despite the widespread prevalence of this condition and the high societal cost it imposes on our Nation, the Federal Government only 

spends approximately $0.83 per year on brain aneurysm research 

for each person afflicted with a brain aneurysm. The Committee is 

concerned that not enough research is focused on prevention and 

requests a report regarding the annual support level for brain aneurysm research funding over the past 5 years, including the types 

of grants supported in the fiscal year 2019 CJ. 

Brain Research through Advancing Innovative Neurotechnologies 

[BRAIN] Initiative.—The Committee continues its strong support 

for the BRAIN Initiative and provides $400,000,000 in fiscal year 

2018. The Committee commends the NIH for its leadership to date 

on the BRAIN Initiative and the progress made in several areas. 

The BRAIN Initiative is developing a more complete understanding 

of brain function and has the possibility of helping millions of people who suffer from a wide variety of neurological and psychiatric 

disorders such as Parkinson’s disease, schizophrenia, Alzheimer’s 

disease, depression, and traumatic brain injury. Powerful new technologies and tools are allowing for the study of anatomical and 

functional abnormalities in neuro-psychiatric diseases, which is the 

key to understanding these diseases and developing therapies and 

cures. 
91 

Cerebral Palsy [CP].—The Committee commends NINDS for developing the CP 5-year Strategic Plan and urges NINDS to implement Funding Opportunity Announcements in support of the top 

priorities and increase its CP research efforts for prevention, treatment, and cure through the lifespan. The Committee encourages 

funding for basic and translational research (including regenerative 

medicine) for improved outcomes for patients with CP, and recommends collaboration with the research and advocacy community. 

Furthermore, the Committee recommends that NIH form a transNIH working group of program officers who manage their Institute’s CP portfolio and that this group regularly interact with CP 

patient advocacy groups. 

Duchenne Muscular Dystrophy.—The Committee is aware of 

stakeholder efforts to achieve validated and qualified biomarkers 

for Duchenne Muscular Dystrophy. The Committee supports these 

activities and urges NINDS to work with other Institutes and with 

the FDA to provide the necessary guidance and to assemble a 

workshop of all stakeholders to advance this work. The Committee 

is also concerned about a lack of access to federally funded data, 

such as imaging and biomarker data, that could support qualification of an MRI imaging biomarker and directs NIH to ensure all 

federally funded investigators, including Duchenne investigators, 

are in full compliance with the data sharing requirements included 

in the 21st Century Cures Act. 

Dystonia.—The Committee encourages NINDS to continue to expand the dystonia research portfolio. NINDS is encouraged to work 

with stakeholders in support of a conference to examine evolving 

scientific opportunities in dystonia research and to foster sharing 

of resources and collaboration among investigators. 

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 prevalent 

neurodegenerative disease in the United States. The ultimate success of these recommendations will depend upon targeted research 

initiatives and increased research capacity, even if innovative support and funding mechanisms are required. The Committee recognizes that NINDS is prioritizing public health concerns with severe 

gaps in unmet medical needs and believes any funding increase for 

NINDS in fiscal year 2018 should include support for the research 

recommendations set forth by the NINDS planning strategy to 

bring us closer to better treatments and a cure for Parkinson’s disease. The Committee also encourages NINDS to submit a report of 

its progress on implementing these recommendations at the conclusion of fiscal year 2018. 

Peripheral Neuropathies.—The Committee is pleased at the 

progress of ongoing research into Guillain-Barre syndrome [GBS], 

chronic inflammatory demyelinating polyneuropathy, and related 

conditions, and notes the important connection between Zika and 

GBS. The Committee encourages NINDS to continue work to advance emerging research in a meaningful way. 

Postural Orthostatic Tachycardia Syndrome [POTS].—With an 

estimated 1,000,000 to 3,000,000 Americans suffering from POTS, 

a neurological disorder that affects mostly adolescent and adult 
92 

women, there are no effective treatments to address this often 

misdiagnosed and debilitating condition. The level of disability resulting from POTS can be similar to that occurring in multiple 

sclerosis and congestive heart failure, but little research funding 

has been dedicated to date to improving understanding of POTS. 

Due to the lack of effective treatments, many patients are unable 

to attend school or work, resulting in significant impacts to the 

U.S. economy. The World Health Organization recently approved 

the first unique ICD code for POTS, which when implemented, will 

hopefully enable more precise epidemiological research on the disease. The Committee expects NIHLBI and NINDS to work with 

stakeholders to stimulate the field and develop strategies that will 

increase our understanding of POTS and lead to effective treatments. 

Stroke.—The Committee is concerned that stroke continues to 

enact a massive burden on our Nation’s long-term health and economic stability, and encourages NIH to expand its investment commensurate with the impact on public health, the economy, and innovative scientific opportunities. NINDS shall continue to implement top priorities identified in the 2012 planning initiative for 

stroke prevention, treatment, and recovery research, particularly 

augmentation of the Stroke Clinical Trials Network, including 

early stroke recovery. The Committee lauds the NINDS for its leadership in convening a workshop on ‘‘Translational Stroke Research: 

Vision and Opportunities’’ and directs the Institute to accelerate 

implementation of key recommendations and other findings. 

Traumatic Brain Injuries [TBI].—The Committee understands 

regenerative medicine research and the use of adult stem cells may 

play an important role in the treatment of TBI. The Committee 

strongly encourages NINDS, with other Institutes and Centers, to 

ensure a robust and coordinated portfolio of TBI research is supported with a focus on how to leverage regenerative medicine research and the use of adult stem cells in the treatment of TBI. The 

Committee requests an update in the fiscal year 2019 CJ on efforts 

in these specific areas of TBI research. 

NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES

Appropriations, 2017 ............................................................................. $4,916,346,000 

Budget estimate, 2018 ........................................................................... 3,782,670,000 

Committee recommendation ................................................................. 5,127,866,000 

The Committee recommendation includes $5,127,866,000 for the 

National Institute of Allergy and Infectious Diseases [NIAID]. 

Autoimmune Neuropathies.—The Committee encourages NIAID 

to work with NINDS and other Institutes and Centers to support 

efforts to gauge the state-of-the-science of autoimmune 

neuropathies research into conditions like Guillain-Barre syndrome 

and chronic inflammatory demyelinating polyneuropathy, and to 

establish a cross-cutting research plan for this portfolio. 

Combating Antibiotic Resistant Bacteria [CARB].—The Committee remains deeply concerned about the threat posed by the increasing prevalence of antibiotic resistant bacteria. In fiscal years 

2016 and 2017, NIAID used funding appropriated by the Committee to expand its support for basic, translational, and applied 

research on antibiotic-resistant pathogens and the molecular mech-
93 

anisms of antimicrobial resistance. The Committee strongly supports NIAID’s efforts to continue these efforts, and includes 

$513,000,000, an increase of $50,000,000, to fund clinical trials of 

new antibiotics and novel uses of licensed antibiotics meant to limit 

the development of antibiotic resistance, as well as the development of diagnostics to quickly identify bacterial pathogens to inform antibacterial stewardship. These funds will also make it possible for NIAID to partner with Federal, academic, and industry researchers to develop diagnostics, immunoprophylactics, therapeutics, and vaccines that target multiple antibiotic-resistant bacteria. The Committee encourages NIH to continue to expand its collaboration with USDA and CDC to increase our understanding of 

antibiotic resistance and improve the responsible use of antibiotics 

in agriculture. The Committee requests an update on these activities in the fiscal year 2019 CJ. 

Hepatitis B [HBV].—The Committee notes that infection with 

HBV is a serious public health threat and is associated with approximately 887,000 deaths each year worldwide, making it a leading cause of death in the world. In the United States, 1 in 20 

Americans has been infected with HBV and up to 2,200,000 are 

chronically infected. Left undiagnosed and untreated, 1 in 4 of 

those with chronic HBV infection will die prematurely from cirrhosis, liver failure, and/or liver cancer. In light of this public 

health threat, the Committee is concerned that NIH research 

spending on HBV research was only $49,000,000 in 2016 and has 

declined by almost 16 percent since fiscal year 2011. With Hepatitis C now curable and study of the entire HBV life cycle now possible, NIAID is urged to intensify its current efforts to find a cure 

for HBV. To meet this goal, the Committee urges NIAID to issue 

targeted calls for HBV research proposals in fiscal year 2018 focused upon therapeutic development and the many research opportunities identified by the scientific community. 

Lyme Disease.—With more than 300,000 Americans suffering 

from Lyme disease, especially in rural States across the United 

States, an improved understanding and treatment of the disease is 

essential for the health and well-being of Americans. The Committee encourages NIH to issue requests for grant applications for 

research to investigate causes of all forms and manifestations of 

Lyme disease, including post-treatment symptoms, as well as research to develop diagnostics, preventions, and treatments for 

those conditions and for complications caused by co-infection by 

other tick-transmitted bacteria, viruses, and parasites. The Committee notes that in patients who suffer from long-term complications associated with Lyme disease, clear treatment pathways are 

often missed as a result of inaccurate and incomplete testing. The 

Committee urges the NIAID, in coordination with CDC, to study 

the long-term effects on patients suffering from post-treatment 

Lyme disease syndrome, or ‘‘chronic Lyme disease.’’ Specifically, 

the Committee urges NIAID to evaluate the effectiveness of laboratory tests associated with the detection of Borrelia burgdorferi to 

diagnose the disease early, which can improve the treatment of patients suffering from chronic Lyme disease. The Committee also encourages the National Library of Medicine, in coordination with 

NIAID, to update its terminology in line with new research to more 
94 

accurately reflect the long-term effects of chronic Lyme disease. 

The Committee requests that NIH report on its Lyme disease program. The report should include: (1) A summary of ongoing or upcoming efforts to advance more sensitive and accurate diagnostic 

tests capable of distinguishing between active and past infection, 

including an analysis of obstacles hindering adoption of direct detection tests for Lyme disease that are currently available or in the 

pipeline; (2) An assessment of the science on persistent infection 

following antibiotic treatment, with a review of recent research on 

biofilms and persistent forms of Lyme bacteria that can tolerate 

standard antibiotic treatment; (3) A summary of NIH research on 

prevention of Lyme disease and related tick-borne diseases, information on the effectiveness of currently available methods for prevention, and a description of methods for prevention NIH plans to 

further investigate; and (4) Details on progress achieving NIH 

Strategic Plan objectives relevant to Lyme disease as well as plans 

to address any shortfalls in meeting goals. 

Malaria.—The Committee urges NIAID to continue its efforts to 

understand the biology of the malaria parasite and to develop tools 

needed for effective and sustainable malaria prevention, treatment, 

and control, including vaccines. 

Sexually Transmitted Diseases [STDs].—The Committee is aware 

of the most recent STD Surveillance Report that found that the 

total combined reported cases of chlamydia, gonorrhea, and syphilis 

reached a record high and that the CDC estimates 20,000,000 new 

STDs occur every year. The Committee encourages NIAID to work 

in collaboration with CDC to develop effective strategies for prevention and treatment approaches, including vaccine development, to 

combat STDs, and to increase research to understand the evolution 

and structure of STDs and the inter-relationship with HIV/AIDS to 

better control for these diseases. 

Translational Vaccinology.—The Committee notes a very promising area in the field of vaccine and immunology is translational 

vaccinology, in which researchers use innovative principles of vaccine design and enhancement to generate novel, experimental vaccines suitable for assessment and development through pre-clinical 

studies and clinical trials. The Committee strongly encourages 

NIAID to support a robust portfolio of extramural, highly meritorious translational vaccine research that focus on an interdisciplinary approach to this research. The Committee requests NIAID 

provide an update in the fiscal year 2019 CJ on expansion opportunities for interdisciplinary translational vaccinology research. 

Vector-borne Disease.—The Committee continues to support 

NIAID’s ongoing research on a variety of vector-borne diseases including Zika, chikungunya, and dengue, and the Institute’s development of effective countermeasures and strategies. The Committee supports NIAID developing new and expanded research efforts to enhance the array of innovative vector control technologies 

to counter transmission of Zika and other vector-borne infectious 

disease threats. 

Zika-Related Conditions.—The Committee encourages NIAID, 

along with other Institutes and Centers, to establish cross-cutting 

research activities to combat Zika-related conditions, including 

Guillain-Barre ́ syndrome. 
95 

NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES

Appropriations, 2017 ............................................................................. $2,650,128,000 

Budget estimate, 2018 ........................................................................... 2,185,509,000 

Committee recommendation ................................................................. 2,887,194,000 

The Committee recommendation includes $2,887,194,000 for the 

National Institute of General Medical Sciences [NIGMS], which includes $1,074,443,000 in transfers available under section 241 of 

the PHS Act. 

Institutional Development Award [IDeA].—The Committee provides $344,313,000 for the IDeA program, an increase of 

$10,952,000. The Committee believes the IDeA program has made 

significant contributions to biomedical research and has led to the 

creation of a skilled workforce and made the program an essential 

component of NIH’s research portfolio. The Committee supports 

this important investment, which extends NIH’s reach nationwide. 

Further, the Committee recognizes the importance of the Centers 

of Biomedical Research Excellence and the IDeA Networks of Biomedical Research Excellence programs and expects funding to be 

maintained for both. These programs are essential to the overall 

success of the program. 

Science Education Partnership Awards [SEPA].—SEPA fosters 

important connections between biomedical researchers and K–12 

teachers and their students. These connections establish an education pipeline to careers in biomedical sciences, which is one of the 

most important areas of workforce development for the U.S. economy. SEPA has been level funded for a number of years and the 

Committee encourages NIGMS to provide additional resources for 

the program within their general increase for fiscal year 2018. Additional funding should be used to award additional innovative K12 science, technology, engineering and mathematics educational 

projects. 

EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH

AND HUMAN DEVELOPMENT

Appropriations, 2017 ............................................................................. $1,379,684,000 

Budget estimate, 2018 ........................................................................... 1,032,029,000 

Committee recommendation ................................................................. 1,426,092,000 

The Committee recommendation includes $1,426,092,000 for the 

Eunice Kennedy Shriver National Institute of Child Health and 

Human Development [NICHD]. 

Congenital Syphilis.—The Committee urges the NICHD to coordinate efforts with NIAID and CDC to identify potential risk factors, increase prevention, improve newborn screening techniques, 

and provide treatment to improve outcomes in women and infants 

infected with Syphilis, with special focus on infants infected with 

HIV and Congenital Syphilis. 

Fragile X [FX].— The Committee commends NIH for the NICHDled effort that has resulted in significant progress in mapping the 

molecular, physiological, biological, and genetic connections among 

Fragile X, the FX protein, and autism. Given the inextricable connection between the FX protein and autism, the Committee urges 

the Director and his counterparts at each Institute with Fragile X 

and autism portfolios to explore ways to create greater efficiency 
96 

and synergy between these two research tracks to accelerate 

translational research toward a better understanding of both conditions and to shorten the time to bring effective treatments for both 

conditions to market. 

Population Research.—The NICHD Population Dynamics Branch 

fosters scientific understanding of changes in human health and 

development at the population level by supporting research and research training in demography, especially through the Population 

Dynamics Centers Research Infrastructure Program, which promotes efficient use of research funding, innovative research, data 

sharing, and the development of young scientists. The Branch also 

spurs scientific innovation in demographic, or population, research 

by wisely investing in large-scale longitudinal studies, including 

the Fragile Families and Child Well Being study and the National 

Survey of Family Growth, the latter which revealed the decline of 

unintended pregnancies in the United States. The Committee urges 

NICHD to sustain its investment in the full spectrum of population 

research activities to advance our understanding of how the demography and health of our Nation are fundamentally intertwined. 

Sports Related Head Impact Research.—The Committee is concerned about the growing prevalence of head impacts, concussion, 

and the associated risk of concussive morbidities among participants in youth sports. The Committee strongly encourages NICHD 

to bolster pediatric sports-related concussion research, including investing in research focused on behavioral interventions and other 

preventative strategies that can reduce head impacts and concussion among young athletes. 

NATIONAL EYE INSTITUTE

Appropriations, 2017 ............................................................................. $732,855,000 

Budget estimate, 2018 ........................................................................... 549,847,000 

Committee recommendation ................................................................. 758,552,000 

The Committee recommendation includes $758,552,000 for the 

National Eye Institute [NEI]. 

Age-Related Macular Degeneration [AMD].—The Committee recognizes NEI-funded research in which combinations of FDA-approved drugs used to treat a variety of conditions from lowering 

blood pressure to treating prostate disease may eventually offer an 

option for preventing vision loss associated with degeneration of 

cells in the retina from AMD and Stargardt disease, the most common form of inherited juvenile macular degeneration. Discovering 

new uses for these already-approved drugs—which act on G protein 

coupled receptors, a family of signaling proteins in various cell 

types throughout the body—provides the quickest possible transition from bench to bedside. 

Audacious Goals Initiative [AGI].—The Committee commends 

NEI’s leadership through its AGI, which aims to restore vision 

within the next decade through regeneration of the retina by replacing cells that have been damaged by disease and injury and restoring their visual connections to the brain. The Committee is 

pleased that NEI has proceeded with two rounds of grants to date 

that relate to novel imaging technologies to help clinicians observe 

the function of individual neurons in human patients and follow 

them over time as they test new therapies, as well as identifying 
97 

new factors that control regeneration and comparing the regenerative process among model organisms, rodents, and non-human primates. 

Glaucoma.—The Committee recognizes the identification of three 

new genes by the NEI Glaucoma Human Genetics Collaboration 

Heritable Overall Operational Database [NEIGHBORHOOD] Consortium that are strongly associated with primary open-angle glaucoma [POAG], the most common form of the disease. The finding 

that variants of these genes may alter the protection of the optic 

nerve from degeneration due to oxidative stress increases the total 

number of genes associated with POAG to 15, demonstrating that 

the underlying mechanisms of the disease may involve the interaction of many genes with environmental influences. 

Usher Syndrome.—The Committee continues to urge NIH to 

prioritize Usher syndrome research at NEI and NIDCD. The Committee requests an update in the fiscal year 2019 CJ. The update 

should include efforts to stimulate the field and to accelerate viable 

human treatment options for those with Usher syndrome. 

NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES

Appropriations, 2017 ............................................................................. $714,261,000 

Budget estimate, 2018 ........................................................................... 533,537,000 

Committee recommendation ................................................................. 737,727,000 

The Committee recommendation includes $737,727,000 for the 

National Institute of Environmental Health Sciences [NIEHS]. 

NATIONAL INSTITUTE ON AGING

Appropriations, 2017 ............................................................................. $2,052,487,000 

Budget estimate, 2018 ........................................................................... 1,303,541,000 

Committee recommendation ................................................................. 2,535,539,000 

The Committee recommendation includes $2,535,539,000 for the 

National Institute on Aging [NIA]. 

Alzheimer’s Disease.—The bill includes $1,828,000,000, an increase of $414,000,000 above fiscal year 2017 for high-quality research on Alzheimer’s disease, subject to the scientific opportunity 

presented in the peer review process. The Committee commends 

NIA for its leadership in supporting longitudinal, population-based 

cohort studies into the causes of dementia. Because rural, poor, and 

minority populations may be at enhanced risk for dementia, the 

value and application of these studies is enhanced when they include individuals from various geographic, ethnic, socio-economic, 

and generational backgrounds. Therefore, the Committee directs 

NIA to diversify its cohort studies, with the specific goal of capturing a diverse sample of Americans whose inclusion would promote a better understanding of the factors underlying variation 

and disparities in dementia risk and ultimately lead to improved 

diagnostic, treatment, and prevention strategies in high risk populations. 

Population Research.—The Committee recognizes the Institute’s 

leadership in making data, especially longitudinal data, available 

to the broader research community. NIA’s investments in data infrastructure, such as the ground-breaking Health and Retirement 

Study [HRS], have spurred significant scientific research findings 

as well as important interagency and international collaborations. 
98 

In fiscal year 2018, the Committee urges NIA and SSA to continue 

working jointly to support the HRS. The Committee also encourages the Institute to consider recommendations recently issued by 

an outside expert Committee regarding NIA’s major surveys and to 

adopt innovations that will enhance data quality and accessibility. 

The Committee also urges NIA to pursue data collection and dissemination and research activities via its support of the prestigious 

Centers of Demography and Economics of Aging. 

Sleep Health and Alzheimer’s.—The Committee recognizes that 

poor sleep health and sleep disorders promote or influence the development of diseases that impair cognitive functioning, such as 

Alzheimer’s. The Committee encourages research to explore the 

linkages between the sleep cycle, cardiovascular system, and Alzheimer’s in an effort to inform prevention. 

NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN

DISEASES

Appropriations, 2017 ............................................................................. $557,851,000 

Budget estimate, 2018 ........................................................................... 417,898,000 

Committee recommendation ................................................................. 576,178,000 

The Committee recommendation includes $576,178,000 for the 

National Institute of Arthritis and Musculoskeletal and Skin Diseases [NIAMS]. 

Epidermolysis Bullosa.—The Committee recognizes the promising scientific gains and applauds private partners advancing research in pursuit of treatments for Epidermolysis Bullosa. The 

Committee encourages NIH to continue to support the intensification of such research at NIAMS. The Committee further encourages NIAMS to leverage Federal funds with public-private partnerships in the areas of Epidermolysis Bullosa and related disorders. 

Scleroderma.—The Committee applauds NIAMS for its support 

of research into diseases that cause fibrosis in various organ systems, such as scleroderma. The Committee encourages NIAMS to 

prioritize research in this area and pursue collaborative opportunities with other ICs investigating fibrotic diseases. 

NATIONAL INSTITUTE ON DEAFNESS AND OTHER COMMUNICATION

DISORDERS

Appropriations, 2017 ............................................................................. $436,875,000 

Budget estimate, 2018 ........................................................................... 325,846,000 

Committee recommendation ................................................................. 451,768,000 

The Committee recommendation includes $451,768,000 for the 

National Institute on Deafness and Other Communication Disorders [NIDCD]. 

Usher Syndrome.—The Committee continues to urge the NIH to 

prioritize Usher syndrome research at NEI and NIDCD. The Committee requests an update in the fiscal year 2019 CJ. The update 

should include efforts to stimulate the field and to accelerate viable 

human treatment options for those with Usher syndrome. 

NATIONAL INSTITUTE OF NURSING RESEARCH

Appropriations, 2017 ............................................................................. $150,273,000 

Budget estimate, 2018 ........................................................................... 113,688,000 

Committee recommendation ................................................................. 155,210,000 
99 

The Committee recommendation includes $155,210,000 for the 

National Institute of Nursing Research [NINR]. 

NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM

Appropriations, 2017 ............................................................................. $483,525,000 

Budget estimate, 2018 ........................................................................... 361,356,000 

Committee recommendation ................................................................. 500,491,000 

The Committee recommendation includes $500,491,000 for the 

National Institute on Alcohol Abuse and Alcoholism [NIAAA]. 

NATIONAL INSTITUTE ON DRUG ABUSE

Appropriations, 2017 ............................................................................. $1,073,320,000 

Budget estimate, 2018 ........................................................................... 864,998,000 

Committee recommendation ................................................................. 1,113,442,000 

The Committee recommendation includes $1,113,442,000 for the 

National Institute on Drug Abuse [NIDA]. 

Adolescent Brain Development [ABCD].—The Committee recognizes and supports the ABCD study. This study will help the understanding of the dramatic brain development that takes place 

during adolescence and how the various experiences people are exposed to during this time interact with each other and their biology 

to affect brain development and, ultimately, social, behavioral, 

health, and other outcomes. The Committee requests an update be 

included in the fiscal year 2019 CJ on the ABCD study. 

Barriers to Research.—The Committee is concerned that restrictions associated with Schedule 1 of the Controlled Substance Act 

effectively limit the amount and type of research that can be conducted on certain schedule 1 drugs, especially marijuana or its 

component chemicals and certain synthetic drugs. At a time when 

we need as much information as possible about these drugs, we 

need to review lowering regulatory and other barriers to conducting 

this research. The Committee directs NIDA to provide an update 

in the fiscal year 2019 CJ on the barriers to research that result 

from the classification of drugs and compounds as Schedule 1 substances. 

Drug Treatment in Justice System Settings.—The Committee understands that providing evidence-based treatment for substance 

use disorders offers the best alternative for interrupting the drug 

use/criminal justice cycle for offenders with drug problems. Untreated substance-using offenders are more likely to relapse into 

drug use and criminal behavior, jeopardizing public health and 

safety and taxing criminal justice system resources. Treatment has 

consistently been shown to reduce the costs associated with lost 

productivity, crime, and incarceration caused by drug use. The 

Committee applauds NIDA’s focus on adult and juvenile justice 

populations in its research, supports this important work, and asks 

for a progress report in the fiscal year 2019 CJ. 

National Testing Program for Schedule I Marijuana-Derived 

Products in U.S. Distribution.—The Committee appreciates NIDA’s 

work in marijuana research, but is concerned that NIDA ceased 

funding for analysis of marijuana samples seized by law enforcement in 2014. Without dedicated funding for this activity, the number of analyzed seized samples has plummeted, meaning that available data is no longer current or robust. The Committee believes 
100 

that such research, along with analysis of marijuana and marijuana-derived products sold commercially in dispensaries or online, 

is essential for informing substance abuse prevention efforts, public 

health policy, and law enforcement tactics across the Federal Government. Therefore, the Committee directs NIDA to work with law 

enforcement, including the Drug Enforcement Agency, to facilitate 

and ultimately fund a National Testing Program for Schedule I 

Marijuana-Derived Products in U.S. distribution to conduct such 

analysis of both samples seized by law enforcement and of samples 

collected from non-DEA approved sources to provide robust reliable 

data that can inform policy. 

Opioid Misuse and Addiction.—The Committee continues to be 

extremely concerned about the epidemic of prescription opioids, 

heroin, and synthetic opioid use, addiction, and overdose in the 

United States. Approximately 144 people die each day in this country from opioid overdose, making it one of the most common causes 

of non-disease-related deaths for adolescents and young adults. 

This crisis has been exacerbated by the availability of fentanyl and 

its analogs in many communities. The Committee appreciates the 

important role that research can and should play in the various 

Federal initiatives aimed at this crisis. Although NIDA has studied 

the effectiveness and risks associated with long-term opioid use for 

chronic pain, little research has been done to investigate new and 

alternative treatment options. The Committee urges NIDA to expand scientific activities related to research on medications used to 

treat and reduce chronic pain. The Committee encourages NIDA to 

coordinate with the agencies of the NIH Pain Consortium, the 

pharmaceutical industry, experts in the field of pain research and 

addiction, and the medical research community at large to identify 

gaps in scientific research related to opioid abuse and addiction, 

and the treatment of chronic pain, especially the development of 

medications with reduced abuse liability. NIDA is encouraged, as 

appropriate, to work with private companies to fund innovative research into such medications and to sponsor research to better understand the effects of long-term prescription opioid use, especially 

as it relates to the prevention and treatment of opioid abuse and 

addiction. Finally, the Committee also requests an update for the 

NIH’s plan of action to implement Section 108 of the Comprehensive Addiction and Recovery Act, directing the NIH to consider recommendations made by the Interagency Pain Research Coordinating Committee in concert with the Pain Management Best Practices Inter-Agency Task Force, and in accordance with the National 

Pain Strategy, the Federal Pain Research Strategy, and the NIHWide Strategic Plan for Fiscal Years 2016–2020, the latter of which 

calls for the relative burdens of individual diseases and medical 

disorders to be regarded as crucial considerations in balancing the 

priorities of the Federal research portfolio. 

Raising Awareness and Engaging the Medical Community in 

Drug Abuse 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 be 
101 

pleased with the NIDAMeD initiative, targeting physicians-intraining, including medical students and resident physicians in primary care specialties (i.e., internal medicine, family practice, and 

pediatrics). NIDA should continue its efforts in this space, providing physicians and other medical professionals with the tools 

and skills needed to incorporate drug abuse screening and treatment into their clinical practices. 

NATIONAL INSTITUTE OF MENTAL HEALTH

Appropriations, 2017 ............................................................................. $1,608,212,000 

Budget estimate, 2018 ........................................................................... 1,244,901,000 

Committee recommendation ................................................................. 1,724,568,000 

The Committee recommendation includes $1,724,568,000 for the 

National Institute of Mental Health [NIMH], including $43,000,000 

appropriated from the NIH Innovation Account. 

Autism Spectrum Disorder [ASD].—The Committee encourages 

NIH’s continued funding of ASD research. The estimated lifetime 

cost of supporting an individual with autism and intellectual disability is $2,400,000, and the cost of supporting an individual with 

autism without intellectual disability is $1,400,000. Based on these 

estimates, the yearly cost of ASD to the United States is 

$236,000,000,000. Medicaid covers autism treatments for nearly 

half of all children with autism and pays for the majority of residential and day programs serving adults with developmental disabilities. NIH-funded research presents an opportunity to mitigate 

the disabling effects of autism and reduce the Federal costs associated with it in the future for children and adults. 

Tick-Borne Diseases.—Lyme disease and other tick-borne diseases are known to cause a wide range of psychiatric manifestations. Published research has shown a higher prevalence of antibodies to Borrelia burgdorferi in psychiatric patients than in 

healthy subjects. Other tick-borne diseases, such as Bartonella 

have also been reported to cause neurological and neurocognitive 

dysfunction, as well as causing agitation, panic disorder, and treatment resistant depression. It is therefore plausible that a certain 

number of cases of severe psychiatric presentations are due to underlying infections, especially since Lyme disease is the number 

one spreading vector-borne disease in the world. To further investigate this hypothesis, the Committee urges NIMH to review the 

published literature on links between tick-borne diseases and psychiatric illnesses, and provide an update in the fiscal year 2019 CJ. 

NATIONAL HUMAN GENOME RESEARCH INSTITUTE

Appropriations, 2017 ............................................................................. $529,537,000 

Budget estimate, 2018 ........................................................................... 399,622,000 

Committee recommendation ................................................................. 546,934,000 

The Committee recommendation includes $546,934,000 for the 

National Human Genome Research Institute [NHGRI]. 

NATIONAL INSTITUTE OF BIOMEDICAL IMAGING AND BIOENGINEERING

Appropriations, 2017 ............................................................................. $357,777,000 

Budget estimate, 2018 ........................................................................... 282,614,000 

Committee recommendation ................................................................. 371,151,000 
102 

The Committee recommendation includes $371,151,000 for the 

National Institute of Biomedical Imaging and Bioengineering 

[NIBIB]. 

In Silico Clinical Trials.—The Committee appreciates the work 

of NIBIB in facilitating technology to move the science of in silico 

clinical trials forward. The Committee directs NIBIB to continue 

and expand this work and to involve other relevant Institutes in 

furthering this effort. 

Traumatic Brain Injury.—Neurotrauma is the umbrella term for 

two primary pathologies, spinal cord injuries and traumatic brain 

injuries. These injuries are unique in that they affect how we are 

and who we are, with incredible variation between patients. The 

sizable incidence of injury and prevalence of disability resulting 

from neurotrauma results in significant human and economic burden. As befits the complexity of the challenges from neurotrauma, 

multiple NIH Institutes and Centers coordinate research, which 

ranges across a wide spectrum, from understanding the cellular 

mechanisms of immediate and delayed damage, though development of better prevention, treatment, and rehabilitation, and engages scientists, engineers, and clinicians from a broad range of 

disciplines. The Committee recognizes the need for cross-disciplinary collaboration to meet these challenges and strongly encourages NIH to support such research through all appropriate support 

mechanisms. 

NATIONAL CENTER FOR COMPLEMENTARY AND INTEGRATIVE HEALTH

Appropriations, 2017 ............................................................................. $134,689,000 

Budget estimate, 2018 ........................................................................... 101,793,000 

Committee recommendation ................................................................. 139,654,000 

The Committee recommendation includes $139,654,000 for the 

National Center for Complementary and Integrative Health 

[NCCIH]. 

Non-Pharmacological Approaches to Pain Management.—The 

Committee is encouraged by the ongoing collaboration between 

NCCIH, VA, DOD, and other Institutes across the NIH to develop 

and test efficacious non-pharmacological approaches to pain management and comorbidities—including opioid misuse, abuse, and 

disorder—in military personnel, veterans, and their families. As 

opioid prescribing rates have increased at the VA in recent years, 

and opioid abuse has risen among young veterans, the Committee 

believes it is critical that we support research on non-pharmacological treatments to ensure the best quality of care for our Nation’s veterans and servicemembers, and urges the NIH, VA, and 

DOD to continue this vital research. The Comprehensive Addiction 

and Recovery Act (Public Law 114–198) calls for an expansion of 

research and education on and delivery of complimentary and integrative health to veterans, and the NCCIH can play an important 

role in coordinating efforts with the VA, DOD, and other relevant 

Federal agencies. 

Translational Science of Natural Products.—The FDA has opened 

new pathways for development and testing of botanical compounds 

for medical applications, advancing complementary and integrative 

health through the use of natural products and their derivatives in 

treating disease. The Committee directs the NCCIH to consider the 
103 

use of natural products in its research portfolio with the goal of 

speeding the development and testing of natural products and their 

derivatives. 

NATIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH DISPARITIES

Appropriations, 2017 ............................................................................. $288,312,000 

Budget estimate, 2018 ........................................................................... 214,723,000 

Committee recommendation ................................................................. 297,784,000 

The Committee recommendation includes $297,784,000 for the 

National Institute on Minority Health and Health Disparities 

[NIMHD]. 

African American Males and Mental Health.—The Committee is 

concerned with the prevalence of mental health issues which go 

undiagnosed, especially in African American males. Despite developments to diagnose and treat conditions, stigma allows many to 

go without the help that is needed. The Committee encourages the 

NIMH to work collaboratively with community partners to develop 

treatments for the populations that are in need. 

Center of Excellence [COE] in Health Disparities.—The Committee has identified a need for additional research into the varying social, biological, economic, and cultural factors that contribute 

to health disparities between racial groups. The rates of premature 

death from stroke and coronary heart disease are higher among African Americans than among Whites. African Americans have higher rates of diabetes, hypertension, and heart disease than other 

groups. Additionally, African Americans experience higher mortality rates from many cancers. Minorities are underrepresented in 

clinical trials and are less likely to survive prostate cancer, breast 

cancer, and lung cancer than their White counterparts. The Committee requests a written report on NIMHD’s COEs within 120 

days of enactment of this act. 

Focal Segmental Glomerulosclerosis [FSGS].—The Committee encourages NIMHD to continue research collaboration with NIDDK 

to address the connection between the APOL1 gene and the onset 

of FSGS. 

Research Centers in Minority Institutions [RCMI].—The Committee continues to recognize the critical role played by minority 

institutions, especially at the graduate level, in addressing the 

health research and training needs of minority populations. In particular, the RCMI program fosters the development of new generations of minority scientists for the Nation and provides support for 

crucial gaps in the biomedical workforce pipeline, with each dollar 

invested being leveraged to generate an additional five to six dollars in competitive research funding. The RCMI program has the 

capability to promote solutions to the significant gap in R01 grant 

funding among black and other minority researchers when compared to non-minority researchers. The Committee expects NIMHD 

to engage stakeholders and the Committee if any changes to the 

RCMI program are being considered, and prior to any Funding Opportunity Announcement release. 

Research Endowment Program.—The Committee commends 

NIMHD for its unique Research Endowment Program, funding to 

help institutions build research infrastructure and recruit, train, 

and maintain a diverse student body and faculty. The Committee 
104 

remains concerned that NIMHD changed the eligibility requirements for the program without community consultation in the FOA 

released June 4, 2015. However, the Committee is encouraged that 

in April 2017 NIMHD established a special workgroup composed of 

representatives from its Advisory Council and the broader community to review eligibility. The Committee requests that the 

workgroup undertake a thorough review, including a review of the 

maximum endowment qualification limits, and provide recommendations on how to evaluate the program and consider eligibility criteria, given the program is now in its 17th year. The Committee requests that NIMHD submit the results of the deliberations and the recommendations to the Committee prior to NIMHD 

issuing the next FOA, no later than 120 days after enactment of 

this act. 

JOHN E. FOGARTY INTERNATIONAL CENTER FOR ADVANCED STUDY IN

THE HEALTH SCIENCES

Appropriations, 2017 ............................................................................. $72,014,000 

Budget estimate, 2018 ........................................................................... ........................... 

Committee recommendation ................................................................. 74,380,000 

The Committee recommendation includes $74,380,000 for the 

Fogarty International Center [FIC]. 

The Committee recommendation maintains support for FIC, 

which coordinates global health research and training conducted by 

U.S. and international investigators, and helps build relationships 

between health research institutions here and abroad. During the 

Ebola outbreak in West Africa in 2014, Fogarty graduates played 

an important role in efforts to contain the spread of virus in Nigeria and Mali, where Fogarty has invested for decades in research 

training. FIC is now focused on strengthening institutions in Guinea, Liberia, and Sierra Leone, countries that possessed little scientific expertise before the pandemic and consequently suffered the 

most. The Committee directs NIH to provide an update on these efforts in its fiscal year 2019 CJ. 

NATIONAL LIBRARY OF MEDICINE

Appropriations, 2017 ............................................................................. $407,510,000 

Budget estimate, 2018 ........................................................................... 373,258,000 

Committee recommendation ................................................................. 420,898,000 

The Committee recommends $420,898,000 for the National Library of Medicine [NLM]. Of the funds provided, $4,000,000 is for 

the improvement of information systems, to remain available until 

September 30, 2019. 

NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCES

Appropriations, 2017 ............................................................................. $705,903,000 

Budget estimate, 2018 ........................................................................... 557,373,000 

Committee recommendation ................................................................. 729,094,000 

The Committee recommendation includes $729,094,000 for the 

National Center for Advancing Translational Sciences [NCATS]. 

The Committee includes bill language allowing up to $24,496,593 

of this amount to be used for the Cures Acceleration Network 

[CAN]. 
105 

Clinical and Translational Science Awards [CTSA] Program.— 

The Committee includes $533,076,000, an increase of $16,956,000, 

for the CTSA Program. The Committee is deeply concerned about 

NCATS’ management of the CTSA program. The Committee has 

provided robust support for the CTSA program over the past several years and NCATS appears to be both ignoring congressional 

intent regarding the number of CTSA hubs as well as attempting 

to erode financial support for the hubs. Specifically, the Committee 

rejects the recent move to reduce some CTSA awards from a 5 year 

grant cycle to 4 years. Prior notification or justification of this significant change was not provided to the Committee, the CTSA community, or in any written document. The Committee expects 

NCATS to rectify this change immediately and directs all awards 

made in fiscal year 2017 and moving forward to be for 5 years. In 

addition, the Committee strongly supports efforts by NIH to train 

the next generation of biomedical researchers by supporting key 

training programs like the ‘‘K’’ and ‘‘T’’ awards. As stated in the 

National Academies of Sciences, Engineering, Medicine report in 

2013, the CTSA program should build on these and other innovative training and education programs that are helping to bridge the 

gap between the basic and clinical sciences. Further, the Committee is concerned NCATS is considering changing CTSA’s configuration and funding structure without adequate congressional 

notification or stakeholder input. Therefore, the Committee directs 

NCATS to maintain the existing support structure, including maintaining the number of CTSA hub awards at no less than the fiscal 

year 2016 level, and to continue funding CTSA hub awards for 5 

years. NCATS is directed to provide an update to the Committee 

no later than 120 days after enactment of this act on any proposed 

changes to the program and prior to any changes being implemented. In addition, the Committee expects the Director to provide 

quarterly updates to the principal investigators of CTSA hubs and 

the Committee, jointly, beginning within 30 days of enactment of 

this act. Finally, the Committee shall be provided written notification at least 3 days in advance of any public release of CTSA grant 

awards. 

NATIONAL INSTITUTE FOR RESEARCH ON SAFETY AND QUALITY

Appropriations, 2017 ............................................................................. ........................... 

Budget estimate, 2018 ........................................................................... $272,000,000 

Committee recommendation ................................................................. ........................... 

The Committee recommendation does not provide funding for the 

National Institute for Research on Safety and Quality [NIRSQ]. 

OFFICE OF THE DIRECTOR

Appropriations, 2017 ............................................................................. $1,667,610,000 

Budget estimate, 2018 ........................................................................... 1,329,833,000 

Committee recommendation ................................................................. 1,796,970,000 

The Committee recommendation includes $1,796,970,000 for the 

Office of the Director [OD]. Within this total, $575,290,000 is provided for the Common Fund. The Committee moves the All of Us 

study from the Common Fund to OD and provides $290,000,000, an 

increase of $60,000,000 above fiscal year 2017. 
106 

Academic Research Enhancement Award [AREA] Program.—The 

Committee believes that biomedical discoveries can occur anywhere, and continues to support programs that foster biomedical 

research and opportunities for students at institutions who may 

not receive significant NIH funding. In particular, the Committee 

continues its long-standing support of the IDeA program. However, 

the Committee notes that many institutions that may benefit from 

the IDeA program are ineligible because they reside in States that 

are not IDeA States. The Committee encourages NIH to enhance 

support for the AREA program and is urged to develop ways to improve ties between institutions that receive significant NIH funding 

and AREA-eligible institutions. 

All of Us Precision Medicine Initiative.—The Committee recommendation supports the All of Us Precision Medicine Initiative 

and has provided $290,000,000 in support of this Initiative. The 

Committee is encouraged by the enormous potential of precision 

medicine for all populations, including children, since much of 

adult health is rooted in the earliest years. The Committee is 

aware that at an All of Us Research Program stakeholder briefing, 

NIH announced plans to develop working groups to address inclusion of the pediatric population and has also indicated plans to host 

a pediatric stakeholder convening. The Committee requests an update within 90 days after enactment of this act on the status and 

timeline for the working groups to release findings regarding pediatric enrollment in the All of Us Research Program and the expected timeline for beginning enrollment of children from diverse 

backgrounds in the program. The Committee expects NIH to ensure that the research cohort includes a sufficient number of children to make meaningful studies possible. 

Amyloidosis.—The Committee recommends that NIH continue to 

expand its research efforts into amyloidosis, a group of rare diseases characterized by abnormally folded protein deposits in tissues. Amyloidosis is often fatal and there is no known cure. Current methods of treatment are risky and unsuitable for many patients. The Committee directs NIH to keep the Committee informed 

on the steps it takes to increase the understanding of the causes 

of amyloidosis and measures that improve the diagnosis and treatment of this devastating group of diseases. 

Angiogenesis.—The Committee recommends that NIH study the 

regulation of vascular growth and its interactions with the immune 

system, stem cells, DNA repair, and microbiome. Further, the Committee urges the NIH to research the impact of metabolism and dietary factors on endothelial cells, specifically to support normal 

physiology and oppose disease, and to study biomarkers of vascular 

health. 

Autism Spectrum Disorder [ASD].—The Committee commends 

NIH for its commitment to the study of ASD recognizing that there 

are many different subtypes of autism and that the full range of 

potential treatments, appropriate to each subtype, have not yet 

been developed. The Committee encourages NIH to explore a collaborative approach to gain a systematic and comprehensive understanding of each subtype, and to translate this understanding to 

develop individualized treatments. Such an approach would harness information from academia and industry, as well as individ-
107 

uals and families impacted by ASD. The European Union has a 

similar integrated research effort underway to focus on this issue, 

the European Autism Interventions—A Multicentre Study for Developing New Medications. The Committee encourages the NIH to 

explore this approach and provide an update in the fiscal year 2019 

CJ. 

Basic Molecular Science.—The Committee understands basic 

science is the foundation of the research pyramid that support biomedical and translational research efforts. The Committee is concerned with the recent decrease in the proportion of basic research. 

The Committee encourages NIH to expand its basic science efforts, 

with a specific focus on basic molecular research to increase scientific understanding at the molecular level in an effort to support 

translational molecular medicine research of tomorrow. The Committee requests an update in the fiscal year 2019 CJ on the percentage of spending on basic science for the past 10 years and specific efforts to promote basic research that supports molecular medicine and regenerative medicine using induced pluripotent stem 

cells. 

Big Data Infrastructure.—Biomedical research has become increasingly reliant on growing amounts of digital data, a development with tremendous and potentially disruptive promise if this 

data can be used effectively to enable major scientific breakthroughs. Figuring out how to make this possible is one of the biggest obstacles facing NIH. In 2012, NIH began an extramural program to provide a framework of pilot programs, centers of excellence, and grant opportunities to advance thinking in how to organize, share, and use big data. NIH is using the results from these 

programs to inform the next phase of development of big data infrastructure, including the ongoing Data Commons Pilot. The second phase is expected to also build off of several other major initiatives including those in cancer, Alzheimer’s disease, the human 

brain, and the All of Us research program. The Committee wants 

to ensure that these efforts are coordinated and overseen to ensure 

all of NIH benefits from them. In its fiscal year 2017 report, the 

Committee directed NIH to work with its external partners and 

stakeholders to provide the Committees on Appropriations of the 

House of Representatives and the Senate a detailed strategic plan 

by May 5, 2018, spelling out it how intends to make big data sustainable, interoperable, accessible, and usable. The plan is to include a roadmap to achieve these objectives, as well as milestones 

and estimates of the resources that will be necessary. The Committee expects to receive the strategic plan, which was first identified in the Senate report dated June 9, 2016, by the May deadline. 

The unanticipated delay in completing the fiscal year 2017 appropriations process means NIH will have had almost 2 years to prepare its plan, extra time that should make it possible to draft a 

comprehensive blueprint to help guide future investments in data 

science. In the interim, the Committee directs NIH to provide a 

status report in the fiscal year 2019 CJ describing the current status of the strategic plan and its progress in finding a suitable candidate to fill the Associate Director for Data Science [ADDS] vacancy. The Committee recognizes the importance of the ADDS to 

provide strategic vision and coordinate as an honest broker across 
108 

NIH on data science issues, and encourages NIH to locate this position within the Office of the Director. 

Botanical Products and Opioid Addiction.—The Committee commends the FDA for establishing guidelines and opening pathways 

for Investigational New Drug [IND] applications for botanical 

drugs. Over the past two decades, the dramatic increase in abuse 

of prescription opioids, non-synthetic opioids, and illicit synthetic 

opioids has grown to epidemic proportions. Scientific rationale and 

laboratory studies suggest a decrease in addictive potential when 

botanical derivatives, including cannabidiol extracts, are used with 

an opioid in treating patients. The Committee supports study of 

this integrative approach to treatment and urges NIH, including 

NIDA, NCCIH, and OCCAM, to support and facilitate trials aimed 

at reducing addiction under appropriate IND applications. 

Brain Research through Application of Innovative Neuro-technologies [BRAIN] Initiative.—The Committee continues to strongly support the BRAIN initiative. The bill provides $400,000,000 an increase of $140,000,000 above fiscal year 2017, to expand the initiative consistent with the BRAIN 2025 report issued in 2014. 

Children in NIH Research.—The inclusion of children in clinical 

research is essential to ensure that children benefit from important 

scientific advances. The Committee appreciates provisions of the 

21st Century Cures Act that will now require NIH to systematically track enrollment data to determine if children are actually 

being enrolled appropriately in clinical research. The Committee 

recognizes that without better data collection and reporting it is 

unable to fully exercise its oversight role, and researchers and 

other stakeholders are unable to determine whether children as a 

whole, or particular pediatric subpopulations, are appropriately 

represented in federally funded biomedical research. The Committee directs NIH to expeditiously implement these new requirements. 

Chronic Fatigue Syndrome [ME/CFS].—The Committee is 

pleased that NIH has begun to expedite research into ME/CFS, including its intramural study and the RFAs for the collaborative research centers. However, the Committee is concerned that the level 

of funding is still very low considering the burden of disease and 

the current plan to expand research will take too long to produce 

FDA-approved treatments and diagnostic tests. The Committee 

urges NIH to collaborate with disease experts and the patient community to identify additional opportunities to expedite progress on 

this understudied disease. Specifically, the Committee recommends 

that NIH consider increasing research funding to be commensurate 

with disease burden and use that funding to further accelerate the 

research field through a set of intramural and extramural investments such as: (1) RFAs for biomarkers and treatment trials, (2) 

additional funding for investigator initiated studies and early stage 

investigator awards, (3) an initiative to reach consensus on the 

case definition, and (4) mechanisms to incentivize researchers to 

enter the field. 

Chronic Overlapping Pain Conditions.—The Committee notes the 

strong evidence base demonstrating deleterious outcomes for patients with Chronic Overlapping Pain Conditions, which include 

hit-or-miss, ineffective, or even harmful treatments, poor health 
109 

and quality of life outcomes, markedly increased disability rates 

and personal and societal financial burdens. The Committee is 

pleased with NIH’s efforts to develop a chronic overlapping pain 

conditions screening tool. However, an expanded, coordinated, and 

collaborative initiative is needed to maximize the Federal research 

investment, reduce spending, and improve clinical practice. There 

is an urgent need to analyze the state of science on Chronic Overlapping Conditions, which will identify both research gaps and future research directions and collaborations. As such, the Committee 

urges the Director to consider the relevant recommendations of the 

Federal Pain Research Strategy to guide the development of a comprehensive effort that spans the basic, translational, and clinical 

research continuum to advance scientific understanding of chronic 

overlapping pain conditions, as well as the development and discovery of safe and effective treatments. 

Facilities and Administrative Costs [F&A].—Central to the Administration’s proposal to reduce Federal investments in biomedical 

research is its proposal to cap the F&A costs of grants, so-called 

‘‘indirect costs,’’ at 10 percent. The F&A cost of a grant is intended 

to cover the indirect costs of biomedical research, ranging from administration and facilities to the cost of equipment shared across 

multiple researchers. For example, at research facilities focused on 

making the next breakthrough in cancer treatment, indirect costs 

supply the air handlers that provide the precise conditions needed 

to generate therapeutic T cells for immunotherapy trials, complex 

data systems to analyze and protect patients’ genomic data, and 

support for the next generation of scientific leaders. The methodology for negotiating indirect costs has been in place since 1965, 

and rates have remained largely stable across NIH grantees for 

decades. The Administration’s proposal would radically change the 

nature of the Federal Government’s relationship with the research 

community, abandoning the Government’s long-established responsibility for underwriting much of the Nation’s research infrastructure, and jeopardizing biomedical research nationwide. The Committee has not seen any details of the proposal that might explain 

how it could be accomplished without throwing research programs 

across the country into disarray. To avoid this possibility, the Committee has included bill language to prohibit HHS from developing 

or implementing a modified approach to funding F&A costs. 

Fetal Tissue Donation Trial.—The Committee acknowledges the 

many differing views on the merits of human fetal tissue research. 

New bill language is included to direct NIH to begin a pilot to determine the adequacy of a fetal tissue donor network for supporting 

all related clinical research from human fetal tissue donated solely 

from stillbirths and spontaneous abortion. 

Gabriella Miller Kids First Research Act.—The Committee provides the full budget request of $12,600,000. The Committee requests that NIH provide information on how it has disbursed funding, including any personnel that are responsible for overseeing the 

allocation of designated research dollars, the criteria that NIH employed to ensure awards will advance the objectives of the act, and 

a description of the research projects that were funded in the fiscal 

year 2019 CJ. 
110 

Gestational Diabetes.—The Committee recognizes the importance 

of research funded by NIH related to gestational diabetes, a disease 

affecting up to 9.2 percent of all pregnant women. Given that both 

women with gestational diabetes and their babies face long-term 

health consequences as a result of the disease, such as increased 

risk of developing type 2 diabetes, the Committee urges NIH to explore additional opportunities for research on gestational diabetes. 

Government-Wide Collaborations.—NIH, VA, and DOD collaborate frequently and successfully on various research activities. The 

Committee looks forward to the report in the fiscal year 2019 CJ 

focusing on the cooperative and strategic approach the agencies 

take in areas of biomedical research that overlap to maximize the 

potential of the research. 

Hepatitis B [HBV].—The Committee recognizes that HBV infection is a serious public health threat. Though infection rates are 

less than one percent in the United States, Asian Americans and 

Pacific Islanders experience about 60 percent of the chronic HBV 

burden. Left undiagnosed and untreated, one in four of those with 

chronic HBV infection will die prematurely from cirrhosis, liver 

failure, and/or liver cancer. The Committee also notes that the link 

between HBV infection and primary liver cancer is well established, with up to 60 percent of global liver cancer cases caused by 

HBV. The Committee requests that OD ensure that NCI, NIAID, 

NIMHD, and NIDDK coordinate their strategic research agendas to 

work toward finding a cure for HBV. The Committee further requests an update on these efforts be included in the fiscal year 

2019 CJ. 

Imaging.—The Committee notes that imaging research occurs in 

multiple Institutes throughout the NIH and is an integral component of the Cancer Moon Shot, the Precision Medicine Initiative, 

and the BRAIN Initiative. The Committee requests that the Director produce an overview of imaging research across the NIH, including in the focused research fields mentioned above, and assess 

the quality of interactions in imaging research within NIH, and report the results in the fiscal year 2019 CJ. 

Induced Pluripotent Stem Cell [iPSC] Technology.—The Committee understands that unlike the controversy linked with embryonic stem cells, iPSCs are derived from adult skin cells making 

them an acceptable alternative therapeutic. iPSCs have many of 

the therapeutic properties of embryonic stem cells, but with the additional advantage that they can be derived from patient skin cells 

for personalized medicine. This establishes iPSCs as a source of 

cells with great value and potential for curing human disease and 

injury. iPSCs could potentially be used to treat a wide range of 

human disease, repair damaged tissue (regenerative medicine), and 

serve as a platform to develop new therapeutics (small molecule 

drugs). However, the Committee notes that additional basic research is essential to realize the full biomedical potential of this 

technology. The Committee encourages NIH to support basic research in this area that leads to pre-clinical trials, cures, 

diagnostics, and treatments. The Committee requests an update in 

the fiscal year 2019 CJ on expansion opportunities being considered related to iPSC technology. 
111 

Inflammatory Bowel Diseases [IBD].—The Committee is concerned with the increasing prevalence of IBD. The Committee 

urges the Director’s office to utilize an overarching mechanism, 

such as the Common Fund, to study the cause of this increase in 

prevalence, including environmental triggers and epigenetics. 

Interagency Pain Research.—Consistent with the Comprehensive 

Addiction and Recovery Act (Public Law 114–198), the Committee 

encourages the Director to intensify and coordinate fundamental, 

translational, and clinical research of the NIH with respect to the 

understanding of pain, the discovery and development of therapies 

for chronic pain, and the development of alternatives to opioids for 

effective pain treatments. In doing so, the Committee urges the 

NIH to consider recommendations of the Federal Pain Research 

Strategy. The Committee requests an update in the fiscal year 

2019 CJ on this initiative. 

Lymphatic System.—The Committee supports building on the 

momentum of the 2015 NIH Lymphatic Symposium by growing the 

cadre of lymphatic researchers through the establishment of extramural interdisciplinary research training programs relevant to the 

lymphatic system in health and disease and by incorporating more 

reviewer expertise in lymphatic biology/disease in the pertinent 

standing study sections within the Center for Scientific Review. 

This research will be instrumental in understanding the pivotal 

role of the lymphatic system in the pathogenesis and/or treatment 

of cancer metastasis, AIDS, auto-immune diseases, obesity, cardiovascular disease, and organ transplantation as well as those affected by lymphatic conditions after cancer or those with congenital 

conditions. 

Mitochondrial Disease Research.—The Committee understands 

that no less than 17 Institutes and offices are involved in a variety 

research efforts related to mitochondrial disease and dysfunction. 

The Committee appreciates the NIH’s support of the trans-NIH 

Mitochondrial Disorders Working Group, the North American 

Mitochondrial Disease Consortium, the Mitochondrial Disease Sequence Data Resource Consortium, and its support for investigator 

initiated intramural and extramural studies, and urges the NIH to 

expand upon its November 2016 research agenda on nutritional 

interventions in primary mitochondrial disorders. The Committee 

understands that the NIH has established the Environmental influences on Child Health Outcomes program, which supports longitudinal studies to investigate the effects of environmental exposures—in conjunction with genetic influences—on children’s health 

and development. The Committee encourages the Director to explore whether the longitudinal cohort studies included within 

ECHO can shed light on any of the mitochondrial diseases occurring in children. The Committee further encourages the Director to 

competitively fund basic and clinical research on mitochondrial disease. 

Mucopolysaccharide [MPS].—MPS diseases are inherited, with 

death occurring for many in early childhood. This systemic disease 

causes progressive damage to the bones, heart, respiratory system, 

and brain. The Committee continues to urge NIH to put a high priority on better understanding and treating MPS and mucolipidosis 

diseases. The Committee commends NIH for allocating funds to 
112 

discover, develop, define, and make available for research animal 

models of human genetic disease. The Committee encourages expanded research of treatments for neurological, chronic inflammation, cardiovascular and skeletal manifestations of MPS, with an 

emphasis on gene therapy. The Committee thanks NINDS, 

NIDDK, and ORDR for funding the Lysosomal Disease Network 

through the Rare Disease Clinical Network and for funding 

lysosomal research meetings. The Committee encourages the NIH 

to increase funding to grantees to incentivize MPS research, particularly given the aging and small population of current researchers. Understanding the manifestations and treatments of both the 

skeletal and neurological disease continues to be the greatest areas 

of unmet need. 

National Laboratories.—NIH is encouraged to enter into collaborative research programs with the Secretary of Energy, National 

Laboratories, and others determined to be appropriate by the Director, to utilize the broader scientific and technological capabilities 

of the Department of Energy [DOE] and National Laboratories. In 

particular, DOE and NIH should work together to support access 

for biomedical researchers to cutting-edge technology resources. 

Neurofibromatosis [NF].—The Committee supports efforts to increase funding and resources for NF research and treatment at 

multiple Institutes, including NCI, NINDS, NIDCD, NHLBI, 

NICHD, NIMH, NCATS, and NEI. Children and adults with NF 

are at significant risk for the development of many forms of cancer; 

the Committee encourages NCI to increase its NF research portfolio in fundamental basic science, translational research, and clinical trials focused on NF. The Committee also encourages NCI to 

support NF centers, clinical trials consortia, preclinical mouse models consortia, and associated tumor sequencing efforts. Because NF 

causes brain and nerve tumors and is associated with cognitive and 

behavioral problems, the Committee urges NINDS to continue to 

aggressively fund fundamental basic science research on NF relevant to nerve damage and repair. Based on emerging findings 

from numerous researchers worldwide demonstrating that children 

with NF are at significant risk for autism, learning disabilities, 

motor delays, and attention deficits, the Committee encourages 

NINDS, NIMH, and NICHD to expand their investments in laboratory-based and clinical investigations in these areas. Since NF2 accounts for approximately 5 percent of genetic forms of deafness, the 

Committee encourages NIDCD to expand its investment in NF2 

basic and clinical research. NF1 can cause vision loss due to optic 

gliomas. The Committee encourages NEI to expand its investment 

in NF1 basic and clinical research. 

Next Generation Researchers Initiative.—The Committee supports 

robust implementation of the Next Generation Researchers Initiative within the Office, as established in the 21st Century Cures 

Act, and is encouraged by NIH’s continued work in this space. The 

Committee directs NIH to prioritize improving opportunities for 

our next generation of researchers by working through the Initiative to coordinate all current and new NIH policies to promote opportunities for new scientists and earlier research independence, 

including enhancing training and mentorship programs for researchers, and enhancing workforce diversity. As required by the 
113 

21st Century Cures Act, the Committee directs NIH to consider the 

recommendations made by the National Academies of Science 

study under Public Law 114–113 in carrying out the activities of 

the Initiative. 

Pediatric Clinical Trials.—The Committee supports the pediatric 

clinical trials conducted under the Best Pharmaceutical Practices 

for Children Act [BPCA], and strongly encourages the NIH to continue to support this program. BPCA has made significant steps in 

closing the knowledge gap on the efficacy of drugs being used on 

children and encourages enhanced coordination of BPCA activities 

with other NIH pediatric research and initiatives, including, but 

not limited to, pediatric cancer, the pediatric MATCH study, muscular dystrophy, the IDeA States Pediatric Clinical Trials Network 

Program, and the All of Us Precision Medicine Initiative. The Committee requests an update in the fiscal year 2019 CJ on the status 

of research related to this topic. 

Phelan-McDermid Syndrome.—Phelan-McDermid Syndrome is a 

genetic disorder caused by a partial deletion of chromosome 22 and 

loss of the SHANK3 gene. The Committee continues to support a 

multi-Institute approach to support research into PhelanMcDermid Syndrome, examining in particular the disorder’s correlation with autism, epilepsy and other developmental disabilities. 

The Committee requests an update in the fiscal year 2019 CJ on 

the status of research related to this topic. 

Population Health Training.—The Committee acknowledges the 

growing understanding that the living systems that produce health 

and disease encompass health determinants ‘‘from cells to society.’’ 

The Office of Behavioral and Social Science Research should continue to work with NIH Institutes and Centers to encourage interdisciplinary population health science training to enhance our understanding of how social, cultural, genetic, biological, and environmental factors combine to influence outcomes in health and human 

development. 

Rehabilitation Research.—The Committee encourages NIH to 

fully implement Section 2040 of the 21st Century Cures Act to enhance the stature, visibility, and coordination of medical rehabilitation research conducted at NIH. The Committee is encouraged by 

the release of NIH’s new Rehabilitation Research Plan, looks forward to reviewing its first annual progress report, and is encouraged by its ongoing efforts to ensure that reporting of rehabilitation 

research is consistent with the definition of ‘‘rehabilitation research’’ included in the legislation. 

Research Facilities.—Much of the Nation’s biomedical research 

infrastructure, including laboratories and research facilities at academic institutions and nonprofit research organizations, is outdated or insufficient. For taxpayers to receive full value from their 

considerable investments in biomedical research, scientists must 

have access to appropriate research facilities. Therefore, 

$25,000,000 is provided for grants or contracts to public, nonprofit, 

and not-for-profit entities to expand, remodel, renovate, or alter existing research facilities or construct new research facilities as authorized under 42 U.S.C. section 283k. The Committee urges NIH 

to consider recommendations made by the NIH Working Group on 

Construction of Research Facilities, including making awards that 
114 

are large enough to underwrite the cost of a significant portion of 

newly constructed or renovated facilities. 

Sleep Disorders.—The Committee recognizes sleep disorders as a 

serious public health concern. Sleep disorders affects approximately 

70,000,000 Americans and contribute to lost productivity, increase 

the risk for accidents, and are associated with other chronic illnesses, such as hypertension and mental health conditions. The 

Committee encourages the NIH to advance the work of the National Center on Sleep Disorders Research, which coordinates research activities across Institutes and Centers. The Committee also 

encourages NIH to facilitate implementation of the ongoing NIH 

Sleep Disorders Research Plan. 

Spina Bifida.—The Committee encourages NIA, NIDDK, 

NICHD, and NINDS to study the causes and care of the neurogenic 

bladder and kidney disease to improve the quality of life of children 

and adults with Spina Bifida; to support research to address issues 

related to the treatment of Spina Bifida and associated secondary 

conditions, such as hydrocephalus; and to invest in understanding 

the myriad co-morbid conditions experienced by individuals with 

Spina Bifida. 

Temporomandibular Disorders [TMD].—The Committee understands that NIH-funded research has demonstrated that 

temporomandibular disorders [TMD] are primarily a multisystem 

disorder with overlapping conditions influenced by multiple biological and environmental factors rather than solely an orofacial pain 

condition. However, diagnosis and care of patients have not 

changed to reflect this major paradigm shift, with many patients 

continuing to receive treatments solely focused on teeth and jaws. 

Moreover, the medical community lacks education regarding the 

complexity and systemic aspects of TMD as well as its many comorbid medical conditions. Patients are treated by a multitude of 

practitioners across numerous disciplines with treatments that 

have the potential to cause harm. To address these issues, the 

Committee requests that NIH provide an update on the state of 

TMD research, activities related to TMD education, and clinical 

studies of TMD in the fiscal year 2019 CJ. 

Trans-NIH Working Group on Fibrosis.—The Committee recognizes that fibrosis can occur across body systems and applauds 

NIH for establishing a trans-NIH working group on fibrosis. The 

Committee encourages NIH to continue the cross-cutting coordination of research between ICs in this area. 

Trauma Research.—To ensure that our Nation’s trauma response 

network and workforce remain adequately prepared, the Committee recommends an increased focus by NIH on trauma research, 

including to establish a NIH-led trauma research agenda coordinated with the extensive, and often groundbreaking, DOD activities 

on trauma. This research is critical to minimize the loss of human 

life, disability, and injury by ensuring that patient-specific trauma 

care is based on scientifically validated findings. 

Trisomy 21.—The Committee recognizes that the presence of a 

third copy of human chromosome 21 may be linked to significant 

immune dysregulation and Alzheimer’s disease, while protecting 

against most cancers and cardiovascular disease among individuals 

with Down syndrome. The Committee strongly encourages NIH to 
115 

pursue an initiative on this topic that will yield scientific learnings 

that could significantly improve the health of individuals with 

Down syndrome as well as millions of typical individuals. 

BUILDINGS AND FACILITIES

Appropriations, 2017 ............................................................................. $128,863,000 

Budget estimate, 2018 ........................................................................... 98,615,000 

Committee recommendation ................................................................. 128,863,000 

The Committee recommendation includes $128,863,000 for NIH 

buildings and facilities. This funding will remain available for obligation for 5 years. 

NIH INNOVATION ACCOUNT, CURES ACT

Appropriations, 2017 ............................................................................. $52,000,000 

Budget estimate, 2018 ........................................................................... 110,000,000 

Committee recommendation ................................................................. 110,000,000 

The Committee recommendation includes $110,000,000 to be 

spent from the NIH Innovation Account for the following activities: 

All of Us.—$100,000,000. 

Regenerative Medicine.—$10,000,000. 

The Committee report reflects distribution of the remainder of 

funding from the NIH Innovation Account to NCI, NINDS, and 

NIMH and expects NIH to transfer funding shortly after enactment 

of this act. 

SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION

The Committee recommends $3,777,592,000 for the Substance 

Abuse and Mental Health Services Administration [SAMHSA]. The 

recommendation includes $133,667,000 in transfers available under 

section 241 of the PHS Act and $12,000,000 in transfers from the 

PPH Fund. 

SAMHSA is responsible for supporting mental health programs 

and alcohol and other drug abuse prevention and treatment services throughout the country, primarily through categorical grants 

and block grants to States. 

Eligible applicants under SAMHSA’s PRNS authorities include 

States, political subdivisions of States, Indian Tribes or tribal organizations, health facilities, or programs operated by or in accordance with a grant or contract with the Indian Health Service, and 

other public or private nonprofit entities. The Committee strongly 

encourages SAMHSA to exercise maximum flexibility allowed when 

developing funding opportunity announcements to ensure that all 

eligible applicants are included. 

The Committee recommendation continues bill language that instructs the Administrator of SAMHSA and the Secretary to exempt 

the Mental Health Block Grant [MHBG] and the Substance Abuse 

Prevention and Treatment [SAPT] Block Grant from being used as 

a source for the PHS evaluation set-aside in fiscal year 2018. 

MENTAL HEALTH

Appropriations, 2017 ............................................................................. $1,181,037,000 

Budget estimate, 2018 ........................................................................... 912,347,000 

Committee recommendation ................................................................. 1,181,037,000 
116 

The Committee recommends $1,181,037,000 for mental health 

services. The recommendation includes $21,039,000 in transfers 

available under section 241 of the PHS Act and $12,000,000 in 

transfers from the PPH Fund. Included in the recommendation is 

funding for programs of regional and national significance [PRNS], 

the MHBG, children’s mental health services, Projects for Assistance in Transition from Homelessness [PATH], and Protection and 

Advocacy for Individuals with Mental Illness [PAIMI]. 

Programs of Regional and National Significance 

The Committee recommends $398,659,000 for PRNS within the 

Center for Mental Health Services [CMHS]. The Committee recommendation includes $12,000,000 in transfers to PRNS from the 

PPH Fund. These programs address priority mental health needs 

by developing and applying evidence-based practices, offering training and technical assistance, providing targeted capacity expansion 

grants, and changing the delivery system through family, client-oriented, and consumer-run activities. 

Within the total provided for PRNS, the Committee recommendation includes funding for the following activities: 

[In thousands of dollars] 

Budget activity Fiscal year 2017 

appropriation 

Fiscal year 2018 

request 

Committee 

recommendation 

CAPACITY: 

Seclusion & Restraint ........................................................... 1,147 1,145 1,147 

Youth Violence Prevention .................................................... ............................ 23,055 ............................

Project AWARE State Grants ................................................. 57,001 ............................ 57,001 

Mental Health First Aid ........................................................ 14,963 ............................ 14,963 

Healthy Transitions ............................................................... 19,951 ............................ 19,951 

National Traumatic Stress Network ...................................... 48,887 46,798 48,887 

Children and Family Programs ............................................. 7,229 6,446 7,229 

Consumer and Family Network Grants ................................. 4,954 4,945 4,954 

MH System Transformation and Health Reform ................... 3,779 3,772 3,779 

Project LAUNCH ..................................................................... 23,605 34,489 23,605 

Primary and Behavioral Health Care Integration ................. 49,877 ............................ 49,877 

Suicide Prevention 

National Strategy for Suicide Prevention .................... 11,000 1,996 11,000 

Zero Suicide ........................................................ 7,000 ............................ 7,000 

American Indian and Alaska Native set-aside .. 2,000 ............................ 2,000 

Suicide Lifeline ..................................................................... 7,198 7,184 7,198 

GLS—Youth Suicide Prevention—States ............................. 35,427 35,382 35,427 

GLS—Youth Suicide Prevention—Campus .......................... 6,488 6,476 6,488 

AI/AN Suicide Prevention Initiative ....................................... 2,931 2,925 2,931 

Homelessness Prevention Programs ..................................... 30,696 30,638 30,696 

Tribal Behavioral Grants ....................................................... 15,000 14,971 15,000 

Minority AIDS ......................................................................... 9,224 4,206 9,224 

Criminal and Juvenile Justice Programs .............................. 4,269 4,261 4,269 

Assisted Outpatient Treatment ............................................. 15,000 14,971 15,000 

Assertive Community Treatment for Ind. With SMI .............. ............................ 5,000 ............................

SCIENCE AND SERVICE: 

GLS—Suicide Prevention Resource Center .......................... 5,988 5,977 5,988 

Practice Improvement and Training ..................................... 7,828 7,813 7,828 

Primary and Behavioral Health Care Integration TA ............ 1,991 ............................ 1,991 

Consumer & Consumer Support TA Centers ........................ 1,918 1,914 1,918 

Minority Fellowship Program ................................................. 8,059 8,044 8,059 

Disaster Response ................................................................ 1,953 1,949 1,953 

Homelessness ........................................................................ 2,296 2,292 2,296 

HIV/AIDS Education ............................................................... ............................ 770 ............................
117 

Infant and Early Childhood Mental Health.—The Committee recognizes the importance of building mental health services for children under age 6, particularly infants and toddlers whose unique 

needs are often overlooked. Early mental health prevention, identification, and treatment may reduce the need for treatment later in 

life when it becomes more difficult, time intensive, and expensive. 

The Committee encourages SAMHSA to explore opportunities to 

expand these efforts. 

Mental Health First Aid.—The Committee is pleased with the 

progress of Mental Health First Aid. In issuing new competitive 

funding opportunities SAMHSA is directed to include as eligible 

grantees local law enforcement agencies, fire departments, and 

emergency medical units with a special emphasis on training for 

crisis de-escalation techniques. SAMHSA is also encouraged to 

prioritize training for veterans, armed services personnel, and their 

family members within the Mental Health First Aid program. 

Practice Improvement and Training.—The Committee recognizes 

the critical need for programs such as Rehabilitation Research and 

Training Centers, which advance the current knowledge base of the 

mental health delivery system by supporting evaluation, training, 

technical assistance, and knowledge translation activities that help 

adults with serious mental health conditions achieve their life 

goals. 

Primary and Behavioral Healthcare Integration [PBHCI].—The 

Committee provides $49,877,000 for PBHCI to support communities to coordinate and integrate primary care services into community-based behavioral health settings. 

Project AWARE.—The Committee continues to fund Project 

AWARE which increases awareness of mental health issues and 

connects young people that have behavioral health issues and their 

families with needed services. Of the amount provided for Project 

AWARE, the Committee directs SAMHSA to use $10,000,000 for 

discretionary grants to support efforts in high-crime, high-poverty 

areas and, in particular, communities that are seeking to address 

relevant impacts and root causes of civil unrest. These grants 

should maintain the same focus as fiscal year 2017 grants. The 

Committee requests a report on progress of fiscal year 2017 grantees 180 days after the enactment of this act. 

Community Mental Health Services Block Grant 

The Committee recommends $562,571,000 for the MHBG. The 

recommendation includes $21,039,000 in transfers available under 

section 241 of the PHS Act. 

The MHBG distributes funds to 59 eligible States and territories 

through a formula based on specified economic and demographic 

factors. Grant applications must include an annual plan for providing comprehensive community mental health services to adults 

with a serious mental illness and children with a serious emotional 

disturbance. 

The Committee recommendation continues bill language requiring that at least 10 percent of the funds for the MHBG program 

be set-aside for evidence-based programs that address the needs of 

individuals with early serious mental illness, including psychotic 

disorders. The Committee commends SAMHSA for its collaboration 
118 

with NIMH on the implementation of this set-aside. The Committee notes that it usually takes 14–17 years to translate research 

findings into practice and hopes that the joint effort between 

NIMH and SAMHSA may be a model for how to reduce this timeframe. The Committee directs SAMHSA to continue its collaboration with NIMH to ensure that funds from this set-aside are only 

used for programs showing strong evidence of effectiveness and 

that target the first episode of psychosis. SAMHSA shall not expand the use of the set-aside to programs outside of the first episode psychosis. The Committee directs SAMHSA to include in the 

fiscal year 2019 CJ a detailed table showing at a minimum each 

State’s allotment, name of the program being implemented, and a 

short description of the program. 

Children’s Mental Health Services 

The Committee recommends $119,026,000 for the Children’s 

Mental Health Services program. This program provides grants 

and technical assistance to support comprehensive, communitybased systems of care for children and adolescents with serious 

emotional, behavioral, or mental disorders. Grantees must provide 

matching funds and services must be coordinated with the educational, juvenile justice, child welfare, and primary healthcare systems. The Committee includes a 10 percent set-aside for an early 

intervention demonstration program with persons not more than 

25 years of age at clinical high risk of developing a first episode 

psychosis. SAMHSA is directed to work with NIMH on the implementation of this set-aside. 

Projects for Assistance in Transition From Homelessness 

The Committee recommends $64,635,000 for PATH, which addresses the needs of individuals with serious mental illness who 

are experiencing homelessness or are at risk of homelessness. 

Funds are used to provide an array of services, such as screening 

and diagnostic services, emergency assistance, case management, 

and referrals to the most appropriate housing environment. 

Protection and Advocacy for Individuals With Mental Illness 

The Committee recommends $36,146,000 for PAIMI. This program helps ensure that the rights of mentally ill individuals are 

protected while they are patients in all public and private facilities 

or while they are living in the community, including in their own 

homes. Funds are allocated to States according to a formula based 

on population and relative per capita incomes. 

SUBSTANCE ABUSE TREATMENT

Appropriations, 2017 ............................................................................. $2,212,506,000 

Budget estimate, 2018 ........................................................................... 2,196,435,000 

Committee recommendation ................................................................. 2,212,506,000 

The Committee recommends $2,212,506,000 for substance abuse 

treatment programs, including PRNS and the substance abuse prevention and treatment block grant to the States. The recommendation includes $81,200,000 in transfers available under section 241 

of the PHS Act. 
119 

Programs of Regional and National Significance 

The Committee recommends $354,427,000 for PRNS within the 

Center for Substance Abuse Treatment [CSAT]. The recommendation includes $2,000,000 in transfers available under section 241 of 

the PHS Act. 

PRNS include activities to increase capacity by implementing 

service improvements using proven evidence-based approaches as 

well as science-to-services activities that promote the identification 

of practices thought to have potential for broad service improvement. 

Within the total provided for PRNS, the Committee recommendation includes funding for the following activities: 

[In thousands of dollars] 

Budget activity Fiscal year 2017 

appropriation 

Fiscal year 2018 

request 

Committee 

recommendation 

CAPACITY: 

Opioid Treatment Programs/Regulatory Activities ................ 8,724 8,708 8,724 

Screening, Brief Intervention, Referral, & Treatment ........... 30,000 46,804 30,000 

Target Capacity Expansion ................................................... 67,192 36,234 67,192 

Medicated Assisted Treatment for Prescription Drug 

and Opioid Addiction (non-add) ............................. 55,800 24,952 55,800 

Pregnant & Postpartum Women ........................................... 19,931 19,931 19,931 

Recovery Community Services Program ................................ 2,434 2,429 2,434 

Children and Families .......................................................... 29,605 29,549 29,605 

Treatment Systems for Homeless ......................................... 36,386 41,225 36,386 

Minority AIDS ......................................................................... 65,570 65,445 65,570 

Criminal Justice Activities .................................................... 78,000 77,852 78,000 

Improving Access to Overdose Treatment ............................ 1,000 ............................ 1,000 

Building Communities of Recovery ....................................... 3,000 1,000 3,000 

SCIENCE AND SERVICE: 

Addiction Technology Transfer Centers ................................ 9,046 9,029 9,046 

Minority Fellowship Program ................................................. 3,539 3,532 3,539 

Building Communities of Recovery.—The Committee appreciates 

SAMHSA’s implementation of new funding for communities of recovery in fiscal year 2017 and continues to encourage SAMHSA to 

promote the expansion of recovery support services as well as reduce stigma associated with addictions. 

Combating Opioid Abuse.—Of the amount provided for Targeted 

Capacity Expansion, the Committee includes $55,800,000 for discretionary grants to States for the purpose of expanding treatment 

services to those with heroin or opioid dependence. The Committee 

continues to direct CSAT to ensure that these grants include as an 

allowable use the support of medication assisted treatment and 

other clinically appropriate services. These grants should target 

States with the highest age adjusted rates of admissions and that 

have demonstrated a dramatic age adjusted increase in admissions 

for the treatment of opioid use disorders. 

Drug Courts.—SAMHSA is directed to ensure that all drug treatment court funding is allocated to serve people diagnosed with a 

substance use disorder as their primary condition. SAMHSA is further directed to ensure that all drug treatment court grant recipients work directly with the corresponding State substance abuse 

agency in the planning, implementation, and evaluation of the 
120 

grant. SAMHSA should expand training and technical assistance to 

drug treatment court grant recipients to ensure evidence-based 

practices are fully implemented. 

Handheld Analyzers.—The Committee understands the role 

played by handheld drug analyzers, particularly for police officers 

and other first responders. These instruments can identify various 

drugs and assist first responders in treatment referral. They also 

keep officers safe by minimizing the exposure to toxic drugs, while 

reducing the overall cost and backlog of cases at crime labs. The 

Committee encourages SAMHSA to support the use of block grant 

funds and funds authorized under section 1003 of the 21st Century 

Cures Act for handheld analyzers. SAMHSA shall provide an update on these efforts in the fiscal year 2019 CJ. 

Oral Fluid Guidelines.—The Committee is pleased with 

SAMHSA’s recommendation of oral fluid as an alternative specimen for drug testing and commends SAMHSA for the progress 

made on issuing oral fluid guidelines for the Federal Workplace 

Drug Testing Programs. The Committee encourages SAMHSA to 

publish the guidelines expeditiously and to implement the guidelines in partnership with stakeholders and other agencies. 

Peer Counseling.—The Committee is aware of the benefits of 

peer-to-peer programs to assist in addiction treatment and counseling, and encourages SAMHSA’s continued support for this approach. However, the Committee also believes that it is important 

for people suffering from addiction and substance abuse to have access to peer counseling and connection to community resources in 

hospital settings. Accordingly, the Committee encourages SAMHSA 

to support counseling and addiction recovery programs focused on 

clinical medical providers to engage peer-to-peer counseling support 

and services in inpatient hospital and emergency department settings. 

Pregnant & Postpartum Women.—The Committee continues to 

support the continuation of the pilot program for State substance 

abuse agencies to address identified gaps in the continuum of care 

furnished to pregnant and postpartum women. The Committee encourages the Department to prioritize States that support bestpractice collaborative models for the treatment and support of pregnant women with opioid use disorders. 

School-based Opioid Prevention.—When awarding opioid research and response grants, the Committee encourages SAMHSA, 

in coordination with CDC, to include school-based intervention programs that provide parents and teachers with the knowledge to 

monitor students and provide an opportunity for early intervention. 

Further, SAMHSA is encouraged to include screening and referral 

to treatment for primary, middle and high school students and 

young adults at universities and to put in place support systems 

to help prevent influence from drug-using peers. 

State Targeted Response to the Opioid Abuse Crisis Grants.—The 

Committee continues to provide $500,000,000 for State Targeted 

Response Grants [STR], for a total of $1,000,000,000 in the past 

two fiscal years. The Committee encourages HHS to ensure that 

these grants are focused on activities that can continue to provide 

opioid related treatment and abuse prevention services after Federal funding has ended. It is critical that the Federal and state re-
121 

sponse to this epidemic continues to prioritize local efforts to support communities facing unmet opioid treatment, prevention, and 

recovery needs. The Committee strongly encourages HHS and 

SAMHSA to refrain from any action that would require States and 

Territories to resubmit a grant proposal for the second year of 

State grant funding. By doing so, States could reduce administrative burdens and the Department could focus on promoting and implementing already approved plans. The Committee directs the 

agency to ensure States provide funds directly to local communities 

and counties to address the opioid crisis in areas of unmet need, 

and to report the Committee on such plans 1 year after enactment. 

SAMHSA is also directed to provide State agencies with technical 

assistance concerning how to enhance outreach and direct support 

to rural and underserved communities and providers in addressing 

this crisis. Further, the Committee is concerned that SAMHSA has 

restricted State flexibility for addressing the opioid crisis by limiting the amount of funding that can be used for opioid prevention 

activities. 

Treatment Facility Expansion.—The Committee is deeply concerned about the devastating impact that the opioid epidemic is 

having on families and communities throughout the country and 

recognizes the need to increase access to treatment facilities. The 

Committee requests that SAMHSA explore ways that grantees 

could access Federal funding for the capital costs of new treatment 

facilities, including planning, construction, repair, preventive maintenance, environmental support, improvement, extension, alteration, purchase of fixed equipment or facilities, as well as the acquisition of land. SAMHSA shall provide an update on these efforts, including any recommendations, in the fiscal year 2019 CJ. 

Viral Hepatitis Screening.—The Committee applauds SAMHSA 

for encouraging grantees to screen for viral hepatitis, including the 

use of innovative strategies like rapid testing and urges SAMHSA 

to continue these efforts. The Committee notes the disproportionate 

impact of viral hepatitis among minority populations and the co-infection rate among individuals with HIV/AIDS. The Committee 

urges SAMHSA to work with minority AIDS grantees to incorporate hepatitis screening into programmatic activities. 

Substance Abuse Prevention and Treatment Block Grant 

The Committee recommends $1,858,079,000 for the Substance 

Abuse Prevention and Treatment Block Grant [SABG]. The recommendation includes $79,200,000 in transfers available under 

section 241 of the PHS Act. According to SAMHSA, at discharge 

from SABG funded programs, 70 percent of individuals demonstrate abstinence from illegal drugs and 83 percent demonstrate 

abstinence from alcohol use. The block grant provides funds to 

States to support alcohol and drug abuse prevention, treatment, 

and rehabilitation services. Funds are allocated to States according 

to a formula. 

SUBSTANCE ABUSE PREVENTION

Appropriations, 2017 ............................................................................. $223,219,000 

Budget estimate, 2018 ........................................................................... 149,703,000 

Committee recommendation ................................................................. 238,219,000 
122 

The Committee recommends $238,219,000 for the Center for Substance Abuse Prevention [CSAP], the sole Federal organization 

with responsibility for improving accessibility and quality of substance abuse prevention services. 

The Committee directs that all of the money appropriated explicitly for Substance Abuse Prevention purposes both in CSAP’s 

PRNS lines as well as the funding from the 20 percent prevention 

set-aside in the SABG be used only for bona fide substance abuse 

prevention activities and not for any other purpose to ensure the 

work in school-based settings is as robust as possible. 

Programs of Regional and National Significance 

The Committee provides $238,219,000 for PRNS within CSAP. 

Through these programs, CSAP supports: development of new practice knowledge on substance abuse prevention; identification of 

proven effective models; dissemination of science-based intervention information; State and community capacity building for implementation of proven, effective substance abuse prevention programs; and programs addressing new needs in the prevention system. 

Within the total provided for PRNS, the Committee recommendation includes funding for the following activities: 

[In thousands of dollars] 

Budget activity Fiscal year 2017 

appropriation 

Fiscal year 2018 

request Committee recommendation 

CAPACITY: 

Strategic Prevention Framework/Partnership for Success .... 109,484 48,427 109,484 

Strategic Prevention Framework Rx ...................................... 10,000 10,000 10,000 

Grants to Prevent Prescription Drug/Opioid Overdose ......... 12,000 11,977 12,000 

First Responder Grants ......................................................... 12,000 12,000 12,000 

Opioid Prevention Grants ...................................................... ............................ ............................ 15,000 

Mandatory Drug Testing ....................................................... 4,894 4,885 4,894 

Minority AIDS ......................................................................... 41,205 28,843 41,205 

Sober Truth on Preventing Underage Drinking (STOP Act) .. 7,000 6,986 7,000 

National Adult-Oriented Media Public Service Campaign ....................................................................... 1,000 ............................ 1,000 

Community-based Coalition Enhancement Grants ...... 5,000 ............................ 5,000 

ICCPUD ......................................................................... 1,000 ............................ 1,000 

Tribal Behavioral Health Grants ........................................... 15,000 14,971 15,000 

SCIENCE AND SERVICE: 

Center for the Application of Prevention Technologies ........ 7,493 7,479 7,493 

Science and Service Program Coordination ......................... 4,072 4,064 4,072 

Minority Fellowship Program ................................................. 71 71 71 

Alternatives to Opioids.—The Committee is aware of programs 

that provide innovative approaches to preventing opioid addiction 

and dependency by using evidenced-based treatment options and 

alternatives to the uses of opioids. The Committee is encouraged 

that these programs can help reduce dependence on opioids and encourages SAMHSA to develop and disseminate best practices in 

preventing opioid abuse. 

Combating Opioid Abuse.—The Committee provides $12,000,000 

for grants to prevent opioid overdose related deaths. As part of the 

initiative to combat opioid abuse, this program will help States 

equip and train first responders and other community partners 
123 

with the use of devices that rapidly reverse the effects of opioids. 

The agreement also provides $12,000,000 for First Responder 

Training grants. Of this amount, $6,000,000 is set aside for rural 

communities with high rates of substance abuse. SAMHSA is directed to ensure applicants outline how proposed activities in the 

grant would work with treatment and recovery communities in addition to first responders. Furthermore, the Committee provides 

$10,000,000 for the Strategic Prevention Framework Rx program to 

increase awareness of opioid abuse and misuse in communities. 

Opioid Prevention Grants.—The Committee understands that efforts to address the opioid crisis must include community-based 

strategies to prevent opioid abuse. Therefore, the bill provides 

$15,000,000 for a new opioid prevention program. SAMHSA shall 

award opioid prevention grants to communities and community 

coalitions based on the current state of evidence-based and promising practices. Of the amounts provided, the Committee directs 

that no more than $1,000,000 be used to conduct an evaluation of 

these grants to determine effectiveness. Further, the Committee directs SAMHSA to continue providing technical assistance to communities and coalitions by developing and distributing a list of best 

practices to prevent opioid abuse. SAMHSA is directed to work 

with NIDA, other Federal agencies, appropriate stakeholder 

groups, and States, in implementing these grants and developing 

best practices. Furthermore, SAMHSA should update this list 

based on new research findings, including the evaluation of the 

opioid prevention program grants. 

HEALTH SURVEILLANCE AND PROGRAM SUPPORT

Appropriations, 2017 ............................................................................. $148,258,000 

Budget estimate, 2018 ........................................................................... 132,348,000 

Committee recommendation ................................................................. 145,830,000 

The Committee recommends $145,830,000 for Health Surveillance and Program Support activities. The recommendation includes $31,428,000 in transfers available under section 241 of the 

PHS Act. 

This activity supports Federal staff and the administrative functions of the agency. It also provides funding to SAMHSA’s surveillance and data collection activities, including national surveys such 

as the National Survey on Drug Use and Health. 

Within the total provided for Health Surveillance and Program 

Support, the Committee recommendation includes funding for the 

following activities: 

[In thousands of dollars] 

Budget activity Fiscal year 2017 

appropriation 

Fiscal year 2018 

request 

Committee 

recommendation 

Health Surveillance ........................................................................ 47,258 33,842 47,258 

Program Management .................................................................... 77,000 73,043 76,000 

Performance & Quality Information Systems ................................ 10,000 12,893 10,000 

Public Awareness and Support ...................................................... 13,000 11,572 11,572 

Behavioral Health Workforce Data ................................................. 1,000 1,000 1,000 
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Methamphetamine Abuse.—The Committee requests that 

SAMHSA, in partnership with the National Center for Health Statistics at CDC, investigate the establishment of a comprehensive 

survey of the rates of methamphetamine abuse and its related indicators. Such a survey would include rates of methamphetamine 

use, treatment admissions due to methamphetamine use, rates of 

overdose and morality, incidence of births of methamphetamine-addicted infants, interactions with law enforcement and child protective services related to methamphetamine use, and any other indicators recommended by SAMHSA and CDC. The Committee requests an update on the feasibility of such a survey in the fiscal 

year 2019 CJ. 

The Committee does not include bill language requested by the 

administration that would provide additional transfer authority to 

the Administrator beyond that which is already provided to the 

Secretary. 

AGENCY FOR HEALTHCARE RESEARCH AND QUALITY

Appropriations, 2017 ............................................................................. $324,000,000 

Budget estimate, 2018 ........................................................................... ........................... 

Committee recommendation ................................................................. 324,000,000 

The Committee provides $324,000,000 for the Agency for 

Healthcare Research and Quality [AHRQ], which is combined with 

the $106,500,000 in mandatory funding from the Patient-Centered 

Outcomes Research Trust Fund. AHRQ was established to enhance 

the quality, appropriateness, and effectiveness of health services, 

as well as access to such services. AHRQ conducts, supports, and 

disseminates scientific and policy-relevant research on topics such 

as promoting high-quality care, eliminating healthcare disparities, 

using information technology, and evaluating the effectiveness of 

clinical services. 

HEALTH COSTS, QUALITY, AND OUTCOMES

The Committee provides $187,156,000 for research on health 

costs, quality, and outcomes [HCQO]. The HCQO research activity 

is focused upon improving clinical practice, improving the 

healthcare system’s capacity to deliver quality care, and tracking 

progress toward health goals through monitoring and evaluation. 

Within the total provided for HCQO, the Committee recommendation includes funding for the following activities: 

[In thousands of dollars] 

Budget activity Fiscal year 2017 

appropriation 

Fiscal year 2018 

request 

Committee 

recommendation 

Research on Health Costs, Quality, and Outcomes: 

Prevention/Care Management ............................................... 11,649 ............................ 11,649 

Health Information Technology ............................................. 16,500 ............................ 16,500 

Patient Safety Research ....................................................... 70,276 ............................ 70,276 

Health Services Research, Data and Dissemination ............ 88,731 ............................ 88,731 

Diagnostic Quality & Safety.—The Committee is concerned about 

the lack of dedicated research into improving how we diagnose 

medical conditions, especially given the magnitude of the public 
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health burden of diagnostic failures that lead to patient harm. According to the 2015 report, ‘‘Improving Diagnosis in Healthcare’’, 

from the National Academy of Sciences, Engineering, and Medicine 

[NASEM], diagnostic errors have been a ‘‘blind spot’’ for health 

care delivery and improving diagnosis is a pressing ‘‘moral, professional, and public health imperative.’’ The Committee requests that 

AHRQ convene a cross-agency working group that will propose a 

strategy to enhance scientific research to improve diagnosis in 

healthcare, as outlined in the 2015 NASEM report. This should include a review of current research, as well as consideration of opportunities for public-private partnerships and the development of 

centers of excellence to propel research forward to improve diagnostic quality and safety while reducing healthcare costs. The Committee requests this information be provided in the fiscal year 2019 

CJ. 

Evidence-Based Practice.—The Committee encourages AHRQ to 

include in its research portfolio a focus on disabilities and chronic 

conditions, including disability as a health disparity. The Committee encourages AHRQ to use all three levels of evidence stratification and assessment recognized by the U.S. Preventative Services Task Force and recognize that the absence of randomized controlled trials does not equate to the absence of evidence. Similarly, 

the Committee encourages AHRQ to recognize that the inability to 

draw conclusions about the comparative effectiveness of a treatment does not mean the treatment is ineffective. 

Health IT Safety.—The Committee recommendation includes 

$16,500,000 for AHRQ’s work on safe health IT practices specifically related to the design, implementation, usability, and safe use 

of health IT systems. The Committee believes this investment will 

generate new evidence regarding safe health IT practices that will 

ultimately be used by ONC, FDA, CMS, and others to inform policy 

interventions. 

Health Services Research.—Health services research provides decisionmakers critical information to improve health care quality, 

increase efficiency, and inform personal health care choices. The 

Committee does not support the administration’s proposal to consolidate AHRQ into the NIH and instead continues to fund the 

agency as an independent operating division within the Department. However, the Committee is concerned that AHRQ and the 

other Federal agencies conducting health services research do not 

sufficiently coordinate their efforts to optimize Federal investments 

in this science. The recommendation includes $1,000,000 for AHRQ 

to contract with an independent entity to study health services research supported by Federal agencies since fiscal year 2012. This 

study should identify research gaps and areas for consolidation, as 

well as propose strategies for better coordination of the Federal 

health services research enterprise. The Committee requests a report on the findings of this study to the Committee not later than 

180 days after the enactment of this act. 

Healthcare-Associated Infections.—Within the Patient Safety 

portfolio, the Committee provides $36,000,000, the same level as in 

fiscal year 2017, for healthcare-associated infection activities. Within this funding level, the Committee includes $10,000,000 for activities as part of the CARB initiative. These funds will support the 
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development and expansion of antibiotic stewardship programs specifically focused on ambulatory and long-term care settings. 

Healthcare Delivery Systems.—Within the Patient Safety port- folio, the Committee includes $10,000,000 for Healthcare Delivery 

Systems grants, or ‘‘patient safety learning labs.’’ The purpose of 

these grants is to test new ways of addressing entrenched patient 

safety issues by using a systems engineering approach. 

Investigator-Initiated Research.—The Committee reiterates its 

strong support for investigator-initiated research and believes this 

research should not target any specific area of health services research but should reflect the best unsolicited ideas from the research community. The Committee is aware that enhanced utilization of independent academic medical centers could lead to innovative and pragmatic solutions that improve clinical practices. 

U.S. Preventative Services Task Force [USPSTF].—The Committee notes the USPSTF’s inclusion of additional stakeholders and 

physician experts during its recent process for drafting the updated 

prostate cancer screening recommendation. However, the Committee remains concerned about the lack of transparency in the 

process and directs the USPSTF to include a description of comments received on the draft recommendation statement and relevant recommendations of other Federal agencies and organizations in any final recommendation. 

MEDICAL EXPENDITURES PANEL SURVEYS

The Committee provides $66,000,000 for Medical Expenditure 

Panel Surveys [MEPS], which collect detailed information annually 

from households, healthcare providers, and employers regarding 

how Americans use and pay for healthcare. The data from MEPS 

are used to develop estimates of healthcare utilization, expenditures, sources of payment, and the degree of health insurance coverage of the U.S. population. 

PROGRAM SUPPORT

The Committee recommends $70,844,000 for program support. 

This activity funds the overall management of AHRQ, including 

salaries, benefits, and overhead costs such as rent. 

CENTERS FOR MEDICARE AND MEDICAID SERVICES

GRANTS TO STATES FOR MEDICAID

Appropriations, 2017 ......................................................................... $262,003,967,000 

Budget estimate, 2018 ...................................................................... 284,798,384,000 

Committee recommendation ............................................................. 284,798,384,000 

The Committee recommends $284,798,384,000 in mandatory 

funding for Grants to States for Medicaid. 

The fiscal year 2018 recommendation excludes $125,219,452,000 

in fiscal year 2017 advance appropriations for fiscal year 2018. As 

requested by the administration, $134,847,759,000 is provided for 

the first quarter of fiscal year 2019. 

The Medicaid program provides medical care for eligible low-income individuals and families. It is administered by each of the 50 

States, the District of Columbia, Puerto Rico, and the territories. 

Federal funds for medical assistance are made available to the 
127 

States according to a formula that determines the appropriate Federal matching rate for State program costs. This matching rate is 

based on the State’s average per capita income relative to the national average and cannot be less than 50 percent. 

PAYMENTS TO HEALTHCARE TRUST FUNDS

Appropriations, 2017 ......................................................................... $299,187,700,000 

Budget estimate, 2018 ...................................................................... 323,497,300,000 

Committee recommendation ............................................................. 323,497,300,000 

The Committee recommends $323,497,300,000 in mandatory 

funding for payments to healthcare trust funds. 

This entitlement account includes the general fund subsidy to 

the Federal Supplementary Medical Insurance Trust Fund for 

Medicare Part B benefits and for Medicare Part D drug benefits 

and administration, plus other reimbursements to the Federal Hospital Insurance Trust Fund for Part A benefits and related administrative costs that have not been financed by payroll taxes or premium contributions. 

The Committee provides $245,396,000,000 for the Federal payment to the Supplementary Medical Insurance Trust Fund. This 

payment provides matching funds for premiums paid by Medicare 

Part B enrollees. 

The Committee further provides $76,133,000,000 for the general 

fund share of benefits paid under Public Law 108–173, the Medicare Prescription Drug, Improvement and Modernization Act of 

2003. As in previous years, the Committee includes bill language 

requested by the administration providing indefinite authority for 

paying the general revenue portion of the Part B premium match 

and provides resources for the Part D drug benefit program in the 

event that the annual appropriation is insufficient. The Committee recommendation also includes $422,000,000 to be 

transferred to the Supplementary Insurance Trust Fund as the 

general fund share of Part D administrative expenses. The Committee recommendation includes $307,000,000 in reimbursements 

to the Health Care Fraud and Abuse Control [HCFAC] fund, which 

reflects the portion of the HCFAC spending to be reimbursed by 

the General Fund. 

PROGRAM MANAGEMENT

Appropriations, 2017 ............................................................................. $3,669,744,000 

Budget estimate, 2018 ........................................................................... 3,587,996,000 

Committee recommendation ................................................................. 3,669,744,000 

The Committee recommends $3,669,744,000 for CMS program 

management, which includes funding for research, program operations, survey and certification programs, and Federal administration. 

Research, Demonstrations and Evaluations.—The Committee recommends $20,054,000 for research, demonstrations, and evaluation 

activities. 

Program Operations 

The Committee recommends $2,519,823,000 for the Program Operations account, which covers a broad range of activities including 

claims processing and program safeguard activities performed by 
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Medicare contractors. These contractors also provide information, 

guidance, and technical support to both providers and beneficiaries. 

ACA Notifications.—The Committee continues bill language requiring the administration to provide detailed enrollment figures to 

the Committees on Appropriations of the House of Representatives 

and the Senate not less than two full business days before any public release of the information. 

Access to Mental Health Care.—The Committee strongly urges 

CMS to pursue initiatives that expand access to quality care and 

increase parity for mental health services. 

Adverse Drug Events.—To improve patient safety and the efficiency of the Medicare Program, the Committee encourages CMS to 

prioritize the adoption of approved quality measures related to 

drugs that are associated most frequently with adverse drug events 

that may result in significant patient harm in the over 65 population. This should be consistent with the Department’s National 

Action Plan for Adverse Drug Event Prevention. 

Caregiver Counseling and Supportive Services.—The Committee 

is aware of a body of evidence that suggests defined counseling and 

supportive services delivered to family (non-paid) caregivers of 

Medicare beneficiaries with Alzheimer’s disease and dementia can 

substantially delay beneficiary placement in an institutional care 

setting and reduce Federal expenditures associated with such care. 

The Committee is concerned about the current and anticipated 

Medicare and Medicaid costs associated with Alzheimer’s disease 

and recommends that CMS, in consultation with ACL, consider a 

pilot or demonstration program to evaluate the impact of such evidence-based Alzheimer’s caregiver support models could have on 

the Medicare and Medicaid programs. 

CT Colonography.—Due to the proven life and cost-savings of 

preventative screening for colorectal cancer, the Committee encourages CMS to consider covering CT Colonography as a Medicare-covered colorectal cancer screening test under section 1861(pp)(1) of 

the Social Security Act. 

Diabetes Prevention and Telehealth.—The Committee commends 

CMS’s 2017 announcement that the Center for Medicare and Medicaid Innovation will test virtual care for the Medicare Diabetes 

Prevention Program. The Committee encourages CMS to consider 

additional ways in which Medicare will cover remote patient monitoring and urges CMS to evaluate how telehealth can be an effective way to prevent and manage diabetes and other chronic diseases, specifically for beneficiaries in rural settings and for those 

without access to specialized chronic disease care. 

Direct and Indirect Remuneration Fees.—The Committee is concerned about the dramatic increase of pharmacy direct and indirect 

remuneration [DIR] fees in Medicare Part D. The Committee requests a report from CMS within 180 days after enactment of this 

act on how to best address this issue, including consideration of options to require that all DIR fees be accounted for a point of sale; 

as part of negotiated price; and that any incentive fees be paid separately. 

Electrodiagnostic [EDX] Tests.—The Committee appreciates that 

CMS provided additional guidance regarding the recommendations 

in the 2014 OIG Report: ‘‘Questionable Billing for Medicare 
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Electrodiagnostic Tests.’’ The Committee notes that utilization of 

codes for EDX testing continues to increase and remains interested 

in comprehensive solutions that advance quality care and cost savings by ensuring patients do not receive unnecessary EDX tests. 

Falls Prevention.—The Committee recognizes the importance of 

injury prevention in seniors and the impact that falls can have on 

morbidity and mortality, as well as the rising aging population in 

the United States. The Committee also recognizes the significant 

positive outcomes in terms of averted morbidity and mortality, as 

well as cost savings, from models such as the Community Aging in 

Place—Advancing Better Living for Elders [CAPABLE] program. 

Funded through the Center for Medicare and Medicaid Innovation’s 

Health Care Innovation Awards, the CAPABLE program utilized 

occupational therapists, nurses, and home repair handymen to 

focus on beneficiary-directed home functional improvements, with 

the aim of delaying entry to skilled nursing facilities. The Committee encourages CMS to look for opportunities to test models related to injury and fall prevention. 

Fraudulent Billing.—During fiscal year 2018, the Committee encourages CMS to investigate diagnostic laboratories’ use of a fraudulent billing practice commonly known as fee forgiveness schemes 

and evaluate what role the agency can have in minimizing this 

practice. These illegal practices can often result in increased Medicare and Medicaid expenditures and can cause undue burden on 

our Nation’s healthcare system. 

Graduate Medical Education.—The Committee recommends that 

the Comptroller General of the United States conduct a study on 

the potential of making graduate medical education payments 

under the Medicare program for mid-level health providers (such as 

physician assistants and nurse practitioners) to allow physicians 

and other health care providers to perform to their full scope of 

practice; and to identify the current, actual costs involved in training residents in different residency specialty types. The Comptroller General shall provide the report within one year of the enactment of this act and shall consult with the Committees on Appropriations of the House of Representatives and the Senate as 

well as the Senate Finance Committee and House Committee on 

Ways and Means and keep the Committees apprised of progress 

quarterly. 

Health Insurance Exchange Transparency.—The Committee continues bill language that requires 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 Benefit and Rate Review, 

Exchange 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 [SHOP] and Employer Activities; and 

Other Exchange Activities. Cost Information should be provided for 

each fiscal year since the enactment of the Patient Protection and 

Affordable Care Act (Public Law 111–148). CMS is also required to 

include the estimated costs for fiscal year 2019. 
130 

Immunization Information System Interoperability.—The Committee is aware that HHS has made HITECH funding available to 

support connectivity and interoperability between Medicaid providers and Immunization Information Systems [IIS]. The Committee encourages the Secretary to work with the Office of Management and Budget to evaluate how waiving match requirements, as 

applicable, may encourage many State and local health departments to take advantage of this funding opportunity. The Committee requests data from CMS on State and local health departments’ expenditures on IIS interoperability within 18 months after 

enactment of this act. 

Intrathecal Pain Pumps.—The Committee continues to be concerned that changes to Medicare billing practice may restrict patient access to intrathecal pain pumps as an option for pain management in States where the boards of pharmacy prohibit sale of 

compounded solutions from a pharmacist to a physician. The Committee looks forward to receiving the study requested in fiscal year 

2017 of the effect of this billing practice change on patient access 

in these States. 

Medicare Advantage.—The Committee continues to be concerned 

that the formula to determine Medicare Advantage reimbursement 

rates is calculated based on the per capita cost of coverage to beneficiaries enrolled in Medicare Part A and/or Part B. The Committee 

is concerned that CMS has not made progress on these payment 

adjustments, and encourages CMS to consider more accurate adjustments for fiscal year 2018. 

Medicare Clinical Laboratory Fees.—Before finalizing implementation of the final regulation (CMS–1621–F) implementing the Protecting Access to Medicare Act of 2014, the Committee encourages 

CMS to continue to work with stakeholders to address data accuracy concerns and ensure that the reported data appropriately represents the full spectrum of laboratories, including hospital, independent, and physician-office laboratories, that are paid under the 

Medicare Clinical Laboratory Fee Schedule. 

Medicare Prescription Drug Plan [PDP] Standardized Reporting.—The Committee requests CMS to provide an update in the 

2019 CJ on how they plan to require standardized reporting by 

PDP sponsors of all price concession received from, and incentive 

payments made to, network pharmacies except those contingent 

price concessions or incentive payments that cannot reasonably be 

determined at the point of sale. 

Plan Finder.—The Committee encourages CMS to enhance the 

Medicare Plan Finder web site to strengthen beneficiary’s ability to 

shop for and choose plans that best meet their needs. CMS should 

consider improvements such as improving navigation on mobile devices, providing information on the estimated out-of-pocket costs for 

Medicare beneficiaries for common services, and providing searchable up-to-date provider network directories. The Committee encourages CMS to solicit input from relevant stakeholders to help 

inform and facilitate such changes. The Committee requests that 

an update of these efforts be provided in the fiscal year 2019 CJ. 

Recovery Audit Contractors [RAC].—The Committee directs the 

Medicare appeals intra-agency working group to provide quarterly 

updates to the Committees on Appropriations of the House of Rep-
131 

resentatives and the Senate reflecting the total number of appeals 

filed, appeals pending, and appeals disposed of for all four levels 

of the appeals process. The quarterly updates should include a 

breakout of RAC and non-RAC claims, an update on RAC contracting and how new RAC requirements have affected the rate of 

appeals. 

Risk Corridor Program.—The agreement continues bill language 

to prevent the CMS Program Management appropriation account 

from being used to support risk corridor payments. The agreement 

directs CMS to provide a report starting with plan year 2014 and 

continuing through the duration of the program to the Committees 

on Appropriations of the House of Representatives and the Senate 

detailing the receipts and transfer of payments for the Risk Corridor Program. 

Rural Health.—While nearly a quarter of the U.S. population 

lives in rural areas, access to CAHs continues to be a challenge for 

many residents as these hospitals face significant financial challenges. The majority of rural residents are older, poorer, and less 

likely to have employer sponsored health plans. As a result, if a 

rural hospital closes, many patients end up driving long distances 

to see a doctor, forgo seeking medical care, or even worse, wait 

until it is too late to seek proper medical attention. These patients 

spend more money out of pocket to travel and miss routine preventative care which will end up increasing healthcare costs in the 

long run. The Committee appreciates the ongoing work of CMS and 

HRSA to analyze the impact of proposed regulations on rural hospitals and other providers and is pleased with the recent establishment of the Rural Health Council to address the unique needs of 

rural communities. The Committee continues to direct CMS to 

work with HRSA’s Office of Rural Health and provide an update 

in the fiscal year 2019 CJ on actions taken to alleviate the disproportionate impact of regulations, reimbursement cuts, and 

workforce issues on rural hospitals. 

Telehealth.—The Committee directs the Administrator, in consultation with the relevant agencies and stakeholders, to submit a 

report within 1 year after enactment of this act to the Committees 

of Appropriations of the House of Representatives and the Senate 

evaluating the use of telehealth and remote patient monitoring 

under all programs and pilots under the Medicare program under 

title XVIII of the Social Security Act and the Medicaid program 

under title XIX of such Act with a waiver of telehealth restrictions 

otherwise applicable under such titles of the Social Security Act (42 

U.S.C. 1395m(m)). The report shall include an assessment of: (A) 

the number of providers and payers using telehealth and remote 

patient monitoring under such programs and pilots; (B) the cost 

impact among the beneficiaries receiving telehealth and remote patient monitoring under such programs and pilots, including with 

respect to preventable hospitalizations, hospital readmissions, and 

emergency room visits, and the total cost of items and services 

under the Medicare and Medicaid programs; (C) beneficiary and 

family caregiver satisfaction with the use of telehealth and remote 

patient monitoring under such programs and pilots; and (D) a comparison of the utilization of, and expenditures for, the same serv-
132 

ices furnished under the Medicare and Medicaid programs in the 

usual clinical setting. 

Therapeutic Foster Care.—The Committee remains concerned 

about the lack of a uniform definition within the Medicaid program 

for therapeutic foster care [TFC] services. A uniform definition 

would improve the ability for more consistent care and treatment. 

The Committee requests an update in the fiscal year 2019 CJ on 

the study requested in House Report 114–699 under this heading. 

Use of Opioid Drugs to Manage Chronic Pain.—The Committee 

understands that opioid pain medications are used and are often 

essential in the appropriate management of acute and chronic pain. 

Given the national problem of misuse and abuse of prescription 

opioid pain medications, the Committee encourages CMS to increase awareness of alternative pain management strategies to 

opioids to reduce opioid monotherapy in appropriate cases. 

Use of Social Security Numbers on Medicare Beneficiaries’ 

Cards.—The Committee is encouraged by CMS plans to start sending new Medicare cards with a Medicare Beneficiary Identifier to 

Medicare beneficiaries by October 2018. The Committee directs 

CMS to provide an update on the progress of this initiative in their 

fiscal year 2019 CJ. 

Vaccine Utilization.—The Committee is concerned about the underutilization of vaccinations, particularly pneumococcal vaccines 

and encourages CMS to continue to require that electronic health 

records communicate with immunization registries, so that clinicians accessing the registries have the most complete immunization 

history available and to continue efforts to remind beneficiaries 

and their providers to adhere to the recommendations. 

State Survey and Certification 

The Committee recommends $397,334,000 for State Survey and 

Certification activities, which ensure that institutions and agencies 

providing care to Medicare and Medicaid beneficiaries meet Federal health, safety, and program standards. On-site surveys are 

conducted by State survey agencies, with a pool of Federal surveyors performing random monitoring surveys. 

The Committee continues to support CMS collecting and analyzing the findings from this surveillance tool to inform the agency’s education and surveillance efforts moving forward. 

Federal Administration 

The Committee recommends $732,533,000 for Federal Administration, which funds the majority of CMS’ staff and operating expenses for routine activities such as planning, implementing, evaluating, and ensuring accountability in the programs administered by 

CMS. 

HEALTH CARE FRAUD AND ABUSE CONTROL

Appropriations, 2017 ............................................................................. $725,000,000 

Budget estimate, 2018 ........................................................................... 751,000,000 

Committee recommendation ................................................................. 745,000,000 

The Committee recommends $745,000,000, to be transferred from 

the Medicare trust funds, for Health Care Fraud and Abuse Control [HCFAC] activities. The latest data demonstrate for every 
133 

$1.00 spent on fraud and abuse, $2.00 is recovered by the Treasury. 

The Committee recommendation includes a base amount of 

$311,000,000 and an additional $434,000,000 through a budget cap 

adjustment authorized by section 251(b) of the Balanced Budget 

and Emergency Deficit Control Act of 1985. 

ADMINISTRATION FOR CHILDREN AND FAMILIES

PAYMENTS TO STATES FOR CHILD SUPPORT ENFORCEMENT AND

FAMILY SUPPORT PROGRAMS

Appropriations, 2017 ............................................................................. $3,010,631,000 

Budget estimate, 2018 ........................................................................... 2,995,400,000 

Committee recommendation ................................................................. 2,995,400,000 

The Committee recommendation includes $2,995,400,000 in fiscal 

year 2018 mandatory funds for Child Support Enforcement and 

Family Support programs. In addition, the Committee recommends 

$1,400,000,000 in advance funding for the first quarter of fiscal 

year 2019. 

These funds support States’ efforts to promote the self-sufficiency 

and economic security of low-income families, including administrative expenses matching funds and incentive payments to States for 

child support enforcement; grants to States to help establish and 

administer access and visitation programs between noncustodial 

parents and their children; payments to territories for benefits to 

certain aged, blind, or disabled individuals; and temporary benefits 

for certain repatriated citizens. 

LOW INCOME HOME ENERGY ASSISTANCE PROGRAM

Appropriations, 2017 ............................................................................. $3,390,304,000 

Budget estimate, 2018 ........................................................................... ........................... 

Committee recommendation ................................................................. 3,390,304,000 

The Committee recommendation includes $3,390,304,000 for 

LIHEAP, which provides home heating and cooling assistance to 

low-income households, generally in the form of payments to energy vendors on behalf of the recipient. Within the total, the Committee recommendation includes up to $2,988,000 for program integrity and oversight efforts, the same as the fiscal year 2017 level. 

REFUGEE AND ENTRANT ASSISTANCE

Appropriations, 2017 ............................................................................. $1,674,691,000 

Budget estimate, 2018 ........................................................................... 1,456,755,000 

Committee recommendation ................................................................. 1,506,691,000 

The Committee recommends $1,506,691,000 for Refugee and Entrant Assistance [REA] programs. These programs provide a variety of benefits and services to refugees, asylees, Cuban and Haitian 

entrants, immigrants arriving on Special Immigrant Visas, trafficking victims, and torture victims (collectively referred to below 

as ‘‘refugees’’). These programs also provide temporary care and 

services for unaccompanied children apprehended by the Department of Homeland Security or other law enforcement agencies, who 

have no lawful immigration status in the United States until they 

can be placed with a parent, guardian, or other sponsor while 

awaiting adjudication of their immigration status. 
134 

The U.S. refugee protection and admission programs reflect U.S. 

humanitarian and strategic interests. The U.S. refugee resettlement program provides for the safe resettlement of some of the 

most vulnerable refugees and not only saves lives, but also 

strengthens our national security by providing support and shared 

responsibility for strategic allies and regions. 

The Committee affirms the community consultation process embedded in the U.S. refugee resettlement program, which is grounded in its public-private partnerships and thrives on cooperation 

among local, State, and Federal stakeholders. In times of sudden 

reductions in refugee arrivals, the Committee encourages HHS, to 

the extent practicable, to ensure that resettlement agencies are 

able to maintain their infrastructure and capacity at a level to continue to serve new refugees, previously arrived refugees, and others 

who remain statutorily eligible for integration services, and to ensure future arrivals are adequately served. 

Transitional and Medical Services 

The Committee recommendation includes $320,000,000 for Transitional and Medical Services [TAMS]. This program provides 

grants to States and nonprofit organizations to provide up to 8 

months of cash and medical assistance to arriving refugees, as well 

as foster care services to unaccompanied minors. 

In fiscal year 2018, HHS estimates the number of eligible arrivals will significantly decrease relative to fiscal years 2016 and 

2017. This is due to a significant estimated reduction in eligible 

Cuban entrants because of the change in administration policy in 

January 2017 that ended the so called ‘‘wet-foot/dry-foot’’ policy, 

and an assumed reduction in the refugee admissions ceiling to 

50,000, which will be set by the State Department later this year. 

Accordingly, the Committee recommendation includes a decrease in 

funding for TAMS, consistent with current HHS estimates and expects the funding level provided will allow HHS to at least sustain 

the current level and scope of services provided to eligible arrivals, 

including maintaining the number of months refugees are eligible 

for benefits. Further, the Committee notes that there is considerable uncertainty in the estimates of the costs for this program, and 

expects HHS to closely monitor this account and promptly notify 

the Committee of any shortfalls so they can be addressed. The 

Committee will consider revised funding needs as necessary. To 

that end, the Committee directs HHS to provide monthly updates 

of eligible arrivals by category to the Committees on Appropriations of the House of Representatives and the Senate. Finally, the 

Committee directs HHS, in future budget justifications, to include 

actual and estimated costs broken out by major category, including 

for the unaccompanied refugee minor program, matching grant program, cash assistance, medical care, and other categories as appropriate. 

The Committee continues to support the matching grant program 

and strongly encourages HHS to increase the percentage of eligible 

arrivals served by the program. Further, the Committee strongly 

encourages HHS to give matching grant organizations flexibility in 

administering their programs, including, when justified, carrying 
135 

over unexpended funding and slots and providing exemptions to 

the 31 day enrollment period. 

Refugee Support Services 

The Committee recommendation includes $207,201,000 for Refugee Support Services. The budget request proposes to consolidate 

funding for Social Services, Preventive Health, and Targeted Assistance into this new program. The Committee supports this consolidation which should simplify administration of refugee services 

at the Federal, State, and local level. This funding would be allocated in a similar manner as currently funded programs, by a combination of formula and competitive grants, based on recent refugee 

and arrival data, including accounting for secondary migration, and 

to address other critical needs. 

The Committee continues to support the services currently provided by the Social Services program, as well as the Targeted Assistance Grant program, which addresses the critical needs of counties with high arrival patterns and high concentrations of refugees 

facing difficulties achieving self-sufficiency. Within the total for 

Refugee Support Services, the Committee recommendation includes 

$4,600,000 for Refugee Health Promotion competitive grants, the 

same as the fiscal year 2017 funding level. 

Victims of Trafficking 

The Committee recommendation includes $20,755,000 for Victims 

of Trafficking programs. These programs support a national network of organizations that provide a variety of services—including 

case management, counseling, benefit coordination, and housing assistance—for victims of commercial sex and forced labor trafficking. 

Within the total, the Committee recommendation includes 

$15,000,000 for services for foreign national victims, and 

$5,755,000 to improve services available for U.S. citizens and legal 

permanent residents. The Committee directs HHS to use the increase in funding provided for the Victims of Trafficking program 

to help address unmet needs in foreign national victim assistance 

programs. The Committee recommendation also includes no less 

than the fiscal year 2017 level for the national human trafficking 

resource center. 

Social Services 

The Committee recommendation consolidates funding for this 

program into a new Refugee Support Services program, as requested by the administration. 

Preventive Health 

The Committee recommendation consolidates funding for this 

program into a new Refugee Support Services program. 

Targeted Assistance 

The Committee recommendation consolidates funding for this 

program into a new Refugee Support Services program, as requested by the administration. 
136 

Unaccompanied Children 

The Committee recommendation includes $948,000,000 for the 

Unaccompanied Children [UC] program. The UC program provides 

temporary shelter and basic services to children who have no lawful immigration status in the United States and who have been apprehended in the United States by the Department of Homeland 

Security or other law enforcement agencies without a parent or 

guardian. HHS takes custody of the children until they can be 

placed with a parent or guardian living in the United States pending resolution of their immigration status, or until their immigration status otherwise changes. 

There is significant uncertainty in the cost estimates for this program, which depend heavily on the number of unaccompanied children coming to the United States and referred to HHS. This year, 

the number of children coming to the United States and referred 

to HHS has significantly decreased. As a result, based on current 

estimates and funding levels, HHS estimates it will carry over unobligated balances from fiscal year 2017 that were not expected to 

be available when formulating the fiscal year 2018 budget request. 

Further, if the number of arrivals continue at roughly this level, 

HHS may need less funding in fiscal year 2018 than in fiscal year 

2017, or as requested for fiscal year 2018. The Committee will continue to work closely with HHS on estimated needs in this program 

as more data becomes available throughout the year to ensure 

HHS has sufficient resources to properly care for children in their 

custody and to continue to provide all post-release services at least 

at the level as provided in fiscal year 2017. 

In addition to the fiscal year 2018 funding provided here, the 

Committee recommendation includes a rescission of $140,000,000 

in prior-year unobligated balances. 

Victims of Torture 

The Committee recommendation includes $10,735,000 for the 

Victims of Torture program. This program provides treatment, social, and legal services to victims of torture and training to 

healthcare providers on treating the physical and psychological effects of torture. 

PAYMENTS TO STATES FOR THE CHILD CARE AND DEVELOPMENT

BLOCK GRANT

Appropriations, 2017 ............................................................................. $2,856,000,000 

Budget estimate, 2018 ........................................................................... 2,761,000,000 

Committee recommendation ................................................................. 2,856,000,000 

The Committee recommends $2,856,000,000 for the Child Care 

and Development Block Grant [CCDBG], a formula grant to States 

that provides financial assistance to families to help pay for child 

care, and otherwise improve the quality of child care programs. 

The CCDBG Act allows HHS to offer guidance to States on childto-provider ratios. Accordingly, the Committee directs the Department to report to the Committees on Appropriations of the House 

of Representatives and the Senate no later than 60 days after the 

date of enactment of this Act on the effect of child-to-provider ratio 

requirements on the average cost of child care, the quality and 
137 

safety of child care programs, and the steps HHS has taken to provide guidance to States on child-to-provider ratios. 

SOCIAL SERVICES BLOCK GRANT

Appropriations, 2017 ............................................................................. $1,700,000,000 

Budget estimate, 2018 ........................................................................... ........................... 

Committee recommendation ................................................................. 1,700,000,000 

The Committee recommends $1,700,000,000 in mandatory funds 

for SSBG, a flexible source of funding that allows States to provide 

a diverse array of services to low-income children and families, the 

disabled, and the elderly. 

CHILDREN AND FAMILIES SERVICES PROGRAMS

Appropriations, 2017 ............................................................................. $11,294,368,000 

Budget estimate, 2018 ........................................................................... 10,204,293,000 

Committee recommendation ................................................................. 11,284,368,000 

The Committee recommends $11,284,368,000 for Children and 

Families Services programs. These funds support a variety of programs for children, youth, and families; Native Americans; victims 

of child abuse, neglect, and domestic violence; and other vulnerable 

populations. 

Head Start 

The Committee recommendation includes $9,253,095,000 for 

Head Start. Head Start provides grants directly to local organizations to provide comprehensive early childhood education services 

to children and their families, from before birth to age 5. 

The Committee continues to direct HHS to ensure that as part 

of the effort to expand the duration of Head Start services, grantees continue to have flexibility to meet the needs of their local community and to fund other quality improvement activities that may 

be necessary to improve the quality of programs prior to expanding 

the duration of services. 

The Committee recommendation includes, in addition to funds 

otherwise available for Early Head Start, $640,000,000, the same 

as the fiscal year 2017 level, for Early Head Start Expansion and 

Child Care Partnerships grants. The Committee continues to direct 

HHS to give equal priority to grantees providing more traditional 

Early Head Start services and those forming child care partnerships. The Committee continues to support this partnership model 

but such partnerships will not be viable in every community and 

in many places it may be more appropriate to simply provide traditional Early Head Start services. 

Within the total for Head Start, the Committee recommendation 

includes up to $25,000,000, the same as the comparable fiscal year 

2017 level, for transition-related costs associated with the Head 

Start Designation Renewal System [DRS]. In addition, the Committee continues to encourage HHS to continue to consider the 

unique challenges faced by Head Start grantees in remote and 

frontier areas when reviewing such grantees’ compliance with 

health and dental screening requirements as part of the DRS. 
138 

Preschool Development Grants 

The Committee recommendation includes $250,000,000 for Preschool Development Grants. This program, as authorized in the 

Every Student Succeeds Act, provides competitive grants to States 

to improve the coordination, collaboration and quality of existing 

early childhood programs; improve the transition from early childhood programs to kindergarten; implement evidence-based practices; improve professional development for early childhood providers; and generally improve educational opportunities for children. All funding provided in fiscal year 2018 will support new 

grants, under the new authorization of the program. 

Consolidated Runaway and Homeless Youth Program 

The Committee recommendation includes $101,980,000 for the 

Consolidated Runaway and Homeless Youth program. This program supports the Basic Centers program, which provides temporary shelter, counseling, and after-care services to runaway and 

homeless youth under age 18 and their families; the Transitional 

Living Program, which provides longer-term shelter and services 

for older youth; and a national toll-free runaway and homeless 

youth crisis hotline. 

Education and Prevention Grants To Reduce Sexual Abuse of Runaway Youth 

The Committee recommendation includes $17,141,000 for Education and Prevention Grants to Reduce Sexual Abuse of Runaway 

and Homeless Youth. This program provides competitive grants for 

street-based outreach and education services for runaway and 

homeless youth who are subjected to, or are at risk of being subjected to, sexual abuse or exploitation. 

Child Abuse Prevention and Treatment State Grants 

The Committee recommendation includes $25,310,000 for the 

Child Abuse Prevention and Treatment State Grant program. This 

program provides formula grants to States to improve their child 

protective service systems. 

Child Abuse Discretionary Activities 

The Committee recommendation includes $33,000,000 for Child 

Abuse Discretionary Activities. This program supports discretionary grants for research, demonstration, and technical assistance to increase the knowledge base of evidence-based practices 

and to disseminate information to State and local child welfare programs. 

Quality Improvement Center for Research-based Infant-Toddler 

Court Teams [QIC–CT].—The Committee supports continued funding for a national resource center to preserve, disseminate, and amplify the work of the QIC-CT by providing training and technical 

assistance in support of such court teams’ efforts across the country. These efforts should build upon and continue the work of sites 

established through the QIC–CT initiative, which have brought together the court system, child welfare agencies, health professionals, and community leaders to improve current practices in the 
139 

child welfare system and make better-informed decisions on behalf 

of the child. 

Community-Based Child Abuse Prevention 

The Committee recommendation includes $39,764,000 for the 

Community-Based Child Abuse Prevention program. 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, including providing direct services 

and improving the coordination between State and communitybased organizations. 

Child Welfare Services 

The Committee recommendation includes $268,735,000 for Child 

Welfare Services. This formula grant program helps State and tribal public welfare agencies improve their child welfare services with 

the goal of keeping families together. These funds help States and 

tribes provide a continuum of services that prevent child neglect, 

abuse or exploitation; allow children to remain with their families, 

when appropriate; promote the safety and permanence of children 

in foster care and adoptive families; and provide training and professional development to the child welfare workforce. 

Child Welfare Research, Training, and Demonstration 

The Committee recommendation includes $17,984,000 for child 

welfare research, training, and demonstration projects. This program provides grants to public and nonprofit organizations for 

demonstration projects that encourage experimental and promising 

types of child welfare services, as well as projects that improve 

education and training programs for child welfare service providers. 

National Survey of Child and Adolescent Well-Being.—The Committee recommendation includes funding within this program for 

HHS to continue the National Survey of Child and Adolescent 

Well-Being. 

Adoption Opportunities 

The Committee recommends $39,100,000 for the Adoption Opportunities program. This program funds discretionary grants to help 

facilitate the elimination of barriers to adoption and provide technical assistance to help States increase the number of children 

adopted, particularly children with special needs. 

The Committee supports ACF’s efforts in fiscal year 2017 to fund 

activities to improve hospital-based adoption support services for 

pregnant and expectant mothers, including training for hospital 

staff and doctors. The Committee supports the continued funding 

of such activities, which will help ensure that mothers who wish 

to make an adoption have access to trained staff and comprehensive supports throughout the adoption process. 

Adoption Incentives 

The Committee recommends $37,943,000 for the Adoption Incentives program. This program provides formula-based incentive payments to States to encourage them to increase the number of adop-
140 

tions of children from the foster care system, with an emphasis on 

children who are the hardest to place. 

Social Services and Income Maintenance Research 

The Committee recommends $6,512,000 for Social Services and 

Income Maintenance Research. These funds support research and 

evaluation of cost-effective programs that increase the stability and 

economic independence of families and contribute to the healthy 

development of children and youth. 

Native American Programs 

The Committee recommends $52,050,000 for Native American 

programs. These funds support a variety of programs to promote 

self-sufficiency and cultural preservation activities among Native 

American, Native Hawaiian, Alaska Native, and Pacific Islander 

organizations and communities. 

Native American Language Preservation.—Within the total, the 

Committee recommendation includes $12,000,000 for Native American language preservation activities, including no less than 

$4,000,000 for Native American language nests and survival 

schools, as authorized by sections 803C(b)(7)(A)–(B) of the Native 

American Programs Act. The Committee directs HHS to give priority to programs with rigorous immersion programs. 

Native American Early Education.—The Committee is concerned 

that some Federal programs that support early childhood development in American Indian and Alaska Native communities are not 

well-coordinated and, therefore, reduce the abilities of these tribal 

communities to develop and implement community-wide early 

childhood initiatives. The Committee encourages the Secretary of 

HHS (through the Assistant Secretary for ACF) to convene a working group of Federal early childhood program administrators, tribal 

early childhood stakeholders, and tribal leaders to examine this 

issue. 

Community Services Block Grant 

The Committee recommendation includes $700,000,000 for the 

Community Services Block Grant [CSBG]. The CSBG is a formula 

grant to States and Indian tribes to provide a wide range of services to alleviate causes of poverty in communities and to assist lowincome individuals in becoming self-sufficient. States are required 

to pass on at least 90 percent of these funds to local communitybased organizations, the vast majority of which are community action agencies. 

Community Economic Development 

The Committee recommendation includes $19,883,000 for the 

Community Economic Development [CED] program, which provides 

grants to community development corporations to support employment and business opportunities for low-income individuals. Community development corporations leverage on average $10 in private capital to every $1 in Federal funds, and the job creation 

standards required by the Office of Community Services are among 

the most stringent in the Federal system. 
141 

The Committee recognizes the value in providing communities 

with the tools necessary to create sustainable economic development to help low-income families living in those communities. In 

awarding funds under this program, the Committee encourages 

ACF to give priority to rural communities, to help them identify 

community service needs and improve upon the services provided 

to low-income individuals and families in such communities. 

Rural Community Facilities 

The Committee recommendation includes $7,500,000 for the 

Rural Community Facilities program, which provides grants to regional non-profit organizations to provide technical assistance to 

small, low-income rural communities, that are not served by other 

similar Federal programs, to help manage, develop, and improve 

safe drinking and waste water facilities. 

National Domestic Violence Hotline 

The Committee recommendation includes $8,250,000 for the National Domestic Violence Hotline. This national, toll-free hotline 

provides critical emergency assistance and information to victims of 

domestic violence 24 hours a day. 

Family Violence Prevention and Services 

The Committee recommendation includes $156,000,000 for Family Violence Prevention and Services programs. These funds support programs to prevent family violence and provide immediate 

shelter and related assistance for victims of domestic violence and 

their dependents. The Committee recommendation is $5,000,000 more than the fiscal year 2017 level. The Committee directs HHS to use the increase 

to supplement existing funding for Native American Tribes and 

Tribal Organizations, and recognizes the importance of providing 

supports that are culturally appropriate to the populations they 

serve. 

Chafee Education and Training Vouchers 

The Committee recommendation includes $43,257,000 for the 

Chafee Education and Training Voucher program. This program 

supports vouchers to foster care youth to help pay for expenses related to postsecondary education and vocational training. 

Disaster Human Services Case Management 

The Committee recommends $1,864,000 for Disaster Human 

Services Case Management. This program assists States in establishing the capacity to provide case management services in a timely manner in the event of a disaster. It ensures that States are able 

to meet social service needs during disasters by helping disaster 

victims prepare recovery plans, referring them to service providers 

and FEMA contacts to identify needed assistance, and providing 

ongoing support and monitoring through the recovery process. 

Program Administration 

The Committee recommendation includes $205,000,000 for the 

Federal costs of administering ACF programs. 
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PROMOTING SAFE AND STABLE FAMILIES

Appropriations, 2017 ............................................................................. $384,765,000 

Budget estimate, 2018 ........................................................................... 404,651,000 

Committee recommendation ................................................................. 384,765,000 

The Committee recommends $384,765,000 for the Promoting Safe 

and Stable Families program. The Committee recommendation includes $325,000,000 in mandatory funds authorized by the Social 

Security Act and $59,765,000 in discretionary appropriations. 

This program supports activities that can prevent the emergence 

of family crises that might require the temporary or permanent removal of a child from his or her home. Grants allow States to operate coordinated programs of family preservation services, time-limited family reunification services, community-based family support 

services, and adoption promotion and support services. 

The Committee notes that the authorization for Promoting Safe 

and Stable Families expired in fiscal year 2016. Mandatory funding 

for certain court improvement programs funded within this account 

were continued in division M of the Consolidated Appropriations 

Act, 2017 but are not assumed to continue in the CBO baseline for 

fiscal year 2018. Accordingly, the Committee recommendation does 

not include continued funding for those activities in fiscal year 

2018. 

PAYMENTS FOR FOSTER CARE AND PERMANENCY

Appropriations, 2017 ............................................................................. $5,764,000,000 

Budget estimate, 2018 ........................................................................... 6,225,000,000 

Committee recommendation ................................................................. 6,225,000,000 

The Committee recommends $6,225,000,000 in mandatory funds 

for Payments for Foster Care and Permanency. In addition, the 

Committee recommends $2,700,000,000 in advance mandatory 

funding for the first quarter of fiscal year 2019. These funds support programs that assist States with the costs of maintaining eligible children in foster care, prepare children for living on their 

own, assist relatives with legal guardianship of eligible children, 

and find and support adoptive homes for children with special 

needs. 

Foster Care Data Collection.—The Committee directs ACF to submit a report to Congress on multigenerational foster care data. The 

Committee is interested in data that may be used to better target 

programs to ensure foster care involvement does not continue from 

generation to generation. The report shall include what data is currently available on whether biological parents of children placed in 

foster care were themselves in foster care at any time, at what age, 

for how long, and if they emancipated from the foster care system. 

The report should also recommend the best method for collecting 

data on multigenerational foster care. 

ADMINISTRATION FOR COMMUNITY LIVING

AGING AND DISABILITY SERVICES PROGRAMS

Appropriations, 2017 ............................................................................. $1,993,815,000 

Budget estimate, 2018 ........................................................................... 1,851,450,000 

Committee recommendation ................................................................. 1,993,815,000 
143 

The Committee recommends an appropriation of $1,993,815,000 

for the Administration for Community Living [ACL], which includes $27,700,000 to be transferred to ACL from the PPH Fund. 

ACL was created with the goal of increasing access to community 

support for older Americans and people with disabilities. It is 

charged with administering programs authorized under the Older 

Americans Act [OAA] and the Developmental Disabilities Act, as 

well as promoting community living policies throughout the Federal Government for older Americans and people with disabilities. 

Home- and Community-Based Supportive Services 

The Committee recommends an appropriation of $350,224,000 for 

the Home- and Community-Based Supportive Services program. 

This program provides formula grants to States and territories to 

fund a wide range of social services that enable seniors to remain 

independent and in their homes for as long as possible. State agencies on aging award funds to designated area agencies on aging 

that, in turn, make awards to local service providers. This activity 

supports services such as transportation, adult day care, physical 

fitness programs, and in-home assistance such as personal care and 

homemaker assistance. The Committee directs ACL to work with 

States to prioritize innovative service models, like naturally occurring retirement communities [NORCs], which help older Americans 

remain independent as they age. The Committee notes that 

NORCs, and similar settings, are a more cost-effective alternative 

to long-term care that enables older Americans to be more engaged 

in their communities while living at home. 

Preventive Health Services 

The Committee recommends $19,848,000 for Preventive Health 

Services. This program funds activities such as medication management and enhanced fitness and wellness programs. These programs 

help seniors stay healthy and avoid chronic disease, thus reducing 

the need for costly medical interventions. The Committee maintains bill language that requires States to use these funds to support evidence-based models that enhance the wellness of seniors. 

Protection of Vulnerable Older Americans 

The Committee recommends $20,658,000 for grants to States for 

the Long-term Care Ombudsman program and the Prevention of 

Elder Abuse program. Both programs provide formula grants to 

States to prevent the abuse, neglect, and exploitation of older individuals. The ombudsman program focuses on the needs of residents 

of nursing homes and other long-term care facilities, while the 

elder abuse prevention program targets the elderly community at 

large. 

National Family Caregiver Support Program 

The Committee recommends $150,586,000 for the National Family Caregiver Support program. Funds appropriated for this activity 

establish a multifaceted support system in each State for family 

caregivers, allowing them to care for their loved ones at home for 

as long as possible. States may use funding to provide information 

to caregivers about available services, assistance to caregivers in 
144 

gaining access to services, caregiver counseling and training, respite care to enable caregivers to be temporarily relieved from their 

caregiving responsibilities, and limited supplemental services that 

fill remaining service gaps. 

Native American Caregiver Support Program 

The Committee recommendation includes $7,556,000 to carry out 

the Native American Caregiver Support program. This program 

provides grants to tribes for the support of American Indian, Alaskan Native, and Native Hawaiian families caring for older relatives 

with chronic illness or disability, as well as for grandparents caring 

for grandchildren. 

Congregate and Home-Delivered Nutrition Services 

The Committee recommends an appropriation of $450,342,000 for congregate nutrition services and $227,342,000 for home-delivered 

meals. These programs address the nutritional needs of older individuals, thus helping them to stay healthy and reduce their risk of 

disability. Funded projects must make home-delivered and congregate meals available at least once a day, 5 days a week, and 

each meal must meet a minimum of one-third of daily dietary requirements. While States receive separate allotments of funds for 

congregate meals, home-delivered meals, and supportive services, 

they have flexibility to transfer funds between these programs. 

Nutrition Services Incentives Program.—The Committee recommendation includes $160,069,000 for the Nutrition Services Incentives Program [NSIP]. NSIP augments funding for congregate 

and home-delivered meals provided to older adults. States and 

tribes may choose to receive all or part of their funding in the form 

of commodities from the USDA. 

Aging Grants to Indian Tribes and Native Hawaiian Organizations 

The Committee recommends $31,208,000 for grants to Native 

Americans. This program provides grants to eligible tribal organizations for the delivery of nutrition and supportive services to Native Americans. 

Aging Network Support Activities 

The Committee recommends $9,961,000 for Aging Network Support activities. These funds support activities that expand public 

understanding of aging and the aging process, apply social research 

and analysis to improve access to and delivery of services for older 

individuals, test innovative ideas and programs, and provide technical assistance to agencies that administer programs authorized 

by the OAA. 

Within funding for the Aging Network Support Activities, the 

Committee supports the continuation of the National Alzheimer’s 

Call Center, which is available in all States, 24 hours a day, 7 days 

a week, year-round, to provide expert advice, crisis counseling, care 

consultation and information referral services in at least 140 languages, for persons with Alzheimer’s disease, their family members 

and informal caregivers. 

The Committee also includes $2,500,000 to help provide supportive services for aging Holocaust survivors in the United States. 
145 

Alzheimer’s Disease Demonstration Grants to States 

The Committee recommendation includes $4,800,000 for Alzheimer’s Disease Demonstration Grants to States. This program 

funds competitive grants to States to test and implement new models of care for individuals with Alzheimer’s disease. 

Alzheimer’s Disease Initiative 

The Committee recommends $14,700,000 in mandatory funding 

be transferred from the PPH Fund to ACL for the Alzheimer’s Disease Initiative. Of the total, $10,500,000 is provided to expand the 

availability of home- and community-based dementia services and 

supports. The remaining $4,200,000 is provided for a public awareness outreach campaign regarding Alzheimer’s disease. 

Lifespan Respite Care 

The Committee recommends $3,360,000 for the Lifespan Respite 

Care program. The Lifespan Respite Care program provides grants 

to States to expand respite care services to family caregivers, improve the local coordination of respite care resources, and improve 

access to and quality of respite care services, thereby reducing family caregiver strain. 

Chronic Disease Self-Management Program 

The Committee recommends $8,000,000 be transferred from the 

PPH Fund to ACL for the Chronic Disease Self-Management Program [CDSMP]. This program assists those with chronic disease to 

manage their conditions and improve their health status. Topics 

covered by the program include nutrition; appropriate use of medications; fitness; and effective communications with healthcare providers. CDSMP has been shown through multiple studies to result 

in significant and measurable improvements in health and quality 

of life, as well as reductions in hospitalizations and emergency 

room visits. 

Elder Falls Prevention 

The Committee recommends that $5,000,000 be transferred from 

the PPH Fund for Elder Falls Prevention activities at ACL. Preventing falls will help seniors stay independent and in their homes 

and avoid costly hospitalizations and hip fractures, which frequently lead to nursing home placement. The Committee intends 

that these funds should be used in coordination with CDC for public education about the risk of these falls, as well as implementation and dissemination of community-based strategies that have 

been proven to reduce the incidence of falls among seniors. 

Elder Rights Support Activities 

The Committee recommends $13,874,000 for Elder Rights Support activities, including $10,000,000 for the Elder Justice Initiative. These activities support programs that provide information, 

training, and technical assistance to legal and aging services organizations in order to prevent and detect elder abuse and neglect. 
146 

Aging and Disability Resource Centers 

The Committee recommendation includes $6,119,000 for Aging 

and Disability Resource Centers [ADRCs]. These centers provide 

information, one-on-one counseling, and access for individuals to 

learn about their long-term services and support options with the 

goal of allowing seniors and individuals with disabilities to maintain their independence. The Committee urges ACL to improve coordination among ADRCs, area agencies on aging, and centers for 

independent living to ensure that there is ‘‘no wrong door’’ to access 

services. 

State Health Insurance Assistance Program 

The Committee recommendation includes $47,115,000 for State 

Health Insurance Assistance Programs [SHIPs], which provide accurate and understandable health insurance information to Medicare beneficiaries and their families. 

Paralysis Resource Center 

The Committee recommendation includes $6,700,000 for the Paralysis Resource Center, which has long provided essential, comprehensive information and referral services to people living with 

paralysis and their families. Since 2002, the program has expanded 

to include a network of information specialists, a substantial quality of life grant program, a Peer and Family support program, a 

one of a kind Paralysis Resource Guide, and a NeuroRecovery Rehabilitation Network. These resources and services focus on the 

promotion of independence and quality of life for the more than 

6,000,000 Americans across the country living with paralysis. 

Limb Loss 

The Committee provides $2,500,000 for the Limb Loss program, 

which supports programs and activities to improve the health of 

people with limb loss and promote their well-being, quality of life, 

prevent disease, and provide support to their families and caregivers. Maintaining these programs is critical to support independent living within the disability community across their life 

course. 

Traumatic Brain Injury 

The Committee provides $9,321,000 for the Traumatic Brain Injury program. The program supports implementation and planning 

grants to States for coordination and improvement of services to individuals and families with traumatic brain injuries. Such services 

can include: pre-hospital care, emergency department care, hospital 

care, rehabilitation, transitional services, education, employment, 

long-term support, and protection and advocacy services. 

The Committee includes not less than the fiscal year 2017 funding level for protection and advocacy services, as authorized under 

section 1305 of Public Law 106–310. 

Developmental Disabilities State Councils 

The Committee recommendation includes $73,000,000 for State 

councils on developmental disabilities. These councils work to develop, improve, and expand the system of services and supports for 
147 

people with developmental disabilities at the State and local level. 

Councils engage in activities such as training, educating the public, 

building capacity, and advocating for change in State policies with 

the goal of furthering the inclusion and integration of individuals 

with developmental disabilities in all aspects of community life. 

Partnerships for Innovation, Inclusion, and Independence 

The Committee does not consolidate the State Councils on Developmental Disabilities, State Independent Living Councils, and 

State Advisory Boards on Traumatic Brain Injury. The Committee 

recognizes the unique role played by each program and believes 

consolidation into one program will not serve the needs of the people living with a disability. 

Developmental Disabilities Protection and Advocacy 

The Committee recommendation includes $38,734,000 for protection and advocacy programs for people with developmental disabilities. This formula grant program provides funds to States to establish and maintain protection and advocacy systems that protect the 

legal and human rights of persons with developmental disabilities 

who are receiving treatment, services, or rehabilitation. 

Voting Access for Individuals With Disabilities 

The Committee recommendation includes $4,963,000 to improve 

voting access for individuals with disabilities. This program provides grants to protection and advocacy organizations to ensure 

that individuals with disabilities have the opportunity to participate in every step of the electoral process, including registering to 

vote, accessing polling places, and casting a vote. 

Developmental Disabilities Projects of National Significance 

The Committee recommendation includes $10,000,000 for 

projects of national significance to assist persons with developmental disabilities. This program funds grants and contracts that 

develop new technologies and demonstrate innovative methods to 

support the independence, productivity, and integration into the 

community of persons with developmental disabilities. 

Technical Assistance.—The Committee includes $643,000 for 

technical assistance and training for the State Councils on Developmental Disabilities. 

Transportation.—The Committee includes $1,000,000 to fund 

transportation assistance activities for older adults and persons 

with disabilities. These activities should focus on the most cost-effective and sustainable strategies that can be replicated to other 

communities. The Committee is pleased with the Inclusive Community Transportation program’s efforts to integrate rural transit systems for individuals with disabilities and older adults to access 

health care services, paratransit, multiple transportation providers, 

and other critical community based supports. These small community demonstration grants should be designed to include the perspectives of individuals with disabilities and older adults in the 

transportation system and service design. 
148 

University Centers for Excellence in Developmental Disabilities 

The Committee recommendation includes $38,619,000 for the 

University Centers for Excellence in Developmental Disabilities 

[UCEDDs], a network of 67 centers that are interdisciplinary education, research and public service units of a university system or 

public or nonprofit entities associated with universities. The funding will keep the national network of Centers strong and able to 

assist States to initiate collaborative research, education, training, 

and service efforts that help States to implement ESSA and WIOA, 

thereby ensuring that youth with disabilities successfully complete 

elementary school and transition from school to postsecondary education and/or integrated employment. The funding also allows the 

Centers to continue to respond to emerging and emergent national 

issues such as assisting in ongoing developmental monitoring, especially for children exposed to lead and other environmental 

teratogens, and for infants exposed to the Zika virus with its resulting complications. This funding also allows the University Centers to continue to address the needs of the rising numbers of individuals on the autism spectrum; demonstrate cost effective long 

term services and supports for adults with disabilities and those 

aging with disabilities; support returning veterans; and provide 

technical assistance to strengthen and support the national network of Centers as the disseminate research and best practices nationwide. 

Independent Living 

The Committee recommendation includes $101,183,000 for the 

Independent Living Program. This program helps ensure that individuals with disabilities can live a productive and independent life 

in society. Funding helps States sustain, improve, and expand independent living services and establish and support a network of centers for independent living. 

National Institute on Disability, Independent Living, and Rehabilitation Research 

The Committee recommendation includes $103,970,000 for the 

National Institute on Disability, Independent Living, and Rehabilitation Research [NIDILRR]. The NIDILRR supports research and 

activities that help to maximize the full potential of individuals 

with disabilities in employment, independent living, and social activities. 

The Committee recognizes that there is a significant opportunity 

over the next decade for the Department to simultaneously lower 

healthcare costs and improve quality of life for the older adult and 

disabled population by embracing the rapidly growing shift to technology solutions for daily living. These solutions are poised to extend the ability to live independently into advanced age, and ‘‘age 

in place’’, helping to bridge the ‘‘care gap’’ so that older and disabled adults might avoid nursing homes and other institutionalized 

care as long as possible, while also remaining connected to their 

families and communities. 

The Committee encourages NIDILRR to continue to support research and activities that help older or disabled adults to increase, 

maintain, or improve their functional capabilities and allow for 
149 

independent living. To that end, the Committee supports increased 

investment in public university research to harness technological 

advances, including wireless sensors, smart materials, and body 

wearables; movers and protective devices; and companion and quality of life robotics, which have the potential to enable mobility, improve health, protect against falls and injuries, maximize community engagement, encourage productivity, and preserve independence among older individuals and their families. Special emphasis 

should be given to research projects that seek to address medically 

underserved areas in rural and frontier regions with high populations of older adults, disabled populations, and tribal communities. 

Assistive Technology 

The Committee recommendation includes $34,000,000 for Assistive Technology [AT]. AT provides States with funding to support 

individuals with disabilities of all ages to obtain devices and services that will increase, maintain, or improve their functional capabilities. 

Program Administration 

The Committee recommends $40,063,000 for program administration at ACL. These funds support salaries and related expenses 

for program management and oversight activities. 

OFFICE OF THE SECRETARY

GENERAL DEPARTMENTAL MANAGEMENT

Appropriations, 2017 ............................................................................. $525,457,000 

Budget estimate, 2018 ........................................................................... 361,966,000 

Committee recommendation ................................................................. 535,457,000 

The Committee recommends $535,457,000 for General Departmental Management [GDM]. The recommendation includes 

$64,828,000 in transfers available under section 241 of the PHS 

Act. 

This appropriation supports activities that are associated with 

the Secretary’s role as policy officer and general manager of the 

Department. It supports health activities performed by the Office 

of the Assistant Secretary for Health [ASH], including the Office of 

the Surgeon General. GDM funds also support the Department’s 

centralized services carried out by several Office of the Secretary 

staff divisions, including personnel management, administrative 

and management services, information resources management, 

intergovernmental relations, legal services, planning and evaluation, finance and accounting, and external affairs. 

Alzheimer’s Education Campaign.—The Committee continues to 

be interested in the Secretary’s progress in implementing a comprehensive outreach and education campaign and directs the Secretary to submit to the Committees on Appropriations of the House 

of Representatives and Senate, the Committee on Finance, the 

Committee on Ways and Means, and the Committee on Energy and 

Commerce an annual report describing the activities carried out 

the preceding fiscal year, and an evaluation of the extent to which 
150 

such activities have been effective in improving the health and 

well-being of racial and ethnic minority groups. 

Antibiotic Resistance.—The Committee supports the CARB initiative that strengthens efforts to prevent, detect, and control illness 

and deaths related to infections caused by antibiotic resistant bacteria. The Committee directs the Department to continue to work 

with DOD, USDA, VA, and FDA to broaden and expand efforts to 

track and store both antibiotic resistant bacteria genes and the mobile genetic elements from antibiotic resistant bacteria along with 

metadata. The Committee also recognizes the importance of basic 

and applied research toward the development of new vaccines as a 

way to prevent future antibiotic resistance through infection prevention and control. The Committee encourages the Secretary to 

prioritize this research as part of its strategy to combat antibiotic 

resistance. The Committee also urges the Secretary to consider the 

use of existing vaccines in antibiotic stewardship efforts to help 

mitigate new resistance development. The Department shall include in the fiscal year 2019 CJ a detailed update on the progress 

being made to implement the CARB national strategy. 

Breast Density.—The Committee encourages the Department to 

expand and intensify applied research on breast density and improved screening tools to detect cancer in patients with dense tissue. The Secretary is encouraged to explore whether mammography reports should indicate to patients if they have dense breast 

tissue. 

Chronic Fatigue Syndrome [ME/CFS].—The Committee supports 

the Department’s ME/CFS Advisory Committee [CFSAC] and is 

concerned that those with ME/CFS have very limited access to clinical care and there are no FDA approved treatments for them. HHS 

is encouraged to use the CFSAC to accelerate progress on research, 

education, training, care, and services to better address the needs 

of over one million Americans suffering from ME/CFS. 

Chronic Pain.—The Committee remains concerned about the 

public health epidemic of chronic pain. The Committee is pleased 

with the Department’s release of the National Pain Strategy and 

encourages the Secretary to implement efforts across all relevant 

HHS agencies and in coordination with the DOD and VA. Given 

the seriousness of this public health epidemic and its relationship 

to the opioid crisis, the Committee requests an update on implementation efforts within 180 days of enactment of this Act. 

Diabetes.—The Committee urges the Secretary to convene a commission comprised of healthcare providers, patient advocates and 

Federal agencies that operate programs that impact the care of 

people with pre-diabetes and diabetes. The goal of such a commission would be to make recommendations about developing improved clinical resources and tools, innovative care models, quality 

measures and registries, diabetes screening programs and other 

prevention activities. 

Drug Resistant Tuberculosis [TB].—The Committee notes the release of the President’s National Action Plan for Combating Multi 

Drug Resistant TB in December 2016. The Committee encourages 

the Secretary to prioritize implementation of the plan in coordination with the Federal TB Task Force, CDC and NIH. 
151 

Evidence-Based Programming.—The Committee is concerned 

about the uneven capacity of HHS operating divisions to apply and 

to build evidence that will improve program effectiveness. The 

Committee believes that the Assistant Secretary of Planning and 

Evaluation [ASPE] can play a central role in improving evaluation 

and evidence-based policymaking across the Department by helping 

all HHS components develop capacity to meet the standards set 

forth in ACF’s Evaluation Policy. The Committee encourages ASPE 

to help operating divisions adopt cost-effective approaches to building evidence through use of innovative grant designs that support 

partnerships between service delivery projects and researchers; by 

leveraging emerging opportunities to use linked data to measure 

performance and conduct comprehensive, rigorous evaluations at a 

reasonable cost; and by partnering with philanthropic organizations that focus on improving the use of rigorous research to inform 

policy. 

Eye Health.—The Committee commends the National Academies 

of Sciences, Engineering, and Medicine for the September 2016 release of its report ‘‘Making Eye Health a Population Health Imperative: Vision for Tomorrow’’ which includes recommendations regarding continued leadership by HHS to reduce the burden of vision impairment. The Committee requests an update from the Secretary regarding HHS’ progress in implementing these recommendations in the fiscal year 2019 CJ. 

Geroscience.—The Committee commends NIA’s leadership of the 

Trans-NIH Geroscience Interest Group, which promotes coordinated discussion and action on NIH-funded geroscience research to 

reduce the burden of age-related diseases. The Committee remains 

concerned over the rates of chronic disease in the older adult population and recognizes that accelerated breakthroughs from 

geroscience research into the biological basis of aging is essential 

to targeting changes that take place as a result of aging. The Committee urges the Secretary to consider establishing an Interagency 

Geroscience Research Coordination Committee [IGRCC] comprised 

of representatives from the NIA, NIAMS, NCI, NEI, NHLBI, 

NINDS, NIGMS, NHGRI, CDC, FDA, DOD, VA, and EPA. The goal 

of the IGRCC would be to identify and direct grants for new 

geroscience research. 

Global Health Research Strategy.—The Committee requests an 

update on how CDC, FDA, BARDA, and NIH jointly coordinate 

global health research activities with specific measurable metrics 

used to track progress toward agreed upon health goals. 

Opioid Medical Record Reporting.—The Committee is deeply concerned about the devastating impact that the opioid epidemic is 

having on families throughout the country, and recognizes that 

medical providers must have access to information about their patients’ past opioid addiction if that information is provided by the 

patient. The Committee encourages the Secretary to develop and 

disseminate standards that would allow hospitals and physicians to 

access the history of opioid addiction in medical records (including 

electronic health records) of any patient who has provided information about such addiction to a healthcare provider. 

Opioid Response.—The Committee believes that the Federal response to the opioid epidemic will be most effective if resources 
152 

made available through the Comprehensive Addiction and Recovery 

Act [CARA] and related programs are directed to strategies that 

are backed by strong evidence or to innovative and promising approaches that will be rigorously evaluated to learn their impact. In 

implementing new and existing programs that address the opioid 

epidemic, the Department is encouraged to utilize evidence-based 

policymaking principles, tools, and program designs such as those 

disseminated by the Evidence-Based Policymaking Collaborative. 

The Committee encourages HHS to collaborate with outside researchers and philanthropic organizations that focus on improving 

the use of rigorous research to inform policy. 

Pharmacy Dispensing.—The Committee is concerned by recent 

reports about the rate at which dangerous drug combinations are 

dispensed, especially in the context of the opioid epidemic, and encourages the Department to research as part of its National Action 

Plan for Adverse Drug Event Prevention how pharmacy practices 

can prevent harmful drug interactions. Further, the Committee encourages collaboration between the CDC, FDA, DEA, AHRQ, pharmacy regulatory and oversight organizations, and patient safety organizations on the prevention of harmful drug interactions. 

Prenatal Opioid Use Disorders and Neonatal Abstinence Syndrome.—The Committee is aware that the Protecting Our Infants 

Act of 2015 requires the Secretary to conduct a review of the Department’s planning and coordination activities related to prenatal 

opioid use disorders and neonatal abstinence syndrome, as well as 

address gaps in research and treatment. The act also requires the 

Secretary to develop recommendations for preventing and treating 

prenatal opioid use disorders and neonatal abstinence syndrome. 

The Committee requests an update on these activities in the fiscal 

year 2019 CJ. 

Public Access.—The Committee commends HHS Operating Divisions that have issued plans in response to the directive issued by 

the White House Office of Science and Technology Policy to support 

increased public access to the results of research funded by the 

Federal Government. The Committee encourages the Department 

to continue its efforts towards full implementation of the directive, 

and requests that an update on progress made be included in its 

fiscal year 2019 CJ. 

Public Health in Indian Country.—The Committee supports the 

Secretary’s current initiatives to address public health crises such 

as viral hepatitis, HIV/AIDS and opioids, that disproportionally impact Indian County. The Committee requests that HHS provide an 

update on these efforts in the fiscal year 2019 CJ. 

Pulmonary Hypertension [PH].—The Committee remains concerned that most PH patients are not diagnosed for many years 

until the condition has reached a catastrophic stage, which leads 

to significant disability, greatly increased mortality, and the need 

for costly and dramatic medical interventions, such as heart-lung 

transplantation. Given the availability of effective therapies for 

early-stage PH, the Department is encouraged to work across agencies and with the patient and professional community to prepare 

recommendations to improve early diagnosis and treatment of PH. 

Rural Communities.—The Committee encourages the Secretary 

to ensure that rural concerns and challenges are adequately rep-
153 

resented in the Department’s policies, programs, and activities, including policies related to the opioid epidemic. The Committee requests that the Secretary include a status of these activities in the 

fiscal year 2019 CJ. 

Surgeon General Report on Poverty.—The Committee notes that 

too many children still live in poverty, compromising their ability 

to be healthy, succeed in school and raise healthy families themselves. A report by the Surgeon General on improving the health 

of children could increase awareness and generate additional effort 

on ameliorating this public health problem. 

Technical Assistance [TA].—The Committee and the Department’s budget office have had a long-standing relationship that allows the Committee to receive legal and technical feedback on 

funding proposals. The Committee relies on TA to ensure that programs and funding initiatives can be implemented as intended. The 

Committee expects its TA requests to be dealt with in a manner 

that is consistent with past precedent, including timely answers 

that respond to the Committee’s specific inquiries. 

United States/Mexico Border.—The Committee urges the Department to continue its efforts to conduct border infectious disease 

surveillance in order to identify and implement needed prevention 

and treatment. The Department could focus on priority surveillance, epidemiology and preparedness activities along the borders 

in order to be able to respond to potential outbreaks and epidemics, 

including those caused by potential bioterrorism agents. 

Vector Control.—The Committee continues to support HHS’s preparedness and response efforts to control outbreaks of Zika virus 

infection and the Committee supports continued collaboration 

amongst the CDC, NIH, FDA, BARDA, DOD, USAID, USDA, DHS, 

and VA. The Committee notes recent reports showing some infants 

born without microcephaly develop it later in life or develop other 

neurological problems. HHS should continue to research and monitor these infants and work closely with the vector control units 

across the country to limit the spread of infected Aedes aegypti 

mosquitoes. In an effort to foster greater coordination, collaboration 

and transparency across agency lines, the Committee urges the 

Secretary to establish a coordinating office to facilitate and expedite the Government’s response to vector-borne disease threats, including combating the spread of disease through innovative vector 

control technologies. 

Zika.—The Committee remains concerned about the multiple 

threats posed by the Zika virus, including health threats to infants 

exposed to the virus. The Committee encourages the Secretary to 

continue surveillance of the disease along with efforts to further develop diagnostics and a vaccine. 

Teen Pregnancy Prevention 

The Committee recommendation includes $101,000,000 for the 

Teen Pregnancy Prevention [TPP] program. This program supports 

competitive grants to public and private entities to replicate evidence-based teen pregnancy prevention approaches. 
154 

Office of Minority Health 

The Committee recommends $56,670,000 for the Office of Minority Health [OMH]. This Office focuses on strategies designed to decrease health disparities and to improve the health status of racial 

and ethnic minority populations in the United States. OMH establishes goals and coordinates all departmental activity related to improving health outcomes for disadvantaged and minority individuals. 

Health Disparities.—The Committee believes that a comprehensive coordinated focus by OMH, HRSA and NIMHD will increase 

the probability of reducing health disparities. This coordinated 

focus should examine the factors that lead to health disparities, including but not limited to age, nutrition, medical conditions, and 

availability of medical support and an appropriate healthcare workforce in both underserved urban and rural settings. HHS is encouraged to partner with community-based organizations that are currently providing medical and nutritional support. 

HIV Community-Based Testing Programs.—The Committee recognizes that several community-based programs have encouraged 

individuals at risk for HIV/AIDS to utilize FDA-approved homebased HIV testing technology to monitor their HIV status. The 

Committee continues to urge the OMH to consider a pilot or demonstration program within existing resources to gauge the effectiveness of this approach. 

HIV/AIDS and Hepatitis C.—The Committee continues to be 

concerned about the HIV/AIDS epidemic in the African American 

community, and is aware of the concurrent high rates of co-infection with Hepatitis C as outlined by the HHS 2015 Forum on Hepatitis C in African American Communities. The Committee encourages OMH to work aggressively to address opportunities to reduce 

the burden of HIV/AIDS and Hepatitis C by exploring partnerships 

for screening and implementing community engagement programs. 

Lupus Initiative.—The Committee continues to support the OMH 

National Health Education Lupus Program and its efforts to develop a clinical trial education and implementation plan for lupus. 

The action plan will focus on developing public-private and community partnerships, evaluating current minority clinical trial education and participation programs, and developing a research plan 

for creating new clinical trial education models in lupus. This will 

inform the development of the broader actionable lupus clinical 

trial education plan. 

Sexual Risk Avoidance 

The Committee recommends $25,000,000 for sexual risk avoidance education. This is a competitive grant program that funds evidenced based abstinence models for adolescents. 

Funding for competitive grants for sexual risk avoidance shall 

use medically accurate information referenced to peer-reviewed 

publications by educational, scientific, governmental, or health organizations; implement an evidence-based approach; and teach the 

benefits associated with self-regulation, success sequencing for poverty prevention, healthy relationships, goal setting, and resisting 

sexual coercion, dating violence, and other youth risk behaviors. 
155 

Office of Women’s Health 

The Committee recommends $32,140,000 for the Office of Women’s Health [OWH]. This office develops, stimulates, and coordinates women’s health research, healthcare services, and public and 

healthcare professional education across the Department. It advances important crosscutting initiatives and develops public-private partnerships, providing leadership and policy direction to address the disparities in women’s health. 

The Committee recommendation includes $3,100,000 to combat 

violence against women through the State partnership initiative. 

This program provides funding to State-level public and private 

health programs to partner with domestic and sexual violence organizations to improve healthcare providers’ ability to help victims of 

violence and improve prevention programs. 

ACCOUNT FOR THE STATE RESPONSE TO THE OPIOID ABUSE CRISIS, 

CURES ACT

Appropriations, 2017 ............................................................................. $500,000,000 

Budget estimate, 2018 ........................................................................... 500,000,000 

Committee recommendation ................................................................. 500,000,000 

The Committee provides $500,000,000 for the State Response To 

Opioid Abuse Crisis Grants. 

OFFICE OF MEDICARE HEARINGS AND APPEALS

Appropriations, 2017 ............................................................................. $107,381,000 

Budget estimate, 2018 ........................................................................... 117,177,000 

Committee recommendation ................................................................. 117,381,000 

The Committee provides $117,381,000 for the Office of Medicare 

Hearings and Appeals [OMHA], including $10,000,000 in Recovery 

Audit contractor recoveries. This Office is responsible for hearing 

Medicare appeals at the Administrative Law Judge [ALJ] level, 

which is the third level of Medicare claims appeals. OMHA ensures 

that Medicare beneficiaries who are dissatisfied with the initial decisions about their benefits or eligibility can appeal and exercise 

their right to a hearing in front of an ALJ. 

Appeals Backlog.—The Committee continues to be concerned over 

the substantial backlog in the number of cases pending before ALJs 

at OMHA. The Committee directs that $10,000,000 in Recovery 

Audit Contractor [RAC] recoveries retained by the Secretary for adjudications related to RACs shall be used as additional funds for 

the necessary expenses of OMHA and the Departmental Appeals 

Board to process RAC-related appeals. The Committee directs 

OMHA to use the additional funds provided to address the current 

backlog and requests a spend plan within 30 days after enactment 

of this Act. This spend plan should include an estimate of total appeals that will be processed in fiscal years 2017–2019 with the resources available. This estimate should include the effect of administrative actions taken to reduce the backlog. 
156 

OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH INFORMATION

TECHNOLOGY

Appropriations, 2017 ............................................................................. $60,367,000 

Budget estimate, 2018 ........................................................................... 38,381,000 

Committee recommendation ................................................................. 60,367,000 

The Committee makes available $60,367,000 to the Office of the 

National Coordinator for Health Information Technology [ONC]. 

ONC is responsible for coordinating Federal health information 

systems and collaborating with the private sector to develop standards for a nationwide interoperable health information technology 

infrastructure. 

Electronic Health Records [EHR].—The Secretary is encouraged 

to study approaches to improve person-centered healthcare through 

patient access to health information. This work should examine accurate and timely record matching so that all EHR systems are collecting the information necessary for a fully interoperable system 

that protects patients from identity mismatch errors, but also considers patient privacy and security. 

OFFICE OF INSPECTOR GENERAL

Appropriations, 2017 ............................................................................. $80,000,000 

Budget estimate, 2018 ........................................................................... 68,085,000 

Committee recommendation ................................................................. 80,000,000 

The Committee recommends $80,000,000 for the HHS Office of 

Inspector General [OIG]. In addition to discretionary funds provided in this act, the Health Insurance Portability and Accountability Act of 1996 provides a permanent appropriation of 

$334,097,000 for OIG. 

OIG conducts audits, investigations, and evaluations of the programs administered by the Department’s operating and staff divisions, including the recipients of the Department’s grant and contract funds. In doing so, OIG addresses issues of waste, fraud, and 

abuse and makes recommendations to improve the efficiency and 

effectiveness of the Department’s programs and operations. 

OFFICE FOR CIVIL RIGHTS

Appropriations, 2017 ............................................................................. $38,798,000 

Budget estimate, 2018 ........................................................................... 32,530,000 

Committee recommendation ................................................................. 38,798,000 

The Committee recommends $38,798,000 for the Office for Civil 

Rights [OCR] in budget authority. OCR is responsible for enforcing 

civil rights-related statutes in healthcare and human services programs. To enforce these statutes, OCR investigates complaints of 

discrimination, conducts program reviews to correct discriminatory 

practices, and implements programs to generate voluntary compliance among providers and constituency groups of health and 

human services. 

RETIREMENT PAY AND MEDICAL BENEFITS FOR COMMISSIONED

OFFICERS

Appropriations, 2017 ............................................................................. $630,408,000 

Budget estimate, 2018 ........................................................................... 618,689,000 

Committee recommendation ................................................................. 618,689,000 
157 

The Committee provides an estimated $618,689,000 in mandatory funds for Retirement Pay and Medical Benefits for Commissioned Officers of the U.S. Public Health Service. This account provides for retirement payments to PHS officers who are retired due 

to age, disability, or length of service; payments to survivors of deceased officers; and medical care to Active Duty and retired officers, as well as their dependents. 

PUBLIC HEALTH AND SOCIAL SERVICES EMERGENCY FUND

Appropriations, 2017 ............................................................................. $1,532,958,000 

Budget estimate, 2018 ........................................................................... 1,662,616,000 

Committee recommendation ................................................................. 1,552,958,000 

The Committee recommends $1,552,958,000 for the Public 

Health and Social Services Emergency Fund. This appropriation 

supports the activities of the Assistant Secretary for Preparedness 

and Response [ASPR] and other components within the Office of 

the Secretary to prepare for the health consequences of bioterrorism and other public health emergencies, including pandemic influenza. It also provides funding for the Department’s cybersecurity 

efforts. 

Office of the Assistant Secretary for Preparedness and Response 

The Committee recommendation includes $1,396,628,000 for activities administered by ASPR. This Office was created by the Pandemic and All-Hazards Preparedness Act [PAHPA] to lead the Department’s activities regarding preventing, preparing for, and responding to public health emergencies, including disasters and acts 

of terrorism. 

National Disaster Medical System.—The Committee continues 

bill language providing coverage under the Federal Employees 

Compensation Act for National Disaster Medical System intermittent employees who are activated for training or deployment. 

Hospital Preparedness Program 

The Committee’s recommendation includes $254,555,000 for the 

Hospital Preparedness Program [HPP]. This program provides 

grants to States to build healthcare coalitions that enhance regional and local hospital preparedness and improve overall surge 

capacity in public health emergencies. The Committee recognizes 

the vital importance of this program in helping communities respond to tragic events, for this reason the Committee includes the 

same funding level as fiscal year 2017. While the Committee acknowledges the need to incorporate risk, the Committee rejects the 

administration proposal to change the allocation formula that 

would leave 26 States and territories without HPP funding. The 

Committee believes this funding should be carefully coordinated 

within communities to continue to provide our Nation’s hospitals 

and emergency responders the necessary tools to respond quickly 

and collaboratively to these and other public health emergencies 

that are inevitable in our Nation’s communities. 

Rural Areas.—The Committee encourages ASPR to ensure that 

hospital systems in remote and rural areas are benefiting from this 

program and are prepared in cases of emergencies, epidemics, or 

natural disasters. 
158 

Biomedical Advanced Research and Development Authority 

[BARDA] 

The Committee recommendation includes $511,700,000 for advanced research and development. 

The Committee commends BARDA for supporting advanced development efforts of industry to develop vaccines, diagnostics, 

drugs, and therapeutics to minimize serious threats of infectious 

disease and urges BARDA to continue to invest in the development 

of countermeasures for infectious diseases through the CARB initiative and the Emerging Infectious Disease program. 

Blood Platelet.—The Committee is aware of BARDA’s investigation into blood platelet-derived medical counter-measures as a hemostatic agent, and urges BARDA to expand its research to address the opportunities that cell stabilization of blood platelets provides, including radiation exposure remediation, acute burn healing, drug delivery, hemorrhagic fevers, and diagnostic imaging. 

Infectious Diseases.—The Committee commends BARDA for supporting advanced development efforts to develop vaccines, 

diagnostics, drugs, and therapeutics to minimize serious threats of 

infectious diseases. BARDA is encouraged to continue to 

proactively prepare for emerging infectious disease outbreaks, including investing in rapid screening technology. 

Tuberculosis.—The National Strategy for CARB identified drug 

resistant TB as a serious threat level pathogen and new diagnostic, 

treatment and prevention tools are urgently needed to address this 

global health threat. The Committee encourages BARDA to support 

the development of new TB diagnostic tests, drugs and vaccines 

through the CARB initiative, and the Emerging Infectious Disease 

program. 

Vector-Borne Disease Control.—The Committee is aware that 

since the enactment of the Pandemic and All-Hazards Preparedness Act, BARDA has led efforts to define, develop, and acquire 

medical countermeasures to reduce the threats of public health 

emergencies such as Zika. The Committee encourages BARDA to 

explore innovative vector control technologies that provide immediate opportunities for countermeasure development to address the 

non-native Zika-carrying Aedes aegypti mosquito population in 

ways that are environmentally friendly and that may reach places 

where many pesticides cannot. 

Project BioShield Special Reserve Fund 

The Committee recommendation includes $510,000,000 for the 

Project BioShield Special Reserve Fund. The Committee is committed to ensuring the Nation is adequately prepared against 

chemical, biological, radiological, and nuclear attacks. The Committee recognizes a public-private partnership to develop medical 

countermeasures [MCMs] is required to successfully prepare and 

defend the Nation against these threats. Where there is little or no 

commercial market, the Committee supports the goal of Government financing providing a market guarantee. 

Other Activities 

The Committee recommendation includes the following amounts 

for the following activities within ASPR: 
159 

—Operations.—$30,938,000; 

—Preparedness and Emergency Operations.—$24,654,000; 

—National Disaster Medical System.—$49,904,000 and 

—Policy and Planning.—$14,877,000. 

Office of the Assistant Secretary for Administration 

The Committee recommends $50,860,000 for information technology cybersecurity in the Office of the Assistant Secretary for Administration. These funds provide for continuous monitoring and 

security incident response coordination for the Department’s computer systems and networks. 

Office of the Assistant Secretary for Health/Medical Reserve Corps 

The Committee recommendation includes $6,000,000 for the 

Medical Reserve Corps program in ASH. This program is a national network of local volunteers who work to strengthen the public health infrastructure and preparedness capabilities of their communities. 

Office of the Secretary 

The Committee recommendation includes $99,470,000 for activities within the Office of the Secretary. 

Pandemic Influenza Preparedness 

The Committee recommendation includes $92,000,000 for Pandemic Influenza Preparedness. Of the total, $17,000,000 is provided 

in annual funding and $75,000,000 in no-year funding. 

Office of Security and Strategic Information 

The Committee includes $7,470,000 for the Office of Security and 

Strategic Information to maintain the security of the Department’s 

personnel, systems, and critical infrastructure. 

PREVENTION AND PUBLIC HEALTH FUND

In fiscal year 2018, the level transferred from the fund after accounting for sequestration is $840,600,000. The Committee includes 

bill language in section 219 of this act that requires that funds be 

transferred within 45 days of enactment of this act to the following 

accounts, for the following activities, and in the following amounts: 

[In thousands of dollars] 

Agency Account Program Committee 

recommendation 

ACL ......................... Aging and Disability Services Programs Alzheimer’s Disease Prevention Education and Outreach.14,700 

ACL ......................... Aging and Disability Services Programs Chronic Disease Self Management ....... 8,000 

ACL ......................... Aging and Disability Services Programs Falls Prevention ..................................... 5,000 

CDC ........................ Immunization and Respiratory Diseases Section 317 Immunization Grants ........ 324,350 

CDC ........................ Emerging and Zoonotic Infectious Diseases.Epidemiology and Laboratory Capacity 

Grants.

40,000 

CDC ........................ Emerging and Zoonotic Infectious Diseases.Healthcare Associated Infections .......... 12,000 

CDC ........................ Chronic Disease Prevention and Health 

Promotion.

Office of Smoking and Health (Tobacco 

Prevention/Media & Quit Lines).

126,000 
160 

[In thousands of dollars] 

Agency Account Program Committee 

recommendation 

CDC ........................ Chronic Disease Prevention and Health 

Promotion.

Breast Feeding Grants (Hospitals Promoting Breastfeeding).8,000 

CDC ........................ Chronic Disease Prevention and Health 

Promotion.

Million Hearts Program ......................... 4,000 

CDC ........................ Chronic Disease Prevention and Health 

Promotion.

Heart Disease & Stroke Prevention Program.53,275 

CDC ........................ Chronic Disease Prevention and Health 

Promotion.

Diabetes ................................................ 52,275 

CDC ........................ Chronic Disease Prevention and Health 

Promotion.

Early Care Collaboratives ...................... 4,000 

CDC ........................ Environmental Health ............................ Lead Poisoning Prevention .................... 17,000 

CDC ........................ CDC–Wide Activities .............................. Preventive Health and Health Services 

Block Grants.

160,000 

SAMHSA .................. Mental Health ........................................ Suicide Prevention (Garrett Lee Smith) 12,000 

GENERAL PROVISIONS

Section 201. The bill continues a provision placing a $50,000 ceiling on official representation expenses. 

Section 202. The bill continues a provision limiting the use of 

certain grant funds to pay individuals more than an annual rate 

of Executive Level II. 

Section 203. The bill continues a provision restricting the Secretary’s use of taps for program evaluation activities unless a report is submitted to the Appropriations Committees of the House 

of Representatives and the Senate on the proposed use of funds. 

Section 204. The bill modifies a provision authorizing the transfer of up to 2.9 percent of PHS Act funds for evaluation activities. 

Section 205. The bill continues a provision restricting transfers 

of appropriated funds and requires a 15-day notification to the 

Committees on Appropriations of the House of Representatives and 

the Senate. 

Section 206. The bill continues a general provision allowing National Health Service Corps contracts to be canceled up to 60 days 

after award. 

Section 207. The bill continues a provision regarding requirements for family planning applicants. 

Section 208. The bill continues language which States that no 

provider services under title X of the PHS Act may be exempt from 

State laws regarding child abuse. 

Section 209. The bill continues language which restricts the use 

of funds to carry out the Medicare Advantage Program if the Secretary denies participation to an otherwise eligible entity. 

Section 210. The bill continues a provision prohibiting the use of 

funds for lobbying activities related to gun control. 

Section 211. The bill continues a provision that limits the assignment of certain public health personnel. 

Section 212. The bill continues a provision which facilitates the 

expenditure of funds for international health activities. 

Section 213. The bill continues a provision permitting the transfer of up to 3 percent of AIDS funds among ICs by the Director of 

NIH and the Director of the Office of AIDS Research at NIH. 
161 

Section 214. The bill continues language which requires that the 

use of AIDS research funds be determined jointly by the Director 

of NIH and the Director of the Office of AIDS Research and that 

those funds be allocated directly to the Office of AIDS Research for 

distribution to the ICs consistent with the AIDS research plan. 

Section 215. The bill continues a provision authorizing the Director of NIH to enter into certain transactions to carry out research 

in support of the NIH Common Fund. 

Section 216. The bill continues a provision permitting NIH to use up to $45,000,000 per project for improvements and repairs of facilities. 

Section 217. The bill continues a provision that transfers funds 

from NIH to HRSA and AHRQ, to be used for National Research 

Service Awards. 

Section 218. The bill continues a provision that provides BARDA 

with authority to enter into a multiyear contract for up to 10 years 

and to repurpose unused termination costs to pay contract invoices. 

Section 219. The bill continues a provision transferring mandatory funds from section 4002 of the Patient Protection and Affordable Care Act to accounts within the Department for activities outlined under the heading ‘‘Prevention and Public Health Fund’’ in 

this report. 

Section 220. The bill continues a provision requiring CJs to include certain FTE information with respect to ACA. 

Section 221. The bill continues a provision related to ACA exchange funding transparency. 

Section 222. The bill continues a provision related to notifications 

for ACA enrollment and Community Health Centers awards. 

Section 223. The bill continues a provision prohibiting funds for 

the Risk Corridor program. 

Section 224. The bill continues a provision for Medicare and 

Medicaid expenses. 

Section 225. The bill restates a requirement for HHS to conduct 

an analysis of the ACA’s impact on eligibility for certain discretionary programs. 

Section 226. The bill continues a provision related to breast cancer screening recommendations. 

Section 227. The bill includes a new provision on NIH indirect 

costs. 

Section 228. The bill includes a new provision rescinding unobligated funds from the Nonrecurring Expenses Fund. 

Section 229. The bill includes a new provision rescinding unobligated funds under the heading ‘‘Refugee and Entrant Assistance’’. 
(162) 

TITLE III 

DEPARTMENT OF EDUCATION 

EDUCATION FOR THE DISADVANTAGED

Appropriations, 2017 ............................................................................. $16,143,790,000 

Budget estimate, 2018 ........................................................................... 16,347,558,000 

Committee recommendation ................................................................. 16,169,198,000 

The Committee recommends an appropriation of $16,169,198,000 

for education for the disadvantaged. 

The programs in the Education for the Disadvantaged account 

provide a foundation of support to help ensure that all children receive a high-quality education. Funds appropriated in this account 

primarily support activities in the 2018–2019 school year. 

Grants to Local Educational Agencies 

Title I grants to local educational agencies [LEAs] provide supplemental education funding, especially in high-poverty areas, for 

local programs that provide extra academic support to help raise 

the achievement of eligible students or, in the case of school-wide 

programs, help all students in high-poverty schools meet challenging State academic standards. Title I grants are distributed 

through four formulas: basic, concentration, targeted, and education finance incentive grant. 

The Committee recommends $15,485,210,000 for the title I 

grants to LEAs program. Of the funds available for title I grants 

to LEAs, up to $5,000,000 shall be available on October 1, 2017 for 

transfer to the Census Bureau for poverty updates; $5,251,398,000 

will become available on July 1, 2018; and $10,841,177,000 will become available on October 1, 2018. The funds that become available on July 1, 2018, and October 1, 2018, will remain available for 

obligation through September 30, 2019. 

Further Opportunities for Children to Unlock Success 

[FOCUS].—The Committee recommendation does not include funding for a new FOCUS grants program or new language requested 

that would authorize the Department to establish new requirements on local educational agencies interested in participating in 

the Flexibility for Equitable Per-Pupil Funding authority in Part F 

of Title I of ESEA. The Committee believes significant changes 

such as this to this recently-reauthorized law should be made as 

needed through legislation considered by the authorizing Committees of Congress. 

Neglected, Delinquent, and At-Risk Youth.—On any given day, 

tens of thousands of young people are in the custody of the juvenile 

justice system. The Committee believes ESSA made significant 

progress in addressing the needs of neglected, delinquent, and atrisk youth and ensuring greater access to educational services upon 
163 

re-entry. While the Committee believes ESSA was a strong step towards a better re-entry system for youth who encounter the juvenile justice system, it is essential that the Department monitor and 

ensure compliance with the re-entry activities required under 

ESSA. Within 180 days of enactment of this act, the Secretary is 

directed to submit a report to the Committee describing how each 

State is meeting the re-entry requirements for youth included in 

ESSA. 

Comprehensive Literacy State Development Grants 

The Committee recommendation includes $190,000,000 for the 

Comprehensive Literacy State Development Grants program. This 

program provides competitive grants to State educational agencies 

[SEAs] that then subgrant at least 95 percent of such funds to eligible entities to support efforts to improve literacy instruction in 

high-need schools and early education programs in a State for each 

of several age bands ranging from birth through 12th grade. 

Innovative Approaches to Literacy 

The Committee recommendation includes $27,000,000 for the Innovative Approaches to Literacy program. This program provides 

competitive grants to national not-for-profit organizations and 

school libraries for providing books and childhood literacy activities 

to children and families living in high-need communities. 

The Committee continues to direct the Department to reserve no 

less than 50 percent of funds under this program for grants to develop and enhance effective school library programs, which may include providing professional development to school librarians, 

books, and up-to-date materials to high-need schools. Further, the 

Committee continues to direct the Department to ensure that 

grants are distributed among eligible entities that will serve geographically diverse areas, including rural areas. 

Migrant Education Program 

The Committee recommends $374,751,000 for the title I Migrant 

Education program. 

This funding supports grants to SEAs for programs to meet the 

special educational needs of the children of migratory agricultural 

workers or migratory fishworkers. Funding also supports activities 

to improve interstate and intrastate coordination of migrant education programs, as well as identify and improve services to the migrant student population. 

Neglected and Delinquent 

The Committee recommends $47,614,000 for the title I Neglected 

and Delinquent program. 

This program provides financial assistance to SEAs for education 

services to neglected and delinquent children and youth in Staterun institutions and for juveniles in adult correctional institutions. 

States are authorized to set aside at least 15 percent, but not more 

than 30 percent, of their Neglected and Delinquent funds to help 

students in State-operated institutions make the transition into locally operated programs and to support the successful reentry of 
164 

youth offenders who are age 20 or younger and have received a secondary school diploma or its recognized equivalent. 

Special Programs for Migrant Students 

The Committee recommends $44,623,000 for Special Programs 

for Migrant Students, which consist of HEP and CAMP. 

HEP projects are 5-year grants to institutions of higher education and other nonprofit organizations to recruit migrant students ages 16 and older and provide the academic and support 

services needed to help them obtain a high school equivalency certificate and subsequently gain employment, attain admission to a 

postsecondary institution or a job training program, or join the 

military. 

CAMP projects are 5-year grants to institutions of higher education and nonprofit organizations to provide tutoring, counseling, 

and financial assistance to migrant students during their first year 

of postsecondary education. 

IMPACT AID

Appropriations, 2017 ............................................................................. $1,328,603,000 

Budget estimate, 2018 ........................................................................... 1,236,435,000 

Committee recommendation ................................................................. 1,340,112,000 

The Committee recommends $1,340,112,000 for the Impact Aid 

program. 

Impact Aid provides financial assistance to school districts affected by the presence of Federal activities and federally owned 

land. These school districts face unique challenges because they 

must educate children living on federally owned land, such as military bases, while federally owned property is also exempt from 

local taxes, a primary source of revenue for local school districts. 

The Committee bill retains language that provides for continued 

eligibility for students affected by the deployment or death of their 

military parent, as long as these children still attend schools in the 

same school district. 

Basic Support Payments.—The Committee recommends 

$1,200,242,000 for the Basic Support Payments program. Under 

this statutory formula, payments are made on behalf of all categories of federally connected children, with a priority placed on 

making payments first to heavily impacted school districts and providing any remaining funds for regular basic support payments. 

Payments for Children With Disabilities.—The Committee bill includes $48,316,000 for Payments for Children With Disabilities. 

Under this program, additional payments are made for certain federally connected children eligible for services under IDEA. 

Facilities Maintenance.—The Committee recommends $4,835,000 

for Facilities Maintenance. This activity provides funding for emergency repairs and comprehensive capital improvements to certain 

school facilities owned by the Department and used by LEAs to 

serve federally connected military dependent students. Funds appropriated for this purpose are available until expended. 

Construction.—The Committee recommends $17,406,000 for eligible LEAs for school construction activities allocated by formula 

under section 7007(a) of ESEA. 
165 

Payments for Federal Property.—The Committee recommends 

$69,313,000 for Payments for Federal Property. These payments 

compensate LEAs specifically for revenue lost due to the removal 

of Federal property from local tax rolls, regardless of whether any 

federally connected children attend schools in the district. The 

budget request proposed eliminating this program. The Committee 

recommendation again rejects this elimination and continues to 

note that this funding represents a key component of fulfilling the 

Federal Government’s commitment to school districts impacted by 

the presence of federally owned land. 

SCHOOL IMPROVEMENT PROGRAMS

Appropriations, 2017 ............................................................................. $4,408,567,000 

Budget estimate, 2018 ........................................................................... 697,231,000 

Committee recommendation ................................................................. 4,458,567,000 

The Committee recommendation includes $4,458,567,000 for the 

School Improvement Programs account. 

Supporting Effective Instruction State Grants 

The Committee recommends $2,055,830,000 for Supporting Effective Instruction State Grants. The appropriation for this program 

primarily supports activities associated with the 2018–2019 academic year. Of the funds provided, $374,389,000 will become available on July 1, 2018, and $1,681,441,000 will become available on 

October 1, 2018. These funds will remain available for obligation 

through September 30, 2019. 

States and LEAs may use funds for a range of activities related 

to the certification, recruitment, professional development, and 

support of teachers and administrators. Activities may include reforming teacher certification and licensure requirements, addressing alternative routes to State certification of teachers, recruiting 

teachers and principals, and implementing teacher mentoring systems, teacher testing, merit pay, and merit-based performance systems. These funds may also be used by districts to hire teachers 

to reduce class sizes. 

The Committee continues to strongly encourage the Department 

to issue clear guidance specifically on the importance of strong 

school leadership, and how States can use existing title II–A resources, including through the optional 3 percent State set-aside, 

to support principals and school leadership, including examples of 

best practices. 

Supplemental Education Grants 

The Committee recommendation includes $16,699,000 for supplemental education grants to the Republic of Marshall Islands [RMI] 

and the Federated States of Micronesia [FSM]. 

This grant program was authorized by the Compact of Free Association Amendments Act of 2003. These funds will be transferred 

from the Department to the Secretary of the Interior for grants to 

these entities. The Committee bill includes language requested in 

the budget that allows the Secretary of Education to reserve 5 percent of these funds to provide FSM and RMI with technical assistance. 
166 

21st Century Community Learning Centers 

The Committee recommends an appropriation of $1,191,673,000 

for the 21st Century Community Learning Centers [21st CCLC] 

program. 

Funds are allocated to States by formula, which in turn, award 

at least 95 percent of their allocations to LEAs, community-based 

organizations, and other public and private entities. Grantees use 

these resources to establish or expand community learning centers 

that provide activities offering significant extended learning opportunities, such as before- and after-school programs, recreational activities, drug and violence prevention, and family literacy programs 

for students and related services to their families. Centers must 

target their services to students who attend schools that are eligible to operate a school-wide program under title I of the ESEA or 

serve high percentages of students from low-income families. 

State Assessments Grants 

The Committee recommends $369,100,000 for the State Assessments Grants program. 

This program provides formula grants to States for developing 

and implementing standards and assessments required by the 

ESEA and helping States and LEAs carry out audits of their assessment systems to eliminate low-quality or duplicative assessments. It also provides competitive grants to States, including consortia of States, to improve the quality, validity, and reliability of 

academic assessments. 

Education for Homeless Children and Youth 

For carrying out education activities authorized by title VII, subtitle B of the McKinney-Vento Homeless Assistance Act, the Committee recommends $77,000,000. 

This program provides assistance to each State to support an office of the coordinator of education for homeless children and 

youth, to develop and implement State plans for educating homeless children, and to make subgrants to LEAs to support the education of those children. Grants are made to States based on the 

total that each State receives in title I grants to LEAs. 

Under the McKinney-Vento Homeless Children and Youth Program, SEAs must ensure that homeless children and youth have 

equal access to the same free public education, including a public 

preschool education, as is provided to other children and youth. 

Training and Advisory Services 

For Training and Advisory Services authorized by title IV of the 

Civil Rights Act, the Committee recommends $6,575,000. 

The funds provided will support awards to operate regional equity assistance centers [EACs]. Each EAC provides services to 

school districts upon request. Activities include disseminating information on successful practices and legal requirements related to 

nondiscrimination on the basis of race, color, sex, or national origin 

in education programs. 
167 

Native Hawaiian Education 

The Committee recommendation includes $33,397,000 for Native 

Hawaiian Education. 

The Committee bill continues a provision that allows funding 

provided by this program to be used for construction. 

Alaska Native Education 

The Committee recommends $32,453,000 for the Alaska Native 

Education. 

These funds help address the unique educational needs of Alaska 

Native schoolchildren. Funds are used for the development of supplemental educational programs to benefit Alaska Natives. The 

Committee bill continues language that allows funding provided by 

this program to be used for construction. The Committee bill also 

includes language overriding the authorizing statute’s requirement 

to make noncompetitive awards to certain organizations. 

The Committee continues to direct the Department to ensure 

that Alaska Native tribes, Alaska Native regional non-profits, and 

Alaska Native corporations have the maximum opportunity to successfully compete for grants under this program by providing these 

entities multiple opportunities for technical assistance in developing successful applications for these funds, both in Alaska and 

via various forms of telecommunications. Further, the Committee 

continues to direct the Department to make every effort to ensure 

that Alaska Natives and Alaskans represent a significant proportion of peer reviewers for grant applications submitted under this 

program. 

Rural Education 

The Committee recommends $175,840,000 for rural education 

programs. 

The Committee expects that rural education funding will be 

equally divided between the Small, Rural School Achievement Program, which provides funds to LEAs that serve a small number of 

students, and the Rural and Low-Income School Program, which 

provides funds to LEAs that serve concentrations of poor students, 

regardless of the number of students served. 

The Committee recognizes that the Department’s new application 

requirement for local education agencies to access Rural Education 

Achievement Program [REAP] funding in fiscal year 2017 prevented some eligible LEAs from accessing grant funding under this 

program. The Committee directs the Department to simplify the 

REAP application process, eliminate unnecessary administrative 

burdens, and directly engage with eligible LEAs and other relevant 

stakeholders to ensure that the Department’s requirements accommodate the unique needs of these small, rural, and remote schools. 

Additionally, the Committee encourages the Department to use any 

unobligated available funding to make awards to LEAs who received a grant in fiscal year 2016, but failed to initially submit an 

application for fiscal year 2017 due to demonstrable administrative 

burden, provided they submit an application for funding. 
168 

Comprehensive Centers 

The Committee recommends $50,000,000 for the Comprehensive 

Centers program. 

These funds provide support to a network of comprehensive centers that are operated by research organizations, agencies, institutions of higher education, or partnerships thereof, and provide 

training and technical assistance on various issues to States, LEAs, 

and schools as identified through needs assessments undertaken in 

each region. The system currently includes 15 regional centers, 

which are charged with providing intensive technical assistance to 

SEAs to increase their capacity to assist LEAs and schools with 

meeting the goals of the ESEA, and 8 content centers, which are 

organized by topic area. 

In selecting priorities for a new cohort of comprehensive centers, 

the Committee continues to direct the Department to recognize the 

unique challenges, emphasized in ESSA, affecting rural schools. 

The Committee strongly encourages the Department to establish at 

least one university-led center in a State with a significant percentage of students in rural schools. Such a center could focus on rural 

education and provide assistance to rural districts that serve high 

poverty and minority students. 

The Committee recommendation includes continued support for a 

comprehensive center, first funded in fiscal year 2016 and as authorized in ESSA, on students at risk of not attaining full literacy 

skills due to a disability, including dyslexia, or developmental 

delay. 

Student Support and Academic Enrichment Grants 

The Committee recommendation includes $450,000,000 for Student Support and Academic Enrichment Grants. This program provides formula grants to States, which then sub-grant to LEAs, to 

help support activities to provide students with a well-rounded education, ensure safe and supportive learning environments, and use 

technology to improve instruction. 

The Committee recommendation maintains bill language included in fiscal year 2017 giving States the option to subgrant 

funds to LEAs, or a consortia of LEAs, on a competitive basis. 

INDIAN EDUCATION

Appropriations, 2017 ............................................................................. $164,939,000 

Budget estimate, 2018 ........................................................................... 143,665,000 

Committee recommendation ................................................................. 165,239,000 

The Committee recommends $165,239,000 for Indian education 

programs. 

Grants to Local Educational Agencies 

For grants to LEAs, the Committee recommends $100,381,000. 

These funds provide financial support to elementary and secondary 

school programs that serve Indian students, including preschool 

children. Funds are awarded on a formula basis to LEAs, schools 

supported and operated by the Department of the Interior/Bureau 

of Indian Education, and in some cases directly to Indian tribes. 
169 

Special Programs for Indian Children 

The Committee recommends $57,993,000 for special programs for 

Indian children. 

Funds are used for demonstration grants to improve Indian student achievement from early childhood education through college 

preparation programs, and for professional development grants for 

training Indians who are preparing to begin careers in teaching 

and school administration. 

Within the total, the Committee recommendation includes 

$43,952,000 for the Native Youth Community Projects initiative, 

the same as the fiscal year level. 

National Activities 

The Committee recommends $6,865,000 for national activities. 

Funds are used to expand efforts to improve research, evaluation, 

and data collection on the status and effectiveness of Indian education programs, and to continue grants to tribal educational departments for education administration and planning. 

The Committee continues to note that there are significant cognitive, psychological, and academic benefits that result from Native 

American language immersion programs. Schools where the indigenous language is the primary language of instruction have a 

strong, positive effect on the educational and social outcomes of 

American Indian, Alaska Native, and Native Hawaiian students 

compared to schools where Native students are taught in English. 

In addition, language education programs are essential for tribal 

self-determination. Within the total, the Committee recommendation includes no less than $1,908,000, an increase of $300,000 

above the fiscal year 2017 funding level, for Native American language immersion programs authorized under section 6133 of ESSA. 

The Committee also intends that funds available for carrying out 

Section 6133 be allocated to all types of eligible entities in a way 

that supports the most extensive possible distribution across geography and language diversity and supports both existing and new 

Native language immersion programs and schools. Further, the 

Committee directs the Department to give the same consideration 

to applicants that propose to provide partial immersion schools and 

programs as to full immersion, as the local tribes, schools, and 

other applicants know best what type of program will most effectively assist their youth to succeed. 

The Committee notes that Native American languages hold a 

unique place in our nation and that the Native American Languages Act of 1990 [NALA] articulates U.S. policy toward Native 

American languages. Since its passage, Native American languages 

have increasingly become the object of school and community revitalization and retention efforts aligned with NALA. Educating students in the medium of a Native American language has demonstrated the same benefits as study in other world languages, including improved learning outcomes and enhanced cognitive ability. 

In the case of Native American students, however, the outstanding 

results in student achievement, high school graduation, and college 

attainment rates produced through access to Native American language medium education schools and programs are lifting some of 

the most disadvantaged youth in the U.S. to the ranks of the most 
170 

academically successful. The Committee recognizes that the establishment of a Native American Language Center to function as a 

consortium for institutions of higher education that have significant experience and expertise in Native American languages and 

Native American language medium education would be a strong 

way to provide nationwide coordination for Native American language activities. In addition, it could promote best practices, develop curricular materials for Native American languages, disseminate high-quality research on the efficacy of programs of instruction in these languages, and serve as an information clearinghouse 

and hub for distance learning and continuing professional development in Native American language education. Further, such a center could provide benefits to practitioners at schools from the PreK to PhD levels who teach through the medium of a Native American language, and include Native American scholars and staff who 

are fluent in Native American languages and have the demonstrated capacity to reach out and collaborate with Native American communities. The Committee therefore directs the Department 

to provide to the Committee a report on the feasibility of designating such a center and the potential associated costs. 

INNOVATION AND IMPROVEMENT

Appropriations, 2017 ............................................................................. $887,575,000 

Budget estimate, 2018 ........................................................................... 1,208,026,000 

Committee recommendation ................................................................. 880,375,000 

The Committee recommends $880,375,000 for programs within 

the Innovation and Improvement account. 

Education Innovation and Research 

The Committee recommendation includes $95,000,000 for the 

Education Innovation and Research [EIR] program. This program 

supports the creation, development, implementation, replication, 

and scaling up of evidence-based, field-initiated innovations designed to improve student achievement and attainment for highneed students. EIR incorporates a tiered evidence framework that 

provides early-phase, mid-phase, and expansion and replication 

grants. This supports interventions throughout the pipeline, from 

smaller grants for early stage projects that are willing to undergo 

rigorous evaluation to test their efficacy to larger grants to scaleup proven-effective interventions that have demonstrated significant impacts through multiple rigorous evaluations. 

The Committee notes that the EIR program is authorized to fund 

evidence-based, field-initiated innovations to improve student 

achievement for high-need students. Accordingly, the Committee 

directs the Department to ensure that funds are used for projects 

in a range of topic areas, based on the needs of local communities 

as determined by field initiated proposals, and that funds are not 

focused or designated for any particular intervention. Further, the 

Committee recommendation does not include new bill language requested under this program and believes changes proposed to the 

recently reauthorized ESEA should be made as needed through legislation considered by the authorizing Committees of Congress. 

The Committee supports the 25 percent set-aside in ESSA for 

EIR grants to benefit rural areas. Further, the Committee encour-
171 

ages the Department to invest in early-phase grants that benefit 

the expansion of education and experiences for educators and students located in rural schools with limited access to advanced 

science courses. Programs could include professional development 

for teachers, lessons taught by scientific experts, and hands-on experience with technology. 

School Leader Recruitment and Support 

The Committee recommendation does not include funding for the 

School Leader Recruitment and Support program, which funds activities to improve the recruitment, placement, support, and retention of effective principals and other school leaders in high-need 

schools. ESSA included new provisions to promote the use of title 

I and title II–A funds to support principals and school leaders, including an optional 3 percent State set-aside of title II-A funds for 

such activities. These State formula funds, as well as funding 

through other competitive grant programs such as the Supporting 

Effective Educator Development [SEED] program, can be used to 

support similar activities as those previously funded by this program. 

Charter School Program 

The Committee recommends $367,172,000 for the Charter School 

Program. This program supports the start-up, replication, and expansion of high-quality charter schools. 

Within the total, the Committee recommendation includes 

$212,872,000 for grants to State entities to support high-quality 

charter schools, including for grants directly to charter school developers in a State if no State entity receives a grant; $110,000,000 

for grants to charter management organizations for the replication 

and expansion of high-quality charter schools; $31,000,000 for facilities financing assistance, of which not less than $21,000,000 

shall be for the Credit Enhancement program; and not less than 

$11,000,000 for national activities to provide technical assistance, 

disseminate best practices, and evaluate the impact of the charter 

school program. 

Within the total for grants to SEAs, the Committee recommendation includes no less than $5,000,000 for developer grants to establish or expand charter schools in underserved, high-poverty, rural 

areas. This could include grants to institutions of higher education, 

or non-profit organizations in partnership with institutions of higher education, which are located in the region and committed to improving educational outcomes for underserved rural students. 

Rural areas present a host of challenges for all types of schools, including charter schools. Institutions of higher education located in 

the area may be uniquely suited to help address some of these 

challenges, and to give students opportunities to learn in non-traditional settings. Further, dedicated funding to expand charter 

schools in rural areas could help expand the evidence-base, including developing curriculum, for charter schools in rural areas. The 

Committee also notes that establishing charter schools in rural, 

particularly underserved areas, will likely require more start-up 

costs than in some other areas, and encourages the Department to 

consider these factors in determining grant award levels. 
172 

Magnet Schools Assistance 

The Committee recommends $97,647,000 for the Magnet Schools 

Assistance program. 

This program supports grants to LEAs to establish and operate 

magnet schools that are part of a court-ordered or federally approved voluntary desegregation plan. Magnet schools are designed 

to attract substantial numbers of students from different social, 

economic, ethnic, and racial backgrounds. Grantees may use funds 

for planning and promotional materials; salaries of instructional 

staff; transportation, as long as such expenses are sustainable beyond the grant period and not a significant portion of the grant; 

and the purchase of technology, educational materials, and equipment. 

Arts in Education 

The Committee recommendation includes $27,000,000 for the 

Arts in Education program. The funding is used for competitive 

awards for national nonprofit organizations engaged in arts education, professional development activities, and model arts education programs. Funds also are used for evaluation and dissemination activities. 

Javits Gifted and Talented Students 

The Committee recommendation includes $12,000,000 for the 

Javits Gifted and Talented Students Education program. Funds are 

used for awards to State and local educational agencies, institutions of higher education, and other public and private agencies for 

research, demonstration, and technical assistance activities designed to enhance the capability of elementary and secondary 

schools to meet the special educational needs of gifted and talented 

students, including those from disadvantaged and underrepresented populations. 

American History and Civics Education 

The Committee recommendation includes $1,815,000 for Presidential and Congressional Academies for American History and 

Civics. Presidential Academies for the Teaching of American History and Civics offer residential workshops to elementary and secondary school teachers to strengthen their knowledge through instruction and interaction with primary scholars and accomplished 

teachers in these fields. The Congressional Academies for Students 

of American History and Civics provide similar workshops to students to enrich their understanding of American history and civics. 

The Committee recommendation does not include funding for National Activities authorized under section 2233 of ESSA. 

Teacher and School Leader Incentive Grants 

The Committee recommendation includes $187,000,000 for 

Teacher and School Leader Incentive Grants. 

This program provides competitive grants to eligible entities to 

develop, implement, improve, or expand human capital management systems or performance-based compensation systems in 

schools. Funds can be used for a wide-range of activities, including 

developing or improving evaluation and support systems that are 
173 

based in part on student achievement; providing principals with 

necessary tools to make school-level decisions; implementing a differentiated salary structure based on a variety of factors; improving 

the recruitment and retaining of effective teachers, principals, and 

other school leaders; and instituting career advancement opportunities that reward effective teachers, principals and other school 

leaders. 

Ready-To-Learn Television 

The Committee recommendation includes $27,741,000 for the 

Ready-to-Learn Television program. 

This program is designed to facilitate student academic achievement by leveraging the power and reach of public television to develop and distribute educational video programming for preschool 

and elementary school children and their parents. 

The Consolidated Appropriations Act, 2017 requires the Department to transfer $2,000,000 to the Ready to Learn program in fiscal year 2017 to address a shortfall in funding relative to initial 

grant award amounts. The Committee recommendation continues 

that funding in the Ready to Learn program in fiscal year 2018. 

This funding will help grantees meet their project objectives and 

successfully produce the high quality educational programming intended by Congress. The Department shall provide each grantee a 

proportional share of such funds based on the grantees’ initial 

budget submissions. 

Supporting Effective Educator Development 

The Committee recommendation includes $65,000,000 for the 

Supporting Effective Educator Development [SEED] program. 

SEED provides competitive grants to improve teacher and principal 

effectiveness by supporting pathways that help teachers, principals, 

or other school leaders with non-traditional preparation and certification obtain employment in underserved LEAs; providing evidence-based professional development; and making services and 

learning opportunities freely available to LEAs. 

SAFE SCHOOLS AND CITIZENSHIP EDUCATION

Appropriations, 2017 ............................................................................. $151,254,000 

Budget estimate, 2018 ........................................................................... 134,857,000 

Committee recommendation ................................................................. 131,254,000 

The Committee recommends a total of $131,254,000 for activities 

to promote safe schools, healthy students, and citizenship education. 

Promise Neighborhoods 

The Committee recommendation includes $73,254,000 for the 

Promise Neighborhoods program. This program awards competitive 

grants to not-for-profit, community-based organizations for the development of comprehensive neighborhood programs designed to 

combat the effects of poverty and improve educational and life outcomes for children and youth, from birth through college. Each 

Promise Neighborhood grantee serves a high-poverty urban neighborhood or rural community. 
174 

The Committee recommendation modifies bill language included 

last year regarding Promise Neighborhood extension grants and directs the Department to award two-year extension grants on a competitive basis no later than March 31, 2018 to high quality Promise 

Neighborhood programs that have demonstrated positive and promising results through their initial implementation grant and that 

propose to continue pursuing ambitious goals through an extension 

of that grant. The Committee expects that grantees would be eligible for extension grants in an amount to allow them to continue to 

pursue ambitious goals while also supporting sustainability planning. Further, the Committee expects that a funding opportunity 

announcement will be published promptly with funding awarded as 

soon as possible, no later than March 31, 2018, to limit disruption 

and uncertainties for grantees. Finally, the Committee encourages 

the Department to prioritize funding for programs operating in particularly underserved areas. 

School Safety National Activities 

The Committee recommendation includes $58,000,000 for the 

School Safety National Activities, including up to $5,000,000 for 

Project SERV. This funding will help schools address the consequences of their students witnessing or being the victim of violence and other root causes of unhealthy school climates. 

Full Service Community Schools 

The Committee recommendation does not include funding for 

Full Service Community Schools. 

ENGLISH LANGUAGE ACQUISITION

Appropriations, 2017 ............................................................................. $737,400,000 

Budget estimate, 2018 ........................................................................... 735,998,000 

Committee recommendation ................................................................. 737,400,000 

The Committee recommends an appropriation of $737,400,000 for 

the English Language Acquisition program. 

The Department makes formula grants to States based on each 

State’s share of the Nation’s limited-English-proficient and recent 

immigrant student population. The program is designed to increase 

the capacity of States and school districts to address the needs of 

these students. The authorizing statute requires that 6.5 percent of 

the appropriation be used to support national activities, which include professional development activities designed to increase the 

number of highly qualified teachers serving limited-English-proficient students; a National Clearinghouse for English Language 

Acquisition and Language Instructional Programs. National activities funds shall be available for 2 years. 

The Committee strongly encourages the Department to help 

make States, school districts, and schools aware of funding available, through this program and others, to improve the English language proficiency and academic achievement of English language 

learners. The Committee notes the Department issued non-regulatory guidance on this issue in 2016. 
175 

SPECIAL EDUCATION

Appropriations, 2017 ............................................................................. $13,064,358,000 

Budget estimate, 2018 ........................................................................... 12,942,126,000 

Committee recommendation ................................................................. 13,066,858,000 

The Committee recommends an appropriation of $13,066,858,000 

for special education programs. 

Grants to States 

The Committee recommendation includes $12,002,848,000 for 

IDEA Part B Grants to States. This program provides formula 

grants to assist States, outlying areas, and other entities in meeting the costs of providing special education and related services for 

children with disabilities. States pass along most of these funds to 

LEAs, but may reserve some for program monitoring, enforcement, 

technical assistance, and other activities. 

The appropriation for this program primarily supports activities 

associated with the 2018–2019 academic year. Of the funds available for this program, $2,719,465,000 will become available on July 

1, 2018, and $9,283,383,000 will become available on October 1, 

2018. These funds will remain available for obligation through September 30, 2019. 

The Committee recommendation continues bill language continuing several provisions relating to MOE requirements, as requested by the administration. 

Preschool Grants 

The Committee recommends $368,238,000 for Preschool Grants. 

This program provides formula grants to States to assist them in 

making available special education and related services for children 

with disabilities aged 3 through 5. States distribute the bulk of the 

funds to LEAs. States must serve all eligible children with disabilities aged 3 through 5 and have an approved application under the 

IDEA. 

Grants for Infants and Families 

The Committee recommends $458,556,000 for the Grants for Infants and Families program under part C of the IDEA. Part C of 

the IDEA authorizes formula grants to States, outlying areas, and 

other entities to implement State-wide systems for providing early 

intervention services to all children with disabilities, ages 2 and 

younger, and their families. The IDEA also gives States the option 

of extending eligibility for part C services to children 3 and older 

if they were previously served under part C and will continue to 

be served until entrance to kindergarten. 

State Personnel Development 

The Committee recommends $38,630,000 for the State Personnel 

Development program. Ninety percent of funds must be used for 

professional development activities. The program supports grants 

to SEAs to help them reform and improve their personnel preparation and professional development related to early intervention, 

educational, and transition services that improve outcomes for students with disabilities. The bill includes language proposed in the 
176 

budget request that allows funds under the program to be used for 

program evaluation. 

Technical Assistance and Dissemination 

The Committee recommends $59,428,000 for Technical Assistance and Dissemination. This program supports awards for technical assistance, model demonstration projects, the dissemination 

of useful information, and other activities. Funding supports activities that are designed to improve the services provided under the 

IDEA. 

Within the total, the Committee recommendation includes 

$15,083,000, an increase of $2,500,000 above the fiscal year 2017 

funding level, to support activities authorized by the Special Olympics Sport and Empowerment Act, including Project UNIFY. 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. 

The Committee strongly encourages the Department to fund a 

demonstration program, of up to $2,000,000, to test early screening 

for dyslexia for students in kindergarten and first grade. This could 

allow for the screening of students in multiple school districts and 

in multiple states to test for the potential benefits of providing 

early screening for students, including helping to ensure that students with dyslexia are identified early and receive the resources 

and evidence-based interventions needed to help them succeed in 

school. 

Personnel Preparation 

The Committee recommends $83,700,000 for the Personnel Preparation program. 

Funds support competitive awards to help address State-identified needs for personnel who are qualified to work with children 

with disabilities, including special education teachers and related 

services personnel. The program is required to fund several other 

broad areas, including training leadership personnel and personnel 

who work with children with low-incidence disabilities, and providing enhanced support for beginning special educators. 

Parent Information Centers 

The Committee recommends $27,411,000 for Parent Information 

Centers. 

This program makes awards to parent organizations to support 

parent training and information centers, including community parent resource centers. These centers provide training and information to meet the needs of parents of children with disabilities living 

in the areas served by the centers, particularly underserved parents, and parents of children who may be inappropriately identified. 

Technology and Media Services 

The Committee recommends $28,047,000 for Technology and 

Media Services. This program makes competitive awards to sup-
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port the development, demonstration, and use of technology and 

educational media activities of value to children with disabilities. 

The Committee continues to recognize the ongoing progress made 

with the tools and services provided under the Educational Technology, Media and Materials program that have allowed more than 

440,000 students with disabilities free access to more than 515,000 

books in digitally accessible formats. The Committee strongly encourages continued effort to expand this program’s reach to K–12 

students in underserved areas. 

REHABILITATION SERVICES

Appropriations, 2017 ............................................................................. $3,535,589,000 

Budget estimate, 2018 ........................................................................... 3,563,008,000 

Committee recommendation ................................................................. 3,562,418,000 

Vocational Rehabilitation State Grants 

The Committee recommends $3,452,931,000 in mandatory funding for Vocational Rehabilitation [VR] State Grants. 

State Grants assist States in providing a range of services to 

help persons with physical and mental disabilities prepare for and 

engage in meaningful employment. 

The Rehabilitation Act requires that not less than 1 percent and 

not more than 1.5 percent of the appropriation for VR State Grants 

be set aside for Grants for American Indians. 

The Committee recommendation continues bill language allowing 

the Department to use unobligated VR State grant funds that remain available subsequent to the reallottment process, to be used 

for innovative activities to improve outcomes for individuals with 

disabilities. 

Client Assistance State Grants 

The Committee recommends $13,000,000 in discretionary funds 

for Client Assistance State Grants. 

This program funds State formula grants to help VR clients or 

client applicants understand the benefits available to them. States 

must operate client assistance programs to receive VR State Grant 

funds. 

Training 

The Committee recommends $29,388,000 for training rehabilitation personnel. This program supports grants to provide training to 

new VR staff, or upgrade the qualifications of existing staff. 

Demonstration and Training Programs 

The Committee recommendation includes $5,796,000 for demonstration and training programs. These programs support activities designed to increase employment opportunities for individuals 

with disabilities by expanding and improving the availability and 

provision of rehabilitation and other services. 

Protection and Advocacy of Individual Rights 

The Committee recommends $17,650,000 for the Protection and 

Advocacy of Individual Rights program. 
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This program provides grants to agencies to protect and advocate 

for the legal and human rights of persons with disabilities who are 

ineligible for the protection and advocacy services available 

through the Developmental Disabilities Assistance and Bill of 

Rights Act or the Protection and Advocacy for Individuals with 

Mental Illness Act. 

Supported Employment State Grants 

The Committee recommendation does not include funding for the 

Supported Employment State Grants Program. 

Independent Living Services for Older Individuals Who Are Blind 

The Committee recommends $33,317,000 for Independent Living 

State Grants. 

This program supports assistance to individuals over age 55 to 

help them adjust to their blindness and continue to live independently, including daily living skills training, counseling, community 

integration information and referral, the provision of low-vision 

and communication devices, and low-vision screening. 

Helen Keller National Center 

The Committee recommends $10,336,000 for the Helen Keller 

National Center for Deaf-Blind Youth and Adults. 

The Helen Keller National Center consists of a national headquarters in Sands Point, New York, with a residential training and 

rehabilitation facility where deaf-blind persons receive intensive 

specialized services; a network of 10 regional field offices that provide referral and counseling assistance to deaf-blind persons; and 

an affiliate network of agencies. 

SPECIAL INSTITUTIONS FOR PERSONS WITH DISABILITIES

AMERICAN PRINTING HOUSE FOR THE BLIND

Appropriations, 2017 ............................................................................. $25,431,000 

Budget estimate, 2018 ........................................................................... 25,383,000 

Committee recommendation ................................................................. 25,431,000 

The Committee recommends $25,431,000 to help support American Printing House for the Blind [APH]. 

APH provides educational materials to students who are legally 

blind and enrolled in programs below the college level. The Federal 

subsidy provides approximately 65 percent of APH’s total sales income. Materials are distributed free of charge to schools and States 

through per capita allotments based on the total number of students who are blind. Materials provided include textbooks and 

other educational aids in Braille, large type, recorded form, and 

computer applications. Appropriated funds may be used for staff 

salaries and expenses, as well as equipment purchases and other 

acquisitions consistent with the purpose of the Act to Promote the 

Education of the Blind. 

The Committee continues to commend APH for the significant 

progress being made through the Resources with Enhanced Accessibility for Learning [REAL] Plan toward developing new technologies to translate educational materials for delivery to students 

who are blind and visually impaired. The Committee continues to 
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support implementation of the REAL plan, and includes no less 

than the fiscal year 2017 level for such activities. 

NATIONAL TECHNICAL INSTITUTE FOR THE DEAF

Appropriations, 2017 ............................................................................. $70,016,000 

Budget estimate, 2018 ........................................................................... 69,883,000 

Committee recommendation ................................................................. 70,016,000 

The Committee recommends $70,016,000 for the National Technical Institute for the Deaf [NTID]. 

NTID, located on the campus of the Rochester Institute of Technology in Rochester, New York, was created by Congress in 1965 

to provide a residential facility for postsecondary technical training 

and education for persons who are deaf. NTID also provides support services for students who are deaf, trains professionals in the 

field of deafness, and conducts applied research. 

The Committee strongly supports NTIDs existing partnership 

with regional institutions, first established with fiscal year 2016 

funds, to expand NTID’s geographical reach and the availability of 

services for individuals who are deaf or hard of hearing in underserved areas. The Committee believes this partnership has been 

successful in its first year of implementation. Accordingly, the 

Committee recommendation includes $2,000,000, the same as the 

fiscal year 2017 level, to continue this partnership, without significant modifications, in fiscal year 2018. 

GALLAUDET UNIVERSITY

Appropriations, 2017 ............................................................................. $121,275,000 

Budget estimate, 2018 ........................................................................... 121,044,000 

Committee recommendation ................................................................. 121,275,000 

The Committee recommends $121,275,000 for Gallaudet University. 

Gallaudet University is a private, not-for-profit institution offering undergraduate and continuing education programs for students 

who are deaf, as well as graduate programs in fields related to 

deafness for students who are hearing and deaf. The university 

conducts basic and applied research related to hearing impairments and provides public service programs for the deaf community. 

This funding also supports the Model Secondary School for the 

Deaf, which serves as a laboratory for educational experimentation 

and development; disseminates curricula, materials, and models of 

instruction for students who are deaf; and prepares adolescents 

who are deaf for postsecondary academic or vocational education or 

the workplace. The university’s Kendall Demonstration Elementary 

School develops and provides instruction for children from infancy 

through age 15. 

CAREER, TECHNICAL, AND ADULT EDUCATION

Appropriations, 2017 ............................................................................. $1,720,686,000 

Budget estimate, 2018 ........................................................................... 1,476,441,000 

Committee recommendation ................................................................. 1,720,686,000 
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Career and Technical Education 

The Committee recommends $1,125,019,000 for the Career and 

Technical Education [CTE] account. 

State Grants.—The Committee recommends $1,117,598,000 for 

CTE State grants. 

Funds provided under the State grant program assist States, localities, and outlying areas to expand and improve their CTE program and help ensure equal access to CTE for populations with 

special needs. Persons assisted range from secondary students in 

prevocational courses through adults who need retraining to adapt 

to changing technological and labor market conditions. Funds are 

distributed according to a formula based on State population and 

State per capita income. 

Under the Indian and Hawaiian Natives programs, competitive 

grants are awarded to federally recognized Indian Tribes or Tribal 

organizations and to organizations primarily serving and representing Hawaiian Natives for services that are additional to what 

these groups receive under other provisions of the Perkins Act. 

Of the funds available for this program, $326,598,000 will become available July 1, 2018, and $791,000,000 will become available on October 1, 2018. These funds will remain available for obligation until September 30, 2019. 

National Programs.—The Committee recommends $7,421,000 to 

support research, development, demonstration, dissemination, evaluation, and assessment of activities aimed at improving the quality 

and effectiveness of CTE. 

Adult Education 

The Committee recommends $595,667,000 for Adult Education 

programs. 

Adult Education State Grants.—The Committee recommendation 

includes $581,955,000 for Adult Education State Grants, which provides grants to States for programs that assist adults in becoming 

literate and in obtaining the skills necessary for employment and 

self-sufficiency. 

National Leadership Activities.—The Committee recommends 

$13,712,000 for adult education national leadership activities. 

STUDENT FINANCIAL ASSISTANCE

Appropriations, 2017 ............................................................................. $24,198,210,000 

Budget estimate, 2018 ........................................................................... 22,932,626,000 

Committee recommendation ................................................................. 24,198,210,000 

The Committee recommends an appropriation of $24,198,210,000 

for programs under the Student Financial Assistance account. 

Federal Pell Grant Program 

The Committee recommends $22,475,352,000 in current year discretionary funding for the Pell grant program. Pell grants provide 

need-based financial assistance that helps undergraduate students 

and their families defray a portion of the costs of postsecondary 

education. Awards are determined according to a statutory needanalysis formula that takes into account a student’s family income 
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and assets, household size, and the number of family members, excluding parents, attending postsecondary institutions. 

The Committee recommendation includes a 1.7 percent increase in the maximum Pell grant award, from $5,920 to $6,020 for the 

2018–2019 award year. This is the first discretionary increase in 

the max award since fiscal year 2007. The Committee recommended funding level for the Pell grant program is also more 

than sufficient to continue Year-Round Pell [YRP], which was permanently reinstated in the Consolidated Appropriations Act, 2017. 

The Committee recommendation also includes a rescission of 

$2,600,000,000 in prior year unobligated balances. In recent years, 

Congress has consistently appropriated more funding than needed 

for the Pell grant program, including funding a critical expansion 

of the program with the reinstatement of YRP in fiscal year 2017. 

Based on current CBO estimates of program costs, including costs 

of reinstating YRP last year, and after including the increase in the 

max award and rescission of unobligated balances included in this 

bill, there will be approximately $6,000,000,000 in unobligated balances remaining at the end of fiscal year 2018. 

Federal Supplemental Educational Opportunity Grant Program 

The Committee recommends $733,130,000 for the Supplemental 

Educational Opportunity Grant [SEOG] program. 

The SEOG program provides funds to approximately 3,700 postsecondary institutions for need-based grants to more than 1.5 million undergraduate students. Institutions must contribute at least 

25 percent toward SEOG awards. Students qualify for grants of up 

to $4,000 by demonstrating financial need. Priority is given to Pell 

grant recipients with exceptional need. 

Federal Work-Study Program 

The Committee bill provides $989,728,000 for the Federal WorkStudy [FWS] program. 

This program provides grants to approximately 3,300 institutions 

and helps nearly 700,000 undergraduate, graduate, and professional students meet the costs of postsecondary education through 

part-time employment. Institutions must provide at least 25 percent of student earnings. 

Within the total for FWS, the Committee recommendation includes $8,390,000, the same as the fiscal year 2017 level, for the 

Work Colleges program authorized under section 448 of the HEA. 

STUDENT AID ADMINISTRATION

Appropriations, 2017 ............................................................................. $1,576,854,000 

Budget estimate, 2018 ........................................................................... 1,697,711,000 

Committee recommendation ................................................................. 1,576,854,000 

The Committee recommends $1,576,854,000 for the Student Aid 

Administration account. These funds are available until September 

30, 2019, and support the Department’s student aid management 

expenses. 

The Committee recommendation includes $696,643,000 for administrative costs and $880,211,000 for loan servicing activities. 

The Committee directs the Department to continue to provide 

quarterly reports detailing its obligation plan by quarter for stu-
182 

dent aid administrative activities broken out by servicer and activity. Further, any reallocation of funds between administrative costs 

and servicing activities within this account should be treated as a 

reprogramming of funds, and the Committee should be notified in 

advance of any such changes. 

Benefits for Servicemembers and Veterans.—The Committee notes 

that too many veterans and servicemembers eligible for certain student loan benefits have not taken advantage of these benefits due 

to a lack of communication between the Departments of Education, 

Defense, and Veterans Affairs, and Federal student loan servicers. 

In accordance with section 455(o) of the Higher Education Act of 

1965 [HEA], eligible military borrowers should not accrue interest 

on their Federal student loans while serving in an area of hostilities. Under the Higher Education Relief Opportunities for Students Act of 2003, servicemembers enrolled in income-driven repayment programs are eligible for a waiver from annual recertification 

obligations of their income. Servicemembers with Federal Perkins 

Loans are also eligible for a cancellation of a percentage of their 

debt, based on qualifying years of military service, in accordance 

with Section 465 of the Higher Education Opportunity Act of 2008. 

Further, many veterans are eligible for a full discharge of their 

Federal student loan debt due to a service-connected disability 

under the Total and Permanent Disability Discharge provisions of 

Section 437 of the HEA. Therefore, the Committee directs the Secretary of Education to enter into a Memorandum of Understanding 

with the Secretaries of Defense and Veterans Affairs to automate 

the application of loan benefits to eligible servicemembers and veterans using information in existing Federal databases in a timely 

manner so that servicemembers and veterans can receive the benefits due under law. The Committee further directs the Secretary of 

Education to brief the Committees on Appropriations of the House 

of Representatives and the Senate, Senate Committee on Health, 

Education, Labor, and Pensions, and the House Committee on Education and the Workforce on the plan for implementing this automation process within 90 days of enactment of this act. 

Cohort Default Rates.—The Committee is concerned that some 

public institutions of higher education operating in economically 

distressed communities have faced challenges in meeting statutory 

requirements to manage and prevent student loan defaults because 

of community-wide factors where the institution operates. The 

Committee strongly encourages the Secretary to use any authority 

available, including under section 435(a)(2)(iii) of the HEA, to provide flexibility in applying section 435(a) to institutions of higher 

education in severely distressed communities in the United States, 

including institutions operating in counties ranking in the bottom 

5 percent of all counties in the Distressed Designation and County 

Economic Status Classification System of the Appalachian Regional 

Commission, or based on other commonly used indices or measures. 

The Committee directs the Secretary to report to the Committees 

on Appropriations of the House of Representatives and the Senate, 

the Senate Committee on Health, Education, Labor, and Pensions, 

and the House Committee on Education and the Workforce on any 

additional statutory authority the Secretary may need to provide 

flexibility to such institutions. 
183 

Electronic Sharing of Tax Data.—Within the total for the Student Aid Administration account, the Committee recommendation 

includes sufficient funding to fully implement the Memorandum of 

Understanding establishing a framework regarding the requirements for electronically sharing tax data over multiple years for 

federal student loan borrowers participating in Income-Driven Repayment (IDR) plans, as announced by the Departments of Treasury and Education on January 17, 2017. 

Extension of Provisional Institutional Eligibility.—By providing 

language that extends the time period the Secretary may allow an 

institution of higher education to remain in provisional status, the 

Committee is addressing concerns that institutional applications 

for recognition by another accreditor have not been processed in 

part due to a lack of staff resources. As such, the extension of this 

time period does not permit institutions to remain with the same 

accreditor or relieve the Secretary of her responsibility to ensure 

that institutions are making timely progress with their applications 

currently being processed by another accrediting agency. 

Loan Counseling.—The Committee notes that Preferred Lender 

List requirements enacted in 2008 are intended to protect students 

and families from unfair lending practices in higher education. The 

implementation of these requirements have affected State-based organizations—including State agencies or authorities, or nonprofit 

organizations that are authorized, established, or chartered by 

State statute—in ways that were not intended by Congress. Statebased organizations report difficulty in partnering with institutions 

of higher education to advise students on their individual education 

financing decisions, including student loan repayment and forgiveness options, even when such advising is requested by the institution’s financial aid administrator. The Committee directs the Department within 180 days of enactment to issue guidance to clarify 

how colleges and universities can allow state-based organizations 

to participate in advising students on campus without violating 

Preferred Lender List rules. Pursuant to statutory restrictions, 

such guidance should not permit institutions of higher education or 

State-based organizations to directly market or advertise Statebased education loan programs to students. 

Public Service Loan Forgiveness Program.—The Committee notes 

that there has been significant concern from borrowers over the 

Department’s consistency and reliability in administering the Public Service Loan Forgiveness [PSLF] program. The Committee encourages the Department, in coordination with its Federal loan 

servicers, to update guidance, information, and processes regarding 

borrower eligibility for PSLF. Further, the Committee encourages 

the Department to provide further clarity regarding employer eligibility under the program, particularly for applicants employed by 

non-profit organizations that provide certain types of public service, 

but are not categorized under section 501(c)(3) of the Internal Revenue Code. This information should be publicly accessible and include real-world examples of organizations that qualify in certain 

fields. 

The Committee also notes that there has been concern with the 

level of service provided to borrowers that intend to seek PSLF. 

The Committee encourages the Department to provide to borrowers 
184 

more regular and current information about the status of processing their PSLF employment certification, the number of qualifying payments made, and the projected date of their forgiveness. 

Further, the Committee encourages the Department to expand the 

use of digital technology in the PSLF program, to allow for employment certifications and PSLF applications to be completed electronically, and with each student loan servicer. Finally, to ensure 

consistency for applicants, the Committee encourages the Department to revisit decisions to rescind employment certification for 

borrowers who were previously approved. 

Student Loan Discharges.—The Committee recognizes that there 

is ongoing disruption to and burden on the lives of students from 

the closure of and misconduct by Corinthian Colleges, Inc. [CCi]. 

Former students who enrolled in many programs of study at more 

than 100 CCi campuses were provided with highly misleading job 

placement rate information. At least 45,000 former CCi students 

have pending applications with the Department for a discharge and 

refund of their fraudulently issued federal loan debt, and the Committee believes that many more students have not applied. The 

Committee directs the Secretary to process applications as expeditiously as possible, and ensure students are aware of their potential eligibility for relief by identifying and contacting borrowers 

who may qualify to assert a defense to repayment utilizing the program-level enrollment information provided to the Department by 

states in 2016. 

Student Loan Servicing.—The Committee recommendation includes new bill language prohibiting the Department from moving 

forward with a new student loan servicing contract unless the new 

student loan servicing solution includes the participation of multiple student loan servicers that contract directly with the Department of Education and allocates student loan borrower accounts to 

participating servicers based on performance. The Committee 

strongly believes relying on one servicer will decrease accountability and add risk to borrowers and taxpayers. Instead, providing 

for the participation of multiple servicers, utilizing common practices, policies and performance metrics, will promote accountability 

and incentivize servicers to provide high-quality service to borrowers. The Committee expects that each servicer would be responsible for managing the full life-cycle of loans, from disbursement to 

pay-off, with exceptions for common origination and disbursement, 

specialty servicing for at-risk borrowers, and other unique servicing 

needs, to ensure competition between servicers. Further, while the 

Department considers the future of the servicing environment, the 

Committee encourages the Department to continue pursuing the 

development of a simple, consistent, and unified experience for all 

student borrowers through a universal web portal. During the collaborative information gathering and stakeholder engagement effort related to the new servicing environment that was announced 

on August 1, 2017, the Department is directed to engage with the 

Committees on Appropriations of the House of Representatives and 

the Senate, the Senate Committee on Health, Education, Labor, 

and Pensions, and the House Committee on Education and the 

Workforce to gather input from Congress on the design of this environment. 
185 

Further, the Committee reiterates the directive included last 

year and again directs the Department to issue a common policies 

and procedures manual, including voluntary best practices, to help 

improve the consistency of servicing for student loan borrowers. 

The manual should include best practices related to how borrowers 

should be counseled about repayment options and benefits. The Department should utilize expertise and resources from its servicers 

in developing this manual which can also serve as the guide for 

servicing standards in the future servicing environment. 

In addition, the Committee reiterates the directive included in 

bill language in the Consolidated Appropriations Act, 2017, and included again in this bill, requiring the Department to allow borrowers, when consolidating student loans, to select from any of the 

existing servicers to service their new consolidated loan. The Committee is deeply concerned with how the Department has adhered 

to congressional directives in this area, including its plan to ignore 

this directive, as part of their proposal to move to a single-servicer 

model. 

HIGHER EDUCATION

Appropriations, 2017 ............................................................................. $2,055,439,000 

Budget estimate, 2018 ........................................................................... 2,038,126,000 

Committee recommendation ................................................................. 2,048,439,000 

The Committee recommends an appropriation of $2,048,439,000 

for higher education programs. 

Aid for Institutional Development 

The Committee recommends $577,514,000 in discretionary funding for Aid for Institutional Development. These totals do not include separately authorized and appropriated mandatory funding. 

Strengthening Institutions.—The Committee bill recommends 

$86,534,000 to provide competitive, 1-year planning and 5-year development grants for institutions with a significant percentage of 

financially needy students and low educational and general expenditures per student in comparison with similar institutions. Applicants may use these funds to develop faculty, strengthen academic programs, improve institutional management, and expand 

student services. 

Hispanic-Serving Institutions [HSIs].—The Committee recommends $107,795,000 for competitive grants to institutions at 

which Hispanic students make up at least 25 percent of enrollment. Funds may be used for acquisition, rental, or lease of scientific or laboratory equipment; renovation of instructional facilities; development of faculty; support for academic programs; institutional management; and purchase of educational materials. 

Promoting Postbaccalaureate Opportunities for Hispanic Americans.—The Committee recommends $9,671,000 for competitive, 5- 

year grants to HSIs to help Hispanic Americans gain entry into 

and succeed in graduate study. Institutions may use funding to 

support low-income students through outreach programs; academic 

support services; mentoring and financial assistance; acquisition, 

rental, or lease of scientific or laboratory equipment; construction 

and other facilities improvements; and purchase of educational materials. 
186 

Strengthening Historically Black Colleges and Universities.—The 

Committee recommends $244,694,000 for the Strengthening 

HBCUs program. The program makes formula grants to HBCUs 

that may be used to purchase equipment; construct and renovate 

facilities; develop faculty; support academic programs; strengthen 

institutional management; enhance fundraising activities; provide 

tutoring and counseling services to students; and conduct outreach 

to elementary and secondary school students. 

Strengthening Historically Black Graduate Institutions 

[HBGIs].—The Committee recommends $63,281,000 for the 

Strengthening HBGIs program. This program provides 5-year 

grants to provide scholarships for low-income students and academic and counseling services to improve student success. Funds 

may also be used for construction, maintenance, and renovation activities; the purchase or lease of scientific and laboratory equipment; and the establishment of an endowment. 

Strengthening Predominately Black Institutions [PBIs].—The 

Committee recommends $9,942,000 for the Strengthening PBIs program. This program provides 5-year grants to PBIs to plan and implement programs to enhance the institutions’ capacity to serve 

more low- and middle-income Black American students. 

Strengthening Asian American and Native American Pacific Islander-Serving Institutions [AANAPISIs].—The Committee recommends $3,348,000 for competitive grants to AANAPISIs that 

have an enrollment of undergraduate students that is at least 10 

percent Asian American or Native American Pacific Islander students. Grants may be used to improve their capacity to serve Asian 

American and Native American Pacific Islander students and lowincome individuals. 

Strengthening Alaska Native and Native Hawaiian-Serving Institutions [ANNHs].—The Committee recommends $13,802,000 for the 

Strengthening ANNHs program. 

The purpose of this program is to improve and expand the capacity of institutions serving Alaska Native and Native Hawaiian students and low-income individuals. Funds may be used to plan, develop, and implement activities that encourage faculty and curriculum development; improve administrative management; renovate educational facilities; enhance student services; purchase library and other educational materials; and, provide education or 

counseling services designed to improve the financial and economic 

literacy of students or their families. 

Strengthening Native American-Serving Non-Tribal Institutions.—The Committee recommends $3,348,000 for this program, 

which serves institutions that enroll at least 10 percent Native 

American students and at least 50 percent low-income students. 

This program helps institutions plan, develop, and implement activities that encourage faculty and curriculum development; improve administrative management; renovate educational facilities; 

enhance student services; and purchase library and other educational materials. 

Strengthening Tribally Controlled Colleges and Universities.— 

The Committee recommends $27,599,000 for this program. Tribal 

colleges and universities rely on a portion of the funds provided to 
187 

address developmental needs, including faculty development, curriculum, and student services. 

Strengthening Masters Degree Programs at Historically Black 

Colleges and Universities.—The Committee recommends $7,500,000 

for this program, authorized by section 723 of the HEA. This program provides grants to specified colleges and universities making 

a substantial contribution to graduate education opportunities at 

the masters 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 

The bill includes a total of $72,164,000 for International Education and Foreign Language Studies programs. 

Funds are used to increase the number of experts in foreign languages and area or international studies to meet national security 

needs through visits and study in foreign countries. 

Domestic Programs.—The Committee recommends $65,103,000 

for domestic program activities related to international education 

and foreign language studies under title VI of the HEA. Funds are 

used to support centers, programs, and fellowships. The Committee 

urges the Secretary to preserve the program’s longstanding focus 

on activities and institutions that address the Nation’s need for a 

strong training and research capacity in foreign languages and 

international studies, including increasing the pool of international 

experts in areas that are essential to national security and economic competitiveness. 

Overseas Programs.—The Committee recommends $7,061,000 for 

overseas programs authorized under the Mutual Educational and 

Cultural Exchange Act of 1961, popularly known as the FulbrightHays Act. Funding is provided for group, faculty, or doctoral dissertation research abroad as well as special bilateral projects. 

Grants focus on training American instructors and students to improve foreign language and area studies education in the United 

States. 

Model Comprehensive Transition and Postsecondary Programs for 

Students With Intellectual Disabilities 

The Committee recommendation includes $11,800,000 for competitive grants to postsecondary institutions to support model programs that help students with intellectual disabilities transition to 

and complete college, as authorized by section 767 of the HEA. 

Funds may be used for student support services; academic enrichment, socialization, or independent living; integrated work experiences; and partnerships with LEAs to support students with intellectual disabilities participating in the model program who are still 

eligible for special education and related services under the IDEA. 

Minority Science and Engineering Improvement 

The Committee recommends $9,648,000 for the Minority Science 

and Engineering Improvement program. Funds are used to provide 

discretionary grants to institutions with minority enrollments 

greater than 50 percent to purchase equipment, develop curricula, 

and support advanced faculty training. Grants are intended to im-
188 

prove science and engineering education programs and increase the 

number of minority students in the fields of science, mathematics, 

and engineering. 

Tribally Controlled Postsecondary Career and Technical Institutions 

The Committee recommends $8,286,000 for tribally controlled 

postsecondary vocational institutions. This program provides 

grants for the operation and improvement of tribally controlled 

postsecondary vocational institutions to ensure continued and expanding opportunities for Indian students. 

Federal TRIO Programs 

The Committee recommends $953,000,000 for Federal TRIO programs, which provide a variety of services to improve postsecondary education opportunities for low-income individuals and 

first-generation college students. 

Upward Bound offers disadvantaged high school students academic services to develop the skills and motivation needed to pursue and complete a postsecondary education; Student Support 

Services provides developmental instruction, counseling, summer 

programs, and grant aid to disadvantaged college students to help 

them complete their postsecondary education; Talent Search identifies and counsels individuals between ages 11 and 27 regarding opportunities for completing high school and enrolling in postsecondary education; Educational Opportunity Centers provide information and counseling on available financial and academic assistance to low-income adults who are first-generation college students; 

and the Ronald E. McNair Postbaccalaureate Achievement Program supports research internships, seminars, tutoring, and other 

activities to encourage disadvantaged college students to enroll in 

doctoral programs. 

The Committee recommendation includes no less than the fiscal 

year 2017 level for each of the TRIO programs, and rejects the administration’s proposed elimination of the McNair 

Postbaccalaureate and Educational Opportunity Centers programs. 

The Committee directs the Secretary to peer review fiscal year 

2017 Upward Bound applications that were initially determined ineligible for further review based on minor technical issues with 

their grant application. Further, after such review, the Committee 

directs the Secretary to award funding to any applicants that 

would have received funding in the fiscal year 2017 grant competition had they been allowed to be reviewed then. The Committee 

recommendation includes an increase for TRIO to ensure that current grantees are not adversely impacted by any grant awards that 

result. 

The Committee continues to be concerned with the timeliness of 

the Department’s announcement of TRIO grant awards and the impact on grantees. The Committee directs the Department conduct 

a review of all grant award deadlines related to Federal TRIO programs and implement recommendations for upholding these deadlines, or modifying them to better-align with grantees’ program 

year and to prevent disruption among grantees and the services 

they provide. 
189 

The Committee is concerned with the Department’s plan to 

abruptly end certain grants under the Education Opportunity Centers [EOC] program after just one year, and without advance notification or warning. While the Committee expects grantees to be 

held to high standards, absent violation of law or regulation, grantees should not have their funding terminated mid-grant without 

significant advance notice and an opportunity to provide corrective 

actions. Except in extraordinary circumstances, the Committee directs the Secretary to ensure that grantees are notified at least 90 

in advance that they are in danger of not having their grant continued unless they take specific corrective actions. Further, the Committee directs the Secretary to provide particular flexibility to new 

grantees, grantees operating in particularly underserved areas, and 

grantees facing other extenuating circumstances. Accordingly, the 

Department shall provide continuation grants to EOC programs according to their initial grant awards. 

Gaining Early Awareness and Readiness for Undergraduate Programs 

The Committee recommends $339,754,000 for GEAR UP, which 

provides grants to States and partnerships of colleges, middle and 

high schools, and community organizations to assist cohorts or students in middle and high schools serving a high percentage of lowincome students. Services provided help students prepare for and 

pursue a postsecondary education. 

The Committee directs the Secretary to announce in the Federal 

Register a Notice for Application for New Awards for State grants 

for this fiscal year and establish a maximum award for such 

awards that accommodates the larger grants made to States under 

previous grant competitions. The Department is strongly encouraged to publish the notice inviting applications as soon as possible. 

The Committee believes that the rejection of the budget’s proposed 

cut to GEAR UP enables the Department to prevent State grantees 

that received higher annual grant amounts based on prior competition maximum award amounts from reducing services as a result 

of a potential lower maximum award for a State grant competition 

in 2018. 

The Committee continues bill language allowing the Department 

to set aside up to 1.5 percent of the total provided for evaluation 

purposes. Further, the Committee directs the Department to work 

with the GEAR UP community and grantees to standardize data 

collection, including through the use of third-party data systems. 

Graduate Assistance in Areas of National Need and Javits Fellowships 

The Committee recommends $23,047,000 to support the Graduate Assistance in Areas of National Need [GAANN] program. 

GAANN supports fellowships through 3-year competitive grants 

to graduate academic departments and programs in scientific and 

technical fields and other areas of national need as determined by 

the Secretary. Fellowship recipients must have excellent academic 

records and high financial need and must be pursuing doctoral degrees or the highest graduate degrees in their academic field. Each 

fellowship consists of a student stipend to cover living costs and an 
190 

institutional payment to cover each fellow’s tuition and other expenses. Institutions of higher education must match 25 percent of 

the grant amount. 

Teacher Quality Partnership Program 

The Committee recommends $38,092,000 for the Teacher Quality 

Partnership [TQP] program. The TQP program helps improve the 

quality of teachers working in high-need schools and early childhood education programs by creating model teacher preparation 

and residency programs. 

Child Care Access Means Parents in Schools 

The Committee recommendation includes $15,134,000 for the 

Child Care Access Means Parents in Schools program. This program provides competitive grants to institutions of higher education to establish or support campus-based child care programs, to 

help support needs and participation of low-income parents in postsecondary education. 

HOWARD UNIVERSITY

Appropriations, 2017 ............................................................................. $221,821,000 

Budget estimate, 2018 ........................................................................... 221,399,000 

Committee recommendation ................................................................. 221,821,000 

The Committee recommends an appropriation of $221,821,000 for 

Howard University. Located in the District of Columbia, Howard 

offers undergraduate, graduate, and professional degrees through 

12 schools and colleges. The university also administers the Howard University Hospital. Federal funds from this account support 

approximately 38 percent of the university’s operating costs. The 

Committee recommends, within the funds provided, not less than 

$3,405,000 for the endowment program. 

Howard University Hospital.—Within the funds provided, the 

Committee recommends $27,325,000 for Howard University Hospital. The hospital provides inpatient and outpatient care, as well 

as training in the health professions. It also serves as a major 

acute and ambulatory care center for the District of Columbia and 

functions as a major teaching facility attached to the university. 

The Federal appropriation provides partial funding for the hospital’s operations. 

COLLEGE HOUSING AND ACADEMIC FACILITIES LOANS PROGRAM

Appropriations, 2017 ............................................................................. $435,000 

Budget estimate, 2018 ........................................................................... 434,000 

Committee recommendation ................................................................. 435,000 

Federal Administration.—The Committee bill includes $435,000 

for Federal administration of the CHAFL, College Housing Loans, 

and Higher Education Facilities Loans programs. Prior to fiscal 

year 1994, these programs provided financing for the construction, 

reconstruction, and renovation of housing, academic, and other educational facilities. While no new loans have been awarded since fiscal year 1993, costs for administering the outstanding loans will 

continue through 2030. These funds will be used to reimburse the 
191 

Department for administrative expenses incurred in managing the 

existing loan portfolio. 

HISTORICALLY BLACK COLLEGE AND UNIVERSITY CAPITAL

FINANCING PROGRAM ACCOUNT

Appropriations, 2017 ............................................................................. $20,484,000 

Budget estimate, 2018 ........................................................................... 20,445,000 

Committee recommendation ................................................................. 20,484,000 

The Committee recommends $20,484,000 for the HBCU Capital 

Financing Program. 

The Committee recommendation includes $20,150,000 to pay the 

loan subsidy costs in guaranteed loan authority under this program. This amount will support an estimated $314,000,000 in new 

loan volume in fiscal year 2018. The remaining $334,000 will be 

used for administrative expenses. 

The HBCU Capital Financing Program makes capital available 

to HBCUs for construction, renovation, and repair of academic facilities by providing a Federal guarantee for private sector construction bonds. Construction loans will be made from the proceeds 

of the sale of the bonds. 

INSTITUTE OF EDUCATION SCIENCES

Appropriations, 2017 ............................................................................. $605,267,000 

Budget estimate, 2018 ........................................................................... 616,839,000 

Committee recommendation ................................................................. 600,267,000 

The Committee recommends $600,267,000 for the Institute of 

Education Sciences [IES]. This account supports education research, development, dissemination, and evaluation; data collection 

and analysis activities; and the assessment of student progress. 

Under the Education Sciences Reform Act of 2002, Congress established IES to provide objective and valid research-driven knowledge that was free of political influence or bias so as to better inform effective education practices at the State and local levels. The 

act required IES, in carrying out its mission, ‘‘to compile statistics, 

develop products, and conduct research, evaluations, and wide dissemination activities in areas of demonstrated national need and 

ensure that such activities conform to high standards of quality, integrity, and accuracy and are objective, secular, neutral, and nonideological and are free of partisan political influence.’’ 

The Committee directs the Director to submit an operating plan 

within 90 days of enactment of this act to the Committees on Appropriations of the House of Representatives and the Senate detailing how IES plans to allocate funding available to the Institute for 

research, evaluation, and other activities authorized under law. 

The Committee supports IES’s plans in fiscal year 2018 to select 

a National Research and Development Center on Improving Rural 

Education. The Committee understands that this center will build 

the capacity of rural schools to use high-quality, scientific research 

to improve student outcomes, as envisioned by ESSA. The Committee is particularly interested in research that addresses the specific needs of diverse rural schools. The Committee strongly encourages IES to establish a research and development center specifically designed for research collaboration between university experts 
192 

and underperforming LEAs in rural districts that serve high poverty and minority students with high dropout rates. Further, the 

research center should address the needs of rural schools in relation to early childhood education, teacher education, school needs 

assessment, and transition to post-secondary education. Priority 

should be given to applicants who create a network of partnerships 

that touch various geographic regions of the Nation. 

To address concerns about the privacy of student data, particularly personally identifiable information, the Committee continues 

to direct the Department to ensure that its employees, contractors, 

and grantees, including States that receive funds from Statewide 

Longitudinal Data System grants, adhere to the strictest and highest standards for protecting personally identifiable information. 

The Committee notes the Department is planning, pursuant to 

Senate Committee Report 114–274, to report to the Committees on 

Appropriations of the House of Representatives and the Senate, as 

well as to the Senate Health, Education, Labor, and Pensions Committee and the House Education and the Workforce Committee, on 

the actions it has taken to comply with this directive. 

RESEARCH, DEVELOPMENT, AND DISSEMINATION

The Committee recommends $185,000,000 for education research, 

development, and national dissemination activities. Funds are 

available for obligation for 2 fiscal years. These funds support 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 improve education. 

STATISTICS

The Committee recommends $107,000,000 for data gathering and 

statistical analysis activities at the National Center for Education 

Statistics [NCES]. 

NCES collects, analyzes, and reports statistics on education in 

the United States. Activities are carried out directly and through 

grants and contracts. The Center collects data on educational institutions at all levels, longitudinal data on student progress, and 

data relevant to public policy. NCES also provides technical assistance to SEAs, LEAs, and postsecondary institutions. 

REGIONAL EDUCATIONAL LABORATORIES

The Committee recommends $54,423,000 to continue support for 

the Regional Educational Laboratories program. Funds available in 

this bill will continue to support a network of 10 laboratories. The 

laboratories are responsible for promoting the use and development 

of knowledge and evidence in broad-based systemic strategies to increase student learning and further school improvement efforts. 

The Committee appreciates the efforts of IES to strengthen the 

connections between practitioners and the research community, so 

that federally supported research is timely, relevant, and responsive to the needs of the field. 
193 

RESEARCH AND INNOVATION IN SPECIAL EDUCATION

The Committee recommends $54,000,000 for research and innovation in special education conducted by the National Center for 

Special Education Research. 

The Center addresses gaps in scientific knowledge to improve 

special education and early intervention services and outcomes for 

infants, toddlers, and children with disabilities. Funds provided to 

the Center are available for obligation for 2 fiscal years. 

SPECIAL EDUCATION STUDIES AND EVALUATIONS

The Committee recommends $10,818,000 for special education 

studies and evaluations. 

This program supports competitive grants, contracts, and cooperative agreements to assess the implementation of IDEA. Funds are 

also used to evaluate the effectiveness of State and local efforts to 

deliver special education services and early intervention programs. 

Funds are available for obligation for 2 fiscal years. 

STATEWIDE DATA SYSTEMS

The Committee recommendation includes $32,281,000 for the 

Statewide Data Systems program. 

This program supports competitive grants to SEAs to enable 

such agencies to design, develop, and implement Statewide, longitudinal data systems to manage, analyze, disaggregate, and use individual data for students of all ages. Early childhood, postsecondary, and workforce information systems may be linked to such 

systems or developed with program funds. The Committee believes 

the Department should continue its efforts to ensure every State 

has the base support necessary to develop effective systems. Funds 

are available for obligation for 2 fiscal years. 

ASSESSMENT

The Committee recommends $156,745,000 to provide support for 

the National Assessment of Educational Progress [NAEP], a congressionally mandated assessment created to measure and report 

the educational achievement of American students in a range of 

subjects and analyze trends over time. 

Within the funds appropriated, the Committee recommends 

$7,745,000 for the National Assessment Governing Board [NAGB], 

which is responsible for formulating policy for NAEP. 

The Committee continues to support assessments for students in 

United States History, Civics, and Geography. The Committee directs NAGB to continue administering assessments in these three 

areas, at least every four years, in accordance with the current 

NAEP schedule. According to this schedule, the next administration will be in 2018 for 8th grade students. 

DEPARTMENTAL MANAGEMENT

PROGRAM ADMINISTRATION

Appropriations, 2017 ............................................................................. $432,000,000 

Budget estimate, 2018 ........................................................................... 438,000,000 

Committee recommendation ................................................................. 430,000,000 
194 

The Committee recommends $430,000,000 for program administration. 

Funds support personnel compensation and benefits, travel, rent, 

communications, utilities, printing, equipment and supplies, automated data processing, and other services required to award, administer, and monitor Federal education programs. Support for 

program evaluation and studies and advisory councils is also provided under this account. 

Borrower Defense Claims Reporting.—The Committee directs the 

Department to report on a quarterly basis to the Committees on 

Appropriations of the House of Representative and the Senate, the 

Senate Committee on Health, Education, Labor, and Pensions, and 

the House Committee on Education and the Workforce, on the receipt and processing by the Department of borrower defense claims 

made pursuant to section 455(h) of the HEA. This should include 

information on the total number of pending borrower defense 

claims, total number of approved borrower defense claims, total 

dollar amount of relief, and total number of denied claims, including disaggregated by State. The report shall also include specific 

actions taken and planned to process this workload in a timely 

manner. The Committee strongly encourages the Department to 

make the reports publicly available on its website. 

Performance Partnerships.—The Committee recommendation 

continues authority for Performance Partnerships as included in 

prior appropriations acts. Performance Partnerships allow States 

and localities to demonstrate better ways of improving outcomes for 

disconnected youth by giving them additional flexibility in using 

discretionary funds across multiple Federal programs. The Committee also continues to encourage the administration to enhance 

its efforts working with existing and potential sites on the full 

range of flexibilities that could be employed to help better serve 

disconnected youth. Finally, the Committee is interested in expanding Performance Partnerships to other populations and programs, 

and has requested reports from GAO to help explore this possibility. 

Pooled Evaluation Authority.—The Committee requests that the 

Department provide a report to the Committee on the planned use 

of pooled evaluation funds under section 8601 of the ESEA, consistent with the required plan under such section, not later than 

15 days prior to any transfer of funds. 

Competitive Grant Priorities for Rural Areas.—The Committee 

continues to encourage the Department to continue efforts to ensure that competitive grants are reaching rural areas and States 

so that support and solutions developed with Federal funding are 

relevant to and available in such areas. 

OFFICE FOR CIVIL RIGHTS

Appropriations, 2017 ............................................................................. $108,500,000 

Budget estimate, 2018 ........................................................................... 106,797,000 

Committee recommendation ................................................................. 117,000,000 

The Committee recommends $117,000,000 for the Office of Civil 

Rights [OCR]. 

OCR is responsible for the enforcement of laws that prohibit discrimination on the basis of race, color, national origin, sex, dis-
195 

ability, and age in all programs and institutions that receive financial assistance from the Department. To carry out this responsibility, OCR investigates and resolves discrimination complaints, 

monitors desegregation and equal educational opportunity plans, 

reviews possible discriminatory practices by recipients of Federal 

education funds, and provides technical assistance to recipients of 

funds to help them meet these civil rights requirements. 

In reviewing, investigating, or deciding whether there has been 

a violation of Title VI of the Civil Rights Act of 1964, on the basis 

of race, color, or national origin, based on an individual’s actual or 

perceived shared Jewish ancestry or Jewish ethnic characteristics, 

the Committee strongly encourages OCR to take into consideration 

the definition and examples of anti-Semitism set forth by the State 

Department’s Special Envoy to Monitor and Combat Anti-Semitism 

when assessing whether a practice was motivated by anti-Semitic 

intent. 

OFFICE OF INSPECTOR GENERAL

Appropriations, 2017 ............................................................................. $59,256,000 

Budget estimate, 2018 ........................................................................... 61,143,000 

Committee recommendation ................................................................. 59,256,000 

The Committee recommends $59,256,000 for OIG. 

OIG has the authority to investigate all departmental programs 

and administrative activities, including those under contract or 

grant, to prevent and detect fraud and abuse, and to ensure the 

quality and integrity of those programs. The Office investigates alleged misuse of Federal funds and conducts audits to determine 

compliance with laws and regulations, efficiency of operations, and 

effectiveness in achieving program goals. 

GENERAL PROVISIONS

Section 301. The bill continues a provision prohibiting the use of 

funds for the transportation of students or teachers in order to 

overcome racial imbalance. 

Section 302. The bill continues a provision prohibiting the involuntary transportation of students other than to the school nearest 

to the student’s home. 

Section 303. The bill continues a provision prohibiting the use of 

funds to prevent the implementation of programs of voluntary 

prayer and meditation in public schools. 

Section 304. The bill continues a provision giving the Secretary 

authority to transfer up to 1 percent of any discretionary funds between appropriations. 

Section 305. The bill continues a provision that allows the Republic of Palau to receive certain Federal funds. 

Section 306. The bill continues a provision making evaluation 

funds pooled under section 8601 of the ESEA available for obligation from July 1, 2018 through September 30, 2019. 

Section 307. The bill continues a general provision allowing certain institutions to continue to use endowment income for student 

scholarships. 
196 

Section 308. The bill continues a provision extending authorization of the National Advisory Committee on Institutional Quality 

and Integrity. 

Section 309. The bill continues a provision extending authority to 

provide account maintenance fees to guarantee agencies. 

Section 310. The bill modifies a provision rescinding fiscal year 

2018 mandatory funding to pay for mandatory costs of increasing 

the maximum discretionary Pell award. 

Section 311. The bill modifies a general provision rescinding discretionary unobligated balances from the Pell grant program. 

Section 312. The bill includes a new provision restoring Pell eligibility for certain students. 

Section 313. The bill includes a new provision giving the Secretary authority to extend provisional eligibility status for certain 

institutions of higher education. 
(197) 

TITLE IV 

RELATED AGENCIES 

COMMITTEE FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR

SEVERELY DISABLED

SALARIES AND EXPENSES

Appropriations, 2017 ............................................................................. $8,000,000 

Budget estimate, 2018 ........................................................................... 6,117,000 

Committee recommendation ................................................................. 8,000,000 

The Committee recommends $8,000,000 for the Committee for 

Purchase from People Who Are Blind or Severely Disabled, of 

which no less than $1,250,000 shall be made available for the Office of Inspector General. 

The AbilityOne program provides more than 46,000 blind or severely disabled Americans with employment opportunities each 

year. The primary purpose of this program is to increase the employment opportunities for people who are blind or have other severe disabilities and, whenever possible, to prepare them to engage 

in competitive employment. Encompassing approximately 

$3,300,000,000 in contracts, it is the Federal Government’s largest 

employment program for the severely disabled. The Committee is 

encouraged by the steps the Commission has taken to implement 

the recommendations outlined in the May 2013 GAO report addressing the concerns regarding the oversight of the Central Nonprofit Agencies, the independent contracted organizations which 

administer the program. The Committee directs the Commission to 

provide an update on these efforts to the Committees on Appropriations of the House of Representatives and the Senate within 120 

days of enactment of this act. 

CORPORATION FOR NATIONAL AND COMMUNITY SERVICE

The Corporation for National and Community Service [CNCS], a 

corporation owned by the Federal Government, was established to 

enhance opportunities for national and community service. CNCS 

administers programs authorized under the Domestic Volunteer 

Service Act, the National and Community Service Trust Act, and 

the SERVE America Act. Grants are awarded to States, public and 

private nonprofit organizations, and other entities to create service 

opportunities for students, out-of-school youth, adults, and seniors. 

The Committee recommendation for CNCS provides a total pro- gram level of $1,018,916,000. 

OPERATING EXPENSES

Appropriations, 2017 ............................................................................. $736,029,000 

Budget estimate, 2018 ........................................................................... 31,689,000 

Committee recommendation ................................................................. 736,429,000 
198 

The Committee recommends $736,429,000 for the operating expenses of CNCS. 

Volunteers in Service to America [VISTA] 

The Committee recommends $92,364,000 for VISTA. This program provides capacity building for small, community-based organizations with a mission of combating poverty. VISTA members 

raise resources, recruit and organize volunteers, and establish and 

expand programs in housing, employment, health, and economic 

development activities. 

National Senior Volunteer Corps 

The Committee recommends $202,117,000 for the National Senior Volunteer Corps programs, a collection of programs that connect 

Americans older than the age of 55 with opportunities to contribute 

their job skills and expertise to community projects and organizations. These programs include the Retired Senior Volunteer Program [RSVP], the Foster Grandparent Program, and the Senior 

Companion Program. 

AmeriCorps State and National Grants 

The Committee recommends $386,010,000 for AmeriCorps State 

and National Grants, which provide funds to local and national organizations and agencies to address community needs in education, 

public safety, health, and the environment. Each of these organizations and agencies, in turn, uses its AmeriCorps funding to recruit, 

place, and supervise AmeriCorps members. AmeriCorps members 

receive a modest living allowance and other benefits proportional 

to their level of time commitment. 

The Committee strongly supports CNCS’ efforts and initiatives in 

several areas, including but not limited to, supporting activities in 

communities experiencing civil unrest and significant violence, including strengthening relationships between communities and law 

enforcement; helping address the opioid epidemic; and responding 

to natural disasters. AmeriCorps programs are uniquely situated to 

respond to such crises that impact communities across the country 

and the Committee strongly encourages CNCS to expand on these 

efforts. 

Commission Investment Fund [CIF].—The Committee recommendation includes no less than $7,500,000, the same as the fiscal year 2017 level for CIF, which provides funds to State commissions for training and technical assistance activities to expand the 

capacity of current and potential AmeriCorps programs, particularly in underserved areas. 

Fixed Amount Grants.—The Committee encourages CNCS to expand opportunities for AmeriCorps programs to utilize fixed 

amount grants, which could reduce unnecessary administrative 

burdens on current and potential AmeriCorps programs. The Committee encourages CNCS to increase the current maximum cost per 

member service year of fixed amount grants to make it more comparable to cost reimbursement grant levels and allow new 

AmeriCorps programs to be eligible to apply for full-time fixed 

amount grants, while also ensuring that fixed amount grantees 
199 

provide a comparable amount of matching funds and that there is 

sufficient oversight and accountability of fixed amount grantees. 

Professional Corps.—The Committee continues to direct CNCS to 

include a determination of need by the local community among the 

factors that a professional corps program may use to demonstrate 

an inadequate number of professional in a community. Further, the 

Committee strongly encourages CNCS to increase the maximum 

amount of operating funds per member service year a professional 

corps program may request as part of their grant application. The 

Committee continues to direct CNCS to provide professional corps 

programs flexibility in justifying the need for operating funds to ensure that these programs are able to provide high-quality services 

in all communities. 

Reduced Full-Time Service Position.—The Committee includes a 

new general provision to allow CNCS to establish a new 1,200 hour 

service position, including a proportional reduction in the education 

award. This will provide AmeriCorps programs increased flexibility, and more closely align member service positions with the 

needs of local communities. 

National Civilian Community Corps [NCCC] 

The Committee recommendation includes $30,000,000 for NCCC, 

a full-time, team-based residential program for men and women 

ages 18 to 24. Members are assigned to one of five campuses for 

a 10-month service commitment. 

Innovation, Demonstration, and Assistance Activities 

The Committee recommendation includes $5,400,000 for innovation, demonstration, and assistance activities. 

Volunteer Generation Fund.—Within the total, the Committee 

recommendation includes $3,800,000 for the Volunteer Generation 

Fund authorized under section 198P of the SERVE America Act, 

the same as the comparable fiscal year 2017 funding level. 

National Days of Service.—The Committee recommendation includes a total of $1,600,000, an increase of $600,000, for National 

Days of Service to include the September 11 National Day of Service and Remembrance and the Martin Luther King, Jr. National 

Day of Service, to be allocated equally by CNCS to support these 

National Days of Service. 

Evaluation 

The Committee recommendation includes $4,000,000 for CNCS 

evaluation activities. 

State Commission Grants 

The Committee recommendation includes $16,538,000 for State 

Commission Grants. 

PAYMENT TO THE NATIONAL SERVICE TRUST

Appropriations, 2017 ............................................................................. $206,842,000 

Budget estimate, 2018 ........................................................................... ........................... 

Committee recommendation ................................................................. 195,000,000 
200 

The Committee recommends an appropriation of $195,000,000 for 

making payments to the National Service Trust, as requested by 

the administration. 

The National Service Trust makes payments of 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 to 

members who serve in the programs of CNCS. 

The Committee recommendation reflects the estimated funding 

needed for the Trust at overall Committee recommended funding 

levels for CNCS. 

SALARIES AND EXPENSES

Appropriations, 2017 ............................................................................. $81,737,000 

Budget estimate, 2018 ........................................................................... 99,735,000 

Committee recommendation ................................................................. 81,737,000 

The Committee recommends an appropriation of $81,737,000 for 

CNCS salaries and expenses. The salaries and expenses appropriation provides funds for staff salaries, benefits, travel, training, rent, 

equipment, and other operating expenses necessary for management of CNCS programs and activities. 

OFFICE OF INSPECTOR GENERAL

Appropriations, 2017 ............................................................................. $5,750,000 

Budget estimate, 2018 ........................................................................... 3,568,000 

Committee recommendation ................................................................. 5,750,000 

The Committee recommends an appropriation of $5,750,000 for 

the CNCS OIG. The OIG’s goals are to increase organizational efficiency and effectiveness within the Corporation and to prevent 

fraud, waste, and abuse. 

ADMINISTRATIVE PROVISIONS

The Committee recommendation includes the following general 

provisions for CNCS: requiring CNCS to make any significant 

changes to program requirements or policy through rule making 

(section 401); stipulating minimum share requirements (section 

402); requiring that donations supplement and not supplant operations (section 403); aligning requirements regarding the use of 

Education Awards at GI bill-eligible institutions (section 404); allowing the required background check of certain applicants to be 

processed by States under terms of the National Child Protection 

Act (section 405); and allowing CNCS to establish a new 1,200 hour 

member service position (section 406). 

CORPORATION FOR PUBLIC BROADCASTING

Appropriations, 2019 ............................................................................. $445,000,000 

Budget estimate, 2020 ........................................................................... ........................... 

Committee recommendation, 2020 ....................................................... 445,000,000 

The Committee recommends $445,000,000 for the Corporation for 

Public Broadcasting [CPB] as an advance appropriation for fiscal 

year 2020. 

The majority of these funds go directly to local public television 

and radio stations to support their programming. CPB funds also 
201 

support the creation of content for radio, television, and other platforms; system support activities that benefit the entire public 

broadcasting community; and CPB’s administrative costs. 

The Committee recommendation includes an additional 

$20,000,000 in fiscal year 2018 for the replacement and upgrade of 

the public broadcasting interconnection system. 

The Committee supports the Corporation’s move to an annual 

interconnection appropriation from a periodic lump sum request. 

Since fiscal year 1991, Congress has provided the Corporation with 

a separate appropriation for interconnection, recognizing its essential role in providing every American the quality and quantity of 

public media services, including educational, informational and cultural content of national, regional and local interest. 

Technology and distribution systems have greatly evolved since 

Congress established the practice of funding public broadcasting 

interconnection. Recognizing technology’s power in creating further 

cost efficiencies across the public media system, the Committee 

supports CPB in replacing and upgrading the public broadcasting 

interconnection system and further investing in systemwide infrastructure and services that benefit the American people. 

FEDERAL MEDIATION AND CONCILIATION SERVICE

SALARIES AND EXPENSES

Appropriations, 2017 ............................................................................. $46,650,000 

Budget estimate, 2018 ........................................................................... 48,655,000 

Committee recommendation ................................................................. 46,650,000 

The Committee recommends $46,650,000 for the Federal Mediation and Conciliation Service [FMCS]. FMCS provides mediation, 

conciliation, and arbitration services to labor and management organizations to prevent and minimize work stoppages and promote 

stable labor-management relationships. FMCS is also authorized to 

provide dispute resolution consultation and training to all Federal 

agencies. 

Within the total, FMCS may utilize up to $900,000 for labormanagement partnership grants. These grants support innovative 

approaches to collaborative labor-management relationships to resolve potential problems, explore ways to improve productivity, and 

avert serious work stoppages. 

FEDERAL MINE SAFETY AND HEALTH REVIEW COMMISSION

SALARIES AND EXPENSES

Appropriations, 2017 ............................................................................. $17,184,000 

Budget estimate, 2018 ........................................................................... 17,053,000 

Committee recommendation ................................................................. 17,184,000 

The Committee recommends $17,184,000 for the Federal Mine 

Safety and Health Review Commission [FMSHRC], which provides 

administrative trial and appellate review of legal disputes under 

the Federal Mine Safety and Health Act of 1977. Most cases involve civil penalties proposed by MSHA. FMSHRC’s administrative 

law judges [ALJs] decide cases at the trial level and the five-member Commission provides review of the ALJ’s decisions. The Committee directs the Federal Mine Safety and Health Review Com-
202 

mission to continue providing priority to reducing the excessive 

time substantive cases on appeal are awaiting a decision. 

INSTITUTE OF MUSEUM AND LIBRARY SERVICES

OFFICE OF MUSEUM AND LIBRARIES: GRANTS AND ADMINISTRATION

Appropriations, 2017 ............................................................................. $231,000,000 

Budget estimate, 2018 ........................................................................... 23,000,000 

Committee recommendation ................................................................. 235,000,000 

The Committee recommends $235,000,000, an increase of 

$4,000,000, for the Institute of Museum and Library Services 

[IMLS]. This agency supports programs for museums and libraries 

that encourage innovation, provide lifelong learning opportunities, 

promote cultural and civic engagement, and improve access to a variety of services and information. 

Within the total for IMLS, the Committee recommendation includes the amounts below: 

[In thousands of dollars] 

Budget activity Fiscal year 2017 

appropriation 

Fiscal year 2018 

request 

Committee recommendation 

Library Services Technology Act [LSTA]: 

Grants to States ................................................................... 156,103 ............................ 160,103 

Native American Library Services ......................................... 4,063 ............................ 4,063 

National Leadership: Libraries .............................................. 13,406 ............................ 13,406 

Laura Bush 21st Century Librarian ...................................... 10,000 ............................ 10,000 

Subtotal LSTA ............................................................... 183,572 ............................ 187,572 

Museum Services Act: 

Museums for America ........................................................... 21,149 ............................ 21,149 

Native American/Hawaiian Museum Services ...................... 972 ............................ 972 

National Leadership: Museums ............................................ 8,113 ............................ 8,113 

Subtotal, MSA .............................................................. 30,234 ............................ 30,234 

African American History and Culture Act .................................... 1,481 ............................ 1,481 

Administration ................................................................................ 14,000 23,000 14,000 

Research, Analysis and Data Collection ....................................... 1,713 ............................ 1,713 

IMLS Total .................................................................... 231,000 23,000 235,000 

MEDICAID AND CHIP PAYMENT AND ACCESS COMMISSION

SALARIES AND EXPENSES

Appropriations, 2017 ............................................................................. $7,765,000 

Budget estimate, 2018 ........................................................................... 8,700,000 

Committee recommendation ................................................................. 7,765,000 

The Committee recommends $7,765,000 for the Medicaid and 

CHIP Payment and Access Commission [MACPAC]. This commission was established in the Children’s Health Insurance Program 

Reauthorization Act of 2009 and is tasked with reviewing State 

and Federal Medicaid and Children’s Health Insurance Program 

access and payment policies and making recommendations to Congress, the Secretary of HHS, and the States on a wide range of 

issues affecting those programs. The Committee recommendation 

will allow MACPAC to continue to carry out these activities. 
203 

MEDICARE PAYMENT ADVISORY COMMISSION

SALARIES AND EXPENSES

Appropriations, 2017 ............................................................................. $11,925,000 

Budget estimate, 2018 ........................................................................... 12,295,000 

Committee recommendation ................................................................. 11,925,000 

The Committee recommends $11,925,000 for the Medicare Payment Advisory Commission [MedPAC], which provides independent 

policy and technical advice on issues affecting the Medicare program. 

NATIONAL COUNCIL ON DISABILITY

SALARIES AND EXPENSES

Appropriations, 2017 ............................................................................. $3,250,000 

Budget estimate, 2018 ........................................................................... 3,211,000 

Committee recommendation ................................................................. 3,250,000 

The Committee recommends $3,250,000 for the National Council 

on Disability [NCD]. NCD is mandated to make recommendations 

to the President, Congress, the Rehabilitation Services Administration, and the National Institute on Disability and Rehabilitation 

Research on issues of concern to individuals with disabilities. The 

Council gathers information on the implementation, effectiveness, 

and impact of the Americans with Disabilities Act and examines 

emerging policy issues as they affect persons with disabilities and 

their ability to enter or re-enter the Nation’s workforce and to live 

independently. 

NATIONAL LABOR RELATIONS BOARD

SALARIES AND EXPENSES

Appropriations, 2017 ............................................................................. $274,224,000 

Budget estimate, 2018 ........................................................................... 258,000,000 

Committee recommendation ................................................................. 274,224,000 

The Committee recommends $274,224,000 for the National Labor 

Relations Board [NLRB or ‘‘the Board’’], which administers and enforces the National Labor Relations Act and protects employee and 

employer rights provided under that act. 

ADMINISTRATIVE PROVISIONS

The Committee maintains language from the fiscal year 2017 appropriations act restricting the use of electronic voting (section 

407). 

NATIONAL MEDIATION BOARD

SALARIES AND EXPENSES

Appropriations, 2017 ............................................................................. $13,800,000 

Budget estimate, 2018 ........................................................................... 13,205,000 

Committee recommendation ................................................................. 13,800,000 

The Committee recommends $13,800,000 for the National Mediation Board [NMB], which mediates labor-management relations in 

the railroad and airline industries under the Railway Labor Act. 

The NMB mediates collective bargaining disputes, conducts elec-
204 

tions to determine the choice of employee bargaining representatives, and administers arbitration of employee grievances. 

OCCUPATIONAL SAFETY AND HEALTH REVIEW COMMISSION

SALARIES AND EXPENSES

Appropriations, 2017 ............................................................................. $13,225,000 

Budget estimate, 2018 ........................................................................... 12,615,000 

Committee recommendation ................................................................. 13,225,000 

The Committee recommends $13,225,000 for the Occupational 

Safety and Health Review Commission [OSHRC]. OSHRC serves as 

a court to resolve disputes between OSHA and employers charged 

with violations of health and safety standards enforced by OSHA. 

RAILROAD RETIREMENT BOARD

The Railroad Retirement Board [RRB] administers the retirement/survivor and unemployment/sickness insurance benefit programs for railroad workers and their families under the Railroad 

Retirement Act and Railroad Unemployment Insurance Act. 

DUAL BENEFITS PAYMENTS ACCOUNT

Appropriations, 2017 ............................................................................. $25,000,000 

Budget estimate, 2018 ........................................................................... 22,000,000 

Committee recommendation ................................................................. 22,000,000 

The Committee recommends $22,000,000 for the Dual Benefits 

Payments Account. This amount includes an estimated $1,000,000 

derived from income taxes on vested dual benefits. This appropriation provides for vested dual benefit payments to beneficiaries covered under both the railroad retirement and Social Security systems. 

FEDERAL PAYMENTS TO THE RAILROAD RETIREMENT ACCOUNTS

Appropriations, 2017 ............................................................................. $150,000 

Budget estimate, 2018 ........................................................................... 150,000 

Committee recommendation ................................................................. 150,000 

The Committee recommends $150,000 for Federal Payments to 

the Railroad Retirement Account. These funds reimburse the railroad retirement trust funds for interest earned on non-negotiated 

checks. 

LIMITATION ON ADMINISTRATION

Appropriations, 2017 ............................................................................. $113,500,000 

Budget estimate, 2018 ........................................................................... 111,225,000 

Committee recommendation ................................................................. 114,500,000 

The Committee recommends $114,500,000 for RRB’s costs associated with the administration of railroad retirement/survivor and 

unemployment/sickness benefit programs. This account limits the 

amount of funds in the railroad retirement and railroad unemployment insurance trust funds that may be used by the Board for administrative expenses. 

The Committee maintains bill language giving RRB the authority to hire new attorneys in the excepted service. 
205 

LIMITATION ON THE OFFICE OF THE INSPECTOR GENERAL

Appropriations, 2017 ............................................................................. $10,000,000 

Budget estimate, 2018 ........................................................................... 8,437,000 

Committee recommendation ................................................................. 11,000,000 

The Committee recommends $11,000,000 for the RRB OIG. This 

Office conducts audits and investigations to protect the integrity of 

the RRB trust funds and provides comprehensive oversight of all 

RRB operations and programs. 

SOCIAL SECURITY ADMINISTRATION

PAYMENTS TO SOCIAL SECURITY TRUST FUNDS

Appropriations, 2017 ............................................................................. $11,400,000 

Budget estimate, 2018 ........................................................................... 11,400,000 

Committee recommendation ................................................................. 11,400,000 

The Committee recommends $11,400,000 in mandatory funds for 

payments to Social Security trust funds. This account reimburses 

the Old Age and Survivors Insurance [OASI] and Disability Insurance [DI] trust funds for special payments to certain uninsured 

persons, costs incurred administering pension reform activities, and 

the value of the interest for benefit checks issued but not negotiated. This appropriation restores the trust funds to the same financial position they would have been in had they not borne these 

costs and they were properly charged to general revenues. 

SUPPLEMENTAL SECURITY INCOME PROGRAM

Appropriations, 2017 ............................................................................. $43,618,163,000 

Budget estimate, 2018 ........................................................................... 38,556,526,000 

Committee recommendation ................................................................. 38,450,927,000 

The Committee recommends $38,450,927,000 in fiscal year 2018 

mandatory funds for the SSI program. This is in addition to the 

$15,000,000,000 provided in the fiscal year 2017 appropriations act 

for the first quarter of fiscal year 2018. In addition, the Committee 

recommends $19,500,000,000 in advance funding for the first quarter of fiscal year 2019. The SSI program guarantees a minimum 

level of income to individuals who are disabled, blind, or older than 

age 65, and meet certain income and resource limitations. 

Federal Benefit Payments 

The Committee recommendation includes a fiscal year 2018 program level of $48,236,000,000 for Federal benefit payments. This 

will support an average monthly benefit of approximately $569 for 

8,100,000 recipients. 

Beneficiary Services 

The Committee recommendation includes $159,000,000 in new 

mandatory budget authority for beneficiary services. 

These funds reimburse vocational rehabilitation [VR] agencies for 

successfully rehabilitating disabled SSI recipients by helping them 

achieve and sustain productive, self-supporting work activity. 

Funds also support the Ticket to Work program that provides SSI 

recipients with a ticket to offer employment networks [ENs], including VR agencies, in exchange for employment and support serv-
206 

ices. Instead of reimbursing ENs for specific services, the Ticket to 

Work program pays ENs based on recipients achieving certain 

milestones and outcomes. 

Research and Demonstration 

The Committee recommendation includes $101,000,000 in mandatory funds for research and demonstration projects conducted 

under sections 1110, 1115, and 1144 of the Social Security Act. 

These funds support a variety of research and demonstration 

projects designed to improve the disability process, promote selfsufficiency and assist individuals in returning to work, encourage 

savings and retirement planning through financial literacy, and 

generally provide analytical and data resources for use in preparing and reviewing policy proposals. 

Administrative Expenses 

The Committee recommendation includes $4,954,927,000 for SSI 

program administrative expenses. This appropriation funds the SSI 

program’s share of administrative expenses incurred through the 

Limitation on Administrative Expenses [LAE] account. 

LIMITATION ON ADMINISTRATIVE EXPENSES

Appropriations, 2017 ............................................................................. $12,480,945,000 

Budget estimate, 2018 ........................................................................... 12,453,000,000 

Committee recommendation ................................................................. 11,988,945,000 

Due to budget constraints, the Committee recommends $11,988,945,000 for SSA’s LAE account. This account provides resources for SSA to administer the OASI, DI, and SSI programs, 

and to support CMS in administering the Medicare program. The 

LAE account is funded by the Social Security and Medicare trust 

funds for their share of administrative expenses, the general fund 

for the SSI program’s share of administrative expenses, and applicable user fees. These funds support core administrative activities 

including processing retirement and disability claims, conducting 

hearings to review disability determination appeals, issuing Social 

Security numbers and cards, processing individuals’ annual earnings information, and ensuring the integrity of Social Security programs through continuing disability reviews [CDR] and SSI redeterminations of non-medical eligibility. 

The Committee recommendation includes $1,735,000,000 for program integrity activities, including CDRs and SSI redeterminations 

of non-medical eligibility. This includes $273,000,000 in base funding and $1,462,000,000 in cap adjustment funding allowed under 

the Budget Control Act [BCA]. The Committee recommendation is 

a $84,000,000 decrease from the fiscal year 2017 funding level, as 

specified in the BCA. Combined, these activities are estimated to 

save approximately $9,828,000,000 over 10 years for the Social Security, Medicare, and Medicaid programs by preventing waste, 

fraud, abuse, and improper payments. 

The Committee is supportive of efforts to reduce improper payments and improve program integrity in the SSA’s disability and 

Supplemental Security Income benefits programs. As part of the 

Bipartisan Budget Act of 2015, Congress empowered SSA to enter 

into an information exchange with a payroll data provider to pre-
207 

vent improper payments of such benefits. These programs have 

proven to be beneficial in reducing improper payments for other 

Federal and State benefits programs, and the Committee urges 

SSA to prioritize the utilization of these opportunities. 

Within the funds provided to SSA for continuing disability reviews under titles II and XVI of the Social Security Act and conducting redeterminations of eligibility, the Committee encourages 

SSA to utilize all of the tools available to it from commercial and 

non-commercial entities that collect and maintain data regarding 

employment and wages, to ensure that disability and SSI benefits 

are properly paid and to reduce fraud and abuse. The Committee 

requests an update in the fiscal year 2019 CJ on the progress that 

SSA has made in utilizing additional tools to identify improper 

payments, as well as progress it has made in those efforts. 

Disability Insurance.—The Committee recognizes that the purpose of the Ticket to Work and Self-Sufficiency Program [Ticket 

Program] is to provide the assistance disabled beneficiaries need to 

return to work. The Committee is aware that the SSA OIG found 

that employment impacts may have been similar for beneficiaries, 

whether they had participated in the Ticket Program or other employment assistance programs. The Committee directs SSA to submit a report no later than 90 days after the enactment of this act 

determining if the Ticket Program is having the desired measurable results and if it is or is not cost effective to continue the Ticket 

Program. 

Medical Vocational Guidelines.—The Committee is dedicated to 

ensuring that the disabled have access to needed benefits, and 

strongly encourages SSA to work with us to achieve that goal. The 

Committee continues to be concerned that SSA uses outdated rules 

to determine whether or not a claimant meets SSA’s definition of 

disability. The Committee is encouraged by SSA’s indication that 

they are beginning the regulatory process, having already received 

input from the National Disability Forum, the National Institute of 

Medicine, as well as various aging and employment experts. These 

initial steps are well received, as Congress continues to work with 

the Administration to modernize the outdated vocational guidelines 

into a structure that reflects the 21st century labor market. However, SSA officials have indicated to GAO that the complete update 

of the occupational grid is not expected to be completed until 2024, 

and at a cost of $178,000,000. As this is the first significant overhaul of the grid in nearly 40 years, the Committee requests SSA 

to submit, no later than 60 days after the enactment of this act, 

a report on its ongoing efforts to update the grid, including the latest status of the Occupational Information System joint project 

with the Department of Labor. In addition, the report shall include 

a study assessing the feasibility of maintaining a continuous update of the medical vocational guidelines every 10 years. In conjunction with the agency’s release of findings, the Committee directs SSA, in coordination with the U.S. Bureau of Labor Statistics, 

to brief the Committee on the status and progress of the ongoing 

update to the Medical Vocational Guidelines no later than 90 days 

after the enactment of this act. 

Reducing the Hearing Backlog.—The Committee is aware of the 

discord between SSA and the ALJ community regarding the imple-
208 

mentation of part of SSA’s Compassionate and Responsive Service 

[CARES] plan to reduce the significant hearing backlog at the 

agency. Specifically, there is concern regarding the Administration’s hiring of Administrative Appeals Judges for non-disability 

and remanded cases. The Committee recognizes the need for further discussion regarding this matter and encourages SSA to engage with the ALJ community and appropriate stakeholders to find 

innovative solutions to address hearing wait times, keeping in 

mind the goal of reducing the backlog to serve the over 1,100,000 

individuals and their families awaiting a hearing decision. 

Social Security Advisory Board.—The Committee recommendation includes not less than $2,300,000 for the Social Security Advisory Board. This board advises the Commissioner of Social Security 

and makes recommendations to Congress and the President on 

policies relating to the OASI, DI, and SSI programs. 

User Fees.—Within the total for LAE, the Committee recommendation includes up to $119,000,000 for administrative activities funded from user fees. This includes $118,000,000 in fees collected from States that request SSA to administer State SSI supplementary payments and up to $1,000,000 from fees collected from 

non-attorney claimant representatives. 

Work Incentives Planning and Assistance [WIPA] and Protection 

and Advocacy for Beneficiaries of Social Security [PABSS].—The 

Committee recommendation includes $23,000,000 for WIPA and 

$7,000,000 for PABSS, the same as the comparable fiscal year 2017 

levels, respectively. These programs provide valuable services to 

help Social Security disability beneficiaries return to work. 

OFFICE OF INSPECTOR GENERAL

Appropriations, 2017 ............................................................................. $105,500,000 

Budget estimate, 2018 ........................................................................... 105,500,000 

Committee recommendation ................................................................. 105,500,000 

The Committee recommends $105,500,000 for SSA’s OIG. This 

includes $75,500,000 funded from the OASI and DI trust funds for 

those programs’ share of OIG’s expenses and $30,000,000 funded 

from general revenues for the SSI program’s share of expenses. 
(209) 

TITLE V 

GENERAL PROVISIONS 

Section 501. The bill continues a provision authorizing transfers 

of unexpended balances. 

Section 502. The bill continues a provision limiting funding to 1- 

year availability unless otherwise specified. 

Section 503. The bill continues a provision limiting lobbying and 

related activities. 

Section 504. The bill continues a provision limiting official representation expenses. 

Section 505. The bill continues a provision clarifying Federal 

funding as a component of State and local grant funds. 

Sections 506 and 507. The bill continues provisions limiting the 

use of funds for abortion. 

Section 508. The bill continues a provision restricting human embryo research. 

Section 509. The bill continues a provision limiting the use of 

funds for promotion of legalization of controlled substances. 

Section 510. The bill continues a provision prohibiting the use of 

funds to promulgate regulations regarding the individual health 

identifier. 

Section 511. The bill continues a provision limiting the use of 

funds to enter into or review contracts with entities subject to the 

requirement in section 4212(d) of title 38, United States Code, if 

the report required by that section has not been submitted. 

Section 512. The bill continues a provision prohibiting the transfer of funds made available in this act to any department, agency, 

or instrumentality of the U.S. Government, except as otherwise 

provided by this or any other act. 

Section 513. The bill continues a provision prohibiting Federal 

funding in this act for libraries unless they are in compliance with 

the Children’s Internet Protection Act. 

Section 514. The bill continues a provision maintaining a procedure for reprogramming of funds. 

Section 515. The bill continues a provision prohibiting candidates 

for scientific advisory committees from having to disclose their political activities. 

Section 516. The bill continues a provision requiring each department and related agency to submit an operating plan. 

Section 517. The bill continues a provision requiring the Secretaries of Labor, Health and Human Services, and Education to submit a report on the number and amounts of contracts, grants, and 

cooperative agreements awarded by the Departments on a noncompetitive basis. 

Section 518. The bill continues a provision prohibiting SSA from 

processing earnings for work performed under a fraudulent social 
210 

security number if based on a conviction for a violation under section 208(a)(6) or (7) of the Social Security Act. 

Section 519. The bill continues a provision prohibiting SSA from 

establishing a totalization agreement with Mexico. 

Section 520. The bill continues a provision regarding funding for 

programs that carry out distribution of sterile needles or syringes. 

Section 521. The bill continues a provision requiring computer 

networks to block pornography. 

Section 522. The bill continues a provision prohibiting funding 

from going to the Association of Community Organizations for Reform Now [ACORN], or any of its affiliates, subsidiaries, allied organizations, or successors. 

Section 523. The bill continues a provision related to reporting 

requirements for conference spending. 

Section 524. The bill continues a provision related to advertisement costs. 

Section 525. The bill continues a provision on Performance Partnerships. 

Section 526. The bill continues a provision regarding reporting 

status of balances of appropriations. 

Section 527. The bill continues a provision rescinding funds from 

the Independent Payment Advisory Board. 

Section 528. The bill modifies a provision rescinding funds from 

the Children’s Health Insurance Program Performance Bonus 

Fund. 

Section 529. The bill modifies a provision rescinding funds from 

the Children’s Health Insurance Program regarding State allotments. 

Section 530. The bill continues a provision rescinding funds from 

the Children’s Health Insurance Program child enrollment contingency fund. 
(211) 

COMPLIANCE WITH PARAGRAPH 7, RULE XVI, OF THE 

STANDING RULES OF THE SENATE 

Paragraph 7 of rule XVI requires that Committee reports on general appropriations bills identify each Committee amendment to 

the House bill ‘‘which proposes an item of appropriation which is 

not made to carry out the provisions of an existing law, a treaty 

stipulation, or an act or resolution previously passed by the Senate 

during that session.’’ 

The Committee is filing an original bill, which is not covered 

under this rule, but reports this information in the spirit of full disclosure. 

The Committee recommends funding for the following programs 

and activities which currently lack authorization: Institute of Education Sciences; parts C and D of the Individuals with Disabilities 

Education Act; Nurse Education Loan Repayment; Education and 

Training Related to Geriatrics; Mental and Behavioral Health 

Training; Children’s Hospital Graduate Medical Education; Title 

XVII of the PHS Act; Ryan White CARE Act; Universal Newborn 

Hearing Screening; Organ Transplantation; Family Planning; 

Rural Health programs; Traumatic Brain Injury programs; Combating Autism Act; Public Health Improvement Act; Healthy Start; 

Telehealth; Health Professions Education Partnership Act; Children’s Health Act; Women’s Health Research and Prevention 

Amendments of 1998; Birth Defects Prevention, Preventive Health 

Amendments of 1993; Substance Abuse and Mental Health Services programs; Low Income Home Energy Assistance Program; Refugee and Entrant Assistance programs (except for Victims of Trafficking); Head Start; Runaway and Homeless Youth programs; 

Adoption Incentives; Developmental Disabilities programs; Voting 

Access for Individuals with Disabilities; Native American Programs; Community Services Block Grant Act programs; National 

Institutes of Health; Assets for Independence; Alzheimer’s Disease 

Demonstration Grants; Office of Disease Prevention and Health 

Promotion; YouthBuild Transfer Act; Assistive Technology Act; 

Carl D. Perkins Career and Technical Education Improvement Act; 

Corporation for Public Broadcasting; National Council on Disability; Older Americans Act; Second Chance Act; Work Incentive 

Planning and Assistance; and Protection and Advocacy for Beneficiaries of Social Security. 

COMPLIANCE WITH PARAGRAPH 7(C), RULE XXVI OF THE 

STANDING RULES OF THE SENATE 

Pursuant to paragraph 7(c) of rule XXVI, on September 7, 2017, 

the Committee ordered favorably reported an original bill (S. 1771) 

making appropriations for the Departments of Labor, Health and 

Human Services, and Education, and related agencies for the fiscal 

year ending September 30, 2018, and for other purposes, provided, 
212 

that the bill be subject to amendment and that the bill be consistent with its subcommittee funding guidance, and provided that 

the Chairman of the Committee or his designee be authorized to 

offer the substance of the original bill as a Committee amendment 

in the nature of a substitute to the House companion measure, by 

a recorded vote of 29–2, a quorum being present. The vote was as 

follows: 

Yeas Nays 

Chairman Cochran Mr. Lankford 

Mr. McConnell Mr. Daines 

Mr. Shelby 

Mr. Alexander 

Ms. Collins 

Ms. Murkowski 

Mr. Graham 

Mr. Blunt 

Mr. Moran 

Mr. Hoeven 

Mr. Boozman 

Mrs. Capito 

Mr. Kennedy 

Mr. Rubio 

Mr. Leahy 

Mrs. Murray 

Mrs. Feinstein 

Mr. Durbin 

Mr. Reed 

Mr. Tester 

Mr. Udall 

Mrs. Shaheen 

Mr. Merkley 

Mr. Coons 

Mr. Schatz 

Ms. Baldwin 

Mr. Murphy 

Mr. Manchin 

Mr. Van Hollen 

COMPLIANCE WITH PARAGRAPH 12, RULE XXVI OF THE 

STANDING RULES OF THE SENATE 

Paragraph 12 of rule XXVI requires that Committee reports on 

a bill or a joint resolution repealing or amending any statute include ‘‘(a) the text of the statute or part thereof which is proposed 

to be repealed; and (b) a comparative print of that part of the bill 

or joint resolution making the amendment and of the statute or 

part thereof proposed to be amended, showing by stricken through 

type and italics, parallel columns, or other appropriate typographical devices the omissions and insertions which would be 

made by the bill or joint resolution if enacted in the form recommended by the committee.’’ 

In compliance with this rule, changes in existing law proposed to 

be made by the bill are shown as follows: existing law to be omitted 
213 

is enclosed in black brackets; new matter is printed in italic; and 

existing law in which no change is proposed is shown in roman. 

TITLE 20—EDUCATION 

CHAPTER 28—HIGHER EDUCATION RESOURCES AND 

STUDENT ASSISTANCE 

SUBCHAPTER I—GENERAL PROVISIONS 

PART B—ADDITIONAL GENERAL PROVISIONS

§ 1011c. National Advisory Committee on Institutional Quality and Integrity 

(a) Establishment 

* * * * * * * 

(f) Termination 

The Committee shall terminate on September 30, ø2017¿ 2018. 

* * * * * * * 

SUBCHAPTER IV—STUDENT ASSISTANCE 

PART A—GRANTS TO STUDENTS IN ATTENDANCE AT INSTITUTIONS OF

HIGHER EDUCATION

SUBPART 1—FEDERAL PELL GRANTS

§ 1070a. Federal Pell Grants: amount and determinations; 

applications 

(a) Program authority and method of distribution 

* * * * * * * 

(b) Purpose and amount of grants 

(1) * * * 

(7) ADDITIONAL FUNDS.— 

(A) IN GENERAL.—* * * 

(i) * * * 

* * * * * * * 

(iv) to carry out this section— 

(I) * * * 

* * * * * * * 

(VIII) ø$1,382,000,000¿ $1,355,000,000 for fiscal 

year 2018; 

* * * * * * * 

(c) Period of eligibility for grants 

ø(5) The period¿ 

(5) MAXIMUM PERIOD.— 

(A) IN GENERAL.—Except as provided in subparagraph (B), 

the period during which a student may receive Federal Pell 

Grants shall not exceed 12 semesters, or the equivalent of 12 

semesters, as determined by the Secretary by regulation. Such 

regulations shall provide, with respect to a student who re-
214 

ceived a Federal Pell Grant for a term but was enrolled at a 

fraction of full-time, that only that same fraction of such semester or equivalent shall count towards such duration limits. 

(B) EXCEPTION.— 

(i) IN GENERAL.—Any Federal Pell Grant that a student received during a period described in subclause (I) or 

(II) of clause (ii) shall not count towards the student’s duration limits under this paragraph. 

(ii) APPLICABLE PERIODS.—Clause (i) shall apply with 

respect to any Federal Pell Grant awarded to a student to 

attend an institution— 

(I) during a period— 

(aa) for which the student received a loan 

under this title; and 

(bb) for which the loan described in item (aa) 

is forgiven under— 

(AA) section 437(c)(1) or 464(g)(1) due to 

the closing of the institution or false certification; or 

(BB) section 455(h) due to the student’s 

successful assertion of a defense to repayment 

of the loan; or 

(II) during a period for which the student did not 

receive a loan under this title but for which, if the student had received such a loan, the student would have 

qualified for loan forgiveness under subclause (I)(bb). 

* * * * * * * 

PART C—WILLIAM D. FORD FEDERAL DIRECT LOAN PROGRAM

§ 1087h. Funds for administrative expenses 

(a) Program authority and method of distribution 

(1) Mandatory funds for fiscal year 2006 

* * * * * * * 

(4) Continuing mandatory funds for account maintenance 

fees 

For each of the fiscal years 2007 through ø2017¿ 2018, there 

shall be available to the Secretary, from funds not otherwise appropriated, funds to be obligated for account maintenance fees payable 

to guaranty agencies under part B and calculated in accordance 

with subsection (b). 
215 

TITLE 48—TERRITORIES AND INSULAR POSSESSIONS 

CHAPTER 18—MICRONESIA, MARSHALL ISLANDS, AND PALAU

SUBCHAPTER I—MICRONESIA AND MARSHALL ISLANDS 

PART B—APPROVAL AND IMPLEMENTATION OF COMPACTS, AS

AMENDED

§ 1921d. Supplemental provisions 

(a) Domestic program requirements 

* * * * * * * 

(f) Continuing programs and laws 

(1) Federated States of Micronesia and Republic of the 

Marshall Islands 

* * * * * * * 

(A) Emergency and disaster assistance 

* * * * * * * 

(B) Treatment of additional programs 

(i) Consultation 

* * * * * * * 

(ix) Applicability 

The government, institutions, and people of Palau 

shall remain eligible for appropriations and to receive 

grants under the provisions of law specified in clauses (ii) 

and (iii) until the end of fiscal year ø2017¿ 2018, to the extent the government, institutions, and people of Palau 

were so eligible under such provisions in fiscal year 2003. 
216 

BUDGETARY IMPACT OF BILL 

PREPARED IN CONSULTATION WITH THE CONGRESSIONAL BUDGET OFFICE PURSUANT TO SEC. 

308(A), PUBLIC LAW 93–344, AS AMENDED 

[In millions of dollars] 

Budget authority Outlays 

Committee 

guidance 1

Amount 

in bill 

Committee 

guidance 1

Amount 

in bill 

Comparison of amounts in the bill with Committee guidance to 

its subcommittees of amounts for 2018: Subcommittee on 

Labor, HHS, Education, and Related Agencies: 

Mandatory ............................................................................ 778,797 778,797 778,320 2 778,320 

Discretionary ........................................................................ 164,066 165,962 168,951 2 170,527 

Security ....................................................................... .................... .................... NA NA 

Nonsecurity ................................................................. 164,066 165,962 NA NA 

Projections of outlays associated with the recommendation: 

2018 ..................................................................................... .................... .................... .................... 3 849,560 

2019 ..................................................................................... .................... .................... .................... 75,282 

2020 ..................................................................................... .................... .................... .................... 19,834 

2021 ..................................................................................... .................... .................... .................... 3,138 

2022 and future years ........................................................ .................... .................... .................... 836 

Financial assistance to State and local governments for 

2018 ......................................................................................... NA 475,555 NA 3 440,448 

1 There is no section 302(a) allocation to the Committee on Appropriations for fiscal year 2018. 

2 Includes outlays from prior-year budget authority. 

3 Excludes outlays from prior-year budget authority. 

NA: Not applicable. 

NOTE.—Consistent with the funding recommended in the bill for continuing disability reviews and redeterminations and for healthcare fraud and abuse control and in accordance with subparagraphs (B) and (C) of section 251(b)(2) of the BBEDCA of 1985, the Committee an- ticipates that the Budget Committee will provide, at the appropriate time, a 302(a) allocation for the Committee on Appropriations reflecting 

an upward adjustment of $1,896,000,000 in budget authority plus associated outlays. Also, pursuant to sections 1001(b)(3)(B) and 1003(b)(3)(B) of the 21st Century Cures Act (Public Law 114–255), a total of $996,000,000 in budget authority and the resulting outlays do 

not count for the purposes of estimates under the Congressional Budget and Impoundment Control Act of 1974 or the Balanced Budget and Emergency Deficit Control Act of 1985. 
217 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2017 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2018 

[In thousands of dollars] 

Item 2017 appropriation Budget estimate Committee recommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2017 appropriation Budget estimate 

TITLE I—DEPARTMENT OF LABOR 

EMPLOYMENT AND TRAINING ADMINISTRATION 

Training and Employment Services 

Grants to States: 

Adult Training, current year .............................................................................................................................. 103,556 102,370 103,556 ............................ ∂1,186 

Advance from prior year ........................................................................................................................... (712,000 ) (712,000 ) (712,000 ) ............................ ............................Fiscal year 2019 ....................................................................................................................................... 712,000 388,000 712,000 ............................ ∂324,000 

Subtotal ................................................................................................................................................ 815,556 490,370 815,556 ............................ ∂325,186 

Youth Training ................................................................................................................................................... 873,416 523,667 873,416 ............................ ∂349,749 Dislocated Worker Assistance, current year ...................................................................................................... 160,860 160,485 160,860 ............................ ∂375 

Advance from prior year ........................................................................................................................... (860,000 ) (860,000 ) (860,000 ) ............................ ............................Fiscal year 2019 ....................................................................................................................................... 860,000 455,000 860,000 ............................ ∂405,000 

Subtotal ................................................................................................................................................ 1,020,860 615,485 1,020,860 ............................ ∂405,375 Subtotal, Grants to States ................................................................................................................... 2,709,832 1,629,522 2,709,832 ............................ ∂1,080,310 

Current year ..................................................................................................................................... (1,137,832 ) (786,522 ) (1,137,832 ) ............................ (∂351,310 ) Fiscal year 2019 .............................................................................................................................. (1,572,000 ) (843,000 ) (1,572,000 ) ............................ (∂729,000 ) 

National Programs: 

Dislocated Worker Assistance National Reserve: 

Current year .............................................................................................................................................. 20,859 87,000 20,859 ............................ ¥66,141 Advance from prior year ........................................................................................................................... (200,000 ) (200,000 ) (200,000 ) ............................ ............................Fiscal year 2019 ....................................................................................................................................... 200,000 30,000 200,000 ............................ ∂170,000 

Subtotal ................................................................................................................................................ 220,859 117,000 220,859 ............................ ∂103,859 Subtotal, Dislocated Worker Assistance .............................................................................................. 1,241,719 732,485 1,241,719 ............................ ∂509,234 
218 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2017 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2018—Continued 

[In thousands of dollars] 

Item 2017 appropriation Budget estimate Committee recommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2017 appropriation Budget estimate 

Native American programs ................................................................................................................................ 50,000 49,905 50,000 ............................ ∂95 Migrant and Seasonal Farmworker programs ................................................................................................... 81,896 ............................ 81,896 ............................ ∂81,896 YouthBuild activities ......................................................................................................................................... 84,534 84,373 84,534 ............................ ∂161 Technical assistance ......................................................................................................................................... 2,500 5,226 ............................ ¥2,500 ¥5,226 Reintegration of Ex-Offenders ........................................................................................................................... 88,078 77,911 88,078 ............................ ∂10,167 Workforce Data Quality Initiative ...................................................................................................................... 6,000 ............................ 5,000 ¥1,000 ∂5,000 Apprenticeship programs .................................................................................................................................. 95,000 89,829 95,000 ............................ ∂5,171 

Total, National Programs .............................................................................................................................. 628,867 424,244 625,367 ¥3,500 ∂201,123 

Current year ......................................................................................................................................... (428,867 ) (394,244 ) (425,367 ) (¥3,500 ) (∂31,123 ) Fiscal year 2019 .................................................................................................................................. (200,000 ) (30,000 ) (200,000 ) ............................ (∂170,000 ) 

Total, Training and Employment Services [TES] .......................................................................................... 3,338,699 2,053,766 3,335,199 ¥3,500 ∂1,281,433 

Current year ......................................................................................................................................... (1,566,699 ) (1,180,766 ) (1,563,199 ) (¥3,500 ) (∂382,433 ) Fiscal year 2019 .................................................................................................................................. (1,772,000 ) (873,000 ) (1,772,000 ) ............................ (∂899,000 ) 

Job Corps 

Operations .................................................................................................................................................................. 1,587,325 1,341,318 1,587,325 ............................ ∂246,007 Construction, Rehabilitation and Acquisition ............................................................................................................ 84,500 74,857 79,500 ¥5,000 ∂4,643 Administration ............................................................................................................................................................ 32,330 32,269 32,330 ............................ ∂61 

Total, Job Corps ............................................................................................................................................ 1,704,155 1,448,444 1,699,155 ¥5,000 ∂250,711 

Current year ......................................................................................................................................... (1,704,155 ) (1,448,444 ) (1,699,155 ) (¥5,000 ) (∂250,711 ) 

Community Service Employment For Older Americans .............................................................................................. 400,000 ............................ 400,000 ............................ ∂400,000 Federal Unemployment Benefits and Allowances (indefinite) ................................................................................... 849,000 790,000 790,000 ¥59,000 ............................
219 

State Unemployment Insurance and Employment 

Service Operations 

Unemployment Compensation [UI]: 

State Operations ................................................................................................................................................ 2,687,600 2,635,775 2,637,600 ¥50,000 ∂1,825 National Activities ............................................................................................................................................. 14,897 12,000 13,897 ¥1,000 ∂1,897 

Subtotal, Unemployment Compensation ....................................................................................................... 2,702,497 2,647,775 2,651,497 ¥51,000 ∂3,722 

Employment Service [ES]: 

Grants to States: 

Federal Funds ........................................................................................................................................... 21,413 21,372 21,413 ............................ ∂41 Trust Funds .............................................................................................................................................. 650,000 394,516 645,000 ¥5,000 ∂250,484 

Subtotal, Grants to States ................................................................................................................... 671,413 415,888 666,413 ¥5,000 ∂250,525 

ES National Activities ........................................................................................................................................ 19,818 19,780 19,818 ............................ ∂38 

Subtotal, Employment Service ...................................................................................................................... 691,231 435,668 686,231 ¥5,000 ∂250,563 

Federal Funds ...................................................................................................................................... (21,413 ) (21,372 ) (21,413 ) ............................ (∂41 ) Trust Funds .......................................................................................................................................... (669,818 ) (414,296 ) (664,818 ) (¥5,000 ) (∂250,522 ) 

Foreign Labor Certifications and Related Activities: 

Federal Administration ...................................................................................................................................... 48,028 47,937 48,028 ............................ ∂91 Grants to States ................................................................................................................................................ 14,282 14,255 14,282 ............................ ∂27 

Subtotal, Foreign Labor Certification ........................................................................................................... 62,310 62,192 62,310 ............................ ∂118 

One-Stop Career Centers/Labor Market Information .................................................................................................. 67,653 67,524 62,653 ¥5,000 ¥4,871 

Total, State UI and ES .................................................................................................................................. 3,523,691 3,213,159 3,462,691 ¥61,000 ∂249,532 

Federal Funds ...................................................................................................................................... (89,066 ) (88,896 ) (84,066 ) (¥5,000 ) (¥4,830 ) Trust Funds .......................................................................................................................................... (3,434,625 ) (3,124,263 ) (3,378,625 ) (¥56,000 ) (∂254,362 ) 

Program Administration 

Training and Employment .......................................................................................................................................... 62,040 59,960 62,040 ............................ ∂2,080 

Trust Funds ....................................................................................................................................................... 8,639 8,623 8,639 ............................ ∂16 

Employment Security .................................................................................................................................................. 3,440 3,462 3,440 ............................ ¥22 

Trust Funds ....................................................................................................................................................... 39,264 39,189 39,264 ............................ ∂75 

Apprenticeship Services ............................................................................................................................................. 36,160 33,935 36,160 ............................ ∂2,225 Executive Direction ..................................................................................................................................................... 7,034 7,021 7,034 ............................ ∂13 
220 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2017 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2018—Continued 

[In thousands of dollars] 

Item 2017 appropriation Budget estimate Committee recommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2017 appropriation Budget estimate 

Trust Funds ....................................................................................................................................................... 2,079 2,075 2,079 ............................ ∂4 

Total, Program Administration ...................................................................................................................... 158,656 154,265 158,656 ............................ ∂4,391 

Federal Funds ...................................................................................................................................... (108,674 ) (104,378 ) (108,674 ) ............................ (∂4,296 ) Trust Funds .......................................................................................................................................... (49,982 ) (49,887 ) (49,982 ) ............................ (∂95 ) 

Total, Employment and Training Administration .......................................................................................... 9,974,201 7,659,634 9,845,701 ¥128,500 ∂2,186,067 

Federal Funds ...................................................................................................................................... 6,489,594 4,485,484 6,417,094 ¥72,500 ∂1,931,610 

Current year ................................................................................................................................ (4,717,594 ) (3,612,484 ) (4,645,094 ) (¥72,500 ) (∂1,032,610 ) Fiscal year 2019 ......................................................................................................................... (1,772,000 ) (873,000 ) (1,772,000 ) ............................ (∂899,000 ) 

Trust Funds .......................................................................................................................................... 3,484,607 3,174,150 3,428,607 ¥56,000 ∂254,457 

EMPLOYEE BENEFITS SECURITY ADMINISTRATION [EBSA] 

Salaries and Expenses 

Enforcement and Participant Assistance ................................................................................................................... 147,400 ............................ 147,400 ............................ ∂147,400 Policy and Compliance Assistance ............................................................................................................................ 26,901 ............................ 26,901 ............................ ∂26,901 Executive Leadership, Program Oversight and Administration ................................................................................. 6,699 ............................ 6,699 ............................ ∂6,699 Employee benefits security programs ........................................................................................................................ ............................ 183,926 ............................ ............................ ¥183,926 

Total, EBSA ................................................................................................................................................... 181,000 183,926 181,000 ............................ ¥2,926 

PENSION BENEFIT GUARANTY CORPORATION (PBGC) 

Pension Benefit Guaranty Corporation Fund 

Consolidated Administrative budget .......................................................................................................................... (519,506 ) (522,917 ) (424,417 ) (¥95,089 ) (¥98,500 ) WAGE AND HOUR DIVISION, Salaries and Expenses .................................................................................................. 227,500 230,068 227,500 ............................ ¥2,568 OFFICE OF LABOR–MANAGEMENT STANDARDS, Salaries and Expenses .................................................................... 38,187 46,634 40,187 ∂2,000 ¥6,447 OFFICE OF FEDERAL CONTRACT COMPLIANCE PROGRAMS, Salaries and Expenses ................................................. 104,476 88,000 103,476 ¥1,000 ∂15,476 
221 

OFFICE OF WORKERS’ COMPENSATION PROGRAMS 

Salaries and Expenses ............................................................................................................................................... 115,424 113,109 115,424 ............................ ∂2,315 

Trust Funds ....................................................................................................................................................... 2,177 2,173 2,177 ............................ ∂4 

Total, Salaries and Expenses ....................................................................................................................... 117,601 115,282 117,601 ............................ ∂2,319 

Federal Funds ...................................................................................................................................... (115,424 ) (113,109 ) (115,424 ) ............................ (∂2,315 ) Trust Funds .......................................................................................................................................... (2,177 ) (2,173 ) (2,177 ) ............................ (∂4 ) 

Special Benefits 

Federal Employees’ Compensation Benefits .............................................................................................................. 217,000 217,000 217,000 ............................ ............................Longshore and Harbor Workers’ Benefits ................................................................................................................... 3,000 3,000 3,000 ............................ ............................

Total, Special Benefits .................................................................................................................................. 220,000 220,000 220,000 ............................ ............................

Special Benefits for Disabled Coal Miners 

Benefit Payments ....................................................................................................................................................... 75,000 65,000 65,000 ¥10,000 ............................Administration ............................................................................................................................................................ 5,319 5,319 5,319 ............................ ............................

Subtotal, fiscal year 2018 program level .................................................................................................... 80,319 70,319 70,319 ¥10,000 ............................

Less funds advanced in prior year ..................................................................................................... ¥19,000 ¥16,000 ¥16,000 ∂3,000 ............................

Total, Current Year ....................................................................................................................................... 61,319 54,319 54,319 ¥7,000 ............................

New advances, 1st quarter, fiscal year 2019 ..................................................................................... 16,000 15,000 15,000 ¥1,000 ............................

Total, Special Benefits for Disabled Coal Miners ........................................................................................ 77,319 69,319 69,319 ¥8,000 ............................

Energy Employees Occupational Illness 

Compensation Fund 

Administrative Expenses ............................................................................................................................................ 59,846 59,846 59,846 ............................ ............................

Black Lung Disability Trust Fund 

Benefit Payments and Interest on Advances ............................................................................................................. 302,115 345,635 345,635 ∂43,520 ............................Workers’ Compensation Programs, Salaries and Expenses ....................................................................................... 38,246 38,246 38,246 ............................ ............................Departmental Management, Salaries and Expenses ................................................................................................. 31,994 30,595 30,595 ¥1,399 ............................
222 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2017 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2018—Continued 

[In thousands of dollars] 

Item 2017 appropriation Budget estimate Committee recommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2017 appropriation Budget estimate 

Departmental Management, Inspector General ......................................................................................................... 330 330 330 ............................ ............................

Subtotal, Black Lung Disability .................................................................................................................... 372,685 414,806 414,806 ∂42,121 ............................

Treasury Department Administrative Costs ............................................................................................................... 356 356 356 ............................ ............................

Total, Black Lung Disability Trust Fund ....................................................................................................... 373,041 415,162 415,162 ∂42,121 ............................Total, Workers’ Compensation Programs ...................................................................................................... 847,807 879,609 881,928 ∂34,121 ∂2,319 

Federal Funds ...................................................................................................................................... 845,630 877,436 879,751 ∂34,121 ∂2,315 

Current year ................................................................................................................................ (829,630 ) (862,436 ) (864,751 ) (∂35,121 ) (∂2,315 ) Fiscal year 2019 ......................................................................................................................... (16,000 ) (15,000 ) (15,000 ) (¥1,000 ) ............................

Trust Funds .......................................................................................................................................... 2,177 2,173 2,177 ............................ ∂4 

OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION (OSHA) 

Salaries and Expenses 

Safety and Health Standards ..................................................................................................................................... 18,000 18,176 18,000 ............................ ¥176 Federal Enforcement ................................................................................................................................................... 208,000 207,465 208,000 ............................ ∂535 Whistleblower enforcement ......................................................................................................................................... 17,500 17,383 17,500 ............................ ∂117 State Programs ........................................................................................................................................................... 100,850 100,658 100,850 ............................ ∂192 Technical Support ....................................................................................................................................................... 24,469 24,281 24,469 ............................ ∂188 Compliance Assistance: 

Federal Assistance ............................................................................................................................................ 70,981 72,351 70,981 ............................ ¥1,370 State Consultation Grants ................................................................................................................................. 59,500 57,665 59,500 ............................ ∂1,835 Training Grants ................................................................................................................................................. 10,537 ............................ 10,537 ............................ ∂10,537 

Subtotal, Compliance Assistance ................................................................................................................. 141,018 130,016 141,018 ............................ ∂11,002 

Safety and Health Statistics ...................................................................................................................................... 32,900 34,326 32,900 ............................ ¥1,426 
223 

Executive Direction and Administration ..................................................................................................................... 10,050 10,952 10,050 ............................ ¥902 

Total, OSHA ................................................................................................................................................... 552,787 543,257 552,787 ............................ ∂9,530 

MINE SAFETY AND HEALTH ADMINISTRATION 

Salaries and Expenses 

Coal Enforcement ....................................................................................................................................................... 160,000 157,026 160,000 ............................ ∂2,974 Metal/Non-Metal Enforcement .................................................................................................................................... 94,500 97,875 94,500 ............................ ¥3,375 Standards Development ............................................................................................................................................. 4,500 5,460 4,500 ............................ ¥960 Assessments ............................................................................................................................................................... 6,627 7,457 6,627 ............................ ¥830 Educational Policy and Development ......................................................................................................................... 39,320 37,365 39,320 ............................ ∂1,955 Technical Support ....................................................................................................................................................... 35,041 34,330 35,041 ............................ ∂711 Program Evaluation and Information Resources [PEIR] ............................................................................................ 17,990 19,169 17,990 ............................ ¥1,179 Program Administration ............................................................................................................................................. 15,838 16,490 15,838 ............................ ¥652 

Total, Mine Safety and Health Administration ............................................................................................. 373,816 375,172 373,816 ............................ ¥1,356 Total, Worker Protection Agencies ................................................................................................................ 1,595,367 1,582,339 1,596,367 ∂1,000 ∂14,028 

Federal Funds ...................................................................................................................................... (1,593,190 ) (1,580,166 ) (1,594,190 ) (∂1,000 ) (∂14,024 ) Trust Funds .......................................................................................................................................... (2,177 ) (2,173 ) (2,177 ) ............................ (∂4 ) 

BUREAU OF LABOR STATISTICS 

Salaries and Expenses 

Employment and Unemployment Statistics ............................................................................................................... 208,000 203,878 208,000 ............................ ∂4,122 Labor Market Information ........................................................................................................................................... 65,000 64,876 65,000 ............................ ∂124 Prices and Cost of Living .......................................................................................................................................... 207,000 209,863 207,000 ............................ ¥2,863 Compensation and Working Conditions ..................................................................................................................... 83,500 82,880 83,500 ............................ ∂620 Productivity and Technology ....................................................................................................................................... 10,500 10,798 10,500 ............................ ¥298 Executive Direction and Staff Services ...................................................................................................................... 35,000 35,547 35,000 ............................ ¥547 

Total, Bureau of Labor Statistics ................................................................................................................. 609,000 607,842 609,000 ............................ ∂1,158 

Federal Funds ...................................................................................................................................... 544,000 542,966 544,000 ............................ ∂1,034 Trust Funds .......................................................................................................................................... 65,000 64,876 65,000 ............................ ∂124 

OFFICE OF DISABILITY EMPLOYMENT POLICY 

Salaries and Expenses ............................................................................................................................................... 38,203 27,203 38,203 ............................ ∂11,000 
224 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2017 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2018—Continued 

[In thousands of dollars] 

Item 2017 appropriation Budget estimate Committee recommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2017 appropriation Budget estimate 

DEPARTMENTAL MANAGEMENT 

Salaries and Expenses 

Executive Direction ..................................................................................................................................................... 30,250 30,951 30,250 ............................ ¥701 Departmental Program Evaluation ............................................................................................................................. 8,040 8,025 8,040 ............................ ∂15 Legal Services ............................................................................................................................................................ 121,745 126,933 123,745 ∂2,000 ¥3,188 

Trust Funds ....................................................................................................................................................... 308 308 308 ............................ ............................

International Labor Affairs ......................................................................................................................................... 86,125 18,500 86,125 ............................ ∂67,625 Administration and Management ............................................................................................................................... 28,834 23,496 23,534 ¥5,300 ∂38 Adjudication ................................................................................................................................................................ 35,000 31,939 35,000 ............................ ∂3,061 Women’s Bureau ......................................................................................................................................................... 12,530 2,925 12,530 ............................ ∂9,605 Civil Rights Activities ................................................................................................................................................. 6,880 6,867 6,880 ............................ ∂13 Chief Financial Officer ............................................................................................................................................... 5,132 9,914 10,432 ∂5,300 ∂518 

Total, Departmental Management Salaries and expenses ........................................................................... 334,844 259,858 336,844 ∂2,000 ∂76,986 

Federal Funds ...................................................................................................................................... (334,536 ) (259,550 ) (336,536 ) (∂2,000 ) (∂76,986 ) Trust Funds .......................................................................................................................................... (308 ) (308 ) (308 ) ............................ ............................

Veterans Employment and Training 

State Administration, Grants ..................................................................................................................................... 175,000 174,667 175,000 ............................ ∂333 Transition Assistance Program .................................................................................................................................. 14,600 16,073 18,500 ∂3,900 ∂2,427 Federal Administration ............................................................................................................................................... 41,027 40,410 42,127 ∂1,100 ∂1,717 National Veterans’ Employment and Training Services Institute .............................................................................. 3,414 3,408 3,414 ............................ ∂6 Homeless Veterans Programs ..................................................................................................................................... 45,000 45,037 45,000 ............................ ¥37 

Total, Veterans Employment and Training ................................................................................................... 279,041 279,595 284,041 ∂5,000 ∂4,446 

Federal Funds ...................................................................................................................................... 45,000 45,037 45,000 ............................ ¥37 Trust Funds .......................................................................................................................................... 234,041 234,558 239,041 ∂5,000 ∂4,483 
225 

IT Modernization 

Departmental support systems .................................................................................................................................. 4,898 4,889 4,898 ............................ ∂9 Infrastructure technology modernization .................................................................................................................... 13,880 24,833 13,880 ............................ ¥10,953 

Total, IT Modernization ................................................................................................................................. 18,778 29,722 18,778 ............................ ¥10,944 

Office of Inspector General 

Program Activities ...................................................................................................................................................... 82,061 80,487 82,061 ............................ ∂1,574 

Trust Funds ....................................................................................................................................................... 5,660 5,649 5,660 ............................ ∂11 

Total, Office of Inspector General ................................................................................................................ 87,721 86,136 87,721 ............................ ∂1,585 Total, Departmental Management ................................................................................................................ 720,384 655,311 727,384 ∂7,000 ∂72,073 

Federal Funds ...................................................................................................................................... 480,375 414,796 482,375 ∂2,000 ∂67,579 

Current Year ................................................................................................................................ (480,375 ) (414,796 ) (482,375 ) (∂2,000 ) (∂67,579 ) 

Trust Funds .......................................................................................................................................... 240,009 240,515 245,009 ∂5,000 ∂4,494 

Total, Workforce Investment Act Programs .................................................................................................. 5,042,854 3,502,210 5,034,354 ¥8,500 ∂1,532,144 

Current year ......................................................................................................................................... (3,270,854 ) (2,629,210 ) (3,262,354 ) (¥8,500 ) (∂633,144 ) Fiscal year 2019 .................................................................................................................................. (1,772,000 ) (873,000 ) (1,772,000 ) ............................ (∂899,000 ) 

Total, Title I, Department of Labor ............................................................................................................... 13,667,361 11,296,656 13,580,982 ¥86,379 ∂2,284,326 

Federal Funds ...................................................................................................................................... 9,875,568 7,814,942 9,840,189 ¥35,379 ∂2,025,247 

Current year ................................................................................................................................ (8,087,568 ) (6,926,942 ) (8,053,189 ) (¥34,379 ) (∂1,126,247 ) Fiscal year 2019 ......................................................................................................................... (1,788,000 ) (888,000 ) (1,787,000 ) (¥1,000 ) (∂899,000 ) 

Trust Funds .......................................................................................................................................... 3,791,793 3,481,714 3,740,793 ¥51,000 ∂259,079 

TITLE II—DEPARTMENT OF HEALTH AND HUMAN SERVICES 

HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) 

Primary Health Care 

Community Health Centers ........................................................................................................................................ 1,490,522 1,488,587 1,490,522 ............................ ∂1,935 Free Clinics Medical Malpractice ............................................................................................................................... 1,000 100 1,000 ............................ ∂900 

Total, Primary Health Care ........................................................................................................................... 1,491,522 1,488,687 1,491,522 ............................ ∂2,835 
226 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2017 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2018—Continued 

[In thousands of dollars] 

Item 2017 appropriation Budget estimate Committee recommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2017 appropriation Budget estimate 

Health Workforce 

Training for Diversity: 

Centers of Excellence ........................................................................................................................................ 21,711 ............................ 21,711 ............................ ∂21,711 Health Careers Opportunity Program ................................................................................................................ 14,189 ............................ 14,189 ............................ ∂14,189 Faculty Loan Repayment ................................................................................................................................... 1,190 ............................ 1,190 ............................ ∂1,190 Scholarships for Disadvantaged Students ........................................................................................................ 45,970 ............................ 45,970 ............................ ∂45,970 

Total, Training for Diversity .......................................................................................................................... 83,060 ............................ 83,060 ............................ ∂83,060 

Training in Primary Care Medicine ............................................................................................................................ 38,924 ............................ 38,924 ............................ ∂38,924 Oral Health Training ................................................................................................................................................... 36,673 ............................ 36,673 ............................ ∂36,673 Interdisciplinary Community-Based Linkages: 

Area Health Education Centers ......................................................................................................................... 30,250 ............................ 32,750 ∂2,500 ∂32,750 Geriatric Programs ............................................................................................................................................ 38,737 ............................ 38,737 ............................ ∂38,737 Mental and Behavorial Health .......................................................................................................................... 9,916 ............................ 9,916 ............................ ∂9,916 Behavioral Health Workforce Education and Training ...................................................................................... 50,000 ............................ 50,000 ............................ ∂50,000 Screening for treatment for material depression ............................................................................................. ............................ ............................ 5,000 ∂5,000 ∂5,000 

Total, Interdisciplinary Community Linkages ............................................................................................... 128,903 ............................ 136,403 ∂7,500 ∂136,403 

Workforce Information and Analysis .......................................................................................................................... 4,663 4,654 4,663 ............................ ∂9 Public Health and Preventive Medicine programs ..................................................................................................... 17,000 ............................ 17,000 ............................ ∂17,000 Nursing Programs: 

Advanced Education Nursing ............................................................................................................................ 64,581 ............................ 69,581 ∂5,000 ∂69,581 Nurse Education, Practice, and Retention ........................................................................................................ 39,913 ............................ 39,913 ............................ ∂39,913 Nursing Workforce Diversity .............................................................................................................................. 15,343 ............................ 15,343 ............................ ∂15,343 Nursing Corps Scholarship and Loan Repayment Program ............................................................................. 83,135 82,977 83,135 ............................ ∂158 Nursing Workforce Development ........................................................................................................................ ............................ ............................ ............................ ............................ ............................Nursing Faculty Loan Program .......................................................................................................................... 26,500 ............................ 26,500 ............................ ∂26,500 
227 

Total, Nursing programs ............................................................................................................................... 229,472 82,977 234,472 ∂5,000 ∂151,495 

Children’s Hospitals Graduate Medical Education .................................................................................................... 300,000 295,000 305,000 ∂5,000 ∂10,000 National Practitioner Data Bank ................................................................................................................................ 18,814 18,000 18,814 ............................ ∂814 

User Fees ........................................................................................................................................................... ¥18,814 ¥18,000 ¥18,814 ............................ ¥814 

Total, Health Workforce ................................................................................................................................. 838,695 382,631 856,195 ∂17,500 ∂473,564 

Maternal and Child Health 

Maternal and Child Health Block Grant .................................................................................................................... 641,700 666,987 641,700 ............................ ¥25,287 Sickle Cell Anemia Demonstration Program .............................................................................................................. 4,455 ............................ 4,455 ............................ ∂4,455 Autism and Other Developmental Disorders .............................................................................................................. 47,099 ............................ 47,099 ............................ ∂47,099 Heritable Disorders ..................................................................................................................................................... 13,883 ............................ 13,883 ............................ ∂13,883 Healthy Start .............................................................................................................................................................. 103,500 128,303 103,500 ............................ ¥24,803 

Healthy Start Initiative (PL 114–254) .............................................................................................................. 15,000 ............................ ............................ ¥15,000 ............................

Universal Newborn Hearing Screening ....................................................................................................................... 17,818 ............................ 17,818 ............................ ∂17,818 Emergency Medical Services for Children .................................................................................................................. 20,162 ............................ 20,162 ............................ ∂20,162 

Total, Maternal and Child Health ................................................................................................................. 863,617 795,290 848,617 ¥15,000 ∂53,327 

Ryan White HIV/AIDS Program 

Emergency Assistance ................................................................................................................................................ 655,876 654,629 655,876 ............................ ∂1,247 Comprehensive Care Programs .................................................................................................................................. 1,315,005 1,312,505 1,315,005 ............................ ∂2,500 

AIDS Drug Assistance Program [ADAP] (NA) .................................................................................................... (900,313 ) (¥898,602 ) (900,313 ) ............................ (∂1,798,915 ) 

Early Intervention Program ......................................................................................................................................... 201,079 204,689 201,079 ............................ ¥3,610 Children, Youth, Women, and Families ...................................................................................................................... 75,088 75,088 75,088 ............................ ............................AIDS Dental Services .................................................................................................................................................. 13,122 13,097 13,122 ............................ ∂25 Education and Training Centers ................................................................................................................................ 33,611 ............................ 33,611 ............................ ∂33,611 Special Projects of National Significance .................................................................................................................. 25,000 ............................ 25,000 ............................ ∂25,000 

Total, Ryan White HIV/AIDS program ............................................................................................................ 2,318,781 2,260,008 2,318,781 ............................ ∂58,773 

Health Care Systems 

Organ Transplantation ............................................................................................................................................... 23,549 23,504 23,549 ............................ ∂45 National Cord Blood Inventory ................................................................................................................................... 12,266 11,245 12,266 ............................ ∂1,021 CW Bill Young Cell Transplantation program ............................................................................................................ 22,109 22,067 22,109 ............................ ∂42 340B Drug Pricing program/Office of Pharmacy Affairs ........................................................................................... 10,238 10,219 19,238 ∂9,000 ∂9,019 

User Fees ........................................................................................................................................................... ............................ ............................ ¥9,000 ¥9,000 ¥9,000 
228 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2017 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2018—Continued 

[In thousands of dollars] 

Item 2017 appropriation Budget estimate Committee recommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2017 appropriation Budget estimate 

Poison Control ............................................................................................................................................................ 18,846 18,810 19,846 ∂1,000 ∂1,036 National Hansen’s Disease Program .......................................................................................................................... 15,206 11,653 11,653 ¥3,553 ............................Hansen’s Disease Program Buildings and Facilities ................................................................................................. 122 ............................ 122 ............................ ∂122 Payment to Hawaii, Treatment of Hansen’s .............................................................................................................. 1,857 1,853 1,857 ............................ ∂4 

Total, Health Care Systems .......................................................................................................................... 104,193 99,351 101,640 ¥2,553 ∂2,289 

Rural Health 

Rural Outreach Grants ............................................................................................................................................... 65,500 50,811 67,500 ∂2,000 ∂16,689 Rural Health Research/Policy Development ............................................................................................................... 9,351 5,000 9,351 ............................ ∂4,351 Rural Hospital Flexibility Grants ................................................................................................................................ 43,609 ............................ 43,609 ............................ ∂43,609 State Offices of Rural Health .................................................................................................................................... 10,000 ............................ 10,000 ............................ ∂10,000 Black Lung Clinics ..................................................................................................................................................... 7,266 6,753 7,266 ............................ ∂513 Radiation Exposure Screening and Education Program ............................................................................................ 1,834 1,831 1,834 ............................ ∂3 Telehealth ................................................................................................................................................................... 18,500 10,000 21,000 ∂2,500 ∂11,000 

Total, Rural Health ....................................................................................................................................... 156,060 74,395 160,560 ∂4,500 ∂86,165 

Family Planning .......................................................................................................................................................... 286,479 286,479 286,479 ............................ ............................Program Management ................................................................................................................................................ 154,000 151,993 154,000 ............................ ∂2,007 

Vaccine Injury Compensation Program Trust Fund 

Post-fiscal year 1988 Claims .................................................................................................................................... 240,000 268,000 240,000 ............................ ¥28,000 HRSA Administrative expenses ................................................................................................................................... 7,750 9,200 7,750 ............................ ¥1,450 

Total, Vaccine Injury Compensation Trust Fund .......................................................................................... 247,750 277,200 247,750 ............................ ¥29,450 Total, Health Resources and Services Administration ................................................................................. 6,461,097 5,816,034 6,465,544 ∂4,447 ∂649,510 
229 

CENTERS FOR DISEASE CONTROL AND PREVENTION 

Immunization and Respiratory Diseases .................................................................................................................... 455,000 497,228 470,000 ∂15,000 ¥27,228 

Pandemic Flu balances (Public Law 111–32) .................................................................................................. (15,000 ) ............................ ............................ (¥15,000 ) ............................Prevention and Public Health Fund 1 ................................................................................................................ (324,350 ) (203,600 ) (324,350 ) ............................ (∂120,750 ) 

Subtotal ......................................................................................................................................................... (794,350 ) (700,828 ) (794,350 ) ............................ (∂93,522 ) 

HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention ......................................... 1,117,278 934,000 1,117,278 ............................ ∂183,278 Emerging and Zoonotic Infectious Diseases .............................................................................................................. 532,922 377,000 532,922 ............................ ∂155,922 

Prevention and Public Health Fund 1 ................................................................................................................ (52,000 ) (137,000 ) (52,000 ) ............................ (¥85,000 ) 

Subtotal ......................................................................................................................................................... 584,922 514,000 584,922 ............................ ∂70,922 

Chronic Disease Prevention and Health Promotion ................................................................................................... 777,646 452,250 817,596 ∂39,950 ∂365,346 

Prevention and Public Health Fund 1 ................................................................................................................ (337,950 ) (500,000 ) (247,550 ) (¥90,400 ) (¥252,450 ) 

Subtotal ......................................................................................................................................................... 1,115,596 952,250 1,065,146 ¥50,450 ∂112,896 

Birth Defects, Developmental Disabilities, Disabilities and Health .......................................................................... 137,560 100,000 139,560 ∂2,000 ∂39,560 

Prevention and Public Health Fund 1 ................................................................................................................ ............................ ............................ ............................ ............................ ............................

Subtotal ......................................................................................................................................................... 137,560 100,000 139,560 ∂2,000 ∂39,560 

Public Health Scientific Services ............................................................................................................................... 489,397 317,032 489,397 ............................ ∂172,365 

Evaluation Tap Funding .................................................................................................................................... ............................ (142,968 ) ............................ ............................ (¥142,968 ) 

Subtotal ......................................................................................................................................................... (489,397 ) (460,000 ) (489,397 ) ............................ (∂29,397 ) 

Environmental Health ................................................................................................................................................. 163,750 157,000 163,750 ............................ ∂6,750 

Childhood lead poisoning prevention (PL 114–254) ........................................................................................ 35,000 ............................ ............................ ¥35,000 ............................Prevention and Public Health Fund 1 ................................................................................................................ (17,000 ) ............................ (17,000 ) ............................ (∂17,000 ) 

Subtotal ......................................................................................................................................................... 215,750 157,000 180,750 ¥35,000 ∂23,750 

Injury Prevention and Control .................................................................................................................................... 286,059 216,165 291,059 ∂5,000 ∂74,894 National Institute for Occupational Safety and Health ............................................................................................. 335,200 200,000 335,200 ............................ ∂135,200 Energy Employees Occupational Illness Compensation Program .............................................................................. 55,358 55,358 55,358 ............................ ............................Global Health .............................................................................................................................................................. 435,121 350,000 433,621 ¥1,500 ∂83,621 Public Health Preparedness and Response ............................................................................................................... 1,405,000 1,266,000 1,405,000 ............................ ∂139,000 Buildings and Facilities ............................................................................................................................................. 10,000 20,000 10,000 ............................ ¥10,000 

CDC-Wide Activities and Program Support 

Prevention and Public Health Fund 1 ......................................................................................................................... (160,000 ) ............................ (160,000 ) ............................ (∂160,000 ) 
230 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2017 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2018—Continued 

[In thousands of dollars] 

Item 2017 appropriation Budget estimate Committee recommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2017 appropriation Budget estimate 

Office of the Director ................................................................................................................................................. 113,570 105,000 113,570 ............................ ∂8,570 

Subtotal, CDC–Wide Activities ...................................................................................................................... (273,570 ) (105,000 ) (273,570 ) ............................ (∂168,570 ) Total, Centers for Disease Control ............................................................................................................... 6,348,861 5,047,033 6,374,311 ∂25,450 ∂1,327,278 

Discretionary ........................................................................................................................................ 6,293,503 4,991,675 6,318,953 ∂25,450 ∂1,327,278 Evaluation Tap Funding (NA) .............................................................................................................. ............................ (142,968 ) ............................ ............................ (¥142,968 ) Pandemic Flu balances (Public Law 111–32) .................................................................................... (15,000 ) ............................ ............................ (¥15,000 ) ............................Prevention and Public Health Fund 1 .................................................................................................. (891,300 ) (840,600 ) (800,900 ) (¥90,400 ) (¥39,700 ) 

Total, Centers for Disease Control Program Level ....................................................................................... (7,255,161 ) (6,030,601 ) (7,175,211 ) (¥79,950 ) (∂1,144,610 ) 

NATIONAL INSTITUTES OF HEALTH 

National Cancer Institute ........................................................................................................................................... 5,371,926 4,174,222 5,558,270 ∂186,344 ∂1,384,048 

Transfer from NIH Innovation, CURES Act 4 ...................................................................................................... 300,000 300,000 300,000 ............................ ............................

Subtotal, National Cancer Institute .............................................................................................................. 5,671,926 4,474,222 5,858,270 ∂186,344 ∂1,384,048 

National Heart, Lung, and Blood Institute ................................................................................................................ 3,217,081 2,534,803 3,322,774 ∂105,693 ∂787,971 National Institute of Dental and Craniofacial Research ........................................................................................... 425,751 320,749 439,738 ∂13,987 ∂118,989 National Institute of Diabetes and Digestive and Kidney Diseases [NIDDK] ............................................................ 1,874,028 1,449,534 1,935,597 ∂61,569 ∂486,063 

Juvenile Diabetes (mandatory) .......................................................................................................................... (150,000 ) (150,000 ) (150,000 ) ............................ ............................

Subtotal, NIDDK program level ..................................................................................................................... 2,024,028 1,599,534 2,085,597 ∂61,569 ∂486,063 

National Institute of Neurological Disorders and Stroke ........................................................................................... 1,782,582 1,312,998 1,861,666 ∂79,084 ∂548,668 

Transfer from NIH Innovation, CURES Act 4 ...................................................................................................... ............................ 43,000 43,000 ∂43,000 ............................

Subtotal, National Institute of Neurological Disorders and Stroke .............................................................. 1,782,582 1,355,998 1,904,666 ∂122,084 ∂548,668 

National Institute of Allergy and Infectious Diseases ............................................................................................... 4,916,346 3,782,670 5,127,866 ∂211,520 ∂1,345,196 National Institute of General Medical Sciences ........................................................................................................ 1,825,685 1,405,509 1,812,751 ¥12,934 ∂407,242 
231 

Evaluation Tap Funding .................................................................................................................................... (824,443 ) (780,000 ) (1,074,443 ) (∂250,000 ) (∂294,443 ) 

Subtotal, NGMS program level ..................................................................................................................... 2,650,128 2,185,509 2,887,194 ∂237,066 ∂701,685 

Eunice Kennedy Shriver National Institute of Child Health and Human Development ............................................ 1,379,684 1,032,029 1,426,092 ∂46,408 ∂394,063 National Eye Institute ................................................................................................................................................. 732,855 549,847 758,552 ∂25,697 ∂208,705 National Institute of Environmental Health Sciences ................................................................................................ 714,261 533,537 737,727 ∂23,466 ∂204,190 National Institute on Aging ........................................................................................................................................ 2,052,487 1,303,541 2,535,539 ∂483,052 ∂1,231,998 National Institute of Arthritis and Musculoskeletal and Skin Diseases ................................................................... 557,851 417,898 576,178 ∂18,327 ∂158,280 National Institute on Deafness and Other Communication Disorders ...................................................................... 436,875 325,846 451,768 ∂14,893 ∂125,922 National Institute of Nursing Research ..................................................................................................................... 150,273 113,688 155,210 ∂4,937 ∂41,522 National Institute on Alcohol Abuse and Alcoholism ................................................................................................ 483,525 361,356 500,491 ∂16,966 ∂139,135 National Institute on Drug Abuse .............................................................................................................................. 1,073,320 864,998 1,113,442 ∂40,122 ∂248,444 National Institute of Mental Health ........................................................................................................................... 1,608,212 1,201,901 1,681,568 ∂73,356 ∂479,667 

Transfer from NIH Innovation, CURES Act 4 ...................................................................................................... ............................ 43,000 43,000 ∂43,000 ............................

Subtotal, National Institute of Mental Health .............................................................................................. 1,608,212 1,244,901 1,724,568 ∂116,356 ∂479,667 

National Human Genome Research Institute ............................................................................................................. 529,537 399,622 546,934 ∂17,397 ∂147,312 National Institute of Biomedical Imaging and Bioengineering ................................................................................. 357,777 282,614 371,151 ∂13,374 ∂88,537 National Center for Complementary and Integrative Health ..................................................................................... 134,689 101,793 139,654 ∂4,965 ∂37,861 National Institute on Minority Health and Health Disparities ................................................................................... 288,312 214,723 297,784 ∂9,472 ∂83,061 John E. Fogarty International Center ......................................................................................................................... 72,014 ............................ 74,380 ∂2,366 ∂74,380 National Center for Advancing Translational Sciences ............................................................................................. 705,903 557,373 729,094 ∂23,191 ∂171,721 National Library of Medicine (NLM) ........................................................................................................................... 407,510 373,258 420,898 ∂13,388 ∂47,640 National Institute for Research on Safety and Quality 3 ........................................................................................... ............................ 272,000 ............................ ............................ ¥272,000 Office of the Director ................................................................................................................................................. 1,667,610 1,329,833 1,796,970 ∂129,360 ∂467,137 

Common Fund (non-add) .................................................................................................................................. (682,856 ) (441,823 ) (575,290 ) (¥107,566 ) (∂133,467 ) Gabriella Miller Kids First Research Act (Common Fund add) ........................................................................ 12,600 12,600 12,600 ............................ ............................

Buildings and Facilities ............................................................................................................................................. 128,863 98,615 128,863 ............................ ∂30,248 NIH Innovation Account, CURES Act 4 ........................................................................................................................ 52,000 496,000 496,000 ∂444,000 ............................NIH Innovation Account, CURES Act transfers .......................................................................................................... ............................ ¥386,000 ¥386,000 ¥386,000 ............................

Total, National Institutes of Health (NIH) .................................................................................................... 33,259,557 25,823,557 35,009,557 ∂1,750,000 ∂9,186,000 

(Evaluation Tap Funding) .................................................................................................................... (824,443 ) (780,000 ) (1,074,443 ) (∂250,000 ) (∂294,443 ) 

Total, NIH Program Level .............................................................................................................................. (34,084,000 ) (26,603,557 ) (36,084,000 ) (∂2,000,000 ) (∂9,480,443 ) 

SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION (SAMHSA) 

Mental Health 

Programs of Regional and National Significance ..................................................................................................... 386,659 277,419 386,659 ............................ ∂109,240 
232 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2017 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2018—Continued 

[In thousands of dollars] 

Item 2017 appropriation Budget estimate Committee recommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2017 appropriation Budget estimate 

Prevention and Public Health Fund 1 ................................................................................................................ (12,000 ) ............................ (12,000 ) ............................ (∂12,000 ) 

Subtotal ......................................................................................................................................................... 398,659 277,419 398,659 ............................ ∂121,240 

Mental Health block grant ......................................................................................................................................... 541,532 400,000 541,532 ............................ ∂141,532 

Evaluation Tap Funding .................................................................................................................................... (21,039 ) (15,539 ) (21,039 ) ............................ (∂5,500 ) 

Subtotal ......................................................................................................................................................... (562,571 ) (415,539 ) (562,571 ) ............................ (∂147,032 ) 

Children’s Mental Health ........................................................................................................................................... 119,026 118,800 119,026 ............................ ∂226 Grants to States for the Homeless (PATH) ................................................................................................................ 64,635 64,512 64,635 ............................ ∂123 Protection and Advocacy ............................................................................................................................................ 36,146 36,077 36,146 ............................ ∂69 

Subtotal, Mental Health ................................................................................................................................ 1,147,998 896,808 1,147,998 ............................ ∂251,190 

(Evaluation Tap Funding) .................................................................................................................... (21,039 ) (15,539 ) (21,039 ) ............................ (∂5,500 ) 

Subtotal, Mental Health program level ........................................................................................... (1,181,037 ) (912,347 ) (1,181,037 ) ............................ (∂268,690 ) 

Substance Abuse Treatment 

Programs of Regional and National Significance ..................................................................................................... 352,427 339,738 352,427 ............................ ∂12,689 

Evaluation Tap Funding .................................................................................................................................... (2,000 ) (2,000 ) (2,000 ) ............................ ............................

Subtotal ......................................................................................................................................................... (354,427 ) (341,738 ) (354,427 ) ............................ (∂12,689 ) 

Substance Abuse block grant .................................................................................................................................... 1,778,879 1,775,497 1,778,879 ............................ ∂3,382 

Evaluation Tap Funding .................................................................................................................................... (79,200 ) (79,200 ) (79,200 ) ............................ ............................

Subtotal, block grant .................................................................................................................................... (1,858,079 ) (1,854,697 ) (1,858,079 ) ............................ (∂3,382 ) Subtotal, Substance Abuse Treatment ......................................................................................................... 2,131,306 2,115,235 2,131,306 ............................ ∂16,071 

(Evaluation Tap Funding) .................................................................................................................... (81,200 ) (81,200 ) (81,200 ) ............................ ............................Subtotal, Program level ....................................................................................................................... (2,212,506 ) (2,196,435 ) (2,212,506 ) ............................ (∂16,071 ) 
233 

Substance Abuse Prevention 

Programs of Regional and National Significance ..................................................................................................... 223,219 149,703 238,219 ∂15,000 ∂88,516 

Total, Substance Abuse Prevention .............................................................................................................. 223,219 149,703 238,219 ∂15,000 ∂88,516 

Health Surveillance and Program Support ................................................................................................................ 116,830 108,922 114,402 ¥2,428 ∂5,480 

Evaluation Tap Funding (NA) ............................................................................................................................ (31,428 ) (23,426 ) (31,428 ) ............................ (∂8,002 ) 

Subtotal ......................................................................................................................................................... 148,258 132,348 145,830 ¥2,428 ∂13,482 Total, SAMHSA ............................................................................................................................................... 3,619,353 3,270,668 3,631,925 ∂12,572 ∂361,257 

(Evaluation Tap Funding) .................................................................................................................... (133,667 ) (120,165 ) (133,667 ) ............................ (∂13,502 ) (Prevention and Public Health Fund 1 ................................................................................................. (12,000 ) ............................ (12,000 ) ............................ (∂12,000 ) 

Total, SAMHSA Program Level ......................................................................................................... (3,765,020 ) (3,390,833 ) (3,777,592 ) (∂12,572 ) (∂386,759 ) 

AGENCY FOR HEALTHCARE RESEARCH AND QUALITY (AHRQ) 3

Healthcare Research and Quality 

Research on Health Costs, Quality, and Outcomes: 

Federal Funds .................................................................................................................................................... 187,156 ............................ 187,156 ............................ ∂187,156 

Subtotal, Health Costs, Quality, and Outcomes ........................................................................................... (187,156 ) ............................ (187,156 ) ............................ (∂187,156 ) 

Medical Expenditures Panel Surveys: 

Federal Funds .................................................................................................................................................... 66,000 ............................ 66,000 ............................ ∂66,000 

Program Support: 

Federal Funds .................................................................................................................................................... 70,844 ............................ 70,844 ............................ ∂70,844 

Total, AHRQ Program Level 3 ........................................................................................................................ (324,000 ) ............................ (324,000 ) ............................ (∂324,000 ) 

Federal funds 3 ..................................................................................................................................... (324,000 ) ............................ (324,000 ) ............................ (∂324,000 ) 

Total, Public Health Service (PHS) appropriation ........................................................................................ 50,012,868 39,957,292 51,805,337 ∂1,792,469 ∂11,848,045 Total, Public Health Service Program Level ................................................................................................. (51,889,278 ) (41,841,025 ) (53,826,347 ) (∂1,937,069 ) (∂11,985,322 ) 

CENTERS FOR MEDICARE AND MEDICAID SERVICES 

Grants to States for Medicaid 

Medicaid Current Law Benefits .................................................................................................................................. 354,223,901 384,608,394 384,608,394 ∂30,384,493 ............................State and Local Administration ................................................................................................................................. 18,975,984 20,811,084 20,811,084 ∂1,835,100 ............................
234 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2017 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2018—Continued 

[In thousands of dollars] 

Item 2017 appropriation Budget estimate Committee recommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2017 appropriation Budget estimate 

Vaccines for Children ................................................................................................................................................. 4,386,584 4,598,358 4,598,358 ∂211,774 ............................

Subtotal, Medicaid Program Level ................................................................................................................ 377,586,469 410,017,836 410,017,836 ∂32,431,367 ............................

Less funds advanced in prior year ..................................................................................................... ¥115,582,502 ¥125,219,452 ¥125,219,452 ¥9,636,950 ............................

Total, Grants to States for Medicaid ............................................................................................................ 262,003,967 284,798,384 284,798,384 ∂22,794,417 ............................

New advance, 1st quarter, fiscal year 2019 .................................................................................. 125,219,452 134,847,759 134,847,759 ∂9,628,307 ............................

Payments to Health Care Trust Funds 

Supplemental Medical Insurance ............................................................................................................................... 214,944,000 245,396,000 245,396,000 ∂30,452,000 ............................Federal Uninsured Payment ....................................................................................................................................... 147,000 132,000 132,000 ¥15,000 ............................Program Management ................................................................................................................................................ 877,500 1,104,000 1,104,000 ∂226,500 ............................General Revenue for Part D Benefit .......................................................................................................................... 82,512,000 76,133,000 76,133,000 ¥6,379,000 ............................General Revenue for Part D Administration .............................................................................................................. 405,000 422,000 422,000 ∂17,000 ............................HCFAC Reimbursement ............................................................................................................................................... 299,000 307,000 307,000 ∂8,000 ............................State Low-Income Determination for Part D .............................................................................................................. 3,200 3,300 3,300 ∂100 ............................

Total, Payments to Trust Funds, Program Level .......................................................................................... 299,187,700 323,497,300 323,497,300 ∂24,309,600 ............................

Program Management 

Research, Demonstration, Evaluation ........................................................................................................................ 20,054 18,054 20,054 ............................ ∂2,000 Program Operations .................................................................................................................................................... 2,519,823 2,441,274 2,519,823 ............................ ∂78,549 State Survey and Certification ................................................................................................................................... 397,334 406,135 397,334 ............................ ¥8,801 Federal Administration ............................................................................................................................................... 732,533 722,533 732,533 ............................ ∂10,000 

Total, Program management ........................................................................................................................ 3,669,744 3,587,996 3,669,744 ............................ ∂81,748 

Health Care Fraud and Abuse Control Account 

Centers for Medicare and Medicaid Services ............................................................................................................ 486,936 536,145 584,766 ∂97,830 ∂48,621 
235 

HHS Office of Inspector General ................................................................................................................................ 82,132 74,246 84,398 ∂2,266 ∂10,152 Medicaid/CHIP ............................................................................................................................................................ 82,132 74,246 ............................ ¥82,132 ¥74,246 Department of Justice ................................................................................................................................................ 73,800 66,363 75,836 ∂2,036 ∂9,473 

Total, Health Care Fraud and Abuse Control ............................................................................................... 725,000 751,000 745,000 ∂20,000 ¥6,000 Total, Centers for Medicare and Medicaid Services .................................................................................... 690,805,863 747,482,439 747,558,187 ∂56,752,324 ∂75,748 

Federal funds ....................................................................................................................................... 686,411,119 743,143,443 743,143,443 ∂56,732,324 ............................

Current year ................................................................................................................................ (561,191,667 ) (608,295,684 ) (608,295,684 ) (∂47,104,017 ) ............................

New advance, fiscal year 2019 ........................................................................................................... (125,219,452 ) (134,847,759 ) (134,847,759 ) (∂9,628,307 ) ............................Trust Funds .......................................................................................................................................... 4,394,744 4,338,996 4,414,744 ∂20,000 ∂75,748 

ADMINISTRATION FOR CHILDREN AND FAMILIES (ACF) 

Payments to States for Child Support Enforcement and 

Family Support Programs 

Payments to Territories .............................................................................................................................................. 33,000 33,000 33,000 ............................ ............................Repatriation ................................................................................................................................................................ 1,000 1,000 1,000 ............................ ............................

Subtotal ......................................................................................................................................................... 34,000 34,000 34,000 ............................ ............................

Child Support Enforcement: 

State and Local Administration ........................................................................................................................ 3,680,840 3,763,200 3,763,200 ∂82,360 ............................Federal Incentive Payments .............................................................................................................................. 585,791 588,200 588,200 ∂2,409 ............................Access and Visitation ........................................................................................................................................ 10,000 10,000 10,000 ............................ ............................

Subtotal, Child Support Enforcement ........................................................................................................... 4,276,631 4,361,400 4,361,400 ∂84,769 ............................Total, Family Support Payments Program Level ........................................................................................... 4,310,631 4,395,400 4,395,400 ∂84,769 ............................

Less funds advanced in previous years .............................................................................................. ¥1,300,000 ¥1,400,000 ¥1,400,000 ¥100,000 ............................

Total, Family Support Payments, current year ............................................................................................. 3,010,631 2,995,400 2,995,400 ¥15,231 ............................

New advance, 1st quarter, fiscal year 2019 ...................................................................................... 1,400,000 1,400,000 1,400,000 ............................ ............................

Low Income Home Energy Assistance (LIHEAP) 

Formula Grants ........................................................................................................................................................... 3,390,304 ............................ 3,390,304 ............................ ∂3,390,304 

Refugee and Entrant Assistance 

Transitional and Medical Services ............................................................................................................................. 490,000 320,000 320,000 ¥170,000 ............................
236 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2017 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2018—Continued 

[In thousands of dollars] 

Item 2017 appropriation Budget estimate Committee recommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2017 appropriation Budget estimate 

Refugee Support Services .......................................................................................................................................... ............................ 159,321 207,201 ∂207,201 ∂47,880 Victims of Trafficking ................................................................................................................................................. 18,755 18,719 20,755 ∂2,000 ∂2,036 Social Services ........................................................................................................................................................... 155,000 ............................ ............................ ¥155,000 ............................Preventive Health ....................................................................................................................................................... 4,600 ............................ ............................ ¥4,600 ............................Targeted Assistance ................................................................................................................................................... 47,601 ............................ ............................ ¥47,601 ............................Unaccompanied Minors .............................................................................................................................................. 948,000 948,000 948,000 ............................ ............................Victims of Torture ....................................................................................................................................................... 10,735 10,715 10,735 ............................ ∂20 

Total, Refugee and Entrant Assistance ........................................................................................................ 1,674,691 1,456,755 1,506,691 ¥168,000 ∂49,936 

Payments to States for the Child Care and Development Block Grant .................................................................... 2,856,000 2,761,000 2,856,000 ............................ ∂95,000 Social Services Block Grant (Title XX) ....................................................................................................................... 1,700,000 ............................ 1,700,000 ............................ ∂1,700,000 

Total, Social Services Block Grant ............................................................................................................... 1,700,000 ............................ 1,700,000 ............................ ∂1,700,000 

Children and Families Services Programs 

Programs for Children, Youth and Families: 

Head Start, current funded ............................................................................................................................... 9,253,095 9,168,095 9,253,095 ............................ ∂85,000 Preschool Development Grants .......................................................................................................................... 250,000 ............................ 250,000 ............................ ∂250,000 Consolidated Runaway, Homeless Youth Program ........................................................................................... 101,980 101,786 101,980 ............................ ∂194 Prevention Grants to Reduce Abuse of Runaway Youth ................................................................................... 17,141 17,108 17,141 ............................ ∂33 Child Abuse State Grants ................................................................................................................................. 25,310 25,262 25,310 ............................ ∂48 Child Abuse Discretionary Activities ................................................................................................................. 33,000 32,937 33,000 ............................ ∂63 Community Based Child Abuse Prevention ....................................................................................................... 39,764 39,688 39,764 ............................ ∂76 Child Welfare Services ...................................................................................................................................... 268,735 268,224 268,735 ............................ ∂511 Child Welfare Training, Research, or Demonstration projects ......................................................................... 17,984 17,950 17,984 ............................ ∂34 Adoption Opportunities ...................................................................................................................................... 39,100 30,072 39,100 ............................ ∂9,028 Adoption Incentive grants ................................................................................................................................. 37,943 37,871 37,943 ............................ ∂72 

Social Services and Income Maintenance Research ................................................................................................. 6,512 6,500 6,512 ............................ ∂12 Native American Programs ......................................................................................................................................... 52,050 49,905 52,050 ............................ ∂2,145 
237 

Community Services: 

Community Services Block Grant Act programs: 

Grants to States for Community Services ............................................................................................... 715,000 ............................ 700,000 ¥15,000 ∂700,000 Economic Development ............................................................................................................................. 19,883 ............................ 19,883 ............................ ∂19,883 Rural Community Facilities ...................................................................................................................... 7,500 ............................ 7,500 ............................ ∂7,500 

Subtotal ................................................................................................................................................ 742,383 ............................ 727,383 ¥15,000 ∂727,383 Subtotal, Community Services ............................................................................................................. 742,383 ............................ 727,383 ¥15,000 ∂727,383 

Domestic Violence Hotline .......................................................................................................................................... 8,250 8,250 8,250 ............................ ............................Family Violence/Battered Women’s Shelters .............................................................................................................. 151,000 151,000 156,000 ∂5,000 ∂5,000 Chafee Education and Training Vouchers ................................................................................................................. 43,257 43,175 43,257 ............................ ∂82 Disaster Human Services Case Management ............................................................................................................ 1,864 1,860 1,864 ............................ ∂4 Program Direction ....................................................................................................................................................... 205,000 204,610 205,000 ............................ ∂390 

Total, Children and Families Services Programs ......................................................................................... 11,294,368 10,204,293 11,284,368 ¥10,000 ∂1,080,075 

Promoting Safe and Stable Families ......................................................................................................................... 325,000 345,000 325,000 ............................ ¥20,000 

Discretionary Funds ........................................................................................................................................... 59,765 59,651 59,765 ............................ ∂114 

Total, Promoting Safe and Stable Families ................................................................................................. 384,765 404,651 384,765 ............................ ¥19,886 

Payments for Foster Care and Permanency 

Foster Care ................................................................................................................................................................. 4,992,000 5,537,000 5,537,000 ∂545,000 ............................Adoption Assistance ................................................................................................................................................... 2,780,000 2,867,000 2,867,000 ∂87,000 ............................Guardianship .............................................................................................................................................................. 152,000 181,000 181,000 ∂29,000 ............................Independent Living ..................................................................................................................................................... 140,000 140,000 140,000 ............................ ............................

Total, Payments to States ............................................................................................................................ 8,064,000 8,725,000 8,725,000 ∂661,000 ............................

Less Advances from Prior Year ........................................................................................................... ¥2,300,000 ¥2,500,000 ¥2,500,000 ¥200,000 ............................

Total, payments, current year ....................................................................................................................... 5,764,000 6,225,000 6,225,000 ∂461,000 ............................

New Advance, 1st quarter, fiscal year 2019 ...................................................................................... 2,500,000 2,700,000 2,700,000 ∂200,000 ............................

Total, ACF ...................................................................................................................................................... 33,974,759 28,147,099 34,442,528 ∂467,769 ∂6,295,429 

Current year ......................................................................................................................................... (30,074,759 ) (24,047,099 ) (30,342,528 ) (∂267,769 ) (∂6,295,429 ) Fiscal year 2019 .................................................................................................................................. (3,900,000 ) (4,100,000 ) (4,100,000 ) (∂200,000 ) ............................

Total, ACF Program Level ............................................................................................................................. 33,974,759 28,147,099 34,442,528 ∂467,769 ∂6,295,429 
238 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2017 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2018—Continued 

[In thousands of dollars] 

Item 2017 appropriation Budget estimate Committee recommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2017 appropriation Budget estimate 

ADMINISTRATION FOR COMMUNITY LIVING 

Aging and Disability Services Programs 

Grants to States: 

Home and Community-based Supportive Services ........................................................................................... 350,224 347,063 350,224 ............................ ∂3,161 Preventive Health .............................................................................................................................................. 19,848 19,810 19,848 ............................ ∂38 Protection of Vulnerable Older Americans-Title VII .......................................................................................... 20,658 20,619 20,658 ............................ ∂39 

Subtotal ......................................................................................................................................................... 390,730 387,492 390,730 ............................ ∂3,238 

Family Caregivers .............................................................................................................................................. 150,586 150,300 150,586 ............................ ∂286 Native American Caregivers Support ................................................................................................................ 7,556 7,517 7,556 ............................ ∂39 

Subtotal, Caregivers ..................................................................................................................................... 158,142 157,817 158,142 ............................ ∂325 

Nutrition: 

Congregate Meals ..................................................................................................................................... 450,342 447,490 450,342 ............................ ∂2,852 Home Delivered Meals .............................................................................................................................. 227,342 225,912 227,342 ............................ ∂1,430 Nutrition Services Incentive Program ....................................................................................................... 160,069 159,765 160,069 ............................ ∂304 

Subtotal ................................................................................................................................................ 837,753 833,167 837,753 ............................ ∂4,586 Subtotal, Grants to States ................................................................................................................... 1,386,625 1,378,476 1,386,625 ............................ ∂8,149 

Grants for Native Americans ...................................................................................................................................... 31,208 31,099 31,208 ............................ ∂109 Aging Network Support Activities ............................................................................................................................... 9,961 9,942 9,961 ............................ ∂19 Alzheimer’s Disease Demonstrations ......................................................................................................................... 4,800 19,490 4,800 ............................ ¥14,690 

Prevention and Public Health Fund 1 ................................................................................................................ (14,700 ) ............................ (14,700 ) ............................ (∂14,700 ) 

Lifespan Respite Care ................................................................................................................................................ 3,360 3,354 3,360 ............................ ∂6 Chronic Disease Self-Management Program ............................................................................................................. ............................ 5,000 ............................ ............................ ¥5,000 

Prevention and Public Health Fund 1 ................................................................................................................ (8,000 ) ............................ (8,000 ) ............................ (∂8,000 ) 

Elder Falls Prevention ................................................................................................................................................ ............................ 5,000 ............................ ............................ ¥5,000 

Prevention and Public Health Fund 1 ................................................................................................................ (5,000 ) ............................ (5,000 ) ............................ (∂5,000 ) 
239 

Elder Rights Support Activities .................................................................................................................................. 13,874 11,851 13,874 ............................ ∂2,023 Aging and Disability Resources ................................................................................................................................. 6,119 6,107 6,119 ............................ ∂12 Senior Community Service Employment Program ...................................................................................................... ............................ ............................ ............................ ............................ ............................State Health Insurance Program ................................................................................................................................ 47,115 ............................ 47,115 ............................ ∂47,115 Paralysis Resource Center .......................................................................................................................................... 6,700 ............................ 6,700 ............................ ∂6,700 Limb loss .................................................................................................................................................................... 2,500 ............................ 2,500 ............................ ∂2,500 Traumatic Brain Injury ............................................................................................................................................... 9,321 3,162 9,321 ............................ ∂6,159 Developmental Disabilities Programs: 

Partnerships for Innovation, Inclusion, and Independence .............................................................................. ............................ 45,000 ............................ ............................ ¥45,000 State Councils ................................................................................................................................................... 73,000 ............................ 73,000 ............................ ∂73,000 Protection and Advocacy ................................................................................................................................... 38,734 38,660 38,734 ............................ ∂74 Voting Access for Individuals with Disabilities ................................................................................................ 4,963 4,954 4,963 ............................ ∂9 Developmental Disabilities Projects of National Significance .......................................................................... 10,000 7,600 10,000 ............................ ∂2,400 University Centers for Excellence in Developmental Disabilities ..................................................................... 38,619 38,546 38,619 ............................ ∂73 

Subtotal, Developmental Disabilities Programs ........................................................................................... 165,316 134,760 165,316 ............................ ∂30,556 

Workforce Innovation and Opportunity Act Independent Living ................................................................................ 101,183 78,156 101,183 ............................ ∂23,027 

National Institute on Disability, Independent Living, and Rehabilitation Research ........................................ 103,970 95,127 103,970 ............................ ∂8,843 Assistive Technology .......................................................................................................................................... 34,000 31,939 34,000 ............................ ∂2,061 

Subtotal, Workforce Innovation and Opportunity Act ................................................................................... 239,153 205,222 239,153 ............................ ∂33,931 

Program Administration ............................................................................................................................................. 40,063 37,987 40,063 ............................ ∂2,076 

Total, Administration for Community Living (ACL) ...................................................................................... 1,966,115 1,851,450 1,966,115 ............................ ∂114,665 

Federal funds ....................................................................................................................................... (1,919,000 ) (1,851,450 ) (1,919,000 ) ............................ (∂67,550 ) Trust Funds .......................................................................................................................................... (47,115 ) ............................ (47,115 ) ............................ (∂47,115 ) (Prevention and Public Health Fund 1 ................................................................................................. (27,700 ) ............................ (27,700 ) ............................ (∂27,700 ) 

Total, ACL program level .............................................................................................................................. 1,993,815 1,851,450 1,993,815 ............................ ∂142,365 

OFFICE OF THE SECRETARY 

General Departmental Management 

General Departmental Management, Federal Funds ................................................................................................. 199,620 203,500 199,620 ............................ ¥3,880 

Teen Pregnancy Prevention Community Grants ................................................................................................ 101,000 ............................ 101,000 ............................ ∂101,000 Evaluation Tap Funding .................................................................................................................................... (6,800 ) ............................ (6,800 ) ............................ (∂6,800 ) 

Subtotal, Grants ............................................................................................................................................ (107,800 ) ............................ (107,800 ) ............................ (∂107,800 ) 

Faith-Based Center .................................................................................................................................................... 1,299 1,299 1,299 ............................ ............................
240 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2017 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2018—Continued 

[In thousands of dollars] 

Item 2017 appropriation Budget estimate Committee recommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2017 appropriation Budget estimate 

Sexual Risk Avoidance ............................................................................................................................................... 15,000 10,000 25,000 ∂10,000 ∂15,000 Minority Health ........................................................................................................................................................... 56,670 56,562 56,670 ............................ ∂108 Office of Women’s Health .......................................................................................................................................... 32,140 32,140 32,140 ............................ ............................Minority HIV/AIDS prevention and treatment ............................................................................................................. 53,900 ............................ 53,900 ............................ ∂53,900 Embryo Adoption Awareness Campaign ..................................................................................................................... 1,000 1,000 1,000 ............................ ............................Planning and Evaluation, Evaluation Tap Funding ................................................................................................... (58,028 ) (57,465 ) (58,028 ) ............................ (∂563 ) 

Subtotal, General Departmental Management ............................................................................................. 460,629 304,501 470,629 ∂10,000 ∂166,128 Total, General Departmental Management ................................................................................................... 460,629 304,501 470,629 ∂10,000 ∂166,128 

Federal Funds ...................................................................................................................................... (460,629 ) (304,501 ) (470,629 ) (∂10,000 ) (∂166,128 ) (Evaluation Tap Funding) .................................................................................................................... (64,828 ) (57,465 ) (64,828 ) ............................ (∂7,363 ) 

Total, General Departmental Management Program .................................................................................... 525,457 361,966 535,457 ∂10,000 ∂173,491 

Office of Medicare Hearings and Appeals ................................................................................................................. 107,381 117,177 107,381 ............................ ¥9,796 Office of the National Coordinator for Health Information Technology ..................................................................... 60,367 38,381 60,367 ............................ ∂21,986 

Office of Inspector General 

Inspector General Federal Funds ............................................................................................................................... 80,000 68,085 80,000 ............................ ∂11,915 

HCFAC funding (NA) .......................................................................................................................................... (334,097 ) ............................ (334,097 ) ............................ (∂334,097 ) 

Total, Inspector General Program Level ....................................................................................................... (414,097 ) (68,085 ) (414,097 ) ............................ (∂346,012 ) 

Office for Civil Rights 

Federal Funds ............................................................................................................................................................. 38,798 32,530 38,798 ............................ ∂6,268 

Retirement Pay and Medical Benefits for Commissioned Officers 

Retirement Payments ................................................................................................................................................. 457,459 456,266 456,266 ¥1,193 ............................Survivors Benefits ...................................................................................................................................................... 31,559 31,583 31,583 ∂24 ............................
241 

Dependents’ Medical Care ......................................................................................................................................... 141,390 130,840 130,840 ¥10,550 ............................

Total, Medical Benefits for Commissioned Officers ..................................................................................... 630,408 618,689 618,689 ¥11,719 ............................

Public Health and Social Services Emergency Fund (PHSSEF) 

Assistant Secretary for Preparedness and Response 

Operations .................................................................................................................................................................. 30,938 30,879 30,938 ............................ ∂59 Preparedness and Emergency Operations .................................................................................................................. 24,654 24,607 24,654 ............................ ∂47 National Disaster Medical System ............................................................................................................................. 49,904 49,809 49,904 ............................ ∂95 Hospital Preparedness Cooperative Agreement Grants: 

Formula Grants .................................................................................................................................................. 254,555 227,201 254,555 ............................ ∂27,354 

Biomedical Advanced Research and Development Authority (BARDA) ...................................................................... 511,700 511,700 511,700 ............................ ............................Policy and Planning ................................................................................................................................................... 14,877 14,849 14,877 ............................ ∂28 Project BioShield ........................................................................................................................................................ 510,000 510,000 510,000 ............................ ............................

Subtotal, Preparedness and Response ......................................................................................................... 1,396,628 1,369,045 1,396,628 ............................ ∂27,583 

Assistant Secretary for Administration 

Assistant Secretary for Administration, Cybersecurity ............................................................................................... 50,860 73,263 50,860 ............................ ¥22,403 Office of Security and Strategic Information ............................................................................................................. 7,470 7,456 7,470 ............................ ∂14 

Public Health and Science 

Medical Reserve Corps ............................................................................................................................................... 6,000 5,989 6,000 ............................ ∂11 Pandemic Influenza Preparedness ............................................................................................................................. 57,000 206,863 92,000 ∂35,000 ¥114,863 

Pandemic Flu balances (Public Law 111–32) .................................................................................................. (15,000 ) ............................ ............................ (¥15,000 ) ............................

Subtotal, Pandemic Influenza Preparedness ................................................................................................ 72,000 206,863 92,000 ∂20,000 ¥114,863 Subtotal, Non-pandemic flu/BioShield/Parklawn/Other construction ........................................................... 950,958 945,753 950,958 ............................ ∂5,205 Total, PHSSEF ................................................................................................................................................ 1,517,958 1,662,616 1,552,958 ∂35,000 ¥109,658 Total, PHSSEF Program level ........................................................................................................................ 1,532,958 1,662,616 1,552,958 ∂20,000 ¥109,658 

Account for the State Response to the Opioid Abuse Crisis, CURES Act 2 .............................................................. 500,000 500,000 500,000 ............................ ............................

Total, Office of the Secretary ....................................................................................................................... 3,395,541 3,341,979 3,428,822 ∂33,281 ∂86,843 

Federal Funds ...................................................................................................................................... 3,288,160 3,224,802 3,321,441 ∂33,281 ∂96,639 Trust Funds .......................................................................................................................................... 107,381 117,177 107,381 ............................ ¥9,796 (Evaluation Tap Funding) .................................................................................................................... (64,828 ) (57,465 ) (64,828 ) ............................ (∂7,363 ) 
242 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2017 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2018—Continued 

[In thousands of dollars] 

Item 2017 appropriation Budget estimate Committee recommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2017 appropriation Budget estimate 

Total, Office of the Secretary Program Level ............................................................................................... 3,475,369 3,399,444 3,493,650 ∂18,281 ∂94,206 Total, Title II, Health and Human Services .................................................................................................. 780,155,146 820,780,259 839,200,989 ∂59,045,843 ∂18,420,730 

Federal Funds ...................................................................................................................................... 775,598,156 816,314,886 834,623,999 ∂59,025,843 ∂18,309,113 

Current year ................................................................................................................................ (646,478,704 ) (677,367,127 ) (695,676,240 ) (∂49,197,536 ) (∂18,309,113 ) Fiscal year 2019 ......................................................................................................................... (129,119,452 ) (138,947,759 ) (138,947,759 ) (∂9,828,307 ) ............................

Trust Funds .......................................................................................................................................... 4,556,990 4,465,373 4,576,990 ∂20,000 ∂111,617 

Total, Pandemic Flu balances (Public Law 111–32) ................................................................................... (30,000 ) ............................ ............................ (¥30,000 ) ............................Total, Prevention and Public Health Fund 1 ................................................................................................. (931,000 ) (840,600 ) (840,600 ) (¥90,400 ) ............................

TITLE III—DEPARTMENT OF EDUCATION 

EDUCATION FOR THE DISADVANTAGED 

Grants to Local Educational Agencies (LEAs) Basic Grants: 

Advance from prior year .................................................................................................................................... (2,390,776 ) (1,840,776 ) (1,840,776 ) (¥550,000 ) ............................Forward funded ................................................................................................................................................. 4,613,625 2,733,460 4,639,033 ∂25,408 ∂1,905,573 Current funded .................................................................................................................................................. 5,000 466,100 5,000 ............................ ¥461,100 

Subtotal, Basic grants current year approp ................................................................................................ 4,618,625 3,199,560 4,644,033 ∂25,408 ∂1,444,473 Subtotal, Basic grants total funds available .............................................................................................. (7,009,401 ) (5,040,336 ) (6,484,809 ) (¥524,592 ) (∂1,444,473 ) 

Basic Grants fiscal year 2019 Advance ........................................................................................................... 1,840,776 3,231,497 1,815,368 ¥25,408 ¥1,416,129 

Subtotal, Basic grants, program level ......................................................................................................... 6,459,401 6,431,057 6,459,401 ............................ ∂28,344 

Concentration Grants: 

Advance from prior year ........................................................................................................................... (1,362,301 ) (1,362,301 ) (1,362,301 ) ............................ ............................Fiscal year 2019 Advance ........................................................................................................................ 1,362,301 1,362,301 1,362,301 ............................ ............................

Subtotal ................................................................................................................................................ 1,362,301 1,362,301 1,362,301 ............................ ............................

Targeted Grants: 

Advance from prior year ........................................................................................................................... (3,544,050 ) (3,819,050 ) (3,819,050 ) (∂275,000 ) ............................
243 

Fiscal year 2019 Advance ........................................................................................................................ 3,819,050 3,544,050 3,831,754 ∂12,704 ∂287,704 

Subtotal ................................................................................................................................................ 3,819,050 3,544,050 3,831,754 ∂12,704 ∂287,704 

Education Finance Incentive Grants: 

Advance from prior year ........................................................................................................................... (3,544,050 ) (3,819,050 ) (3,819,050 ) (∂275,000 ) ............................Fiscal year 2019 Advance ........................................................................................................................ 3,819,050 3,544,050 3,831,754 ∂12,704 ∂287,704 

Subtotal ................................................................................................................................................ 3,819,050 3,544,050 3,831,754 ∂12,704 ∂287,704 

Subtotal, Grants to LEAs, program level ...................................................................................................... 15,459,802 15,881,458 15,485,210 ∂25,408 ¥396,248 

FOCUS Grants (ESIA–I–E) ................................................................................................................................. ............................ 1,000,000 ............................ ............................ ¥1,000,000 

Innovative Approaches to Literacy ............................................................................................................................. 27,000 ............................ 27,000 ............................ ∂27,000 Comprehensive literacy development grants ............................................................................................................. 190,000 ............................ 190,000 ............................ ∂190,000 State Agency Programs: 

Migrant .............................................................................................................................................................. 374,751 374,039 374,751 ............................ ∂712 Neglected and Delinquent/High Risk Youth ...................................................................................................... 47,614 47,523 47,614 ............................ ∂91 

Subtotal, State Agency programs ................................................................................................................. 422,365 421,562 422,365 ............................ ∂803 

Migrant Education: 

High School Equivalency Program ................................................................................................................... 44,623 44,538 44,623 ............................ ∂85 

Total, Education for the disadvantaged ....................................................................................................... 16,143,790 16,347,558 16,169,198 ∂25,408 ¥178,360 

Current year ......................................................................................................................................... (5,302,613 ) (4,665,660 ) (5,328,021 ) (∂25,408 ) (∂662,361 ) Fiscal year 2019 .................................................................................................................................. (10,841,177 ) (11,681,898 ) (10,841,177 ) ............................ (¥840,721 ) 

Total, Forward Funded .................................................................................................................................. (5,225,990 ) (3,155,022 ) (5,251,398 ) (∂25,408 ) (∂2,096,376 ) 

IMPACT AID 

Basic Support Payments ............................................................................................................................................ 1,189,233 1,166,012 1,200,242 ∂11,009 ∂34,230 Payments for Children with Disabilities .................................................................................................................... 48,316 48,224 48,316 ............................ ∂92 Facilities Maintenance (Sec. 8008) ........................................................................................................................... 4,835 4,826 4,835 ............................ ∂9 Construction (Sec. 8007) ........................................................................................................................................... 17,406 17,373 17,406 ............................ ∂33 Payments for Federal Property (Sec. 8002) ............................................................................................................... 68,813 ............................ 69,313 ∂500 ∂69,313 

Total, Impact aid .......................................................................................................................................... 1,328,603 1,236,435 1,340,112 ∂11,509 ∂103,677 

SCHOOL IMPROVEMENT PROGRAMS 

Supporting Effective Instruction State Grants ........................................................................................................... 374,389 ............................ 374,389 ............................ ∂374,389 
244 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2017 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2018—Continued 

[In thousands of dollars] 

Item 2017 appropriation Budget estimate Committee recommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2017 appropriation Budget estimate 

Advance from prior year .................................................................................................................................... (1,681,441 ) (1,681,441 ) (1,681,441 ) ............................ ............................Fiscal year 2019 ................................................................................................................................................ 1,681,441 ............................ 1,681,441 ............................ ∂1,681,441 

Subtotal, Supporting Effective Instruction State Grants, program level ..................................................... 2,055,830 ............................ 2,055,830 ............................ ∂2,055,830 

Supplemental Education Grants ................................................................................................................................ 16,699 16,667 16,699 ............................ ∂32 21st Century Community Learning Centers ............................................................................................................... 1,191,673 ............................ 1,191,673 ............................ ∂1,191,673 State Assessments ..................................................................................................................................................... 369,100 377,281 369,100 ............................ ¥8,181 Education for Homeless Children and Youth ............................................................................................................. 77,000 69,867 77,000 ............................ ∂7,133 Training and Advisory Services (Civil Rights) ........................................................................................................... 6,575 6,563 6,575 ............................ ∂12 Education for Native Hawaiians ................................................................................................................................ 33,397 ............................ 33,397 ............................ ∂33,397 Alaska Native Education Equity ................................................................................................................................. 32,453 ............................ 32,453 ............................ ∂32,453 Rural Education .......................................................................................................................................................... 175,840 175,506 175,840 ............................ ∂334 Comprehensive Centers .............................................................................................................................................. 50,000 51,347 50,000 ............................ ¥1,347 Student Support and Academic Enrichment grants .................................................................................................. 400,000 ............................ 450,000 ∂50,000 ∂450,000 

Total, School Improvement Programs ........................................................................................................... 4,408,567 697,231 4,458,567 ∂50,000 ∂3,761,336 

Current year ......................................................................................................................................... (2,727,126 ) (697,231 ) (2,777,126 ) (∂50,000 ) (∂2,079,895 ) Fiscal year 2019 .................................................................................................................................. (1,681,441 ) ............................ (1,681,441 ) ............................ (∂1,681,441 ) 

Total, Forward Funded .................................................................................................................................. (2,588,002 ) (622,654 ) (2,638,002 ) (∂50,000 ) (∂2,015,348 ) 

INDIAN EDUCATION 

Grants to Local Educational Agencies ....................................................................................................................... 100,381 100,190 100,381 ............................ ∂191 Federal Programs: 

Special Programs for Indian Children .............................................................................................................. 57,993 37,921 57,993 ............................ ∂20,072 National Activities ............................................................................................................................................. 6,565 5,554 6,865 ∂300 ∂1,311 

Subtotal, Federal Programs .......................................................................................................................... 64,558 43,475 64,858 ∂300 ∂21,383 
245 

Total, Indian Education ................................................................................................................................ 164,939 143,665 165,239 ∂300 ∂21,574 

INNOVATION AND IMPROVEMENT 

Education Innovation and Research .......................................................................................................................... 100,000 370,000 95,000 ¥5,000 ¥275,000 American History and Civics Academies ................................................................................................................... 1,815 ............................ 1,815 ............................ ∂1,815 American History and Civics National Activities ....................................................................................................... 1,700 ............................ ............................ ¥1,700 ............................School Leader Recruitment and Support ................................................................................................................... 14,500 ............................ ............................ ¥14,500 ............................Charter Schools Grants .............................................................................................................................................. 342,172 500,000 367,172 ∂25,000 ¥132,828 Magnet Schools Assistance ........................................................................................................................................ 97,647 96,463 97,647 ............................ ∂1,184 Teacher and School Leader Incentive Grants ............................................................................................................ 200,000 199,563 187,000 ¥13,000 ¥12,563 Ready-to-Learn Television .......................................................................................................................................... 25,741 ............................ 27,741 ∂2,000 ∂27,741 Supporting Effective Educator Development (SEED) ................................................................................................. 65,000 42,000 65,000 ............................ ∂23,000 Arts in Education ....................................................................................................................................................... 27,000 ............................ 27,000 ............................ ∂27,000 Javits Gifted and Talented Students ......................................................................................................................... 12,000 ............................ 12,000 ............................ ∂12,000 

Total, Innovation and Improvement .............................................................................................................. 887,575 1,208,026 880,375 ¥7,200 ¥327,651 

Current year ......................................................................................................................................... (887,575 ) (1,208,026 ) (880,375 ) (¥7,200 ) (¥327,651 ) 

SAFE SCHOOLS AND CITIZENSHIP EDUCATION 

Promise Neighborhoods .............................................................................................................................................. 73,254 60,000 73,254 ............................ ∂13,254 School Safety National Activities ............................................................................................................................... 68,000 74,857 58,000 ¥10,000 ¥16,857 Full-Service Community Schools ................................................................................................................................ 10,000 ............................ ............................ ¥10,000 ............................

Total, Safe Schools and Citizenship Education ........................................................................................... 151,254 134,857 131,254 ¥20,000 ¥3,603 

ENGLISH LANGUAGE ACQUISITION 

Current funded ........................................................................................................................................................... 47,931 47,840 47,931 ............................ ∂91 Forward funded .......................................................................................................................................................... 689,469 688,158 689,469 ............................ ∂1,311 

Total, English Language Acquisition ............................................................................................................ 737,400 735,998 737,400 ............................ ∂1,402 

SPECIAL EDUCATION 

State Grants: 

Grants to States Part B current year ............................................................................................................... 2,719,465 1,766,099 2,719,465 ............................ ∂953,366 

Part B advance from prior year ............................................................................................................... (9,283,383 ) (9,283,383 ) (9,283,383 ) ............................ ............................

Grants to States Part B (fiscal year 2019) ...................................................................................................... 9,283,383 10,124,103 9,283,383 ............................ ¥840,720 

Subtotal, program level ................................................................................................................................ 12,002,848 11,890,202 12,002,848 ............................ ∂112,646 
246 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2017 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2018—Continued 

[In thousands of dollars] 

Item 2017 appropriation Budget estimate Committee recommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2017 appropriation Budget estimate 

Preschool Grants ............................................................................................................................................... 368,238 367,538 368,238 ............................ ∂700 Grants for Infants and Families ....................................................................................................................... 458,556 457,684 458,556 ............................ ∂872 

Subtotal, program level ................................................................................................................................ 12,829,642 12,715,424 12,829,642 ............................ ∂114,218 

IDEA National Activities (current funded): 

State Personnel Development ............................................................................................................................ 38,630 41,551 38,630 ............................ ¥2,921 Technical Assistance and Dissemination (including Special Olympics Education) ......................................... 56,928 44,261 59,428 ∂2,500 ∂15,167 Personnel Preparation ....................................................................................................................................... 83,700 83,541 83,700 ............................ ∂159 Parent Information Centers ............................................................................................................................... 27,411 27,359 27,411 ............................ ∂52 

EducationalTechnology, Media, and Materials ........................................................................................................... 28,047 29,990 28,047 ............................ ¥1,943 

Subtotal, IDEA National Activities ................................................................................................................ 234,716 226,702 237,216 ∂2,500 ∂10,514 Total, Special education ............................................................................................................................... 13,064,358 12,942,126 13,066,858 ∂2,500 ∂124,732 

Current year ......................................................................................................................................... (3,780,975 ) (2,818,023 ) (3,783,475 ) (∂2,500 ) (∂965,452 ) Fiscal year 2019 .................................................................................................................................. (9,283,383 ) (10,124,103 ) (9,283,383 ) ............................ (¥840,720 ) 

Subtotal, Forward Funded ............................................................................................................................. (3,546,259 ) (2,591,321 ) (3,546,259 ) ............................ (∂954,938 ) 

REHABILITATION SERVICES 

Vocational Rehabilitation State Grants ..................................................................................................................... 3,398,554 3,452,931 3,452,931 ∂54,377 ............................Client Assistance State grants .................................................................................................................................. 13,000 12,975 13,000 ............................ ∂25 Training ...................................................................................................................................................................... 29,388 30,131 29,388 ............................ ¥743 Demonstration and Training programs ...................................................................................................................... 5,796 5,785 5,796 ............................ ∂11 Protection and Advocacy of Individual Rights [PAIR] ............................................................................................... 17,650 17,616 17,650 ............................ ∂34 Supported Employment State grants ......................................................................................................................... 27,548 ............................ ............................ ¥27,548 ............................Independent Living: 

Services for Older Blind Individuals ................................................................................................................. 33,317 33,254 33,317 ............................ ∂63 

Helen Keller National Center for Deaf/Blind Youth and Adults ................................................................................ 10,336 10,316 10,336 ............................ ∂20 
247 

Total, Rehabilitation services ....................................................................................................................... 3,535,589 3,563,008 3,562,418 ∂26,829 ¥590 

SPECIAL INSTITUTIONS FOR PERSONS WITH DISABILITIES 

American Printing House for the Blind ...................................................................................................................... 25,431 25,383 25,431 ............................ ∂48 National Technical Institute for the Deaf [NTID]: 

Operations ......................................................................................................................................................... 70,016 69,883 70,016 ............................ ∂133 

Gallaudet University: 

Operations ......................................................................................................................................................... 121,275 121,044 121,275 ............................ ∂231 

Total, Gallaudet University ........................................................................................................................... 121,275 121,044 121,275 ............................ ∂231 Total, Special Institutions for Persons with Disabilities .............................................................................. 216,722 216,310 216,722 ............................ ∂412 

CAREER, TECHNICAL, AND ADULT EDUCATION 

Career Education: 

Basic State Grants/Secondary & Technical Education State Grants, current funded ..................................... 326,598 158,499 326,598 ............................ ∂168,099 

Advance from prior year ........................................................................................................................... (791,000 ) (791,000 ) (791,000 ) ............................ ............................Fiscal year 2019 ....................................................................................................................................... 791,000 791,000 791,000 ............................ ............................

Subtotal, Basic State Grants, program level ...................................................................................... 1,117,598 949,499 1,117,598 ............................ ∂168,099 

National Programs ............................................................................................................................................. 7,421 27,407 7,421 ............................ ¥19,986 

Subtotal, Career Education ........................................................................................................................... 1,125,019 976,906 1,125,019 ............................ ∂148,113 

Adult Education: 

State Grants/Adult Basic and Literacy Education: 

State Grants, current funded ................................................................................................................... 581,955 485,849 581,955 ............................ ∂96,106 

National Leadership Activities ................................................................................................................................... 13,712 13,686 13,712 ............................ ∂26 

Subtotal, Adult education ............................................................................................................................. 595,667 499,535 595,667 ............................ ∂96,132 Total, Career, Technical, and Adult Education ............................................................................................ 1,720,686 1,476,441 1,720,686 ............................ ∂244,245 

Current year ......................................................................................................................................... (929,686 ) (685,441 ) (929,686 ) ............................ (∂244,245 ) Fiscal year 2019 .................................................................................................................................. (791,000 ) (791,000 ) (791,000 ) ............................ ............................Total, Forward Funded ......................................................................................................................... (929,686 ) (685,441 ) (929,686 ) ............................ (∂244,245 ) 
248 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2017 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2018—Continued 

[In thousands of dollars] 

Item 2017 appropriation Budget estimate Committee recommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2017 appropriation Budget estimate 

STUDENT FINANCIAL ASSISTANCE 

Pell Grants—maximum grant (NA) ........................................................................................................................... (4,860 ) (4,860 ) (4,960 ) (∂100 ) (∂100 ) Pell Grants .................................................................................................................................................................. 22,475,352 22,432,626 22,475,352 ............................ ∂42,726 Federal Supplemental Educational Opportunity Grants ............................................................................................. 733,130 ............................ 733,130 ............................ ∂733,130 Federal Work Study ..................................................................................................................................................... 989,728 500,000 989,728 ............................ ∂489,728 

Total, Student Financial Assistance [SFA] ................................................................................................... 24,198,210 22,932,626 24,198,210 ............................ ∂1,265,584 

STUDENT AID ADMINISTRATION 

Salaries and Expenses ............................................................................................................................................... 696,643 680,711 696,643 ............................ ∂15,932 Servicing Activities ..................................................................................................................................................... 880,211 1,017,000 880,211 ............................ ¥136,789 

Total, Student Aid Administration ................................................................................................................ 1,576,854 1,697,711 1,576,854 ............................ ¥120,857 

HIGHER EDUCATION 

Aid for Institutional Development: 

Strengthening Institutions ................................................................................................................................. 86,534 ............................ 86,534 ............................ ∂86,534 Hispanic Serving Institutions ............................................................................................................................ 107,795 107,590 107,795 ............................ ∂205 Promoting Post-Baccalaureate Opportunities for Hispanic Americans ............................................................ 9,671 9,653 9,671 ............................ ∂18 Strengthening Historically Black Colleges (HBCUs) ......................................................................................... 244,694 244,229 244,694 ............................ ∂465 Strengthening Historically Black Graduate Institutions ................................................................................... 63,281 63,161 63,281 ............................ ∂120 Strengthening Predominantly Black Institutions .............................................................................................. 9,942 9,923 9,942 ............................ ∂19 Asian American Pacific Islander ....................................................................................................................... 3,348 3,342 3,348 ............................ ∂6 Strengthening Alaska Native and Native Hawaiian-Serving Institutions ......................................................... 13,802 13,776 13,802 ............................ ∂26 Strengthening Native American-Serving Nontribal Institutions ........................................................................ 3,348 3,342 3,348 ............................ ∂6 Strengthening Tribal Colleges ........................................................................................................................... 27,599 27,547 27,599 ............................ ∂52 Strengthening HBCU Masters programs ........................................................................................................... 7,500 ............................ 7,500 ............................ ∂7,500 

Subtotal, Aid for Institutional development ................................................................................................. 577,514 482,563 577,514 ............................ ∂94,951 
249 

International Education and Foreign Language: 

Domestic Programs ........................................................................................................................................... 65,103 ............................ 65,103 ............................ ∂65,103 Overseas Programs ............................................................................................................................................ 7,061 ............................ 7,061 ............................ ∂7,061 

Subtotal, International Education & Foreign Lang ...................................................................................... 72,164 ............................ 72,164 ............................ ∂72,164 

Postsecondary Program for Students with Intellectual Disabilities .......................................................................... 11,800 11,778 11,800 ............................ ∂22 Minority Science and Engineering Improvement ........................................................................................................ 9,648 9,630 9,648 ............................ ∂18 Tribally Controlled Postsec Voc/Tech Institutions ...................................................................................................... 8,286 8,270 8,286 ............................ ∂16 Federal TRIO Programs ............................................................................................................................................... 950,000 808,289 953,000 ∂3,000 ∂144,711 GEAR UP ..................................................................................................................................................................... 339,754 219,000 339,754 ............................ ∂120,754 Graduate Assistance in Areas of National Need ....................................................................................................... 28,047 5,775 23,047 ¥5,000 ∂17,272 Teacher Quality Partnerships ..................................................................................................................................... 43,092 ............................ 38,092 ¥5,000 ∂38,092 Child Care Access Means Parents in School ............................................................................................................. 15,134 ............................ 15,134 ............................ ∂15,134 

Total, Higher Education ................................................................................................................................ 2,055,439 1,545,305 2,048,439 ¥7,000 ∂503,134 

HOWARD UNIVERSITY 

Academic Program ..................................................................................................................................................... 191,091 190,721 191,091 ............................ ∂370 Endowment Program .................................................................................................................................................. 3,405 3,405 3,405 ............................ ............................Howard University Hospital ........................................................................................................................................ 27,325 27,273 27,325 ............................ ∂52 

Total, Howard University ............................................................................................................................... 221,821 221,399 221,821 ............................ ∂422 

COLLEGE HOUSING AND ACADEMIC FACILITIES LOANS PROGRAM ............................................................................ 435 434 435 ............................ ∂1 

HISTORICALLY BLACK COLLEGE AND UNIVERSITY (HBCU) 

CAPITAL FINANCING PROGRAM ACCOUNT 

HBCU Federal Administration ..................................................................................................................................... 334 333 334 ............................ ∂1 HBCU Loan Subsidies ................................................................................................................................................. 20,150 20,112 20,150 ............................ ∂38 

Total, HBCU Capital Financing Program ...................................................................................................... 20,484 20,445 20,484 ............................ ∂39 

INSTITUTE OF EDUCATION SCIENCES (IES) 

Research, Development and Dissemination ............................................................................................................... 187,500 194,629 185,000 ¥2,500 ¥9,629 Statistics .................................................................................................................................................................... 109,500 111,787 107,000 ¥2,500 ¥4,787 Regional Educational Laboratories ............................................................................................................................ 54,423 54,320 54,423 ............................ ∂103 Research in Special Education .................................................................................................................................. 54,000 53,897 54,000 ............................ ∂103 Special Education Studies and Evaluations .............................................................................................................. 10,818 10,797 10,818 ............................ ∂21 Statewide Data Systems ............................................................................................................................................ 32,281 34,473 32,281 ............................ ¥2,192 
250 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2017 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2018—Continued 

[In thousands of dollars] 

Item 2017 appropriation Budget estimate Committee recommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2017 appropriation Budget estimate 

Assessment: 

National Assessment ......................................................................................................................................... 149,000 148,717 149,000 ............................ ∂283 National Assessment Governing Board ............................................................................................................. 7,745 8,219 7,745 ............................ ¥474 

Subtotal, Assessment ................................................................................................................................... 156,745 156,936 156,745 ............................ ¥191 Total, IES ....................................................................................................................................................... 605,267 616,839 600,267 ¥5,000 ¥16,572 

DEPARTMENTAL MANAGEMENT 

Program Administration: 

Salaries and Expenses ...................................................................................................................................... 431,000 438,000 430,000 ¥1,000 ¥8,000 Building Modernization ...................................................................................................................................... 1,000 ............................ ............................ ¥1,000 ............................

Total, Program administration ...................................................................................................................... 432,000 438,000 430,000 ¥2,000 ¥8,000 

Office for Civil Rights ................................................................................................................................................ 108,500 106,797 117,000 ∂8,500 ∂10,203 Office of Inspector General ........................................................................................................................................ 59,256 61,143 59,256 ............................ ¥1,887 

Total, Departmental management ................................................................................................................ 599,756 605,940 606,256 ∂6,500 ∂316 Total, Title III, Department of Education ...................................................................................................... 71,637,749 66,342,354 71,721,595 ∂83,846 ∂5,379,241 

Current year ......................................................................................................................................... (49,040,748 ) (43,745,353 ) (49,124,594 ) (∂83,846 ) (∂5,379,241 ) Fiscal year 2019 .................................................................................................................................. (22,597,001 ) (22,597,001 ) (22,597,001 ) ............................ ............................

TITLE IV—RELATED AGENCIES 

Committee For Purchase From People Who Are Blind Or Severely Disabled ............................................................ 8,000 6,117 8,000 ............................ ∂1,883 
251 

CORPORATION FOR NATIONAL AND COMMUNITY SERVICE 

Operating Expenses 

Domestic Volunteer Service Programs: 

Volunteers in Service to America [VISTA] ......................................................................................................... 92,364 4,910 92,364 ............................ ∂87,454 National Senior Volunteer Corps: 

Foster Grandparents Program .................................................................................................................. 107,702 117 107,702 ............................ ∂107,585 Senior Companion Program ...................................................................................................................... 45,512 117 45,512 ............................ ∂45,395 Retired Senior Volunteer Program ............................................................................................................ 48,903 117 48,903 ............................ ∂48,786 

Subtotal, Senior Volunteers ................................................................................................................. 202,117 351 202,117 ............................ ∂201,766 Subtotal, Domestic Volunteer Service .................................................................................................. 294,481 5,261 294,481 ............................ ∂289,220 

National and Community Service Programs: 

AmeriCorps State and National Grants ............................................................................................................ 386,010 2,341 386,010 ............................ ∂383,669 Innovation, Assistance, and Other Activities .................................................................................................... 5,000 ............................ 5,400 ∂400 ∂5,400 Evaluation .......................................................................................................................................................... 4,000 ............................ 4,000 ............................ ∂4,000 National Civilian Community Corps (NCCC)(subtitle E) ................................................................................... 30,000 24,087 30,000 ............................ ∂5,913 State Commission Support Grants .................................................................................................................... 16,538 ............................ 16,538 ............................ ∂16,538 

Subtotal, National and Community Service ................................................................................................. 441,548 26,428 441,948 ∂400 ∂415,520 Total, Operating expenses ............................................................................................................................ 736,029 31,689 736,429 ∂400 ∂704,740 

National Service Trust ................................................................................................................................................ 206,842 ............................ 195,000 ¥11,842 ∂195,000 Salaries and Expenses ............................................................................................................................................... 81,737 99,735 81,737 ............................ ¥17,998 Office of Inspector General ........................................................................................................................................ 5,750 3,568 5,750 ............................ ∂2,182 

Total, Corp. for National and Community Service ....................................................................................... 1,030,358 134,992 1,018,916 ¥11,442 ∂883,924 

CORPORATION FOR PUBLIC BROADCASTING: 

Fiscal year 2020 (current) with fiscal year 2018 comparable ........................................................................ 445,000 ............................ 445,000 ............................ ∂445,000 Fiscal year 2019 advance with fiscal year 2017 comparable (NA) ................................................................. (445,000 ) (445,000 ) (445,000 ) ............................ ............................

Rescission of fiscal year 2019 funds (NA) .............................................................................................. ............................ (¥445,000 ) ............................ ............................ (∂445,000 ) 

Subtotal, fiscal year 2019 program level ........................................................................................... 445,000 ............................ 445,000 ............................ ∂445,000 

Fiscal year 2018 advance with fiscal year 2016 comparable (NA) ................................................................. (445,000 ) (445,000 ) (445,000 ) ............................ ............................

Rescission of fiscal year 2018 funds (NA) .............................................................................................. ............................ (¥441,500 ) ............................ ............................ (∂441,500 ) 
252 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2017 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2018—Continued 

[In thousands of dollars] 

Item 2017 appropriation Budget estimate Committee recommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2017 appropriation Budget estimate 

Subtotal, fiscal year 2018 program level ........................................................................................... 445,000 3,500 445,000 ............................ ∂441,500 

Public television interconnection system (current) ........................................................................................... 50,000 ............................ 20,000 ¥30,000 ∂20,000 

Federal Mediation and Conciliation Service .............................................................................................................. 46,650 48,655 46,650 ............................ ¥2,005 Federal Mine Safety and Health Review Commission ............................................................................................... 17,184 17,053 17,184 ............................ ∂131 Institute of Museum and Library Services ................................................................................................................. 231,000 23,000 235,000 ∂4,000 ∂212,000 Medicaid and Chip Payment and Access Commission ............................................................................................. 7,765 8,700 7,765 ............................ ¥935 Medicare Payment Advisory Commission ................................................................................................................... 11,925 12,295 11,925 ............................ ¥370 National Council on Disability ................................................................................................................................... 3,250 3,211 3,250 ............................ ∂39 National Labor Relations Board ................................................................................................................................. 274,224 258,000 274,224 ............................ ∂16,224 National Mediation Board .......................................................................................................................................... 13,800 13,205 13,800 ............................ ∂595 Occupational Safety and Health Review Commission ............................................................................................... 13,225 12,615 13,225 ............................ ∂610 

RAILROAD RETIREMENT BOARD 

Dual Benefits Payments Account ............................................................................................................................... 25,000 22,000 22,000 ¥3,000 ............................Less Income Tax Receipts on Dual Benefits ............................................................................................................. ¥2,000 ¥1,000 ¥1,000 ∂1,000 ............................

Subtotal, Dual Benefits ................................................................................................................................ 23,000 21,000 21,000 ¥2,000 ............................

Federal Payments to the Railroad Retirement Accounts ........................................................................................... 150 150 150 ............................ ............................Limitation on Administration ..................................................................................................................................... 113,500 111,225 114,500 ∂1,000 ∂3,275 Limitation on the Office of Inspector General ........................................................................................................... 10,000 8,437 11,000 ∂1,000 ∂2,563 

SOCIAL SECURITY ADMINISTRATION 

Payments to Social Security Trust Funds .................................................................................................................. 11,400 11,400 11,400 ............................ ............................

Supplemental Security Income Program 

Federal Benefit Payments .......................................................................................................................................... 52,941,736 48,236,000 48,236,000 ¥4,705,736 ............................Beneficiary Services ................................................................................................................................................... 89,000 159,000 159,000 ∂70,000 ............................Research and Demonstration ..................................................................................................................................... 58,000 101,000 101,000 ∂43,000 ............................Afghanistan Special Immigrant Visa ......................................................................................................................... ............................ ............................ ............................ ............................ ............................
253 

Administration ............................................................................................................................................................ 5,029,427 5,060,526 4,954,927 ¥74,500 ¥105,599 

Subtotal, SSI program level .......................................................................................................................... 58,118,163 53,556,526 53,450,927 ¥4,667,236 ¥105,599 

Less funds advanced in prior year ..................................................................................................... ¥14,500,000 ¥15,000,000 ¥15,000,000 ¥500,000 ............................

Subtotal, regular SSI current year ................................................................................................................ 43,618,163 38,556,526 38,450,927 ¥5,167,236 ¥105,599 

New advance, 1st quarter, fiscal year 2019 ...................................................................................... 15,000,000 19,500,000 19,500,000 ∂4,500,000 ............................

Total, SSI program ........................................................................................................................................ 58,618,163 58,056,526 57,950,927 ¥667,236 ¥105,599 

Limitation on Administrative Expenses 

OASI/DI Trust Funds ................................................................................................................................................... 5,145,407 4,916,768 4,950,073 ¥195,334 ∂33,305 HI/SMI Trust Funds ..................................................................................................................................................... 1,684,753 2,012,556 1,620,795 ¥63,958 ¥391,761 Social Security Advisory Board ................................................................................................................................... 2,300 2,300 2,300 ............................ ............................SSI .............................................................................................................................................................................. 3,706,485 3,671,376 3,565,777 ¥140,708 ¥105,599 

Subtotal, regular LAE .................................................................................................................................... 10,538,945 10,603,000 10,138,945 ¥400,000 ¥464,055 

User Fees: 

SSI User Fee activities ...................................................................................................................................... 126,000 118,000 118,000 ¥8,000 ............................

CBO adjustment ....................................................................................................................................... ¥3,000 ¥3,000 ¥3,000 ............................ ............................

SSPA User Fee Activities ................................................................................................................................... 1,000 1,000 1,000 ............................ ............................

CBO adjustment ....................................................................................................................................... ¥1,000 ¥1,000 ¥1,000 ............................ ............................

Subtotal, User fees .............................................................................................................................. 123,000 115,000 115,000 ¥8,000 ............................Subtotal, Limitation on administrative expenses ................................................................................ 10,661,945 10,718,000 10,253,945 ¥408,000 ¥464,055 

Program Integrity: 

OASDI Trust Funds ............................................................................................................................................ 496,058 345,850 345,850 ¥150,208 ............................SSI ..................................................................................................................................................................... 1,322,942 1,389,150 1,389,150 ∂66,208 ............................

Subtotal, Program integrity funding ............................................................................................................. 1,819,000 1,735,000 1,735,000 ¥84,000 ............................Total, Limitation on Administrative Expenses .............................................................................................. 12,480,945 12,453,000 11,988,945 ¥492,000 ¥464,055 

Office of Inspector General 

Federal Funds ............................................................................................................................................................. 29,787 30,000 30,000 ∂213 ............................
254 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2017 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2018—Continued 

[In thousands of dollars] 

Item 2017 appropriation Budget estimate Committee recommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2017 appropriation Budget estimate 

Trust Funds ................................................................................................................................................................ 75,713 75,500 75,500 ¥213 ............................

Total, Office of Inspector General ................................................................................................................ 105,500 105,500 105,500 ............................ ............................

Adjustment: Trust fund transfers from general revenues ......................................................................................... ¥5,029,427 ¥5,060,526 ¥4,954,927 ∂74,500 ∂105,599 

Total, Social Security Administration ........................................................................................................... 66,186,581 65,565,900 65,101,845 ¥1,084,736 ¥464,055 

Federal funds ....................................................................................................................................... 58,782,350 58,212,926 58,107,327 ¥675,023 ¥105,599 

Current year ................................................................................................................................ (43,782,350 ) (38,712,926 ) (38,607,327 ) (¥5,175,023 ) (¥105,599 ) New advances, 1st quarter, fiscal year 2019 ............................................................................ (15,000,000 ) (19,500,000 ) (19,500,000 ) (∂4,500,000 ) ............................

Trust funds .......................................................................................................................................... 7,404,231 7,352,974 6,994,518 ¥409,713 ¥358,456 

Total, Title IV, Related Agencies .................................................................................................................. 68,485,612 66,244,555 67,363,434 ¥1,122,178 ∂1,118,879 

Federal Funds ...................................................................................................................................... 60,945,956 58,759,624 60,231,491 ¥714,465 ∂1,471,867 

Current Year ................................................................................................................................ (45,500,956 ) (39,259,624 ) (40,286,491 ) (¥5,214,465 ) (∂1,026,867 ) Fiscal Year 2019 Advance .......................................................................................................... (15,000,000 ) (19,500,000 ) (19,500,000 ) (∂4,500,000 ) ............................Fiscal Year 2020 Advance .......................................................................................................... (445,000 ) ............................ (445,000 ) ............................ (∂445,000 ) 

Trust Funds .......................................................................................................................................... 7,539,656 7,484,931 7,131,943 ¥407,713 ¥352,988 

Grand Total ................................................................................................................................................................. 933,945,868 964,663,824 991,867,000 ∂57,921,132 ∂27,203,176 

1 Sec.4002 of Public Law 111–148. 2 21st Century CURES Act (Public Law 114–255); fiscal year 2017 funds provided in Public Law 114–254. 3 Fiscal year 2018 budget request proposes consolidating the Agency for Healthcare Research and Quality within the National Institutes of Health as the National Institute for Research on Safety and Quality. 4 Reflects transfer from NIH Innovation Account to NCI, NINDS and NIMH. 

Æ