1 

" ! HOUSE OF REPRESENTATIVES 116TH CONGRESS

1st Session 

REPORT

116–62 

DEPARTMENTS OF LABOR, HEALTH AND 

HUMAN SERVICES, AND EDUCATION, AND 

RELATED AGENCIES APPROPRIATIONS 

BILL, 2020 

R E P O R T 

OF THE

COMMITTEE ON APPROPRIATIONS 

HOUSE OF REPRESENTATIVES 

ON

H.R. 2740 

together with 

MINORITY VIEWS 

MAY 15, 2019.—Committed to the Committee of the Whole House on the 

State of the Union and ordered to be printed 


E:\Seals\Congress.#13
DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND 

RELATED AGENCIES APPROPRIATIONS BILL, 2020 

U.S. GOVERNMENT PUBLISHING OFFICE

WASHINGTON : 

1 

36–295 

" ! HOUSE OF REPRESENTATIVES 116TH CONGRESS

1st Session 

REPORT

2019

116–62 

DEPARTMENTS OF LABOR, HEALTH AND 

HUMAN SERVICES, AND EDUCATION, AND 

RELATED AGENCIES APPROPRIATIONS 

BILL, 2020 

R E P O R T 

OF THE

COMMITTEE ON APPROPRIATIONS 

HOUSE OF REPRESENTATIVES 

ON

H.R. 2740 

together with 

MINORITY VIEWS 

MAY 15, 2019.—Committed to the Committee of the Whole House on the 

State of the Union and ordered to be printed 


E:\Seals\Congress.#13
36–295 

116TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 1st Session 116–62 

DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND RELATED AGENCIES APPROPRIATIONS BILL, 2020 

MAY 15, 2019.—Committed to the Committee of the Whole House on the State of 

the Union and ordered to be printed 

Ms. DELAURO, from the Committee on Appropriations, 

submitted the following 

R E P O R T 

together with 

MINORITY VIEWS 

[To accompany H.R. 2740] 

The Committee on Appropriations submits the following report in 

explanation of the accompanying bill making appropriations for the 

Departments of Labor, Health and Human Services (except the 

Food and Drug Administration, the Agency for Toxic Substances 

and Disease Registry and the Indian Health Service), and Education, and the Committee for Purchase from People Who Are 

Blind or Severely Disabled, Corporation for National and Community Service, Corporation for Public Broadcasting, Federal Mediation and Conciliation Service, Federal Mine Safety and Health Review Commission, Institute of Museum and Library Services, Medicaid and CHIP Payment and Access Commission, Medicare Payment Advisory Commission, National Council on Disability, National Labor Relations Board, National Mediation Board, Occupational Safety and Health Review Commission, Railroad Retirement 

Board, and Social Security Administration for the fiscal year ending September 30, 2020, and for other purposes. 

2 

INDEX TO BILL AND REPORT 

Page number 

Bill Report 

Summary of Estimates and Appropriation .............................................. ........ 3 

General Summary of the Bill .................................................................... ........ 3 

Title I—Department of Labor: 

Employment and Training Administration ....................................... 2 13 

Employee Benefits Security Administration ..................................... 18 21 

Pension Benefit Guaranty Corporation ............................................. 18 22 

Wage and Hour Division .................................................................... 19 22 

Office of Labor-Management Standards ........................................... 20 23 

Office of Federal Contract Compliance Programs ............................ 20 24 

Office of Workers’ Compensation Programs ..................................... 20 24 

Occupational Safety and Health Administration ............................. 24 26 

Mine Safety and Health Administration ........................................... 26 29 

Bureau of Labor Statistics ................................................................. 27 30 

Office of Disability Employment Policy ............................................. 28 31 

Departmental Management ............................................................... 28 31 

General Provisions .............................................................................. 33 35 

Title II—Department of Health and Human Services: 

Health Resources and Services Administration ............................... 42 36 

Centers for Disease Control and Prevention .................................... 50 56 

National Institutes of Health ............................................................. 57 80 

Substance Abuse and Mental Health Services Administration ...... 64 116 

Agency for Healthcare Research and Quality ................................... 69 127 

Centers for Medicare & Medicaid Services ....................................... 70 128 

Administration for Children and Families ........................................ 75 142 

Administration for Community Living .............................................. 86 155 

Office of the Secretary ........................................................................ ........ 161 

Public Health and Social Services Emergency Fund ................ 93 169 

General Provisions .............................................................................. 95 173 

Title III—Department of Education: 

Education for the Disadvantaged ...................................................... 117 177 

Impact Aid ........................................................................................... 118 179 

School Improvement Programs .......................................................... 119 180 

Indian Education ................................................................................. 120 184 

Innovation and Improvement ............................................................. 121 185 

Safe Schools and Citizenship Education ........................................... 121 190 

English Language Acquisition ........................................................... 122 192 

Special Education ................................................................................ 122 193 

Rehabilitation Services ....................................................................... 126 196 

Special Institutions for Persons with Disabilities ............................ 127 197 

Career, Technical and Adult Education ............................................ 128 198 

Student Financial Assistance ............................................................. 128 200 

Federal Direct Student Loan Program Account ............................... ........ 204 

Student Aid Administration ............................................................... 128 205 

Higher Education ................................................................................ 130 207 

Howard University .............................................................................. 131 213 

College Housing and Academic Facilities Loans .............................. 131 213 

Historically Black College and University Capital Financing Program Account ................................................................................... 131 213 

Institute of Education Sciences .......................................................... 133 214 

Departmental Management ............................................................... 134 216 

General Provisions .............................................................................. 135 222 

Title IV—Related Agencies: 

Committee for Purchase from People Who Are Blind or Severely 

Disabled ............................................................................................ 141 223 

Corporation for National and Community Service ........................... 142 223 

Corporation for Public Broadcasting ................................................. 146 226 

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Page number 

Bill Report 

Federal Mediation and Conciliation Service ..................................... 147 227 

Federal Mine Safety and Health Review Commission ..................... 148 227 

Institute of Museum and Library Services ....................................... 149 227 

Medicaid and CHIP Payment and Access Commission ................... 149 229 

Medicare Payment Advisory Commission ......................................... 149 229 

National Council on Disability ........................................................... 149 229 

National Labor Relations Board ........................................................ 150 230 

National Mediation Board .................................................................. 150 231 

Occupational Safety and Health Review Commission ..................... 150 232 

Railroad Retirement Board ................................................................ 150 232 

Social Security Administration .......................................................... 153 233 

Title V—General Provisions: 

House of Representatives Report Requirements .............................. ........ 240 

SUMMARY OF ESTIMATES AND APPROPRIATIONS

The following table compares on a summary basis the appropriations, including trust funds for fiscal year 2020, the budget request 

for fiscal year 2020, and the Committee recommendation for fiscal 

year 2020 in the accompanying bill. 

2020 LABOR, HHS, EDUCATION BILL 

[Discretionary funding in thousands of dollars] 

Budget Activity 

Fiscal Year— 2020 Committee compared to— 

2019 

Enacted 

2020 

Budget 

2020 

Committee 

2019 

Enacted 

2020 

Budget 

Department of Labor ......................... $12,123,251 $10,905,405 $13,321,641 +1,198,390 +2,416,236 

Department of Health and Human 

Services ......................................... 90,490,781 78,085,971 99,375,512 +8,884,731 +21,289,541 

Department of Education .................. 71,448,416 64,005,915 75,923,812 +4,475,396 +11,917,897 

Related Agencies ............................... 15,316,511 13,543,842 15,678,035 +361,524 +2,134,193 

GENERAL SUMMARY OF THE BILL

For fiscal year 2020, the Committee recommends a total of 

$191,718,000,000 in current year discretionary funding, including 

offsets and adjustments. The fiscal year 2020 recommendation is 

an increase of $11,745,000,000 above the fiscal year 2019 enacted 

level. 

The Labor-HHS-Education bill supports some of the nation’s 

most critical programs that touch individuals and families throughout their lifespan, from Early Head Start to Social Security. Many 

of the bill’s programs have been shortchanged over the past eight 

years, and the President’s fiscal year 2020 budget request, if enacted, would do irreparable damage to critical programs that provide opportunities for millions of families. Instead, through this 

bill, the Committee is moving ambitiously to make up for lost 

ground by recommending increased investments to help provide 

every individual with a better chance at a better life—with a good 

education, a good job, and access to affordable health care. 

The Committee recommends historic investments in education 

programs, including early childhood development, K–12 public education, Special Education, and postsecondary education. 

The Committee continues to build on investments made over the 

past four years in biomedical research by increasing the National 

Institutes of Health (NIH), while also beginning a new multi-year 

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initiative to rebuild Federal, State, and local public health capacity 

through a significant increase in the Centers for Disease Control 

and Prevention (CDC). 

And the Committee invests in workforce training, and reverses 

years of eroding budgets at the Wage and Hour Division (WHD) 

and the Occupational Safety and Health Administration (OSHA), 

while continuing to protect retired workers by including a significant increase for the Social Security Administration’s operating expenses. 

Some of the most notable initiatives in fiscal year 2020 include: 

EARLY CHILDHOOD EDUCATION

The Committee includes nearly $20,000,000,000 for early childhood education programs through the Child Care and Development 

Block Grant, Head Start, and Preschool Development Grants—an 

increase of $4,000,000,000 over the fiscal year 2019 enacted level. 

This is the largest single-year increase ever provided for these programs. 

Child care is one of the most critical needs of families with young 

children—but CCDBG currently reaches only 15 percent of the 

nearly 14 million children who are eligible to receive child care 

services. The increase included in this bill will provide CCDBGfunded child care for approximately 300,000 additional children, 

which will also enable more parents in low-income families to remain in the workforce. 

The bill also provides an increase of $1,500,000,000 for Head Start, including increases of $750,000,000 for Quality Improvement 

Funding for Trauma-Informed Care and $525,000,000 for Early 

Head Start-Child Care Partnerships. Early Head Start reaches approximately seven percent of eligible children, but the increase in 

this bill will expand access to an additional 80,000 infants and toddlers from low-income families. 

The Committee further recommends an increase of $100,000,000 

for Preschool Development Grants to build State and local capacity 

to provide early childhood care and education for children birth 

through five from low- and moderate-income families. This would 

be the first increase for Preschool Development Grants since the 

program was initiated in fiscal year 2015 and it would enable continued support for additional States to implement or expand preschool programs. 

INVESTING IN PUBLIC EDUCATION

The Committee is committed to increasing investments in core 

formula grant programs that support high-quality public education 

opportunities for all students. Our nation’s public schools serve 

more than 50 million children, more than 50 percent of whom come 

from low-income families. Research shows that low-income students are more likely to struggle academically and often attend 

high-need schools with fewer resources, less experienced teachers, 

and more limited access to advanced coursework. At the same time, 

there is growing evidence that increases in education spending are 

correlated with improved educational outcomes. Unfortunately, 

support for federal K–12 formula programs has been relatively 

stagnant over the past decade, allowing inflation to erode the value 

of this vital assistance. 

5 

Overall, the Committee recommendation provides $42,232,117,000 for federal K–12 education programs, including Individuals with Disabilities Education Act (IDEA), an increase of 

$3,382,571,000 over the fiscal year 2019 enacted level and 

$8,136,130,000 over the fiscal year 2020 budget request. The recommendation is a nine percent increase over last year. 

In particular, the Committee recommends an additional $1,000,000,000 over the fiscal year 2019 enacted level and the fiscal year 2020 budget request for Title I–Grants to Local Educational Agencies for a total of $16,859,802,000. Title I serves an 

estimated 25 million students in nearly 90 percent of school districts and nearly 60 percent of all public schools. 

The Committee also increases investment in formula programs 

that have not seen any increase in several years. The Committee 

recommendation includes $2,555,830,000 for Supporting Effective 

Instruction State Grants (Title II–A), an increase of $500,000,000 

over the fiscal year 2019 enacted level. The fiscal year 2020 budget 

request proposes to eliminate this program. Funds provide States 

and school districts with a flexible source of funding to strengthen 

the skills and knowledge of teachers, principals, and administrators to enable them to improve student achievement. Title II–A 

represents the only dedicated funding stream for teacher professional development for many States and school districts. The Committee’s recommended 24 percent increase would be the program’s 

first increase since 2010. 

The Committee recommends $980,000,000 for the English Language Acquisition program, which provides formula grants to 

States to serve English Leaners (EL), an increase of $242,600,000 

over the fiscal year 2019 enacted level and the fiscal year 2020 

budget request. Federal data show that significant achievement 

gaps exist between ELs and their peers. However, funding to support these students has been flat since fiscal year 2015. At the 

same time, many States and school districts have experienced rapid 

growth in their EL populations. The Committee recommends $13,364,392,000 for Individuals 

with Disabilities Education Act (IDEA) Part B Grants to States, 

which is $1,000,000,000 above the fiscal year 2019 enacted level 

and the fiscal year 2020 budget request, reflecting the largest increase to the program in more than a decade. The Committee is 

concerned that the federal share of the excess cost of educating students with disabilities has declined and notes the critical role this 

increase will play in helping to reverse this trend. 

SOCIAL-EMOTIONAL LEARNING INITIATIVE

The Committee includes a new initiative to support a landmark 

federal investment in social-emotional learning (SEL), ‘‘whole child’’ 

approaches to education, and community schools. A recent study by 

the Collaborative for Academic, Social, and Emotional Learning 

found that students who received SEL interventions showed lasting 

positive impacts on variables such as high school graduation rates 

and college attendance, and lower likelihoods of being arrested or 

being diagnosed with a clinical mental health disorder. 

In total, the Committee recommends $260,000,000 for the initiative, which includes dedicated funding for SEL and ‘‘whole child’’ 

projects and activities across a variety of programs within the DeVerDate Sep 11 2014 06:50 May 16, 2019 Jkt 036295 PO 00000 Frm 00009 Fmt 6659 Sfmt 6602 E:\HR\OC\HR062.XXX HR062
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partment of Education. In particular, $170,000,000 is made available through the Education Innovation and Research program for 

grants for evidence-based, field-initiated innovations that address 

student social, emotional, and cognitive needs. The Committee also recommends $25,000,000 through the Supporting Effective Educator Development (SEED) grant program for 

a new competition to support professional development that helps 

educators incorporate SEL into teaching, and for pathways into 

teaching that provide a strong foundation in child development and 

learning, including skills for implementing SEL. The Committee 

also recommends $40,000,000, an increase of $22,500,000 over the 

fiscal year 2019 enacted level for the Full-Service Community 

Schools Program, which supports evidence-based models to meet 

the holistic needs of children and families. The fiscal year 2020 

budget request proposes to eliminate this program. In addition, $25,000,000 is provided within School Safety National Activities to increase the number of well-trained school counselors, social workers, psychologists, or other mental health professionals qualified to provide school-based mental health services. 

Research shows that building the capacity of students to develop 

social and emotional skills, and take responsibility for their community, can reduce bullying, violence, and aggressive behaviors, 

making schools safer. 

SUPPORTING ACCESS TO AND COMPLETION OF POSTSECONDARY

EDUCATION

The Committee recommendation includes robust increases to bolster the supports students need to access and complete postsecondary education, including sufficient funding to support an increase in the maximum Pell Grant by $150 over the fiscal year 

2019 enacted level and the fiscal year 2020 budget request, from 

$6,195 to $6,345 to help the award keep up with inflation. 

In addition, the Committee recommendation provides $1,434,000,000 for Federal Work Study, an increase of 

$304,000,000 over the fiscal year 2019 enacted level and 

$934,000,000 over the fiscal year 2020 budget request. The Committee recommendation also includes $1,028,000,000 for the Supplemental Educational Opportunity Grants, an increase of 

$188,000,000 over the fiscal year 2019 enacted level. The fiscal 

year 2020 budget request proposes to eliminate this program. 

To support a variety of outreach and support services to encourage low-income, often first-generation individuals, to enter and 

complete college, the Committee recommendation includes 

$1,160,000,000 for the TRIO programs, an increase of $100,000,000 

over the fiscal year 2019 enacted level and $210,000,000 over the 

fiscal year 2020 budget request. The Committee also recommends 

$395,000,000 for the Gaining Early Awareness and Readiness for 

Undergraduate Programs, which is $35,000,000 more than the fiscal year 2019 enacted level. The fiscal year 2020 budget request 

proposes to eliminate this funding stream and support similar activities through a modified TRIO program. 

To help close gaps among racial and socioeconomic groups in college enrollment and degree attainment, the Committee recommendation includes a total of $917,464,000 for programs that 

serve high proportions of students of color, an increase of 

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$250,910,000 over the fiscal year 2019 enacted level and 

$377,845,000 over the fiscal year 2020 budget request. This funding will help support institutions, such as Historically Black Colleges and Universities, Hispanic-Serving Institutions and Tribally 

Controlled Colleges and Universities. 

NIH RESEARCH

The Committee includes $41,084,000,000 for the National Institutes of Health, an increase of $2,219,000,000 within this bill, 

which is a larger increase than the Committee has provided in 

three of the previous four fiscal years. This bill ensures a net increase of at least $2,000,000,000 over the previous year for NIH research, despite the loss of $219,000,000 due to reductions in funding made available through the CURES Act. 

The Committee continues its ongoing support for NIH initiatives, 

including the Cancer Moonshot; the BRAIN Initiative; the ‘‘All of 

Us’’ Precision Medicine Initiative; Alzheimer’s research; and research to develop a universal flu vaccine. 

In addition, the bill includes sufficient funding to provide an 

across-the-board increase of approximately five percent for all Institutes and Centers (IC). The Committee is concerned that Congress 

has moved too far in the direction of targeted funding for specific 

initiatives, which has resulted in less funding being available for 

foundational research that may lead to unforeseeable scientific 

breakthroughs. This bill maximizes the across-the-board increase 

for all ICs, thereby ensuring a significant boost for the best peerreviewed research across all scientific disciplines. 

PUBLIC HEALTH SYSTEMS

The Committee makes a significant investment to improve the 

long-term capacity of Federal, State, and local public health systems. The bill includes $8,275,363,000 for the Centers for Disease 

Control and Prevention (CDC), an increase of $937,622,000 over 

the fiscal year 2019 enacted level. 

The bill begins a multi-year initiative to modernize public health 

capacity at CDC and its public health partners at the state and 

local levels. A new investment of $100,000,000 will start to move 

our public health system away from antiquated data reporting to 

a common data platform that will enable the public health workforce to use real-time data to predict and prevent public health 

threats in the future. 

The Committee also invests in existing programs to address some 

of the country’s most costly chronic diseases. These conditions are 

costly in reduced quality of life as well as high medical costs. The 

bill includes a total increase of $44,700,000 to prevent Diabetes and 

Heart Disease; an increase of $37,500,000 to promote early detection and prevention of cancer; and an increase of $16,000,000 to expand targeted activities to reach underserved minority populations. 

The bill also includes an increase of $40,000,000 to expand efforts 

to reduce tobacco use, with an emphasis on the troubling increase 

in e-cigarette use among youth. 

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WOMEN’S HEALTH

The Committee makes a strong commitment to advance women’s 

health after years of underfunding and deliberate attempts by the 

Administration to undermine programs that ensure access to 

health care for women in low-income communities. 

The bill includes $400,000,000 for Title X Family Planning, an 

increase of $113,521,000 above the fiscal year 2019 enacted level 

and the 2020 budget request. Title X-funded health care providers 

serve more than four million low-income women and men every 

year—offering contraceptive counseling and services, screening for 

STDs and HIV/AIDS, screening for cervical and breast cancer, and 

primary health care services. Two-thirds of Title X patients have 

incomes below the federal poverty level, and 60 percent of women 

who receive health care services from a Title X-funded clinic consider it their primary provider. 

The bill also includes $110,000,000 for the Teen Pregnancy Prevention Program, an increase of $9,000,000 above the fiscal year 

2019 enacted level and $110,000,000 above the 2020 budget request. 

The Committee maintains last year’s investment of $50,000,000 

for an initiative to reduce maternal mortality rates while further 

bolstering that effort with an increase of $5,000,000 through the 

Maternal and Child Health Bureau; an increase of $2,500,000 to 

educate midwives to address the national shortage of maternity 

care providers; and increased funding through the Office on Women’s Health. 

And the Committee strongly supports the mission of the 

WISEWOMAN program, helping uninsured and under-insured lowincome women ages 40 to 64 understand and reduce their risk for 

heart disease and stroke; by providing risk factor screenings; and 

connecting them with lifestyle programs, health counseling and 

other community resources that promote healthy behavior change. 

The Committee includes an increase of $25,650,000 to expand the 

program to all 50 States and the District of Columbia. 

HIV INITIATIVE

The Committee invests in a new HIV initiative to reduce transmission of HIV by 90 percent in the next 10 years. The bill includes 

an increase of nearly $500,000,000 for HIV research, prevention, 

and treatment—almost twice the size of the increase requested by 

the Administration. 

The bill includes an increase of $170,000,000 for HRSA programs—including Ryan White and Community Health Centers—to 

increase the use of pre-exposure prophylaxis (PrEP) among people 

at high risk for HIV transmission and to increase the use of 

antiretroviral therapy (ART) for individuals living with HIV. 

The bill also includes $140,000,000 for CDC activities to diagnose 

people with HIV as early as possible after infection, link people to 

effective treatment and prevention strategies, and respond rapidly 

to clusters and outbreaks of new HIV infections. There is also an 

increase of $16,919,000 for School Health-HIV and an increase of 

$17,000,000 for the Minority AIDS Initiative, a cross-cutting initiative to improve prevention, care, and treatment for minority populations disproportionately affected by HIV. 

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Furthermore, the Committee rejects the Administration’s proposal to cut NIH’s HIV research budget by more than 

$400,000,000. Instead, the Committee continues to invest in research that led to breakthroughs in current treatments such as 

PrEP and ART. The bill includes an increase of $149,000,000 for 

NIH to continue funding research that could lead to an HIV vaccine or a cure. 

FIREARM INJURY AND MORTALITY PREVENTION RESEARCH

The Committee addresses the public health emergency of firearm 

violence for the first time in more than two decades. According to 

CDC data, there were nearly 40,000 firearm-related deaths in 

2017. In addition, more than 130,000 non-fatal firearm injuries 

from assault or self-harm are treated annually in hospital emergency departments. 

To address this public health emergency, the bill includes a total of $50,000,000 for research through CDC and NIH to better understand and prevent injury and death as a result of firearm violence. 

Research is intended to focus on activities that will have the greatest potential public health impact, including strengthening data 

collection to better understand firearm deaths and non-fatal injuries to help inform firearm injury prevention; and applied research 

projects and evaluation that align with the Institute of Medicine/ 

National Research Council recommendations to better understand 

public health prevention strategies for reducing firearm injury and 

death. 

In addition, the Committee includes increases of $13,000,000 for 

Project AWARE and $5,000,000 for Healthy Transitions. These programs began as a part of the 2013 ‘‘Now Is the Time’’ initiative and 

are designed to increase access to mental health treatment for 

youth and young adults reporting symptoms of major depression, 

serious psychological stress, and suicidal thoughts and actions. 

PREPARING WORKERS FOR GOOD JOBS WITH FAIR WAGES

The biggest economic challenge of our time is that too many people are in jobs that do not pay them enough money to live on. More 

than two-thirds of adults do not have a four-year degree, and economic projections show that soon two out of three jobs will require 

some education and training beyond the high school level. 

To that end, the Committee provides new investments in several 

areas of workforce training. Overall, the Committee recommendation includes $5,846,270,000 for programs authorized by the Workforce Innovation and Opportunity Act, an increase of $624,915,000, 

above fiscal year 2019 and $1,583,280,000 above the fiscal year 

2020 budget request. In addition, the Committee recommendation 

provides $250,000,000, an increase of $90,000,000 over the fiscal 

year 2019 enacted level and fiscal year 2020 budget request, to expand the registered apprenticeship model and $1,868,655,000, an 

increase of $150,000,000 over the fiscal year 2019 enacted level and 

$853,072,000 over the fiscal year 2020 budget request for Job 

Corps. These programs, and others, will help in the effort to ensure 

everyone can benefit from the economic recovery, and that everyone 

has the training they need to get good jobs with fair wages. 

To help meet local and regional labor market demand for a skilled workforce, the Committee includes a new $150,000,000 iniVerDate Sep 11 2014 06:50 May 16, 2019 Jkt 036295 PO 00000 Frm 00013 Fmt 6659 Sfmt 6602 E:\HR\OC\HR062.XXX HR062
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tiative to support community colleges—the Strengthening Community Colleges Training Grant (SCCTG) program—in providing 

training to workers in in-demand industries, such as manufacturing, information technology, health care, and energy among others. Community colleges are strategically placed to meet not only 

the educational needs of our country, but our workforce development needs, as well. SCCTGs will help community colleges and 

other four-year colleges and universities through consortia build capacity and leverage their expertise and resources, so that more individuals are acquiring industry-recognized skills. 

PROTECTING AMERICA’S WORKERS

The Committee recommends $1,840,453,000 for Department of 

Labor agencies responsible for worker protection and worker rights. 

This is an increase of $236,586,000 over the fiscal year 2019 enacted level and $462,961,000 over the fiscal year 2020 budget request. 

WHD employs fewer investigators today than it did in 1948, despite the workforce having grown significantly in that time. To help 

make up for this lost ground, hold bad-acting employers accountable and defend working people so they receive the pay they earned 

and are legally entitled to, the Committee recommendation includes $298,131,000, an increase of $69,131,000 over fiscal year 

2019 enacted level and an increase of $65,563,000 over the fiscal 

year 2020 budget request. 

OSHA currently has the lowest number of health and safety inspectors in the agency’s 48-year history. OSHA enforcement is critical to preventing workplace tragedies from occurring, which is why 

it is concerning that the number of OSHA investigations following 

a work-related fatality or catastrophe reached 929 investigations in 

fiscal year 2018, up almost 100 from the previous year, reflecting 

a ten-year high. To make up for years of flat funding and the erosion of capacity at OSHA, the Committee includes $660,908,000, an 

increase of $103,121,000 over the fiscal year 2019 enacted level and 

$103,375,000 over the fiscal year 2020 budget request for this critical worker protection agency. 

The Committee also recommends $341,500,000 for the National 

Labor Relations Board, an increase of $67,276,000 over the fiscal 

year 2019 enacted level and $99,950,000 over the fiscal year 2020 

budget request. This increase will address the 17 percent decline 

in field staff the Board has seen in over just two years by supporting 300 additional regional field staff and two unfilled regional 

director positions. 

Oversight of the Executive Branch 

The Subcommittee has also fulfilled its responsibility to maintain 

oversight of the Executive Branch by holding six oversight hearings—in addition to annual hearings on the fiscal year 2020 budget 

request. The Committee has focused on abuses in health care, education, and labor in addition to holding Administration officials accountable for their actions. These oversight hearings have informed 

many of the decisions in the fiscal year 2020 Labor-HHS-Education 

bill—including the first investment in firearm injury and mortality 

prevention research in more than two decades. Furthermore, the 

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Subcommittee intends to hold additional oversight hearings 

throughout the rest of this Congress. 

OVERSIGHT HEARINGS

Impact of the Administration’s Policies Affecting the Affordable 

Care Act. The Committee held a hearing to examine the Administration’s intentional policies to undermine the Affordable Care Act, 

which have raised prices for Americans already struggling with 

skyrocketing health care costs. Moreover, the fiscal year 2020 budget request makes clear that the Administration has not abandoned 

its attacks on the ACA or protections for people with preexisting 

conditions. The Committee examined those policies, specifically 

with regards to affordability, the increasing number of uninsured, 

and the quality of health insurance benefits. As a result of the 

Committee’s hearing, this bill directs the Centers for Medicare & 

Medicaid Services (CMS) to allocate no less than $100,000,000 of 

carryover funds in fiscal year 2020 to support the ACA Navigators 

program, as well as outreach, enrollment assistance, and advertising during the next ACA open enrollment period. 

Reviewing the Administration’s Unaccompanied Children Program. The Committee held a hearing to examine the Administration’s cruel and immoral policy of family separation, which led to 

thousands of immigrant children being forcibly separated from 

their parents, with no plan to reunify them. Many of these children 

were less than 12 years old, and some were less than 12 months 

old. Furthermore, the Administration’s policies led to tens of thousands of children spending additional months in federal custody instead of being placed in a home with relatives willing to care for 

them. These intentional policies also caused hundreds of millions 

of dollars in cost overruns, forcing the Secretary to transfer or reprogram $385,000,000 from other HHS programs. As a result of the 

Committee’s hearing, this bill places legal conditions on funding for 

the Unaccompanied Children program to return the program to its 

core mission of taking care of vulnerable children and placing them 

with sponsors, rather than acting as an extension of the Administration’s failed immigration policies. 

Protecting Student Borrowers: Loan Servicing Oversight. Today, 44.7 million people owe $1,500,000,000,000 in student loans, more 

than credit card debt or car loans. During the Subcommittee’s oversight hearing on loan servicing, Members of Congress heard from 

a panel of experts on the critical role loan servicing plays in assisting these individuals with paying off their debt. Unfortunately, 

there are serious concerns that these servicing companies are failing and that the Department of Education is asleep at the wheel. 

In particular, the Subcommittee heard from the Assistant Inspector 

General for Audit in the Office of the Inspector General (OIG) at 

the Department, who testified that between 2015 and 2017, loan 

servicers were out of compliance in 61 percent of the Federal Student Aid (FSA) monitoring reports analyzed. According to the OIG 

report, ‘‘by not holding servicers accountable for instances of noncompliance with Federal loan servicing requirements, FSA did not 

provide servicers with an incentive to take actions to mitigate the 

risk of continued servicer noncompliance that could harm students.’’ Such noncompliance includes loan servicers failing to provide borrowers with accurate information about their repayment 

12 

options, miscalculating how much students should be paying 

through income-based repayment, and putting borrowers into forbearance without first informing them of other, less costly options. 

As a result, the Committee recommendation includes new bill 

language requiring the Department to award student loan servicer 

contracts on the basis of their past performance and compliance 

with Federal and state law. It also requires the Department to 

prioritize services to help borrowers avoid delinquency or default in 

contract solicitations and for the Department to include accountability measures that account for the performance of the portfolio 

and contractor compliance with FSA guidelines. 

Addressing the Public Health Emergency of Gun Violence. The 

Committee held the first appropriations hearing in more than two 

decades on the public health emergency of gun violence. In 2017 

alone, guns killed nearly 40,000 Americans, including 24,000 suicide deaths. It is imperative that our foremost public health and 

medical research agencies are engaged to better understand this 

crisis. As a result of the Committee’s hearing, this bill includes 

$50,000,000 for the CDC and NIH to support firearm injury and 

mortality prevention research, with the potential to identify interventions that will save hundreds of thousands of lives in the future. 

Oversight of For-Profit Colleges: Protecting Students and Taxpayer Dollars from Predatory Practices. The Subcommittee held a 

hearing on predatory for-profit colleges. The Subcommittee has a 

vested interest in conducting rigorous oversight of these schools as 

they receive nearly 14 percent of all Pell Grant funding, and while 

accounting for only 9 percent of all students enrolled in postsecondary education, they account for more than a third of all defaults. In addition, during the hearing, the Subcommittee heard 

testimony from a disabled veteran who was assured by a for-profit 

college that he would not take out any student loans to enroll and 

would only use grant aid and GI Bill benefits to attend; however, 

he came to find out that he now owes approximately $100,000 in 

student loan debt, and was unable to find employment in his field 

of study after graduating from the for-profit institution. His story 

is not an outlier. 

For-profit colleges prey on servicemembers and veterans with aggressive marketing and recruiting because of a loophole, known as 

90/10, that allows for-profit colleges to exclude from the cap on federally derived institutional revenue any Federal aid and educational benefits from sources other than the Department of Education. To shine a light on this problem and assist in identifying 

solutions, the Committee directs the Secretary of Education to submit a report to the Committees on Appropriations providing an 

analysis of all for-profit institutions receiving 85 percent or more 

of their revenue from Department of Education sources as well as 

revenue from the Department of Veterans Affairs (VA) and Department of Defense (DoD), as later described in the Committee report. 

In addition, the Committee is deeply concerned by the Secretary 

of Education’s agenda to roll back regulations that protect the wellbeing of students and taxpayers. While a court has ordered the Secretary to implement the 2016 Borrower Defense regulation, which 

provides relief to students who were defrauded and misled by institutions of higher education, the Secretary recently testified that not 

13 

one claim has been approved since June 2018. To conduct further 

oversight, the Committee directs the Secretary to provide updates 

to the Borrower Defense to Repayment Report on FSA’s Data Center on a monthly basis and directs the Secretary to submit a report 

to the Committees on Appropriations on the number of claims and 

the total amount of the loans covered by those claims by school and 

institutional type, as later described in the Committee report. 

Combatting Wage Theft: The Critical Role of Wage and Hour Enforcement. The Subcommittee held an oversight hearing on wage 

theft and heard testimony from a panel of experts on how pay-related violations by employers cost workers billions of dollars annually. In addition, the Subcommittee discussed how the WHD employs fewer investigators today than it did in 1948, despite the 

workforce having grown significantly in that time. To help make up 

for this lost ground, hold bad-acting employers accountable and defend working people so they receive the pay they earned and are 

legally entitled to, the Committee recommendation for the WHD includes $298,131,000, an increase of $69,131,000 over the fiscal year 

2019 enacted level and an increase of $65,563,000 over the fiscal 

year 2020 budget request. 

TITLE I—DEPARTMENT OF LABOR 

EMPLOYMENT AND TRAINING ADMINISTRATION

Appropriation, fiscal year 2019 ......................................................... $9,905,660,000 

Budget request, fiscal year 2020 ....................................................... 8,573,241,000 

Committee Recommendation ............................................................. 10,614,487,000 

Change from enacted level ............................................................. +708,827,000 

Change from budget request .......................................................... +2,041,246,000 

The Employment and Training Administration (ETA) administers Federal job training grant programs and Trade Adjustment 

Assistance and provides funding for the administration and oversight of the State Unemployment Insurance and Employment Service system. 

TRAINING AND EMPLOYMENT SERVICES

Appropriation, fiscal year 2019 ......................................................... $3,502,700,000 

Budget request, fiscal year 2020 ....................................................... 3,247,407,000 

Committee Recommendation ............................................................. 3,977,615,000 

Change from enacted level ............................................................. +474,915,000 

Change from budget request .......................................................... +730,208,000 

Training and Employment Services provides funding for Federal 

job training programs authorized primarily by the Workforce Innovation and Opportunity Act of 2014 (WIOA). 

Adult Employment and Training Activities.—For Adult Employment and Training Activities, the Committee recommends 

$900,000,000, which is $54,444,000 more than the fiscal year 2019 

enacted level and the fiscal year 2020 budget request. 

Youth Employment and Training Activities.—For Youth Employment and Training Activities, the Committee recommends 

$964,000,000, which is $60,584,000 more than the fiscal year 2019 

enacted level and the fiscal year 2020 budget request. 

The Committee remains concerned with the challenges facing 

disconnected youth and encourages the Department to prioritize 

funding for such youth and develop new strategies, including how 

to market the Department’s youth-based resources to disconnected 

14 

and opportunity youth through social media, local advertisements 

and partnerships with local communities and workforce boards. 

Dislocated Worker Employment and Training Activities.—For 

Dislocated Worker Employment and Training Activities, the Committee recommends $1,103,360,000, which is $62,500,000 more 

than the fiscal year 2019 enacted level and the fiscal year 2020 

budget request. 

Dislocated Worker Assistance National Reserve.—The Committee 

recommends $370,859,000 for the Dislocated Workers National Reserve, an increase of $150,000,000 over the fiscal year 2019 enacted 

level and $236,142,000 over the fiscal year 2020 budget request. 

Community colleges are strategically positioned to meet not only 

the educational needs of our country, but our workforce development needs as well. The Committee recommendation includes 

$150,000,000 for a new initiative—the Strengthening Community 

College Training Grants—to better align workforce development efforts in in-demand industries with postsecondary education. The 

Trade Adjustment Assistance Community College Career Training 

Grant (TAACCCT) Program made a major investment in community colleges between 2010 and 2014 and achieved success in helping more adults attain industry-recognized skills and credentials. 

Nearly 500,000 individuals enrolled in programs supported through 

TAACCCT and earned more than 320,000 credentials in areas of 

manufacturing, healthcare, information technology, energy, transportation and other industries. To build on lessons learned from 

this initiative, the Committee recommendation includes new funding to support a competitive capacity building grant program to 

again leverage community colleges in supporting local workforce 

development and industry needs and to collaborate with employers 

in the design and implementation of courses and programs. 

Within 120 days of enactment of this Act, the Committee directs 

the Secretary to issue a Solicitation for Grant Applications (SGA) 

for this program. The Committee also directs the Secretary to make 

individual grants to community colleges of at least $1,500,000, unless grants are awarded in consortia to community colleges and 

other eligible institutions of higher education as defined in section 

101(a) of the Higher Education Act. In making grant awards, the 

Committee directs the Secretary to ensure geographic diversity 

among grant recipients, to require a plan for third party evaluations in each individual grant proposal and to conduct a national 

assessment of all grantee proposals once complete. In addition, the 

Committee directs the Secretary to ensure grantees incorporate a 

plan for sustainability of funding under the grant proposal. While 

grants may be awarded to a consortium of institutions of higher 

education, including public and private, non-profit four-year institutions, the Committee directs the Secretary to ensure that the 

lead grantee in the consortium is a community college. The Committee directs the Secretary to report to the Committees on Appropriations not less than 45 days in advance of issuing the SGA with 

specific details of the SGA and 15 days in advance of announcing 

awards through this program. The Secretary is directed to update 

the Committees quarterly thereafter until all funds are expended. 

Native Americans.—For the Indian and Native American programs, the Committee recommends $55,000,000, which is $500,000 

15 

more than the fiscal year 2019 enacted level. The fiscal year 2020 

budget request proposes to eliminate this program. 

Migrant and Seasonal Farmworkers.—For the National Farmworker Jobs program, the Committee recommends $98,896,000, 

which is $10,000,000 more than the fiscal year 2019 enacted level. 

The fiscal year 2020 budget request proposes to eliminate this program. The Committee recommendation includes sufficient funding 

for the first time to carry out Section 127(a)(1) of WIOA to support 

farmworker youth activities. The Committee recommendation also 

includes new bill language that changes the availability of funds 

from July 1 to April 1 to improve administrative efficiencies and 

ensure grants are awarded in a timely manner. 

YouthBuild.—For the YouthBuild program, the Committee recommends $127,500,000, which is $37,966,000 more than the fiscal 

year 2019 enacted level and $42,966,000 more than the fiscal year 

2020 budget request. 

Reintegration of Ex-Offenders.—The Committee recommends 

$100,000,000 for ex-offender retraining and reintegration activities, 

which is $6,921,000 more than the fiscal year 2019 enacted level 

and $21,676,000 more than the fiscal year 2020 budget request. 

The Committee directs the Department to ensure grantees establish formal partnerships with employers and that program participants receive industry recognized credentials and training in fields 

that prepare them for successful reintegration, including ensuring 

participants receive training and credentials in fields where their 

record is not a barrier to entry or continued employment. The Committee also directs the Department to consider the needs of communities that have recently experienced significant unrest. 

Workforce Data Quality Initiative.—The Committee recommends 

$8,000,000 for the Workforce Data Quality Initiative, which is 

$2,000,000 more than the fiscal year 2019 enacted level. The fiscal 

year 2020 budget request proposes to eliminate this program. The 

Committee supports the work of States in using these funds to create and utilize data to align preschool through workforce systems. 

Apprenticeship Grants.—The Committee recommends 

$250,000,000 for the apprenticeship grants program, which is 

$90,000,000 more than the fiscal year 2019 enacted level and fiscal 

year 2020 budget request. The Committee established this program 

to expand work-based learning programs in in-demand industries 

through registered apprenticeships. Registered apprenticeships are 

a proven strategy for meeting the needs of our nation’s workforce 

and industry simultaneously. 

However, the Committee is deeply concerned that funds are 

being used to support unregistered apprenticeship programs, an 

untested, unproven, and duplicative version of registered apprenticeships. The Committee is also concerned that the funding under 

this program is not being used effectively to support State, regional, and local apprenticeship efforts, as well as efforts by intermediaries to expand registered apprenticeships into new industries 

and to expand opportunities for underserved or underrepresented 

populations. 

Therefore, the bill includes new language clarifying that funds 

may only be used for registered apprenticeships and requires that 

funds be used by the Secretary to support State grants and for conVerDate Sep 11 2014 06:50 May 16, 2019 Jkt 036295 PO 00000 Frm 00019 Fmt 6659 Sfmt 6602 E:\HR\OC\HR062.XXX HR062
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tracts and cooperative agreements for national and local apprenticeship intermediaries. 

As part of these opportunities, the Committee directs the Secretary to continue funding for business and labor industry partner 

intermediaries as part of the set asides for national and local intermediaries and ensure that labor intermediaries are given opportunities to apply for competitive grants, cooperative agreements, contracts, and other funding opportunities. The Committee urges the 

Secretary to ensure that States engage both business and labor as 

part of any State funding opportunities associated with this program. 

The Committee directs the Secretary to submit a report to the 

Committees on Appropriations providing details on entities awarded funding, selection criteria used, and the funding amount for 

each grant or contract awarded at the time such awards are made. 

Not later than 90 days after enactment of this Act, the Department 

shall provide the Committees on Appropriations a detailed spend 

plan of anticipated uses of funds made available, including administrative costs. 

While the Committee recognizes the important role of registered 

apprenticeship programs in developing our nation’s workforce, 

more could be done to leverage registered apprenticeships in aligning our nation’s workforce development and traditional educational 

systems. The Committee therefore requests a report, not later than 

120 days from enactment of this Act, outlining how registered apprenticeships may be used to connect secondary and postsecondary 

systems with workforce development, providing examples, best 

practices for replication in the field, and an examination of postsecondary degree-apprenticeship and dual enrollment strategies, including dual enrollment for high school students through construction and manufacturing-oriented accredited apprenticeship colleges. 

The report should include information on the Department’s efforts 

to expand apprenticeship programs to high school aged youth in 

order to connect such youth to professions in-demand fields facing 

shortages. 

The Committee supports the use of apprenticeship grants that 

provide worker education in in-demand fields, including first responder, utility (water), as well as in goods movement sectors such 

as global logistics, rail and other freight-related employment. 

Furthermore, the Committee is concerned with the persistent 

gender inequity in apprenticeship programs. While apprenticeships 

are an important path to the middle-class, women are often underrepresented in apprenticeship programs, and women who do participate often make far less than their male counterparts. The 

Committee encourages the Department to commit to addressing 

these inequalities within the apprenticeship programs and directs 

the Department to include an update on such efforts in its fiscal 

year 2021 Congressional Budget Justification. 

Open Data Reporting.—The Committee encourages the Secretary, 

to the extent practicable, to disclose information related to registered apprenticeships, including through the Apprenticeship.gov 

website, or its successor website, and to be published using an open 

source description language to allow for public search and comparison of such data, including data on credentials earned through or 

as a result of registered apprenticeships. 

17 

National Defense Workforce Pipeline.—Over the next ten years, 

an estimated 15,000 new workers will be needed to support new 

submarine construction, with a particular focus on trades such as 

welding, pipefitting, electrical, machining, shipfitting, and carpentry, among others. The Committee encourages the Department 

to work with the Departments of Defense, Education, and Commerce to develop and implement a strategy for strengthening the 

workforce pipeline, including new submarine construction. 

Engineering Programs.—The Committee encourages the Department to support programs based on engineering concepts for career 

transitioning professionals, returning veterans, and youth in underserved areas. 

JOB CORPS

Appropriation, fiscal year 2019 ......................................................... $1,718,655,000 

Budget request, fiscal year 2020 ....................................................... 1,015,583,000 

Committee Recommendation ............................................................. 1,868,655,000 

Change from enacted level ............................................................. +150,000,000 

Change from budget request .......................................................... +853,072,000 

Job Corps is the nation’s largest residential employment and 

workforce development program for youth, helping prepare thousands of young people ages 16 through 24 for jobs in in-demand occupations with good wages each year. 

Operations.—For Job Corps Operations, the Committee recommends $1,603,325,000, which is the same as the fiscal year 2019 

enacted level and $694,868,000 more than the fiscal year 2020 

budget request. 

Construction, Rehabilitation, and Acquisition.—The Committee 

recommends $233,000,000 for construction, rehabilitation, and acquisition activities of Job Corps centers, which is $150,000,000 

more than the fiscal year 2019 enacted level and $157,984,000 

more than the fiscal year 2020 budget request. The increase in 

funding is intended to support the elimination of Job Corps’ maintenance backlog. 

Administration.—The Committee recommends $32,330,000 for 

the administrative expenses of the Job Corps program, which is the 

same as the fiscal year 2019 enacted level and $220,000 more than 

the fiscal year 2020 budget request. 

The Committee is concerned with the administration of the Job 

Corps program, including its financial management, the underutilization of centers relative to on-board strength, and performance incentives. 

The Committee directs the Department to submit a report, within 90 days of enactment of this Act, on obligations, outlays, and unobligated funds for the most recent fiscal year to the Committees 

on Appropriations and to the authorizing committees of jurisdiction. 

To better utilize Job Corps centers, the Committee directs the 

Department to include an update in the fiscal year 2021 Congressional Budget Justification on specific outreach and admissions efforts that includes the most recent geographic assignment plan required by Sec. 145(c) of the WIOA, including an analysis of Job 

Corps application and enrollment data to evaluate the relative efficacy of different outreach strategies for prospective Job Corps applicants and their families, including social media, national teleVerDate Sep 11 2014 06:50 May 16, 2019 Jkt 036295 PO 00000 Frm 00021 Fmt 6659 Sfmt 6602 E:\HR\OC\HR062.XXX HR062
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vision or radio buys, and local outreach efforts. The Committee encourages the Department to hire additional Outreach and Admissions staff to increase recruitment efforts targeted at disconnected 

youth in large cities and rural areas. 

The Committee requests an update in its fiscal year 2021 Congressional Budget Justification on how the Department will rebalance Job Corps incentive payments in order to ensure student outcomes are the highest priority, including a timeline for implementation. 

The Department has announced plans to reduce Job Corps training opportunities in Florida by nearly half relative to the State’s 

capacity five years ago, despite Florida having the fourth largest 

population of disconnected youth and annually sending hundreds of 

youth out-of-state to receive Job Corps training. The Committee directs the Department to submit to the Committees on Appropriations, within 90 days of enactment of this Act, the most recent geographic assignment plan required by Sec. 145(c) of the WIOA, including the analyses required by Sec. 145(c)(2)(A) and (B), as well 

as a detailed plan for increasing Job Corps’ Florida slot capacity to 

align with demand in the State. 

COMMUNITY SERVICE EMPLOYMENT FOR OLDER AMERICANS

Appropriation, fiscal year 2019 ......................................................... $400,000,000 

Budget request, fiscal year 2020 ....................................................... – – – 

Committee Recommendation ............................................................. 463,800,000 

Change from enacted level ............................................................. +63,800,000 

Change from budget request .......................................................... +463,800,000 

The Community Service Employment for Older Americans program provides grants to public and private non-profit organizations 

that subsidize part-time work in community service activities for 

unemployed persons aged 55 and older whose family income is 

below 125 percent of the poverty level. 

The Committee recommends $463,800,000 for the Community 

Service Employment for Older Americans program, which is 

$63,800,000 more than the fiscal year 2019 enacted level. The fiscal 

year 2020 budget request proposes to eliminate this program. 

FEDERAL UNEMPLOYMENT BENEFITS AND ALLOWANCES

Appropriation, fiscal year 2019 ......................................................... $790,000,000 

Budget request, fiscal year 2020 ....................................................... 680,000,000 

Committee Recommendation ............................................................. 680,000,000 

Change from enacted level ............................................................. ¥110,000,000 

Change from budget request .......................................................... – – – 

The Trade Adjustment Assistance program (TAA) provides assistance to workers adversely affected by international trade. TAA 

provides training, income support, wage subsidies for older workers, job search and relocation allowances to groups of workers who 

file a petition and are certified as eligible to apply for such benefits 

due to job losses resulting from increases in imports or foreign 

trade. 

The mandatory funding provided for this program is dependent 

upon the Administration’s economic assumptions and the Committee’s recommendation for fiscal year 2020 is lower than the fiscal 

year 2019 enacted level for this reason. 

19 

STATE UNEMPLOYMENT INSURANCE AND EMPLOYMENT SERVICE

OPERATIONS

Appropriation, fiscal year 2019 ......................................................... $3,335,649,000 

Budget request, fiscal year 2020 ....................................................... 3,475,986,000 

Committee Recommendation ............................................................. 3,465,761,000 

Change from enacted level ............................................................. +130,112,000 

Change from budget request .......................................................... ¥10,225,000 

The total includes $3,381,695,000 from the Employment Security 

Administration Account from the Unemployment Trust Fund and 

$84,066,000 from the General Fund of the Treasury. These funds 

are used to support the administration of Federal and State unemployment compensation laws. 

Unemployment Insurance Compensation.—For Unemployment Insurance (UI) Compensation, the Committee recommends 

$2,618,230,000, which is $102,414,000 more than the fiscal year 

2019 enacted level and $3,000,000 more than the fiscal year 2020 

budget request. 

The recommendation provides contingency funding for increased 

workloads that States may face in the administration of UI. The 

Committee recommendation includes new bill language so that, 

during fiscal year 2020, for every 100,000 increase in the total average weekly insured unemployment above 1,758,000, an additional 

$28,600,000 shall be made available from the Unemployment Trust 

Fund. 

While the national unemployment rate has declined, investments 

in state unemployment systems are still critical for ensuring claimants receive timely processing of benefits. The Committee recommendation includes new bill language requiring the Secretary to 

provide unearned above-base State UI funds through supplemental 

funding opportunities to States, in order to improve operations and 

modernize State UI systems to help ensure that workers and their 

families receive fast and high-quality assistance in their time of 

need. 

The Committee is aware that when a large worker dislocation occurs, an American Job Center (AJC) in a local area will experience 

a surge in the demand for services. The Committee expects the Department to continue assisting State agencies and AJCs, as appropriate, with Rapid Response activities to provide a surge response 

in these situations, so that impacted workers are provided necessary assistance without delay. The Committee directs the Department to work closely with States and local AJCs to understand if 

any difficulties in providing TAA services are related to service capacity issues and to include this information in its fiscal year 2021 

Congressional Budget Justification. The Committee includes $9,000,000, the same as the fiscal year 2019 enacted level and $3,000,000 more than the fiscal year 2020 

budget request for the continued support of the UI Integrity Center 

of Excellence (UIICE), including $6,000,000 for the benefit of States 

to the entity operating the UIICE. The Committee includes $117,000,000 for the Reemployment 

Services and Eligibility Assessments program, and an additional 

$58,000,000 is made available pursuant to the Bipartisan Budget 

Act of 2018 (P.L. 115–123), which is $25,000,000 more than the fiscal year 2019 enacted level and equal to the fiscal year 2020 budget 

request. 

20 

Unemployment Compensation National Activities.—The Committee recommends $12,000,000 for National Activities, which is 

the same as the fiscal year 2019 enacted level and $36,000,000 

below the fiscal year 2020 budget request. 

Employment Service.—The Committee recommends $680,000,000 

for the Employment Service allotment to States, which is 

$16,948,000 more than the fiscal year 2019 enacted level and the 

fiscal year 2020 budget request. 

The Committee also recommends $22,318,000 for Employment 

Service National Activities, which is $2,500,000 more than the fiscal year 2019 enacted level and the fiscal year 2020 budget request. 

The increase in funds is intended to help modernize, streamline 

and reduce the processing backlog for the Work Opportunity Tax 

Credit certification process. 

Foreign Labor Certification.—The Committee recommends 

$70,560,000 for the Foreign Labor Certification (FLC) program, 

which is $8,250,000 more than the fiscal year 2019 enacted level 

and equal to the fiscal year 2020 budget request. The recommendation includes $56,278,000 for Federal administration and 

$14,282,000 for grants to States in proportion to their use of the 

H–2A and H–2B programs. 

H–2A Program.—The H–2A program has tripled in size from approximately 80,000 approved H–2A jobs in fiscal year 2008 to more 

than 240,000 in fiscal year 2018. Given the program’s growth, the 

program’s requirements against adverse effects on U.S. workers, 

and the potential for U.S. worker displacement and exploitation of 

both U.S. and vulnerable foreign workers, the Committee directs 

the Secretary to submit a report to the Committees on Appropriations on the Department’s implementation and enforcement of the 

H–2A program’s requirements within 180 days of enactment of this 

Act. The report shall include a comprehensive analysis of inspections, audits, investigations, administrative complaints and judicial 

litigation and data regarding findings of violations of H–2A program; the actions taken following such findings; and the remedies 

sought and obtained. 

One-Stop Career Centers/Labor Market Information.—The Committee recommends $62,653,000 for One-Stop Career Centers and 

Labor Market Information, which is equal to the fiscal year 2019 

enacted level and $3,327,000 more than the fiscal year 2020 budget 

request. 

ADVANCES TO THE UNEMPLOYMENT TRUST FUND AND OTHER FUNDS

The Committee recommends such sums as necessary for Advances to the Unemployment Trust Fund and Other Funds. The 

funds are made available to accounts authorized under Federal and 

State unemployment insurance laws and the Black Lung Disability 

Trust Fund when the balances in such accounts are insufficient. 

PROGRAM ADMINISTRATION

Appropriation, fiscal year 2019 ......................................................... $158,656,000 

Budget request, fiscal year 2020 ....................................................... 154,265,000 

Committee Recommendation ............................................................. 158,656,000 

Change from enacted level ............................................................. – – – 

Change from budget request .......................................................... +4,391,000 

21 

The recommendation includes $108,674,000 from the General 

Fund of the Treasury and $49,982,000 from the Employment Security Administration Account in the Unemployment Trust Fund. 

Office of Apprenticeship.—The Committee urges the Department 

to ensure that each of the State Offices of Apprenticeship are fully 

and adequately staffed. Further, the Committee directs the Department to include, in its fiscal year 2021 Congressional Budget Justification, information on what percentage of Program Administration funds are used to support registered apprenticeships and nonregistered apprenticeships, respectively, in fiscal years 2019 and 

2020, as well as the full-time equivalent staffing levels for each of 

these efforts. 

EMPLOYEE BENEFITS SECURITY ADMINISTRATION

SALARIES AND EXPENSES

Appropriation, fiscal year 2019 ......................................................... $181,000,000 

Budget request, fiscal year 2020 ....................................................... 193,500,000 

Committee Recommendation ............................................................. 183,155,000 

Change from enacted level ............................................................. +2,155,000 

Change from budget request .......................................................... ¥10,345,000 

The Employee Benefits Security Administration (EBSA) assures 

the security of retirement, health and other workplace-related benefits of working people. The Committee recommends $183,155,000 for EBSA, which is 

$2,155,000 more than the fiscal year 2019 enacted level and 

$10,345,000 less than the fiscal year 2020 budget request. 

On October 11, 2018, DOL–OIG issued a report entitled ‘‘EBSA 

Can Provide Greater Oversight of the Thrift Savings Plan by 

Strengthening its Audit Program.’’ The Committee is concerned 

with the DOL–OIG finding that despite identifying significant IT 

security weaknesses, of all recommendations made in the Thrift 

Savings Plan (TSP) audit reports EBSA issued from 2010 through 

2017, 73 percent remain open. In response, the Committee provides 

$2,155,000 for EBSA to perform a comprehensive, detailed review 

of the TSP’s IT operating environment—specifically to review the 

adequacy of controls at contractor sites and over contractor IT personnel and monitor the agency’s progress in remediating previously 

identified issues. The Committee directs EBSA to provide a summary of the review’s findings to the Committees on Appropriations, 

and to publicly post the review on its website, once it is complete. 

The Committee is encouraged that EBSA agrees with DOL–OIG’s 

recommendations and directs the agency to update the Committees 

on Appropriations on the status of their implementation within 90 

days of the enactment of this Act. 

The Committee is deeply concerned by the Department of Labor’s 

efforts to sabotage the Affordable Care Act (ACA) and strip access 

to affordable, comprehensive health coverage from millions of 

Americans through its association health plan (AHP) rule. The 

AHP rule seeks to expand skimpy plans that do not provide consumers with access to the care they need or financial protection 

against the high cost of many medical conditions. The rule will increase costs for consumers and destabilize the health insurance 

marketplace by cherry-picking healthier, lower cost individuals, 

while leaving older, sicker, and more expensive consumers in the 

22 

traditional market with skyrocketing costs. This will be devastating 

for patients with pre-existing conditions, who the Administration 

already tried to abandon by refusing to defend the ACA and its key 

patient protections in court. The Committee agrees with a Federal 

judge’s recent conclusion that the AHP rule ‘‘is clearly an end-run 

around the ACA’’ and that that it ‘‘does violence’’ to the Employee 

Retirement Income Security Act. Therefore, the bill does not include the Administration’s requested increase for the administration of AHPs under the new rule. 

PENSION BENEFIT GUARANTY CORPORATION

Appropriation, fiscal year 2019 ......................................................... $445,363,000 

Budget request, fiscal year 2020 ....................................................... 452,858,000 

Committee Recommendation ............................................................. 452,858,000 

Change from enacted level ............................................................. +7,495,000 

Change from budget request .......................................................... – – – 

Congress established the Pension Benefit Guaranty Corporation 

to insure the defined-benefit pension plans of working people. 

The recommendation includes new bill language that extends the 

period of availability for administrative expenses to ensure the 

agency has sufficient time to manage a large, unanticipated influx 

of participants. 

WAGE AND HOUR DIVISION

SALARIES AND EXPENSES

Appropriation, fiscal year 2019 ......................................................... $229,000,000 

Budget request, fiscal year 2020 ....................................................... 232,568,000 

Committee Recommendation ............................................................. 298,131,000 

Change from enacted level ............................................................. +69,131,000 

Change from budget request .......................................................... +65,563,000 

WHD enforces Federal minimum wage, overtime pay, recordkeeping, and child labor requirements of the Fair Labor Standards 

Act. WHD also has enforcement and other administrative responsibilities related to the Migrant and Seasonal Agricultural Worker 

Protection Act, the Employee Polygraph Protection Act, the Family 

and Medical Leave Act, the Davis Bacon Act, and the Service Contract Act. 

On April 9, 2019, the Subcommittee on Labor-HHS-EducationRelated Agencies held a hearing entitled ‘‘Combatting Wage Theft: 

The Critical Role of Wage and Hour Enforcement,’’ during which 

the Subcommittee heard from a panel of national experts how payrelated violations by employers cost workers billions of dollars annually. The Subcommittee discussed how WHD employs fewer investigators today than it did in 1948, despite the workforce having 

grown significantly in that time, and how the agency’s lack of resources hinders efforts to make sure workers receive their promised 

wages. By the end of the hearing, there was bipartisan consensus 

that increased funding was needed to make sure WHD has the resources to carry out its statutory mission and protect workers. Panelists also discussed how agencies such as WHD can implement a 

strategic enforcement approach to use limited resources to 

sustainably change employer behavior. 

To address these urgent needs, the Committee provides an increase of $69,131,000 over the fiscal year 2019 enacted level and 

$65,563,000 over the fiscal year 2020 budget request. The ComVerDate Sep 11 2014 06:50 May 16, 2019 Jkt 036295 PO 00000 Frm 00026 Fmt 6659 Sfmt 6602 E:\HR\OC\HR062.XXX HR062
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mittee directs WHD to hire at least 500 additional investigators 

with the increased funding. This increase would bring WHD to 

roughly 1,300 investigators, to reverse the impacts of years of flat 

funding that have eroded and reduced investigative capacity. The 

Committee also urges WHD to explore and expand strategic enforcement approaches to the agency’s work to make the most of this 

increase. 

When the Payroll Audit Independent Determination (PAID) program was first announced in March 2018, the Department pledged 

to do an evaluation of it after six months before expanding it, 

which is why the Committee is concerned that the PAID program 

was expanded in October 2018 without any prior evaluation or 

knowledge of its effectiveness. The Department frequently cites the 

$304,000,000 in wages WHD recovered in fiscal year 2018 as a justification for its actions; however, the agency has not disclosed how 

much of that amount was recovered through the PAID program. In 

addition, the Department has not disclosed how much the PAID 

program costs to administer or how many businesses participate. 

To provide needed transparency, the Committee directs WHD to 

provide a report to the Committees on Appropriations within 30 

days of enactment of this Act, and quarterly thereafter, detailing 

administrative expenditures on PAID, amounts recovered through 

PAID, and the number of businesses participating in PAID since 

March 2018. 

The Committee is also deeply concerned with recently proposed 

regulatory rollbacks at WHD. The Department’s proposed overtime 

rule would take away basic benefits from roughly three million 

workers that were protected under the 2016 overtime rule, which 

would have raised the overtime salary threshold to $47,476 with 

automatic annual increases. The proposed joint employer rule 

would limit corporate liability when contractors and franchisees 

commit wage theft. Further, efforts to revise and repeal protections 

for 16- and 17-year-olds in health care professions would put teenagers at risk of injury. Taken together, these proposals reflect a 

systematic effort to tip the scales to benefit powerful corporate interests at the expense of working people. The Committee strongly 

urges WHD to adjust course and abandon misguided proposals that 

stand in conflict with the agency’s mission to protect workers. 

OFFICE OF LABOR-MANAGEMENT STANDARDS

SALARIES AND EXPENSES

Appropriation, fiscal year 2019 ......................................................... $41,187,000 

Budget request, fiscal year 2020 ....................................................... 49,134,000 

Committee Recommendation ............................................................. 40,187,000 

Change from enacted level ............................................................. ¥1,000,000 

Change from budget request .......................................................... ¥8,947,000 

The Office of Labor Management Standards (OLMS) administers 

the Labor-Management Reporting and Disclosure Act, which establishes safeguards for union democracy and union financial integrity, and requires public disclosure reporting by unions, union officers, employees of unions, labor relations consultants, employers, 

and surety companies. 

The Committee is aware that the Department chose to use transfer authority provided by the Committee to transfer $1,235,000 

24 

from the State Unemployment Insurance and Employment Service 

Operations appropriation to this account to support activities under 

the International Union Compliance Audit Program (I–CAP). The 

Committee acknowledges the Department’s inconsistency in supporting enforcement efforts across the agency and believes this 

transfer reflects misplaced priorities. Therefore, the Committee recommendation includes a $1,000,000 decrease for OLMS below the 

2019 enacted level and $8,947,000 below the fiscal year 2020 budget request. The Committee rejects the budget request to provide 

funds that would support and expand I–CAP. 

OFFICE OF FEDERAL CONTRACT COMPLIANCE PROGRAMS

SALARIES AND EXPENSES

Appropriation, fiscal year 2019 ......................................................... $103,476,000 

Budget request, fiscal year 2020 ....................................................... 103,576,000 

Committee Recommendation ............................................................. 120,000,000 

Change from enacted level ............................................................. +16,524,000 

Change from budget request .......................................................... +16,424,000 

The OFCCP ensures equal employment opportunity in the Federal contracting community through enforcement, regulatory work, 

outreach and education to workers and their advocates. 

OFCCP is responsible, per Executive Order 11246 (EO 11246), 

for ensuring federal contractors and subcontractors take affirmative action to ensure that all individuals have an equal opportunity 

for employment, without regard to race, color, religion, sex, or national origin. 

To support OFCCP’s efforts to make sure contractors and subcontractors are adhering fully with EO 11246, the Committee provides an increase of $16,524,000 over the fiscal year 2019 enacted 

level, and $16,424,000 above the fiscal year 2020 budget request, 

to add personnel, expand enforcement, and ensure contactor and 

subcontractor compliance with reporting requirements. 

In the fiscal year 2021 Congressional Budget Justification, the 

Committee directs OFCCP to detail the agency’s compliance and 

enforcement efforts with regard to promoting equal opportunities 

for employment by contractors and subcontractors to the Federal 

government, including technology contractors and subcontractors. 

OFFICE OF WORKERS’ COMPENSATION PROGRAMS

SALARIES AND EXPENSES

Appropriation, fiscal year 2019 ......................................................... $117,601,000 

Budget request, fiscal year 2020 ....................................................... 117,782,000 

Committee Recommendation ............................................................. 120,782,000 

Change from enacted level ............................................................. +3,181,000 

Change from budget request .......................................................... +3,000,000 

The Office of Workers’ Compensation Programs (OWCP) administers the Federal Employees’ Compensation Act, the Longshore 

and Harbor Workers’ Compensation Act, the Energy Employees Occupational Illness Compensation Program Act, and the Black Lung 

Benefits Act. These programs provide eligible injured and disabled 

workers and their survivors with compensation, medical benefits, 

and services including rehabilitation, supervision of medical care, 

and technical and advisory counseling. 

25 

The recommendation includes $118,609,000 in General Funds 

from the Treasury, $3,185,000 above the fiscal year 2019 enacted 

level and $3,000,000 above the fiscal year 2020 request, and 

$2,173,000 from the Special Fund established by the Longshore 

and Harbor Workers’ Compensation Act. 

The Committee continues to support the efforts of OWCP to reduce fraud and abuse related to the prescription of compound pharmaceuticals and opioids and encourages continued collaboration 

with the DOL–OIG on this critical issue. 

SPECIAL BENEFITS

Appropriation, fiscal year 2019 ......................................................... $230,000,000 

Budget request, fiscal year 2020 ....................................................... 234,600,000 

Committee Recommendation ............................................................. 234,600,000 

Change from enacted level ............................................................. +4,600,000 

Change from budget request .......................................................... – – – 

These funds provide mandatory benefits under the Federal Employees’ Compensation Act. 

SPECIAL BENEFITS FOR DISABLED COAL MINERS

Appropriation, fiscal year 2019 ......................................................... $25,319,000 

Budget request, fiscal year 2020 ....................................................... 34,970,000 

Committee Recommendation ............................................................. 34,970,000 

Change from enacted level ............................................................. +9,651,000 

Change from budget request .......................................................... – – – 

These funds provide mandatory benefits to coal miners disabled 

by black lung disease, to their survivors and eligible dependents, 

and for necessary administrative costs. 

The Committee recommends $34,970,000 for Special Benefits for 

Disabled Coal Miners. This amount is in addition to the 

$14,000,000 appropriated in fiscal year 2019 as an advance for the 

first quarter of fiscal year 2020. The total program level recommendation is $9,651,000 more than the fiscal year 2019 enacted 

level and the same as the fiscal year 2020 budget request. 

The Committee recommendation also provides $14,000,000 as an 

advance appropriation for the first quarter of fiscal year 2021. 

These funds ensure uninterrupted payments to beneficiaries. 

ADMINISTRATIVE EXPENSES, ENERGY EMPLOYEES OCCUPATIONAL

ILLNESS COMPENSATION FUND

Appropriation, fiscal year 2019 ......................................................... $59,098,000 

Budget request, fiscal year 2020 ....................................................... 59,846,000 

Committee Recommendation ............................................................. 59,846,000 

Change from enacted level ............................................................. +748,000 

Change from budget request .......................................................... – – – 

These funds provide mandatory benefits to eligible employees or 

survivors of employees of the Department of Energy (DOE); its contractors and subcontractors; companies that provided beryllium to 

DOE; atomic weapons employees who suffer from a radiation-related cancer, beryllium-related disease, or chronic silicosis as a result of their work in producing or testing nuclear weapons; and 

uranium workers covered under the Radiation Exposure Compensation Act. 

26 

BLACK LUNG DISABILITY TRUST FUND

Appropriation, fiscal year 2019 ......................................................... $328,182,000 

Budget request, fiscal year 2020 ....................................................... 365,240,000 

Committee Recommendation ............................................................. 365,240,000 

Change from enacted level ............................................................. +37,058,000 

Change from budget request .......................................................... – – – 

The Black Lung Disability Trust Fund, supported with mandatory funding, pays black lung compensation, medical and survivor 

benefits, and administrative expenses when no mine operator can 

be assigned liability for such benefits, or when mine employment 

ceased prior to 1970. The Black Lung Disability Trust Fund is financed by an excise tax on coal, reimbursements from responsible 

mine operators, and short-term advances from the Treasury. The 

Emergency Economic Stabilization Act of 2008 authorized a restructuring of the Black Lung Disability Trust Fund debt and required that annual operating surpluses be used to pay down the 

debt until all remaining obligations are retired. 

OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION

SALARIES AND EXPENSES

Appropriation, fiscal year 2019 ......................................................... $557,787,000 

Budget request, fiscal year 2020 ....................................................... 557,533,000 

Committee Recommendation ............................................................. 660,908,000 

Change from enacted level ............................................................. +103,121,000 

Change from budget request .......................................................... +103,375,000 

The Occupational Safety and Health Act of 1970 established the 

OSHA to assure safe and healthy working conditions by setting 

and enforcing standards and by providing training, outreach, education and assistance. 

Within the total for OSHA, the Committee provides the following 

amounts: 

Budget Activity FY 2020 

Committee 

Safety and Health Standards ......................................................................................................................... $23,100,000 

Federal Enforcement ....................................................................................................................................... 246,383,000 

Whistleblower Programs ................................................................................................................................. 18,809,000 

State Programs ............................................................................................................................................... 123,233,000 

Technical Support ........................................................................................................................................... 30,597,000 

Federal Compliance Assistance ..................................................................................................................... 86,623,000 

State Consultation Grants .............................................................................................................................. 64,687,000 

Training Grants .............................................................................................................................................. 12,690,000 

Safety and Health Statistics .......................................................................................................................... 41,168,000 

Executive Direction and Administration ......................................................................................................... 13,618,000 

The Committee is concerned that the number of OSHA investigations following a work-related fatality or catastrophe reached 929 

investigations in fiscal year 2018, up almost 100 from the previous 

year, reflecting a ten-year high. OSHA enforcement is critical to 

preventing workplace tragedies from occurring, which is why the 

Committee is concerned that OSHA currently has the lowest number of health and safety inspectors in the agency’s 48-year history. 

Further, the Committee notes that under OSHA’s current staffing levels, it would take the agency an average of 165 years to inspect each employer within its jurisdiction just one time. To restore 

OSHA capacity to staffing levels in fiscal year 2010, when the average frequency for inspections was once every 129 years, the ComVerDate Sep 11 2014 06:50 May 16, 2019 Jkt 036295 PO 00000 Frm 00030 Fmt 6659 Sfmt 6602 E:\HR\OC\HR062.XXX HR062
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mittee provides an increase of $103,121,000 over the fiscal year 

2019 enacted level and $103,375,000 more than the fiscal year 

2020 budget request. To ensure OSHA makes adequate progress in 

hiring additional inspectors, the Committee directs the agency to 

submit quarterly reports on new hiring and overall personnel numbers to the Committees on Appropriations. The report shall include 

the number of inspector vacancies and the number of on-board inspectors. 

The Committee is deeply concerned with the Department’s failure to comply with a provision of the Department of Labor Appropriations Act, 2018 requiring the Secretary to reserve not less than $4,500,000 for Capacity Building Developmental grants in the 

Susan Harwood Training Program. After the Committee inquired 

on the funding status, the Department informed the Committee 

that OSHA was unable to satisfy the funding requirement because 

it received an insufficient number of eligible, qualified applications 

to award $4,500,000 for Capacity Building Developmental grants. 

Instead, OSHA used funds for five noncompetitive awards. To provide increased transparency and oversight, the Committee modifies 

the bill’s noncompetitive reporting requirement to capture those instances, like Harwood, where there are several smaller awards that 

individually do not meet the reporting threshold but do in total. 

Further, the Committee directs OSHA to publish Funding Opportunity Notices for fiscal year 2020 funds for the Susan Harwood 

Training Grant program no later than June 30, 2020. 

Whistleblowers are this nation’s eyes and ears, identifying and 

helping to control not only hazards facing workers at jobsites, but 

also practices that endanger the public’s health, safety, or wellbeing. According to OSHA’s own data, since fiscal year 2014, the 

number of whistleblower investigators has declined 24 percent 

while the number of complaints has grown by 29 percent, and in 

fiscal year 2018, the backlog of cases has grown to 2,540 pending 

cases. To assure that claims are processed in a timely manner, the 

Committee directs OSHA to maintain all current regional supervisory positions in the whistleblower program. 

The Committee notes it is OSHA’s responsibility under the law 

to approve and monitor State-run OSHA plans. If the agency removes on the ground oversight, it will make it increasingly difficult 

for OSHA to effectively oversee State programs. OSHA regional 

and area offices work directly with States to set inspection goals, 

taking into account staffing and funding levels in each State. Regional and area officials review State-run program performance reports and meet with State officials to monitor their progress toward 

meeting their inspection goals. OSHA’s regions also conduct reviews of each State-run program called Federal Annual Monitoring 

Evaluation reviews. Removing this on the ground oversight would 

have significant negative consequences for worker safety. Therefore, the Committee directs OSHA to maintain all regional full-time 

equivalent staff that monitor State plans. Within 90 days of enactment of this Act, and every six months thereafter, OSHA shall report staffing levels for those monitoring State plans to the Committees on Appropriations. 

In February of 2019, the GAO published a report on safety and 

health records of Department of Defense (DoD) contractors that 

found that among the sample of contractors they studied, 80 perVerDate Sep 11 2014 06:50 May 16, 2019 Jkt 036295 PO 00000 Frm 00031 Fmt 6659 Sfmt 6602 E:\HR\OC\HR062.XXX HR062
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cent of DoD contractors inspected by OSHA had received a citation 

for an OSHA violation, and that some involved serious worker injuries or fatalities. The report also found that some contractors continued to receive contracts after receiving OSHA citations for serious workplace safety and health violations. Of great concern, GAO 

also found that the DoD contracting offices did not know how to access and use the data on OSHA’s website to learn about safety and 

health violations or severe injuries of prospective or current contractors. Further, GAO found that the incidence of OSHA violations 

among all inspected companies with DoD contracts cannot be determined because ‘‘OSHA does not require its staff to obtain and enter 

a corporate identification number in its inspection data, which is 

needed to match contracting data to inspection data.’’ To educate 

DoD procurement officers on how to use the OSHA website to find 

citation and other records, the Committee directs OSHA, in consultation with DoD, to develop a webinar for DoD procurement officers on how to use OSHA’s website to find OSHA violations and Severe Injury Reports. This webinar shall be developed and provided 

to DoD within 180 days of enactment of this Act and shall be sent 

to the Committees on Appropriations. In addition, within 360 days 

of enactment of this Act, the Committee directs OSHA compliance 

officers to gather the Employee Identification Number from all inspections of worksites with more than 20 employees. 

The Committee is concerned that it does not receive information 

about how much OSHA spends on its Voluntary Protection Programs (VPP); therefore, within 180 days of enactment of this Act, 

the Committee directs OSHA to submit to the Committees on Appropriations how much was spent on VPP annually since fiscal 

year 2015. In addition, OSHA shall include VPP spending information in its fiscal year 2021 Congressional Budget Justification. To 

make sure there is adequate funds control within VPP, the Committee recommendation includes new bill language allowing not 

more than $3,500,000 for VPP. 

The Committee recognizes the challenge of ensuring adequate enforcement in remote geographical areas, such as the Pacific territories, and that there have been worker fatalities and injuries in 

areas where there is no permanent enforcement presence. The 

Committee encourages OSHA to ensure compliance safety and 

health officers are adequately serving these territories and to provide an assessment of need for areas with no permanent enforcement presence in its fiscal year 2021 Congressional Justification. 

The Committee is deeply concerned that OSHA is failing to move 

forward to develop and issue needed standards on major safety and 

health problems. One issue of particular concern is workplace violence, a serious and growing problem that has reached epidemic 

levels. Workplace violence is now the third leading cause of death 

and is responsible for nearly 30,000 serious injuries every year. 

Nurses, medical assistants, emergency responders and social workers face some of the greatest threats, suffering more than 70 percent of all workplace assaults. Women workers are at particular 

risk, suffering two out of every three serious workplace violence injuries. In January 2017, OSHA committed to developing and 

issuing a workplace violence standard, but the agency has not yet 

completed a required small business review, and there is no estimated date for the issuance of a proposed or final rule. The ComVerDate Sep 11 2014 06:50 May 16, 2019 Jkt 036295 PO 00000 Frm 00032 Fmt 6659 Sfmt 6602 E:\HR\OC\HR062.XXX HR062
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mittee believes issuing a workplace violence standard to protect 

workers in health care and social services should be a top priority 

for the Department. In order to monitor the agency’s progress on 

this important rule, the Committee directs OSHA to brief the Committees on Appropriations, within 90 days of enactment of this Act, 

on a schedule for moving this rule to completion, including the 

dates on which a proposed rule and final rule will be issued. 

Although occupational noise is a leading cause of hearing loss, 

which, in turn, is one of the most commonly recorded occupational 

illnesses, the current OSHA Noise Standard for occupational noise 

has not been updated since its inception in 1983. Accordingly, to 

better protect U.S. employees and reduce noise-induced hearing 

loss, OSHA should explore updating the more than 35-year old 

standard to the level currently required by the DoD and many U.S. 

employers. 

The Committee strongly urges OSHA not to revoke ancillary provisions from the 2017 final rule limiting exposure to beryllium that 

protect workers in shipyard and construction industries. Such an 

effort would reflect the first time OSHA has proposed to weaken 

a standard protecting workers against a known human carcinogen, 

and it would leave construction and shipyard workers vulnerable to 

life-threatening beryllium-related diseases. 

MINE SAFETY AND HEALTH ADMINISTRATION

SALARIES AND EXPENSES

Appropriation, fiscal year 2019 ......................................................... $373,816,000 

Budget request, fiscal year 2020 ....................................................... 376,043,000 

Committee Recommendation ............................................................. 417,290,000 

Change from enacted level ............................................................. +43,474,000 

Change from budget request .......................................................... +41,247,000 

The Mine Safety and Health Administration (MSHA) enforces 

the Federal Mine Safety and Health Act in underground and surface coalmines and metal/non-metal mines. 

The Committee notes MSHA’s budget has been frozen over the 

past six years, which has eroded the agency’s capacity to protect 

mine workers. To restore MSHA’s capacity, the Committee provides 

an increase of $43,474,000 over the fiscal year 2019 enacted level 

and $41,247,000 more than the fiscal year 2020 budget request. 

This increase will support MSHA’s enforcement of the 2014 respirable dust rule and expanded monitoring of operator compliance 

with its existing silica rule. In addition, the Committee strongly encourages MSHA to develop a more protective silica monitoring 

standard. 

The Committee continues bill language designating up to $2,000,000 for mine rescue recovery activities, and provides for the 

retention of fees up to $2,499,000 for the testing and certification 

of equipment. The Committee includes $10,537,000 for State assistance training grants. 

The Committee is concerned by MSHA’s proposal to merge the 

Coal Mine Safety and Health budget activity with the Metal and 

Nonmetal Mine Safety and Health budget activity. Given the differences in complex safety and health issues between both categories of inspections, the Committee is concerned that a merger 

could compromise MSHA’s mission and make workers less safe. 

30 

Therefore, the Committee recommendation does not consolidate 

these two activities as proposed in the fiscal year 2020 budget request. 

BUREAU OF LABOR STATISTICS

SALARIES AND EXPENSES

Appropriation, fiscal year 2019 ......................................................... $615,000,000 

Budget request, fiscal year 2020 ....................................................... 655,000,000 

Committee Recommendation ............................................................. 675,800,000 

Change from enacted level ............................................................. +60,800,000 

Change from budget request .......................................................... +20,800,000 

The Bureau of Labor Statistics (BLS) is an independent national 

statistical agency that collects, processes, analyzes, and disseminates essential economic data to the Congress, Federal agencies, 

State and local governments, businesses, and the public. Its principal surveys include the Consumer Price Index and the monthly 

unemployment series. The Committee recommendation includes $610,800,000 from the 

General Fund of the Treasury and $65,000,000 from the Employment Security Administration Account in the Unemployment Trust 

Fund. 

Within the total for BLS, the Committee provides the following 

amounts: 

Budget Activity FY 2020 

Committee 

Employment and Unemployment Statistics ................................................................................................... $237,900,000 

Labor Market Information ............................................................................................................................... 65,000,000 

Prices and Cost of Living .............................................................................................................................. 222,900,000 

Compensation and Working Conditions ......................................................................................................... 88,400,000 

Productivity and Technology ........................................................................................................................... 14,200,000 

Executive Direction and Staff Services .......................................................................................................... 47,400,000 

The Committee is concerned that a decade of flat funding has left 

BLS in critical condition. Therefore, the Committee provides an increase of $60,800,000 over the fiscal year 2019 enacted level, and 

$20,800,000 over the fiscal year 2020 budget request, to make up 

for the loss of purchasing power and to take full advantage of advances in statistical methods to produce the high-quality statistics 

required for a thriving, 21st century economy. Specifically, the 

Committee directs BLS to spend $40,000,000 of the total increase 

to support the following essential investments: 

• Modernize the Consumer Expenditure Survey and provide 

robust data to support the Supplemental Poverty measure; 

• Provide an annual supplement to the Current Population 

Survey to allow for collection of data on contingent and alternative work arrangements every two years and data on other 

topics related to the labor force in the alternate years, including an occasional veterans supplement; 

• Expand Job Openings and Labor Turnover Survey to provide greater industry detail and State-level data; 

• Modernize Industrial Price and Import/Export Program 

systems; 

• Modernize Quarterly Census of Employment and Wages 

systems for data collection and communication with States; 

31 

• Modernize infrastructure for BLS public internet and public database; • Continue research and work toward a pilot test of a new 

Survey of Employer Provided Training; • Continue research and work toward a pilot test of a quickresponse employer survey (either Annual Refiling Survey or 

Employment Cost Index platform); • Add a second Electronic Data Collection Facility to expand 

electronic collection and improve resilience; and, • Invest in staff development, cybersecurity, and other 

computationally intensive or IT capacity related upgrades. In addition, the Committee provides $10,000,000 for a new youth 

cohort for the National Longitudinal Survey of Youth (NLSY). The 

Committee notes that the current NLSY 1979 and NLSY 1997 cohorts cannot provide information about teens and young adults 

under the age of 25, as they are entering the labor market—leaving 

critical gaps in data about the new generation of young workers. 

By establishing a new cohort, BLS will be able to better produce 

timely and relevant data on the U.S. labor workforce. 

Furthermore, the Committee is aware of the development of artificial intelligence and encourages BLS to examine this trend’s impact on the economy. Finally, the Committee provides $10,000,000 to support BLS’ 

eventual headquarters move. 

OFFICE OF DISABILITY EMPLOYMENT POLICY

SALARIES AND EXPENSES

Appropriation, fiscal year 2019 ......................................................... $38,203,000 

Budget request, fiscal year 2020 ....................................................... 27,000,000 

Committee Recommendation ............................................................. 38,500,000 

Change from enacted level ............................................................. +297,000 

Change from budget request .......................................................... +11,500,000 

Office of Disability Employment Policy provides policy guidance 

and leadership to eliminate employment barriers to people with 

disabilities. 

The Committee recommendation is $297,000 above the fiscal year 2019 enacted level and $11,500,000 above the fiscal year 2020 

budget request. 

DEPARTMENTAL MANAGEMENT

SALARIES AND EXPENSES

Appropriation, fiscal year 2019 ......................................................... $338,064,000 

Budget request, fiscal year 2020 ....................................................... 266,866,000 

Committee Recommendation ............................................................. 382,939,000 

Change from enacted level ............................................................. +44,875,000 

Change from budget request .......................................................... +116,073,000 

The Departmental Management appropriation provides funds for 

the staff responsible for Departmental operations, management, 

and policy development. 

The recommendation includes $382,631,000 from the General 

Fund of the Treasury, $44,875,000 above the fiscal year 2019 enacted level and $116,073,000 above the fiscal year 2020 budget request, and $308,000 from the Employment Security Administration 

Account in the Unemployment Trust Fund. 

32 

Within the total for Departmental Management, the Committee 

provides the following amounts: 

Budget Activity FY 2020 

Committee 

Program Direction and Support ..................................................................................................................... $30,250,000 

Departmental Evaluation ................................................................................................................................ 8,040,000 

Legal Services ................................................................................................................................................ 128,374,000 

International Labor Affairs ............................................................................................................................. 122,125,000 

Administration and Management ................................................................................................................... 29,004,000 

Adjudication .................................................................................................................................................... 35,000,000 

Women’s Bureau ............................................................................................................................................. 17,750,000 

Civil Rights Activities ..................................................................................................................................... 6,880,000 

Chief Financial Officer ................................................................................................................................... 5,516,000 

Of the $122,125,000 recommended for the International Labor 

Affairs Bureau (ILAB), the Committee directs the Secretary to allocate not less than $36,000,000 in grants to build the capacity of 

countries to enforce labor rights to promote a more level playing 

field for workers in the United States, including as a priority Mexico, while maintaining existing grant funding for combatting child 

labor. 

The Committee is concerned by a GAO report, which found that 

limited resources have prevented more proactive monitoring of 

trade partner compliance under 14 trade agreements with 20 countries, as well as monitoring of trade preference programs with 120 

countries. In response, the Committee directs ILAB to provide an 

increase of $3,500,000 over fiscal year 2019 to the Office of Trade 

and Labor Affairs (OTLA) to fund an additional 20 U.S.-based fulltime equivalent employees to increase monitoring and enforcement 

activities, and directs ILAB to spend an increase of $2,500,000 to 

fund no fewer than five additional labor attaches in critical U.S. 

Embassies to increase field-based and international monitoring and 

labor compliance facilitation, including two in Mexico and one each 

in Bangladesh, Vietnam, and Geneva, Switzerland, for engagement 

with the International Labor Organization. In addition, ILAB is directed to continue its work on three key reports including DOL’s 

Findings on the Worst Forms of Child Labor; the List of Goods Produced by Child Labor or Forced Labor; and the List of Products 

Produced by Forced or Indentured Child Labor. 

The Committee is also concerned with violence and threats 

shown towards activists around the world, including gender-based 

violence targeted towards women activists, particularly in nations 

with which we have trade agreements with enforceable labor and 

environmental protections. The Committee urges ILAB to more actively engage with trade partner nations to end these human rights 

violations so as to better comport with the labor provisions of trade 

agreements. Of the $17,750,000 appropriated to the Women’s Bureau, the Committee provides $4,994,000 for the Women in Apprenticeship 

and Nontraditional Occupations (WANTO) program, an increase of 

$4,000,000 over fiscal year 2019. The Committee rejects the fiscal 

year 2020 budget request’s proposal to eliminate WANTO. This 

program helps employers and labor unions recruit, train, and retain women for nontraditional employment opportunities. These resources are essential in helping women overcome traditional barVerDate Sep 11 2014 06:50 May 16, 2019 Jkt 036295 PO 00000 Frm 00036 Fmt 6659 Sfmt 6602 E:\HR\OC\HR062.XXX HR062
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riers to entry and supporting women’s full participation in the 

labor force. 

The Committee directs the Department to submit its annual Operating Plan to the Committees on Appropriations within the 45- 

day statutory deadline. 

There are concerns about the breakdown of the normal flow of 

information from some areas of the Department to the Committee. 

The Committee expects the Department to correct these shortcomings. If no improvement is made, the Committee will evaluate 

the resources spent on the offices and staff involved in the unacceptable delays regarding the transmission of information to the 

Committee and whether the resources are better allocated to other 

areas of the bill. 

The Committee understands that, as the largest advertiser in the 

U.S., the Federal government should work to ensure fair access to 

its advertising contracts for small disadvantaged businesses and 

businesses owned by minorities and women. The Committee directs 

the Department to include the following information in its fiscal 

year 2021 budget justification: Expenditures for fiscal year 2019 

and expected expenditures for fiscal years 2020 and 2021, respectively, for (1) all contracts for advertising services; and (2) contracts 

for the advertising services of (I) socially and economically disadvantaged small business concerns (as defined in section 8(a)(4) of 

the Small Business Act (15 U.S.C. 637(a)(4)); and (II) women- and 

minority-owned businesses. 

The Committee directs the Department to provide a report not 

later than 30 days after the conclusion of each quarter detailing 

the number of full-time equivalent employees and attrition by principal office and appropriations account. 

The Committee directs the Department to provide a report to the 

Committees on Appropriations within 120 days of enactment of this 

Act on the number of full-time equivalent employees and funds obligated for personnel, training, equipment and travel to provide security for the Secretary and others covered under applicable security detail provisions within this Act for fiscal years 2018 and 2019. 

In addition, the Department shall submit a report to the Committees reflecting projected costs for fiscal years 2020 and 2021 in the 

fiscal year 2021 Congressional Budget Justification. 

The Committee supports targeted investments in impoverished 

areas, particularly in persistent poverty counties and in other highpoverty census tracts. To understand how programs funded 

through the Department are serving these particular areas, the 

Committee directs the Department to submit a report to the Committees on Appropriations on the percentage of funds allocated by 

all competitive grant programs and other anti-poverty programs in 

fiscal years 2017, 2018 and 2019 and estimates for fiscal year 2020 

to serve individuals living in persistent poverty counties, as defined 

as a county that has had 20 percent or more of its population living 

in poverty over the past 30 years, as measured by the 1990 and 

2000 decennial censuses and the most recent Small Area Income 

and Poverty estimates, and high-poverty areas, as defined as any 

census tract with a poverty rate of at least 20 percent as measured 

by the 2013–2017 5-year data series available from the American 

Community Survey of the Census Bureau. The Department shall 

report this information to the Committees within 90 days of such 

34 

data being available and provide a briefing to the Committees not 

later than 180 days of enactment of this Act on how the Department is carrying out this directive. 

The Committee is supportive of efforts by the Department to consider evidence of effectiveness in grant competitions. 

The Committee continues to support efforts to improve customer 

service in accordance with Executive Order 13571—Streamlining 

Service Delivery and Improving Customer Service. The Committee 

directs the Secretary to develop standards to improve customer 

service and incorporate the standards into the performance plans 

required under 31 U.S.C. 1115. 

The Committee directs the Department to comply with title 31 

of the United States Code, including the development of organizational priority goals and outcomes such as performance outcome 

measures, output measures, efficiency measures, and customer 

service measures. 

VETERANS EMPLOYMENT AND TRAINING

Appropriation, fiscal year 2019 ......................................................... $300,041,000 

Budget request, fiscal year 2020 ....................................................... 306,041,000 

Committee Recommendation ............................................................. 316,341,000 

Change from enacted level ............................................................. +16,300,000 

Change from budget request .......................................................... +10,300,000 

The recommendation includes $60,000,000 from the General 

Fund of the Treasury and $256,341,000 from the Employment Security Administration Account in the Unemployment Trust Fund. 

The Veterans Employment and Training (VETS) program serves 

America’s veterans and separating service members by preparing 

them for meaningful careers, providing employment resources and 

expertise, and protecting their employment rights. 

Within the total for VETS, the Committee provides the following 

amounts: 

Budget Activity FY 2020 

Committee 

State Administration Grants .......................................................................................................................... $180,000,000 

Transition Assistance Program ...................................................................................................................... 29,379,000 

Federal Administration ................................................................................................................................... 43,548,000 

Veterans Employment and Training Institute ................................................................................................ 3,414,000 

Homeless Veterans Reintegration Program .................................................................................................... 60,000,000 

The Committee recommendation includes $29,379,000 for the 

Transition Assistance Program, which is $6,000,000 more than the 

fiscal year 2019 enacted level and the same as the fiscal year 2020 

budget request. The additional funding will enhance the quality of 

employment support services for transitioning service members and 

allow VETS to develop and implement a course curriculum to help 

military spouses overcome the challenges they face related to employment and career development. 

The Committee includes $60,000,000 for the Homeless Veterans 

Reintegration Program to further support the needs of veterans experiencing homelessness. 

The Committee includes $500,000 to support the HIRE Vets Medallion Program authorized by the Honoring Investments in Recruiting and Employing American Military Veterans Act of 2017. 

The Committee recommendation includes $300,000 within Federal Administration to establish a Disabled Veteran Program 

35 

(DVP) to address the high unemployment and low labor force participation rate of veterans with service-connected and non-serviceconnected disabilities. The DVP will help increase employment and 

advancement opportunities for veterans with disabilities by working with federal, state, and private partners to promote the hiring 

of veterans with disabilities, improve coordination of available employment services and supports, and to identify and share employment best practices for hiring, retaining, and advancing veterans 

with disabilities in the workforce. 

INFORMATION TECHNOLOGY MODERNIZATION

Appropriation, fiscal year 2019 ......................................................... $23,269,000 

Budget request, fiscal year 2020 ....................................................... 37,000,000 

Committee Recommendation ............................................................. 37,000,000 

Change from enacted level ............................................................. +13,731,000 

Change from budget request .......................................................... – – – 

Information Technology (IT) Modernization provides a dedicated 

source of funding for Department-wide IT modernization projects 

together with funding through the Department’s Working Capital 

Fund. 

The Committee provides an increase of $13,731,000 over the fiscal year 2019 enacted level, and the same level as the fiscal year 

2020 budget request, to support Department-wide IT initiatives. 

While the Committee is supportive of the Department’s efforts to 

seek efficiencies and meet IT needs within a longer-term plan, the 

Committee rejects the Department’s requests for additional transfer authority. 

OFFICE OF INSPECTOR GENERAL

Appropriation, fiscal year 2019 ......................................................... $89,147,000 

Budget request, fiscal year 2020 ....................................................... 90,121,000 

Committee Recommendation ............................................................. 96,121,000 

Change from enacted level ............................................................. +6,974,000 

Change from budget request .......................................................... +6,000,000 

The DOL–OIG conducts audits of Department programs and operations in order to determine that they comply with the applicable 

laws and regulations, that they use resources effectively, and that 

they are achieving their intended results. 

The recommendation includes $90,461,000 from the General 

Fund of the Treasury, $6,974,000 above the fiscal year 2019 enacted level and $6,000,000 above the fiscal year 2020 budget request, and $5,660,000 from the Employment Security Administration Account in the Unemployment Trust Fund. 

The Committee supports the DOL–OIG efforts to reduce fraud 

and abuse in the Workers’ Compensation programs related to the 

prescription of compound pharmaceuticals and opioids, among 

other areas. 

GENERAL PROVISIONS

Sec. 101. The Committee continues a provision to prohibit the 

use of Job Corps funds for the salary of an individual at a rate in 

excess of Executive Level II. 

36 

(TRANSFER OF FUNDS)

Sec. 102. The Committee modifies a provision providing the Secretary with the authority to transfer up to one percent of discretionary funds between appropriations, provided that no appropriation is increased by more than three percent by any such transfer. 

Sec. 103. The Committee continues a prohibition on use of funds 

to purchase goods that are in any part produced by indentured children. 

Sec. 104. The Committee continues a provision related to grants 

made from funds available to the Department under the American 

Competitiveness and Workforce Improvement Act. 

Sec. 105. The Committee continues a provision to prohibit recipients of funds provided to the Employment and Training Administration from using such funds for the compensation of any individual at a rate in excess of Executive Level II. 

(TRANSFER OF FUNDS)

Sec. 106. The Committee continues a provision providing the Secretary with the authority to transfer funds made available to the 

Employment and Training Administration to Program Administration for technical assistance and program integrity activities. 

(TRANSFER OF FUNDS)

Sec. 107. The Committee continues a provision allowing up to 

0.75 percent of discretionary appropriations provided in this Act for 

specific Department of Labor agencies to be used by the Office of 

the Chief Evaluation Officer for evaluation purposes consistent 

with the terms and conditions in this Act applicable to such office. 

Sec. 108. The Committee modifies a provision relating to surplus 

property and apprenticeship programs. 

Sec. 109. The Committee includes a new provision providing an 

additional year for the expenditure of funds for unemployment insurance projects carried out in fiscal years 2015 through 2019 by 

State consortia. 

Sec. 110. The Committee continues a provision relating to the 

Secretary’s security detail. 

Sec. 111. The Committee modifies a provision relating to the 

Treasure Island Job Corps Center. 

Sec. 112. The Committee includes a new provision ensuring that 

the proceeds of any sale of a Job Corps center are returned to the 

program under 158(g) of the WIOA. 

TITLE II—DEPARTMENT OF HEALTH AND HUMAN 

SERVICES 

HEALTH RESOURCES AND SERVICES ADMINISTRATION

Appropriation, fiscal year 2019 ......................................................... $6,843,503,000 

Budget request, fiscal year 2020 ....................................................... 5,841,352,000 

Committee Recommendation ............................................................. 7,326,109,000 

Change from enacted level ............................................................. +482,606,000 

Change from budget request. ......................................................... +1,484,757,000 

The Health Resources and Services Administration (HRSA) supports programs that provide health services to disadvantaged, 

medically underserved, and special populations; decrease infant 

37 

mortality rates; assist in the education of health professionals; and 

provide technical assistance regarding the utilization of health resources and facilities. 

PRIMARY HEALTH CARE

Appropriation, fiscal year 2019 ......................................................... $1,626,522,000 

Budget request, fiscal year 2020 ....................................................... 1,626,522,000 

Committee Recommendation ............................................................. 1,676,522,000 

Change from enacted level ............................................................. +50,000,000 

Change from budget request. ......................................................... +50,000,000 

Health Centers 

The Committee recommends $1,676,522,000 for the Health Centers program, which is $50,000,000 above the fiscal year 2019 enacted level and the fiscal year 2020 budget request. 

The Committee includes bill language providing up to 

$120,000,000 for the Federal Tort Claims Act program, which is 

the same as the fiscal year 2019 enacted level and the fiscal year 

2020 budget request. 

Domestic HIV Initiative.—The Committee includes $50,000,000 

within the Health Centers program for the first year of the initiative to reduce the transmission of HIV by 90 percent over the next 

ten years. Funds will be distributed to Health Centers in high-need 

jurisdictions to increase the use of pre-exposure prophylaxis (PrEP) 

among people at high risk for HIV transmission. 

Behavioral Interventions for Pain Management.—In addressing 

the opioid epidemic, the Committee recognizes the growing need for 

highly trained professionals to deliver evidence-based behavioral 

interventions for pain management. The Committee encourages 

HRSA to invest in programs that expand access to treatment for 

substance use disorders in Federally-Qualified Health Centers 

(FQHCs) and requests a report within 180 days of enactment of 

this Act about continued gaps in the behavioral health workforce 

and whether graduate-level health service psychologists in FQHCs 

could improve health outcomes. 

Health Professional Shortage Area.—The Committee directs 

HRSA to submit a report within 180 days of enactment of this Act 

examining the impact of rotating residents on the calculation of 

health care providers’ Health Professional Shortage Area (HPSA) 

scores. 

Improving Integration of Health Centers and Home Visiting.— 

The Committee supports HRSA’s continued promotion of expanded 

partnerships between Health Centers and evidence-based home visiting programs to improve maternal and child health outcomes in 

high-need communities. The Committee appreciates the Bureau’s 

efforts to identify how these partnerships may fit within Health 

Centers’ scope of practice, recognizing the ways in which home visiting programs can provide cost-effective benefits such as care coordination and service referral that help Health Centers achieve 

community health goals. 

Native Hawaiian Health Care Program.—The Committee provides $19,000,000 for the Native Hawaiian Health Care Program, 

an increase of $1,500,000 above the fiscal year 2019 enacted level. 

The Native Hawaiian Healthcare Systems helps improve the health 

status of Native Hawaiians by making health education, health 

38 

promotion, disease prevention, and Native Hawaiian traditional 

healing services available. 

Free Clinics Medical Malpractice 

The Committee recommends $1,000,000 for carrying out responsibilities under the Federal Tort Claims Act, the same as fiscal 

year 2019 enacted level and the fiscal year 2020 budget request. 

The program provides medical malpractice coverage to individuals 

involved in the operation of free clinics to expand access to health 

care services to low-income individuals in medically underserved 

areas. 

HEALTH WORKFORCE

Appropriation, fiscal year 2019 ......................................................... $1,096,695,000 

Budget request, fiscal year 2020 ....................................................... 304,714,000 

Committee Recommendation ............................................................. 1,244,942,000 

Change from enacted level ............................................................. +148,247,000 

Change from budget request .......................................................... +940,228,000 

Health Professional Staffing Shortages.—The Committee recognizes the current and growing shortage of primary care physicians, 

psychiatrists, behavioral health specialists, and geriatric medical 

professionals. The Committee requests a report within 120 days of 

enactment of this Act on ways HRSA can support efforts to recruit, 

train, and support health professionals in these fields, including existing workforce training opportunities and recommendations to address health professional staffing shortages. 

Rural Health Workforce.—The Committee encourages HRSA to 

explore opportunities for collaboration and partnership with schools 

and programs that offer rural residencies, rural health certificates, 

or otherwise recognized rural curriculum in order to increase the 

placement of health care providers and professionals with rural 

health training in HRSA Health Workforce Programs. 

Shortage Designation Modernization Project.—The Committee is 

concerned that HRSA is implementing the Shortage Designation 

Management System without a thorough understanding of the potential impact of the revised Health Professional Shortage Area 

scores on States. The Committee requests a briefing from HRSA 

within 60 days of enactment of this Act on the revised methodology 

and implications for addressing health care workforce shortages in 

States. 

Trafficking Awareness for Health Professionals.—The Committee 

encourages HRSA to identify best practices for accredited schools 

of medicine or nursing to train students in identifying and responding to human trafficking victims and to respond appropriately to 

such individuals. Best practices should be developed in consultation 

with law enforcement personnel, social service providers, and other 

experts in the field of human trafficking. 

Health Professions 

The Committee recommends $854,942,000 for the Health Professions programs, which is $108,247,000 above the fiscal year 2019 

enacted level and $550,228,000 above the fiscal year 2020 budget 

request. The Health Professions programs support grants for the 

development of the health workforce in fields challenged by a high 

need and insufficient supply of health professionals. Given that colVerDate Sep 11 2014 06:50 May 16, 2019 Jkt 036295 PO 00000 Frm 00042 Fmt 6659 Sfmt 6602 E:\HR\OC\HR062.XXX HR062
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leges and universities serve the dual role of training students and 

carrying out a majority of Federally-funded biomedical research, 

the Committee believes that they serve as an ideal setting to expose future clinicians to the evidence base that underlies their intended profession. 

National Health Service Corps 

The Committee includes $120,000,000 for the National Health 

Service Corps (NHSC), $15,000,000 above the fiscal year 2019 enacted level and the fiscal year 2020 budget request. NHSC supports 

qualified health care providers dedicated to working in underserved 

communities in urban, rural, and tribal areas through scholarships 

and loan repayment assistance. 

The Committee directs HRSA to examine the application processes and eligibility requirements for both NHSC recruits and provider locations, including the HPSA qualification and scoring. The 

Committee requests a report within 120 days of enactment of this 

Act with recommendations on how the NHSC program, including 

the HPSA application and scoring process, may be modified to increase recruitment and field strength as well as diversify provider 

sites. 

National Health Service Corps Loan Repayment Program.—The 

Committee encourages HRSA to conduct a review of the NHSC 

Loan Repayment Program with a specific focus on the qualifications for the program and whether those qualifications, including 

designation as an HPSA, alone capture candidates that effectively 

address the health care needs of the community. 

Centers of Excellence 

The Committee includes $25,000,000 for Centers of Excellence 

(COE), $1,289,000 above the fiscal year 2019 enacted level and 

$25,000,000 above the 2020 budget request. The Committee commends the Bureau of Health Workforce (BHW) on the continued 

implementation of COE and notes that partnerships with HRSA 

have allowed minority health professions institutions to address 

the need for diverse and culturally competent health professionals 

that contribute to the healthcare needs of underrepresented populations. The Committee asks that HRSA report within 120 days of 

enactment of this Act on the achievements and challenges of COE 

and the contribution COE makes to workforce development. 

Health Careers Opportunity Program 

The Committee includes $20,000,000 for the Health Careers Opportunity Program (HCOP), $5,811,000 above the fiscal year 2019 

enacted level and $20,000,000 above the fiscal year 2020 budget request. The Committee notes that HCOPs have assisted students 

from minority and economically disadvantaged backgrounds to 

enter the health professions for decades by focusing on student development, retention, matriculation, and graduation. The Committee encourages BHW to continue its improvement of the diversity and distribution of needed health care professionals through 

National Health Career Opportunity Program Academies 

(NHCOPA) and report back to Congress within 120 days of enactment of this Act on the progress of the NHCOPA pipeline. 

40 

Faculty Loan Repayment 

The Committee includes $1,190,000 for Faculty Loan Repayment, the same as the fiscal year 2019 enacted level and $1,190,000 

above the fiscal year 2020 budget request. 

Scholarships for Disadvantaged Students 

The Committee includes $53,470,000 for Scholarships for Dis- advantaged Students, $4,500,000 above the fiscal year 2019 enacted level and $53,470,000 above the fiscal year 2020 budget request. These scholarships provide financial stability to disadvantaged and non-traditional students and are an important resource 

to the influx of eligible students going into the health professions. 

Within this program, the Committee directs $2,500,000 to be set 

aside to educate midwives to address the national shortage of maternity care providers, and specifically the lack of adequate diversity in the maternity care workforce. 

Primary Care Training and Enhancement 

The Committee includes $48,924,000 for Primary Care Training 

and Enhancement, the same as the fiscal year 2019 enacted level 

and $48,924,000 above the fiscal year 2020 budget request. 

Oral Health Training 

The Committee recommends $40,673,000 for Oral Health Training programs, the same as the fiscal year 2019 enacted level and 

$40,673,000 above the fiscal year 2020 budget request. These programs serve to increase the number of medical graduates from minority and disadvantaged backgrounds and to encourage students 

and residents to choose primary care fields and practice in underserved urban and rural areas. 

The Committee includes not less than $12,000,000 for General 

Dentistry Programs and not less than $12,000,000 for Pediatric 

Dentistry Programs. The Committee directs HRSA to provide continuation funding for predoctoral and postdoctoral training grants 

initially awarded in fiscal year 2015, and for section 748 Dental 

Faculty Loan Program (DFLRP) grants initially awarded in fiscal 

years 2016, 2017, 2018 and 2019. The Committee continues to support DFLRP awards with a 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. 

Area Health Education Centers 

The Committee provides $41,250,000 for the Area Health Edu- cation Centers (AHEC) program, $2,000,000 above the fiscal year 

2019 enacted level and $41,250,000 above the fiscal year 2020 

budget request. AHEC facilitates the diversity of the healthcare 

workforce; increases access to healthcare; delivers vital patient 

care; reduces health disparities; improves health outcomes; and increases revenue by creating new jobs and services. The AHEC programs and centers play a critical national role in addressing health 

care workforce shortages, particularly those in primary care 

through an established infrastructure. The AHEC Program grantees support the recruitment and retention of physicians, students, 

faculty and other primary care providers in rural and medically unVerDate Sep 11 2014 06:50 May 16, 2019 Jkt 036295 PO 00000 Frm 00044 Fmt 6659 Sfmt 6602 E:\HR\OC\HR062.XXX HR062
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derserved areas by providing local, community-based, interdisciplinary primary care training. 

The Committee encourages HRSA to support AHEC oral health 

projects that establish primary points of service and address the 

need to help patients find treatment outside of hospital emergency 

rooms. The Committee encourages HRSA to work with programs 

that have already been initiated by some State dental associations 

to refer emergency room patients to dental networks. 

Geriatrics Program 

The Committee provides $43,384,000 for the Geriatrics Workforce Enhancement Program (GWEP), $2,647,000 above the fiscal 

year 2019 enacted level and $43,384,000 above the fiscal year 2020 

budget request. This program provides grants for training across 

the provider continuum to integrate geriatrics and primary care delivery systems. 

Mental and Behavioral Health Education Training Programs 

The Committee includes $36,916,000 for Mental and Behavioral 

Health Education Training Programs (MBHET), the same as the 

fiscal year 2019 enacted level and the fiscal year 2020 budget request. This program provides grants to institutions of higher education and accredited training programs to recruit and train professionals and faculty in areas of mental and behavioral health. 

Graduate Psychology Education.—Within the total for MBHET, 

the Committee includes $18,000,000 for the inter-professional 

Graduate Psychology Education (GPE) Program to increase the 

number of health service psychologists trained to provide integrated services to high-need, underserved populations in rural and 

urban communities. 

Behavioral Health Workforce Education and Training 

The Committee includes $85,000,000 for the Behavioral Health 

Workforce Education and Training Grant Program (BHWET), 

$10,000,000 above the fiscal year 2019 enacted level and the fiscal 

year 2020 budget request. This program establishes and expands 

internships or field placement programs in behavioral health serving populations in rural and medically underserved areas. 

Peer Support Specialists in the Opioid Use Disorder Workforce.— 

Within the total for BHWET, the Committee includes $39,800,000, 

an increase of $10,000,000 above the fiscal year 2019 enacted level, 

for community-based experiential training for students preparing 

to become peer support specialists and other types of behavioral 

health-related paraprofessionals. This program provides training in 

the provision of opioid use disorder (OUD) and other substance use 

disorder (SUD) prevention, treatment, and recovery services in 

high-need and high-demand areas. The program will expand and 

improve access to quality treatment and foster an integrated approach to address OUD and other SUD treatment emphasizing the 

role of the family and lived experience of the consumer through 

academic, community, and non-traditional community organization 

partnerships. 

42 

Loan Repayment Program for Substance Use Disorder Treatment 

Workforce 

The Committee includes $25,000,000 to establish the Loan Repayment Program for Substance Use Disorder Treatment Workforce, which was authorized under section 7071 of the SUPPORT 

for Patients and Communities Act (P.L. 115–271). This program 

will address shortages in the substance use disorder workforce by 

providing for the repayment of education loans for individuals 

working in a full-time SUD treatment job that involves direct patient care in either a Mental Health Professional Shortage Area or 

a county where the overdose death rate exceeds the national average. 

Mental and Substance Use Disorder Workforce Training Demonstration 

The Committee includes $10,000,000 to establish the Mental and 

Substance Use Disorder Workforce Training Demonstration, which 

was authorized under section 9022 of the 21st Century Cures Act 

(P.L. 114–255). The Committee recognizes that treating the over 20 

million Americans with a substance use disorder (SUD) will require 

training that is too often lacking in our nation’s current addiction 

workforce. HRSA has projected a workforce shortage of 250,000 

providers in the SUD/mental health field by 2025. This program 

will make grants to institutions including but not limited to medical schools and FQHCs to support training for medical residents 

and fellows in psychiatry and addiction medicine, as well as nurse 

practitioners, physician assistance, and others, to provide SUD 

treatment in underserved communities. 

Workforce Information and Analysis 

The Committee includes $5,663,000 for Workforce Innovation 

and Analysis, the same as the fiscal year 2019 enacted level and 

$1,000,000 above the fiscal year 2020 budget request. 

Public Health and Preventive Medicine Programs 

The Committee includes $19,000,000 for Public Health and Preventive Medicine Training Grant Programs, $2,000,000 above the 

fiscal year 2019 enacted level and $19,000,000 above the fiscal year 

2020 budget request. Within this total, the Committee provides an 

increase of $1,500,000 for the Preventive Medicine Residency 

Training Program and an increase of $500,000 for Public Health 

Training Centers. 

Advanced Education Nursing 

The Committee includes $77,585,000 for the Advanced Education 

Nursing Workforce Program, $3,004,000 above the fiscal year 2019 

enacted level and $77,585,000 above the fiscal year 2020 budget request. This program provides traineeships and curriculum and faculty development to improve advanced nursing education and increase the number of qualified nurses in the primary care workforce. 

The Committee continues to provide $8,000,000 to award grants 

for the clinical training of sexual assault nurse examiners to administer medical forensic examinations and treatments to victims 

43 

of sexual assault in hospitals, health centers, and other emergency 

healthcare service provider settings. 

Nurse Practitioner Optional Fellowship Program.—The Committee includes an increase of $20,000,000 to make grants to establish or expand optional community-based nurse practitioner fellowship programs that are accredited or in the accreditation process 

for practicing postgraduate nurse practitioners (NPs) in primary 

care or behavioral health. The Committee directs HRSA to give 

preference to Federally Qualified Health Centers (FQHCs), as defined by section 1861(aa)(4) of the Social Security Act. The Committee is concerned the nation is unprepared for healthcare provider shortages and recognizes that optional postgraduate programs with this focus, integrating primary care and behavioral 

health, will help to address this problem. Patients need expert primary care and behavioral health providers prepared to manage the 

social and clinical complexities experienced in FQHCs. A key focus 

of the program will be training and professional development in the 

integration of primary care and behavioral health. The program 

will provide original fellowships for transitioning to an integrated 

model of care consistent with the current high standards of NP 

education and practice meeting the needs of our nation’s most vulnerable populations. 

Nursing Education, Practice, Quality, and Retention 

The Committee includes $43,590,000 for the Nurse Education, 

Practice, Quality and Retention (NEPQR) Program, $1,677,000 

above the fiscal year 2019 enacted level and $43,590,000 above the 

fiscal year 2020 budget request. The NEPQR program supports 

academic, service, and continuing education projects to enhance 

nursing education, improve the quality of patient care, increase 

nurse retention, and strengthen the nursing workforce. The program focuses on exposing students to enhanced curriculum and 

meaningful clinical experience and training in medically underserved areas, so that they will be more likely to choose to work in 

these settings after graduation. 

Nursing Workforce Diversity 

The Committee includes $18,037,000 for the Nursing Workforce 

Diversity (NWD) program, $694,000 above the fiscal year 2019 enacted level and $18,037,000 above the fiscal year 2020 budget request. The NWD program supports stipends, scholarships, and a 

variety of pre-entry preparation, advanced entry preparation, and 

retention activities for students from disadvantaged backgrounds. 

NURSE Corps Scholarship and Loan Repayment 

The Committee includes $90,620,000 for NURSE Corps, 

$3,485,000 above the fiscal year 2019 enacted level and $7,485,000 

above the fiscal year 2020 budget request. 

Nursing Faculty Loan Program 

The Committee includes $29,640,000 for the Nursing Faculty 

Loan Program, $1,140,000 above the fiscal year 2019 enacted level 

and $29,640,000 above the fiscal year 2020 budget request. This 

program makes grants to schools of nursing who in turn provide 

44 

student loans to graduate-level nursing students to increase the 

number of qualified nurse faculty. 

Children’s Hospitals Graduate Medical Education 

The Committee recommends $350,000,000 for the Children’s Hospitals Graduate Medical Education (CHGME) Payment program, 

$25,000,000 above the fiscal year 2019 enacted level and 

$350,000,000 above the fiscal year 2020 budget request. The 

CHGME Payment program helps eligible hospitals maintain graduate medical education programs, which support the training of 

residents to care for the pediatric population and enhance the supply of primary care and pediatric medical and surgical subspecialties. 

Medical Student Education 

The Committee includes $40,000,000 to expand support to colleges of medicine at public universities located in the top quintile 

of States projected to have a primary care provider shortage. This 

is $15,000,000 above the fiscal year 2019 enacted level and 

$40,000,000 above the fiscal year 2020 budget request. The Committee directs HRSA to maintain existing eligibility criteria for the 

second year of grants for this program. 

National Practitioner Data Bank 

The Committee assumes $18,814,000 for the National Practitioner Data Bank, which is the same as the fiscal year 2010 enacted level and the fiscal year 2020 budget request. 

MATERNAL AND CHILD HEALTH

Appropriation, fiscal year 2019 ......................................................... $926,789,000 

Budget request, fiscal year 2020 ....................................................... 783,200,000 

Committee Recommendation ............................................................. 972,751,000 

Change from enacted level ............................................................. +45,962,000 

Change from budget request .......................................................... +189,551,000 

Maternal and Child Health Block Grant 

The Committee recommends $705,000,000 for the Maternal and 

Child Health Block Grant, $27,300,000 above the fiscal year 2019 

enacted level and $44,300,000 above the fiscal year 2020 budget request. States use the block grant to improve access to care for 

mothers, children, and their families; reduce infant mortality; provide pre-and post-natal care; support screening and health assessments for children; and provide systems of care for children with 

special health care needs. 

Special Projects of Regional and National Significance 

The Committee continues bill language identifying a specific 

funding level for Special Projects of Regional and National Significance (SPRANS). The Committee provides the following within 

SPRANS: 

Budget Activity FY 2020 

Committee 

Set-aside for Oral Health ............................................................................................................................... $5,250,000 

Set-aside for Epilepsy .................................................................................................................................... 3,642,000 

Set-aside for Sickle Cell Disease ................................................................................................................... 3,000,000 

45 

Budget Activity FY 2020 

Committee 

Set-aside for Fetal Alcohol Syndrome ............................................................................................................ 477,000 

Adverse Childhood Experiences.—The Committee is aware that 

childhood trauma and toxic stress have been linked to negative 

health outcomes through adulthood, including higher rates of diabetes, stroke, depression, lapses in cognitive abilities, and developmental delays, suicide, and substance misuse, among others. The 

Committee recognizes that promoting awareness to parents and 

health care providers around the impact of trauma on the developing brain and the importance of encouraging supportive and responsive relationships with caring adults as two promising strategies. The Committee encourages the Maternal and Child Health 

Bureau (MCHB) to develop protocols to train professionals to 

screen, diagnose, and provide evidence-based interventions to individuals suffering from adverse childhood experiences such as child 

abuse and neglect, witnessing interpersonal violence, family substance abuse, family separation, parental divorce, parental loss, 

and mental illness, to promote developmental resiliency. 

Alliance for Maternal Health Safety Bundles.—The Committee 

includes $5,000,000, an increase of $2,000,000 above the fiscal year 

2019 enacted level, to expand implementation of the Alliance for 

Innovation on Maternal Health program’s maternal safety bundles 

to all U.S. States, the District of Columbia, and U.S. territories, as 

well as tribal entities. Maternal safety bundles are a set of targeted 

and evidence-based best practices that, when implemented, improve patient outcomes and reduce maternal mortality and severe 

maternal morbidity. 

Breastfeeding Services and Supplies.—The Committee recognizes 

that exclusivity and duration of breastfeeding confers meaningful 

clinical benefits for babies and mothers and saves health care costs. 

The Committee remains committed to improving breastfeeding 

rates across the country and understands that there may be risk 

factors during pregnancy and delivery that can impact a mother’s 

ability to meet her own breastfeeding duration goals. The Committee urges HRSA, during the next review of the Women’s Preventive Services Guidelines for breastfeeding services and supplies, to 

incorporate into the clinical and implementation considerations section of the guideline: evidence of the critical timeframe for 

breastfeeding initiation following delivery; and recommendations 

for assessing risk factors, initiating milk production and ensuring 

that women are able to build supply and sustain breastfeeding in 

the early post-partum period (as well as during the antenatal, 

perinatal, and the postpartum period) in both pre-term and term 

infants. 

Children’s Health and Development.—The Committee continues 

to provide $3,500,000 to continue efforts to promote systemic 

change that would positively impact the policy of child-health-related institutions and systems in States with high levels of childhood poverty. 

Hemophilia Treatment Centers.—The Committee provides level 

funding for Hemophilia Treatment Centers. The Regional Hemophilia Network Program uses a regional infrastructure of hemophilia treatment centers to promote and improve the comprehenVerDate Sep 11 2014 06:50 May 16, 2019 Jkt 036295 PO 00000 Frm 00049 Fmt 6659 Sfmt 6602 E:\HR\OC\HR062.XXX HR062
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sive care of individuals with hemophilia and related bleeding disorders or clotting disorders. 

Infant-Toddler Court Teams.—The Committee includes 

$10,000,000 for the third year of a cooperative agreement to support research-based Infant-Toddler Court Teams to change child 

welfare practices to improve well-being for infants, toddlers, and 

their families. The Committee expects this increase of $7,000,000 

above the fiscal year 2019 enacted level to: (1) build upon the work 

of sites established through the Quality Improvement Center for 

Research-based Infant Toddler Court Teams, including by providing training and technical assistance in support of such court 

teams’ efforts across the country, and (2) support additional outreach sites to start a court team. 

Maternal Mortality Disparities.—The Committee is concerned 

about the finding from the Centers for Disease Control and Prevention (CDC) that black women experience maternal mortality at 

nearly four times the rate of white women. Black maternal mortality rates in the U.S. are similar to rates in developing countries 

at 40 deaths per 100,000. The Committee includes $23,000,000, the 

same as the fiscal year 2019 enacted level, for State Maternal 

Health Innovation Grants that will establish demonstrations to implement evidence-based interventions to address critical gaps in 

maternity care service delivery and reduce maternal mortality. The 

demonstrations will be representative of the demographic and geographic composition of communities most affected by maternal mortality. The Committee encourages HRSA to work with States to collect comprehensive data associated with all pregnancy-associated 

and pregnancy-related deaths, regardless of the outcome of the 

pregnancy. 

Pediatric Hospice Care.—The Committee understands the unique 

conditions surrounding pediatric hospice care and grief support for 

families including the need to support family members, the recognition that child death can have more intense and longer grieving periods, and the need for development of best practices for counseling, 

support, medication, and other factors impacting the end of life experience for children. The Committee provides $1,000,000 within 

SPRANS to work with experienced hospice providers which are not 

conflicted by decisions of whether to provide hospice or curative 

treatments in the hospital to children nearing the end of life to establish a pilot program aimed at developing best practices. 

Set-aside for Oral Health.—The Committee includes $250,000 to 

continue demonstration projects to increase the implementation of 

integrating oral health and primary care practice. The projects 

should model the core clinical oral health competencies for non-dental providers that HRSA published and initially tested in its 2014 

report, Integration of Oral Health and Primary Care Practice. The 

Committee expects the Chief Dental Officer to continue to direct 

the design, monitoring, oversight, and implementation of these 

projects. 

Maternal and Child Health Programs 

In addition to the Maternal and Child Health Block Grant, the 

MCHB supports several programs to improve the health of all 

mothers, children, and their families. These programs support activities that develop systemic mechanisms for the prevention and 

47 

treatment of sickle cell disease; provide information and research 

on and promote screening of autism and other developmental disorders; provide newborn and child screening of heritable disorders; 

provide grants to reduce infant mortality and improve perinatal 

outcomes; fund States to conduct newborn hearing screening; and 

provide grants to improve existing emergency medical services. 

Within the total for Maternal and Child Health Programs, the 

Committee recommends the following amounts: 

Budget Activity FY 2020 

Committee 

Sickle Cell Anemia Program ........................................................................................................................... $7,000,000 

Autism and Other Developmental Disorders .................................................................................................. 53,099,000 

Heritable Disorders ......................................................................................................................................... 22,000,000 

Healthy Start .................................................................................................................................................. 130,500,000 

Universal Newborn Hearing ............................................................................................................................ 17,818,000 

Emergency Medical Services for Children ...................................................................................................... 22,334,000 

Screening and Treatment for Maternal Depression ....................................................................................... 5,000,000 

Pediatric Mental Health Access ..................................................................................................................... 10,000,000 

Sickle Cell Anemia Demonstration Program 

The Committee provides $7,000,000 for the Sickle Cell Anemia 

Demonstration Program, $2,545,000 more than the fiscal year 2019 

enacted level and $7,000,000 more than the fiscal year 2020 budget 

request. 

Autism and Other Developmental Disorders 

The Committee recommends $53,099,000 for Autism and Other 

Developmental Disorders, $2,500,000 above the fiscal year 2019 enacted level and $53,099,000 above the fiscal year 2020 budget request. These programs seek to improve the health and well-being 

of children and adolescents with autism spectrum disorder and 

other developmental disabilities and to advance best practices for 

the early identification and treatment of autism and related developmental disabilities. 

Leadership Education in Neurodevelopmental and Related Disabilities.—The Committee provides not less than $35,245,000 for 

the Leadership Education in Neurodevelopmental and Related Disabilities (LEND) program, an increase of $1,745,000 above the fiscal year 2019 enacted level. This funding will support the program’s capacity to train professionals to screen, diagnose, and provide evidence-based interventions to individuals with autism spectrum disorder and other developmental disabilities as authorized 

by the Autism CARES Act (P.L. 113–157). This program provides 

advanced training to students and fellows from at least 12 disciplines in the identification, assessment, and treatment of children 

and youth with a wide range of developmental disabilities, including autism. 

Heritable Disorders 

The Committee provides $22,000,000 for the Heritable Disorders 

program, which is $5,617,000 above the fiscal year 2019 enacted 

level and $22,000,000 above the fiscal year 2020 budget request. 

This program supports activities that strengthen the newborn 

screening system to ensure infants born in every State receive 

48 

rapid identification, early intervention, and potentially life-saving 

treatment. 

Severe Combined Immune Deficiency.—Within the total amount 

for Heritable Disorders, the Committee provides $3,000,000, an increase of $1,000,000 above the fiscal year 2019 enacted level, for 

the third year of a grant to continue supporting wider implementation, education, and awareness of newborn screening for Severe 

Combined Immune Deficiency. 

Healthy Start 

The Committee recommends $130,500,000 for the Healthy Start program, $8,000,000 above the fiscal year 2019 enacted level and 

the fiscal year 2020 budget request. The program provides grants 

to communities with high rates of infant mortality to support primary and preventive health care services for mothers and their infants. 

Maternal Mortality.—The Committee recognizes the rising maternal mortality rate in the U.S. as a pressing public health issue. 

Analysis of maternal mortality review committee data indicates 

that over 60 percent of pregnancy-related deaths are preventable. 

The Committee includes $15,000,000, an increase of $3,000,000 

above the fiscal year 2019 enacted level, for Healthy Start grantees 

to support nurse practitioners, certified nurse midwives, physician 

assistants, and other maternal-child advance practice health professionals within all program sites nationwide. Clinical staff will 

provide direct access to well-woman care and maternity care services to reduce barriers in access to maternity care and help address 

maternal health disparities among high-risk and underserved 

women. Clinical staff will also support health educators by conducting training on maternal early warning signs. 

RYAN WHITE HIV/AIDS PROGRAM

Appropriation, fiscal year 2019 ......................................................... $2,318,781,000 

Budget request, fiscal year 2020 ....................................................... 2,388,781,000 

Committee Recommendation ............................................................. 2,435,157,000 

Change from enacted level ............................................................. +116,376,000 

Change from budget request .......................................................... +46,376,000 

The Ryan White Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) program funds activities to 

address the care and treatment of persons living with HIV/AIDS 

who are either uninsured or underinsured and need assistance to 

obtain treatment. The program provides grants to States and eligible metropolitan areas to improve the quality, availability, and coordination of health care and support services to include access to 

HIV-related medications; grants to service providers for early intervention outpatient services; grants to organizations to provide care 

to HIV infected women, infants, children, and youth; and grants to 

organizations to support the education and training of health care 

providers. 

Within the total for the Ryan White HIV/AIDS program, the 

Committee provides the following amounts: 

Budget Activity FY 2020 

Committee 

Emergency Assistance .................................................................................................................................... $677,535,000 

Comprehensive Care Programs ...................................................................................................................... 1,331,665,000 

49 

Budget Activity FY 2020 

Committee 

AIDS Drug Assistance Program ............................................................................................................. 912,017,000 

Early Intervention Program ............................................................................................................................. 207,567,000 

Children, Youth, Women, and Families .......................................................................................................... 76,047,000 

AIDS Dental Services ...................................................................................................................................... 13,296,000 

Education and Training Centers .................................................................................................................... 34,047,000 

Special Projects of National Significance ...................................................................................................... 25,000,000 

Domestic HIV Initiative ................................................................................................................................... 70,000,000 

Domestic HIV Initiative.—The Committee includes $70,000,000 

within the Ryan White HIV/AIDS Program for the first year of an 

initiative to reduce the transmission of HIV by 90 percent over the 

next ten years. Funds will be distributed to high-need jurisdictions 

to increase linkage, engagement, and retention in care with the 

goal of increasing viral suppression among people living with HIV. 

Minority AIDS Initiative.—The Committee includes $175,000,000 

within the Ryan White program for the Minority AIDS Initiative, 

an increase of $5,923,000 above the fiscal year 2019 enacted level 

and the fiscal year 2020 budget request. 

HEALTH CARE SYSTEMS

Appropriation, fiscal year 2019 ......................................................... $115,193,000 

Budget request, fiscal year 2020 ....................................................... 111,018,000 

Committee Recommendation ............................................................. 123,693,000 

Change from enacted level ............................................................. +8,500,000 

Change from budget request .......................................................... +12,675,000 

These programs support national activities that enhance health 

care delivery in the U.S. Activities include maintaining a national 

system to allocate and distribute donor organs to individuals awaiting transplant; building an inventory of cord blood units; maintaining a national system for the recruitment of bone marrow donors; 

operating the 340B drug discount program; and operating a national toll-free poison control hotline. 

Within the total for Health Care Systems, the Committee provides the following amounts: 

Budget Activity FY 2020 

Committee 

Organ Transplantation ................................................................................................................................... $32,049,000 

National Cord Blood Inventory ....................................................................................................................... 16,266,000 

C.W. Bill Young Cell Transplantation Program .............................................................................................. 24,609,000 

Office of Pharmacy Affairs ............................................................................................................................. 10,238,000 

Poison Control Centers ................................................................................................................................... 24,846,000 

Hansen’s Disease Program ............................................................................................................................ 13,706,000 

Hansen’s Disease Buildings and Facilities ................................................................................................... 122,000 

Hansen’s Payment to Hawaii ......................................................................................................................... 1,857,000 

Organ Transplantation 

The Committee includes $32,049,000 for the Organ Transplantation program, which is $6,500,000 above the fiscal year 2019 enacted level and $4,500,000 above the fiscal year 2020 budget request. 

Liver Transplantation Policy.—The Committee supports the new 

liver allocation policy that was recently passed by the Organ Procurement and Transplantation Network (OPTN) Board of Directors. 

The policy, called the ‘‘Acuity Model’’, reduces inequities by ensuring that transplants are prioritized by the medical need of patients 

50 

wherever they may live (rural or urban), whatever their socioeconomic status, and regardless of the organ procurement infrastructure in their area. 

National Living Donor Assistance Center Program.—The Committee includes $10,000,000 for the National Living Donor Assistance Center (NLDAC), an increase of $6,500,000 above the fiscal 

year 2019 enacted level. The NLDAC currently supports donation 

and expands access to transplantation through reimbursement of 

organ donor travel expenses. The Committee strongly supports 

HRSA’s three-year demonstration project to assess the impact of 

reimbursement of lost wages on individuals’ willingness to become 

living organ donors. The Committee urges HRSA to consider the 

expansion of NLDAC to reimburse a comprehensive range of living 

donor expenses for the greatest possible number of donors, including lost wages, childcare, eldercare, and similar expenses for donor 

caretakers and expansion of income eligibility for the program to 

allow as many donors as possible to qualify. 

National Cord Blood Inventory 

The Committee recommends $16,266,000 for the National Cord 

Blood Inventory (NCBI), the same as the fiscal year 2019 enacted 

level and $4,000,000 above the fiscal year 2020 budget request. The 

NCBI program builds a genetically and ethnically diverse inventory 

of high-quality umbilical cord blood for transplantation. 

C.W. Bill Young Cell Transplantation Program 

The Committee recommends $24,609,000 for the C.W. Bill Young 

Cell Transplantation program, the same as the fiscal year 2019 enacted level and the fiscal year 2020 budget request. This program 

provides support to patients who need a bone marrow or umbilical 

cord blood transplant, which may be necessary for some patients 

who have leukemia, lymphoma, sickle cell anemia, or other inherited metabolic or immune system disorders. The Committee appreciates HRSA’s efforts to increase the diversity of the volunteer registry and encourages HRSA to expand efforts to improve the availability, efficiency, and safety of transplants and improve outcomes 

for all transplant recipients regardless of socioeconomic status, age, 

ethnic ancestry, or any other individually defining characteristic. 

Regenerative Cell Therapy Pilot Registry.—The Committee looks 

forward to reviewing the state of the science report required by 

P.L. 114–104 on using adult stem cells and birthing tissues to develop new types of therapies for patients, for the purpose of considering the potential inclusion of such new types of therapies in the 

C.W. Bill Young Cell Transplantation Program. 

Office of Pharmacy Affairs 

The Committee provides $10,238,000 for the Office of Pharmacy 

Affairs, which is the same as the fiscal year 2019 enacted level and 

the fiscal year 2020 budget request. The Office of Pharmacy Affairs 

oversees the 340B Drug Pricing Program, which requires drug 

manufacturers to provide discounts on outpatient prescription 

drugs to certain safety net health care providers. 

51 

Poison Control Centers 

The Committee recommends $24,846,000 for Poison Control Centers, which is $2,000,000 above the fiscal year 2019 enacted level 

and the fiscal year 2020 budget request. This program funds poison 

centers, supports a national toll-free number (800–222–1222), and 

implements a nationwide media campaign to educate the public 

and health care providers about poison prevention and poison center services. 

Hansen’s Disease Program 

The Committee recommends $15,685,000 for the Hansen’s Disease Program, Hansen’s Disease buildings and facilities, and payment to Hawaii for treatment, which is the same as the fiscal year 

2019 enacted level and $2,175,000 above the fiscal year 2020 budget request. The Hansen’s Disease Program provides medical care, 

education, and research for Hansen’s disease (leprosy) and related 

conditions. 

RURAL HEALTH

Appropriation, fiscal year 2019 ......................................................... $317,794,000 

Budget request, fiscal year 2020 ....................................................... 188,645,000 

Committee Recommendation ............................................................. 317,794,000 

Change from enacted level ............................................................. – – – 

Change from budget request .......................................................... +129,149,000 

Rural Health programs provide funding to improve access, quality, and coordination of care in rural communities; for research on 

rural health issues; for technical assistance and recruitment of 

health care providers; for screening activities for individuals affected by the mining, transport, and processing of uranium; for the 

outreach and treatment of coal miners and others with occupationrelated respiratory and pulmonary impairments; and for the expansion of telehealth services. 

Attracting Health Care Providers to Rural Communities.—Rural 

healthcare providers ensure that essential health care services are 

made available to people living in rural and underserved communities, many of whom are seniors. However, the rural hospital closure crisis is leaving millions of patients without access to 

healthcare providers. Since 2010, nearly 104 rural hospitals have 

closed and one-in-three rural hospitals is financially vulnerable. 

The Committee requests an update in the fiscal year 2021 Congressional Justification on the best practices and strategies to attract 

healthcare practitioners to rural clinics and hospitals in areas with 

healthcare professional shortages. 

Coordinating with USDA.—The Committee notes the passage of 

the Agriculture Improvement Act and increased use of United 

States Department of Agriculture (USDA) programs to help better 

deliver health care services and improve health outcomes in rural 

America. The Committee further notes the Agriculture Improvement Act creates a new Rural Health Liaison position which is directed to consult with HHS in coordinating activities at the USDA 

that could impact health in rural America. The Committee encourages HRSA, namely the Federal Office of Rural Health Policy, to 

coordinate with USDA and, when established, the Rural Health Liaison to ensure communities have access to the full suite of federal 

52 

resources and those resources are used effectively to improve 

health outcomes. 

Rural Health Outreach Programs 

The Committee includes $84,609,000 for Rural Health Care Services Outreach, Network, and Quality Improvement Grants, which 

is $7,109,000 above the fiscal year 2019 enacted level and 

$43,798,000 above the 2020 budget request. These programs fund 

activities that improve access to and coordination of care in rural 

communities, with a focus on building sustainable health programs 

that continue beyond Federal funding. Outreach programs focus on 

supporting rural community needs related to issues such as behavioral health, oral health, care coordination, quality improvement, 

workforce training, chronic disease management and enhancing the 

rural health care delivery system of rural hospitals, clinics and 

other safety net providers. 

Telementoring Training Center.—The Committee includes 

$3,000,000 within the total for Rural Health Outreach Programs to 

support a telementoring training center to train academic medical 

centers and other centers of excellence in the creation of technology-enabled telementoring learning programs that facilitate the 

dissemination of best practice specialty care to primary care providers and care teams across the country. To ensure access to quality healthcare for underserved populations, there is a need for costeffective, long-term professional education and support of primary 

care providers in rural and underserved areas, especially for treatment of complex conditions such as diabetes, addiction (particularly 

concerning the opioid epidemic), hypertension, obesity, and HIV/ 

AIDS, among others. The Committee directs HRSA to give preference to models of professional education and support that are 

adaptable to culturally and regionally diverse populations. 

Rural Health Research and Policy Development 

The Committee includes $9,351,000 for Rural Health Research, 

the same as the fiscal year 2019 enacted level and $4,351,000 

above the fiscal year 2020 budget request. 

Rural Hospital Flexibility Grants 

The Committee includes $59,000,000 for the Rural Hospital 

Flexibility Grants program and the Small Rural Hospital Improvement program, which is $5,391,000 above the fiscal year 2019 enacted level and $59,000,000 above the fiscal year 2020 budget request. 

State Offices of Rural Health 

The Committee includes $12,500,000 for State Offices of Rural 

Health, $2,500,000 above the fiscal year 2019 enacted level and 

$12,500,000 above the fiscal year 2020 budget request. 

Black Lung Clinics 

The Committee includes $12,000,000 for Black Lung Clinics, 

$1,000,000 above the fiscal year 2019 enacted level and the fiscal 

year 2020 budget request. 

53 

Telehealth 

The Committee includes $28,500,000 for Telehealth, an increase 

of $4,000,000 above the fiscal year 2019 enacted level and 

$18,500,000 above the fiscal year 2020 budget request. Within the 

funds provided for Telehealth, the Committee provides $6,000,000 

for Telehealth Centers for Excellence, an increase of $2,000,000 

above the fiscal year 2019 enacted level. These Centers identify 

best practices, serve as national training resources, and test the efficacy of different telehealth clinical applications. Telehealth can 

provide rural patient access to quality primary and specialty care 

that would otherwise require patients to travel long distances for 

diagnosis and treatment. The Centers of Excellence serve to promote the adoption of telehealth programs across the country by 

validating technology, establishing training protocols, and by providing a comprehensive template for states to integrate telehealth 

into their state health provider network. Additional funding for the 

Centers of Excellence will serve to promote the adoption of telehealth services nation-wide and thus help to address the access to 

care issue faced by rural America. 

In addition, the Committee provides $2,000,000 to support a comprehensive evaluation of telehealth investments to date on rural 

areas and populations, to include an assessment of access, cost, experience, and effectiveness for patients and providers. The Committee directs HRSA to conduct additional evaluations in conjunction with an academic medical center not previously funded 

through the Telehealth Centers of Excellence program that has experience providing telemedicine services across the care continuum 

in medically underserved areas in both rural and urban settings. 

Telehealth Solutions and Virtual Models of Care.—The Committee believes that innovative, scalable, and patient-centric solutions are necessary to address the opioid crisis. The Committee 

urges HRSA to consider telehealth solutions and virtual models of 

care, specifically those models that allow for increased access to 

care professionals while decreasing geographic barriers and cost of 

care such as remote patient monitoring models. The Committee encourages the Secretary to consider pilot programs on a variety of 

telehealth solutions with the goal of finding an effective, scalable 

solution to treating substance use disorder in rural communities 

where access to care is limited. 

Rural Communities Opioid Response 

The agreement provides $100,000,000 for the Rural Communities 

Opioid Response program. This amount fully funds continuing activities—the reduction in comparison to fiscal year 2019 reflects 

one-time investments in fiscal year 2019 that do not need to be repeated in fiscal year 2020. 

Rural Health Residency Program 

The Committee includes $10,000,000 for Rural Health Residency 

Program, the same as the fiscal year 2019 enacted level and 

$10,000,000 above the fiscal year 2020 budget request. 

54 

FAMILY PLANNING

Appropriation, fiscal year 2019 ......................................................... $286,479,000 

Budget request, fiscal year 2020 ....................................................... 286,479,000 

Committee Recommendation ............................................................. 400,000,000 

Change from enacted level ............................................................. +113,521,000 

Change from budget request .......................................................... +113,521,000 

The Committee includes $400,000,000 for the Family Planning program, which is $113,521,000 above the fiscal year 2019 enacted 

level and the 2020 budget request. The Family Planning program 

administers Title X of the Public Health Service Act. This program 

plays a vital role not only in ensuring access to affordable contraceptive education, services, and supplies, but also in STD prevention, screening, and treatment; cervical and breast cancer 

screenings; first-line infertility services; and other community and 

health care services. 

The bill includes language directing the Secretary to carry out 

the Title X Family Planning program in accordance with the regulations that were in place on January 18, 2017. The Committee directs the Secretary to ensure that grantees certify that they: (1) 

provide medically accurate and complete counseling, including referral as requested, on all matters; (2) shall not condition the receipt of Title X-supported services on patients remaining sexually 

abstinent until marriage; and (3) will not make any appointments 

or referrals for patients that are contrary to the patient’s wishes. 

PROGRAM MANAGEMENT

Appropriation, fiscal year 2019 ......................................................... $155,250,000 

Budget request, fiscal year 2020 ....................................................... 151,993,000 

Committee Recommendation ............................................................. 155,250,000 

Change from enacted level ............................................................. – – – 

Change from budget request .......................................................... +3,257,000 

Program management supports the cost of Federal staff and related activities to coordinate, direct, and manage the programs of 

HRSA. 

Chief Dental Officer.—The Committee is pleased that HRSA has 

restored the position of Chief Dental Officer (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 requests an update in the fiscal year 2021 Congressional 

Budget Justification request on how the CDO is serving as the 

agency representative on oral health issues to international, national, State or local government agencies, universities, and oral 

health stakeholder organizations. 

Chronic Obstructive Pulmonary Disease.—The Committee commends HRSA for its partnership with the National Heart, Lung, 

and Blood Institute on educating providers and patients, including 

in rural and low-income communities, on COPD awareness, detection and management best practices. The agency’s efforts in this 

area are a model for effective collaboration across Federal agencies. 

Oral Health Literacy.—The Committee includes $500,000 to continue the development of an oral health awareness and education 

campaign across relevant HRSA divisions, including the Health 

Centers Program, Oral Health Workforce, Maternal and Child 

Health, Ryan White HIV/AIDS Program, and Rural Health. The 

55 

Committee directs HRSA to identify oral health literacy strategies 

that are evidence-based and focused on oral healthcare prevention 

and education, including prevention of oral disease such as early 

childhood and other caries, periodontal disease, and oral cancer. 

The Committee expects the Chief Dental Officer to play a key role 

in the design, monitoring, oversight, and implementation of this 

project. 

HRSA Strategy to Address Intimate Partner Violence 2017–2020 

and Project Catalyst.—The Committee recommends continued support for the HRSA Strategy to Address Intimate Partner Violence 

2017–2020, and specifically supports training, technical assistance 

and resource development to assist public health and health care 

professionals in better serving individuals and communities impacted by intimate partner violence. 

Targeted Investments in Persisten Poverty Counties.—The Committee supports targeted investments in impoverished areas, particularly in persistent poverty counties and in other high-poverty 

census tracts. To understand how programs funded through the 

Department are serving these particular areas, the Committee directs the Department to submit a report to the Committees on Appropriations on the percentage of funds allocated by all competitive 

grant programs and other anti-poverty programs in fiscal years 

2017, 2018 and 2019 and estimates for fiscal year 2020 to serve individuals living in persistent poverty counties, as defined as a 

county that has had 20 percent or more of its population living in 

poverty over the past 30 years, as measured by the 1990 and 2000 

decennial censuses and the most recent Small Area Income and 

Poverty estimates, and high-poverty areas, as defined as any census tract with a poverty rate of at least 20 percent as measured 

by the 2013–2017 5-year data series available from the American 

Community Survey of the Census Bureau. The Department shall 

report this information to the Committees within 90 days of such 

data being available and provide a briefing to the Committees not 

later than 180 days after enactment of this Act on how the Department is carrying out this directive. 

VACCINE INJURY COMPENSATION PROGRAM TRUST FUND

Appropriation, fiscal year 2019 ......................................................... $317,200,000 

Budget request, fiscal year 2020 ....................................................... 319,200,000 

Committee Recommendation ............................................................. 319,200,000 

Change from enacted level ............................................................. +2,000,000 

Change from budget request .......................................................... – – – 

The National Vaccine Injury Compensation Program provides a 

system of compensation for individuals with vaccine-associated injuries or deaths. Funds for claims from vaccines administered on 

or after October 1, 1988 are generated by a per-dose excise tax on 

the sale of selected prescribed vaccines. The Vaccine Injury Compensation Trust Fund receives revenues raised by this tax. Trust 

funds made available will support the liability costs of vaccines administered after September 30, 1988. The Committee recommends $11,200,000 for administration of 

the program, which is $2,000,000 above the fiscal year 2019 enacted level and the same as the fiscal year 2020 budget request. 

This increase will enable HRSA to hire additional contractors to 

conduct initial medical reviews and full-time medical officers to reVerDate Sep 11 2014 08:41 May 16, 2019 Jkt 036295 PO 00000 Frm 00059 Fmt 6659 Sfmt 6602 E:\HR\OC\HR062.XXX HR062
56 

view the contractors’ work. The additional funding will also allow 

HRSA to process additional claims and reduce the backlog of 

claims. 

CENTERS FOR DISEASE CONTROL AND PREVENTION

Appropriation, fiscal year 2019 ......................................................... $7,337,741,000 

Budget request, fiscal year 2020 ....................................................... 6,587,190,000 

Committee Recommendation ............................................................. 8,275,363,000 

Change from enacted level ............................................................. +937,622,000 

Change from budget request .......................................................... +1,688,173,000 

The Committee recommendation for the Centers for Disease Control and Prevention (CDC) program level includes $7,140,755,000 

in discretionary budget authority, $55,358,000 in mandatory funds 

under the terms of the Energy Employees Occupational Illness 

Compensation Program Act, $854,250,000 in transfers from the 

Prevention and Public Health (PPH) Fund, and $225,000,000 in 

transfers from the Nonrecurring Expenses Fund. 

CDC’s mission is to protect Americans from health, safety, and 

security threats, which it accomplishes by supporting core public 

health functions at State, local, and Tribal health departments, detecting and responding to new and emerging health threats, promoting health and safety, and providing leadership in the public 

health workforce. 

IMMUNIZATION AND RESPIRATORY DISEASES

Appropriation, fiscal year 2019 ......................................................... $798,405,000 

Budget request, fiscal year 2020 ....................................................... 730,231,000 

Committee Recommendation ............................................................. 847,558,000 

Change from enacted level ............................................................. +49,153,000 

Change from budget request. ......................................................... +117,327,000 

The Committee recommendation includes $499,758,000 in discretionary budget authority and $347,800,000 in transfers from the 

PPH Fund. 

Immunization grants are awarded to State and local public 

health departments for planning, developing, and conducting childhood, adolescent, and adult immunization programs, including enhancement of the vaccine delivery infrastructure. CDC directly 

maintains a stockpile of vaccines, supports consolidated purchase of 

vaccines for State and local health agencies, and conducts surveillance, investigations, and research into the safety and efficacy of 

new and presently-used vaccines. 

Within the total for Immunization and Respiratory Diseases, the 

Committee recommends the following amounts: 

Budget Activity FY 2020 

Committee 

Section 317 Immunization Program ............................................................................................................... $650,000,000 

National Immunization Survey .............................................................................................................. 12,864,000 

Acute Flaccid Myelitis ........................................................................................................................... 10,000,000 

Influenza Planning and Response ................................................................................................................. 197,558,000 

Acute Flaccid Myelitis.—The Committee includes $10,000,000 to 

support CDC’s efforts to identify the cause, prevention, and treatment of acute flaccid myelitis. Since 2014, this rare but serious condition that affects the nervous system was confirmed in 579 cases 

in at least 41 States, with a median age of four years old. 

57 

Cost Estimates.—The Committee looks forward to reviewing the 

fiscal year 2021 report on estimated funding needs of the Section 

317 Immunization Program and urges that the report be updated 

and submitted not later than February 1, 2020. The updated report 

should include an estimate of optimum State and local operations 

funding, as well as a discussion of the role of the 317 Program, as 

coverage for vaccination under public and private resources continues to evolve. The fiscal year 2021 report should include specific 

information on the estimated cost to fully address evidence-based 

public health strategies that could be funded through the CDC to 

improve coverage for human papillomavirus and influenza. The 

Committee also notes that this long-standing report failed to meet 

the expected deadline by many months and sometimes has been 

late by over a year. In order to assess the needs of this critical program concurrent with the appropriations cycle, the Committee expects the report to be submitted on time. 

Immunization Rates.—The measles outbreaks in multiple States 

highlight the importance of immunizations, which are the most effective way to protect the public from highly infectious and potentially deadly diseases. The Committee is concerned that areas 

where immunization rates have fallen below the threshold necessary to prevent future outbreaks put the public health at risk. 

The Committee believes that it is important to public health to increase the rate at which people in the U.S. choose to vaccinate 

themselves and their children. Within the funding provided, the 

Committee supports CDC’s efforts to understand and address obstacles to vaccination including access, hesitancy and misinformation. 

Influenza Vaccine.—The Committee includes an increase of 

$10,000,000 to improve the effectiveness of and reduce barriers to 

seasonal influenza vaccination. Furthermore, the Committee encourages CDC to consider including vaccines produced through recombinant DNA technology in addition to traditionally-produced 

vaccines in future solicitations to facilitate the competitive process 

for all vaccine manufacturers. 

Section 317 Immunization Program.—The Committee views the 

317 Immunization Program, including the Vaccines for Children 

Program, as a pivotal part of the U.S. public health infrastructure. 

The Committee includes an increase of $39,153,000 for the enhancement of this infrastructure, as it is critical to ensure high 

vaccination coverage levels, prevention of vaccine-preventable diseases, and rapid response to outbreaks. 

HIV/AIDS, VIRAL HEPATITIS, SEXUALLY TRANSMITTED DISEASES, AND

TUBERCULOSIS PREVENTION

Appropriation, fiscal year 2019 ......................................................... $1,132,278,000 

Budget request, fiscal year 2020 ....................................................... 1,318,056,000 

Committee Recommendation ............................................................. 1,335,197,000 

Change from enacted level ............................................................. +202,919,000 

Change from budget request .......................................................... +17,141,000 

CDC provides national leadership and support for prevention research and the development, implementation, and evaluation of 

evidence-based HIV, viral hepatitis, sexually transmitted diseases 

(STD), and tuberculosis (TB) prevention programs serving persons 

affected by, or at risk for, these infections. Activities include surVerDate Sep 11 2014 06:50 May 16, 2019 Jkt 036295 PO 00000 Frm 00061 Fmt 6659 Sfmt 6602 E:\HR\OC\HR062.XXX HR062
58 

veillance, epidemiologic and laboratory studies, and prevention activities. CDC provides funds to State, local, and tribal health departments and community-based organizations to develop and implement integrated community prevention plans. 

Within the total for HIV/AIDS, Viral Hepatitis, STD, and TB 

Prevention, the Committee recommends the following amounts: 

Budget Activity FY 2020 

Committee 

Domestic HIV/AIDS Prevention and Research ................................................................................................ $945,631,000 

School Health-HIV .................................................................................................................................. 50,000,000 

Viral Hepatitis ................................................................................................................................................ 50,000,000 

Sexually Transmitted Diseases ....................................................................................................................... 167,310,000 

Tuberculosis .................................................................................................................................................... 152,256,000 

Infectious Diseases & the Opioid Epidemic .................................................................................................. 20,000,000 

Community-Based Organizations.—The Committee recognizes 

that community-based organizations play a crucial role because of 

their capacity to reach communities highly impacted by HIV. The 

Committee directs CDC to ensure that planning councils reflect 

their local epidemic by including community-based organizations 

and people living with HIV. The Committee further requests CDC’s 

progress of engaging such communities be included in the fiscal 

year 2021 Congressional Budget Justification. 

Congenital Syphilis.—The Committee is concerned regarding the 

recent data showing that congenital syphilis (CS) cases are at the 

highest level since 1997. The Committee urges CDC to design an 

initiative that will, among other approaches, strengthen prenatal 

outreach programs in high burden States, for patients, including 

those with a drug addiction, who are at a high risk for contracting 

syphilis. The Committee further urges CDC to increase awareness 

of CS through community organizations and to inform STD and 

drug addiction clinics of the importance of multi-testing throughout 

pregnancy. 

Emphasis on Comprehensive Services.—In recent fiscal years, the 

Committee has provided historic resources to combat the opioid epidemic, with a particular focus on expanding access to treatment, 

and treating and preventing comorbidities that can be associated 

with injection drug use. At the Committee’s urging, the Department has rightfully prioritized efforts that increase access to treatment and recovery services. For all programs not focused exclusively on prevention of substance abuse, the Committee directs the 

Department to continue its emphgasis on evidence-based medical 

interventions, and to ensure that all such interventions, including 

programs that focus on harm reduction, provide referral to treatment and recovery services. 

HIV Initiative.—The Committee includes an increase of 

$140,000,000 to support the goal of reducing new HIV infections by 

90 percent in the next ten years. CDC will focus on areas of the 

country that constitute the majority of new HIV infections annually 

to diagnose people with HIV as early as possible after infection, 

link people to effective treatment and prevention strategies, and respond rapidly to clusters and outbreaks of new HIV infections. Innovative data management solutions will be developed and deployed, and access to pre-exposure prophylaxis increased, along 

with better detection and response to HIV clusters. 

59 

Infectious Diseases and the Opioid Epidemic.—The Committee includes an increase of $15,000,000 to strengthen efforts to conduct 

surveillance to improve knowledge of the full scope of the burden 

of infectious diseases (including viral, bacterial and fungal pathogens) associated with substance use disorders, and in collaboration 

with State and local health departments, health care facilities, and 

providers, deploy existing authorities to prevent and detect infectious diseases associated with substance use disorder and strengthen linkages to addiction, mental health and infectious diseases 

treatment. 

Latent Tuberculosis.—CDC estimates that there are up to 13 million individuals in the U.S. with latent TB infection. The preventive treatment of individuals with latent TB infection will prevent 

future active TB cases and reduce future healthcare costs. The 

Committee requests a report on progress towards TB elimination 

in the U.S., including identification and preventive treatment of TB 

infection cases, in the fiscal year 2021 Congressional Budget Justification. 

Pre-Exposure Prophylaxis.—The Committee recognizes that the 

advancement of Pre-Exposure Prophylaxis (PrEP) is one of the 

most effective methods for preventing the spread of HIV, yet there 

continues to be barriers to access to PrEP. The Committee also requests that CDC and HRSA work to engage with, and support infrastructure for the implementation of PrEP in a diversity of service sites, including community health centers, Title X and STD 

clinics. 

School Health.—The Committee includes an increase of 

$16,919,000 to bolster school capacity for sexual health education, 

and access to sexual health services and safe and supportive environments. 

Sexually Transmitted Infections.—The Committee includes an increase of $10,000,000 for sexually transmitted infections (STI) prevention and control. The Committee is concerned that STI rates 

across the U.S. are at a 20-year high. Furthermore, the Committee 

recognizes that sexually transmitted diseases are associated with 

increased risk of HIV acquisition. The Committee urges CDC to include, as part of the focused HIV initiative, an expansion of STI 

programs and initiatives designed to increase HIV testing; Pre-Exposure Prophylaxis and condom availability at STD clinics; increase in the number of Disease Intervention Specialists to prevent 

the spread of STIs and HIV; and implementation of HIV and STI 

education and prevention programs in schools. 

Tuberculosis.—The Committee includes an increase of 

$10,000,000 to combat tuberculosis through research for new tools, 

and support of prevention and treatment. 

Viral Hepatitis.—The Committee recognizes that viral hepatitis 

can cause serious health consequences for people living with HIV 

and that 25 percent of people living with HIV are also living with 

hepatitis C virus (HCV), and about 10 percent of people living with 

HIV are also living with hepatitis B virus (HBV). The Committee 

urges CDC to incorporate viral hepatitis prevention, testing, and 

linkage to care and treatment into its response to the HIV epidemic. 

Viral Hepatitis Vaccine.—The Committee is concerned that despite the availability of hepatitis B (HBV) vaccine, less than 25 perVerDate Sep 11 2014 06:50 May 16, 2019 Jkt 036295 PO 00000 Frm 00063 Fmt 6659 Sfmt 6602 E:\HR\OC\HR062.XXX HR062
60 

cent of adults age 19 and older are vaccinated. According to CDC’s 

most recent survey of Vaccination Coverage Among Adults, this 

poor vaccination rate remains flat and has not improved in several 

years. Therefore, the Committee urges the CDC to partner with 

State, local and tribal health departments, along with leading national hepatitis B organizations to develop a plan that takes into 

account best practices and model strategies to increase HBV immunization coverage among adults. The Committee requests a report 

within 90 days of enactment of this Act of CDC’s plan to increase 

the rate of HBV adult vaccination to the levels necessary to eliminate new infections of hepatitis B in the U.S. and to improve collaboration and coordination across CDC to achieve this plan. 

EMERGING AND ZOONOTIC INFECTIOUS DISEASES

Appropriation, fiscal year 2019 ......................................................... $620,372,000 

Budget request, fiscal year 2020 ....................................................... 509,472,000 

Committee Recommendation ............................................................. 644,622,000 

Change from enacted level ............................................................. +24,250,000 

Change from budget request .......................................................... +135,150,000 

The Committee recommendation includes $592,622,000 in discretionary appropriations and $52,000,000 in transfers from the PPH 

Fund. Programs funded under Emerging and Zoonotic Infectious 

Diseases (EZID) support the prevention and control of infectious 

diseases through surveillance, outbreak investigation and response, 

research, and prevention. 

Within the total for EZID, the Committee recommends the following amounts: 

Budget Activity FY 2020 

Committee 

Core Infectious Diseases ................................................................................................................................ $438,800,000 

Emerging Infectious Diseases ............................................................................................................... 188,797,000 

Lab Safety and Quality ......................................................................................................................... 8,000,000 

Antibiotic Resistance Initiative ............................................................................................................. 173,000,000 

Vector-borne Diseases ........................................................................................................................... 43,603,000 

Lyme Disease ......................................................................................................................................... 13,000,000 

Prion Disease ......................................................................................................................................... 7,000,000 

Chronic Fatigue Syndrome .................................................................................................................... 5,400,000 

Food Safety ..................................................................................................................................................... 66,000,000 

National Health Care Safety Network ............................................................................................................ 22,750,000 

Quarantine ...................................................................................................................................................... 31,572,000 

Advanced Molecular Detection ....................................................................................................................... 32,500,000 

Epidemiology and Laboratory Capacity .......................................................................................................... 40,000,000 

Healthcare-Associated Infections ................................................................................................................... 12,000,000 

Harmful Algal Blooms .................................................................................................................................... 1,000,000 

Advanced Molecular Detection.—The Committee includes an increase of $2,500,000 to support the dissemination of technologies to 

State and local health departments to advance the nation’s public 

health system. 

Antibiotic Resistance.—The Committee includes an increase of 

$5,000,000 and recognizes the importance of addressing the problem of antibiotic-resistant bacteria through a ‘‘One Health’’ approach, and by tracking resistance through local, regional, national, 

and global surveillance. The Committee encourages CDC to competitively award research activities that address aspects of antibiotic resistance related to ‘‘One Health,’’ including global surveillance, and research and development for new tools to counter antibiotic resistance among entities, including public academic medical 

61 

centers, veterinary schools with agriculture extension services, and 

public health departments whose proposals are in line with CDC’s 

strategy for addressing antibiotic resistant bacteria. Furthermore, 

the Committee is pleased with CDC’s Antimicrobial Resistance 

(AMR) Challenge and its implementation of a ‘‘One Health’’ approach to encourage governments, private industries, and non-governmental organizations across the world to combat AMR. The 

Committee encourages CDC to build on findings and experiences 

from the AMR Challenge as it winds down the effort later this 

year. 

Harmful Algal Blooms.—The Committee includes $1,000,000 to 

support the work that CDC is doing to conduct surveillance for and 

report health concerns related to harmful algal blooms and urges 

CDC to continue this work with a focus on fresh water and other 

affected waters: (1) to provide more outreach to numerous State 

and local public health officials to use these surveillance and reporting systems; (2) to work with other agencies, in addition to the 

U.S. Army Corp of Engineers, including the Environmental Protection Agency, National Institute of Environmental Health Sciences, 

National Oceanic and Atmospheric Administration, and United 

States Geological Survey, to integrate disparate sets of data to 

allow for a broader understanding of the spatial and temporal dynamics of the environmental and health impacts of harmful algal 

blooms (HABs); and (3) to continue to work together on efforts that 

support HAB surveillance, emergency response, and mitigation of 

public health impacts. The Committee encourages CDC to expand 

the scope of this work to include focus on impacted populations 

where citizens rely on potentially impacted waters for their drinking water, fishing and recreation, including the Great Lakes. There 

is an important nexus between freshwater and drinking water, and 

CDC is encouraged to expand their work regionally to understand 

HABs impact on our nation’s largest fresh bodies of water. 

Food Safety.—The Committee includes an increase of $6,000,000 

to help address the critical unmet needs in the nation’s food safety 

system, in part through programs that enhance State and local 

public health capacity to support vital national surveillance, improve foodborne outbreak detection and investigations, enhance 

food safety prevention efforts, and maintain vigilance for emerging 

threats to our nation’s food supply. 

Lyme Disease.—The Committee includes an increase of 

$1,000,000 to intensify CDC’s efforts to develop improved 

diagnostics, and bolster critical prevention and surveillance networks. 

Mycotic Diseases.—The Committee includes an increase of 

$2,000,000 in Emerging Infectious Diseases to enhance efforts to 

prevent illness and death from fungal diseases. 

National Healthcare Safety Network.—The Committee includes 

an increase of $1,750,000 for the National Healthcare Safety Network. The Committee encourages CDC to work with the Centers 

for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) to 

identify and deploy existing policy authorities and resources that 

may be used to increase the number of hospitals and other health 

care facilities (including long-term care facilities) that report antibiotic use and resistance data to the National Healthcare Safety 

62 

Network with the aim of meeting the goal set forth in the National 

Action Plan for Combating Antibiotic Resistance Bacteria for 95 

percent of hospitals to report these data by 2020. Within one year, 

CDC, CMS and ONC should report to Congress on the new strategies implemented to increase reporting, current number of hospitals and other health care facilities reporting, and any additional 

authorities or resources needed to meet the National Action Plan 

goal. 

Prion Disease.—The Committee provides an increase of $1,000,000 for prion disease. The Committee supports the work of 

the National Prion Disease Pathology Surveillance Center to develop a real-time field test for the presence of chronic wasting disease (CWD). The CWD-related workload is in addition to the Center’s ongoing efforts related to human prion diseases that includes 

research, surveillance, tissue banking, and technical and supportive assistance to providers and families. 

Vector-Borne Diseases.—The Committee includes an increase of 

$5,000,000 and recognizes the critical role of CDC to continue to 

address new and existing vector-borne disease threats, such as the 

Zika virus; advance innovation and discovery; and provide support 

to States and Territories, particularly those at the greatest risk of 

outbreaks. 

Vector-Borne Disease Centers of Excellence.—The Committee is 

concerned about the Pacific Northwest being an underserved region 

for funding and representation in the Regional Centers of Excellence in Vector-Borne Diseases network recently established by 

CDC. The ecology, disease transmission dynamics, and resources 

for vector-borne disease training, surveillance, and control in the 

Northwest differ significantly from those in the five regional centers currently funded. The Committee encourages CDC to examine 

options to provide greater coverage of the Northwest region for vector-borne disease resources. 

CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION

Appropriation, fiscal year 2019 ......................................................... $1,187,771,000 

Budget request, fiscal year 2020 ....................................................... 951,250,000 

Committee Recommendation ............................................................. 1,357,571,000 

Change from enacted level ............................................................. +169,800,000 

Change from budget request .......................................................... +406,321,000 

The Committee recommendation includes $1,080,121,000 in discretionary appropriations and $277,450,000 in transfers from the 

PPH Fund. Programs supported within Chronic Disease Prevention 

and Health Promotion (CDPHP) provide national leadership and 

support for State, tribal, and community efforts to promote health 

and well-being through the prevention and control of chronic diseases. 

The recommendation for CDPHP maintains the existing program 

line items as they were funded in fiscal year 2019 and does not 

provide funding for the America’s Health Block Grant proposed 

again in the fiscal year 2020 Congressional Budget Justification. 

The Committee supports evidence-based strategies to address public health priorities through proven State-based grant programs, 

utilizing related national organizations for technical assistance, 

and encourages CDC to continue and expand these successful approaches. 

63 

Within the total provided, the Committee recommends the following amounts: 

Budget Activity FY 2020 

Committee 

Tobacco ........................................................................................................................................................... $250,000,000 

Nutrition, Physical Activity, and Obesity ........................................................................................................ 58,920,000 

High Obesity Rate Counties .................................................................................................................. 15,000,000 

School Health ................................................................................................................................................. 17,400,000 

Food Allergies ........................................................................................................................................ 2,000,000 

Health Promotion ............................................................................................................................................ 29,100,000 

Glaucoma ............................................................................................................................................... 4,000,000 

Vision and Eye Health ........................................................................................................................... 2,000,000 

Alzheimer’s Disease ............................................................................................................................... 10,500,000 

Inflammatory Bowel Diseases ............................................................................................................... 1,000,000 

Interstitial Cystitis ................................................................................................................................. 1,100,000 

Excessive Alcohol Use ........................................................................................................................... 5,000,000 

Chronic Kidney Disease ......................................................................................................................... 2,500,000 

Chronic Disease Education & Awareness ............................................................................................. 3,000,000 

Prevention Research Centers ......................................................................................................................... 32,461,000 

Heart Disease and Stroke .............................................................................................................................. 160,062,000 

Diabetes .......................................................................................................................................................... 168,129,000 

National Diabetes Prevention Program .......................................................................................................... 30,000,000 

Cancer Prevention and Control ...................................................................................................................... 410,049,000 

Breast and Cervical Cancer .................................................................................................................. 245,000,000 

WISEWOMAN .................................................................................................................................. 46,770,000 

Breast Cancer Awareness for Young Women ........................................................................................ 4,960,000 

Cancer Registries .................................................................................................................................. 51,440,000 

Colorectal Cancer .................................................................................................................................. 45,294,000 

Comprehensive Cancer .......................................................................................................................... 19,675,000 

Johanna’s Law ....................................................................................................................................... 12,000,000 

Ovarian Cancer ...................................................................................................................................... 12,000,000 

Prostate Cancer ..................................................................................................................................... 14,205,000 

Skin Cancer ........................................................................................................................................... 5,000,000 

Cancer Survivorship Resource Center ................................................................................................... 475,000 

Oral Health ..................................................................................................................................................... 20,000,000 

Safe Motherhood/Infant Health ...................................................................................................................... 60,000,000 

Maternal Mortality Review Committees ................................................................................................ 12,000,000 

Preterm Birth ......................................................................................................................................... 2,000,000 

Sudden Unexpected Infant Death & Sudden Unexplained Death in Childhood ................................... 2,000,000 

Other Chronic Diseases .................................................................................................................................. 31,000,000 

Arthritis .................................................................................................................................................. 12,000,000 

Epilepsy ................................................................................................................................................. 11,500,000 

National Lupus Patient Registry ........................................................................................................... 7,500,000 

Racial and Ethnic Approaches to Community Health ................................................................................... 71,950,000 

Good Health and Wellness in Indian Country ....................................................................................... 21,000,000 

Million Hearts ................................................................................................................................................. 4,000,000 

National Early Child Care Collaboratives ...................................................................................................... 4,500,000 

Hospitals Promoting Breastfeeding ................................................................................................................ 10,000,000 

Alzheimer’s Disease.—The Committee provides an increase of $5,000,000 to build a robust Alzheimer’s and other dementias public health infrastructure across the country, as authorized by the 

Building Our Largest Dementia (BOLD) Infrastructure for Alzheimer’s Act. 

Arthritis.—The Committee includes an increase of $1,000,000 for 

arthritis, the country’s leading cause of disability, to further support the national dissemination of evidence-based programs. 

Chronic Disease Education and Awareness.—The Committee recognizes CDC’s work with stakeholders to expand public health education and awareness activities that help to improve surveillance, 

diagnosis, and proper treatment for chronic diseases. The Committee includes $3,000,000 for a new effort to award grants to address chronic diseases and their risk factors that do not already 

have a specified amount under CDC in this report. This approach 

64 

would utilize a competitive grant process to strengthen the science 

base for prevention, education, and public health awareness for a 

variety of chronic diseases such as chronic obstructive pulmonary 

disease and psoriasis. 

Chronic Obstructive Pulmonary Disease.—The Committee urges 

CDC to do more to address Chronic Obstructive Pulmonary Disease 

(COPD), the nation’s fourth leading cause of death, including fully 

engaging with the timely implementation of the COPD National 

Action Plan, developed by the National Heart, Lung, Blood Insitute 

in coordination with CDC. CDC should fully integrate COPD surveillance, research, prevention, and management strategies into its 

existing chronic disease efforts. 

Colorectal Cancer.—The Committee includes an increase of 

$2,000,000 for colorectal cancer. The Committee is concerned with 

the increasing rate of colorectal cancer among younger adults. The 

Committee urges CDC to identify risk factors that may be associated with this increase among younger adults and further identify 

trends of increase by race and socioeconomic status. The Committee requests a report on the risk factors for colorectal cancer no 

later than 180 days after enactment of this Act. 

Diabetes.—The Committee includes an increase of $20,000,000 

for additional efforts to prevent diabetes, its complications, and to 

reduce inequities through prevention strategies, translational research, and education. The Committee also includes an increase of 

$4,700,000 for the Diabetes Prevention Program to expand efforts 

of this public-private partnership that provides diabetes prevention 

for people with prediabetes. The Committee encourages CDC to 

support diabetes screening programs located in hospital settings. 

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 includes 

an increase of $500,000 for the National Early Child Care 

Collaboratives Program to support direct provider-level training in 

implementation of healthy eating and physical activity best practices, including strategies for engaging families. Funds will also 

support technical assistance to States for integrating such best 

practices into existing State and local systems for early care and 

education, such as professional development for providers. The additional $500,000 above the fiscal year 2019 funding level shall be 

used to expand geographic reach to at least two new geographic 

areas, with a focus on provider-level interventions, and to support 

the testing of pilots regarding innovative ways to engage families 

in health promotion in early care and education. 

Eating Disorders.—The Committee encourages CDC to assist 

States in collecting data by including standard questions on 

unhealthy weight control practices for eating disorders, including 

binge eating, through the Youth Risk Behavior Surveillance System and the Behavioral Risk Factor Surveillance System. 

Epilepsy.—The Committee includes an increase of $3,000,000 to 

support epidemiologic studies, national dissemination of evidencebased programs to improve access of care and expand provider education and public awareness campaigns to reduce stigma. 

Excessive Alcohol Use.—The Committee includes an increase of 

$1,000,000 to strengthen the scientific foundation for preventing 

excessive alcohol use. 

65 

Fatty Liver Disease.—The Committee recognizes that the prevalence of non-alcoholic fatty liver disease and non-alcoholic 

steatohepatitis is growing dramatically in the U.S. The Committee 

encourages CDC to develop prevention, education, diagnosis, and 

treatment programs to combat existing incidence and provide appropriate prevention activities to mitigate further increases. 

Food Allergies.—The Committee includes $2,000,000 for a schoolbased effort to reduce potentially fatal anaphylactic reactions due 

to food allergies. 

Glaucoma.—The Committee is pleased by CDC’s work in improving glaucoma screening, referral, and treatment particularly for 

populations that face disparity in access to glaucoma care. Early 

detection and treatment are vital in glaucoma care because, by the 

time vision loss or other symptoms appear, permanent and irreversible damage to the eye has already occurred and lost vision 

cannot be restored. 

Heart Disease and Stroke.—The Committee includes an increase 

of $20,000,000 to support, strengthen, and expand evidence-based 

initiatives, given that almost half of the U.S. population has some 

form of cardiovascular disease. 

High Obesity Rate Counties.—The Committee continues to include $15,000,000 to support the rural extension and outreach services grants for rural counties with an obesity prevalence of over 40 

percent. CDC is encouraged to give preference to projects in States 

where at least 10 percent of counties meet the requirements of the 

program. 

Hospitals Promoting Breastfeeding.—The Committee includes an 

increase of $2,000,000 for evidence-based practice improvements in 

hospitals, with an emphasis on physician and care provider education, with the aim of supporting breastfeeding and increasing 

breastfeeding rates. 

Inflammatory Bowel Diseases.—The Committee commends CDC 

for investing in research on the epidemiology of Irritable Bowel 

Diseases (IBD) in the U.S. as well as on disparities in treatment 

patterns and overall health outcomes within minority populations 

and underserved communities. The Committee recognizes the need 

to increase the rate of early diagnoses and to improve health outcomes in these populations. The Committee encourages CDC to 

continue supporting this research and to develop a plan to reduce 

the time for persons from underserved communities to receive a diagnosis, including by increasing understanding and awareness of 

IBD among these populations and the healthcare providers who 

serve them. 

Interstitial Cystitis.—The Committee includes an increase of 

$100,000 for interstitial cystitis activities. This increase is to support additional funding for education, outreach, and public awareness activities. 

Johanna’s Law.—The Committee includes an increase of 

$4,500,000 for CDC’s Inside Knowledge Campaign that raises 

awareness of the five main types of gynecological cancer: cervical, 

ovarian, uterine, vaginal, and vulvar. This campaign educates 

women of all ages, races, and ethnic groups, and healthcare providers. 

Lung Cancer.—The Committee remains concerned about the high 

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66 

ment of lung cancer translates into higher survival rates, but only 

16 percent of lung cancer cases are diagnosed early when the disease is most treatable. The Committee encourages CDC to work to 

increase public awareness of lung cancer screening for individuals 

at high risk for lung cancer and increase the percentage of highrisk individuals who are screened. 

Lymphedema.—The Committee commends the Division of Cancer 

Prevention and Control for working to expand access to resources 

on lymphedema. The Committee notes that lymphedema is the 

most common side effect of many cancer treatments and urges the 

Division to work with stakeholders to advance information and resources for healthcare professionals and the public on this often debilitating condition. 

Nutrition, Physical Activity and Obesity.—The Committee includes an increase of $2,000,000 to expand efforts to protect the 

health of individuals at every stage of life by encouraging regular 

physical activity, good nutrition, and preventing adult and childhood obesity. 

Oral Health.—The Committee includes an increase of $1,000,000 

for oral health. The Committee is aware that there are some Community Dental Health Coordinators (CDHCs) that serve in schoolbased settings where they provide oral health education, 

screenings, cleanings and dental sealants. The Committee encourages CDC to engage Federal partners, external stakeholders, including current and former grantees of the program, to determine 

how CDHCs can be used to continually educate and provide preventative care in school-based settings. 

Ovarian Cancer.—The Committee includes an increase of 

$2,000,000 for ovarian cancer prevention activities. The Committee 

notes that ovarian cancer causes more deaths each year than any 

other gynecological cancer in the U.S. 

Polycystic Ovary Syndrome.—The Committee recognizes the significant health burden of Polycystic Ovary Syndrome (PCOS), 

which has metabolic, reproductive, dermatologic, and mental health 

manifestations. PCOS is a pervasive metabolic health issue that increases the risk of type 2 diabetes, infertility, nonalcoholic fatty 

liver disease, pregnancy complications, endometrial cancer, depression, cardiovascular disease, and other comorbidities. Studies report inadequate information about PCOS, a delay in diagnosis, and 

50 to 70 percent of PCOS patients go undiagnosed or misdiagnosed. 

There is also a paucity of data in the U.S. on PCOS prevalence, 

ethnic and genetic differences, and its impacts on long-term health. 

Therefore, the Committee encourages CDC to raise awareness and 

increase knowledge about PCOS among the general public, PCOS 

patients and health care providers. 

Prostate Cancer.—The Committee includes an increase of 

$1,000,000 to expand the public’s awareness of prostate cancer 

risks, screening and treatment, and improve surveillance of this 

disease, which is the most commonly diagnosed cancer in men and 

the second leading cause of cancer deaths among men in the U.S. 

Prevention Research Centers.—The Committee includes an increase of $7,000,000 for additional institutions to join the national 

network committed to conducting prevention research and translating research results into policy and public health practice that 

address local public health needs. 

67 

Psoriatic Disease.—The Committee recognizes the growing body 

of evidence linking psoriatic disease, which impacts more than 

eight million Americans, to other comorbidities such as cardiovascular disease, mental health and substance abuse challenges, 

kidney disease, and other conditions. The Committee commends 

CDC for identifying opportunities for expanded research on psoriatic disease in its Public Health Agenda for Psoriasis and Psoriatic 

Arthritis. 

Racial and Ethnic Approaches to Community Health.—The Committee includes an increase of $16,000,000 for Racial and Ethnic 

Approaches to Community Health for additional approved but unfunded organizations for the first year of a three-year cooperative 

agreement, with at least two additional grantees from each of the 

racial and ethnic target populations described in the funding announcement CDC–RFA–DP18–1813. The Committee continues 

funding for Good Health and Wellness in Indian Country at the fiscal year 2019 enacted level. 

Reducing Residual Cardiovascular Risk.—Cholesterol therapies, 

such as statins, have been successful in reducing risk of cardiovascular disease in many individuals, but substantial residual and 

untreated risk remains beyond cholesterol management. The Committee commends CDC for playing an important role in bridging 

the knowledge gap and encouraging healthcare professionals and 

their patients to take action toward well-informed decisions for 

care. The Committee urges CDC to promote awareness among physicians and patients of residual cardiovascular risk beyond statin 

therapy, and the importance of taking preventative action to reduce 

this risk. 

Safe Motherhood and Infant Health.—The Committee recognizes 

CDC’s ongoing efforts to address the pressing public health issue 

of rising maternal mortality rate in the U.S. Each year, almost 700 

women die during or within a year of the end of their pregnancy 

in the U.S. as a result of pregnancy or delivery complications. 

These statistics are all the more concerning given that accurate 

and complete data regarding the cause of pregnancy-related deaths 

is lacking. The Committee includes $12,000,000 in the Safe Motherhood and Infant Health Program for CDC to continue its technical assistance to existing State Maternal Mortality Review Committees (MMRCs) to build stronger data systems, improve data collection at the State level and create consistency in data collection 

across State MMRCs. The Committee believes this investment will 

lead to better information necessary to provide accurate national 

statistics for U.S. maternal mortality rates and will inform datadriven actions for preventing these deaths. Furthermore, the Committee commends CDC for funding State-based Perinatal Quality 

Collaboratives (PQCs) that focus on improving maternal and neonatal outcomes using known prevention strategies such as reducing 

early elective deliveries. CDC is encouraged to continue support for 

PQCs particularly due to the rise in maternal mortality rates and 

neonatal abstinence syndrome (NAS) as a result of the opioid crisis. 

PQCs are working to address a number of important health threats 

to women and infants, including the impacts of opioid use disorder 

and NAS. This platform can also be integrated into existing Statebased bio-surveillance efforts to pilot the integration of a maternal 

health component, ensuring any additional efforts work within the 

68 

PQC infrastructure and strengthen those existing efforts to improve the data available and its ability to impact and improve clinical care and community linkages. 

Furthermore, the Committee requests CDC to provide routine 

updates on the status of implementing programs authorized under 

the Preventing Maternal Deaths Act of 2018. 

Skin Cancer.—The Committee includes an increase of $2,000,000 

for skin cancer prevention activities, the most common cancer in 

the U.S. 

Sudden Unexpected Infant Death and Sudden Unexplained Death 

in Childhood.—The Committee is aware that Sudden Infant Death 

Syndrome (SIDS) is the leading cause of death of infants under one 

year of age in the U.S. Currently, there is no known way to prevent 

SIDS, but there are ways to reduce the risk. Several factors 

present during pregnancy, at birth, and throughout the first year 

after birth that can impact SIDS risk. The Committee encourages 

CDC to increase public awareness and provider education to reduce 

the risks. 

Furthermore, the bill includes $2,000,000 for training grants to 

States, local governmental entities and nonprofits to improve the 

quality of death scene investigations and resulting prevention efforts, utilizing CDC training curriculum, with standardized forms 

and doll re-enactment. 

Tobacco.—The Committee is deeply troubled by the dramatic increase in e-cigarette use among youth and concurs with the Surgeon General that youth use of e-cigarettes has reached epidemic 

levels. The Committee is also concerned that certain populations 

and regions of the country continue to experience high rates of tobacco use and are disproportionately burdened by tobacco-related 

disease and premature death. The Committee urges CDC to continue its efforts to reduce this and other disparities in tobacco use 

prevalence. Accordingly, the Committee includes an increase of 

$40,000,000 so that CDC and States can use evidence-based strategies to more robustly respond to the public health risk caused by 

the dramatic increase of youth use of e-cigarettes, enhance efforts 

to reduce tobacco use among certain populations and in areas with 

high tobacco use rates and tobacco-related mortality, as well as expand its highly effective Tips from Former Smokers campaign. 

Vision and Eye Health.—The Committee includes an increase of 

$1,000,000 to enhance programs that prevent blindness and preserve sight. The Committee changes the title of this line to better 

reflect the extensive surveillance, epidemiological, and public 

health research and intervention capacity of CDC’s Vision Health 

Initiative and its wide-ranging vision and eye health promotion, 

and disease prevention partnerships with Federal, State, and community partners. 

WISEWOMAN.—The Committee strongly supports the mission of 

the WISEWOMAN program, helping uninsured and under-insured 

low-income women ages 40 to 64 understand and reduce their risk 

for heart disease and stroke; by providing risk factor screenings; 

and connecting them with lifestyle programs, health counseling and 

other community resources that promote healthy behavior change. 

The Committee includes an increase of $25,650,000 to expand the 

program to all 50 States and the District of Columbia. 

69 

BIRTH DEFECTS, DEVELOPMENTAL DISABILITIES, DISABILITIES AND

HEALTH

Appropriation, fiscal year 2019 ......................................................... $155,560,000 

Budget request, fiscal year 2020 ....................................................... 112,000,000 

Committee Recommendation ............................................................. 161,560,000 

Change from enacted level ............................................................. +6,000,000 

Change from budget request .......................................................... +49,560,000 

This account supports efforts to conduct research on and address 

the causes of birth defects and developmental disabilities, as well 

as reduce the complications of blood disorders and improve the 

health of people with disabilities. 

Within the total, the Committee recommends the following 

amounts: 

Budget Activity FY 2020 

Committee 

Child Health and Development ...................................................................................................................... $65,800,000 

Birth Defects ......................................................................................................................................... 19,000,000 

Fetal Death ............................................................................................................................................ 900,000 

Fetal Alcohol Syndrome ......................................................................................................................... 11,000,000 

Folic Acid ............................................................................................................................................... 3,150,000 

Infant Health ......................................................................................................................................... 8,650,000 

Autism ................................................................................................................................................... 23,100,000 

Health and Development for People with Disabilities ................................................................................... 68,660,000 

Disability & Health incl. Child Development ........................................................................................ 30,000,000 

Tourette Syndrome ................................................................................................................................. 2,000,000 

Early Hearing Detection and Intervention ............................................................................................. 10,760,000 

Muscular Dystrophy ............................................................................................................................... 6,000,000 

Attention Deficit Hyperactivity Disorder ................................................................................................ 1,900,000 

Fragile X ................................................................................................................................................ 2,000,000 

Spina Bifida .......................................................................................................................................... 8,000,000 

Congenital Heart ................................................................................................................................... 8,000,000 

Public Health Approach to Blood Disorders ................................................................................................... 4,400,000 

Hemophilia Activities ...................................................................................................................................... 3,500,000 

Hemophilia Treatment Centers ....................................................................................................................... 5,100,000 

Thalassemia ................................................................................................................................................... 2,100,000 

Neonatal Abstinence Syndrome ...................................................................................................................... 2,000,000 

Surveillance for Emerging Threats to Mothers and Babies .......................................................................... 10,000,000 

Congenital Heart Defects.—The Committee includes an increase 

of $4,000,000 for grants or cooperative agreements to provide technical assistance to State and local agencies to complement intramural programs and to conduct applied research related to screening newborns, evaluation, diagnosis, results reporting, data collection, surveillance, intervention programs, systems, and follow-up of 

children identified through Critical Congenital Heart Defects 

screening to better understand the long-term outcomes and needs 

of this population. 

Duchenne Muscular Dystrophy Surveillance.—The Committee is 

encouraged by CDC’s support of efforts to implement the updated 

ICD 10 code for Duchenne and Becker Muscular Dystrophy 

(DBMD) and requests an update on the use of MD STARnet to 

measure how accurately and effectively the code is being applied to 

known cases of DBMD. The Committee is also aware of CDC’s ongoing efforts to assess healthcare utilization and disease burden in 

DBMD and requests an update in the fiscal year 2021 Congressional Budget Justification. 

Health Promotion for People with Disabilities.—The Committee 

supports the National Center on Birth Defects and Developmental 

Disabilities in funding the National Center on Health, Physical AcVerDate Sep 11 2014 06:50 May 16, 2019 Jkt 036295 PO 00000 Frm 00073 Fmt 6659 Sfmt 6602 E:\HR\OC\HR062.XXX HR062
70 

tivity, and Disability (NCHPAD) and its primary goal of promoting 

better health, wellness, and quality of life for people with disabilities. The Committee encourages NCHPAD to implement a demonstration project to develop and implement strategies to reduce diabetes and obesity among people who are mobility-impaired. 

Maternal Mortality.—The Committee remains concerned about 

the maternal mortality rate in the U.S., which doubled in the last 

two decades. In light of studies exploring the effect of Cesarean sections on maternal mortality, the Committee urges CDC to provide 

technical assistance for State databases and data collection of pregnancy-associated and pregnancy-related deaths, to include data on 

whether a delivery was vaginal, via Cesarean section, or otherwise. 

Furthermore, the Committee is concerned that implicit bias may be 

a factor in the disproportionately high mortality rate of black mothers compared to their white counterparts. Accordingly, the Committee encourages the CDC to provide technical assistance to State 

Maternal Mortality Review Committees that includes evidence-informed interventions to address implicit bias in health care providers and to States establishing Maternal Mortality Review Committees. 

Myotonic Dystrophy.—The Committee recognizes that myotonic 

dystrophy is a serious degenerate genetic condition that is often 

difficult to diagnose. However, early detection can improve health 

outcomes for individuals living with the condition. The Committee 

encourages CDC to review how it can advance education, knowledge, and related outreach activities to foster myotonic screening 

for newborns. The Committee requests an update on these activities in the fiscal year 2021 Congressional Budget Justification. 

Spina Bifida.—The Committee includes an increase of $2,000,000 

for Spina Bifida, the most common permanently disabling congenital disability compatible with life in the U.S. While Spina 

Bifida and related neural tube defects are sometimes preventable 

through education and adequate daily folic acid consumption, there 

are an estimated 166,000 individuals, more than half of whom are 

18 and older, living with all forms of this complex birth defect. The 

Committee encourages CDC to use funding provided for the National Spina Bifida Program to support the continuation of the 

Spina Bifida Clinical Care Monitoring and Tracking Program 

which works with the National Spina Bifida Registry to guide the 

health care community in best treatment options for people living 

with Spina Bifida. 

Surveillance for Emerging Threats to Mothers and Babies.—The 

Committee recognizes the innovative work of the National Center 

on Birth Defects and Developmental Disabilities, and also recognizes the threat that the Zika virus continues to pose to mothers 

and babies across the United States and the U.S. Territories. The 

Committee urges the Center to continue to track mothers and infants to better understand how exposure to Zika and other emerging threats can affect children as they age. 

Thalassemia.—The Committee is aware of the critical work done 

by the thalassemia program at CDC in identifying patients with 

this rare genetic blood disorder and connecting them to services 

and to life-saving treatment centers. Thalassemia patients experience serious comorbidities that can impact almost every aspect of 

their lives. The Committee urges CDC to continue and strengthen 

71 

this collaboration among thalassemia treatment centers, non-profits organizations, and patients and their families. 

PUBLIC HEALTH SCIENTIFIC SERVICES

Appropriation, fiscal year 2019 ......................................................... $496,397,000 

Budget request, fiscal year 2020 ....................................................... 468,000,000 

Committee Recommendation ............................................................. 603,897,000 

Change from enacted level ............................................................. +107,500,000 

Change from budget request .......................................................... +135,897,000 

This account supports programs that provide leadership and 

training for the public health workforce, support infrastructure to 

modernize public health surveillance, promote and facilitate science 

standards and policies, and improve access to information on disease outbreaks and other threats. 

Within the total, the Committee recommends the following 

amounts: 

Budget Activity FY 2020 

Committee 

Health Statistics ............................................................................................................................................. $160,397,000 

Surveillance, Epidemiology, and Informatics ................................................................................................. 387,500,000 

Public Health Workforce ................................................................................................................................. 56,000,000 

Familial Hypercholesterolemia.—The Committee includes 

$500,000 for provider education and public awareness for Familial 

Hypercholesterolemia (FH), an inherited genetic disorder that 

causes early, aggressive, heart disease. The Committee is concerned that more than 90 percent of those in the U.S. who are affected with FH are completely unaware of the condition, and supports CDC working with a national organization to increase provider education and public awareness so that early diagnosis and 

treatment can normalize the risk of heart disease for people with 

FH. 

Neurological Diseases Surveillance System.—The Committee is 

pleased that CDC initiated developmental and implementation 

work for the National Neurological Conditions Surveillance System 

(NNCSS). The NNCSS will provide a foundation for the evaluation 

and understanding of neurological conditions by collecting information on incidence and prevalence, geographic clusters of conditions, 

demographic variability, outcome measures and health care practices and utilization. The Committee provides $5,000,000 within 

the total for Surveillance, Epidemiology, and Informatics to add at 

least one severe neuropsychiatric disorder, such as schizophrenia, 

to NNCSS implementation. 

Primary Immunodeficiencies.—The Committee includes 

$3,000,000, an increase of $2,000,000, to continue and expand the 

existing program of education and awareness related to primary 

immunodeficiencies. This program has proven effective in identifying undiagnosed patients and linking them to centers of care. 

With NIH estimating that one to two percent of the U.S. population 

is affected by these disorders, a greater commitment is required to 

maximize the benefits of this effort. 

Public Health Data Surveillance/IT Systems Modernization.— 

The Committee acknowledges that CDC has taken important steps 

to modernize its surveillance infrastructure through the implementation of its Surveillance Strategy and development of its essential 

72 

Surveillance Data Platform, but recognizes that more needs to be 

done to ensure that CDC can develop and deploy world-class data 

and analytics that scale rapidly in emergencies, provide predictive 

capacity to identify emerging threats, reduce burden on public 

health partners who are reporting data and ensure bidirectional information flows. The nation’s public health data systems are antiquated, rely on obsolete surveillance methods, and are in dire need 

of security upgrades. Lack of interoperability, reporting consistency, and data standards leads to errors in quality, timeliness, and 

communication. In addition, CDC must take steps to ensure that 

the public health workforce possesses and maintains state of the 

art data science skills needed to put the data to use through public 

health action. The Committee includes $100,000,000 for the first 

year of a multi-year initiative for CDC to lead the effort to improve 

public health data by providing support to Federal data modernization efforts including the National Center for Health Statistics, 

State, local, tribal and territorial partners, and to work with academic and private sector partners to innovate new tools and approaches for maximizing the public health impact of the data that 

keeps our communities safe and healthy. Within 120 days of enactment of this Act, the Committee requests a multi-year plan for this 

initiative, including at least five years of budget projections, as well 

as the innovation strategy for surveys conducted by the National 

Center for Health Statistics. 

Public Health Workforce.—The bill includes an increase of 

$5,000,000 to support expansion of workforce and training programs, including the Epidemic Intelligence Service, that provide 

HHS, and State and local health departments with skilled staff, 

technical assistance, and education services. The Committee recognizes that a robust and well-trained public health workforce is critical. 

ENVIRONMENTAL HEALTH

Appropriation, fiscal year 2019 ......................................................... $209,350,000 

Budget request, fiscal year 2020 ....................................................... 157,000,000 

Committee Recommendation ............................................................. 243,350,000 

Change from enacted level.. ........................................................... +34,000,000 

Change from budget request. ......................................................... +86,350,000 

The Committee recommendation includes $226,350,000 in discretionary appropriations and $17,000,000 in transfers from the PPH 

Fund. 

Programs supported within Environmental Health conduct surveillance and data collection to detect and address emerging pathogens and environmental toxins that pose significant challenges to 

public health, as well as determine whether and at what level of 

exposure these substances are harmful to humans. 

Within the total, the Committee recommends the following 

amounts: 

Budget Activity FY 2020 

Committee 

Environmental Health Laboratory ................................................................................................................... $73,750,000 

Newborn Screening Quality Assurance Program ................................................................................... 20,000,000 

Newborn Screening /Severe Combined Immunodeficiency Diseases .................................................... 1,250,000 

Environmental Health Activities ..................................................................................................................... 54,600,000 

Environmental Health Activities ............................................................................................................ 21,000,000 

Safe Water ............................................................................................................................................. 8,600,000 

73 

Budget Activity FY 2020 

Committee 

Amyotrophic Lateral Sclerosis (ALS) Registry ....................................................................................... 10,000,000 

Climate Change ..................................................................................................................................... 15,000,000 

Environmental and Health Outcome Tracking Network ................................................................................. 40,000,000 

Asthma ........................................................................................................................................................... 34,000,000 

Trevor’s Law ................................................................................................................................................... 1,000,000 

Childhood Lead Poisoning .............................................................................................................................. 40,000,000 

Childhood Lead Poisoning.—The Committee includes an increase 

of $5,000,000 to strengthen blood lead surveillance by supporting 

additional State and local programs to improve blood lead screening test rates, identify high-risk populations, and ensure effective 

follow-up for children with elevated blood lead levels. 

Climate and Health.—The Committee recognizes that communities are already having to adapt to the health effects caused by 

climate change, including health threats from increased spread of 

vector-borne diseases, higher levels of air pollution, hotter temperatures, extreme weather events, and longer allergy seasons. The 

Committee includes an increase of $5,000,000 for the Climate and 

Health Program to expand investments to a larger number of 

States, cities, or Tribes to plan for public health threats caused by 

climate change, and to conduct an analysis of grantee programs to 

allow for broad sharing of best practices and strategies that best 

protect public health. 

Environmental Health Tracking Network.—The Committee includes an increase of $6,000,000 to add at least three States that 

participate in this public health surveillance system that develops 

a comprehensive data source of environmental hazard, exposure, 

and health data. 

Laboratory Harmonization.—The Committee includes an increase 

of $4,000,000 to enhance efforts of the Environmental Health Laboratory to harmonize the reporting of clinical laboratory test results, so that more patients can have access to dependable and accurate results, which play an important role in medical decisionmaking. 

National Asthma Control Program.—The Committee includes an 

increase of $5,000,000 for the National Asthma Control Program 

(NACP). The Committee directs the NACP to increase the number 

of States carrying out programmatic activities and to use a population-adjusted burden of disease criteria as a significant factor for 

new competitive awards. 

Newborn Screening.—The Committee includes an increase of 

$4,000,000 to further support newborn screening efforts and so that 

affected newborns can receive early and often life-saving treatment. 

Per and Polyfluoroalkyl Substances Screening.—The Committee 

includes $5,000,000 for CDC to conduct a health study at multiple 

domestic, non-Department of Defense sites to examine the health 

effects of exposure to per- and polyfluoroalkyl substances (PFAS) 

for the purpose of expanding the science about the relationship between PFAS exposure and certain health outcomes. 

74 

INJURY PREVENTION AND CONTROL

Appropriation, fiscal year 2019 ......................................................... $648,559,000 

Budget request, fiscal year 2020 ....................................................... 628,839,000 

Committee Recommendation ............................................................. 697,559,000 

Change from enacted level ............................................................. +49,000,000 

Change from budget request .......................................................... +68,720,000 

Programs supported within Injury Prevention and Control provide national leadership on violence and injury prevention, conduct 

research and surveillance, and promote evidence-based strategies 

to inform real-world solutions to prevent premature death and disability and to reduce human suffering and medical costs caused by 

injury and violence. 

Within the total, the Committee recommends the following 

amounts: 

Budget Activity FY 2020 

Committee 

Intentional Injury ............................................................................................................................................ $144,730,000 

Domestic Violence and Sexual Violence ................................................................................................ 34,700,000 

Child Maltreatment ...................................................................................................................... 7,250,000 

Child Sexual Abuse Prevention .................................................................................................... 2,000,000 

Youth Violence Prevention ..................................................................................................................... 15,100,000 

Domestic Violence Community Projects ................................................................................................ 5,500,000 

Firearm Injury and Mortality Prevention Research ............................................................................... 25,000,000 

Rape Prevention .................................................................................................................................... 54,430,000 

Suicide ................................................................................................................................................... 10,000,000 

National Violent Death Reporting System ...................................................................................................... 25,500,000 

Unintentional Injury ........................................................................................................................................ 11,800,000 

Traumatic Brain Injury .......................................................................................................................... 6,750,000 

Drowning ................................................................................................................................................ 2,000,000 

Elderly Falls ........................................................................................................................................... 3,050,000 

Injury Prevention Activities ............................................................................................................................. 28,950,000 

Opioid Overdose Prevention and Surveillance ............................................................................................... 475,579,000 

Injury Control Research Centers .................................................................................................................... 11,000,000 

Adverse Childhood Experiences.—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 geographic, race and ethnicity, disability and socioeconomic status and to work with State and local health departments to implement evidence-based interventions aimed at reducing adverse childhood experience. 

Child Sexual Abuse Prevention.—While the incidence of child sexual abuse is believed to be far greater than reported, it is estimated 

to affect nearly 10 percent of all U.S. children, according to CDC. 

In light of the harmful physical, cognitive and emotional effects on 

a child’s development, a far more proactive approach is needed to 

prevent child sexual abuse. Therefore, the Committee includes 

$2,000,000 for a new research effort supporting the development, 

evaluation, and dissemination of effective child sexual abuse prevention practice and policy. 

Drowning.—The Committee includes $2,000,000 to prevent fatal 

drownings. This funding allows CDC to scale proven drowning prevention programs with national organizations working with underserved youth, and to support State drowning surveillance efforts 

and a national plan on water safety. 

75 

Elderly Falls.—The Committee includes an increase of 

$1,000,000 to enhance programs and research to prevent older 

adult falls. 

Firearm Injury and Mortality Prevention Research.—The Committee includes $25,000,000 for firearm injury and mortality prevention research through a public health approach that focuses on 

data to understand its causes and to inform prevention strategies. 

According to CDC data, there were nearly 40,000 firearm-related 

deaths in 2017. In addition, more than 130,000 non-fatal firearm 

injuries from assault or self-harm are treated annually in hospital 

emergency departments. The Committee directs CDC to focus on 

activities that will have the greatest potential public health impact 

including strengthen data collection to better understand firearm 

deaths and non-fatal injuries to help inform firearm injury prevention; and conduct evaluation and other applied research projects 

that align with the Institute of Medicine/National Research Council 

recommendations to better understand public health prevention 

strategies for reducing firearm injury and death. Projects should 

focus on addressing the gaps in knowledge, such as the characteristics of firearm violence, risk and protective factors for self-directed 

and interpersonal firearm violence, and effectiveness of interventions to prevent firearm injury such as safe storage practices. 

Injury Prevention Research Centers.—The Committee includes an 

increase of $2,000,000 to award additional Center grants. Furthermore, the Committee is aware of alarming rates of injury and their 

significant potential to affect the long-term psychological and physical well-being of college athletes. Thus, the Committee encourages 

CDC to work with the Centers to identify best practice standards 

to prevent these injuries. 

National Violent Death Reporting System.—The Committee includes an increase of $2,000,000 for the only State-based surveillance system that pools information together from multiple sources 

into a usable, anonymous database of all types of violent deaths so 

that prevention efforts can be informed and progress monitored. 

Opioid Abuse and Overdose Prevention.—The Committee commends CDC for its leadership on combating opioid drug overdoses. 

The Committee encourages the Director to continue to implement 

these activities based on population-adjusted burden of disease criteria, including mortality data (age adjusted rate), as significant 

criteria when distributing funds for overdose prevention activities. 

Rape Prevention.—The Committee includes an increase of 

$5,000,000 to amplify funding to States and Territories to support 

essential rape prevention and education programs. 

Suicide.—The Committee recognizes that suicide is devastating 

communities across the U.S., as evidenced by more than 47,000 

deaths in 2017. While depression and other mental health conditions are a significant risk factor for suicide, less than half of the 

people who die from suicide have a known mental health condition. 

The Committee includes $10,000,000 for a new effort at CDC to explore the leading mechanisms of suicide deaths and identify prevention strategies to reduce the deaths by suicide through pilot 

projects to enhance the completeness of data to capture mechanisms of death; expand syndromic surveillance; and support research and evaluation projects to understand the pathways and 

76 

mechanisms that contribute to suicide attempts, and identify prevention strategies. 

NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH

Appropriation, fiscal year 2019 ......................................................... $336,300,000 

Budget request, fiscal year 2020 ....................................................... 190,000,000 

Committee Recommendation ............................................................. 346,300,000 

Change from enacted level ............................................................. +10,000,000 

Change from budget request .......................................................... +156,300,000 

The National Institute for Occupational Safety and Health 

(NIOSH) conducts applied research, develops criteria for occupational safety and health standards, and provides technical services 

to government, labor, and industry, including training for the prevention of work-related diseases and injuries. This appropriation 

supports surveillance, health hazard evaluations, intramural and 

extramural research, instrument and methods development, dissemination, and training grants. 

Within the total for NIOSH, the Committee recommends the following amounts: 

Budget Activity FY 2020 

Committee 

National Occupational Research Agenda ....................................................................................................... $118,000,000 

Agricultural, Forestry, and Fishing ........................................................................................................ 27,500,000 

Education and Research Centers ................................................................................................................... 31,000,000 

Personal Protective Technology ...................................................................................................................... 20,000,000 

Mining Research ............................................................................................................................................. 59,500,000 

Firefighter Cancer Registry ............................................................................................................................ 1,600,000 

Other Occupational Safety and Health Research .......................................................................................... 116,200,000 

National Mesothelioma Registry and Tissue Bank ............................................................................... 1,600,000 

Total Worker Health ............................................................................................................................... 8,300,000 

Agricultural, Forestry, and Fishing.—The Committee includes an 

increase of $2,000,000 to expand efforts to protect workers in this 

sector by providing leadership in applied research, disease and injury surveillance, education and prevention. 

Education and Research Centers.—The Committee includes an 

increase of $2,000,000 to further support efforts to reduce work-related injuries and illnesses by prevention research, and implementing programs to improve occupational health and safety. 

Firefighter Cancer Registry.—The Committee includes an increase of $600,000 to further support the implementation of the 

Firefighter Cancer Registry Act of 2018. 

Mesothelioma.—The Committee recognizes that CDC undertook a 

feasibility study for a mesothelioma patient registry in fiscal year 

2019 to evaluate case finding methodologies to determine incidence 

and prevalence, demographics and risk factors. The Committee includes an increase of $400,000 to take the next step toward establishment of a national mesothelioma patient registry through collecting data on individuals suffering from the disease and identify 

gaps in treatment in order for researchers to develop new treatments and a cure for this disease, which is among the deadliest 

and most painful cancers. The Committee encourages CDC to establish priorities for successful outcomes; develop and revise standards of care and treatment best practices; share evidence-based information between physicians across the country; and implement 

benchmarks to improve care for mesothelioma patients. 

77 

Total Worker Health.—The Committee includes an increase of 

$2,000,000 in the Other Occupational Safety and Health Research 

line for the Total Worker Health program that funds Centers of Excellence that advance the overall safety, health, and well-being of 

the diverse population of workers in our nation. 

ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION

PROGRAM

Appropriation, fiscal year 2019 ......................................................... $55,358,000 

Budget request, fiscal year 2020 ....................................................... 55,358,000 

Committee Recommendation ............................................................. 55,358,000 

Change from enacted level ............................................................. – – – 

Change from budget request .......................................................... – – – 

The Energy Employees Occupational Illness Compensation Program (EEOICPA) provides compensation to employees and survivors of employees of Department of Energy facilities and private 

contractors who have been diagnosed with a radiation-related cancer, beryllium-related disease, or chronic silicosis as a result of 

their work. NIOSH estimates occupational radiation exposure for 

cancer cases, considers and issues determinations for adding classes of workers to the Special Exposure Cohort, and provides administrative support to the Advisory Board on Radiation and Worker 

Health. 

GLOBAL HEALTH

Appropriation, fiscal year 2019 ......................................................... $488,621,000 

Budget request, fiscal year 2020 ....................................................... 456,984,000 

Committee Recommendation ............................................................. 523,621,000 

Change from enacted level ............................................................. +35,000,000 

Change from budget request .......................................................... +66,637,000 

Through its Global Health activities, CDC coordinates, cooperates, participates with, and provides consultation to other nations, 

Federal agencies, and international organizations to prevent and 

contain diseases and environmental health problems and to develop 

and apply health promotion activities. In cooperation with ministries of health and other appropriate organizations, CDC tracks 

and assesses evolving global health issues and identifies and develops activities to apply CDC’s technical expertise. 

Within the total, the Committee recommends the following 

amounts: 

Budget Activity FY 2020 

Committee 

Global AIDS Program ...................................................................................................................................... $128,421,000 

Global Tuberculosis ........................................................................................................................................ $10,000,000 

Global Immunization Program ........................................................................................................................ $226,000,000 

Polio Eradication ................................................................................................................................... $176,000,000 

Other Global/Measles ............................................................................................................................ $50,000,000 

Parasitic Diseases and Malaria ..................................................................................................................... $26,000,000 

Global Disease Detection and Emergency Response ..................................................................................... $123,400,000 

Global Public Health Capacity Development ................................................................................................. $9,800,000 

Global Disease Detection.—With the intent of maintaining the 

global health capacity developed over the past five years with 

Ebola supplemental funds, the Committee includes an increase of 

$25,000,000 to advance global efforts to detect epidemic threats 

earlier, respond more effectively, and prevent avoidable crises. The 

78 

Committee supports CDC’s efforts to provide additional support for 

program implementation, and scientific and technical experts in Atlanta and in the field with concentrated efforts on countries, populations, and programs where resources will have the greatest public 

health impact. 

Global Health Research.—The Committee supports CDC’s work 

to protect 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. As emerging infectious 

diseases like Ebola and Zika represent profound challenges for our 

health system, the Committee supports continued and enhanced 

work in research and development aimed at creating new tools to 

respond to health threats at home and abroad. The Committee 

urges CDC officials to ensure that the importance of research and 

development to global health security is appropriately reflected in 

their international engagements. 

Global Health Security Strategy.—The Committee is disappointed 

that the Global Health Security Strategy failed to meet the required deadline and remains past due. The Committee expects the 

Administration to prioritize this document and promptly provide it 

to the appropriate Congressional committees. 

Global Tuberculosis.—The Committee provides and increase of 

$10,000,000 above the fiscal year 2019 program level for Global Tuberculosis activities. These funds are intended to supplement, not 

supplant, existing funding provided through a transfer from Tuberculosis in the HIV/AIDS, Viral Hepatitis, STD and TB Prevention 

account to Global Tuberculosis in the Global Health account. 

Global Water Strategy.—The Committee recognizes CDC’s work 

to provide sustainable Water, Sanitation, & Hygiene (WASH) in 

healthcare facilities, aligned with the 2017 US Global Water Strategy, and to support WASH efforts to contribute to the elimination 

of cholera as a public health threat as outlined by Ending Cholera—A Global Roadmap to 2030. The Committee urges CDC to increase its WASH efforts in areas where Neglected Tropical Diseases are endemic, and to enhance efforts to improve the impact of 

WASH interventions in humanitarian emergencies by assisting 

partners to improve monitoring of WASH interventions, conduct research on innovative WASH interventions, and improve disease 

surveillance for WASH-related illness among refugees, displaced 

persons, and emergency affected populations. The Committee further encourages CDC to provide laboratory support for global 

WASH activities. 

Population-based Surveillance Platforms.—The Committee directs at least $3,000,000 to be used to support existing longitudinal 

population-based infectious disease surveillance platforms that enable comparative analysis between urban and rural populations in 

the developing world. 

Soil Transmitted Helminth and Related Diseases of Poverty.—The 

Committee includes $1,500,000 to extend currently funded CDC 

projects aimed at surveillance, source remediation and clinical care 

to reduce soil transmitted helminth infection. 

79 

PUBLIC HEALTH PREPAREDNESS AND RESPONSE

Appropriation, fiscal year 2019 ......................................................... $855,200,000 

Budget request, fiscal year 2020 ....................................................... 825,000,000 

Committee Recommendation ............................................................. 880,200,000 

Change from enacted level ............................................................. +25,000,000 

Change from budget request .......................................................... +55,200,000 

The Public Health Preparedness and Response (PHPR) account 

supports programs that build and strengthen national preparedness for public health emergencies, both naturally-occurring and intentional. PHPR supports needs assessments, response planning, 

training, epidemiology and surveillance, and upgrades for laboratory capacity and communications systems. 

Within the total, the Committee recommends the following 

amounts: 

Budget Activity FY 2020 

Committee 

State and Local Preparedness and Response Capability .............................................................................. $708,200,000 

Public Health Emergency Preparedness Cooperative Agreement ......................................................... 700,000,000 

Academic Centers for Public Health Preparedness .............................................................................. 8,200,000 

CDC Preparedness and Response .................................................................................................................. 172,000,000 

BioSense ................................................................................................................................................ 23,000,000 

All Other CDC Preparedness and Response ......................................................................................... 149,000,000 

Public Health Preparedness Cooperative Agreements.—The Committee includes an increase of $25,000,000 to enhance support to 

State and local health departments in developing and maintaining 

capable, flexible, and adaptable public health systems ready to rapidly respond in an emergency. 

Strategic National Stockpile.—The Committee recognizes the reorganization of the Strategic National Stockpile (SNS) to the Office 

of the Assistant Secretary for Preparedness and Response. The 

Committee expects that CDC will continue its significant role in 

providing scientific expertise in decision-making related to procurement of countermeasures, and maintaining strong relationships 

with State and local public health departments to facilitate efficient deployment of countermeasures in public health emergencies. 

BUILDINGS AND FACILITIES

Appropriation, fiscal year 2019 ......................................................... $30,000,000 

Budget request, fiscal year 2020 ....................................................... 30,000,000 

Committee Recommendation ............................................................. 255,000,000 

Change from enacted level ............................................................. +225,000,000 

Change from budget request .......................................................... +225,000,000 

The Committee recommendation includes $30,000,000 in discretionary budget authority and $225,000,000 in transfers from the 

HHS Nonrecurring Expenses Fund. 

This account supports capital projects as well as repairs and improvements to restore, maintain, and improve CDC’s assets at facilities in seven States and San Juan, Puerto Rico. 

The Committee continues language to allow CDC to retain unobligated funds in the Individual Learning Accounts from departed 

employees to support the replacement of the underground and surface coal mine safety and health research facility. 

Chamblee Research Support Building 108 and Campus Infrastructure Improvements.—The Committee directs $225,000,000 

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search Support Building 108 and campus infrastructure improvements. These one-time projects will result in enhanced research 

collaboration and long-term lease cost avoidance. 

CDC-WIDE ACTIVITIES AND PROGRAM SUPPORT

Appropriation, fiscal year 2019 ......................................................... $323,570,000 

Budget request, fiscal year 2020 ....................................................... 155,000,000 

Committee Recommendation ............................................................. 323,570,000 

Change from enacted level ............................................................. – – – 

Change from budget request .......................................................... +168,570,000 

The Committee recommendation includes $163,570,000 in discretionary funds and $160,000,000 in transfers from the PPH Fund. 

This account supports public health leadership and support activities at CDC. 

Within the total, the Committee recommends the following 

amounts: 

Budget Activity FY 2020 

Committee 

Preventive Health and Health Services Block Grant ..................................................................................... $160,000,000 

Public Health Leadership and Support .......................................................................................................... 113,570,000 

Infectious Disease Rapid Response Reserve Fund ........................................................................................ 50,000,000 

Infectious Disease Rapid Response Reserve Fund.—The Committee includes $50,000,000 for the Infectious Diseases Rapid Response Reserve Fund. The Reserve Fund will provide an immediate 

source of funding to quickly respond to a future, imminent infectious disease crisis that endangers lives. Funds are available until 

expended. 

Preventive Health and Health Services Block Grant.—The Committee continues to support the Preventive Health and Health 

Services Block grant, of which at least $7,000,000 is to support direct services to victims of sexual assault and to prevent rape. 

NATIONAL INSTITUTES OF HEALTH

Appropriation, fiscal year 2019 ......................................................... $39,084,000,000 

Budget request, fiscal year 2020 ....................................................... 34,151,068,000 

Committee Recommendation ............................................................. 41,084,000,000 

Change from enacted level ............................................................. +2,000,000,000 

Change from budget request .......................................................... +6,932,932,000 

The Committee recommendation for the National Institutes of 

Health (NIH) program level includes $39,937,179,000 in discretionary appropriations and $1,146,821,000 in Public Health Service 

Act section 241 evaluation set-aside transfers. Within the total appropriation, the Committee recommendation includes $492,000,000 

in budget authority authorized in the 21st Century Cures Act (P.L. 

114–255). The bill includes an increase in discretionary budget authority of $2,219,000,000 above the fiscal year 2019 enacted level, 

which is necessary to maintain an overall increase of 

$2,000,000,000 while compensating for a reduction of $219,000,000 

in funding made available by the Cures Act. 

The mission of NIH is to seek fundamental knowledge about the 

nature and behavior of living systems and the application of that 

knowledge to enhance health, lengthen life, and reduce illness and 

disability. NIH conducts and supports research to understand the 

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81 

standing towards designing new approaches for preventing, diagnosing, and treating disease and disability; and ensure that these 

approaches are widely available. 

The recommendation includes funding for initiatives established in the 21st Century Cures Act, including a total of $195,000,000 for 

the Cancer Moonshot Initiative; $500,000,000 for the ‘‘All of Us’’ 

precision medicine initiative (including $149,000,000 from the 

Cures Act); $411,000,000 for the Brain Research through Application of Innovative Neurotechnologies (BRAIN) Initiative (including 

$140,000,000 from the Cures Act); and $8,000,000 for regenerative 

medicine. 

The Committee includes specific funding allocations for a number 

of initiatives and activities detailed in the Institute- and Centerspecific sections below. The funding level also allows for an increase of 5 percent outside of these designated activities to support 

other efforts, including an increase in the number of new and competing Research Project Grants, with a focus on early-stage investigators and investigators seeking first-time renewals. The Committee expects NIH to provide a stipend level increase to training 

grantees that is consistent with any fiscal year 2020 Federal employee pay raise. 

NATIONAL CANCER INSTITUTE (NCI) 

Appropriation, fiscal year 2019 ......................................................... $6,143,892,000 

Budget request, fiscal year 2020 ....................................................... 5,246,737,000 

Committee Recommendation ............................................................. 6,444,165,000 

Change from enacted level ............................................................. +300,273,000 

Change from budget request .......................................................... +1,197,428,000 

Mission.—NCI leads, conducts, and supports cancer research 

across the nation to advance scientific knowledge and help all people live longer, healthier lives. 

Cancer Moonshot.—The Committee directs NIH to transfer 

$195,000,000 from the NIH Innovation Account to NCI to support 

the Cancer Moonshot initiative. These funds were authorized in the 

21st Century Cures Act (P.L. 114–255). 

Childhood Cancer Data Initiative.—The Committee includes 

$50,000,000 for the first year of the Childhood Cancer Data Initiative, as proposed in the fiscal year 2020 budget request. The development of new therapies is important to finding a cure for childhood cancers, many of which have not seen new therapies in decades. 

Brain Cancer in Children.—The Committee recognizes that brain 

cancer remains the most fatal of all pediatric cancers. Despite 

progress in other diseases, pediatric brain cancer survival rates 

have not improved for decades and have lagged behind the strides 

made in other cancers. The majority of children who survive may 

experience lifelong impairments and disabilities that result from 

high levels of toxicity associated with treatment. The committee 

strongly encourages NIH to support additional research on pediatric brain cancer, including but not limited to drug delivery methods and new therapies with reduced levels of toxicity and long-term 

complications. 

Cancer Immunotherapy.—The Committee continues to be encouraged by new breakthroughs in cancer immunotherapy, which are 

revolutionizing treatments for a growing number of cancers. The 

82 

Committee urges NCI to prioritize research and trials for innovative immunotherapeutic approaches. In some cases, however, the 

side effects of such treatments are far different than those associated with chemotherapy. Early recognition and management of 

cancer immunotherapy-related side effects can result in resolution 

of these side effects before permanent damage is done, and allows 

for continued cancer treatment. The Committee urges NCI to 

prioritize research and education on the underlying mechanisms of 

cancer immunotherapy. 

Children’s Oncology Group.—The Committee continues to support the important work of the Children’s Oncology Group and encourages NCI to continue their important role in drug development. 

The majority of childhood cancer patients are enrolled in trials conducted by the Children’s Oncology Group and advances in treatment are dependent on their ability to conduct trials quickly and 

enroll as many pediatric patients as possible. 

Clinical Trials for Primary Prevention of Breast and Ovarian 

Cancers.—The Committee urges NCI to support phase I, phase II, 

phase II/III, and phase III clinical trials focused on primary 

immunoprevention of breast cancer and primary 

immunoprevention of ovarian cancer. The Committee encourages 

NCI to include costs related to GMP and GLP expenses, direct subject/patient expense reimbursement associated with enrollment, 

participation, retention, long-term patient outcomes, and long-term 

research outcomes. These trials should involve relevant underrepresented and minority communities. The Committee encourages 

NCI to work consultation with NCI-designated Cancer Centers, the 

National Clinical Trials Network, the NCI Community Research 

Program, and nonprofit foundations currently working in this area. 

Collaboration Between Agencies Regarding Pediatric Investigation 

of Appropriate New Drugs.—The Committee recognizes that Title V 

of Food and Drug Administration Reauthorization Act (FDARA) 

amended the Pediatric Research Equity Act (PREA) to support the 

early evaluation of potentially effective drugs by requiring evaluation of new molecularly targeted drugs and biologics intended for 

adults with cancer if the drug is directed at a molecular target substantially relevant to the growth or progress of a pediatric cancer. 

The law directs the FDA, in collaboration with the NCI, to establish, publish, and regularly update a list of molecular targets considered based on data the Agency determines to be adequate, to be 

substantially relevant to the growth or progression of pediatric cancers, and that may trigger the requirement for pediatric investigations. The Committee encourages NCI and FDA to continue to collaborate with the patient community, providers, and manufactures, 

and continue to conduct a transparent and inclusive process to implement FDARA. 

Deadliest Cancers.—The Committee notes that while more effective screening methods and treatments have lowered overall cancer 

incidence and death rates, several cancer types with particularly 

low survival rates have limited screening methods, and effective 

treatments for these cancers are also limited. The Recalcitrant 

Cancers Research Act of 2012 defined ‘‘recalcitrant cancers’’ as 

those with a five-year survival rate below 50 percent. These cancers account for nearly half of all cancer deaths in the U.S. and include cancers of the brain, esophagus, liver, lung, ovary, pancreas, 

83 

and stomach. The Committee notes that in fiscal year 2020, NCI 

will report on the effectiveness of the scientific framework process 

NCI undertook to carry out implementation of the Recalcitrant 

Cancers Research Act. 

Early Onset Colorectal Cancer.—The Committee notes that while 

overall colorectal cancer incidence rates decreased over the last 20 

years, there has been an increase among adults ages 20–54. The 

Committee urges NCI to support research on the causes for the increased rate of colorectal cancer in this population. The Committee 

encourages NCI to expand its knowledge of the natural history of 

the disease to help advance the development of improved screening 

modalities and treatment. 

Electronic Cigarettes.—The Committee recognizes that the increased use of electronic cigarettes and similar devices pose possible threats to public health, particularly for teenagers and young 

adults. While these devices are often promoted as safe alternatives 

to tobacco, studies suggest they may still contain chemicals that 

pose health risks to the user. The Committee urges NIH to expand 

research on the oral health consequences of e-cigarettes, and to 

consider interdisciplinary collaboration between schools of dentistry 

and traditional cancer researchers. 

Kidney Cancer.—The Committee is concerned with the growing 

number of kidney cancer diagnoses and lack of early detection of 

the disease. The Committee encourages NCI to continue to 

prioritize meritorious research that could assist in developing diagnostic tests and early detection techniques. 

Liver Cancer.—The Committee commends NCI for supporting research on liver cancer and for its inter-institute work to encourage 

more research focused on liver cancer, but urges greater priority to 

address the threat of liver cancer, the second deadliest cancer with 

a five-year survival rate of 20 percent. 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, encourages continued close collaboration with National Institute of Allergy and Infectious Diseases (NIAID) and the National Institute of 

Diabetes and Digestive and Kidney Diseases (NIDDK) and active 

participation in the Director’s newly-established Trans-NIH Hepatitis B working group. The Committee requests an update on NCI’s 

activities in these areas in the fiscal year 2021 Congressional Justification. 

Melanoma.—The Committee encourages NCI to support research 

from development of experimental models to identify mechanisms 

and associated biomarkers of risk for development of melanoma, 

new technologies for early detection as well as trials that develop 

population-based evidence for screening, including ophthalmologic, 

and sun protection practices. The Committee also encourages collaboration with the FDA to develop scientific review pathways that 

more efficiently evaluate new sunscreen ingredients. 

Discovery of biomarkers of response and resistance is critical at 

this point in melanoma research. The Committee urges NCI to support mechanistic research into response and resistance to therapy, 

and to develop a strategic plan across the public and private sector 

to systematically focus on biomarker research with the most advanced technologies (genetic, gene expression, or protein-based), so 

84 

that physicians have the diagnostic tools to deliver personalized 

medicine to each patient. The Committee also urges NCI to continue the advances in adjuvant therapy by extending research to 

earlier stage disease and testing shorter, less toxic and more economical regimens. The Committee further encourages research to 

understand mechanisms that underlie clinical dormancy to provide 

an effective means of preventing tumor recurrence and improving 

quality of life and longevity of survivors. 

The Committee is aware symptomatic brain (CNS) and 

leptomeningeal (LMD) metastases remain difficult to treat and 

may become the last frontier in systemic therapy in melanoma and 

other cancers. The Committee urges expanding research to identify 

treatments for CNS and LMD melanoma, which may pave the way 

for advances in other cancers. 

Melanoma is a heterogeneous cancer and includes rare subtypes 

such as uveal melanoma, the most common cancer of the eye, as 

well as mucosal and pediatric melanoma. States have difficulty 

capturing and defining cases due to the complex nature of arriving 

at the true diagnosis. The Committee encourages NCI to support 

research through national registries to better understand natural 

history, epidemiology, as well as patient reported and clinical outcomes in these rare melanoma subtypes. 

The Committee requests an update on these requests in the fiscal year 2021 Congressional Justification. 

Metastatic Cancer in the Surveillance, Epidemiology, and End 

Results Registry.—The Committee notes recent discussions about 

modernizing the Surveillance, Epidemiology, and End Results 

(SEER) Registry and filling in key data gaps, such as metastatic 

recurrence. The Committee encourages NCI to advance this effort 

in a systematic and meaningful way that ultimately improves 

SEER Registry infrastructure and capabilities. 

Office of Cancer Survivorship.—The Committee recognizes that 

the Office of Cancer Survivorship (OCS) provides leadership in research on a wide range of cancer survivorship topics. However, the 

Committee recognizes that the needs of childhood cancer survivors 

are unique. By 2020, there will be at least 500,000 childhood cancer survivors in the U.S. Two-thirds of childhood cancer survivors 

suffer from at least one health problem late effect caused from 

their treatment. The Committee urges the OCS to provide a special 

focus on childhood cancer survivorship, including analyzing secondary prevention strategies that go beyond the standard and routine therapies of diet, exercise and tobacco avoidance and focus on 

specific needs for childhood cancer survivors, such as psycho-social 

treatments. 

Pancreatic Cancer.—Pancreatic cancer is the third leading cause 

of cancer-related death in the U.S. More than 56,700 Americans 

will be diagnosed with the disease in 2019, representing a two percent increase over last year, and pancreatic cancer remains the 

only major cancer with a five-year survival rate in the single digits 

at just nine percent. The Committee appreciates NCI’s recent submissions of the five-year updates to the reports required by the Recalcitrant Cancer Research Act of 2012. The Committee encourages 

NCI to continue to support research efforts to advance progress for 

patients diagnosed with pancreatic cancer and other cancers with 

low five-year survival rates. 

85 

Pediatric Immunotherapy Trials.—The Committee encourages 

NCI to collaborate with pediatric immunotherapy trials that are 

combining novel immunotherapy with the standard-of-care chemotherapy and radiation treatments. The Committee recognizes the 

need for the expansion of scope in ongoing trials to include more 

types of pediatric cancers and encourages NCI to use data produced 

from the trials when creating larger comprehensive data sets. 

Prostate Cancer.—The Committee is aware of NCI’s efforts in 

prostate cancer research and encourages additional investment into 

understanding why certain populations, including African-American men and men with a strong family history of prostate cancer, 

have the highest incidence rate of this disease. The Committee 

urges NCI to consider how diagnostic and genetic testing and 

screening may reduce the rate of mortality among high-risk populations. 

Rare Cancer Therapeutic Research and Development Program.— More than 500,000 Americans are diagnosed with a rare form of 

cancer every year. Rare cancers account for 374 of 396 distinct 

forms of cancer, and include all pediatric cancers. Each of these 

forms of cancer would benefit from targeted therapies that frequently work more effectively and with fewer side effects than traditional chemotherapy and radiation. The NCATS novel scientific 

model has proven successful in addressing other rare diseases and 

would benefit rare cancer therapeutic development. Therefore, the 

Committee urges NCI to collaborate with NCATS as appropriate on 

a rare cancer translational medicine initiative to accelerate the 

study of commonalities across rare cancers and the development of 

platform treatments for rare cancers to help patients who often 

have no other options. 

Recalcitrant Cancers.—The Committee encourages NCI to incorporate the deadliest forms of childhood cancers into the recalcitrant 

cancers category, and to prioritize research on such cancers, which 

include anaplastic astrocytoma, diffuse intrinsic pontine glioma, 

glioblastoma, Juvenile myelomonocytic leukemia, high risk neuroblastoma, recurrent osteosarcoma, rhabdomyosarcoma, and diffuse 

anaplastic Wilms tumors. The Committee urges NCI to utilize 

available resources to aid in the discovery of better treatments and 

cures to improve overall childhood cancer survival rates. The Committee requests that NCI include an update on the progress being 

made to increase childhood cancer research in the Fiscal Year 2021 

Congressional Justification. 

Specialized Programs of Research Excellence in Cancer.—The 

Committee notes that the SPORE program is NCI’s cornerstone effort to promote collaborative, interdisciplinary translational cancer 

research. The Committee continues support for the SPORE grant 

program as it works to bring basic research into practical treatments, including multi-center SPORE grants to encourage better 

understanding of closely related cancers in function and impact on 

different organ systems to advance science toward more effective 

treatments, cures, and prevention. The Committee requests an update in the fiscal year 2021 Congressional Budget Justification on 

a timeline to expand multi-center SPORE grants. 

Women and Lung Cancer.—The Committee notes that lung cancer has a disparate impact on women, particularly younger women 

who have never smoked. Additional research strategies are needed 

86 

to explore the differences in women with respect to lung cancer risk 

factors, incidence, and histology. The Committee urges NCI to accelerate research into treatments and implementation of lung cancer preventive services for women. The Committee requests an update on these activities in the fiscal year 2021 Congressional Justification. 

NATIONAL HEART, LUNG, AND BLOOD INSTITUTE (NHLBI)

Appropriation, fiscal year 2019 ......................................................... $3,488,335,000 

Budget request, fiscal year 2020 ....................................................... 3,002,696,000 

Committee Recommendation ............................................................. 3,658,822,000 

Change from enacted level ............................................................. +170,487,000 

Change from budget request .......................................................... +656,126,000 

Mission.—NHLBI provides global leadership for a research, 

training, and education program to promote the prevention and 

treatment of heart, lung, and blood disorders and enhance the 

health of all individuals so that they can live longer and more fulfilling lives. 

Chronic Obstructive Pulmonary Disease.—The Committee commends NHLBI and HRSA on educating providers and patients, including in rural and low-income communities, on Chronic Obstructive Pulmonary Disease (COPD) awareness, detection and management best practices. The agencies’ efforts in this area are a model 

for effective collaboration across Federal agencies. The Committee 

encourages NHLBI to accelerate implementation of the action plan 

across relevant Federal agencies by supporting research and partnerships with various agencies. 

Alzheimer’s Disease and Vascular Dementia.—The Committee 

recognizes the value that well-characterized, longitudinal, population-based cohort studies provide in bringing to light more information about the risk factors related to dementia. By studying participants over time, much can be learned about cognitive decline 

and early biomarkers that will help us understand the role of environmental and genetic factors in disease development and progression. In time, however, mature cohorts naturally dwindle as participants pass away, requiring that the research mission be adjusted 

to continue to leverage the previous science and build upon it. 

Therefore, the Committee urges NHLBI to fund a pilot project on 

next generation cohorts, with the goal of determining the feasibility 

of recruiting descendant cohort participants to continue study into 

the development and progression of risk factors and to detect early 

signs of cognitive decline. 

Asthma.—The Committee applauds NHLBI for its efforts to develop new National Asthma Education and Prevention guidelines. 

According to CDC, 24.6 million U.S. adults and children have asthma. Appropriate asthma management can significantly reduce costly services, including hospitalizations. 

Blood Donor Questionnaire Educational Materials.—The Committee is concerned that certain FDA guidance in the educational 

materials provided in the blood donor questionnaire are inappropriate and misguided. The recommendations for deferral should not 

mention someone’s sexual orientation, and rather focus on risk factors that might expose a potential donor to blood-borne illness. The 

Committee strongly recommends that NHLBI continue to provide 

87 

the FDA with the latest science on the risks of transmission of 

STIs through blood donation and transfusion. 

Heart Disease.—Heart disease is the leading cause of death for 

both men and women in the U.S. Despite significant progress over 

the last half century, the Committee is concerned that this largely 

preventable disease continues to place a high burden on our nation’s health and economy. The Committee is discouraged that new 

evidence shows that previous declines in cardiovascular disease 

(CVD) have stalled or even reversed for certain demographics. The 

Committee supports a NIH-wide prioritization of heart research to 

significantly strengthen the fight against heart disease. We commend NHLBI for its work focused on congenital heart disease, 

high-risk populations, including rural communities, and on the relationship between high blood pressure and age-related cognitive 

impairment and dementia. We further support NHLBI for its research on South Asians, who are four times more likely to have 

heart disease than the general public; experience heart attacks ten 

years earlier; and have higher mortality rates from heart disease 

than any other ethnic group. 

Lymphedema and Lymphatic Diseases.—The Committee commends NHLBI’s efforts to expand research on lymphedema and 

lymphatic diseases and encourages continued implementation of 

the research recommendations of the 2015 Trans-NIH Lymphatics 

Symposium and coordination across relevant Institutes and Centers. 

Reducing Residual Cardiovascular Risk.—Cardiovascular events 

account for one of every three deaths in the United States; about 

2,300 Americans die of cardiovascular disease each day. Cholesterol 

therapies, such as statins, have been successful in reducing risk of 

cardiovascular disease, but substantial residual and untreated risk 

remains for these individuals beyond cholesterol management. A 

clinical trial called REDUCE-IT has demonstrated a 25 percent relative risk reduction in major adverse cardiovascular events beyond 

cholesterol management, from the use of highly purified and stable 

eicosapentaenoic acid (EPA) in addition to statin therapy. The 

Committee is concerned that, despite these statistics, many individuals do not regularly access treatments for residual risk beyond 

statin therapy. The Committee urges NHLBI to support research 

in this area as well as efforts, particularly through the ‘‘Know Your 

Numbers’’ campaign, to promote awareness among physicians and 

patients of the residual cardiovascular risks beyond statin therapy 

and the importance of taking preventative action to reduce this 

risk. 

Sickle Cell Disease.—Sickle cell disease (SCD) is the most common inherited blood disorder in the U.S. 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, 

which is currently the only therapy that can cure the disease. The 

Committee urges NHLBI to prioritize and implement robust investment to drastically spur, strengthen, accelerate and coordinate 

sickle cell disease research. The Committee also encourages NIH to 

support clinical trials for treatment of SCD, which includes multiple promising approaches to eradicate this disease, save lives, and 

reduce dramatically the substantial health care costs associated 

88 

with SCD for children and adults. Finally, the Committee encourages NIH to consider programs both domestically and globally to 

evaluate the effectiveness of screening technologies for infants and 

children with the sickle cell trait and disease. 

Sleep and Circadian-Dependent Mechanisms Contributing to Opiate Use Disorder.—The Committee applauds NIDA and NINDS for 

their work to address the opioid crisis through innovative research 

directions supported by the Helping to End Addiction Long-Term 

(HEAL) Initiative. The Committee notes the promise that research 

on sleep and circadian mechanisms can play in the prevention and 

treatment of opiate use disorder and encourages NIDA to work collaboratively with NHLBI and other relevant Institutes and Centers 

to continue the exploration of innovative research pathways. 

Sleep Disorders.—The Committee commends the recent expansion and advancement of the sleep and circadian research portfolio 

under the coordination of the National Center on Sleep Disorders 

Research (NCSDR). The Committee encourages dedicated research 

activities on specific sleep disorders, such as narcolepsy and restless legs syndrome, to ensure scientific progress benefits patients 

impacted by debilitating conditions disordering their sleep and biological rhythms. 

The Heart Truth Program.—For over a decade, The Heart Truth 

program has worked to raise awareness about women’s risk of 

heart disease. The program’s goals have been to increase awareness that heart disease is the leading cause of death among women 

and to increase the conversations between women and their 

healthcare providers. Accordingly, the Committee encourages the 

NHLBI to continue support for The Heart Truth program, and to 

continue working closely with its longstanding partners, as well as 

new, non-traditional partners, to broaden the program’s reach. 

NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL RESEARCH

(NIDCR)

Appropriation, fiscal year 2019 ......................................................... $461,781,000 

Budget request, fiscal year 2020 ....................................................... 397,493,000 

Committee Recommendation ............................................................. 484,350,000 

Change from enacted level ............................................................. +22,569,000 

Change from budget request .......................................................... +86,857,000 

Mission.—The mission of NIDCR is to improve dental, oral, and 

craniofacial health through research, research training, and the 

dissemination of health information. 

Oral Health.—The Committee recognizes that oral health is integral to overall health and that the oral cavity holds tremendous 

promise for indicating disease and health issues, targeting therapies, and diagnostic and therapeutic discovery. The Committee encourages NIDCR to continue research on the underlying biologic 

mechanisms of dental, oral and craniofacial diseases and their potential linkages to other diseases, including cardiovascular disease, 

Alzheimer’s disease, diabetes mellitus, and others. 

Surgeon General’s Report on Oral Health.—The Committee appreciates NIDCR’s contributions to the Surgeon General’s 2020 Report on Oral Health and looks forward to the much-needed update 

of the seminal Oral Health in America report from 2000. 

89 

NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY

DISEASES (NIDDK)

Appropriation, fiscal year 2019 ......................................................... $2,029,823,000 

Budget request, fiscal year 2020 ....................................................... 1,746,493,000 

Committee Recommendation ............................................................. 2,129,027,000 

Change from enacted level ............................................................. +99,204,000 

Change from budget request .......................................................... +382,534,000 

Mission.—The NIDDK mission is to conduct and support medical 

research and research training and disseminate science-based information on diabetes and other endocrine and metabolic diseases; 

digestive diseases, nutritional disorders, and obesity; and kidney, 

urologic, and hematologic diseases, to improve people’s health and 

quality of life. 

Conditions of the Pancreas.—The Committee encourages NIDDK 

to further support research activities focused on conditions of the 

pancreas, particularly pancreatitis and pancreatic cancer, and to 

consider leveraging collaborative opportunities to advance auxiliary 

projects for ongoing successful efforts. 

End-Stage Renal Disease.—The Committee recognizes the work 

in supporting critical kidney research that NIDDK has accomplished including end-stage renal disease (ESRD). The Committee 

continues to encourage NIDDK to work with stakeholders to facilitate new opportunities for research. 

Glomerular Diseases.—The Committee recognizes the work that 

the Cure Glomeruloneuropathy (CureGN) initiative and the Nephrotic Syndrome Study Network (NEPTUNE) are supporting to 

obtain insights into these diseases that could lead to breakthroughs 

for critical clinical trials. The Committee encourages NIDDK to 

continue supporting research that has proven to lead to new therapies. 

Hepatitis B.—The Committee notes that hepatitis B virus (HBV) 

infections are a serious public health threat. The hepatitis B research community convened a virtual consensus conference to prepare a ‘‘Roadmap for a Cure’’ that resulted in identifying the most 

urgent research questions related to hepatitis B. The Committee 

urges NIDDK to pursue these research opportunities and to work 

in coordination with other Institutes and Centers on hepatitis B research planning. 

Inflammatory Bowel Diseases.—The Committee continues to encourage NIDDK to incorporate patient centricity in Inflammatory 

Bowel Diseases (IBD) research, including support for a 

translational bedside-to-bench research that leverages patient priorities and perspectives with respect to biomedical research, such 

as personalized medicine approaches, to address a patient-identified clinical need. The Committee recognizes interactions among 

food, the gut, and the brain/nervous system as an area of high interest to patients and relevant to multiple chronic gastrointestinal 

diseases that is supported by a growing body of evidence, and identifies it as a potential topic for ongoing research. 

Interstitial Cystitis.—The Committee is pleased with the progress 

of interstitial cystitis research through the MAPP Program. The 

Committee encourages NIDDK and stakeholders to continue collaboration on a comprehensive state of the science conference to examine mechanisms for scientific opportunity. 

90 

Pediatric Kidney Disease.—The Committee is encouraged by the 

research funded by NIDDK on pediatric kidney disease and continues to urge the Institute to support research toward multicenter 

clinical and translational research focused on clinical approaches to 

children with kidney disease. However, the Committee believes 

that NIDDK could do more to support research toward the development of novel therapeutic strategies that utilize genomics and personalized medicine in this patient population. To this end, the 

Committee urges NIDDK to fund additional research and support 

clinical trials in this area. The Committee requests that NIDDK report back in the fiscal year 2021 Congressional Justification on the 

progress made towards additional pediatric focused clinical trials 

and novel therapeutic development. 

NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE

(NINDS)

Appropriation, fiscal year 2019 ......................................................... $2,274,413,000 

Budget request, fiscal year 2020 ....................................................... 2,026,031,000 

Committee Recommendation ............................................................. 2,385,571,000 

Change from enacted level ............................................................. +111,158,000 

Change from budget request .......................................................... +359,540,000 

Mission.—The NINDS mission is to seek fundamental knowledge 

about the brain and nervous system and use that knowledge to reduce the burden of neurological disease. 

BRAIN Initiative.—The Committee directs NIH to transfer 

$70,000,000 from the NIH Innovation Account to NINDS to support 

the BRAIN Initiative. These funds were authorized in the 21st 

Century Cures Act (P.L. 114–255). This collaborative effort is revolutionizing the understanding of how neural components and their 

dynamic interactions result in complex behaviors, cognition, and 

disease, while accelerating the development of transformative tools 

to explore the brain in unprecedented ways making information 

previously beyond reach accessible. 

Opioids.—The Committee continues to support the HEAL (Helping to End Addiction Long-Term) Initiative, a trans-NIH effort to 

speed scientific solutions to stem the national opioid public health 

crisis. This initiative builds on extensive, well-established NIH research, including basic science of the complex neurological pathways involved in pain and addiction, implement science to develop 

and test treatment models, and research to integrate behavioral 

interventions with medication-assisted treatment for opioid use disorder. The Committee includes no less than the fiscal year 2019 enacted level of $250,000,000 within NINDS for this research. 

Acute Flaccid Myelitis.—The Committee is aware that there remains no dedicated funding for Acute Flaccid Myelitis (AFM), an 

inflammatory disease of the spinal cord characterized by acute 

onset flaccid paralysis that predominantly affects healthy children 

and young adults. Epidemiological evidence has suggested an association between AFM and circulating viruses which produce respiratory, gastrointestinal and febrile illnesses. AFM falls into the 

same category of disease as Poliomyelitis. In response to a recent 

upsurge in cases of AFM in young children, the Committee urges 

that NIH, including NINDS and NIAID, determine a clinical characterization and disease pathogenesis for AFM. 

91 

Advancement of Non-Opioid Chronic Pain Therapies.—Fifty million Americans suffer from chronic pain; living with chronic pain 

can be life-altering, deeply impacting people on many levels. The 

current state of chronic pain management is often inadequate for 

many patients and places an economic burden on the health care 

system, costing the U.S. $560 billion annually. Management of 

chronic pain often requires both non-pharmacological treatment as 

well as medicines. Unfortunately, the current pharmacological options do not meet the needs of all patients, and additional treatments are needed. The Committee requests in the fiscal year 2021 

Congressional Justification an update on the progress of the development and advancement of non-opioid chronic pain therapies. 

Dystonia.—The Committee commends NINDS for holding a conference on dystonia to revitalize the dystonia research portfolio. 

The Committee encourages NINDS to follow the recommendations, 

including identifying new research and therapeutic needs that will 

lead to a better understanding of dystonia etiology and evaluation 

of the status of translational research that may lead to more treatment options for those affected by dystonia. 

Headache Disorders.—The Committee strongly urges NINDS to 

fund fundamental, translational, and clinical research on headache 

disorders, including migraine, post-traumatic headache, the 

trigeminal autonomic cephalalgias, and intracranial hypo/hypertension through the HEAL study. 

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 U.S. The Committee recognizes 

that NINDS is prioritizing public health concerns with severe gaps 

in unmet medical needs and supports the research recommendations set forth by the NINDS planning strategy to bring us closer 

to better treatments and a cure for Parkinson’s disease. The Committee also encourages NINDS to submit an update of its progress 

on implementing these recommendations in the fiscal year 2021 

Congressional Justification. 

Peripheral Neuropathies.—The Committee notes the continued 

progress of ongoing research into Guillain-Barre syndrome (GBS), 

chronic inflammatory demyelinating polyneuropathy (CIDP), and 

related conditions. The Committee encourages NINDS to continue 

its work with NIAID and stakeholders on a state of the science conference on evolving research and scientific mechanisms. 

Stroke.—Due in large part to NIH-funded research, the stroke 

mortality rate has decreased by 71 percent since 1969. Despite this 

remarkable progress, strokes cost Americans $37 billion annually 

in health care bills and lost productivity at work. Furthermore, 

after more than four decades of steep decline, stroke death rates 

in the U.S. have recently slowed, stalled, or reversed among some 

groups. The Committee encourages the NINDS to prioritize studies 

that help develop interventions to reduce health disparities in 

stroke and to advance promising stroke prevention, treatment, and 

rehabilitation research, including endovascular therapy and tele-rehabilitation. The Committee also urges continued collaboration 

with the other Institutes and Centers on research related to vascular contributions to cognitive impairment and dementia. 

92 

Traumatic Brain Injury.—The Committee understands that regenerative medicine, including the use of adult stem cells and 

neuroplasticity may play an important role in developing treatment 

of Traumatic Brain Injury (TBI). The Committee strongly encourages NINDS to work with all relevant parts of NIH, including NIA, 

to support a robust and coordinated portfolio of TBI research that 

explores all promising avenues to facilitate functional repair of 

damaged circuitry in TBI, including research on regenerative medicine and neuroplasticity. The Committee requests an update in the 

fiscal year 2020 Congressional Justification on efforts in these specific areas of TBI research. 

Valosin-Containing Protein Disease.—The Committee encourages 

NINDS to support research on the Valosin-Containing Protein 

(VCP) gene and the related disorders to develop a focused patient 

natural history study. 

NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES (NIAID)

Appropriation, fiscal year 2019 ......................................................... $5,523,324,000 

Budget request, fiscal year 2020 ....................................................... 4,754,379,000 

Committee Recommendation ............................................................. 5,808,268,000 

Change from enacted level ............................................................. +284,944,000 

Change from budget request .......................................................... +1,053,889,000 

Mission.—The NIAID mission is to conduct and support basic 

and applied research to better understand, treat, and ultimately 

prevent infectious, immunologic, and allergic diseases. 

Universal Influenza Vaccine.—The Committee directs NIAID to 

allocate at least $200,000,000 to support basic, translational, and 

clinical research to develop a universal influenza vaccine that provides robust, long-lasting protection against multiple subtypes of 

flu, rather than a select few. Such a vaccine would eliminate the 

need to update and administer the seasonal flu vaccine each year 

and could provide protection against newly emerging flu strains, 

potentially including those that could cause a flu pandemic. The 

Committee requests an update on these efforts within 60 days of 

enactment of this Act. 

Combating Antibiotic-Resistant Bacteria.—The Committee includes sufficient funding to maintain NIAID research related to 

combating antibiotic-resistant bacteria at no less than the fiscal 

year 2019 enacted level. These funds enable NIAID to support research on antimicrobial (drug) resistance, including basic research 

on how microbes develop resistance, new and faster diagnostics, 

and clinical trials designed to find new vaccines and treatments effective against drug-resistant microbes. 

2020 AIDS Conference.—The Committee recognizes the United 

States is hosting the International AIDS Conference for the first 

time since 2012. The Committee includes $5,100,000 for the U.S. 

contribution to the AIDS2020 Conference. 

Centers for AIDS Research.—As part of the domestic HIV initiative, the Committee includes $51,000,000 for the Centers for AIDS 

Research, an increase of $6,000,000 above the estimated fiscal year 

2019 enacted level and the same as the fiscal year 2020 budget request. These Centers will offer evidence-based practices on prevention and treatment to initiative partners and evaluate the initiative. 

93 

Autoimmune Disease Coordinating Committee.—The Committee 

recognizes the devastating impact of autoimmune diseases on the 

lives of some 50 million Americans and the promise of groundbreaking research underway at NIH to determine underlying 

causes of autoimmune disease and emerging evidence of 

connectivity to other conditions, such as cancer. The Committee 

urges NIH to expand collaborations with internal and external research experts, professional associations, patient groups, and other 

stakeholders to advance current research priorities, promising 

areas of inquiry, and opportunities for NIH and the Coordinating 

Committee to make progress in autoimmune disease research. 

Autoimmune Neuropathies.—The Committee is pleased at the 

progress between NIAID and NINDS on a state-of-the-science conference on autoimmune neuropathies research into conditions like 

Guillain-Barre syndrome (GBS) and chronic inflammatory 

demyelinating polyneuropathy (CIDP). The Committee continues to 

encourage both Institutes to continue their work with patient 

stakeholders on this important conference. 

Celiac Disease.—The Committee encourages NIH to devote sufficient, focused research to the study of Celiac disease, including the 

autoimmune causation underpinning the affliction. Today, the only 

known treatment for this disease is a gluten-free diet; but, recent 

public and private sector research has revealed that such a ‘‘treatment’’ is insufficient for many who suffer from Celiac disease. 

Therefore, the Committee urges NIAID to support new research to 

better coordinate existing research and focus new research efforts 

toward causation and ultimately, a cure of this disease. NIAID is 

encouraged to coordinate with other Institutes and Centers as appropriate and to submit its plan for coordination and execution of 

this research to the Committee on Appropriations no later than 90 

days after enactment of this Act. 

Food Allergy Research.—The Committee recognizes the serious 

issue of food allergies which affect approximately eight percent of 

children and ten percent of adults in the U.S. The Committee commends the ongoing work of NIAID in supporting clinical sites for 

this critical research, including seven sites as part of the Consortium of Food Allergy Research (CoFAR). The Committee urges NIH 

to support robust investment to expand its clinical research network to add new centers of excellence in food allergy clinical care 

and to select such centers from those with a proven expertise in 

food allergy research. 

Gonorrhea.—The Committee continues to be concerned about the 

prevalence of gonorrhea, the 75 percent increase in the incidence 

of this disease over the past nine years, and the drug resistance to 

multiple classes of antibiotics. The Committee commends NIAID 

for its efforts in developing new antibiotics to kill the bacterium 

that causes this disease and encourages NIAID to continue its 

work in this area for diagnosis, treatments, and cures for this STI. 

Hereditary Angioedema.—The Committee recognizes NIAID for 

its ongoing stewardship of the Hereditary Angioedema (HAE) research portfolio, including advancements that have taken HAE 

from a debilitating and fatal condition to a manageable chronic disease. The Committee notes the potential of gene therapy and other 

cutting-edge research to further improve health outcomes for HAE 

94 

patients and encourages NIAID to maintain the commitment to 

HAE research at this critical time. 

HIV Prevention in Women.—The Committee notes that recent 

clinical studies have found limited success in the use of PrEP to 

prevent HIV infection in women. Effective prevention strategies for 

women are essential to curtailing new HIV infections. The Committee urges NIAID to support research on the most effective strategies for preventing HIV infections. 

Lyme Disease and Other Tick-Borne Diseases.—The Committee 

encourages NIAID to intensify research and development on Lyme 

and other tick-borne diseases, including research that will increase 

understanding of the full range of processes that cause Lyme disease infection. This should include research on the physiology of 

Borrelia burgdorferi and Borrelia mayonii, including the mechanisms of possible persistent infection, potential treatment protocols 

for extended or long-term symptoms attributed to Lyme and other 

tick-borne diseases, and development of more sensitive and accurate diagnostic tests for Lyme and tick-borne diseases, including 

next generation polymerase chain reaction (PCR) and new testing 

methodologies such as proteomics and metabolomics. The Committee directs NIAID to support research on the heightened incidence of Lyme Disease and vector-borne diseases due to global 

warming. 

Microbicides.—The Committee recognizes that with NIH and 

USAID leadership, research has shown the potential for 

antiretroviral (ARV) drugs to prevent HIV infection in women. The 

Committee encourages NIAID to continue coordination with 

USAID, the State Department, and others to advance ARV-based 

microbicide development efforts with the goal of enabling regulatory approval of the first safe and effective microbicide for women 

and supporting an active ARV-based microbicide pipeline to 

produce additional solutions to prevent HIV and to help end the 

epidemic. 

Post-Infectious Neuroimmune Disorders.—The Committee is concerned that children, following streptococcal and other infections, 

are experiencing the onset of neuropsychiatric and behavioral disorders. These auto-inflammatory encephalopathic conditions, including Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) and Pediatric Acuteonset Neuropsychiatric Syndrome (PANS), are often misdiagnosed. 

Delays in diagnosis and lack of developed avenues of treatment result in a devastating escalation of mental health symptoms and associated costs. The Committee encourages NIH to prioritize research efforts in this area and report to the Committee on the current understanding of incidence, causes, diagnostic criteria, and 

treatment of these conditions and to describe the status of research 

related to this area in the fiscal year 2021 Congressional Justification. 

Syphilis.—The Committee continues to be concerned about the 

increased rates in syphilis, the rise in congenital syphilis, and the 

link between syphilis and transmitting HIV. The Committee commends NIAID for the work in this area and encourages them to 

continue and accelerate the development of screening tests, vaccines for prevention and new treatment options, for both adults and 

95 

newborns, to provide a quicker more efficient way to diagnose and 

define the stages of this infection. 

Threat of Emerging Infectious Diseases.—The usage of machine 

learning, data-driven dynamical modeling, and other big data techniques, to identify early warning signals for outbreaks of rare diseases, is an integral part of scientific research on the ecology and 

evolution of infectious diseases. The Committee recognizes the 

threat of Emerging Infectious Diseases (EID) from animals and 

urges NIH to support further research in disease mapping and 

forecasting in order to identify early warning signals for outbreaks 

of emerging diseases. The Committee directs NIH to include a 

progress report on the use of machine learning and validated 

mechanistic models to advance critical biomedical research, improve decision support for epidemiological interventions, and enhance human health in the fiscal year 2021 Congressional Justification. 

Tuberculosis.—Tuberculosis (TB) remains one of the deadliest infectious diseases worldwide. Research has been key to developing 

the tools currently available to combat TB, such as rapid diagnostic 

testing, medications, and vaccine for some forms of the disease. 

However, there is a need for safer and more effective medications, 

faster diagnostics, and more effective vaccines. The Committee 

commends NIAID for developing the NIAID Strategic Plan for Tuberculosis Research and urges NIAID to expand research to address the research questions outlined in the Plan and stimulate the 

development of promising diagnostics, treatments, and vaccines. 

NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES (NIGMS)

Appropriation, fiscal year 2019 ......................................................... $2,872,780,000 

Budget request, fiscal year 2020 ....................................................... 2,472,838,000 

Committee Recommendation ............................................................. 3,033,183,000 

Change from enacted level ............................................................. +160,403,000 

Change from budget request .......................................................... +560,345,000 

Mission.—NIGMS supports basic research that increases our understanding of biological processes and lays the foundation for advances in disease diagnosis, treatment, and prevention. 

Institutional Development Awards.—The Committee provides $381,573,000 for the Institutional Development Awards (IDeA) program, an increase of $20,000,000 above the fiscal year 2019 enacted level. IDeA supports high-quality research and investigators 

throughout the country in States in which the success rate for NIH 

grants has been historically low. 

EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH

AND HUMAN DEVELOPMENT (NICHD)

Appropriation, fiscal year 2019 ......................................................... $1,506,458,000 

Budget request, fiscal year 2020 ....................................................... 1,296,732,000 

Committee Recommendation ............................................................. 1,580,084,000 

Change from enacted level ............................................................. +73,626,000 

Change from budget request .......................................................... +283,352,000 

Mission.—NICHD investigates human development throughout 

the entire life process, with a focus on understanding disabilities 

and important events that occur during pregnancy. 

Congenital Syphilis.—The Committee is concerned about the rise 

of congenital syphilis and the lifelong health effects the disease can 

have on a child, as well as the link between syphilis, and other 

96 

STIs, and the rise in injection drug use. The Committee encourages 

NICHD to prioritize research in this area and to work with NIAID 

on new testing, diagnosis, and treatment efforts. 

Endometriosis.—The Committee is aware that endometriosis is a 

serious chronic condition that impacts an estimated one in 10 

women in the U.S. between the ages of 18 and 49. Women with 

this condition can suffer up to 10 years before being properly diagnosed, often due to lack of awareness, invasive methods of diagnosis, and limited treatment options. The Committee directs 

NICHD to submit a report to the Committee within 180 days of enactment of this Act on the current state of endometriosis, including 

topics such as disease prevalence, an evaluation of diagnostic 

standards, treatment options, and outcomes. The report should also 

identify remaining knowledge gaps in understanding this disease 

and recommendations for filling these gaps. Further, the Committee encourages NICHD, in collaboration with the CDC, to continue to support education, outreach, and awareness to promote 

early and accurate diagnosis of endometriosis. 

Fertility Issues for Rare Disease Patients.—Patients with rare diseases like thalassemia face a number of issues related to reproductive health due to complications both from their conditions and 

from their treatments. Because of medical advances, many rare disease patients are now living long enough to contemplate fertility, 

when it may previously not have been feasible. The Committee requests that NICHD provide an report on current research and future initiatives to address these issues in the fiscal year 2021 Congressional Justification and continue to provide updates to the 

Committee on advances being made. 

Male Reproductive Health.—The Committee encourages NICHD 

to support research on male mechanisms of infertility. There is a 

gap in the knowledge of how to diagnose and treat male infertility 

and abnormal embryo development. The Committee supports research to identify new proteins and sperm structures that are necessary for normal sperm formation and, consequently, for fertility 

and embryo development 

Maternal Mortality.—The Committee encourages NICHD to continue its support of research into the leading causes of maternal 

morbidity and mortality. As black women experience maternal mortality at nearly four times the rate of white women, the Committee 

strongly urges NICHD to support research that investigates factors 

contributing to this disparity, and tests evidence-based interventions to address this disparity. NICHD should collaborate with 

NIMHD as appropriate. 

Maternal-Fetal Medicine Units Network.—NICHD’s investment 

in maternal and child health outcomes is essential to understanding rising maternal mortality rates and to optimize maternal 

and child health. The Committee fully supports the work of the 

Maternal Fetal Medicine Units network (MFMU) and encourages 

NICHD to continue to build on its success by ensuring its highly 

efficient structure of multicenter collaborative research continues. 

The Committee is particularly concerned that any change in the 

funding mechanism or structure for the MFMU could compromise 

the ability of the network to remain nimble and directly address 

the changing landscape of women’s health, including to reduce 

health disparities. The Committee directs NICHD to submit a reVerDate Sep 11 2014 06:50 May 16, 2019 Jkt 036295 PO 00000 Frm 00100 Fmt 6659 Sfmt 6602 E:\HR\OC\HR062.XXX HR062
97 

port to the Committee outlining any potential changes being considered to the funding mechanism or structure of the MFMU network within 90 days of enactment of this Act. 

Population Research.—Since the Institute’s inception in 1962, 

NICHD has had a clear mandate to support a robust research portfolio focusing on maternal and child health, the social determinants 

of health, and human development across the lifespan. NICHD has 

supported innovative and influential population science initiatives, 

including numerous scientific research initiatives that have advanced our understanding of specific diseases and conditions, including obesity, autism, and maternal mortality, and, further, how 

socioeconomic and biological factors jointly determine human 

health. The Committee urges NICHD to reaffirm its commitment 

to supporting population research as part of its revised 2020–2024 

strategic plan. 

Spina Bifida.—The Committee recognizes that Spina Bifida is 

the most common permanently disabling birth defect in the U.S. 

While Spina Bifida and related neural tube defects are sometimes 

preventable through education and adequate daily folic acid consumption, there are an estimated 166,000 individuals, more than 

half of whom are 18 and older, living with all forms of this complex 

birth defect. The Committee supports the efforts of the National 

Spina Bifida Program (NSBP) to continue the Spina Bifida Clinical 

Care Monitoring and Tracking program, which works with the National Spina Bifida Registry to guide the health care community in 

best treatment options for people living with Spina Bifida. The 

Committee encourages NIH to expand the National Spina Bifida 

Patient Registry to allow for the inclusion of more clinics. 

Task Force on Research in Pregnant and Lactating Women.—The 

Committee is aware that PRGLAC’s report to the Secretary dated 

September 2018 outlined 15 recommendations to facilitate the inclusion of pregnant women and lactating women in clinical research, and commends the Secretary for extending the task force 

for two additional years. The Committee believes with this extension, the Task Force should oversee the implementation of the already released recommendations working with other relevant NIH 

Institutes and Centers as well as the FDA; and should ensure 

health care professionals and consumers have accurate information 

on the safety and efficacy of drugs taken by these populations. The 

Committee looks forward to reviewing future recommendations 

from the task force and to working with NICHD on this issue. The 

Committee requests a progress report within 120 days of enactment of this Act. 

NATIONAL EYE INSTITUTE (NEI)

Appropriation, fiscal year 2019 ......................................................... $796,536,000 

Budget request, fiscal year 2020 ....................................................... 685,644,000 

Committee Recommendation ............................................................. 835,465,000 

Change from enacted level ............................................................. +38,929,000 

Change from budget request .......................................................... +149,821,000 

Mission.—NEI conducts and supports basic and clinical research, 

research training, and other programs with respect to blinding eye 

diseases, visual disorders, and mechanisms of visual function, preservation of sight, and the special health problems and needs of individuals who are visually-impaired or blind. 

98 

Blepharospasm.—The Committee continues to encourage NEI to 

pursue collaboration with stakeholders on cross-cutting research 

opportunities that affect all forms of dystonia, including 

blepharospasm. 

Human Ocular Tissue Availability.—The Committee encourages 

NEI to work with nonprofit eye banks to find solutions to provide 

high quality, low cost human ocular tissue to universities and other 

nonprofit research institutions. 

NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES (NIEHS)

Appropriation, fiscal year 2019 ......................................................... $774,707,000 

Budget request, fiscal year 2020 ....................................................... 666,854,000 

Committee Recommendation ............................................................. 812,570,000 

Change from enacted level ............................................................. +37,863,000 

Change from budget request .......................................................... +145,716,000 

Mission.—NIEHS’s mission is to discover how the environment 

affects people in order to promote healthier lives. 

Asthma.—The Committee notes with concern the evidence suggesting a causal link between air pollution and the development of 

asthma. The Committee urges NIEHS to explore this potential 

causal link and any interventions necessary to prevent the development of asthma. 

NATIONAL INSTITUTE ON AGING (NIA)

Appropriation, fiscal year 2019 ......................................................... $3,083,410,000 

Budget request, fiscal year 2020 ....................................................... 2,654,144,000 

Committee Recommendation ............................................................. 3,286,107,000 

Change from enacted level ............................................................. +202,697,000 

Change from budget request .......................................................... +631,963,000 

Mission.—NIA’s mission is to understand the nature of aging and 

the aging process, and diseases and conditions associated with 

growing older, in order to extend the healthy, active years of life. 

Alzheimer’s Disease.—In recognition that Alzheimer’s disease 

poses a serious threat to the nation’s long-term health and economic stability, the Committee recommends a total of no less than 

$2,392,000,000 for Alzheimer’s disease research, as recommended 

in the NIH Bypass Budget Proposal for Fiscal Year 2020. NIA 

should continue to address the research goals set forth in the National Plan to Address Alzheimer’s disease, as well as the recommendations from recent research summits on Alzheimer’s disease and related dementias and care and services for individuals 

living with these conditions. 

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. The 

Committee directs NIA to support diversity in its cohort studies, 

with the specific goal of better understanding disease burden and 

biomarkers by race and geographic region. The Committee believes 

this could be accomplished through enhanced partnerships between 

existing NIA-funded Alzheimer’s Disease Research Centers (ADRC) 

and non-ADRC dementia centers in high-risk geographic regions or 

through the creation of new long-term cohorts in under-represented 

groups/regions. 

99 

The Committee also recognizes that as 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. The Committee 

encourages NIA to support a pilot program to test communitybased clinical trials for the prevention of cognitive decline. Such a 

longitudinal study should include an ethnically representative sample, incorporate genomic and environmental Alzheimer’s disease 

risk factors, and monitor cognitive and motor function, disability, 

and morbidity over time. 

Population Research.—The Committee applauds NIA for supporting an innovative and productive population aging research 

portfolio. The Committee urges NIA to pursue its plans to renew 

and expand the Demography and Economics of Aging Centers Program and to reaffirm the Institute’s commitment to supporting population aging research overall as part of its revised strategic directions document, Aging Well in the 21st Century: Strategic Directions for Research on Aging. 

NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN

DISEASES (NIAMS)

Appropriation, fiscal year 2019 ......................................................... $605,065,000 

Budget request, fiscal year 2020 ....................................................... 520,829,000 

Committee Recommendation ............................................................. 634,637,000 

Change from enacted level ............................................................. +29,572,000 

Change from budget request .......................................................... +113,808,000 

Mission.—NIAMS’s mission is to support research into the 

causes, treatment, and prevention of arthritis and musculoskeletal 

and skin diseases; the training of basic and clinical scientists to 

carry out this research; and the dissemination of information on research progress in these diseases. 

Alopecia Areata.—The Committee notes NIAMS leadership is 

continuing autoimmune research to advance treatment development for alopecia areata and related conditions. The Committee requests an update from NIAMS on developments from cross-cutting 

autoimmune research projects in the fiscal year 2021 Congressional 

Justification. 

Epidermolysis Bullosa.—The Committee continues to recognize 

promising scientific gains and applauds private partners advancing 

research in pursuit of treatments for Epidermolysis Bullosa. The 

Committee encourages NIH to continue supporting research for 

Epidermolysis Bullosa. 

Scleroderma.—The Committee notes the work of NIAMS and 

other stakeholders in the recent discovery of the biomarker CCL2 

that can lead to early detection of scleroderma. The Committee continues to encourage NIAMS to support the scleroderma research 

portfolio and continue collaborative opportunities with other Institutes and community stakeholders to advance critical research. 

100 

NATIONAL INSTITUTE ON DEAFNESS AND OTHER COMMUNICATION

DISORDERS (NIDCD)

Appropriation, fiscal year 2019 ......................................................... $474,404,000 

Budget request, fiscal year 2020 ....................................................... 408,358,000 

Committee Recommendation ............................................................. 497,590,000 

Change from enacted level ............................................................. +23,186,000 

Change from budget request .......................................................... +89,232,000 

Mission.—NIDCD conducts and supports biomedical and behavioral research and research training in the normal and disordered 

processes of hearing, balance, taste, smell, voice, speech, and language. NIDCD also conducts and supports research and research 

training related to disease prevention and health promotion; addresses special biomedical and behavioral problems associated with 

people who have communication impairments or disorders; and 

supports efforts to create devices which substitute for lost and impaired sensory and communication function. 

Spasmodic Dysphonia.—The Committee continues to encourage 

NIDCD to work with stakeholders to advance critical research into 

spasmodic dysphonia. 

NATIONAL INSTITUTE OF NURSING RESEARCH (NINR)

Appropriation, fiscal year 2019 ......................................................... $162,992,000 

Budget request, fiscal year 2020 ....................................................... 140,301,000 

Committee Recommendation ............................................................. 170,958,000 

Change from enacted level ............................................................. +7,966,000 

Change from budget request .......................................................... +30,657,000 

Mission.—The mission of NINR is to promote and improve the 

health of individuals, families, and communities. To achieve this 

mission, NINR supports and conducts clinical and basic research 

and research training on health and illness, research that spans 

and integrates the behavioral and biological sciences, and develops 

the scientific basis for clinical practice. 

NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM (NIAAA)

Appropriation, fiscal year 2019 ......................................................... $525,591,000 

Budget request, fiscal year 2020 ....................................................... 452,419,000 

Committee Recommendation ............................................................. 551,278,000 

Change from enacted level ............................................................. +25,687,000 

Change from budget request .......................................................... +98,859,000 

Mission.—NIAAA’s mission is to generate and disseminate fundamental knowledge about the effects of alcohol on health and 

well-being, and apply that knowledge to improve diagnosis, prevention, and treatment of alcohol-related problems, including alcohol 

use disorder, across the lifespan. 

NATIONAL INSTITUTE ON DRUG ABUSE (NIDA)

Appropriation, fiscal year 2019 ......................................................... $1,419,844,000 

Budget request, fiscal year 2020 ....................................................... 1,296,379,000 

Committee Recommendation ............................................................. 1,489,237,000 

Change from enacted level ............................................................. +69,393,000 

Change from budget request .......................................................... +192,858,000 

Mission.—NIDA’s mission is to advance science on the causes 

and consequences of drug use and addiction and to apply that 

knowledge to improve individual and public health. 

Opioids.—The Committee continues to support the HEAL (Helping to End Addiction Long-Term) Initiative, a trans-NIH effort to 

101 

speed scientific solutions to stem the national opioid public health 

crisis. This Initiative builds on extensive, well-established NIH research, including basic science of the complex neurological pathways involved in pain and addiction, implementation science to develop and test treatment models, and research to integrate behavioral interventions with medication-assisted treatment for opioid 

use disorder. The Committee includes no less than the fiscal year 

2019 enacted level of $250,000,000 within NIDA for this research. 

The Committee continues to be extremely concerned about the 

crisis of prescription opioids, heroin, and illicit synthetic opioid use, 

addiction and overdose in the U.S. Approximately 192 people die 

each day in this country from drug overdose (over 130 of those are 

directly from opioids). This crisis has been exacerbated by the 

availability of illicit fentanyl and its analogs in many communities. 

The Committee appreciates the important role that research plays 

in the various federal initiatives aimed at this crisis. The Committee encourages NIDA to emphasize: the development of safe and 

effective medications, including new formulations and combinations 

to treat opioid use disorders and to prevent and reverse overdose; 

the role of comprehensive care models to prevent opioid misuse, expand treatment capacity, enhance access to overdose reversal medications, and enhance prescriber practice; testing the effectiveness 

of medications and other treatment interventions within the justice 

system; and developing evidence-based strategies to integrate 

screening and treatment for opioid use disorders in emergency department and primary care settings. 

Addressing the Opioid Crisis in Rural Regions.—The Committee 

encourages NIDA to continue its partnership with the CDC, 

SAMHSA, and the Appalachian Regional Commission in support of 

research to help communities develop comprehensive approaches to 

prevent and treat consequences of opioid injection, including substance use disorders, overdose, HIV, hepatitis B and C virus infections, and sexually transmitted infections. These projects will serve 

as models for addressing the consequences associated with opioid 

injection epidemics that can be implemented by health systems in 

similar rural communities in the U.S. 

Barriers to Research.—The Committee is concerned that restrictions associated with Schedule I of the Controlled Substance Act effectively limit the amount and type of research that can be conducted on certain Schedule I drugs, especially marijuana or its 

component chemicals and new synthetic drugs and analogs. At a 

time when we need as much information as possible about these 

drugs to find antidotes for their harmful effects, we should be lowering regulatory and other barriers to conducting this research. 

The Committee directs NIDA to provide a short report on the barriers to research that result from the classification of drugs and 

compounds as Schedule I substances. 

Electronic Cigarettes.—The Committee understands that electronic cigarettes (e-cigarettes) and other vaporizing equipment are 

increasingly popular among adolescents, and requests that NIDA 

fund research on the use and consequences of these devices. The 

Committee also supports the Population Assessment of Tobacco 

and Health (PATH) Study, a collaboration between NIDA and the 

FDA Center for Tobacco Products to help scientists learn how and 

why people start using tobacco products, quit using them, and start 

102 

using them again after they have quit, as well as how different tobacco products affect health outcomes over time. 

The HEALthy Brain and Child Development Study.—The Committee recognizes and supports the NIH HEALthy Brain and Child 

Development (HEALthy BCD) Study, which will establish a large 

cohort of pregnant women, including those affected by the opioid 

crisis, and follow them and their children for at least 10 years. This 

knowledge will be critical to help predict and prevent some of the 

known impacts of pre- and postnatal exposure to drugs or adverse 

environments, including risk for future substance use, mental disorders, and other behavioral and developmental problems. The 

Committee recognizes that the HEALthy BCD Study is supported 

in part by the HEAL Initiative, and encourages other NIH Institutes, such as NICHD, NIMH, NHLBI, NCI, NIAAA, NIMH, NINR, 

as well as the Office of the Director, to support this important 

study. 

Housing Supports and Substance Use Disorder Treatment Outcomes and Costs.—The Committee acknowledges that there is 

growing anecdotal evidence to suggest a strong correlation between 

successful substance use disorder treatment outcomes and stable 

housing arrangements, especially for those facing mental health 

challenges or of limited economic means. The Committee strongly 

encourages NIDA to support a multidisciplinary academic research 

partnership using clinical expertise and cost function analysis 

(CFA) to assess how affordable housing impacts substance use disorder treatment outcomes and costs in acutely affected regions like 

New England where, according to the Federal Reserve Bank of Boston, each state in the six-state region spends more per capita on 

opioid related costs including criminal justice, medical treatment, 

and medical complications, and where treating opioid use disorder 

on an emergency and long-term basis comprises the majority of 

costs. 

Kratom.—The Committee requests that NIH expand research on 

all health impacts of kratom, including its constituent compounds, 

mitragynine, and 7-hydroxymitragynine. The Committee is aware 

of the potential promising results of kratom for acute and chronic 

pain patients who seek safer alternatives to sometimes dangerously 

addictive and potentially deadly prescription opioids. 

Marijuana Research.—The Committee is concerned that marijuana public policies in States (medical marijuana, recreational 

use, etc.) are being changed without the benefit of scientific research to help guide those decisions. The Committee encourages 

NIH to continue supporting a full range of research on the health 

effects of marijuana and its components, including research to understand how marijuana policies affect public health. 

Raising Awareness and Engaging the Medical Community in 

Drug Abuse and Addiction Prevention and Treatment.—The Committee notes that 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 pleased with the NIDAMED initiative, 

targeting physicians-in-training, including medical students and 

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cine, family practice, and pediatrics). The Committee encourages 

NIDA to continue its efforts in this space, providing physicians and 

other medical professionals with the tools and skills needed to incorporate substance misuse and addiction screening and treatment 

into their clinical practices. The Committee encourages NIDA and 

CDC to develop strategies for increasing participation in its online 

continuing medical education course on safe prescribing for pain 

and managing patients who misuse prescription opioids. The Committee also encourages NIDA and CDC to develop strategies for increasing participation in its online continuing medical education 

courses on safe prescribing for pain and managing patients who 

abuse prescription opioids. 

NATIONAL INSTITUTE OF MENTAL HEALTH (NIMH)

Appropriation, fiscal year 2019 ......................................................... $1,870,296,000 

Budget request, fiscal year 2020 ....................................................... 1,630,442,000 

Committee Recommendation ............................................................. 1,961,704,000 

Change from enacted level ............................................................. +91,408,000 

Change from budget request .......................................................... +331,262,000 

Mission.—NIMH’s mission is to transform the understanding and 

treatment of mental illnesses through basic and clinical research, 

paving the way for prevention, recovery, and cure. 

Computational Medicine and RNA Molecules.—The Committee is 

encouraged by recent advances in computational medicine that are 

helping scientists understand what causes disease and how disease 

progresses. One such example is new evidence about how a person’s sex, race, ethnicity, and geographic origin affect the individual’s regulatory RNA molecules and the proteins that these molecules control. More research on these links could uncover new and 

important biological discoveries, improve our understanding of disease processes and herald highly personalized approaches to diagnosis, prognosis and therapy. The Committee urges NHGRI to support additional research on RNA molecules and the mechanisms 

through which they affect biological processes that cause disease. 

BRAIN Initiative.—The Committee directs NIH to transfer 

$70,000,000 from the NIH Innovation Account to NIMH to support 

the BRAIN Initiative. These funds are authorized by the 21st Century Cures Act (P.L. 114–255). This collaborative effort is revolutionizing our understanding of how neural components and their 

dynamic interactions result in complex behaviors, cognition, and 

disease, while accelerating the development of transformative tools 

to explore the brain in unprecedented ways making information 

previously beyond reach accessible. 

Disproportionate Suicides by Youth of Color.—The Committee is 

pleased with NIMH efforts to prioritize suicide prevention research. 

The Committee notes that the rate of suicide has increased by 2 

percent each year since 2006, and that suicide is the second leading 

cause of death among children ages 10 to 17. The Committee is especially concerned with recent findings that African-American children ages 5 to 12 are dying by suicide at nearly twice the rate of 

their white counterparts. Accordingly, the Committee encourages 

NIMH to continue its support of research to address youth suicide, 

with a focus on addressing the disparity in youth of color. NIMH 

should collaborate with other NIH institutes, including NIMHD, as 

appropriate. 

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NATIONAL HUMAN GENOME RESEARCH INSTITUTE (NHGRI)

Appropriation, fiscal year 2019 ......................................................... $575,579,000 

Budget request, fiscal year 2020 ....................................................... 495,448,000 

Committee Recommendation ............................................................. 603,710,000 

Change from enacted level ............................................................. +28,131,000 

Change from budget request .......................................................... +108,262,000 

Mission.—NHGRI’s mission is to accelerate scientific and medical 

breakthroughs that improve human health by driving cutting-edge 

research, developing new technologies, and studying the impact of 

genomics on society. 

Emerging Centers of Excellence in Genomic Sciences.—The Committee includes $10,000,000 for a new competitively awarded center-based award program for ‘‘Emerging Centers of Excellence’’. 

The purpose of the awards is to build capacity at institutions that 

are not prior or present awardees of the Centers for Excellence in 

Genomic Sciences program. The Committee urges NHGRI to include plans for sustainment of this capacity-building mechanism in 

its 2020 vision report. 

NATIONAL INSTITUTE OF BIOMEDICAL IMAGING AND BIOENGINEERING

(NIBIB)

Appropriation, fiscal year 2019 ......................................................... $389,464,000 

Budget request, fiscal year 2020 ....................................................... 335,986,000 

Committee Recommendation ............................................................. 408,498,000 

Change from enacted level ............................................................. +19,034,000 

Change from budget request .......................................................... +72,512,000 

Mission.—The NIBIB mission is to improve health by leading the 

development and accelerating the application of biomedical technologies. 

NATIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH DISPARITIES

(NIMHD)

Appropriation, fiscal year 2019 ......................................................... $314,679,000 

Budget request, fiscal year 2020 ....................................................... 270,870,000 

Committee Recommendation ............................................................. 341,244,000 

Change from enacted level ............................................................. +26,565,000 

Change from budget request .......................................................... +70,374,000 

Mission.—NIMHD’s mission is to lead scientific research to improve minority health and reduce health disparities. 

Research Centers at Minority Institutions.—The Committee recognizes the important role of the RCMI program in developing the infrastructure required to enhance biomedical research conducted at 

historically minority serving institutions. This infrastructure is 

critical to supporting the development of new investigators and 

sustaining an established workforce conducting world-class biomedical research that emphasizes the advancement of minority 

health and the reduction of health disparities. Therefore, the Committee includes $75,000,000, an increase of $11,186,000, for RCMIs 

to ensure that critical capacity development in historically minority 

graduate and health professional schools continues to be enhanced 

to meet these critical needs. In addition, the Committee recognizes 

the importance of the RCMI Translational Research Network in ensuring that collectively, institutions can engage in multi-site collaborative research. 

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Research Endowment Program.—The Committee is concerned by 

NIMHD’s lack of engagement with stakeholders and the broader 

community regarding Research Endowment Program (REP) eligibility. The Committee urges NIMHD to move forward with the recommendations made by the Advisory Council workgroup to restore 

endowment eligibility for REP to the original Congressional intent. 

The Committee requests that NIMHD report to the Committee on 

progress made to implement these recommendations prior to 

NIMHD issuing its next FOA for REP. 

Focal Segmental Glomerulosclerosis.—The Committee encourages 

NIMHD to collaborate with other Institutes and Centers and stakeholders to expand research opportunities on the APOL1 gene that 

causes African-Americans to be disproportionately affected by focal 

segmental glomerulosclerosis. 

Interdisciplinary Rural African-American Aging Research.—Although racial and rural disparities in health have been well-documented, there remain major gaps in our understanding of how psycho-social stressors, particularly those salient and unique to the experiences of rural African-Americans, contribute to multi-system 

aging across biological systems. The committee urges NIMHD to 

work with extramural partners to develop the infrastructure needed for conducting interdisciplinary aging epidemiologic studies in 

rural contexts despite the above challenges. The committee encourages NIMHD to prioritize efforts focused on establishing partnerships with rural stakeholders and service providers; implementing 

a multistage probability sampling design for rural populations, and 

creating a sophisticated recruitment and project management and 

database system; and conducting research involving collection of biological and physiological aging measures, specifically in rural 

areas through the application of novel methods to collect biospecimens in participants’ homes. 

Maximizing Access to Research Careers.—The Committee recognizes the importance of the Maximizing Access to Research Centers 

(MARC) program and encourages the continuation and enhancement of efforts underway with our nation’s historically black colleges and universities (HBCUs). The Committee also recognizes the 

important work of those HBCUs located in rural parts of the U.S., 

particularly the Black Belt region in educating significant numbers 

of underserved students in STEM fields, and it encourages the NIH 

to continue and strengthen its engagement of institutions located 

in this region. 

NATIONAL CENTER FOR COMPLEMENTARY AND INTEGRATIVE HEALTH

(NCCIH)

Appropriation, fiscal year 2019 ......................................................... $146,473,000 

Budget request, fiscal year 2020 ....................................................... 126,081,000 

Committee Recommendation ............................................................. 153,632,000 

Change from enacted level ............................................................. +7,159,000 

Change from budget request .......................................................... +27,551,000 

Mission.—The mission of NCCIH is to define, through rigorous 

scientific investigation, the usefulness and safety of complementary 

and integrative health interventions and their roles in improving 

health and health care. 

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NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCES (NCATS)

Appropriation, fiscal year 2019 ......................................................... $806,373,000 

Budget request, fiscal year 2020 ....................................................... 694,112,000 

Committee Recommendation ............................................................. 845,783,000 

Change from enacted level ............................................................. +39,410,000 

Change from budget request .......................................................... +151,671,000 

Mission.—NCATS was established to transform the translational 

process so that new treatments and cures for disease can be delivered to patients faster. 

Clinical and Translational Science Awards.—The Committee expects NIH to fund Clinical and Translational Science Awards at not 

less than the level provided in fiscal year 2018. 

JOHN E. FOGARTY INTERNATIONAL CENTER (FIC)

Appropriation, fiscal year 2019 ......................................................... $78,109,000 

Budget request, fiscal year 2020 ....................................................... 67,235,000 

Committee Recommendation ............................................................. 84,926,000 

Change from enacted level ............................................................. +6,817,000 

Change from budget request .......................................................... +17,691,000 

Mission.—FIC’s mission is to support and facilitate global health 

research conducted by U.S. and international investigators, building partnerships between health research institutions in the U.S. 

and abroad, and training the next generation of scientists to address global health needs. 

NATIONAL LIBRARY OF MEDICINE (NLM)

Appropriation, fiscal year 2019 ......................................................... $441,997,000 

Budget request, fiscal year 2020 ....................................................... 380,463,000 

Committee Recommendation ............................................................. 463,599,000 

Change from enacted level ............................................................. +21,602,000 

Change from budget request .......................................................... +83,136,000 

Mission.—The NLM collects and organizes information important 

to biomedicine; serves as a national information resource for medical education, research, and health service activities; enhances access to biomedical literature through electronic services; serves the 

public by providing electronic access to reliable health information 

for consumers; supports and directs the national network of libraries of medicine; provides grants for research in biomedical communications, medical library development, and training health information specialists; conducts and supports research in biomedical 

informatics and computational biology; and creates information resources for genomics, molecular biology, toxicology, medical images, 

environmental health, emergency preparedness and response, and 

health services research. 

OFFICE OF THE DIRECTOR (OD)

Appropriation, fiscal year 2019 ......................................................... $1,909,075,000 

Budget request, fiscal year 2020 ....................................................... 1,756,544,000 

Committee Recommendation ............................................................. 2,049,992,000 

Change from enacted level ............................................................. +140,917,000 

Change from budget request .......................................................... +293,448,000 

Mission.—The OD provides leadership to NIH research enterprise and coordinates and directs initiatives that crosscut NIH. OD 

is responsible for the development and management of intramural 

and extramural research and research training policy, the review 

of program quality and effectiveness, the coordination of selected 

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NIH-wide program activities, and the administration of centralized 

support activities essential to the operations of NIH. 

All of Us Program.—The Committee provides a total of $500,000,000 for the All of Us precision medicine initiative, an increase of $124,000,000 above the fiscal year 2019 enacted level. 

The Committee recognizes the importance of including populations historically underrepresented in biomedical research in the 

All of Us research program, a key component of the precision medicine initiative. By ensuring meaningful and broad inclusion, the 

program ensures more equitable benefit from future medical discoveries using All of Us data, including those in the field of cancer 

research. The Committee directs NIH to continue its efforts to recruit and retain participants from these historically underrepresented populations so that the All of Us scientific resources reflect the rich diversity of our country. 

Biomedical Research Facilities.—The Committee includes 

$25,000,000 for grants or contracts to public 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. 

We also support the Director’s efforts to ensure geographic and 

institutional diversity of the grant program through the Institutions of Emerging Excellence, and direct NIH to allocate no less 

than 25 percent of funding for this program to these institutions. 

Common Fund.—The Committee recommends $617,761,000 for 

the Common Fund (CF), and an additional $12,600,000 provided to 

support the Gabriella Miller Kids First Research Act for the sixth 

year of the ten-year Pediatric Research Initiative. NIH is expected 

to continue the longstanding CF policy for projects to be shortterm, high-impact awards, with no projects receiving funding for 

more than ten years. 

Environmental Influences on Child Health Outcomes.—The Committee includes no less than the fiscal year 2019 enacted level for 

the Environmental Influences on Child Health Outcomes (ECHO) 

Project, which has the potential to greatly increase understanding 

of these critical determinants of health across the lifespan, through 

its observational cohorts and the IDeA States Pediatric Clinical 

Trials Network. The Committee encourages continued communication about to the program’s progress toward goals, milestones, and 

projected funding estimates with both external stakeholders and 

Congress. 

Regenerative Medicine.—The Committee provides $8,000,000 for 

regenerative medicine activities authorized in the 21st Century 

Cures Act. 

Regenerative medicine and tissue engineering are emerging disciplines that aim to revolutionize the treatment of disease by providing cures rather than treating symptoms. Approaches include 

the use of Induced Pluripotent Stem Cell technology, derived from 

adult skin cells, to provide limitless supplies of cells for transplant 

therapy and disease modeling as well as bioengineering and tissue 

engineering to generate replacement tissues and organs. The Committee encourages NIH to support research into the fields of regenerative medicine and tissue engineering. 

Advisory Committees.—The Committee is concerned that despite 

the legal requirement that all NIH advisory councils have at least 

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two representatives from the fields of public health and the behavioral or social sciences, recent reviews of the membership of advisory councils reveal that not all Institutes and Centers are in compliance with this requirement. The Committee urges compliance 

with this statute and requests a report on the fields of public 

health and behavioral and social sciences that are represented on 

each advisory committee. 

Biorepository Catalog.—The Committee is encouraged by efforts 

within the medical research community to better understand 

chronic diseases through biorepositories which store medical tissues and associated information for scientific research. Increasing 

awareness and utilization of these biorepositories by the wider 

medical community would be highly useful to science, medicine, 

and national security. The Committee directs NIH to partner with 

one or more research institutions to implement innovative approaches for improving the discoverability of biorepositories for tissues and associated data for cardiovascular diseases, 

neurodegenerative diseases, and cancer. The Committee expects 

NIH, along with the sponsoring research institution or institutions, 

to establish protocols for the release of tissues and associated data 

from such biorepositories. 

Harassment Policies.—The Committee recognizes that recent 

events make clear that harassment occurs in all workplaces, including science and medicine, and that changing the culture that 

fosters sexual harassment will require sustained commitment and 

resources. The National Academies of Sciences, Engineering, and 

Medicine report released last year found that sexual harassment is 

rampant in the labs and institutions supported by NIH and American taxpayers. The Committee commends NIH for taking steps to 

remind institutions of the agency’s expectation that they implement and enforce policies for reporting sexual harassment and notify NIH when key personnel named on an NIH grant award have 

been removed because of sexual harassment concerns. However, as 

the funder of the vast majority of biomedical research conducted in 

the U.S., the Committee believes NIH must play a more active role 

in changing the culture that has long perpetuated the problem. The 

Committee directs NIH to require institutions not just to notify the 

agency when key personnel named on an NIH grant award are removed because of sexual harassment concerns, but also when they 

are placed on administrative leave for such concerns, and to submit 

to the Committee plans to implement measures that attend to harassment in extramural settings with the same level of attention 

and resources as those devoted to other research misconduct. The 

Committee also directs NIH to support research in the areas identified in the Report, including the psychology underlying harassment 

and the experiences and outcomes of diverse groups when subjected 

to harassment. Additionally, the Committee directs NIH to collaborate with the National Academies to develop best practices for developing more diverse and inclusive cultures in the grantee research environments, including training individuals in institutions 

that receive NIH funds to recognize and address sexual harassment, and evaluating the efficacy of various sexual harassment 

training programs. 

Mitochondrial Disease.—The Committee is aware that medical 

research continues to identify new mitochondrial disorders and to 

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confirm the central role that mitochondrial dysfunction plays in a 

host of major diseases. The Committee urges the Director to support one or more mitochondrial disease centers of excellence. The 

Committee also encourages the Director to continue supporting and 

empowering efforts to coordinate this work, including through the 

trans-NIH Mitochondrial Disorders Working Group. The Committee strongly supports continuing the work of the North American Mitochondrial Disease Consortium (NAMDC) and the 

Mitochondrial Disease Sequence Data Resource (MSeqDR) Consortium, and applauds the work of NINDS to develop the first set of 

Common Data Elements (CDEs) for mitochondrial disease to support further research, including through the BRAIN Initiative as 

well as the All of Us and ECHO research programs. 

Needs of Children in NIH-Wide Initiatives.—The Committee requests an update from the NIH Director within 120 days of enactment of this Act on how NIH will focus on the unique needs of children in its NIH-wide initiatives that span multiple institutes and 

centers, as well as its highest priority initiatives, including but not 

limited to the All of Us Research Program, the BRAIN Initiative, 

and the Cancer Moonshot. The Committee asks that this update 

describe the inclusion of pediatric subjects, research relevant to pediatrics, specific funding allocations, support for pediatric physician 

scientists, and a strategy to more proportionally target funds within these initiatives to pediatric research. The Committee commends 

NIH for the establishment of the Trans-NIH Pediatric Research 

Consortium to help coordinate pediatric research at NIH. The Committee also requests an update on the activities of the Consortium 

and its plans to better coordinate pediatric research across the institutes, including identifying gaps and opportunities for collaboration. 

Office of AIDS Research.—The Committee directs NIH to increase funding for HIV/AIDS research by at least the same percentage as the increase in NIH overall funding. The Committee recognizes that OAR’s AIDS allocation to each IC is based on scientific 

need and opportunity. Therefore, individual IC AIDS budgets may 

not each grow at the same rate, but total AIDS and non-AIDS 

funding will continue to grow at a comparable rate. 

Office of Behavioral and Social Sciences Research.—The OBSSR 

was established to coordinate and promote basic, clinical, and 

translational research in the behavioral and social sciences in support of the NIH mission. The Committee supports OBSSR’s activities aimed at strengthening these sciences by enhancing trans-NIH 

investments in longitudinal datasets, technology in support of behavior change, innovative research methodologies, and promoting 

the inclusion of behavioral and social sciences in initiatives at the 

NIH Institutes and Centers. In partnership with other Institutes 

and Centers, OBSSR co-funds highly-rated grants that the ICs cannot fund alone. While the NIH budget has grown in recent years, 

OBSSR funding has remained stagnant. Therefore, the Committee 

encourages NIH to provide OBSSR funding commensurate with increases given to the ICs. 

Women and Opioid Use Disorder.—Research suggests that gender differences in opioid use have significant implications for preventing opioid misuse and treating pain and opioid use disorder 

(OUD), For example, women are more likely to be prescribed 

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opioids for pain, even for chronic conditions such as headache for 

which there is little evidence that opioids are an effective treatment. Some medications for treatment of addiction are not as effective in women as they are in men, and vice versa. Additionally, 

OUD treatment approaches that address an individual’s needs as 

a caregiver, such as child care and domestic counseling, have 

shown improved engagement of women in treatment. However, 

much of what is known about substance use interventions is based 

on the experiences and concerns of men. The Committee urges NIH 

to support research related to women and OUD, including research 

that identifies treatment approaches that may be more effective in 

women. 

Women in Research.—Women represent half of the U.S. population. As such, conditions and diseases that are specific to women’s health, or those that present differently in women than men, 

must be a priority for Federally-funded research. The Committee 

encourages the NIH, under the leadership of the Office of Research 

on Women’s Health and the NICHD, to do the following: report on 

the total dollar amount of research invested in health conditions 

specific to women over the last ten years, including but not limited 

to pregnancy, gynecologic oncology, and infertility; provide a list of 

which Institutes provide the highest amount of funding toward 

health research on conditions specific to women; and report on how 

and whether funding for research in this area is coordinated across 

the NIH. The Committee looks forward to a report from the NIH 

in the fiscal year 2020 Congressional Justification. 

Multi-Institute Research Issues 

Firearm Injury and Mortality Prevention Research.—The Committee includes at least $25,000,000 to support research on the prevention of gun violence. Research should focus on biological, behavioral, and environmental mechanisms that underlie aggression, as 

well as prevention of self-directed violence. 

Trisomy 21.—The Committee commends NIH for its support of 

the Investigation of Co-Occurring Conditions Across the Lifespan to 

Understand Down Syndrome (INCLUDE) Initiative. The Committee includes no less than $60,000,000 within the Office of the 

Director for the INCLUDE Initiative, an increase of $22,000,000 

above the expected fiscal year 2019 funding level. The Committee 

expects that this multi-year, trans-NIH research initiative may 

yield scientific discoveries that could significantly improve the 

health and quality of life of individuals with Down syndrome as 

well as millions of typical individuals. 

Amyloidosis.—The Committee encourages NIH to continue its expansion of 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. Left 

untreated, there is an average survival of 15 months. Current 

methods of treatment are risky and unsuitable for many patients. 

The Committee directs NIH to inform the Committee on the steps 

taken to increase the understanding of the causes of amyloidosis 

and the measures taken to improve the diagnosis and treatment of 

this devastating group of diseases in the fiscal year 2021 Congressional Justification. 

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Amyotrophic Lateral Sclerosis (compromise language proposed by 

NIH).—The Committee directs the NIH Director to facilitate further efforts involving at a minimum, NINDS and NIA to study ALS 

disease mechanisms and identified genes to facilitate the expeditious development of targeted therapies. These efforts shall bring 

together research results that will be available to academic researchers, nonprofit organizations, and industry researchers, and 

will supplement, not supplant, existing NIH-supported activities for 

ALS research. The near-term research opportunity to find a cure 

is real for ALS. Any such breakthroughs will have significant benefits for related neurological conditions including traumatic brain injury (TBI), Parkinson’s, and Alzheimer’s. The Committee directs 

the NIH to report to the Committee within 180 days of enactment 

of this act on progress in furthering these research areas. 

Brain and Body Health.—The Committee encourages partnership 

and collaboration with entities able to explore the similarities in 

the brains and comorbid conditions of those with Alzheimer’s disease, dementia, and autism, to facilitate studies related to brain 

and body health, including studies designed to improve and empirically validate a variety of supports for complex conditions. 

Childhood Post-Infectious Neuroimmune Disorders.—The Committee is concerned that children, following streptococcal and other 

infections, are experiencing the onset of neuropsychiatric and behavioral disorders. These auto-inflammatory encephalopathic conditions, including Pediatric Autoimmune Neuropsychiatric Disorders 

Associated with Streptococcal Infections (PANDAS) and Pediatric 

Acute-onset Neuropsychiatric Syndrome (PANS), are often 

misdiagnosed. Delays in diagnosis and lack of developed avenues of 

treatment result in a devastating escalation of mental health symptoms and associated costs. The Committee encourages the NIH to 

prioritize research efforts in this area and report to the Committee 

on incidence, causes, diagnostic criteria, and treatment of these 

conditions, including ways to further understanding and improve 

clinical care. 

Chronic Fatigue Syndrome.—The Committee commends the NIH 

on its new ME/CFS efforts, including its plans for a 2019 conference on accelerating research into ME/CFS and its formation of 

the National Advisory Neurological Disorders and Stroke (NANDS) 

Council Working Group. The Committee encourages NIH to expand 

ME/CFS efforts such as (1) new ME/CFS disease specific funding 

announcements, including those with set-aside funds, to deliver 

needed diagnostics and treatments as quickly as possible, (2) an 

initiative to reach consensus on the ME/CFS case definition, and 

(3) mechanisms to incentivize researchers to enter the field. 

Coordination with the National Endowment for the Humanities.—The Committee supports interagency collaboration between 

NIH and the National Endowment for the Humanities (NEH). The 

Committee strongly encourages NIH to engage with NEH in collaborative funding initiatives that combine research in health and 

medical fields with scholarship originating in humanities disciplines. The Committee recognizes that integrated research and 

education should include scientists, health professionals, and humanists to create opportunities for new approaches to both research and practice in health care. 

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Dual Diagnosis Addiction and Mental Health Research.—A Surgeon General report recently showed that over 40 percent of Americans with a substance use disorder suffer a dual diagnosis with comorbid mental illness. Understanding the relationship between 

mental illness and addiction is imperative to providing effective 

treatment. The Committee encourages NIMH, NIDA, and other relevant Institutes and Centers as appropriate to support research on 

this topic. 

Duchenne Muscular Dystrophy.—Duchenne muscular dystrophy 

is a severe type of muscular dystrophy for which there is no cure 

and for which the average life expectancy is in the second decade. 

The Committee strongly encourages NIH to significantly expand its 

support for research on Duchenne muscular dystrophy, particularly 

accelerating and optimizing the clinical trial process through novel 

and innovative trial designs, such as platform trials, which might 

serve as a model for other rare diseases communities. The Committee also urges NIH to support methodological research on challenges, such as redosing, manufacturing supply, and potential immune response, associated with the advent of gene therapies for 

rare diseases, such as Duchenne. 

Ehlers-Danlos Syndrome.—The Committee encourages NIH to 

support research with respect to Ehlers-Danlos Syndrome and related connective tissue disorders. 

Fibrotic Diseases.—The Committee notes recent discoveries by 

Institutes concerning fibrotic diseases. The Committee continues to 

encourage NIH to work to advance critical fibrotic disease research. 

Food is Medicine.—The Committee recognizes the important role 

of nutrition in health outcomes and commends work being done 

across integrated care organizations, as coordinated by NIDDK, to 

conduct research on Food is Medicine. The Committee further encourages additional collaboration among the Institutes on these 

topics, included but not limited to: medically-tailored meals, medical nutrition therapy, produce prescription programs, maternal nutrition, and gut microbial changes. 

Fragile X.—The Committee commends NIH for supporting research to understand the nature of Fragile X (FX) and its association with other conditions such as autism. The Committee encourages NIH to continue to fund at least three FX research centers, 

supporting interdisciplinary research in important new areas. The 

Committee urges NIH to assure that the FX research centers program includes clinical and translational research that directly addresses the needs of affected children and their families, and that 

applicants for new centers may propose clinical trials as part of 

their research portfolio. Given the inextricable connection between 

the FX protein and autism, the Committee urges the Director and 

her counterparts at each institute with Fragile X and autism portfolios to explore ways to create greater efficiency and synergy 

among 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 including the funding for clinical trials for both disorders. 

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lated into therapies and diagnostic tools that benefit patient care 

while disseminating cutting-edge information to the professional 

community. The Committee notes the importance of flagship initiatives, including the Clinical and Translational Science Awards program, to these important efforts. 

Gene-Environment Interactions in Neurodegenerative Disorders in 

the Diverse Populations of African-Americans and Latinos.—In the 

context of NIH’s robust neurological disease research portfolio, the 

committee commends the leadership of the NIH in advancing the 

relevant objectives of the 21st Century Cures Act and the BRAIN 

Initiative. The Committee is concerned and recognizes the need to 

better understand the interactions between genetics and environmental factors, in particular with elderly and diverse populations 

of African Americans and Latinos. The Committee encourages NIH 

to accelerate collaborative research across relevant institutes and 

the research community to address the goal of determining the role 

of the interaction between environmental exposures to toxic chemicals and genetics and their impact on neurodegenerative disorders 

in diverse populations of African Americans and Latinos, to allow 

for earlier diagnosis and subsequent treatment to arrest the progression of these devastating neurodegenerative disorders. 

Headache Disorders.—The Committee recognizes that migraine is 

the second leading cause of global disability, and that migraine and 

other headache disorders are poorly responsive to opioids, but that 

these drugs are often inappropriately prescribed for these diseases. 

Under the HEAL Initiative, the NIH has recently issued Funding 

Opportunity Announcements for research relevant to all types of 

pain, including migraine and headache disorders, and a few specific 

announcements that focus specifically on increasing research on 

back pain and hemodialysis-related pain. The Committee strongly 

urges the Director of NIH to consider a similar focused group of 

HEAL Initiative Requests for Applications to fund fundamental, 

translational, and clinical research on headache disorders, including migraine, post-traumatic headache, the trigeminal autonomic 

cephalalgias, and intracranial hypo/hypertension. 

Hepatitis B.—The Committee commends the Director for establishing a trans-NIH Hepatitis B Working group to include representation from NCI, NIAID, NIDDK and NIMHD to coordinate 

their research agendas to fund the research necessary to find a 

cure for hepatitis B and improve liver cancer outcomes. The Committee urges the Director to use the Common Fund to support the 

integrated trans-NIH research needed to fully address these conditions. The Committee requests that the Office of the Director keep 

the Committee informed on progress of the Trans-Institute Hepatitis B Working Group and requests a status report be sent to the 

Committee within 90 days of enactment of this bill into law. 

Inflammatory Bowel Diseases.—The Committee recognizes that 

as many as 3.1 million persons in the U.S. are impacted by Crohn’s 

disease and ulcerative colitis and is concerned about the growing 

prevalence of IBD and other autoimmune diseases and disorders in 

the country. The Committee also recognizes that IBD is a complex, 

immune-mediated, chronic disease model relevant to other such 

disorders, and that multiple research topics must be explored to 

understand IBD including psychosocial issues; health disparities; 

triggering environmental factors; the complex interplay between 

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food, mind-gut, and immune response; and the maternal health of 

IBD patients as well as their children. The Committee encourages 

NIH to explore these and other research questions with multiple 

Institutes and Centers, including NIDDK, NICHD, and NIMHD. 

Intramural Non-Human Primate Research.—The Committee has 

expressed concern since 2015 about the NIH’s intramural use of 

nonhuman primates in biomedical research. The Committee is especially concerned by a nearly 50 percent increase in NIH’s use of 

nonhuman primates in research involving pain and distress since 

fiscal year 2014. The Committee is encouraged, however, by the 

NIH’s January 2019 letter to Congress expressing support for the 

retirement of primates no longer needed for research. The Committee urges the NIH to accelerate efforts to reduce and replace the 

use of nonhuman primates with alternative research models and 

directs the NIH to provide a report to the Committee no later than 

180 days after enactment that includes: (1) an overview of current 

NIH nonhuman primate use, including a table with summaries of 

all active projects, USDA pain categories, and their cost; (2) a detailed explanation of current NIH efforts to reduce and replace the 

use of primates in research with alternative methods; (3) an assessment of existing research technology not already in use by NIH to 

reduce and replace primate research and the feasibility of employing it to meet current and future research needs; (4) an assessment 

of areas where alternatives to primate research may not yet be 

available; (5) a detailed strategy and timeline for the reduction and 

replacement of NIH primate research with alternative research 

methods; and (6) standard operating procedures for the retirement 

of nonhuman primates no longer needed in research to suitable 

sanctuaries. 

Lyme and Other Tick-Borne Diseases.—The Committee encourages NIH to improve early diagnosis and treatment of Lyme and 

other tick-borne diseases (TBD) to prevent the development of late 

stage disease and more serious and longer-term disability, but also 

intensify research on diagnosis and treatment of late stage and 

chronic disease. In addition to development of highly sensitive and 

specific diagnostics for all stages of disease, a goal should be to develop diagnostics with appropriate sensitivity and specificity for the 

detection of infection. Treatments also should be developed for all 

stages of Lyme and other TBD, determining optimal combinations 

of new candidate or older drugs and exploring novel combinations. 

The Committee strongly encourages NIH to hold a workshop on 

the numerous molecular and functional mechanisms that Borrelia 

burgdorferi (Bb) employs to evade and subvert the immune system 

of the human host and the immune responses and consequences. 

The Committee supports inclusion of other TBD pathogens to consider shared and unique characteristics of the pathogens as NIH 

determines practical for the workshop, with participation by researchers who have published peer-reviewed articles describing 

such mechanisms and immune cell responses, particularly for Bb. 

National Commission on Lymphatic Diseases.—The Committee 

applauds the Office of the Director, NHLBI, NIDDK, and NIAID 

for facilitating the 2015 Trans-NIH Lymphatics Symposium. The 

Committee notes the scientific potential that lymphatics research 

has to treat a wide variety of severe diseases, including heart disease, AIDS, diabetes, rheumatoid arthritis, Alzheimer’s, and canVerDate Sep 11 2014 06:50 May 16, 2019 Jkt 036295 PO 00000 Frm 00118 Fmt 6659 Sfmt 6602 E:\HR\OC\HR062.XXX HR062
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cer. The Committee recommends continuing and extending the efforts of the trans-NIH Coordinating Committee for Lymphatic Research, with participation from other relevant institutes, to explore 

scientific directions that might expand and advance research in 

this field. 

National Laboratories.—Collaborative research efforts between 

the NIH and the Department of Energy (DOE) are pushing the 

boundaries in health research, including drug discovery, brain research and other biomedical research areas. The Committee encourages NIH to expand its relationships with DOE and the National Laboratories to work together more closely and in more strategic ways to leverage DOE’s research capabilities, including instrumentation, materials, modeling and simulation, and data 

science, which will support application in many areas of biomedical 

research. Not later than 180 days after enactment of this Act, NIH 

shall provide to the Committee a report on successful NIH–DOE 

collaborations to date. 

Neurofibromatosis.—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, as well 

as deafness, blindness, developmental delays and autism; the Committee encourages NCI to increase its NF research portfolio in fundamental laboratory science, patient-directed research, and clinical 

trials focused on NF-associated benign and malignant cancers. The 

Committee also encourages NCI to support clinical and preclinical 

trials consortia. Because NF can cause blindness, pain, and hearing 

loss, the Committee urges NINDS to continue to aggressively fund 

fundamental basic science research on NF relevant to restoring 

normal nerve function. Based on emerging findings from numerous 

researchers worldwide demonstrating that children with NF are at 

significant risk for autism, learning disabilities, motor delays, and 

attention deficits, the Committee encourages NINDS, NIMH, and 

NICHD to increase their investments in laboratory-based and patient-directed research 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-related research. NFl can cause vision loss due to optic gliomas. The 

Committee encourages NEI to expand its investment in NF1-focused research on optic gliomas and vision restoration. 

Pediatric Physician-Scientist Workforce.—The Committee is concerned about the challenges in attracting and retaining researchers, particularly physician-scientists, to careers in pediatrics and 

the impact these challenges will have on the pace of innovation and 

discovery. The Committee directs NIH to build upon the formation 

of the Trans-NIH Pediatric Research Consortium (N–PeRC) to develop a framework for expanded pediatric research training that 

would supplement and not supplant existing programs, cut across 

multiple Institutes and Centers, and focus on supporting individual 

physician-scientists who have not yet achieved a level of research 

independence so they can be qualified to meet current and future 

needs in pediatric research. 

Undiagnosed Disease Network.—The Committee continues to 

support the work of the Undiagnosed Disease Network (UDN) and 

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urges the UDN to continue efforts to enhance access to patients, 

caregivers, and other stakeholders as well as make information obtained through the UDL available to other Federal agencies. 

Wound Care Research.—In its fiscal year 2019 Congressional 

Justification, NIGMS estimates the direct cost of chronic wounds to 

the healthcare system to exceed $50 billion. Patients with nonhealing wounds are likely to be older adults, nonambulatory or paralyzed, unable to provide self-care, and/or suffering from dementia. 

The committee urges NIH to explore ways to optimize resources for 

specific chronic and acute wound care research at multiple Institutes. The research may include understanding the development of 

chronic wounds, including transition from acute wounds, and on 

development of treatments that simultaneously reduce pain, promote healing, and prevent infection and on methods to diagnose 

and monitor chronic wounds. The Committee directs NIH to provide a report to the Committee summarizing NIH’s investments in 

wound care funding over the past five years within 90 days of enactment of this Act. 

BUILDINGS AND FACILITIES

Appropriation, fiscal year 2019 ......................................................... $200,000,000 

Budget request, fiscal year 2020 ....................................................... 200,000,000 

Committee Recommendation ............................................................. 200,000,000 

Change from enacted level ............................................................. – – – 

Change from budget request .......................................................... – – – 

Mission.—This account provides for the design, construction, improvement, and major repair of clinical, laboratory, and office 

buildings and supporting facilities essential to the mission of the 

NIH. The funds in this appropriation support the buildings on the 

main NIH campus in Bethesda, Maryland; the Animal Center in 

Poolesville, Maryland; the National Institute of Environmental 

Health Sciences facility in Research Triangle Park, North Carolina; 

and other smaller facilities throughout the U.S. 

NIH INNOVATION ACCOUNT

This account supports NIH programs authorized in the 21st Century Cures Act (P.L. 114–255). 

SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION

Appropriation, fiscal year 2019 ......................................................... $5,742,496,000 

Budget request, fiscal year 2020 ....................................................... 5,677,600,000 

Committee Recommendation ............................................................. 5,870,996,000 

Change from enacted level ............................................................. +128,500,000 

Change from budget request .......................................................... +193,396,000 

The Committee recommendation for the Substance Abuse and 

Mental Health Services Administration (SAMHSA) program level 

includes $5,725,329,000 in discretionary budget authority, 

$133,667,000 in PHS Evaluation Tap Funding, and $12,000,000 in 

transfers from the Prevention and Public Health (PPH) Fund. 

The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of 

Health and Human Services that leads public health efforts to advance the behavioral health of the nation. SAMHSA’s mission is to 

reduce the impact of substance abuse and mental illness on America’s communities. 

117 

The Committee continues to include bill language that exempts 

the Mental Health Block Grant and the Substance Abuse Prevention and Treatment Block Grant as a source for the Public Health 

Service Act section 241 evaluation set-aside in fiscal year 2020. 

MENTAL HEALTH

Appropriation, fiscal year 2019 ......................................................... $1,558,013,000 

Budget request, fiscal year 2020 ....................................................... 1,506,086,000 

Committee Recommendation ............................................................. 1,656,013,000 

Change from enacted level ............................................................. +98,000,000 

Change from budget request .......................................................... +149,927,000 

Within the total provided for Mental Health Programs of Regional and National Significance, the Committee includes the following amounts: 

Budget Activity FY 2020 

Committee 

Capacity: 

Seclusion and Restraint ........................................................................................................................ $1,147,000 

Project AWARE ....................................................................................................................................... 84,001,000 

Mental Health Awareness Training ....................................................................................................... 20,963,000 

Healthy Transitions ................................................................................................................................ 30,951,000 

Improving Mental Health on College Campuses .................................................................................. 1,000,000 

Infant and Early Childhood Mental Health ........................................................................................... 10,000,000 

Children and Family Programs ............................................................................................................. 7,229,000 

Consumer and Family Network Grants ................................................................................................. 4,954,000 

Project LAUNCH ..................................................................................................................................... 23,605,000 

Mental Health System Transformation .................................................................................................. 3,779,000 

Primary and Behavioral Health Care Integration ................................................................................. 49,877,000 

National Strategy for Suicide Prevention .............................................................................................. 16,200,000 

Zero Suicide .................................................................................................................................. 14,000,000 

American Indian and Alaska Native Set-Aside ............................................................................ 2,200,000 

Suicide Lifeline ...................................................................................................................................... 20,000,000 

Garrett Lee Smith-Youth Suicide Prevention.

State Grants ................................................................................................................................. 35,427,000 

Campus Grants ............................................................................................................................ 6,488,000 

American Indian and Alaska Native Suicide Prevention ...................................................................... 2,931,000 

Tribal Behavioral Health Grants ........................................................................................................... 20,000,000 

Homeless Prevention Programs ............................................................................................................. 30,696,000 

Minority AIDS ......................................................................................................................................... 9,224,000 

Criminal and Juvenile Justice Programs ............................................................................................... 9,269,000 

Assisted Outpatient Treatment ............................................................................................................. 15,000,000 

Assertive Community Treatment for Individuals with Serious Mental Illness ..................................... 10,000,000 

Science and Service: 

Garrett Lee Smith-Suicide Prevention Resource Center ....................................................................... 5,988,000 

Practice Improvement and Training ...................................................................................................... 7,828,000 

Consumer and Consumer Support Technical Assistance Centers ........................................................ 1,918,000 

Primary and Behavioral Health Care Integration Technical Assistance .............................................. 1,991,000 

Minority Fellowship Program ................................................................................................................. 10,059,000 

Disaster Response ................................................................................................................................. 1,953,000 

Homelessness ........................................................................................................................................ 2,296,000 

Criminal and Juvenile Justice Programs.—The Committee includes an increase of $5,000,000 to continue to address unmet need 

for effective behavioral health services and supports that are accessible before, during, and after incarceration and continue in the 

community for those with a mental or substance use disorder. 

Improving Mental Health on College Campuses.—The Committee 

includes $1,000,000 to plan, establish, and begin coordinating and 

evaluating a targeted public education campaign designed to increase access to mental health services for students at institutions 

of higher education, as well as to reduce the stigma associated with 

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such services, as authorized by section 9033 of the 21st Century 

Cures Act (P.L. 114–255). 

Infant and Early Childhood Mental Health.—The Committee includes an increase of $5,000,000 to fund grants in additional 

States, which will expand access to a range of evidence-based and 

culturally-appropriate infant and early childhood mental health 

services, and to aid in addressing the national shortage of mental 

health professionals with infant and early childhood expertise. 

Minority Fellowship Program.—As Congress seeks to better address substance abuse and mental health disorders across all populations, the Committee includes an increase of $2,000,000 in the 

Minority Fellowship Program in order to improve prevention, 

wellness, and treatment across the lifespan. The Committee recognizes the critical importance of supporting a diverse behavioral 

health workforce and its effectiveness in addressing substance use 

disorders and mental health issues impacting minority and underserved populations. 

Now is the Time.—To increase access to mental health services, 

as set out by the 2013 ‘‘Now is the Time’’ plan, the Committee includes an increase of $13,000,000 for Project AWARE, which is designed to identify children and youth in need of mental health services, to increase access to mental health treatment, and promote 

mental health literacy among teachers and school personnel. Recent data from the National Survey on Drug Use and Health indicates that there has been a significant increase in the number of 

youth and young adults aged 12 to 25 reporting symptoms of major 

depression, serious psychological distress, and suicidal thoughts 

and actions. The Committee encourages SAMHSA to sustain and 

strengthen its grant and other programs that support school-based 

and campus-based services aimed at preventing and treating mental health challenges experienced by youth and young adults. In 

addition, the Committee provides an increase of $5,000,000 for the 

Healthy Transitions program, which provides grants to States and 

Tribes to improve access to mental disorder treatment and related 

support services for young people aged 16 to 25 who either have, 

or are at risk of developing a serious mental health condition. 

PTSD in First Responders.—The Committee is aware of research 

indicating that individuals working in the civilian first responder 

disciplines of law enforcement, fire services, and emergency medical services are at greater risk for full or partial post-traumatic 

stress disorder (PTSD) than most other occupations because their 

responsibilities routinely entail confrontation with traumatic 

stressors. The Committee encourages SAMHSA to examine PTSD 

among this population, including prevalence rate, risk factors, 

symptom presentation, course, comorbidities, and rates of suicidal 

thoughts and actions. 

Suicide Prevention.—The Committee recognizes the rising rate of 

suicide and notes that family and friends are often in the best position to recognize the warning signs of suicide and to help an atrisk individual get treatment. The Committee urges SAMHSA to 

develop and disseminate programs to provide specialized training 

and resources on identifying and responding to people at risk of 

suicide for families and friends of at-risk individuals. Given that 

LGBTQ youth are more than four times more likely to attempt suicide than their peers, and that one in five LGBTQ youth and more 

119 

than one in three transgender youth report attempting suicide this 

past year, SAMHSA must be equipped to provide specialized resources to this at-risk community. The Committee urges SAMHSA 

to provide specific training programs for National Suicide Prevention Lifeline counselors to increase competency in serving LGBTQ 

youth through the utilization of existing specialized resources. The 

Committee also urges SAMHSA to consider the diversion of calls 

to specialty partners who are best situated to serve the LGBTQ 

community. The Committee includes an increase of $5,000,000 to 

expand the implementation of the Zero Suicide model, a comprehensive, multi-setting approach to suicide prevention in health 

care systems. The Committee also includes an increase of 

$8,000,000 for the Suicide Life-line to expand support for rapid access at any time of the day or night to crisis intervention, and 

when needed, emergency response. In fiscal year 2018, the Lifeline 

answered 18 percent more calls than in the prior fiscal year. On 

August 14, 2018, the National Suicide Hotline Improvement Act 

(P.L. 115–233) was signed into law, which asked the Federal Communications Commission and SAMHSA to conduct a study examining the feasibility of designating a three-digit dialing code and 

provide overall recommendations for improving the National Suicide Prevention Lifeline. SAMHSA has completed their portion of 

the study that reveals that the greatest challenges to the effectiveness of the Lifeline are its capacity to respond rapidly to the steadily increasing call volume and uneven coverage among States. A 

three-digit dialing code is anticipated to increase call volume, further exasperating these challenges. To address this issue, the Committee includes additional resources for the Suicide Lifeline to be 

used for grants to build capacity in States with the highest need. 

Additionally, the Committee requests that SAMSHA report in the 

fiscal year 2021 Congressional Budget Justification the following: 

answer rates from each State, average wait time per State, how the 

Lifeline Centers are funded State-by-State, State-based resources 

per capita, total amount of funds spent on the suicide prevention 

lifeline by State, and how Congress can support the Lifeline’s 

State-based capacity challenges as demand continues to grow. 

Mental Health Block Grant 

The Committee includes a total of $757,571,000, an increase of 

$35,000,000, for the Mental Health Block Grant. The block grant 

provides funds to States to support mental illness prevention, 

treatment, and rehabilitation services. Funds are allocated according to a statutory formula among the States that have submitted 

approved annual plans. 

The Committee continues the 10 percent set-aside within the 

Mental Health Block Grant total for evidence-based programs that 

address the needs of individuals with early serious mental illness, 

including psychotic disorders. The Committee expects SAMHSA to 

continue its collaboration with the National Institute of Mental 

Health to encourage States to use this block grant funding to support programs that demonstrate strong evidence of effectiveness. 

Furthermore, the Committee directs a new five percent set-aside 

of the total for evidence-based crisis care programs addressing the 

needs of individuals with serious mental illnesses and children 

with serious mental and emotional disturbances. The Committee 

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directs SAMHSA to use the set-aside to fund, at the discretion of 

eligible States and Territories, some or all of a set of core crisis 

care elements including: centrally deployed 24/7 mobile crisis units, 

short-term residential crisis stabilization beds, evidence-based protocols for delivering services to individuals with suicide risk, and 

regional or State-wide crisis call centers coordinating in real time. 

The Committee directs SAMHSA to include in the fiscal year 2021 

budget request a detailed table showing at a minimum: State allotments, the name of the program being implemented, and a short 

description of the program. 

National Child Traumatic Stress Initiative 

The Committee includes $70,887,000, an increase of $7,000,000, 

for the National Child Traumatic Stress Initiative. The National 

Child Traumatic Stress Initiative continues to be an extremely valuable resource to improve behavioral health services and interventions for children and adolescents exposed to traumatic events. The 

increase in funding is provided for new grants to expand support 

for community-based mental health clinics through the National 

Child Traumatic Stress Network, who develop and promote effective community practices for children and adolescents exposed to a 

wide array of traumatic events. 

Children’s Mental Health 

The Committee includes $130,000,000, an increase of $5,000,000, 

for the Children’s Mental Health program. This program supports 

grants and technical assistance for community-based services for 

children and adolescents with serious emotional, behavioral, or 

mental disorders, and assists States and local jurisdictions in developing integrated systems of community care. 

Projects for Assistance in Transition from Homelessness 

The Committee includes $66,635,000, an increase of $2,000,000 

for the Projects for Assistance in Transition from Homelessness 

(PATH) program. The PATH program supports grants to States 

and Territories for assistance to individuals suffering from severe 

mental illness and/or substance abuse disorders and who are homeless or at imminent risk of becoming homeless. Grants may be used 

for outreach, screening and diagnostic treatment services, rehabilitation services, community mental health services, alcohol or drug 

treatment services, training, case management services, supportive 

and supervisory services in residential settings, and a limited set 

of housing services. 

Protection and Advocacy for Individuals with Mental Illness 

The Committee includes $36,146,000 for the Protection and Advocacy for Individuals with Mental Illness program. This program 

serves to 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. Funds are allocated to 

States according to a formula based on population and relative per 

capita incomes. 

121 

Certified Community Behavioral Health Clinics 

The Committee includes $150,000,000 to provide grants to continue the improvement of mental disorder treatment, services, and 

interventions for children and adults, including the use of long-acting injectable medications approved for the treatment of serious 

mental illness and assistance to those with severe mental health 

needs who are at risk of recidivism. These mental health centers 

can provide, but are not limited to, the following services: crisis 

care, residential treatment, outpatient mental health and primary 

care services, and community re-entry supports. 

SUBSTANCE ABUSE TREATMENT

Appropriation, fiscal year 2019 ......................................................... $3,818,756,000 

Budget request, fiscal year 2020 ....................................................... 3,787,967,000 

Committee Recommendation ............................................................. 3,842,256,000 

Change from enacted level ............................................................. +23,500,000 

Change from budget request .......................................................... +54,289,000 

Substance Abuse Prevention and Treatment Block Grant 

The Committee includes a program level of $1,858,079,000 for 

the Substance Abuse Prevention and Treatment Block Grant provide funding to States to support alcohol and drug abuse prevention, treatment, and rehabilitation services. The Committee recognizes the critical role the block grant plays in State systems across 

the country. 

State Opioid Response Grants 

The Committee includes $1,500,000,000 for grants to States to 

address the opioid crisis, of which $50,000,000 is for grants to Indian Tribes or tribal organizations. In addition, the Committee continues the 15 percent set-aside for States with the highest age-adjusted mortality rate related to opioid use disorders. Consistent 

with the objective of Comprehensive Opioid Recovery Centers, as 

authorized in section 7121 of the SUPPORT Act, the Committee 

recognizes that there is a tremendous need for increasing access to 

coordinated, comprehensive care services that utilize the full range 

of FDA-approved medications and evidence-based treatments. 

These long-term care and support services provided through the 

State Opioid Response grants program dramatically improve outcomes for individuals and generate meaningful outcomes data to 

contribute to best practices for substance use disorders. 

Within the total provided for Programs of Regional and National 

Significance, the Committee recommends the following amounts: 

Budget Activity FY 2020 

Committee 

Capacity: 

Opioid Treatment Programs and Regulatory Activities ......................................................................... $8,724,000 

Screening, Brief Intervention, Referral to Treatment ............................................................................ 33,000,000 

Budget Authority ........................................................................................................................... 31,000,000 

PHS Evaluation Funds .................................................................................................................. 2,000,000 

Targeted Capacity Expansion-General .................................................................................................. 100,192,000 

Medication-Assisted Treatment .................................................................................................... 89,000,000 

Tribal Set-aside ................................................................................................................... 10,000,000 

Grants to Prevent Prescription Drug/Opioid Overdose .......................................................................... 12,000,000 

First Responder Training ....................................................................................................................... 36,000,000 

Rural Focus .................................................................................................................................. 18,000,000 

Grants to Develop Curricula for DATA Act Waivers .............................................................................. 4,000,000 

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Budget Activity FY 2020 

Committee 

Pregnant and Postpartum Women ........................................................................................................ 29,931,000 

Recovery Community Services Program ................................................................................................ 2,434,000 

Children and Families ........................................................................................................................... 29,605,000 

Treatment Systems for Homeless .......................................................................................................... 38,386,000 

Minority AIDS ......................................................................................................................................... 65,570,000 

Criminal Justice Activities ..................................................................................................................... 89,000,000 

Drug Courts .................................................................................................................................. 70,000,000 

Improving Access to Overdose Treatment ............................................................................................. 1,000,000 

Building Communities of Recovery ....................................................................................................... 6,000,000 

Peer Support Technical Assistance Center ........................................................................................... 2,000,000 

Strengthening Community Crisis Response Systems ........................................................................... 2,500,000 

Comprehensive Opioid Recovery Centers .............................................................................................. 10,000,000 

Science and Service: 

Addiction Technology Transfer Centers ................................................................................................. 9,046,000 

Minority Fellowship Program ................................................................................................................. 4,789,000 

Comprehensive Opioid Recovery Centers.—The Committee includes $10,000,000 to help ensure that people with substance use 

disorders can access proper treatment, as authorized by section 

7121 of the SUPPORT Act. The Committee recognizes that there 

is a tremendous need for increasing access to coordinated, comprehensive care services that utilize the full range of FDA-approved medications and evidence-based treatments. These longterm care and support services dramatically improve outcomes for 

individuals and generate meaningful outcomes data to contribute to 

best practices for substance use disorders. 

Criminal Justice Activities.—The Committee provides 

$89,000,000 for the Criminal Justice Activities program. Of this 

amount, the Committee directs that not less than $70,000,000 will 

be used exclusively for Drug Court activities. The Committee continues to direct SAMHSA to ensure that all funding appropriated 

for Drug Treatment Courts is allocated to serve people diagnosed 

with a substance use disorder as their primary condition. The Committee directs SAMHSA to ensure that all drug treatment court 

grant recipients work directly with the corresponding State substance abuse agency in the planning, implementation, and evaluation of the grant. The Committee further directs SAMHSA to expand training and technical assistance to drug treatment court 

grant recipients to ensure evidence-based practices are fully implemented. 

The Committee recognizes the importance of providing comprehensive services to those who suffer from severe mental health 

issues. The Committee is aware that there can be a correlation between mental health disturbances and repeat criminal offenders. 

Therefore, the Committee strongly encourages SAMHSA’s Criminal 

Justice Activities to prioritize funding for centers that provide assistance to those with severe mental health needs who are at risk 

of recidivism. These mental health centers can provide, but are not 

limited to, the following services: crisis care, residential treatment, 

outpatient mental health and primary care services, and community re-entry supports. The Committee strongly encourages 

SAMHSA to prioritize applications from areas with high rates of 

uninsured individuals, poverty, and substance use disorders. 

Digital Health.—The Committee appreciates SAMHSA’s dedication to provide science-based, best-practice guidance to the behavioral health field. In H. Rept. 115–862, the Committee requested 

123 

that SAMHSA include an update on its efforts to update the January 2015 Federal Guidelines for Opioid Treatment Programs in its 

fiscal year 2020 Congressional Budget Justification. This information was not included in the fiscal year 2020 Congressional Budget 

Justification, but prescription digital health technologies are now 

used to deliver evidence-based therapeutic interventions to patients 

to prevent, manage or treat a medical disorder or disease. Within 

one year of enactment of this Act, the Committee directs SAMHSA 

to provide a report to Congress that includes a discussion on how 

prescription technologies could be used by the behavioral health 

field as a tool to combat substance abuse and amplify mental 

health services. 

Emphasis on Comprehensive Services.—In recent fiscal years, the 

Committee has provided historic resources to combat the opioid epidemic, with a particular focus on expanding access to treatment, 

and treating and preventing comorbidities that can be associated 

with injection drug use. At the Committee’s urging, the Department has rightfully prioritized efforts that increase access to treatment and recovery services. For all programs not focused exclusively on prevention of substance abuse, the Committee directs the 

Department to continue its emphasis on evidence-based medical 

interventions, and to ensure that all such interventions, including 

programs that focus on harm reduction, provide referral to treatment and recovery services. 

Grants to Develop Curricula for DATA Act Waivers.—The Committee includes $4,000,000 for this new program, which is authorized by section 3203 of the SUPPORT for Patients and Communities Act, to enhance access to substance use disorder treatment 

by providing grants to accredited schools of allopathic or osteopathic medicine and teaching hospitals located in the U.S. to support the development of curricula. 

Grants to Prevent Prescription Drug/Opioid Overdose and First 

Responder Training.—The Committee includes $12,000,000 for 

Grants to Prevent Prescription Drug/Opioid Overdose Related 

Deaths. The Committee also includes $36,000,000 for First Responder Training for Opioid Overdose Reversal Drugs, of which 

$18,000,000 is to address the critical needs of the rural populations. 

The Committee notes strong concerns about the increasing number of unintentional overdose deaths attributable to prescription 

and nonprescription opioids. SAMHSA is urged to take steps to encourage and support the use of Substance Abuse and Prevention 

Block Grant funds for opioid safety education and training, including initiatives that improve access for licensed healthcare professionals, including paramedics, to emergency devices used to rapidly 

reverse the effects of opioid overdoses. Such initiatives should incorporate robust evidence-based intervention training and facilitate 

linkage to treatment and recovery services. 

Peer Support Technical Assistance Center.—The Committee provides $2,000,000 for the creation of a Peer Support Technical Assistance Center, as authorized in section 7152 of the SUPPORT 

Act. The Center will provide technical assistance and support to recovery community organizations and peer support networks, including such assistance and support related to best practices and 

data collection. 

124 

Pregnant and Postpartum Women.—The Committee provides $29,931,000 for Pregnant and Postpartum Women. The Committee 

recognizes SAMHSA for its work managing the Pregnant and 

Postpartum Women program which utilizes a family-centered approach to provide comprehensive residential substance use disorder 

treatment services for pregnant and postpartum women, their 

minor children and for other family members. A provision in the 

Comprehensive Addiction and Recovery Act (CARA) authorizes 

SAMHSA to allocate a portion of these resources for a pilot program to State alcohol and drug agencies to support outpatient, intensive outpatient and related services in a family-centered approach. The Committee encourages SAMHSA to fund an additional 

cohort of States above and beyond those pilots already funded. 

Screening, Brief Intervention, and Referral to Treatment.—The 

Committee includes an increase of $3,000,000 for a new effort focused on reducing underage drinking. The Committee provides this 

additional funding for grants to pediatric health care providers in 

accordance with the specifications outlined in section 9016 of the 

21st Century Cures Act. Training grants should focus on screening 

for underage drinking, and opioid and other drug use. 

Strengthening Community Crisis Response Systems.—The Committee provides $2,500,000 for the creation of a competitive grant 

opportunity to support communities for crisis intervention and prevention, as authorized by section 9007 of the 21st Century Cures 

Act. 

Targeted Capacity Expansion.—The Committee includes 

$100,192,000 for Targeted Capacity Expansion activities. Of this 

amount, the Committee includes $89,000,000 for the MedicationAssisted Treatment for Prescription Drug and Opioid Addiction 

program, of which $10,000,000 is for grants to Indian tribes, tribal 

organizations, or consortia. The Center for Substance Abuse Treatment is directed to include as an allowable use medication-assisted 

treatment and other clinically appropriate services to achieve and 

maintain abstinence from all opioids and heroin and prioritize 

treatment regimens that are less susceptible to diversion for illicit 

purposes. 

Treatment Systems for Homeless.—The Committee includes 

$38,386,000 for the Treatment Systems for Homeless program, 

which is an increase of $2,000,000 to expand the Grants for the 

Benefit of Homeless Individuals program. 

Center for Substance Abuse Treatment 

Addiction Treatment Centers.—The Committee encourages all addiction treatment centers to either offer comprehensive care for 

substance use and mental health disorders on site or have a network in place should they need to refer patients to services not 

available in their location. This includes having available a multidisciplinary staff to provide a range of diagnostic tools, 

psychopharmacology, all forms of evidence-based medication assisted treatment for substance use disorders (methadone, 

buprenorphine, vivitrol, and naltrexone), psychotherapy, contingency management, and recovery supports. 

Continuum of Care.—Evidence demonstrates that efforts to coordinate opioid abuse treatment that promote a continuum of care 

model can produce effective results. Successful examples include 

125 

the development of ‘‘no wrong door’’ treatment models like scale-up 

training, availability of peer coaches, and the use of mobile application technology to enhance access to services and successful treatment outcomes and support long-term relapse prevention. 

SAMHSA is encouraged to work with State and local grantees to 

prioritize the implementation of coordinated continuum of care approaches. 

Medication-Supported Therapy.—The Committee is concerned 

that relapse following opioid detoxification is a contributing factor 

to the overdose crisis. The Committee appreciates SAMHSA’s efforts to address this within the Federal grant population by emphasizing that opioid detoxification should be followed by medication 

to prevent relapse to opioid dependence and encourages SAMHSA 

to disseminate and implement this policy in all settings where detoxification is offered, including rehabilitation and criminal justice 

settings. 

Opioid Treatment.—The Committee is aware that pregnancy and 

child birth can present a unique window of opportunity to assist 

parents in overcoming addiction to opioids and other substances. 

The Committee encourages SAMHSA to support approaches that 

consider the needs of infants and mothers impacted by substance 

use as a dyad, to enhance treatment effectiveness, improve treatment outcomes, and reduce relapse and the number of subsequent 

substance-impacted pregnancies. 

Sober Homes.—The Committee urges SAMHSA to provide information, training and support for communities dealing with the 

opioid addiction crisis. Specifically, to provide information to local 

government officials regarding sober home best practices, providing 

information and support to State and local governments on model 

legislation dealing with effective oversight of drug treatment facilities, sober homes and marketing entities, in an effort to protect 

vulnerable persons with substance use disorder, and their families, 

from fraudulent and abusive practices. 

SUBSTANCE ABUSE PREVENTION

Appropriation, fiscal year 2019 ......................................................... $205,469,000 

Budget request, fiscal year 2020 ....................................................... 244,090,000 

Committee Recommendation ............................................................. 212,469,000 

Change from enacted level ............................................................. +7,000,000 

Change from budget request .......................................................... ¥31,621,000 

The Committee does not accept the proposal to include 

$100,000,000 for the Drug-Free Communities program in 

SAMHSA’s Substance Abuse Prevention appropriation. The Committee directs the program to remain in the Office of National Drug 

Control Policy. 

Within the total provided for Programs of Regional and National 

Significance, the Committee provides the following amounts: 

Budget Activity FY 2020 

Committee 

Capacity: 

Strategic Prevention Framework ............................................................................................................ $119,484,000 

Strategic Prevention Framework Rx ............................................................................................. 10,000,000 

Federal Drug-Free Workplace ................................................................................................................ 4,894,000 

Minority AIDS Initiative .......................................................................................................................... 46,205,000 

Sober Truth on Preventing Underage Drinking ..................................................................................... 10,000,000 

National Adult-Oriented Media Public Service Campaign ........................................................... 2,000,000 

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Budget Activity FY 2020 

Committee 

Community Based Coalition Enhancement Grants ...................................................................... 7,000,000 

Interagency Coordinating Committee to Prevent Underage Drinking .......................................... 1,000,000 

Tribal Behavioral Health Grants ........................................................................................................... 20,000,000 

Science and Service: 

Center for the Application of Prevention Technologies ........................................................................ 7,493,000 

Science and Service Program Coordination .......................................................................................... 4,072,000 

Minority Fellowship Program ................................................................................................................. 321,000 

Minority AIDS Initiative.—The Committee includes an increase 

of $5,000,000 for the Minority AIDS Initiative to expand efforts for 

HIV/AIDS prevention, screening, treatment, education, and outreach to minority communities heavily impacted by HIV/AIDS 

though culturally and linguistically appropriate care and services. 

Sober Truth on Preventing Underage Drinking Act (STOP Act).— 

The Committee includes an increase of $1,000,000 for the public 

service campaign and an increase of $1,000,000 for communitybased coalition enhancement grants. These increases will strengthen efforts to reduce and prevent underage drinking. 

HEALTH SURVEILLANCE AND PROGRAM SUPPORT

Appropriation, fiscal year 2019 ......................................................... $160,258,000 

Budget request, fiscal year 2020 ....................................................... 139,457,000 

Committee Recommendation ............................................................. 160,258,000 

Change from enacted level ............................................................. – – – 

Change from budget request .......................................................... +20,801,000 

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

Budget Activity FY 2020 

Committee 

Health Surveillance ........................................................................................................................................ $47,258,000 

PHS Evaluation Funds ........................................................................................................................... 30,428,000 

Program Support ............................................................................................................................................ 79,000,000 

Public Awareness and Support ...................................................................................................................... 13,000,000 

Performance and Quality Information Systems ............................................................................................. 10,000,000 

Drug Abuse Warning Network ........................................................................................................................ 10,000,000 

Behavioral Health Workforce .......................................................................................................................... 1,000,000 

PHS Evaluation Funds ........................................................................................................................... 1,000,000 

Inpatient Treatment for Mental Health and Substance Abuse Disorders.—The Committee recognizes that communities across the 

nation are experiencing a shortage of psychiatric and substance 

abuse treatment capacity to provide acute inpatient care. According 

to the Treatment Advocacy Center, communities should have a capacity of 40 to 60 inpatient beds per 100,000 residents. However, 

the national average is 11.7 beds per 100,000 residents. Therefore, 

the Committee directs SAMHSA to study the impact of the inpatient hospital bed shortage on mental health and substance abuse 

treatment and recovery and provide those findings to the Committee within 90 days of enactment of this Act. 

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AGENCY FOR HEALTHCARE RESEARCH AND QUALITY

HEALTHCARE RESEARCH AND QUALITY

Appropriation, fiscal year 2019 ......................................................... $338,000,000 

Budget request, fiscal year 2020 ....................................................... – – – 

Committee Recommendation ............................................................. 358,217,000 

Change from enacted level ............................................................. +20,217,000 

Change from budget request .......................................................... +358,217,000 

The Committee includes $358,217,000 in program level funding 

for the Agency for Healthcare Research and Quality (AHRQ), including $339,809,000 in budget authority and $18,208,000 in transfers available under section 241 of the PHS Act. 

AHRQ’s mission is to produce evidence to make health care safer, 

higher quality, more accessible, equitable, and affordable, and to 

work within HHS and with other partners to make sure that the 

evidence is understood and used. 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. 

Within the total for AHRQ, the House includes the following 

amounts: 

Budget Activity FY 2020 

Committee 

Prevention/Care Management ........................................................................................................................ $12,649,000 

Health Information Technology (IT) ................................................................................................................ 16,500,000 

Patient Safety Research ................................................................................................................................. 80,776,000 

Health Services Research, Data, and Dissemination .................................................................................... 105,192,000 

Medical Expenditure Panel Survey ................................................................................................................. 71,800,000 

Program Management .................................................................................................................................... 71,300,000 

Antimicrobial Resistance.—The Committee continues to provide 

no less than $10,000,000 for combating antibiotic-resistant bacteria. 

Diagnostic Errors.—Within the Patient Safety portfolio, the Committee includes no less than $4,000,000 to support improving diagnosis in medicine, including a multiyear competitive grant program 

to address diagnostic errors, which may include the establishment 

of Research Centers of Diagnostic Excellence to develop systems, 

measures, and new technology solutions to improve diagnostic safety and quality. This is an increase of $2,000,000 above the fiscal 

year 2019 enacted level. 

EvidenceNOW Health Extension Regional Offices.—The Committee supports the work of AHRQ to better serve the health needs 

of rural and under-served minorities through such programs as the 

Evidence Now network. The Committee encourages AHRQ to expand its efforts to include additional health extension program 

sites connected to public academic health centers in States with 

high populations of ethnically under-served minorities, rural communities, and tribal populations. 

Kratom.—The Committee notes that little research has been 

done to date on natural products that are used by many to treat 

pain in place of opioids. These natural plants and substances include kratom and cannabidiol (CBD). Given the wide availability 

and increased use of these substances, it is imperative to know 

more about potential risks or benefits, and whether or not they can 

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have a role in finding new and effective non-opioid methods to treat 

pain. The Committee recommends an additional $3,000,000 for this 

research and directs AHRQ to make center-based grants to address 

research which will lead to clinical trials in geographic regions 

which are among the hardest hit by the opioid crisis. 

Understanding the Impact of Prior Authorization.—The Committee is concerned about the potential adverse impacts the prior 

authorization process has on patient health outcomes. The Committee includes no less than $500,000 for research that examines 

whether and to what extent delays in treatment due to prior authorization negatively impact patient outcomes. 

CENTERS FOR MEDICARE AND MEDICAID SERVICES

GRANTS TO STATES FOR MEDICAID

Appropriation, fiscal year 2019 ............................................. $276,236,212,000 

Budget request, fiscal year 2020 ........................................... 273,188,478,000 

Committee Recommendation ................................................. 273,188,478,000 

Change from enacted level ................................................. ¥3,047,734,000 

Change from budget request .............................................. – – – 

Medicaid provides health coverage to eligible populations, including eligible low-income adults, children, pregnant women, elderly 

adults, and people with disabilities. Medicaid is administered by 

States, according to Federal requirements. The program is funded 

jointly by States and the Federal government. 

This amount does not include $137,931,797,000, which was provided as advance funding for the first quarter of fiscal year 2020. 

In addition, the Committee recommends an advance appropriation 

of $139,903,075,000 for program costs in the first quarter of fiscal 

year 2021. 

The Committee continues bill language providing indefinite 

budget authority for unanticipated costs in fiscal year 2020. Federal Medicaid grants reimburse States for a portion of their expenditures in providing health care for individuals whose income 

and resources fall below specified levels. Subject to certain minimum requirements, States are provided certain limited authority 

within the law to set eligibility, coverage, and payment levels. 

PAYMENTS TO THE HEALTH CARE TRUST FUNDS

Appropriation, fiscal year 2019 ............................................. $378,343,800,000 

Budget request, fiscal year 2020 ........................................... 410,796,100,000 

Committee Recommendation ................................................. 410,796,100,000 

Change from enacted level ................................................. +32,452,300,000 

Change from budget request .............................................. – – – 

This account includes the general fund subsidy to the Federal 

Supplementary Medical Insurance Trust Fund for Medicare Part B 

benefits, and Medicare drug benefits and administration, as well as 

other reimbursements to the Federal Hospital Insurance Trust 

Fund for benefits and related to administrative costs, which have 

not been financed by payroll taxes or premium contributions. The 

Committee continues bill language providing indefinite authority to 

pay the general revenue portion of the Medicare Part B premium 

match and providing resources for the Medicare Part D drug benefit program in the event that the annual appropriation is insufficient. 

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PROGRAM MANAGEMENT

Appropriation, fiscal year 2019 ......................................................... $3,669,744,000 

Budget request, fiscal year 2020 ....................................................... 3,579,427,000 

Committee Recommendation ............................................................. 3,984,744,000 

Change from enacted level ............................................................. +315,000,000 

Change from budget request .......................................................... +405,317,000 

Research, Demonstration, and Evaluation 

The Committee includes $20,054,000 for Research, Demonstration, and Evaluation, which is the same as the fiscal year 2019 enacted level and $20,054,000 more than the fiscal year 2020 budget 

request. 

Program Operations 

The Committee includes $2,824,823,000 for Program Operations, which is $305,000,000 more than the fiscal year 2019 enacted level 

and $435,121,000 more than the fiscal year 2020 budget request. 

This office administers the programs under the Centers for Medicare & Medicaid Services (CMS), funds beneficiary outreach and 

education, maintains information technology infrastructure needed 

to support various claims processing systems, and supports other 

programmatic improvements. 

Medicaid Health Home.—The Committee urges the Secretary to 

establish standards for qualification as a Medicaid health home 

that ensure the requirement to ‘‘coordinate prompt care for children with medically complex conditions, including access to pediatric emergency services at all times,’’ is not limited to facilities 

with an onsite or affiliated emergency department. The requirement to include access to pediatric emergency services at all times 

should include facilities that coordinate with another entity that 

provides emergency services. 

Adult Vaccinations.—Adults seeking access to and coverage for 

vaccines encounter multiple financial hurdles. Addressing costsharing and payment issues with Part D vaccines is critical to ensuring that Medicare beneficiaries have access to vaccines that 

have the potential to prevent serious disease. To help in addressing 

current low vaccination rates, the Committee encourages CMS to 

find ways for patients to have no-cost access to Part D vaccines, 

similar to the coverage of Part B vaccines. 

Alternatives to Cardiac Stress Test.—The Committee is aware of 

the significant health and cost savings advantages of new technology for non-invasive diagnosis of coronary arterial disease (e.g., 

coronary computed tomography angiography and associated technologies). These less invasive diagnostic options have been recognized by private insurers, health associations, and other health systems as a preferred option for diagnosing coronary arterial disease. 

The Committee strongly encourages CMS to assess the benefits to 

patient care and savings to Federal health programs these less 

invasive options represent, when determining reimbursement policies. The Committee requests an update in the fiscal year 2021 

Congressional Justification on the diagnostic options available 

under CMS-administered health programs for coronary arterial disease. 

Ambulatory Surgical Centers.—The Committee requests an update on any increased costs to the Medicare program and its beneVerDate Sep 11 2014 06:50 May 16, 2019 Jkt 036295 PO 00000 Frm 00133 Fmt 6659 Sfmt 6602 E:\HR\OC\HR062.XXX HR062
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ficiaries due to the potential migration of procedures from ambulatory surgical centers (ASCs) to higher cost settings. The update 

should examine volume changes over the past ten years and identify whether there are procedures that are migrating from ASCs to 

higher cost settings. The update also should include any recent 

changes in the ASC payment system to address migration of procedures. 

Biosimilars.—The Committee is concerned about the underutilization of lower cost biosimilars, particularly those in Medicare 

Part B, and encourages the Administration to support development 

and implementation of new policies such as reducing patient copays or creating shared cost savings programs with healthcare providers that would help to increase the uptake of biosimilars in the 

United States. The Committee encourages CMS to identify the uptake rate for biosimilars in the Medicare and Medicaid populations. 

Birth Centers.—The Committee is concerned that the U.S. spends 

significantly more per capita on childbirth than any other industrialized nation, with costs estimated to be well over $50 billion annually, and yet despite this investment continues to rank far behind 

almost all other developed countries in birth outcomes for both 

mothers and babies, including high rates of preterm birth, low 

birth weight, and high maternal and infant mortality. The Committee was pleased that the CMMI Strong Start Initiative was created to look at how three different models of care (Maternity Care 

Homes, Centering Group Model Prenatal Care, and Birth Centers) 

would impact these outcomes and the costs associated with childbirth. The Committee notes that findings of this five-year study 

showed no differences in cost or outcomes for the Maternity Care 

Home model, and some slight cost savings and improved rates of 

low birthweight for the Centering model. But the birth centers, 

which provided a midwife-led model of holistic care, showed significant cost savings and improved childbirth outcomes across all 

measures. The Committee urges CMS to widely disseminate these 

findings to payors and consumers. Since Medicaid is the primary 

payor for almost half of all childbearing women and newborns in 

this country, the Committee strongly urges CMS to develop a proposal for how it will increase access to birth centers and midwives 

in all state Medicaid programs, and incentivize this model of care 

for low-risk women. The Committee requests a report within 120 

days of enactment of this Act. 

BRCA Genetic Testing.—The Committee understands that the 

use of pre-treatment interventions, such as screening for biomarkers or testing through the use of companion diagnostics, can help 

healthcare providers select treatment options with a greater probability of success leading to better outcomes for patients. The Committee also recognizes that the use of these interventions can reduce unnecessary costs in the current health care system by avoiding ineffective treatments and that awareness of genetic risk factors can encourage preventive care and early diagnosis. An example is in breast cancer, the most common cancer among women. Genetic predisposition is responsible for up to 10 percent of cases of 

breast cancer. Two genetic mutations, BRCA1 and BRCA2, have 

been found to significantly contribute to the genetic risk of developing breast cancer. Between 55 percent and 90 percent of women 

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time compared to only 12.5 percent among women in the general 

population, and breast cancers related to BRCA mutations have a 

higher chance of recurrence and of developing into triple-negative 

breast cancer, which is difficult to treat. The Committee urges 

CMS to identify ways to expand access to BRCA genetic testing, especially among the most vulnerable patient populations; expand 

eligibility criteria for testing and screenings; and increase public 

and health care provider awareness of the importance of early testing and companion diagnostics. 

Center for Program Integrity.—The Committee applauds CMS’s 

Center for Program Integrity’s efforts to shift from a pay-and-chase 

model to one that prioritizes claim review prior to payment. The 

time to identify and resolve billing errors and therefore avoid improper payments is during the claim adjudication and prior to payments being made. Once a claim is paid, it is harder to address 

billing errors and improper payments. The Committee encourages 

the Center to explore how it can leverage effective commercial prepayment solutions to rapidly review and adjudicate outlier payments within Medicare’s Inpatient Prospective Payment System. 

Central Receiving Facilities.—The Committee is aware there are 

Central Receiving Facilities (CRFs), or similarly designated facilities, receiving mental health patients in Crisis Stabilization Unit 

in-patient care, which are not presently deemed eligible for Medicare Part A reimbursement for patient psychiatric admissions. The 

Committee encourages CMMI to explore the feasibility and cost 

savings to CMS resulting from a demonstration project authorizing 

reimbursements to full-continuum CRFs with an integrated medical and community-based service provider, admitting mental 

health patients where it is psychiatrically determined that a patient requires more than one night of hospitalization. 

Charitable Assistance.—The Committee remains concerned with 

the promulgation of rules restricting the utilization of charitable 

assistance to Medigap plans, marketplace plans, and other forms of 

coverage, as well as the implementation of associated barriers to 

care, most notably out-of-pocket accumulators. These restrictions 

are particularly harmful for patients with rare, chronic, and lifethreatening conditions that have historically relied on charitable 

assistance as a necessary safety net to maintain access to life-sustaining therapies or care. CMS is encouraged to examine efforts to 

protect patient access to charitable assistance and rein-in coverage 

practices where they harmfully or arbitrarily obstruct the availability of charitable assistance for patients with critical circumstances and limited alternatives. 

Chief Dental Officer.—The Committee is concerned that the Chief 

Dental Officer position at CMS has been vacant since October 

2017. Without a dentist to oversee oral health issues in Medicare 

and Medicaid, this vacancy leaves a significant gap of clinical oral 

health expertise within CMS. Medicaid provides oral health services to millions of children, pregnant women, and adults across the 

country. The Early Periodic Screening, Diagnosis and Treatment 

program requires dental services to be provided to beneficiaries eligible for the program. The Children’s Health Insurance Program 

also requires dental services as part of the benefit package available to children. A licensed dentist clinician is an invaluable resource to these programs and the agency’s strategy to expand acVerDate Sep 11 2014 06:50 May 16, 2019 Jkt 036295 PO 00000 Frm 00135 Fmt 6659 Sfmt 6602 E:\HR\OC\HR062.XXX HR062
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cess to oral health care. The Committee urges CMS to move forward with filling this vacancy. 

Diabetic Retinal Exams.—The Committee recognizes that diabetic retinopathy remains a major national health challenge. According to the National Eye Institute within the National Institutes 

of Health, early detection and treatment of diabetic retinopathy can 

reduce the risk of blindness by 95 percent. The Committee encourages CMS to update its policy to promote earlier diagnosis by making diabetic retinal exams more accessible to diabetic patients in 

primary care settings, through the use of digital retinal imaging 

with remote specialist interpretation. 

Clinical Laboratory Fee Schedule.—The Committee is pleased 

that CMS developed and issued a panel pricing policy that ensures 

the agency is not paying more for a single clinical diagnostic laboratory test, or a group of individual clinical diagnostic tests, than 

it would for a clinical diagnostic laboratory testing panel that tests 

for the same analytic(s). This new policy was effective January 1, 

2019, and the Committee requests that the agency submit a report 

no later than 90 days after enactment of this Act to the Committees on Appropriations, as well as the authorizing Committees of 

jurisdiction, on the status of the implementation of this new policy 

and the cost savings to the Medicare program. 

Community Participatory Health Dashboard.—The Committee 

encourages CMS and CDC to devise a strategy on how to construct 

a decision-support tool that includes Geographic Information System epidemiologic data paired with Medicaid and other health program claims data that can contribute to community-participatory 

health prevention efforts. The strategy could guide HHS agencies 

to collaborate to construct a dashboard for community use to evaluate rates of disease and the associated costs. 

Depression and Precision Medicine.—The Committee recognizes 

that millions of Medicare beneficiaries are living with depression 

and primary care physicians often treat these patients, prescribing 

a significant share of prescription drugs for depression. The Committee is concerned that current Medicare policies may interfere 

with the ability of primary care physicians to have access to precision medicine tests to guide the selection of drugs for depression. 

The Committee encourages CMS to review and update existing 

local coverage policies for genetic testing for depression to ensure 

Medicare beneficiaries have coverage for these tests when seen by 

their primary care physician. 

Dialysis-Related Amyloidosis.—The Committee is concerned that 

patients suffering from Dialysis-Related Amyloidosis may not have 

access to FDA-approved treatments, including apheresis treatments 

administered in the dialysis facility. The Committee is particularly 

concerned that CMS has not acted in a timely manner in assigning 

an appropriate Medicare benefit category for such apheresis treatments, following FDA approval in 2015. The Committee urges CMS 

to complete its benefit category analysis and issue a determination 

as soon as possible. The Committee directs CMS, in conjunction 

with FDA, to report to the Committee within 90 days of enactment 

of this act, on the status of CMS’s benefit category analysis and expected timeline for determination. 

Disproportionate Share Hospitals.—The Committee is concerned 

about the effect Disproportionate Share Hospitals (DSH) funding 

133 

cuts will have on providers, patients, and communities nationwide. 

The Committee directs CMS to study the effects of the DSH cuts, 

under current law, on hospitals ability to furnish care for those uninsured and underserved, and to train and retain quality staff. 

Drug Pricing Report.—The Committee directs the Secretary of 

Health and Human Services to submit a report to the Committees 

on Appropriations not later than 120 days after the date of enactment of this Act regarding price changes of prescription drugs since 

2008. The report should include comparative prescription drug 

prices (net of rebates) paid by the following programs for the 10 

most frequently prescribed drugs and the 10 highest-cost drugs for 

each of the following: (1) The Medicare program under part B of 

title XVIII of the Social Security Act; (2) The Medicare prescription 

drug program under part D of title XVIII of the Social Security Act; 

(3) The Medicaid program under title XIX of the Social Security 

Act; and (4) The Department of Veterans Affairs. The report should 

also provide a breakdown of the comparative prices (net of rebates) 

for each of the 10 most frequently prescribed drugs and the 10 

highest-cost drugs between ambulatory settings and retail settings. 

In addition, the report should include total annual costs due to prescription drugs to the Medicare program under part B of title XVIII 

of the Social Security Act, the Medicare prescription drug program 

under part D of title XVIII of such Act, and the Medicaid program 

under title XIX of such Act. Finally, the report should list the 

drugs that have been registered for sale by the Food and Drug Administration (FDA) in the past five years that have benefited significantly from government grants or research subsidies in either 

the pre-clinical or clinical stages of development, as well as the 

price (net of rebates) and total spending in Medicare and Medicaid 

for each of those drugs. 

Duchenne/Becker ICD10 Code.—The Committee is aware of the 

addition of the new ICD10 code for Duchenne/Becker to the CMS 

FY 2019 Coding Addenda. The Committee requests an update in 

the FY 2021 Congressional Justification regarding the rates of utilization for the newly established ICD10 code. 

Extravasations.—The Committee is aware of evidence demonstrating the prevalence of extravasations in nuclear medicine 

procedures. Extravasations of diagnostic radiopharmaceuticals negatively affect the sensitivity and quantification of nuclear medicine 

scans. Extravasations can affect disease staging and treatment assessment, result in unnecessary invasive procedures and additional 

radiation exposure, and lead to higher costs for patients and payers. The Committee encourages CMS to consider adding required 

monitoring of injection quality and submission of reportable 

extravasations to the Nuclear Regulatory Commission to its conditions of participation for nuclear medicine services. The Committee 

requests an update on this issue in the fiscal year 2021 Congressional Budget Justification. 

GAO Report on Anesthesia Services.—The Committee recognizes 

the importance of access to timely and accurate data on payment 

rates for medical services. Recently there have been efforts to examine the difference in Medicare rates and private payment rates, 

including by the Medicare Payment Advisory Commission. The 

Committee understands, however, access to necessary data is limited and, therefore, leads to inconclusive and incomplete findings. 

134 

As such, the Committee, to the extent feasible, encourages the Government Accountability Office to update its July 2007 report entitled, ‘Medicare Physician Payments: Medicare and Private Payment Differences for Anesthesia Services’. In this report, GAO 

noted the ‘2004 average Medicare payments for a set of seven anesthesia services provided by anesthesiologists alone were 67 percent 

lower than average private insurance payments in 41 Medicare 

payment localities.’ In updating this report, GAO should examine, 

to the extent feasible, if this payment discrepancy remains and how 

payment rates in Medicare and the private market for anesthesia 

services have changed since 2004. 

Geographic Practice Cost Index.—The Committee encourages 

CMS to create a more transparent process for the development of 

Geographic Practice Cost Index so that the various inputs can be 

better understood. 

Home Visiting Programs.—The Committee recognizes the wide 

range of improved outcomes and cost-savings that evidence-based 

home visiting programs provide to first-time at-risk mothers and 

their children. However, the Committee is concerned that the lack 

of clarity on how to use Medicaid dollars alongside other funding 

sources has slowed or stopped state action to effectively leverage 

Medicaid to support home visiting services. The Committee directs 

the Centers for Medicaid and CHIP Services (CMCS) to build on 

its 2016 Joint Informational Bulletin on this topic to clarify how 

Medicaid dollars can be blended and braided appropriately to reach 

eligible families, and also provide streamlined coverage options for 

home visiting. In addition, once CMCS has finalized its November 

2018 Medicaid Managed Care rule, the Committee directs CMCS to 

update its November 2017 Informational Bulletin on Delivery System and Provider Payment Initiatives under Medicaid Managed 

Care Contracts to explain how states can use the revised managed 

care authority to fund evidence-based home visiting programs. 

Hospital Acquired Conditions.—The Committee recognizes that 

HHS research has shown that preventable Hospital-Acquired Conditions (HACs), including pressure ulcers and their associated complications, kill more than 60,000 hospital patients per year. October 

2017 data from CMS’s Office of Enterprise Data and Analytics 

identified an alarming 58 percent increase in pressure ulcer discharges between the first quarter of 2016 and the first quarter of 

2017. The Committee believes additional efforts to reduce the prevalence of HAIs and their associated complications through HHS 

and CMS are necessary to reduce these events. The Committee 

supports efforts by CMS to conduct an evaluation of agency efforts 

to: (1) monitor the rising prevalence of HACs; (2) reduce the incidence of HACs and subsequent Hospital Acquired Infections, including pressure ulcers; and (3) develop and enact more effective 

reduction practices. 

Hospital Outpatient Prospective Payment.—The Committee is 

concerned about the rule entitled ‘‘Medicare Program: Changes to 

Hospital Outpatient Prospective Payment and Ambulatory Surgical 

Center Payment Systems and Quality Reporting Programs’’ (83 

Fed. Reg. 58818, November 21, 2018) and urges CMS to reconsider 

this rule after taking into account harmful effects to hospitals that 

are designated as a Sole Community Hospital, or that are located 

in a HRSA-designated Health Professional Shortage Area (HPSA). 

135 

The Committee requests a report within 180 days of enactment of 

this Act detailing the financial impacts of this rule on these two 

categories of hospitals and the impact of the rule on the health provider workforce within HRSA-designated HPSAs. 

Limited Wraparound Coverage.—The Committee strongly urges 

CMS to extend the pilot program established by a final regulation 

published on March 18, 2015, to allow limited wraparound benefits, 

or supplements, to individual health insurance coverage (or Basic 

Health Plan coverage). Wraparound coverage is a specialized offering targeted to help part-time workers and retirees whose employers or former employers meet standards of responsibility and have 

agreed to provide this supplemental coverage as an option. The 

Committee recommends this pilot program be made permanent. 

The Committee requests a report within 90 days of enactment of 

this Act on the status of the program. 

Liquid Oxygen.—The Committee urges the Secretary to monitor 

the supplemental liquid oxygen market to evaluate the impact that 

policy has on oxygen patients and suppliers and to ensure appropriate patient access to all modalities of supplemental oxygen, particularly in the gap years of competitive bidding, and address any 

market access problems as identified. 

Malnutrition.—Malnutrition in older adults remains a serious 

health problem in the United States. One in two older adults is either malnourished, or at risk of becoming malnourished. In addition to the impact on quality of life for seniors, malnutrition imposes significant burdens on the U.S. health care system. The annual cost of disease-associated malnutrition in older Americans is 

more than $50 billion. And yet, CMS has declined to include malnutrition quality measurements in the Hospital Inpatient Quality 

Reporting Program. The Committee is concerned that, by failing to 

include such measures, the U.S. health care system is not taking 

advantage of the clinical and financial benefits of quality malnutrition care. The Committee strongly urges CMS to include malnutrition quality measurements in the Hospital Inpatient Quality Reporting Program. 

Medicaid Dental Audits.—The Committee is concerned that failure to use professional guidelines or established state Medicaid 

manual parameters in the auditing process can result in inaccurate 

and unreasonable Medicaid dental audits. These practices deter 

providers from participation in the program and negatively affect 

care to patients. The Committee therefore directs CMS to instruct 

contracted auditors to utilize dental profession clinical guidelines, 

best practices, and policies of the American Academy of Pediatric 

Dentistry and American Dental Association when conducting dental audits, and require independent peer-to-peer review. The Committee directs CMS to report back to the Committee within 90 days 

of enactment of this Act on steps taken to address these auditing 

concerns. 

Medicare Promotion.—The Committee directs CMS to avoid taking any action that actively promotes one form of Medicare coverage over another, particularly with respect to the choice between 

traditional Medicare and Medicare Advantage (MA). The Committee further directs CMS to design and maintain its online coverage options tool in a manner that provides complete and unbiased information, particularly as CMS works to replace the MediVerDate Sep 11 2014 06:50 May 16, 2019 Jkt 036295 PO 00000 Frm 00139 Fmt 6659 Sfmt 6602 E:\HR\OC\HR062.XXX HR062
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care Plan Finder with the new Medicare Coverage Tools platform. 

Furthermore, CMS should remain objective and neutral in its education and outreach materials concerning options that beneficiaries 

have during the open enrollment period and at any other time. 

Medicare Simulation.—The Committee supports efforts by CMS 

to perform data simulations on the potential impact of more comprehensive payment incentives for efficiency and quality in the 

Medicare program. This Medicare simulation could test consolidation of Medicare’s readmissions, complications, and value-based 

purchasing programs into one value-based payment program that 

is focused on a larger set of avoidable outcomes and uses clinically 

credible categorical risk-adjustment for comparing performance. 

Such a simulation would increase transparency and give CMS and 

Congress guidance about how to improve care and reduce health 

care costs within the programs. 

Medicare-reimbursable Expenses.—The Committee is concerned 

that CMS is considering regulations or guidance that would regulate the allocation of funds from a liability or no-fault related settlement, judgment, award, or other payment to pay for an individual’s future medical or future prescription drug treatment expenses 

that would otherwise be reimbursable by Medicare. The Committee 

urges the Agency not to promulgate a mandatory or voluntary regulation, which would be likely to harm Medicare beneficiaries, as 

well as the liability primary plan providers such as automobile, liability or no-fault insurers including those who self-insure. 

Medicare Reimbursement in Noncontiguous States and Territories.—The Committee requests the Government Accountability 

Office conduct an audit to examine Medicare funding for noncontiguous U.S. States and the territories. This report would review the 

Medicare reimbursement rate formula for noncontagious states and 

block grant funding level for the territories compared to the expenses in these locations and the funding provided to states in the 

Continental United States. 

Mental Health Parity.—The Mental Health Parity and Addiction 

Equity Act (MHPAEA) was enacted more than 10 years ago to prevent group health plans and health insurance providers that provide mental health or substance use disorder benefits from imposing less favorable benefit limitations on qualifying mental health 

benefits than on medical or surgical benefits. The Committee is 

aware of instances where insurers, covered health care plans and 

managed care organizations (MCO), including MCOs that manage 

state Medicaid programs, may be imposing conditions for access to 

treatment for mental health services, including services for Down 

syndrome and autism spectrum disorder, that are not imposed on 

medical or surgical benefits. These limitations may include parent 

or caregiver participation requirements, preauthorization processes, 

location of services exclusions, and fail-first policies. The Committee directs CMS to ensure compliance with MHPAEA by regularly issuing guidance to insurers, covered healthcare plans, and 

MCOs, that outlines how compliance with MHPAEA is to be 

achieved. This guidance should include recommendations for appropriate training of personnel responsible for benefit authorizations, 

adverse benefit determinations, and payments. These agencies 

should ensure that such informational bulletins also provide approVerDate Sep 11 2014 06:50 May 16, 2019 Jkt 036295 PO 00000 Frm 00140 Fmt 6659 Sfmt 6602 E:\HR\OC\HR062.XXX HR062
137 

priate consumer and complaint information that helps patients 

take action when they encounter MHPAEA violations. 

National Health Expenditure (NHE) Database.—The Committee 

is concerned about discrepancies between official CMS estimates 

and industry surveys suggesting that CMS understates the growth 

of private health insurance and total health spending at the household level. If private health spending is under reported in NHE, estimates of total health U.S. spending may be too low as well. The 

Committee requests that CMS include information in its FY 2021 

budget justification explaining its methodology for including data 

in the National Health Expenditure database, as well as an analysis of how CMS-published data compares to other comparable information on health expenditures. 

New Medical Residency Training Programs.—Given the growing 

physician workforce shortage, the Committee strongly encourages 

CMS to utilize its discretion to extend the time period described in 

section 413.79(e) of title 42, Code of Federal Regulations, for new 

residency programs in areas facing physician shortages before a 

full-time equivalent resident cap is applied, as authorized in P.L. 

105–33. Moreover, the Committee recommends that the agency 

meet with physician, hospital, and other industry stakeholders 

from underserved areas to better understand changes in population 

health. The agency shall provide an update to the Committees on 

Appropriations on these efforts within 90 days of enactment of this 

Act. 

Nonemergency Medical Transportation.—The Committee is concerned about the impact of the administration’s policy to permit 

state Medicaid programs to drop Nonemergency Medical Transportation (NEMT) coverage. The committee directs CMS to commission a study by the National Academy of Medicine to examine the 

impact on Medicaid beneficiaries of the potential elimination of 

NEMT from state Medicaid programs, including impacts to beneficiaries with chronic diseases including End Stage Renal Disease, 

substance abuse disorders, pregnant mothers, and patients living 

in remote areas. The Committee strongly urges CMS to delay implementation of any changes to NEMT benefits until the study has 

been submitted to the Congress. 

Non-Opioid Pain Management.—The Committee believes that 

providing affordable non-opioid pain management to patients covered by Medicare and Medicaid is critical to combating drug addiction and the opioid crisis. Opioids may be inadvertently 

incentivized over alternative pain management treatments through 

CMS packages which provide hospitals with the same payment regardless of whether the additional cost of a non-opioid postsurgical 

pain management treatment is incurred. 

Nurse Practitioner/Physician Assistants.—The Committee is 

aware of the clinical training site shortage for Nurse Practitioner/ 

Physician Assistant (NP/PA) students, and recognizes that re-performing student documentation is a significant administrative burden for teaching clinicians. Therefore, as CMS continues to eliminate paperwork burdens for clinicians, the Committee encourages 

the Secretary to authorize all teaching clinicians to verify, rather 

than re-document, notes provided by NP/PA students during the 

provision of evaluation and management services, in order to ensure that this paperwork burden is eliminated. 

138 

Nurse Staffing Requirements.—The Committee recognizes the 

link between appropriate nurse staffing levels and improved patient safety and outcomes. As part of its oversight function, CMS 

is charged with ensuring that Medicare-participating hospitals 

meet important patient safety standards, including meeting appropriate nurse staffing requirements. The Committee requests that 

CMS provide, in its fiscal year 2021 Congressional Justification, information relating to its criteria for evaluating appropriate nurse 

staffing. 

Nursing Home Safety.—The Committee is concerned about the 

findings of the HHS Office of Inspector General (OIG) report entitled, ‘‘CMS Guidance to State Survey Agencies on Verifying Correction of Deficiencies Needs to be Improved to Help Ensure the 

Health and Safety of Nursing Home Residents.’’ The Committee requests a report within 60 days of enactment of this Act on the actions that CMS has taken to implement the OIG’s recommendations. In addition, the report should include an assessment of 

whether the CMS Special Focus Facility Initiative has substantially improved the quality of care at underperforming nursing facilities and what, if any, improvements to the initiative need to be 

made. 

Orphan Drugs.—The Committee understands that 1 in 10 Americans is impacted by a rare disease and that the Orphan Drug Act 

incentivizes the discovery of diagnostics and treatments that confirm prognosis, prolong life, and realize health system savings. Despite progress, however, treatments exist for only 5 percent of rare 

diseases. Scientific advancement is discovering the next generation 

of biologic and gene therapy medicines that have the potential to 

both modify disease progression and revolutionize the treatment of 

fatal and debilitating rare diseases. To realize these potentials, the 

Committee urges CMS to support access to biologic and gene therapies, including potential testing of health insurance benefit designs 

that eliminate specialty tiers. 

Out-of-State Cases.—The Committee recognizes that children, 

particularly those with highly complex conditions and healthcare 

needs, often require healthcare services outside of their home 

states and that the process of screening and enrolling out-of-state 

providers in Medicaid programs can delay a child’s access to care. 

The Committee applauds CMS for recognizing these challenges, 

particularly by including plans for a pilot to screen Medicaid providers on behalf of states in its most recent Medicaid Program Integrity Strategy. The Committee urges the agency to advance this 

pilot. 

Pneumococcal Vaccine.—The Committee is concerned about the 

underutilization of pneumococcal vaccinations for adults, including 

high-risk adults where vaccination rates do not exceed 20 percent, 

and strongly urges CMS to work toward achievement of the 

Healthy People 2020 goals to reduce invasive pneumococcal infections and increase the percentage of adults (age 65 or older) who 

are vaccinated against pneumococcal disease. The Committee encourages CMS to support development and implementation of electronic health records and other technologies, such as reminder recall programs, to identify Medicare beneficiaries who have not received the full course of pneumococcal vaccinations and remind 

139 

those beneficiaries and their providers to adhere to the recommendations. 

Preliminary Determinations.—As the Committee has reported, 

CMS previously granted ‘‘preliminary determinations’’ to hospitals 

to be designated as a Critical Access Hospitals (CAH). Following 

CMS guidance, these facilities made preparations to receive a final 

CAH designation, including paying for expensive upgrades and an 

on-site survey. Subsequently, CMS revised its guidance for attaining CAH designation. Due to the length of time required to comply 

with the requirements included in the preliminary determination, 

facilities that were deemed in compliance by CMS proceeded to 

comply with CMS guidance, but were then subsequently denied 

final CAH status due to the change in CMS policy regarding CAH 

designation. The Committee remains concerned about the financial 

and operational sustainability of these hospitals, which acted in 

good faith but may have been put in a difficult situation by revisions to Federal policy. The Committee supports efforts by HHS to 

help identify funding opportunities for these affected facilities, provided that the facilities meet all other requirements for any such 

funding opportunities. 

Prior Authorization.—The Committee is aware that Medicare Advantage (MA) plans have increased the use of prior authorization 

(PA), which requires physicians and other health care providers to 

obtain advance approval from the plan before services can be delivered to patients. While PA is a valid utilization review tool to ensure appropriate care, health care provider experience and research 

studies demonstrate that inappropriate use of PA causes significant 

patient care delays, administrative costs and workflow disruptions. 

The Committee directs CMS to improve Medicare beneficiary timely access to care, increase transparency, and reduce the burdens on 

patients and providers by providing guidance to MA plans on their 

use of PA. Specifically, CMS should require MA plans to selectively 

apply PA requirements, excluding from PA those services that 

align with evidence-based guidelines and have historically high PA 

approval rates. In addition, CMS should increase transparency by 

requiring MA plans to report annually to the Secretary a list of 

items and services that are subject to PA, the percentage of PA requests approved, and the average time for approval. Finally, the 

Committee encourages CMS to work with stakeholders to increase 

the use of electronic prior authorization. 

Protected Classes.—The Committee is concerned by the recent 

proposed rule, ‘‘Modernizing Part D and Medicare Advantage to 

Lower Drug Prices and Reduce Out-of-Pocket Expenses.’’ Shortly 

after Congress enacted the Medicare Part D program, CMS required all Part D plans to have adequate coverage for six therapeutic categories of drugs, known as protected classes, to ensure 

patients have timely access to critical therapies combating HIV, 

cancer, mental health conditions, and other serious illnesses. The 

provisions of this proposed rule would allow increased use of prior 

authorizations and step therapy requirements and potentially delay 

access to these therapies. 

Rural Health Care Access.—In order to address regional disparities in health care access and quality, when developing regulations, 

the Committee supports efforts by CMS to take into account factors 

that could negatively impact the ability of hospitals to provide care 

140 

for rural communities. The Committee is particularly concerned 

about areas with low population density, low household income, or 

high rates of rural hospital closure. 

Sepsis.—The Committee is concerned that sepsis and antibiotic 

resistant bacteria continue to be leading public health threats that 

are responsible for a significant number of deaths, as well as rising 

costs within the healthcare system. According to the most recent 

data, the national average compliance rate for CMS’s sepsis treatment measure, known as SEP–1, is only 49 percent. The Committee urges CMS to issue a Request for Information to gather 

views on proposals to modernize and optimize CMS’s current SEP– 

1 measure. The Committee requests an update on these activities 

in the fiscal year 2021 Congressional Budget Justification. 

Social Determinants of Health.—The Committee is aware that social determinants of health are critical drivers of health outcomes 

and health care costs and that early childhood development is affected by social factors. The Committee encourages CMS to clarify 

and disseminate the strategies that states can implement under 

current Medicaid and CHIP authority, or through waivers, to address social determinants of health in the provision of health care, 

including strategies specifically targeting the pediatric population. 

This should include guidance on how states can encourage and 

incentivize managed care organizations to address social determinants of health through contracts. 

Standardized Assessment-Based Data.—The Committee is aware 

that CMS has recently developed standardized assessment-based 

data that is designed specifically for adult Medicare beneficiaries 

and does not address the needs of an individual under the age of 

twenty-one, especially a child with complex medical needs that may 

also include an intellectual or developmental disability. The Committee recommends that CMS work with relevant partners to develop, test, and implement appropriate assessment tools and quality indicators for children currently served in pediatric post-acute 

and long-term healthcare facilities. 

Sexually Transmitted Infection (STI) Screening.—The Committee 

continues to be concerned about high rates of STIs, especially in 

pregnant women and young adults. To help curb the spread of 

these diseases and address this public health problem, and to reach 

at-risk and vulnerable populations at every opportunity, the Committee directs CMS to collaborate with the CDC’s Division of STD 

Prevention to develop a screening and treatment initiative under 

its Medicaid Program. The Committee also notes that some states 

are limiting reimbursement for STI testing to only once a year. 

This is counter to CDC guidelines which recommend testing at 

three-to-six month intervals for certain individuals. The Committee 

urges CMS to encourage states to comply with CDC screening 

guidelines. 

Virtual Health Care.—The Committee recognizes the potential 

for virtual health care to help meet the needs of patients and families across the country, especially in rural areas. The Committee is 

aware that the lack of consistency related to billing and coding for 

such services across Medicaid programs can result in challenges 

and inefficiencies related to payment for and data analysis of virtual care services. To address this issue, the Committee encourages 

CMS to issue guidance outlining a recommended but voluntary set 

141 

of billing codes, modifiers, or place of service designations for use 

in state Medicaid programs. 

State Survey and Certification 

The Committee provides $407,334,000 for State Survey and Certification activities, which is $10,000,000 more than the fiscal year 

2019 enacted level and $34,858,000 less than the fiscal year 2020 

budget request. State Survey and Certification supports certifications of Medicare and Medicaid certified health care facilities to 

ensure that beneficiaries receive care at facilities that meet health, 

safety, and quality standards required by CMS. 

Survey Frequency Rates.—The Committee is concerned that flat 

funding for several consecutive years has reduced the frequency of 

statutorily-mandated surveys of health care facilities. The Committee provides an increase of $10,000,000 to improve survey frequency rates for nursing homes, home health agencies, and hospice 

facilities, as well as increase quality oversight for facility types 

without statutorily-mandated survey frequency standards. 

Federal Administration 

The Committee provides $732,533,000 for Federal Administration 

activities related to the Medicare and Medicaid programs, which is 

the same as the fiscal year 2019 enacted level and $15,000,000 

below the fiscal year 2020 budget request. The Federal Administration funding supports CMS staff, along with operating and administrative expenses for information technology, communication, utilities, rent and space requirements, as well as administrative contracts. 

Quality Improvement Organizations.—The Committee does not 

include funding requested by the Administration to shift personnel 

costs to the Federal Administration account that have previously 

been funded by a mandatory appropriation. 

HEALTH CARE FRAUD AND ABUSE CONTROL ACCOUNT

Appropriation, fiscal year 2019 ......................................................... $765,000,000 

Budget request, fiscal year 2020 ....................................................... 792,000,000 

Committee Recommendation ............................................................. 786,000,000 

Change from enacted level ............................................................. +21,000,000 

Change from budget request .......................................................... ¥6,000,000 

This includes a base amount of $311,000,000 and an additional 

$475,000,000 through a discretionary budget cap adjustment authorized under section 251(b) of the Balanced Budget and Emergency Deficit Control Act of 1985. The Health Care Fraud and 

Abuse Control Account (HCFAC) funds support activities conducted 

by CMS, the HHS Office of Inspector General, and the Department 

of Justice. This level is $21,000,000 above the fiscal year 2019 enacted level and $6,000,000 below the fiscal year 2020 budget request. 

This funding is in addition to other mandatory funding provided 

through authorizing legislation. The funding will provide resources 

to continue efforts for Medicaid program integrity activities, for 

safeguarding the Medicare prescription drug benefit and the Medicare Advantage program, and for program integrity efforts related 

to these programs carried out by the Department of Justice. 

142 

The Committee revises bill language to enable the Secretary to 

fund the Senior Medicare Patrol Program administered by the Administration for Community Living from either discretionary or 

mandatory funds provided to this account. 

The Committee expects all recipients of funds from the Health 

Care Fraud and Abuse Control Account, the Centers for Medicare 

& Medicaid Services, the Department of Health and Human Services Office of Inspector General, and the Department of Justice, to 

use funds for efforts to address fraud and abuse as described in 

section 1128C of the Social Security Act. 

Medicaid Program Integrity.—The Committee supports efforts by 

CMS to develop a Medicaid Program Integrity Strategy. The Committee encourage States to utilize all available tools to increase 

transparency and oversight, ensure compliance with Federal rules, 

and reduce improper payments. 

ADMINISTRATION FOR CHILDREN AND FAMILIES

PAYMENTS TO STATES FOR CHILD SUPPORT ENFORCEMENT AND

FAMILY SUPPORT PROGRAMS

Appropriation, fiscal year 2019 ......................................................... $2,922,247,000 

Budget request, fiscal year 2020 ....................................................... 2,890,000,000 

Committee Recommendation ............................................................. 2,890,000,000 

Change from enacted level ............................................................. ¥32,247,000 

Change from budget request .......................................................... – – – 

The Payments to States for Child Support Enforcement and 

Family Support Programs support State-administered programs of 

financial assistance and services for low-income families to promote 

their economic security and self-sufficiency. 

The Committee also recommends $1,400,000,000 in advance 

funding, as requested, for the first quarter of fiscal year 2021 to ensure timely payments for Child Support Enforcement programs. 

LOW INCOME HOME ENERGY ASSISTANCE

Appropriation, fiscal year 2019 ......................................................... $3,690,304,000 

Budget request, fiscal year 2020 ....................................................... – – – 

Committee Recommendation ............................................................. 3,840,304,000 

Change from enacted level ............................................................. +150,000,000 

Change from budget request .......................................................... +3,840,304,000 

The Low Income Home Energy Assistance Program (LIHEAP) 

supports eligible families and households through programs providing assistance with energy costs. 

The Committee recommends $3,840,304,000 for the Low Income 

Home Energy Assistance program, $150,000,000 above the fiscal 

year 2019 enacted level and $3,840,304,000 above the fiscal year 

2020 budget request. The Committee strongly opposes the Administration’s proposal to eliminate this important program that serves 

almost six million low-income households each year. 

Hold Harmless.—The Committee is concerned that as a result of 

yearly formula variances, some States received a reduction in funding in fiscal year 2019 despite a $50,000,000 increase in the overall 

account. To correct this and hold States, territories, and Tribes 

(funded through the States) harmless from reductions when overall 

funding in the account is increased in a given fiscal year, the bill 

includes language to restore funding to States and territories at fiscal year 2018 levels, and then distribute the additional 

143 

$200,000,000 recommended in this bill (over the fiscal year 2018 

enacted level) to States and territories in proportions similar to 

previous fiscal years. 

Information Memorandum.—The Committee believes there is a 

need for additional transparency in the statutory formula distribution of LIHEAP funds. Therefore, the Secretary is encouraged to 

publish on its website an Information Memorandum for LIHEAP 

Appropriations and Regular Block Grant Allocations for fiscal year 

2020. This will help provide grantees with relevant information 

concerning fiscal year 2020 LIHEAP funding. 

Technical Assistance.—The Committee strongly encourages ACF 

to expand its use of contracts with nonprofit organizations with the 

fiscal expertise required for technical assistance, training, and 

monitoring of LIHEAP program activities, and to report back to the 

Committee within 90 days of enactment of this Act on efforts towards using nonprofit organizations in the future, in accordance 

with the authorizing legislation. 

Weatherization.—The Committee recognizes that some States use 

waivers to provide weatherization funding above LIHEAP’s current 

cap. The Committee is interested in how many of these waivers 

have allowed States to implement health, safety and other innovative practices, through LIHEAP’s weatherization program and the 

related weatherization program at the Department of Energy. The 

Committee directs the agency to provide a report within 120 days 

of enactment of this Act describing the types of allowable weatherization activities and to what extent LIHEAP grantees are using 

DOE rules for their LIHEAP-funded weatherization work, as reported by State LIHEAP grantees on their most current LIHEAP 

Plan submitted to the Administration for Children and Families 

(ACF). 

REFUGEE AND ENTRANT ASSISTANCE

Appropriation, fiscal year 2019 ......................................................... $1,905,201,000 

Budget request, fiscal year 2020 ....................................................... 1,804,066,000 

Committee Recommendation ............................................................. 2,411,701,000 

Change from enacted level ............................................................. +506,500,000 

Change from budget request .......................................................... +607,635,000 

The Office of Refugee Resettlement (ORR) programs are designed 

to help refugees, asylees, Cuban and Haitian entrants, and trafficking victims become employed and self-sufficient. These programs also provide for care of unaccompanied alien children in 

Federal custody and victims of torture. 

Funding for several of the programs within this account is highly 

dependent on estimates and as such, it is critical that ORR communicate changes to estimated numbers of arrivals and costs as they 

become available. The Committee directs ORR to provide monthly 

updates of arrivals each month by category, including refugees, 

asylees, Cuban and Haitian entrants, Special Immigrant Visas, and 

unaccompanied alien children, to include any updates in estimated 

funding needs as a result of changes in trends in those categories. 

Within the total, the Committee includes the following: 

Budget Activity FY 2020 

Committee 

Transitional and Medical Services ................................................................................................................. $354,000,000 

Victims of Trafficking ..................................................................................................................................... 28,255,000 

144 

Budget Activity FY 2020 

Committee 

Refugee Support Services .............................................................................................................................. 207,201,000 

Unaccompanied Children ............................................................................................................................... 1,803,245,000 

Victims of Torture ........................................................................................................................................... 19,000,000 

Transitional and Medical Services 

The Committee includes $354,000,000, which is equal to the fis- cal year 2019 enacted level and $35,000,000 above the fiscal year 

2020 budget request. The Transitional and Medical Services program provides grants to States and nonprofit organizations to provide refugees and other eligible populations with up to eight 

months of cash and medical assistance. The Committee includes 

sufficient funding to provide the full eight months of assistance for 

all qualified arrivals estimated in fiscal year 2020. 

Victims of Trafficking 

National Human Trafficking Hotline.—The recommendation includes an additional $1,500,000 to fund the National Human Trafficking Hotline at its authorized funding level of $3,500,000. The 

Committee expects ACF to include in its fiscal year 2021 Congressional Budget Justification a line item noting enacted and requested funding levels for the Hotline. 

Refugee Support Services 

The recommendation includes $207,201,000, which is equal to 

the fiscal year 2019 enacted level and $56,380,000 above the fiscal 

year 2020 budget request. The Refugee Support Services program 

provides formula and competitive grants to States and nonprofit organizations to address barriers to employment and help refugees 

become self-sufficient. 

Unaccompanied Children 

The recommendation includes $1,803,245,000 for the Unaccompanied Alien Children (UAC) Program, which is $500,000,000 

above the fiscal year 2019 enacted level and the fiscal year 2020 

budget request. The Committee provides this additional funding 

with legal restrictions on the use of funds, to ensure the UAC program fulfills its statutory mission to care for children in ORR’s custody and to place them with sponsors as expeditiously as possible. 

To address the Committee’s significant concerns with how the program is currently operating, while acknowledging the tremendous 

needs of the children referred to ORR’s care, the Committee includes increased funding contingent on the conditions included in 

bill language and in the directives included in this report. 

The Committee directs ORR to prioritize funding for expanded 

use of community-based residential care placements (including 

long-term and transitional foster care and small group homes) and 

shelter care other than large-scale institutional shelter facilities. 

The bill includes language requiring the Secretary of HHS to submit a spend plan for all funds provided in the Refugee and Entrant 

Assistance account and to submit an updated plan every 60 days. 

The Committee expects the spend plan to reflect spending levels included in this report (including legal services, child advocates, and 

post-release services as directed below) and to demonstrate the 

145 

steps ORR is taking to increase permanent bed capacity so that 

continued reliance on influx facilities will not be necessary. The Committee includes an increase of not less than $30,000,000 

above the funding available in fiscal year 2019 to provide qualified 

and independent legal services for unaccompanied children, including but not limited to know-your-rights orientations, legal 

screenings, court preparation and assistance, representation, and 

pro bono referrals. The Committee notes that legal counsel for unaccompanied children increases the efficiency and effectiveness of 

immigration proceedings and significantly reduces the failure-toappear rate of children who are released from HHS custody. The 

recommended increase would allow for the resumption of services 

to children released from ORR custody and the extension of released-child representation to high-release communities that are 

not currently being served. The recommendation includes not less than $10,000,000 for the 

Child Advocate program, which provides support for particularly 

vulnerable children, including victims of abuse or trafficking, children 12 or younger, and those who are expected to remain in ORR 

custody for prolonged periods of time. The Committee notes that 

Independent Child Advocates provide a vital resource to the most 

vulnerable unaccompanied and separated children in Federal custody by identifying and advocating for their best interests with 

Federal agencies including HHS, Department of Homeland Security (DHS) and the Department of Justice (DOJ). The Committee 

directs ORR to ensure the continued independence of the Child Advocate program from other contracted service providers to avoid 

any conflicts of interest. The recommendation includes not less than $60,000,000 for home 

studies and increased social services following release (i.e., post-release services). ORR should arrange for such services to be provided by non-governmental organizations (NGOs) with experience 

and expertise in working with these children. 

The Committee directs ORR to comply with the March 8, 2019 

ruling of the Ms. L.; et al., v. U.S. ICE; et al. case, and to account 

for any children who were separated from their parents by DHS 

and referred to ORR on or after July 1, 2017. The Committee provides $4,000,000 for ORR to prioritize this work. Starting no later 

than 30 days after enactment of this Act, HHS is directed to provide monthly reports to the Committee on the progress of this effort. 

Memorandum of Agreement.—The bill includes a proviso to prohibit any funding from being used to implement or enforce the 

Memorandum of Agreement (MOA) between ORR and DHS that 

provides for information sharing and permits ICE to detain and remove sponsors and other members of a household applying to sponsor a child. The MOA deters potential sponsors from approaching 

ORR, extending stays in custody—further traumatizing children, 

and exponentially increasing costs of the program. The Committee 

strongly believes that sponsors will come forward faster if the MOA 

is formally and publicly terminated, and directs the Secretary to rescind it immediately. 

Influx Shelters.—The Committee believes the need for influx 

shelters in fiscal years 2018 and 2019 has been due largely to the 

Administration’s misguided and willfully harmful policies toward 

146 

unaccompanied children. The Committee strongly supports the 

medical, psychological, and child welfare advocacy communities in 

their compelling arguments against, and well-founded reasons to 

limit, the use of influx shelters. The Committee includes funding 

in the bill and directives in this report to support ORR efforts to 

phase out the use of influx shelters by increasing permanent bed 

capacity. However, until this capacity is established, the Committee supports strong oversight of influx facilities and includes bill 

language prohibiting the use of soft-sided dormitories and limiting 

the use of influx shelters under a series of conditions designed to 

maximize child welfare and minimize additional trauma to children. 

In addition, within 30 days of enactment of this Act, and monthly 

thereafter, the Committee directs ORR to submit a report for each 

influx shelter in operation. This report must include the total number of children in care at the facility and the demographic data of 

those children; the average length of time children at the influx 

shelter have been in care, both at the influx shelter and in ORR 

custody; the capacity and occupancy rates of the influx shelter; the 

expected length of time the influx facility will remain in operation; 

and the steps ORR is taking to increase permanent bed capacity 

so that continued reliance on the influx facility will not be necessary. 

Ongoing Separations.—The Committee is alarmed by the Office 

of Inspector General’s January 17, 2019 Report ‘‘Separated Children Placed in Office of Refugee Resettlement Care’’ (Report OEI– 

BL–18–00511), that finds that ORR is still receiving children separated from their parents by immigration officials. The bill includes 

a requirement that the Secretary update the Committee, and make 

publicly available online on a weekly basis, the number of children 

referred to ORR’s care who have been designated by DHS, or subsequently by HHS case managers, as having been separated (under 

any circumstances) from the parent or legal guardian with whom 

they were in DHS custody. The Committee considers this information to be critical to oversight efforts to make sure that family separation does not occur again. 

Prohibiting HHS from Facilitating ICE.—The bill includes a provision prohibiting funds from being used to facilitate DHS removing sponsors or potential sponsors of unaccompanied children based 

on information provided by ORR as part of the sponsor’s application to accept custody of an unaccompanied child, except when that 

information meets specified criteria. 

Congressional Oversight.—The Committee reiterates its position 

on the importance of Congressional oversight of facilities that 

house unaccompanied children. HHS was clearly mistaken when it 

denied entry to three Members of Congress attempting to enter the 

Homestead facility on April 8, 2019, despite the fiscal year 2019 enacted law that explicitly prohibits HHS from using funds to do so. 

The bill includes a modification of that general provision to ensure 

proper Congressional oversight of conditions at these facilities during normal business hours without any requirement to provide advance notice of arrival. 

In-Kind Donations.—The bill continues to include a general provision to allow for in-kind donations from the private sector, nonVerDate Sep 11 2014 06:50 May 16, 2019 Jkt 036295 PO 00000 Frm 00150 Fmt 6659 Sfmt 6602 E:\HR\OC\HR062.XXX HR062
147 

governmental organizations and other groups to support children in 

ORR’s care. 

Siblings in ORR Care.—The bill includes a general provision 

mandating, to the extent practicable, siblings be cared for in the 

same facility, or be placed with the same sponsor. 

Communicating with Congress.—The Committee directs the Department to notify the Committees on Appropriations prior to making any administrative or policy changes expected to impact the 

number of children in ORR custody; shelter operations; the placement of children with sponsors; or any post-release services. 

Data Reporting.—The previous year’s experience between DHS 

and HHS revealed interoperability gaps and data reporting limitations in HHS’ online case management system. The Committee encourages ORR to explore whether there are commercially available 

software solutions capable of enhancing data reporting. 

Protection of DNA.—The Committee continues to prohibit any 

governmental agency or private entity from accessing, using, or 

storing any genetic material, data, or information collected in this 

reunification effort, including for the purpose of criminal or immigration enforcement. Any genetic material, data, or information obtained should be fully destroyed after testing and the probability 

of a genetic relationship is calculated. The entities conducting the 

DNA testing shall obtain the consent of any individual over age 18 

prior to testing, and shall make every effort to obtain the consent 

of a guardian prior to testing on anyone under age 18. The Committee requests ORR continue to include in its fiscal year 2021 

Congressional Budget Justification the steps it is taking to protect 

the privacy and genetic material and data of individuals who are 

being tested as part of reunification efforts. 

Facility Oversight.—The Committee expects ORR to maintain 

strict oversight of all ORR-funded care provider facilities and correct violations of Federal, State or local codes related to the standards of childcare or the well-being of children. The Committee reiterates its direction, pursuant to House Report 115–862, that ORR, 

within 60 days of the enactment of this Act, submit a report to the 

Committee detailing the number and nature of facility violations, 

and the steps it is taking to work with grantees to address and prevent such infractions. 

Age-Outs.—The Committee is concerned about reports that approximately two-thirds of unaccompanied children turning 18 years 

old while in the care and custody of ORR are transferred directly 

to the custody of Immigration and Customs Enforcement (ICE), 

often because of a lack of planning for alternative placements during the child’s time in ORR care. The Committee directs ORR to 

develop a tangible post-18 plan for every 17-year-old unaccompanied child in ORR care at least two weeks in advance of his or 

her 18th birthday. Each post-18 plan should at a minimum identify 

an appropriate non-secure placement for the child and identify any 

necessary social support services for the child. 

Victims of Torture 

The Committee includes $19,000,000 for the Victims of Torture 

program, which is $5,000,000 above the fiscal year 2019 enacted 

level and the fiscal year 2020 budget request. The program funds 

non-profit organizations providing healing and support services to 

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refugees, asylees and asylum seekers, who need help overcoming 

the effects of torture. 

PAYMENTS TO STATES FOR THE CHILD CARE AND DEVELOPMENT

BLOCK GRANT

Appropriation, fiscal year 2019 ......................................................... $5,276,000,000 

Budget request, fiscal year 2020 ....................................................... 5,276,000,000 

Committee Recommendation ............................................................. 7,676,000,000 

Change from enacted level ............................................................. +2,400,000,000 

Change from budget request .......................................................... +2,400,000,000 

The Committee recommends $7,676,000,000 for the Child Care 

and Development Block Grant (CCDBG) program, which is 

$2,400,000,000 above the fiscal year 2019 enacted level and the fiscal year 2020 budget request. The CCDBG provides funds according to a formula to States, territories, and Tribes to provide financial assistance to help low-income working families and families engaged in training or education activities access child care and to 

improve the quality of child care for all children. 

The bill includes the largest funding increase ever provided for 

the Child Care and Development Block Grant. CCDBG reaches 

only 15 percent of the nearly 14 million children who are eligible 

to receive child care services. The Committee believes that significant additional investment is necessary to address large gaps in 

the number of eligible children served by the program. The increase included in this bill will provide CCDBG-funded child care 

to almost 300,000 additional eligible children, enable more low-income parents to work, allow States to expand eligibility for children 

and families, and raise payments to providers. 

Diaper Need and Child Care.—The Committee recognizes that 

many low-income families spend twice as much on diapers for their 

children compared to families who have the means to buy diapers 

in bulk at low price. The Committee is deeply concerned that 1 in 

3 families in the U.S. struggles to afford diapers, which leads to 

higher poverty and increased health risks for infants and toddlers. 

The Committee also notes that many child care centers, including 

ones under the Child Care and Development Block Grant, require 

parents to provide diapers for their children who attend. Therefore, 

the Committee requests HHS to submit a report, within 180 days 

of enactment of this Act, estimating the amount of diapers and diapering supplies that enrolled child care providers require for the 

population of children under the age of three who are served under 

the Child Care and Development Block Grant and the estimated 

cost of those diapers and diaper supplies. 

SOCIAL SERVICES BLOCK GRANT

Appropriation, fiscal year 2019 ......................................................... $1,700,000,000 

Budget request, fiscal year 2020 ....................................................... – – – 

Committee Recommendation ............................................................. 1,700,000,000 

Change from enacted level ............................................................. – – – 

Change from budget request .......................................................... +1,700,000,000 

The Social Services Block Grants provides grants to States by 

formula. States have the flexibility to determine what services and 

activities are supported, provided they are targeted at a broad set 

of goals, including reducing or eliminating poverty, achieving or 

maintaining self-sufficiency, and preventing neglect, abuse, or exploitation of children and adults. 

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CHILDREN AND FAMILIES SERVICES PROGRAMS

Appropriation, fiscal year 2019 ......................................................... $12,239,225,000 

Budget request, fiscal year 2020 ....................................................... 11,187,485,000 

Committee Recommendation ............................................................. 13,967,468,000 

Change from enacted level ............................................................. +1,728,243,000 

Change from budget request .......................................................... +2,779,983,000 

The Children and Families Services programs fund activities 

serving children, youth, families, the developmentally disabled, Native Americans, victims of child abuse and neglect and domestic violence, and other vulnerable populations. 

The Committee recommends the following amounts: 

Budget Activity FY 2020 

Committee 

Programs for Children, Youth, and Families: 

Head Start ............................................................................................................................................. $11,563,095,000 

Early Head Start-Child Care Partnerships ................................................................................... 1,330,000,000 

Preschool Development Grants .............................................................................................................. 350,000,000 

Runaway/Homeless Youth ..................................................................................................................... 125,280,000 

Abuse of Runaway Youth Prevention .................................................................................................... 22,141,000 

State Child Abuse Prevention ............................................................................................................... 90,000,000 

Discretionary Child Abuse Prevention ................................................................................................... 34,000,000 

Community-Based Child Abuse Prevention ........................................................................................... 75,000,000 

Child Welfare Services .......................................................................................................................... 268,735,000 

Child Welfare Training .......................................................................................................................... 17,984,000 

Adoption Opportunities .......................................................................................................................... 42,100,000 

Adoption Incentives ............................................................................................................................... 75,000,000 

Social Services/Income Maintenance Research .................................................................................... 7,012,000 

Native American Programs .................................................................................................................... 60,000,000 

Community Services: 

Community Services Block Grant .......................................................................................................... 760,000,000 

Community Economic Development ...................................................................................................... 25,000,000 

Rural Community Facilities ................................................................................................................... 11,000,000 

Domestic Violence Hotline .............................................................................................................................. 12,000,000 

Family Violence/Battered Women’s Shelters .................................................................................................. 175,000,000 

Independent Living Training Vouchers ........................................................................................................... 43,257,000 

Disaster Human Services Case Management ................................................................................................ 1,864,000 

Program Direction ........................................................................................................................................... 209,000,000 

Head Start 

The Committee recommends $11,563,095,000 for the Head Start 

program, which is $1,500,000,000 above the fiscal year 2019 enacted level and the fiscal year 2020 budget request. Head Start 

promotes school readiness of children under 5 from low-income 

families through education, health, social and other services. 

Early Head Start-Child Care Partnerships.—The Committee recommends $1,330,000,000 for Early Head Start-Child Care Partnership (EHS–CCPs) and EHS Expansion, which is $525,000,000 

above the fiscal year 2019 enacted level and the fiscal year 2020 

budget request. The EHS–CCP program brings together EHS and 

child care through layering of funding to provide comprehensive 

and continuous services to low-income infants, toddlers, and their 

families. The program enhances developmental services and supports for low-income infants and toddlers, and their families, by 

providing strong relationship-based experiences and preparing 

them for the transition into Head Start and preschool. The Committee understands the Office of Head Start (OHS) was only able 

to fund approximately 18 percent of applicants for this funding in 

fiscal year 2019, despite many highly-qualified grant applications. 

The Committee provides additional funding to support expansion of 

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the EHS and EHS–CCPs to add over 80,000 more slots for eligible 

children. 

Quality Improvement Funding for Trauma-Informed Care.—The 

Committee is aware of the rise of adverse childhood experiences 

(ACE) attributable to increased prevalence of substance misuse, 

economic hardship, home and community violence, and other traumatic experiences that can negatively impact child development 

and lead to disruptions in classroom environments. The Committee 

recommends $750,000,000 be allocated within section 640(a)(5) of 

the Head Start Act for grantees to engage in activities that support 

children and families who have experienced trauma, such as increasing services from mental health professionals to provide expert care and counseling to families and the Head Start workforce; 

providing staff training on trauma-informed approaches to service 

delivery; and adding staff to Head Start classrooms. Funding 

should be made available for all grantees, with awards not less 

than $100,000 for smaller grantees, to ensure that quality improvement funding is awarded in amounts substantial enough to have 

a meaningful impact for children enrolled in these programs. 

Tribal Colleges and Universities-Head Start Partnership Program.—The Committee directs $8,000,000 to the Head Start program to reestablish the Tribal Colleges and Universities (TCU)– 

Head Start Partnership Program. Only 39 percent of Indian Head 

Start teachers and assistants meet the national standard for qualified teachers, compared to almost 75 percent nationwide. Reinvesting in early childhood education at TCUs will help to address 

these disparities in the preparation of Head Start teachers in Indian Country. 

Cost of Living Adjustment.—The Committee includes 

$217,000,000 for a cost of living adjustment. 

Service Duration.—The Committee understands that the Head 

Start program standard finalized in Fall 2016 that required programs to provide 1,020 annual hours of planned class operations 

over the course of at least eight months per year was based on research showing that at-risk children benefit from longer exposure 

to enriching early learning programs. The Committee directed 

funding in previous fiscal years to help Head Start programs meet 

the extended duration requirement. The Committee continues to 

encourage extended duration, especially in communities with demonstrated family need, and requests a briefing from OHS not later 

than 30 days after the comment period on the NPRM has closed. 

In addition, the Committee requests OHS to include in future 

budget justifications the number of Head Start slots that offer 

1,020 hours of service per year duration programs. It is the Committee’s expectation that additional flexibility for providers that are 

not in a position to offer extended duration services at this time 

will not result in reductions to services to vulnerable children who 

would benefit from extended duration. 

Migrant and Seasonal Head Start.—The Committee is concerned 

with recent Migrant and Seasonal Head Start (MSHS) enrollment 

declines and understands that the program may fluctuate due to 

reasons outside of OHS’s control, however, the Committee directs 

OHS to be responsive to the needs of communities as demands 

change. 

151 

Further, the Committee supports OHS’s restoration of MSHS 

program funding to terminated localities and the maintenance of 

student enrollment levels through increased consideration of all impoverished student populations subject to transient living conditions or unstable educational environments. In order to avoid recent issues with grantee fiscal irresponsibility, the Committee directs OHS to assess program service capacity based on the aggregate of individual applicants’ regional partnerships, as opposed to 

a single organization’s supposed ability to conduct an equivalent 

nationwide program coordination. The Committee encourages OHS 

to partner with local academic institutions that have established 

regional networks of accredited resources. OHS shall submit a report to the Committee on these efforts within 60 days of enactment 

of this Act. 

Preschool Development Grants 

The Committee recommends $350,000,000 for Preschool Development Grants, which is $100,000,000 above the fiscal year 2019 enacted level and $350,000,000 above the fiscal year 2020 budget request. This program provides grants to States to build State and 

local capacity to provide early childhood care and education for 

children birth through five from low- and moderate-income families. The Committee understands 47 States and territories received 

planning grants in fiscal year 2018 to conduct needs assessments 

and gather data about the current early learning landscape in their 

States. The Committee notes that fiscal year 2019 funding may 

only allow about half of the States that received planning grants 

to receive implementation grants. The Committee includes additional funding in this bill to fund applications from the fiscal year 

2019 competition that may not have received funding due to budget 

constraints. 

Runaway and Homeless Youth 

The Committee recommends $147,421,000 for the Runaway and 

Homeless Youth (RHY) program, which is $20,000,000 above the 

fiscal year 2019 enacted level and $28,300,000 above the fiscal year 

2020 budget request. The Committee supports the ability of grantees to provide prevention services, such as counseling and case 

management, regardless of enrollment in residential services. 

Homeless Management Information System.—RHY program 

grantees are required to report data in the RHY-Homeless Management Information System (HMIS), which is maintained by the Department of Housing and Urban Development and provides an 

array of data on programs for the homeless. The Committee strongly encourages ACF to continue providing technical assistance to 

support RHY programs through this transition to ensure accurate 

and timely reporting of data on outcomes for homeless children and 

youth. 

State Child Abuse Prevention 

The Committee recommends $90,000,000 for Child Abuse Prevention and Treatment Act (CAPTA) State Grants, which is 

$4,690,000 above the fiscal year 2019 enacted level and the fiscal 

year 2020 budget request. 

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Plans of Safe Care.—The Committee continues to emphasize the 

importance of Safe Care Plans and addressing the health and safety of the child, and any substance use disorder treatment for their 

caregivers. The Committee urges the Secretary to prioritize funding 

for States that have high rates of neonatal abstinence syndrome or 

are seeing an increase in neonatal abstinence syndrome rates, and 

that partner with community-based organizations to deliver services that are consistent with the Safe Care Plan for these newborns 

and their caregivers. The Committee also directs ACF to enhance 

their coordination with the States and continue working with those 

States with high rates of neonatal abstinence syndrome and with 

States that are seeing an increase in new cases of neonatal abstinence syndrome. The Committee requests an update on the work 

of the Secretary and ACF to implement these new policies. 

Child Abuse Discretionary Activities 

Child Abuse Hotline.—The Committee includes an increase of 

$1,000,000 to support an additional year of the innovation grant to 

develop and research text- and online chat-based intervention and 

education services through a national child abuse hotline. The 

Committee is pleased that the recent initiation of the text line has 

increased the incidence of youth seeking assistance from Hotline 

counselors and looks forward to data regarding best practices for 

delivering services through text and chat platforms. 

Community-Based Child Abuse Prevention 

The Committee recommends $75,000,000 for Community-Based Child Abuse Prevention, which is $35,236,000 above the fiscal year 

2019 enacted level and the fiscal year 2020 budget request. These 

formula grants support community-based approaches to child abuse 

and neglect prevention. 

Adoption Opportunities 

The Committee recommends $42,100,000 for Adoption Opportunities, which is $3,000,000 above the fiscal year 2019 enacted level 

and the fiscal year 2020 budget request. 

Social Services Research and Demonstration 

The Committee recommends $7,012,000 for Social Services and 

Income Maintenance Research, which is $500,000 above the fiscal 

year 2019 enacted level and the fiscal year 2020 budget request. 

Community Resource Centers.—The Committee directs the program to research how centralized community resource centers, 

which allow citizens to apply for several Federal social services in 

a single location, can reduce the burden on constituents and ensure 

the cost-effective allocation of Federal resources. 

Veterans’ Mediation.—The Committee encourages the program to 

research topics related to mediation strategies that reduce homelessness, unemployment, declining physical and mental health, and 

substance abuse among veterans and military families. 

Native American Programs 

The Committee recommends $60,000,000 for Native American 

Programs, which is $5,450,000 above the fiscal year 2019 enacted 

level and $7,950,000 above the fiscal year 2020 budget request. 

153 

These programs assist Tribal and village governments and Native 

American institutions and organizations in their efforts to support 

and develop stable, diversified local economies. Tribes and nonprofit organizations use funds to develop and implement sustainable community-based social and economic programs and services 

to improve the well-being of Native people. Within the total, the recommendation includes $14,000,000 for 

Native American language preservation activities. The Committee 

provides not less than $5,000,000 for language immersion programs 

as authorized by section 803C(b)(7)(A)–(C) of the Native American 

Programs Act, as amended by the Esther Martinez Native American Language Preservation Act of 2006. 

Community Services Programs 

Community Services Block Grant.—The Committee recommends 

$760,000,000 for the Community Services Block Grant, which is 

$35,000,000 more than the fiscal year 2019 enacted level and 

$760,000,000 more than the fiscal year 2020 budget request. The 

Community Services Block Grant provides funds to alleviate the 

causes and conditions of poverty in communities. 

Community Economic Development.—The Committee recommends $25,000,000 for Community Economic Development 

Grants, which is $5,117,000 above the fiscal year 2019 enacted 

level and $25,000,000 more than the fiscal year 2020 budget request. Community Economic Development is a grant program 

which funds Community Development Corporations seeking to address the economic needs of low-income individuals and families 

through the creation of sustainable business development and employment opportunities. 

Rural Community Facilities Development.—The Committee recommends $11,000,000 for the Rural Community Facilities Development program, which is $2,000,000 above the fiscal year 2019 enacted level, and $11,000,000 above the fiscal year 2020 budget request. Rural Community Development is a grant program that 

works with regional and Tribal organizations to manage safe water 

systems in rural communities. 

Domestic Violence Hotline 

The Committee recommends $12,000,000 for the Domestic Violence Hotline, which is $1,750,000 above the fiscal year 2019 enacted level and the fiscal year 2020 budget request. The Hotline 

provides 24-hour, toll-free and confidential services immediately 

connecting callers to local service providers. Additional funding is 

recommended to add capacity and reduce the number of calls, 

chats, and texts that go unanswered due to a lack of resources. 

Family Violence Prevention and Battered Women’s Shelters 

The Committee recommends $175,000,000 for the Family Violence Prevention and Battered Women’s Shelters programs, which 

is $10,500,000 above the fiscal year 2019 enacted level and the fiscal year 2020 budget request. The Family Violence Prevention and 

Services Act programs provide funding to support the prevention of 

incidents of family violence, domestic violence, and dating violence, 

and provide the immediate shelter and supportive services for 

adult and youth victims (and their dependents). 

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Independent Living Training Vouchers 

The Committee understands that foster and homeless youth experience increased burdens in accessing and completing higher education. The Committee is deeply concerned that access to the Free 

Application for Federal Student Aid (FAFSA), federal financial aid, 

and other existing resources and programs, including TRIO and the 

Chafee Education and Training Voucher program, are not consistently available and that many children are not aware of these resources. Therefore, the Committee urges the Department of Education and ACF to work together with State and tribal welfare systems and runaway and homeless youth programs to conduct further outreach and disseminate information on financial aid, TRIO, 

and the Chafee program to these audiences. The Committee also 

requests that these resources be made available online so that foster youth can also access them. 

Program Direction 

The Committee recommends $209,000,000 for Program Direction, 

which is $4,000,000 above the fiscal year 2019 enacted level and 

the fiscal year 2020 request. 

Status of Funds.—The Committee directs ACF to provide the 

quarterly status of balances report, as required in Section 524 of 

the bill, at the account and program level of detail displayed in the 

table at the end of this report. 

PROMOTING SAFE AND STABLE FAMILIES

Appropriation, fiscal year 2019 ......................................................... $444,765,000 

Budget request, fiscal year 2020 ....................................................... 404,765,000 

Committee Recommendation ............................................................. 424,765,000 

Change from enacted level ............................................................. ¥20,000,000 

Change from budget request .......................................................... +20,000,000 

The Committee recommends $345,000,000 in mandatory funds and $79,765,000 in discretionary funds for the Promoting Safe and 

Stable Families program. This program enables each State to operate a coordinated program of family preservation services, community-based family support services, time-limited reunification services, and adoption promotion and support services. States receive 

funds based on their share of children in all States receiving food 

stamp benefits. The recommendation includes $20,000,000 to support Kinship Navigator programs. The Committee understands 

that the Clearinghouse of evidence-based programs is not yet fully 

established, so discretionary appropriations are provided for transition funding while Kinship Navigator programs eligible for IV–E 

reimbursement are being identified. 

Family First Implementation.—The Committee is aware that P.L. 

115–123 authorized States to receive the same Title IV–E Federal 

matching funds for maintenance costs for children who are living 

with a parent in a licensed family-based residential Substance Use 

Disorder (SUD) treatment facility as if the child were placed in outof-home foster care, away from the parent. The Committee understands the goal of this funding is to enable the parent to continue 

or resume parenting and reduce the burden on the foster care system; therefore, the Committee urges ACF to work with States to 

ensure that this authority and funding is used to broaden access 

to family-based SUD treatment. 

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PAYMENTS FOR FOSTER CARE AND PERMANENCY

Appropriation, fiscal year 2019 ......................................................... $6,035,000,000 

Budget request, fiscal year 2020 ....................................................... 5,744,000,000 

Committee Recommendation ............................................................. 5,744,000,000 

Change from enacted level ............................................................. ¥291,000,000 

Change from budget request .......................................................... – – – 

The Committee also recommends an advance appropriation of 

$3,000,000,000 for the first quarter of fiscal year 2021 to ensure 

timely completion of first quarter grant awards. 

Adoption and Foster Care Analysis and Reporting System 

(AFCARS) Data Elements.—The Committee is very disappointed 

that HHS chose to delay final enactment of regulations that collect 

critical child welfare data elements in order to remove LGBTQ 

identity data. Abandoning data collection on LGBTQ foster youth, 

parents, and guardians, is a clear sign that HHS is abdicating its 

statutory responsibilities to promote the well-being, safety, and 

permanency of LGBTQ foster youth by limiting the ability to track 

and improve these outcomes for LGBTQ foster youth, as well as to 

track recruitment of LGBTQ foster and adoptive parents in an effort to provide diverse family placements for diverse foster youth. 

ADMINISTRATION FOR COMMUNITY LIVING

AGING AND DISABILITY SERVICES PROGRAMS

Appropriation, fiscal year 2019 ......................................................... $2,120,200,000 

Budget request, fiscal year 2020 ....................................................... 1,996,556,000 

Committee Recommendation ............................................................. 2,294,343,000 

Change from enacted level ............................................................. +174,143,000 

Change from budget request .......................................................... +297,787,000 

Created in 2012, the Administration for Community Living 

(ACL) brings together the efforts and achievements of the Administration on Aging, the Administration on Intellectual and Developmental Disabilities, and the HHS Office on Disability to serve as 

the Federal agency responsible for increasing access to community 

supports, while focusing attention and resources on the unique 

needs of older Americans and people with disabilities across the 

lifespan. 

The Committee continues to fund the Senior Medicare Patrol 

Program through the Health Care Fraud and Abuse Control Account. 

Reorganization.—The Committee is disappointed that the Secretary notified the Committee of an intent to reorganize ACL less 

than 30 days after the President’s budget was submitted to Congress. For the purposes of transparency with the public and in accordance with the spirit of an annual budget justification and review process, the Committee directs ACL to submit future reorganization proposals through Congressional Budget Justifications so 

that Congress may fully consider any reorganization in the context 

of the annual budget process and with input from stakeholders. 

The Committee strongly urges ACL to engage with stakeholders 

before it implements its current reorganization plan, and expects 

ACL to engage with union representatives as early as practicable 

to address any employee concerns. 

156 

Home and Community-Based Supportive Services 

The Committee recommends $422,000,000 for Home and Community-Based Supportive Services, which is $36,926,000 over the fiscal year 2019 enacted level and the fiscal year 2020 budget request. 

This program provides formula grants to States and territories to 

fund a wide range of social services that enable seniors to remain 

independent in their homes for as long as possible. 

Preventive Health Services 

The Committee recommends $24,848,000 for Preventive Health 

Services, which is the same as the fiscal year 2019 enacted level 

and the fiscal year 2020 budget request. This program funds activities that help seniors remain healthy and avoid chronic diseases. 

While States have the flexibility to use funding provided through 

this program to fund Chronic Disease Self-Management Education 

(CDSME) and Falls Prevention programs, the Committee does not 

accept the proposal to consolidate these programs within Preventive Health Services. 

Protection of Vulnerable Older Americans 

The Committee recommends $23,658,000 for activities to protect vulnerable older Americans, which is $2,000,000 above the fiscal 

year 2019 enacted level and $3,030,000 above the fiscal year 2020 

budget request. These programs provide grants to States for protection of vulnerable older Americans through the Long-Term Care 

Ombudsman and Prevention of Elder Abuse and Neglect programs. 

The Committee recommends additional funding to expand the 

reach of the ombudsman program to assisted living facilities. 

Family Caregiver Support Services 

The Committee recommends $200,000,000 for the National Caregiver Support program, which is $18,814,000 above the fiscal year 

2019 enacted level and $49,414,000 above the fiscal year 2020 

budget request. This program offers a range of support services to 

family caregivers, including assistance in accessing services such as 

respite care, counseling, support groups, and caregiver training. 

Native American Caregiver Support Services 

The Committee recommends $12,056,000 for the Native American Caregiver Support program, which is $2,000,000 above the fiscal year 2019 enacted level and $4,500,000 above the fiscal year 

2020 budget request. 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 disabilities. 

Congregate and Home-Delivered Nutrition Services 

The Committee recommends a total of $1,000,000,000 for senior 

nutrition. The recommendation includes: $525,000,000 for Congregate Nutrition Services, which is $29,658,000 above the fiscal 

year 2019 enacted level and the fiscal year 2020 budget request; 

$305,000,000 for Home-Delivered Meal Services, which is 

$53,658,000 above the fiscal year 2019 enacted level and the fiscal 

year 2020 budget request; and $170,000,000 for the Nutrition Services Incentives program, which is $9,931,000 above the fiscal year 

157 

2019 enacted level and the fiscal year 2020 budget request. These 

programs help older Americans remain healthy and independent in 

their communities by providing meals and related services in a variety of settings (including congregate facilities such as senior centers) and via home-delivery to older adults who are homebound due 

to illness, disability, or geographic isolation. 

Native American Nutrition and Supportive Services 

The Committee recommends $37,208,000 for Native American 

Nutrition and Supportive Services, which is $3,000,000 above the 

fiscal year 2019 enacted level and the fiscal year 2020 budget request. This program provides grants to Tribes to promote the delivery of nutrition and home and community-based supportive services to Native American, Alaskan Native, and Native Hawaiian elders. 

Aging Network Support Activities 

The Committee recommends $12,461,000 for Aging Network Support Activities, which is $5,000,000 below the fiscal year 2019 enacted level and $958,000 above the fiscal year 2020 budget request. 

This program supports activities that expand public understanding 

of aging and the aging process. 

Holocaust Survivor’s Assistance.—The Committee continues to 

provide not less than $5,000,000 for the Holocaust Survivor’s Assistance program. This program provides supportive services for 

aging Holocaust survivors living in the U.S. 

Alzheimer’s Disease Program 

The Committee recommends $27,500,000 for the Alzheimer’s disease program, which is $4,000,000 above the 2019 enacted program 

level and $8,010,000 above the fiscal year 2020 budget request. 

This program provides competitive matching grants to a limited 

number of States to encourage program innovation and coordination of public and private services for people with Alzheimer’s disease and their families. 

Additionally, the Committee recognizes the complexity of care required by persons with advanced dementia and the tremendous 

value of caregivers and of unpaid respite care. The Committee provides an increase of $4,000,000 for the Alzheimer’s disease program 

to issue grants to demonstrate the benefits of providing direct respite care services to caregivers supporting individuals living with 

Alzheimer’s Disease and Related Dementias (ADRD). 

Respite Care 

The Committee recommends $5,500,000 for Respite Care, which 

is $1,390,000 above the fiscal year 2019 enacted level and 

$2,140,000 above the fiscal year 2020 budget request. The program 

focuses on easing the burdens of caregiving by providing grants to 

eligible State organizations to improve the quality of, and access to, 

respite care for family caregivers. The Committee notes that funding increases included in the Family Caregivers Support Services 

and Alzheimer’s Disease programs will provide States with additional funding available for respite care direct services. 

158 

Falls Prevention 

The Committee recommends $5,000,000 to be transferred from 

the PPH Fund to ACL for the Falls Prevention program, which is 

the same as the fiscal year 2019 enacted level and $5,000,000 

above the fiscal year 2020 budget request. Falls prevention grants 

support the promotion and dissemination of prevention tools delivered in community settings. 

Chronic Disease Self-Management Program 

The Committee recommends $8,000,000 to be transferred from 

the PPH Fund to ACL for the Chronic Disease Self-Management 

program, which is the same as the fiscal year 2019 enacted level 

and $8,000,000 above the fiscal year 2020 budget request. This program supports grants to States for low-cost, evidence-based prevention models that use state-of-the-art techniques to help those with 

chronic conditions address issues related to the management of 

their disease. 

Elder Rights Support Activities 

The Committee recommends $20,874,000 for Elder Rights Support Activities, which is $5,000,000 above the fiscal year 2019 enacted level and $7,000,000 above the fiscal year 2020 budget request. This program supports efforts that provide information, 

training, and technical assistance to legal and aging services organizations working to prevent and detect elder abuse and neglect. 

The Committee supports ACL’s efforts to develop a National 

Adult Maltreatment Reporting System and provides an increase of 

$3,000,000 to enhance the data system and assist States making 

system modifications to access it. An additional $2,000,000 is provided for additional screening for elder abuse, neglect, and exploitation. The Committee recognizes that the opioid crisis is affecting 

Adult Protective Services, especially with respect to clients who 

have been victimized by those using opioids and believes this work 

can be part of the increased screening effort. This should not come 

at the expense of existing Elder Rights Support activities. 

Aging and Disability Resource Centers 

The Committee recommends $8,119,000 for Aging and Disability 

Resource Centers, which is the same as the fiscal year 2019 enacted level and $2,000,000 above the fiscal year 2020 budget request. These centers provide information, counseling and access for 

individuals to learn about the services and support options available to seniors and the disabled so they may retain their independence. 

State Health Insurance Assistance Program 

The Committee recommends $55,000,000 for the State Health Insurance Assistance Program, which is $5,885,000 above the fiscal 

year 2019 enacted level and $18,885,000 above the fiscal year 2020 

budget request. The State Health Insurance Assistance Program 

provides Medicare beneficiaries with information, counseling, and 

enrollment assistance. 

159 

Paralysis Resource Center 

The Committee recommends $8,700,000 for the Paralysis Resource Center, which is the same as the fiscal year 2019 enacted 

level and $8,700,000 above the fiscal year 2020 budget request. The 

Paralysis Resource Center offers activities and services aimed at 

increasing independent living for people with paralysis and related 

mobility impairments, and supporting integration into the physical 

and cultural communities in which they live. 

Limb Loss Resource Center 

The Committee recommends $4,000,000 for the Limb Loss Resource Center, which is $500,000 above the fiscal year 2019 enacted level and $4,000,000 above the fiscal year 2020 budget request. The Limb Loss Resource Center supports a variety of programs and services for those living with limb loss, including a national peer support program, educational events, training for consumers and healthcare professionals, and information and referral 

services. 

Traumatic Brain Injury 

The Committee recommends $12,321,000 for the Traumatic 

Brain Injury program, which is $1,000,000 above the fiscal year 

2019 enacted level and $3,000,000 above the fiscal year 2020 budget request. The program provides grants to States for the development of a comprehensive, coordinated family and person-centered 

service system at the State and community level for individuals 

who sustain a traumatic brain injury. 

Developmental Disabilities State Councils 

The Committee recommends $80,000,000 for State Councils on 

Developmental Disabilities, which is $4,000,000 above the fiscal 

year 2019 enacted level and $24,000,000 above the fiscal year 2020 

budget request. The Developmental Disabilities State Councils 

work to develop, improve and expand the system of services and 

supports for people with developmental disabilities. 

Developmental Disabilities Protection and Advocacy 

The Committee recommends $43,000,000 for Developmental Disabilities Protection and Advocacy, which is $2,266,000 above the 

2019 enacted level and $4,266,000 above the fiscal year 2020 budget request. This formula grant program provides funding to States 

to establish and maintain protection and advocacy systems to protect the legal rights of persons with developmental disabilities. 

Voting Access for Individuals with Disabilities 

The Committee recommends $8,963,000 for Voting Access for Individuals with Disabilities program, which is $2,000,000 above the 

fiscal year 2019 enacted level and $4,000,000 above the fiscal year 

2020 budget request. The Voting Access for Individuals with Disabilities program authorized by the Help America Vote Act provides formula grants to ensure full participation in the electoral 

process for individuals with disabilities, including registering to 

vote, accessing polling places, and casting a vote. 

160 

Developmental Disabilities Projects of National Significance 

The Committee recommends $13,000,000 for Developmental Disabilities Projects of National Significance, which is $1,000,000 

above the fiscal year 2019 enacted level and $11,950,000 above the 

fiscal year 2020 budget request. This program funds grants and 

contracts that develop new technologies and demonstrate innovative methods to support the independence, productivity, and integration of those living with a disability into the community. 

University Centers for Excellence in Developmental Disabilities 

The Committee recommends $41,619,000 for University Centers 

for Excellence in Developmental Disabilities, which is $1,000,000 

above the fiscal year 2019 enacted level and $9,073,000 above the 

fiscal year 2020 budget request. The University Centers for Excellence in Developmental Disabilities Education, Research, and Service are a nationwide network of independent but interlinked centers, representing a national resource for addressing issues, finding 

solutions, and advancing research related to the needs of individuals with developmental disabilities and their families. 

Independent Living 

The Committee recommends $116,183,000 for the Independent 

Living program, of which $25,378,000 is for the Independent Living 

State Grants program and $90,805,000 is for the Centers for Independent Living program. This funding level is equal to the fiscal 

year 2019 enacted level and $7,537,000 above the fiscal year 2020 

budget request. Independent Living programs maximize the leadership, empowerment, independence, and productivity of individuals 

with disabilities. 

National Institute on Disability, Independent Living, and Rehabilitation Research 

The Committee recommends $108,970,000 for the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), which is the same as the fiscal year 2019 enacted level and $18,599,000 above the fiscal year 2020 budget request. NIDILRR generates knowledge and promotes its effective 

use to enhance the abilities of people with disabilities to perform 

activities of their choice in the community and to expand society’s 

capacity to provide full opportunities for its citizens with disabilities. 

Assistive Technology 

The Committee recommends $37,000,000 for Assistive Technology, which is $1,000,000 above the fiscal year 2019 enacted level 

and $5,061,000 above the fiscal year 2020 budget request. The 

Committee provides a $1,000,000 increase for Section 4 of the Assistive Technology Act. Assistive Technology (AT) supports programs providing grants to States for addressing assistive technology needs of individuals with disabilities. The goal is to increase 

awareness of and access to assistive technology devices and services that may help with education, employment, daily activities, 

and inclusion of people with disabilities in their communities. 

161 

The Committee continues to provide $2,000,000 for competitive 

grants to support existing and new alternative financing programs 

that provide for the purchase of AT devices. 

Program Administration 

The Committee recommends $41,063,000 for Program Administration, which is the same as the fiscal year 2019 enacted level and 

$2,076,000 above the fiscal year 2020 budget request. This funding 

supports Federal administrative costs associated with administering ACL’s programs. 

OFFICE OF THE SECRETARY

OFFICE OF MEDICARE HEARINGS AND APPEALS

Appropriation, fiscal year 2019 ......................................................... $182,381,000 

Budget request, fiscal year 2020 ....................................................... 182,381,000 

Committee Recommendation ............................................................. 182,381,000 

Change from enacted level ............................................................. – – – 

Change from budget request .......................................................... – – – 

This Office supports hearings at the administrative law judge 

level, the third level of Medicare claims appeals. 

Medicare Appeals Backlog.—The Committee remains concerned 

about the size of the Medicare Appeals Backlog. The Committee 

continues to provide a significantly elevated funding level for the 

Office of Medicare Hearings and Appeals—an amount that was initially provided in fiscal year 2018. 

GENERAL DEPARTMENTAL MANAGEMENT

Appropriation, fiscal year 2019 ......................................................... $545,457,000 

Budget request, fiscal year 2020 ....................................................... 408,749,000 

Committee Recommendation ............................................................. 549,997,000 

Change from enacted level ............................................................. +4,540,000 

Change from budget request .......................................................... +141,248,000 

Of the funds provided, $64,828,000 shall be derived from evaluation set-aside funds available under section 241 of the Public 

Health Service Act, which is the same as the fiscal year 2018 enacted level and $4,012,000 below the fiscal year 2020 budget request. 

This appropriation supports activities that are associated with 

the Secretary’s roles as policy officer and general manager of the 

Department of Health and Human Services. The Office of the Secretary also implements administration and Congressional directives, and provides assistance, direction and coordination to the 

headquarters, regions, and field organizations of the department. 

In addition, this funding supports the Office of the Surgeon General and several other health promotion and disease prevention activities that are centrally administered. 

Advertising Contracts.—The Committee understands that, as the 

largest advertiser in the United States, the federal government 

should work to ensure fair access to its advertising contracts for 

small disadvantaged businesses and businesses owned by minorities and women. The Committee directs the Department to include 

the following information in its fiscal year 2021 budget justification: Expenditures for fiscal year 2019 and expected expenditures 

for fiscal years 2020 and 2021, respectively, for (1) all contracts for 

advertising services; and (2) contracts for the advertising services 

162 

of (I) socially and economically disadvantaged small business concerns (as defined in section 8(a)(4) of the Small Business Act (15 

U.S.C. 637(a)(4)); and (II) women- and minority-owned businesses. 

Customer Service.—The Committee continues to support efforts 

to improve customer service in accordance with Executive Order 

13571—Streamlining Service Delivery and Improving Customer 

Service. The Committee directs the Secretary to develop standards 

to improve customer service and incorporate the standards into the 

performance plans required under 31 U.S.C. 1115. 

Departmental Appeals Board.—The Committee includes 

$20,000,000 for the Departmental Appeals Board, including rent 

and overhead costs, an increase of $6,000,000 above the fiscal year 

2019 enacted level. The additional funds are provided to address 

the growing backlog of cases at the Medicare Operations Division, 

as well as the influx in workload due to increased dispositions from 

the Office of Medicare Hearings and Appeals. 

Domestic Violence Survivors with Companion Animals.—The 

Committee urges the Secretary of Health and Human Services to 

enter into consultations with the Secretary of Agriculture as soon 

as possible, and enter into any memoranda of understanding as directed, in order to establish during fiscal year 2020 the requirements for grant application and execution under Section 12502 of 

P.L. 115–334, the Agriculture Improvement Act of 2018, to provide 

emergency and transitional shelter and housing options for domestic violence survivors with companion animals. 

Gene and Cellular Therapies.—The Committee is encouraged by 

the promise of the new cancer treatment, CAR T-cell therapy that 

is already producing remarkable results for patients. The Committee urges the Secretary to ensure coordination between NIH, 

FDA, and CMS to develop policies that support the innovation of 

new gene and cell therapies and protect patient access by providing 

equitable reimbursement for these therapies and the associated 

services needed by patients being treated. The Committee requests 

an update in the fiscal year 2021 Congressional Budget Justification on activities to ensure appropriate patient access to these 

treatments. 

HIV Initiative.—The Committee supports the Administration’s 

HIV Initiative to decrease new HIV diagnosis by 75 percent by 

2025 and 90 percent by 2030. The initiative builds on existing HIV 

programs and new innovations to ramp up HIV testing, care and 

treatment, and prevention services, including Pre-Exposure Prophylaxis. 

The Committee includes the full amount of funding requested for 

the HIV Initiative under HRSA, CDC, and NIH. Moreover, the 

Committee provides additional increases—beyond the fiscal year 

2020 budget request—of $46,376,000 for the Ryan White HIV/AIDS 

program; $5,000,000 for the Minority AIDS program in SAMHSA; 

and $6,100,000 for Minority HIV/AIDS prevention and treatment 

activities under the Office of the Secretary. The Committee also rejects the Administration’s proposal to cut funding for NIH’s HIV research portfolio; instead, the bill includes an increase of approximately $149,000,000 for NIH’s HIV research to continue its efforts 

to develop an HIV vaccine or a cure. 

The Committee directs the Secretary to submit to the Committees on Appropriations a comprehensive multi-year plan outlining 

163 

the HIV Initiative, including metrics the Department will use to 

measure progress on reducing HIV transmission, as well as cost estimates for the initiative for fiscal years 2021 through 2025. The 

Secretary shall submit an initial plan within 90 days of enactment 

of this Act and then annually thereafter. 

KidneyX.—The Committee recognizes that more than 40 million 

Americans are living with kidney diseases, and for more than 

700,000 of those individuals, the diseases progress to kidney failure, requiring access to dialysis or kidney transplantation to live. 

The Committee also notes that kidney failure accounts for approximately $35,000,000,000 in annual Medicare spending, while kidney 

disease accounts for a total of approximately $115,000,000,000 in 

annual Medicare spending. Given the high cost of kidney disease 

in both health consequences and federal spending, the Committee 

includes $10,000,000 for the Office of the Secretary for prize competitions (as described in section 24 of The Stevenson-Wydler Technology Innovation Act of 1980 (15 U.S.C. 3719)) through a publicprivate partnership to accelerate the development and adoption of 

novel therapies and technologies that improve the diagnosis and 

treatment of patients with kidney diseases, including prize competitions to accelerate innovation in dialysis. The Committee urges 

the Secretary to coordinate across operating divisions—including 

NIH, FDA, and CMS—to demonstrate a Department-wide commitment to supporting innovative therapies and technologies with the 

potential to improve quality of life for individuals with kidney diseases while reducing federal costs. The Committee requests that 

the Secretary include a multi-year plan in the fiscal year 2021 Congressional Budget Justification outlining possible prize competitions in future fiscal years. 

Maternal Mental Health.—The Committee is concerned that up 

to 20 percent of new or expectant mothers will experience a maternal mental health disorder during pregnancy or within the first 

year after childbirth—such as depression, anxiety, or postpartum 

psychosis. Untreated maternal mental health disorders negatively 

impact the short and long-term health of affected mothers and 

their children, with symptoms leading to adverse birth outcomes, 

impaired maternal-infant bonding, poor infant growth, childhood 

emotional and behavioral problems, and significant medical and 

economic cost. The Committee directs the Secretary to submit a report, in consultation with HRSA, SAMSHA, CDC, CMS, Office of 

the Surgeon General, Office on Women’s Health, and Office of Minority Health, to the Committees on Appropriations within 180 

days of enactment of this Act on the role that each agency can take 

to address gaps in maternal mental health public awareness, 

screening, diagnosis and delivery for pregnant and postpartum 

women. 

Nondiscrimination Report.—The Committee directs the Secretary 

to submit a report within 90 days of enactment of this Act on the 

Department’s efforts to enforce nondiscrimination regulations 45 

CFR 75.300 (c) and (d) in health and human service programs, specifically including efforts to ensure that foster children are not discriminated against based on their sexual orientation and gender 

identity, given that HHS-funded research has shown that lesbian, 

gay, bisexual, and transgender (LGBT) foster children suffer poorer 

outcomes related to safety, well-being, and permanency than their 

164 

non-LGBTQ counterparts, including greater rates of poor treatment, multiple placements, longer stays in residential care rather 

than in family settings, and greater rates of hospitalization for 

emotional reasons, criminal justice involvement, and homelessness. 

Nonrecurring Expenses Fund.—The Committee includes bill language in the CDC account to direct funding to the Chamblee Research Support Building 108 project and campus infrastructure improvements. 

Performance Measures.—The Committee directs the Department 

to comply with title 31 of the United States Code, including the development of organizational priority goals and outcomes such as 

performance outcome measures, output measures, efficiency measures, and customer service measures. 

Proposed Reductions in the Fiscal Year 2020 Budget Request.— 

The Committee includes no funds for Secretarial Initiatives and Innovations or Acquisition Reform. These activities were proposed for 

reduction or elimination in the fiscal year 2020 budget request. The 

Committee agrees with the Secretary’s proposal to support acquisition reform through the HHS Service and Supply Fund. 

Research on Poverty.—The Committee includes sufficient funding 

for the Office of the Assistant Secretary for Planning and Evaluation to continue the existing Poverty Research Center cooperative 

agreement in fiscal year 2020. The Committee includes an increase 

of $1,000,000 above the fiscal year 2019 enacted level for the fourth 

year of this five-year cooperative agreement to initiate new research projects, data analysis, and evaluation plans. 

Section 520 Report.—The Committee commends HHS and the 

CDC for working with state and local partners to take necessary 

steps to reduce the number of new infections of HIV and hepatitis 

due to intravenous drug use. The Committee notes that studies 

have shown that People Who Inject Drugs (PWIDs) are twice as 

likely to be unaware of their HIV status as the general public. The 

Committee also recognizes that syringe services programs (SSPs) 

have been associated with reduced risk for infection of HIV, viral 

hepatitis and other blood-borne infections. Section 520 of division 

H of the fiscal year 2016 Consolidated Appropriations Act allowed 

for elements of SSPs to be purchased if it was determined that a 

state or local jurisdiction was experiencing, or was at risk for, a 

significant increase in hepatitis infections or an HIV outbreak due 

to injection drug use. Such authority was continued in fiscal years 

2017, 2018, and 2019. Therefore, the Committee directs the Secretary to submit a report within 180 days of enactment of this Act 

on the implementation of Sec. 520 of P.L. 114–113, P.L. 115–31, 

and P.L. 115–141. The report should include the number of states, 

programs, or grantees requesting the use of funds for SSPs; the 

number of PWIDs served; information on services provided to the 

PWIDs and the programs to which such PWIDs were linked; and, 

where possible, the impact of such programs on HIV and hepatitis 

infection rates. 

Staffing Reports.—The Committee continues a general provision 

requiring the Department to submit a staffing report to the Committees on Appropriations by the 15th day of each month. The 

Excel table shall include: the names, titles, grades, agencies, and 

divisions of all of the political appointees, special government emVerDate Sep 11 2014 06:50 May 16, 2019 Jkt 036295 PO 00000 Frm 00168 Fmt 6659 Sfmt 6602 E:\HR\OC\HR062.XXX HR062
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ployees, and detailees that were employed by or assigned to the Department during the previous month. 

Teen Pregnancy Prevention Evidence Review.—The Committee includes $600,000 for the Assistant Secretary for Planning and Evaluation to maintain and continue to update the existing Teen Pregnancy Prevention Evidence Review. 

Office of the Assistant Secretary for Health 

African American Children and Suicide.—The Committee is concerned that the suicide rate among children ages 10 to 17 increased 

by 70 percent between 2006 and 2016. The Committee is also concerned that African American children ages 5 to 12 are dying by 

suicide at nearly twice the rate of their white counterparts. Accordingly, the Committee directs the Office of the Surgeon General to 

submit a report on this pressing public health issue, within 90 days 

of enactment of this Act, including an examination of factors that 

may be causing this disparity as well as evidence-based interventions. The Surgeon General should collaborate with the CDC, 

SAMHSA, ACF, the National Institute of Minority Health and 

Health Disparities, the National Institutes of Mental Health, and 

the National Institute of Child Health and Human Development, as 

appropriate. 

Chronic Fatigue Syndrome Advisory Committee.—The Committee 

is concerned about the Secretary’s decision to disband the Chronic 

Fatigue Syndrome Advisory Committee (CFSAC) without alternative plans to carry out its functions and current projects. There 

remains an urgent need for U.S. inter-agency coordination and collaboration with stakeholders to adequately address the needs of the 

ME/CFS health crisis. In the absence of CFSAC, the Committee requests that HHS submit a plan within 90 days of enactment of this 

Act outlining how the Department intends to address the crisis in 

ME/CFS clinical care; accelerate drug development for ME/CFS; 

and collaborate across HHS agencies and stakeholders. 

Embryo Adoption Awareness Campaign.—The Committee includes $1,000,000 for the Embryo Adoption Awareness Campaign, 

the same as the fiscal year 2019 enacted level. These funds will be 

used to educate Americans about the existence of frozen human 

embryos (resulting from in-vitro fertilization), which may be available for donation or adoption to help other couples build their families. The Committee includes bill language permitting these funds 

also to be used to provide medical and administrative services to 

individuals adopting embryos, deemed necessary for such adoptions, consistent with the Code of Federal Regulations. 

Immunization Objectives.—The Healthy People immunization 

and infectious disease objectives are a cornerstone to national efforts to protect against vaccine preventable conditions across the 

lifespan. As the Office of Disease Prevention and Health Promotion 

(ODPHP) works to finalize objectives for Healthy People 2030, the 

Committee notes that the proposed list of objectives includes only 

eight immunization objectives. This reduction is a missed opportunity to emphasize immunizations at a time when it is critically 

important to elevate this as a public health priority across the lifespan. The HHS Strategic Plan recognizes that infectious diseases 

are a major health and economic burden for the United States and 

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cluding immunizations and screenings, especially for high-risk, 

high-need populations. To help fulfill this priority, the Committee 

strongly urges ODPHP to work with the National Vaccine Program 

Office to adopt an Adult Immunization Composite Status Measure 

Objective, which targets multiple vaccine preventable conditions 

(influenza, Td/Tdap, zoster and pneumococcal) in one quality measure. Adoption of the Composite would align HP2030 objectives with 

external health care quality measurement tools, streamlining the 

patchwork of existing adult immunization measures, reducing the 

reporting burden to providers, and providing a meaningful national 

picture of access to this important preventive service. 

Reorganization.—The Committee strongly opposes the Secretary’s 

reorganization of the Office of the Assistant Secretary for Health— 

in particular, the Secretary’s misguided decision to merge the Office of Adolescent Health into the Office of Population Affairs and 

the decision to dismantle HHS Regional Offices that currently administer the Title X Family Planning program. The Committee believes the reorganization will harm the Teen Pregnancy Prevention 

Program and its ability to provide evidence-based and medically accurate programs that reduce teen pregnancy. The Committee disagrees with the Secretary’s decision to move forward with the reorganization after satisfying only the bare minimum of requirements 

for congressional notification. As a result, the Committee modifies 

reprogramming authority to remove the ability of the Secretary to 

reorganize offices unless the reorganization proposal is included in 

the President’s budget request. 

Sexual Risk Avoidance.—The Committee includes no funding for 

grants to implement education in sexual risk avoidance, also 

known as abstinence-only until marriage programs. 

Sexually Transmitted Infections (STIs).—The Committee is aware 

of the recent statistics regarding the rise in STIs across the nation 

and is pleased that the Assistant Secretary for Health is creating 

a National STD Action Plan to address increasing rates in these 

diseases. The Committee requests a report within 90 days of enactment of this Act on the Administration’s progress on such an Action Plan. 

Teen Pregnancy Prevention.—The Committee strongly supports 

the Teen Pregnancy Prevention (TPP) Program and the first two 

five-year cycles of grants. The TPP Program has been widely cited 

as a high-quality evidence-based program, including by the bipartisan Commission on Evidence-Based Policymaking. Unfortunately, 

in July 2017, HHS sought to abruptly shorten existing grants after 

the third year of their five-year awards. This action was subsequently found to be unlawful and overturned by multiple federal 

courts. Although HHS was ordered to restore funding for the final 

two years of the grants, the attempt to de-fund awards in the middle of multi-year programs caused considerable disruption. The 

committee is therefore providing a sixth year of funding for grants 

awarded for fiscal years 2015 through 2019 to mitigate this disruption and increase the opportunity for grantees to meet the original 

goals for their projects. 

Office of Minority Health 

The Committee provides $65,000,000 for the Office of Minority 

Health (OMH), which is $8,330,000 above the fiscal year 2019 enVerDate Sep 11 2014 06:50 May 16, 2019 Jkt 036295 PO 00000 Frm 00170 Fmt 6659 Sfmt 6602 E:\HR\OC\HR062.XXX HR062
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acted level and $13,202,000 more than the fiscal year 2020 budget 

request. The OMH works with U.S. Public Health Service agencies 

and other agencies of the Department to address the health status 

and quality of life for racial and ethnic minority populations in the 

United States. OMH develops and implements new policies; partners with States, Tribes, and communities through cooperative 

agreements; supports research, demonstration, and evaluation 

projects; and disseminates information. 

Health Disparities.—The Committee includes an increase of 

$13,202,000 above the amount requested in the fiscal year 2020 

budget request and directs OMH to allocate the additional funds 

for research or public health interventions related to Sickle Cell, 

Sickle Cell Trait, Lupus, Alzheimer’s, Diabetes, and peripheral artery disease, as well as stomach, liver, and cervical cancer to help 

reduce the racial and ethnic disparities that exist in these diseases. 

The Committee encourages OMH to support research at Historically Black Colleges and University medical colleges and Hispanic 

Serving Institution medical schools to explore the disproportionate 

impact these diseases have on minority populations. 

The Committee directs OMH to submit an update to the Committees on Appropriations no later than September 30, 2020, including 

the name of each organization receiving funding in fiscal year 2020; 

the amount of each award; a summary of each project; and a projected timeline for each project. 

Hispanic Serving Institutions.—The Committee urges the Office 

of Minority Health to enter into cooperative agreements with Hispanic Serving Institution medical schools in addition to their work 

with Historically Black Colleges and Universities medical schools. 

The Committee requests a report on these efforts within 180 days 

of enactment of this Act. 

Office on Women’s Health 

The Committee includes $36,000,000 for the Office on Women’s 

Health, which is $3,860,000 above the fiscal year 2019 enacted 

level and $8,684,000 more than the fiscal year 2019 budget request. 

The Committee includes $4,100,000, an increase of $1,000,000 

over the fiscal year 2019 enacted level, 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. 

Maternal Mortality.—The Committee continues to be concerned 

about the high rate of maternal mortality in the United States. The 

Committee includes additional funding for OWH’s activities to reduce maternal mortality, including expansion of evidence-based 

interventions and dissemination of information about evidencebased interventions. 

Menstrual Hygiene Products.—The Committee is concerned with 

the lack of data on the usage of—and preferences for—different 

types of menstrual hygiene products, which are basic health care 

necessities. The Committee directs the Office on Women’s Health 

to commission a study on the usage of, type, preferences, and frequency in changing of different menstrual hygiene products by race 

and socioeconomic status. The Committee directs the Office on 

168 

Women’s Health to commission the study in time to be submitted 

to Congress no later than 180 days after enactment of this Act. 

OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH

INFORMATION TECHNOLOGY

Appropriation, fiscal year 2019 ......................................................... $60,367,000 

Budget request, fiscal year 2020 ....................................................... 43,000,000 

Committee Recommendation ............................................................. 60,367,000 

Change from enacted level ............................................................. – – – 

Change from budget request .......................................................... +17,367,000 

The Office of the National Coordinator (ONC) is the principal 

Federal entity charged with coordinating efforts to implement and 

use health information technology and exchange electronically 

health information. 

Patient Data Matching.—The Committee is aware that one of the 

most significant challenges inhibiting the safe and secure electronic 

exchange of health information is the lack of a consistent patient 

data matching strategy. With the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act, 

a clear mandate was placed on the Nation’s healthcare community 

to adopt electronic health records and health exchange capability. 

Although the Committee continues to carry a prohibition against 

HHS using funds to promulgate or adopt any final standard providing for the assignment of a unique health identifier for an individual until such activity is authorized, the Committee notes that 

this limitation does not prohibit HHS from examining the issues 

around patient matching. Accordingly, the Committee continues to 

encourage the Secretary, acting through the ONC and CMS, to provide technical assistance to private-sector-led initiatives to develop 

a coordinated national strategy that will promote patient safety by 

accurately identifying patients to their health information. 

OFFICE OF INSPECTOR GENERAL

Appropriation, fiscal year 2019 ......................................................... $80,000,000 

Budget request, fiscal year 2020 ....................................................... 80,000,000 

Committee Recommendation ............................................................. 85,000,000 

Change from enacted level ............................................................. +$5,000,000 

Change from budget request .......................................................... +$5,000,000 

The Committee provides $85,000,000 for the Office of Inspector 

General (OIG), which is $5,000,000 more than the fiscal year 2019 

enacted level and $5,000,000 more than the fiscal year 2020 budget 

request. 

In addition, within the Health Care Fraud and Abuse Control 

(HCFAC) program discretionary appropriations for fiscal year 2020, 

the Committee provides the OIG with $93,000,000. Mandatory appropriations for this office also are contained in the HCFAC program and the Health Insurance Portability and Accountability Act 

of 1996. 

Unaccompanied Children.—The Committee appreciates the OIG’s 

ability to respond quickly to warning signs in the Office of Refugee 

Resettlement’s (ORR) Unaccompanied Children program and looks 

forward to the OIG’s forthcoming series of reports on critical issues 

related to unaccompanied children in ORR’s custody. 

169 

OFFICE FOR CIVIL RIGHTS

Appropriation, fiscal year 2019 ......................................................... $38,798,000 

Budget request, fiscal year 2020 ....................................................... 30,286,000 

Committee Recommendation ............................................................. 38,798,000 

Change from enacted level ............................................................. – – –

Change from budget request .......................................................... +8,512,000 

The Office for Civil Rights (OCR) is responsible for enforcing civil 

rights statutes that prohibit discrimination in health and human 

services programs. OCR implements the civil rights laws through 

a compliance program designed to generate voluntary compliance 

among all HHS recipients. 

Expulsions and Suspensions in the Head Start program.—The 

Committee is deeply concerned about expulsions and suspensions 

that occur in preschool settings and K–3 classrooms, particularly 

given the racial and gender disparities that exist. These outcomes 

are problematic given the research that indicates these practices 

can adversely affect development, health, and education outcomes. 

The Committee strongly urges the Office of Civil Rights to collect 

data annually from all Head Start grantees on the number and 

type of suspension and expulsions of children enrolled in Head 

Start or Early Head Start, disaggregated by race/ethnicity, sex, disability status, and English Language Learner (ELL) status. The Office of Civil Rights should also submit to the Committee on Appropriations of the House of Representatives no later than 180 days 

after the enactment of this act, and annually thereafter, a report 

detailing school discipline in all Head Start programs, including 

disaggregated data and any disparities by subgroup in disciplinary 

rates. The report should include specific recommendations given to 

schools on expulsions and suspensions—including evidence-based 

interventions, consumer education specific to each school, and opportunities to improve school climate. The Committee urges OCR 

to provide technical assistance to help prevent or severely limit expulsion and suspension practices in Head Start programs; eliminate disparities in the provision of discipline; and ensure the safety 

and well-being of all young children. 

RETIREMENT PAY AND MEDICAL BENEFITS FOR COMMISSIONED

OFFICERS

Appropriation, fiscal year 2019 ......................................................... $629,209,000 

Budget request, fiscal year 2020 ....................................................... 623,591,000 

Committee Recommendation ............................................................. 623,591,000 

Change from enacted level ............................................................. ¥5,618,000 

Change from budget request .......................................................... – – – 

The Committee provides for retirement pay and medical benefits 

of Public Health Service Commissioned Officers, for payments 

under the Retired Serviceman’s Family Protection Plan, and for 

medical care of dependents and retired personnel. 

PUBLIC HEALTH AND SOCIAL SERVICES EMERGENCY FUND

Appropriation, fiscal year 2019 ......................................................... $2,631,458,000 

Budget request, fiscal year 2020 ....................................................... 2,666,591,000 

Committee Recommendation ............................................................. 3,008,458,000 

Change from enacted level ............................................................. +377,000,000 

Change from budget request .......................................................... +341,867,000 

170 

This account supports the activities of the Assistant Secretary for 

Preparedness and Response (ASPR) and other components within 

the Office of the Secretary to prevent, prepare for, and respond to 

the health consequences of bioterrorism and other public health 

emergencies, including pandemic influenza. It also includes funding 

for the Department’s cybersecurity efforts. 

Office of the Assistant Secretary for Preparedness and Response 

The Committee provides $2,372,128,000 for activities administered by ASPR. ASPR is responsible for coordinating national policies and plans for medical and public health preparedness and for 

administering a variety of public health preparedness programs. 

Research and Development.—The Committee supports the critical 

role of research and development (R&D) for new tools to protect 

Americans from the threat of biological incidents, including infectious diseases and diseases of epidemic potential, and supports the 

prioritization of R&D within the National Biodefense Strategy. The 

Committee requests that HHS include in the fiscal year 2021 Congressional Budget Justification an update on progress made in supporting U.S. leadership and investment in emerging technologies 

and medical countermeasures, including new drugs, diagnostics, 

vaccines, and devices, as well as an update on progress made towards integrating research and development into Federal Planning, 

including work to facilitate policies and incentives across interagency response R&D efforts. 

Public Health Emergency Medical Countermeasures Enterprise 

Multi-Year Budget.—The Committee appreciates the release of the 

Public Health Emergency Medical Countermeasures Enterprise 

multi-year budget in February 2019. The Committee expects more 

timely future submissions, as the updates are due annually. 

Operations 

The Committee includes $30,938,000 for Operations. This account supports activities within the Assistant Secretary’s Immediate Office; the Office of the Chief Operating Officer; the Office of 

Acquisitions Management, Contracts, and Grants; and the Office of 

Financial Planning and Analysis. 

Preparedness and Emergency Operations 

The Committee includes $24,654,000 for Preparedness and Emergency Operations. The Preparedness and Emergency Operations 

account funds the Office of Emergency Management, which support 

a full spectrum of emergency management responsibilities, including planning, coordination, logistics, training, and responding to 

planned events and unplanned incidents. 

National Disaster Medical System 

The Committee includes $57,404,000 for the National Disaster 

Medical System (NDMS). NDMS deploys trained medical teams to 

communities impacted by public health and medical emergencies 

due to natural and man-made incidents. 

Hospital Preparedness Program 

The Committee includes $316,555,000, an increase $52,000,000, 

for the Hospital Preparedness Program (HPP). HPP supports coopVerDate Sep 11 2014 06:50 May 16, 2019 Jkt 036295 PO 00000 Frm 00174 Fmt 6659 Sfmt 6602 E:\HR\OC\HR062.XXX HR062
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erative agreements with State, local, and territorial health departments to build healthcare coalitions that improve regional and local 

hospital preparedness and surge capacity in public health emergencies. 

High Consequence, Emerging, Infectious Disease Threats.—The 

Committee supports the continuation of the nation’s preparedness 

against high consequence, emerging, infectious disease threats such 

as Ebola, Lassa Fever, Severe Acute Respiratory Syndrome (SARS), 

Middle Eastern Respiratory Syndrome (MERS), and other special 

pathogens. The Committee includes $11,000,000 to be provided directly to the National Ebola Training and Education Center 

(NETEC) and the ten existing regional Ebola and other special 

pathogen treatment centers. 

Hospital Preparedness Grants.—The Committee includes an increase of $35,000,000 for critical support to State, local and regional partners to advance health care system preparedness and 

response. 

Regional Disaster Health Response System Demonstration Pilots.—The Committee includes $6,000,000 for the expansion of the 

current Regional Disaster Health Response System demonstration 

pilots. The Committee directs HHS to include a plan in the fiscal 

year 2021 Congressional Budget Justification that is based on the 

results of these pilots that does not duplicate current services. 

Treatment Reimbursement.—During the Ebola outbreak, Americans who became infected were successfully treated at Academic 

Health Centers, using a reimbursement model to ensure adequate 

compensation for treatment provided to Ebola victims. Unfortunately, this model has not been extended to other serious communicable diseases such as Lassa fever, which represent an equal 

risk. Given the significant cost of preparedness and care associated 

with any serious communicable disease, when any Federal agency 

refers any highly contagious individuals to a designated treatment 

center, the Committee encourages the use of the previously developed reimbursement model for Ebola to be applied. 

Biomedical Advanced Research and Development Authority 

The Committee includes $566,700,000, an increase of $5,000,000, 

for the Biomedical Advanced Research and Development Authority 

(BARDA). BARDA supports the advanced development of vaccines, 

drugs, and therapeutics for potential serious public health threats, 

including chemical, biological, radiological, and nuclear threats, 

pandemic influenza, and emerging and re-emerging infectious diseases. 

Blood Products.—The Committee remains concerned over the 

predicted platelet shortfall and vulnerability of the current blood 

supply, in the event of an emergency. Advanced blood products, 

e.g., freeze-dried platelets and plasma are key to insuring a national response capability in order to save lives. Next-generation 

blood products are needed. The Committee encourages the acceleration of the development of freeze-dried hemostatic products. 

Tuberculosis.—The Committee previously encouraged BARDA to 

support the development of new tuberculosis (TB) diagnostic tests, 

drugs and vaccines for drug resistant TB. The Committee requests 

a report on this issue within 180 days of enactment of this Act. 

172 

Vaccine Production.—The Committee urges BARDA to support 

vaccines produced through recombinant DNA technology in addition to traditionally-produced vaccines to facilitate the competitive 

process for all vaccine manufacturers. 

Zika Vaccine Development.—The number of new Zika virus infections has dropped dramatically because much of the population in 

Zika-endemic areas has developed an immunity to the virus. However, like other similar mosquito-borne flaviviruses, the virus is 

likely to reemerge in these areas in several years, and could 

emerge unpredictably in isolated areas in the meantime, including 

within the U.S. Given the links between Zika virus infections and 

serious birth defects, and the length of time necessary to develop 

vaccines, the Committee believes it is prudent to continue efforts 

to develop a vaccine for the Zika virus. Within the total funding 

provided for BARDA, the Committee directs BARDA to continue to 

support research and development on a vaccine for the Zika virus. 

Policy and Planning 

The Committee includes $14,877,000 for Policy and Planning. 

The Office of Policy and Planning leads HHS’ emergency preparedness and response strategic direction and policy coordination. 

Project BioShield Special Reserve Fund 

The Committee includes $735,000,000 for Project BioShield. 

These funds support the acquisition of promising medical countermeasures developed through BARDA contracts for the most serious 

public health threats. 

Strategic National Stockpile 

The Committee includes $920,000,000, an increase of 

$310,000,000, for the Strategic National Stockpile. The Committee 

commends the Department for its efforts to achieve efficiencies in 

its public health preparedness activities. The Committee continues 

to expect that CDC will have a significant role in providing scientific expertise in decision-making related to the procurement of 

countermeasures, as well as maintaining strong relationships with 

State and local public health departments to facilitate efficient deployment of countermeasures in public health emergencies. 

Forward Deployment.—The Committee strongly urges HHS to 

use discretion in allowing the forward deployment of Strategic National Stockpile (SNS) medication in reasonable quantities in or 

near high-threat, high-density urban jurisdictions that have demonstrated an ability to stand up Points of Dispensing faster than 

SNS medications can be delivered to jurisdictions. 

Saline.—The Committee encourages ASPR to explore ways with 

industry to surge normal IV saline production capabilities for response efforts. 

Vulnerable Populations.—The Committee is concerned about the 

availability of medical countermeasures for individuals who are 

immunocompromised with common conditions like eczema, HIV, 

and diabetes. Some traditional vaccines contain a live virus that 

can be harmful or even fatal for patients with these conditions. 

Therefore, the Committee encourages HHS to evaluate its stockpile 

of medical countermeasures to ensure appropriate supplies are 

available to protect these vulnerable populations. 

173 

Office of the Assistant Secretary for Administration—Cybersecurity 

The Committee provides $58,860,000 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 Security and Strategic Information 

The Committee provides $7,470,000 for the Office of Security and 

Strategic Information to maintain the security of the Department’s 

personnel, systems, and critical infrastructure. 

Office of Public Health and Science—Medical Reserve Corps 

The Committee includes $6,000,000 for the Medical Reserve 

Corps program, which is a network of local volunteers who work 

to strengthen the public health infrastructure and preparedness capabilities of their communities. 

Pandemic Influenza Preparedness 

The Committee includes $270,000,000, an increase of 

$10,000,000, for the pandemic influenza preparedness program. 

This funding supports research and development of vaccines and 

the next-generation influenza medical countermeasures, preparedness testing and evaluation, and stockpiling. 

Pandemic Influenza Efficiencies.—The Committee is committed 

to improving and modernizing our nation’s pandemic influenza preparedness and ensuring first responders are protected. To that end, 

HHS is urged to consider novel pandemic stockpiling concepts, such 

as Vendor Managed Inventory, already used successfully in the 

Strategic National Stockpile, which will reduce the overhead required to maintain the pandemic stockpile, and will ensure a safe, 

reliable supply of pandemic countermeasures are available from 

vaccine manufacturers as is required. 

Pandemic Influenza Vaccine.—The Committee remains concerned 

about our nation’s limited ability to rapidly respond to a pandemic 

influenza outbreak and meet the Federal government’s goal of delivering vaccines within 12 weeks of a declared pandemic. Historically HHS has entered into agreements with multiple suppliers to 

ensure optimal level of preparedness against pandemic influenza 

outbreaks. The Committee encourages HHS to advance multiple 

technologies that can produce a vaccine within 12 weeks of a pandemic influenza declaration. 

GENERAL PROVISIONS

Sec. 201. The Committee continues a provision to limit the 

amount available for official reception and representation expenses. 

Sec. 202. The Committee continues a provision to limit the salary 

of an individual through an HHS grant or other extramural mechanism to not more than the rate of Executive Level II. 

Sec. 203. The Committee continues a provision to prohibit the 

Secretary from using evaluation set-aside funds until the Committees on Appropriations receive a report detailing the planned use 

of such funds. 

174 

Sec. 204. The Committee continues a provision regarding the enacted level for the PHS evaluation set-aside. 

(TRANSFER OF FUNDS)

Sec. 205. The Committee modifies a provision permitting the Secretary of HHS to transfer up to one percent of any discretionary 

funds between appropriations, provided that no appropriation is increased by more than three percent by any such transfer to meet 

emergency needs. 

Sec. 206. The Committee modifies the 60 day flexibility for National Health Service Corps contract terminations. 

Sec. 207. The Committee continues a provision to prohibit the 

use of Title X funds unless the applicant for the award certifies to 

the Secretary that it encourages family participation in the decision of minors to seek family planning services and that it provides 

counseling to minors on how to resist attempts to coerce minors 

into engaging in sexual activities. 

Sec. 208. The Committee continues a provision stating that no 

provider of services under Title X shall be exempt from any law requiring notification or the reporting of child abuse, child molestation, sexual abuse, rape, or incest. 

Sec. 209. The Committee continues a provision related to the 

Medicare Advantage program. 

Sec. 210. The Committee continues a provision prohibiting funds 

from being used to advocate or promote gun control. 

Sec. 211. The Committee continues a provision to allow funding 

for HHS international HIV/AIDS and other infectious disease, 

chronic and environmental disease, and other health activities 

abroad to be spent under the State Department Basic Authorities 

Act of 1956. 

Sec. 212. The Committee continues a provision authorizing certain international health activities. 

(TRANSFER OF FUNDS)

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

(TRANSFER OF FUNDS)

Sec. 214. The Committee continues a provision that makes NIH 

funds for human immunodeficiency virus research available to the 

Office of AIDS Research. 

Sec. 215. The Committee continues a provision granting authority to the Office of the Director of the NIH to enter directly into 

transactions in order to implement the NIH Common Fund for 

medical research and permitting the Director to utilize peer review 

procedures, as appropriate, to obtain assessments of scientific and 

technical merit. 

Sec. 216. The Committee continues a provision clarifying that 

funds appropriated to NIH institutes and centers may be used for 

minor repairs or improvements to their buildings, up to $3,500,000 

per project with a total limit for NIH of $45,000,000. 

175 

(TRANSFER OF FUNDS)

Sec. 217. The Committee continues a provision transferring one 

percent of the funding made available for National Institutes of 

Health National Research Service Awards to the Health Resources 

and Services Administration. 

Sec. 218. The Committee continues the Biomedical Advanced Research and Development Authority ten year contract authority. 

Sec. 219. The Committee continues language requiring HHS to 

include certain information concerning the number of full-time Federal employees and contractors working on the Affordable Care Act 

in the fiscal year 2021 budget request. 

Sec. 220. The Committee continues specific report requirements 

for CMS’s Health Insurance Exchange activities in the fiscal year 

2021 budget request. 

Sec. 221. The Committee continues a provision prohibiting the 

CMS Program Management account from being used to support 

risk corridor payments. 

(TRANSFER OF FUNDS)

Sec. 222. The Committee continues language directing the spending of the Prevention and Public Health fund. 

PREVENTION AND PUBLIC HEALTH FUND

The Committee continues a provision that directs the transfer of 

the Prevention and Public Health Fund. In fiscal year 2020, the 

level appropriated for the fund is $893,950,000 after accounting for 

sequestration. The Committee includes bill language in section 222 

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: 

Agency Budget Activity FY 2020 

Committee 

ACL ........................... Alzheimer’s Disease Program ................................................................................. $14,700,000 

ACL ........................... Chronic Disease Self-Management ........................................................................ $8,000,000 

ACL ........................... Falls Prevention ...................................................................................................... $5,000,000 

CDC ........................... Breastfeeding Grants (Hospitals Promoting Breastfeeding) .................................. 10,000,000 

CDC ........................... Diabetes .................................................................................................................. 72,275,000 

CDC ........................... Epidemiology and Laboratory Capacity Grants ...................................................... 40,000,000 

CDC ........................... Healthcare Associated Infections ........................................................................... 12,000,000 

CDC ........................... Heart Disease and Stroke Prevention Program ...................................................... 57,075,000 

CDC ........................... Million Hearts Program .......................................................................................... 4,000,000 

CDC ........................... Preventive Health and Health Services Block Grant ............................................. 160,000,000 

CDC ........................... Tobacco ................................................................................................................... 129,600,000 

CDC ........................... Section 317 Immunization Grants ......................................................................... 347,800,000 

CDC ........................... Lead Poisoning Prevention ..................................................................................... 17,000,000 

CDC ........................... Early Care Collaboratives ....................................................................................... 4,500,000 

SAMHSA .................... Garrett Lee Smith—Youth Suicide ........................................................................ $12,000,000 

Sec. 223. The Committee modifies a provision relating to breast 

cancer screening. 

Sec. 224. The Committee continues a provision relating to indirect cost negotiated rates. 

176 

(TRANSFER OF FUNDS)

Sec. 225. The Committee continues a provision permitting transfer of funds within NIH, if such funds are related to opioid and 

pain management research. 

Sec. 226. The Committee continues certain Congressional notification requirements. 

Sec. 227. The Committee continues a provision related to a report 

on staffing. 

Sec. 228. The Committee continues a provision allowing HHS to 

cover travel expenses when necessary for employees to obtain medical care when they are assigned to duty in a location with a public 

health emergency. 

Sec. 229. The Committee continues a provision relating to donations for unaccompanied alien children. 

Sec. 230. The Committee includes a new provision rescinding unobligated funds from prior-year Children’s Health Insurance Program State allotments. 

Sec. 231. The Committee modifies a provision relating to Members of Congress and oversight of facilities responsible for the care 

of unaccompanied alien children. 

Sec. 232. The Committee includes a new provision ensuring that 

efforts are taken to place unaccompanied alien children who are 

siblings together. 

Sec. 233. The Committee includes a new provision prohibiting 

funds from being used to facilitate the Secretary of Homeland Security taking certain actions against sponsors of unaccompanied alien 

children, except under certain conditions. 

Sec. 234. The Committee includes a new provision prohibiting 

funds from being used to house unaccompanied alien children in 

certain facilities, unless the Secretary grants limited-duration 

waivers. 

Sec. 235. The Committee includes a new provision requiring a 

weekly report on unaccompanied alien children who were separated 

from their parents or legal guardians and transferred to the care 

of the Office of Refugee Resettlement. 

Sec. 236. The Committee includes a new provision prohibiting 

funds from being awarded to an organization that does not comply 

with Federal nondiscrimination regulations. 

Sec. 237. The Committee includes a new provision related to primary and secondary school costs for eligible dependents of HHS 

personnel stationed in the Commonwealth of Puerto Rico, the Commonwealth of the Northern Mariana Islands, and other territories 

or possessions of the United States. 

Sec. 238. The Committee includes a new provision prohibiting 

funds from being used to implement, enforce, or otherwise give effect to certain revisions of the Code of Federal Regulations. 

Sec. 239. The Committee includes a new provision prohibiting 

funds from being used to publish a proposed rule relating to a nonemergency medical transportation benefit for Medicaid beneficiaries. 

Sec. 240. The Committee includes a new provision prohibiting 

funds from being used to finalize, implement, or enforce a rule related to conscience rights. 

177 

TITLE III—DEPARTMENT OF EDUCATION 

EDUCATION FOR THE DISADVANTAGED

Appropriation, fiscal year 2019 ......................................................... $16,543,790,000 

Budget request, fiscal year 2020 ....................................................... 16,376,790,000 

Committee Recommendation ............................................................. 17,563,802,000 

Change from enacted level ............................................................. +1,020,012,000 

Change from budget request .......................................................... +1,187,012,000 

This account provides foundational funding to help ensure all 

children receive a fair, equitable and high-quality education. Of the total amount available, $6,638,625,000 is appropriated for 

fiscal year 2020 for obligation on or after July 1, 2021 and 

$10,841,177,000 is appropriated for fiscal year 2020 for obligation 

on or after October 1, 2021. 

Grants to Local Educational Agencies 

For fiscal year 2020, the Committee recommends $16,859,802,000 for Title I grants to LEAs, an increase of $1,000,000,000 over the 

fiscal year 2019 enacted level and the fiscal year 2020 budget request, reflecting the largest increase to the program in more than 

a decade. Title I is the cornerstone of federal K–12 education programs and critical to the nation’s collective efforts to ensure that 

every child has the opportunity to obtain a high-quality education. 

The program serves an estimated 25 million students in nearly 90 

percent of school districts and nearly 60 percent of all public 

schools. Providing additional resources so that children can succeed 

in school and in life is one of the Committee’s highest priorities in 

the bill. 

Of the amounts provided for Title I programs, $6,459,401,000 is 

available for Basic Grants to Local Educational Agencies (LEAs or 

school districts), which is the same as both the fiscal year 2019 enacted level and the fiscal year 2020 budget request. Basic grants 

are awarded to school districts with at least 10 low-income children 

who make up more than two percent of the school-age population. 

Within the amount for Title I Basic Grants, up to $5,000,000 is 

made available to the Secretary of Education (Secretary) on October 1, 2019, to obtain annually-updated LEA-level poverty data 

from the Bureau of the Census. 

The Committee recommends $1,362,301,000 for Title I Concentration Grants, which is the same as both the fiscal year 2019 

enacted level and the fiscal year 2020 budget request. Concentration Grants target funds to school districts in which the number of 

low-income children exceeds 6,500 or 15 percent of the total schoolage population. 

The Committee recommends $4,519,050,000 for Title I Targeted 

Grants, which is $500,000,000 above the fiscal year 2019 enacted 

level and the 2020 budget request. Targeted Grants provide higher 

payments to school districts with high numbers or percentages of 

low-income students. 

The Committee recommends $4,519,050,000 for Title I Education 

Finance Incentive Grants (EFIGs), which is $500,000,000 above the 

fiscal year 2019 enacted level and the 2020 budget request. EFIGs 

provide payments to States and school districts that incorporate equity and effort factors to improve the equity of State funding systems. 

178 

Our nation’s public schools serve more than 50 million children, 

more than 50 percent of whom come from low-income families. Research shows that low-income students are more likely to struggle 

academically and often attend high-need schools with fewer resources, less-experienced teachers, and more limited access to advanced coursework. Unfortunately, support for federal K–12 formula programs has been relatively stagnant over the past decade, 

allowing inflation to erode the value of this vital assistance. The 

Committee is concerned by research from the Center on Budget 

and Policy Priorities that finds that 29 States spent less per student in 2015 than they had in the 2008 school year, before the 

Great Recession. The Committee intends for this historic increase 

for Title I, and for other K–12 programs, to help reverse a decade 

of disinvestment and austerity for our schools and communities. 

The Committee is encouraged by recent research on community 

school models, including findings that well-implemented community schools lead to improved student and school outcomes while 

meeting the needs of low-income students. The Committee notes 

that under Schoolwide Programs in the Elementary and Secondary 

Education Act (ESEA), schools may describe efforts, and use funds, 

to support strategies to address schools’ needs that include a community schools approach, such as the use of a community schools 

coordinator, expanded and enriched learning time opportunities, 

active family and community engagement, collaborative leadership 

practices, and integrated student supports. 

The Committee is concerned by the Department’s proposed Supplement not Supplant Non-Regulatory Informational Document for 

leaving a key fiscal requirement unregulated and without a meaningful standard against which the Department can enforce compliance. The Committee is concerned the informational guidance will 

lead to the abuse of flexibility and an erosion of the effectiveness 

of the federal investment in public education. Therefore, the Committee urges the Department to abandon its proposal and engage 

in negotiated rulemaking and robust public comment to promulgate 

a meaningful standard for compliance with the requirements of 

ESEA. 

Comprehensive Literacy Development Grants 

The Committee recommends $195,000,000 for Comprehensive 

Literacy Development Grants, which is $5,000,000 above the fiscal 

year 2019 enacted level. The fiscal year 2020 budget request proposes to eliminate this program. Funds are awarded to States to 

subgrant to school district and/or early education programs to improve literacy instruction for disadvantaged students. 

Innovative Approaches to Literacy 

The Committee recommends $29,000,000 for Innovative Approaches to Literacy, a $2,000,000 increase over the fiscal year 

2019 enacted level. The fiscal year 2020 budget request proposes to 

eliminate this program. Funds support competitive grants to school 

libraries and national not-for-profit organizations to provide books 

and literacy activities to children and families in high-need communities. 

179 

State Agency Programs: Migrant 

The Committee recommends $380,000,000 for the State Agency Program for Migrant Education, which is $5,249,000 above the fiscal year 2019 enacted level and the fiscal year 2020 budget request. 

This program supports special educational and related services for 

children of migrant agricultural workers and fishermen, including: 

(1) Supplementary academic education; (2) remedial or compensatory instruction; (3) English for limited English proficient students; (4) testing; (5) guidance counseling; and (6) other activities 

to promote coordination of services across States for migrant children whose education is interrupted by frequent moves. 

State Agency Programs: Neglected and Delinquent 

For the State Agency Program for Neglected and Delinquent 

Children, the Committee recommends $50,000,000, which is 

$2,386,000 about the fiscal year 2019 enacted level and the fiscal 

year 2020 budget request. This formula grant program supports 

educational services for children and youth under age 21 in Staterun institutions, attending community day programs, and in correctional facilities. A portion of these funds is provided for projects 

that support the successful re-entry of youth offenders into postsecondary and vocational programs. 

Special Programs for Migrant Students 

The Committee recommends $50,000,000 for the Special Programs for Migrant Students, which is $5,377,000 above the fiscal 

year 2019 enacted level and the fiscal year 2020 budget request. 

These programs make grants to colleges, universities, and nonprofit organizations to support educational programs designed for 

students who are engaged in migrant and other seasonal farm 

work. The High School Equivalency Program (HEP) recruits migrant students age 16 and over and provides academic and support 

services to help those students obtain a high school equivalency 

certificate and subsequently to gain employment or admission to a 

postsecondary institution or training program. The College Assistance Migrant Program (CAMP) provides tutoring and counseling 

services to first-year, undergraduate migrant students and assists 

those students in obtaining student financial aid for their remaining undergraduate years. 

IMPACT AID

Appropriation, fiscal year 2019 ......................................................... $1,446,112,000 

Budget request, fiscal year 2020 ....................................................... 1,371,799,000 

Committee Recommendation ............................................................. 1,498,112,000 

Change from enacted level ............................................................. +52,000,000 

Change from budget request .......................................................... +126,313,000 

This account supports payments to school districts affected by 

Federal activities, such as those that educate children whose families are connected with the military or who live on Indian land. 

Basic Support Payments 

The Committee recommends $1,351,242,000 for Basic Support 

Payments to LEAs, which is $50,000,000 above the fiscal year 2019 

enacted level and the fiscal year 2020 budget request. Basic Support Payments compensate school districts for lost tax revenue and 

180 

are made on behalf of Federally-connected children, such as children of members of the uniformed services who live on Federal 

property. 

Payments for Children with Disabilities 

The Committee recommends $48,316,000 for Payments for Children with Disabilities, which is the same as both the fiscal year 

2019 enacted level and the fiscal year 2020 budget request. These 

payments compensate school districts for the increased costs of 

serving Federally-connected children with disabilities. 

Facilities Maintenance 

The Committee recommends $4,835,000 for Facilities Maintenance, which is the same as both the fiscal year 2019 enacted level 

and the fiscal year 2020 budget request. These capital payments 

are authorized for maintenance of certain facilities owned by the 

Department. 

Construction 

The Committee recommends $17,406,000 for the Construction 

program, which is the same as both the fiscal year 2019 enacted 

level and the fiscal year 2020 budget request. Funding is allocated 

by formula to eligible LEAs for school construction activities under 

section 7007(a) of ESEA. 

Payments for Federal Property 

The Committee recommends $76,313,000 for Payments for Fed- eral Property, which $2,000,000 above the fiscal year 2019 enacted 

level. The fiscal year 2020 budget request proposes to eliminate 

this program. Funds are awarded to school districts to compensate 

for lost tax revenue as the result of Federal acquisition of real 

property since 1938. 

SCHOOL IMPROVEMENT PROGRAMS

Appropriation, fiscal year 2019 ......................................................... $5,246,967,000 

Budget request, fiscal year 2020 ....................................................... 675,614,000 

Committee Recommendation ............................................................. 6,016,470,000 

Change from enacted level ............................................................. +769,503,000 

Change from budget request .......................................................... +5,340,856,000 

The Committee recommendation includes $6,016,470,000 for the 

School Improvement Programs account. 

Supporting Effective Instruction State Grants 

The Committee recommends $2,555,830,000 for Supporting Effective Instruction State Grants (Title II–A), which is $500,000,000 

above fiscal year 2019 enacted level. The fiscal year 2020 budget 

request proposes to eliminate the program. Title II–A grants provide States and school districts with a flexible source of funding to 

strengthen the skills and knowledge of teachers, principals, and administrators to enable them to improve student achievement. Title 

II–A represents the only dedicated funding stream for teacher professional development for many States and districts. The Committee’s recommended funding level, which provides a 24 percent increase, would be the program’s first increase since fiscal year 2010. 

Taking into account the impact previous cuts to Title II–A have 

181 

had on support for educator professional development, the Committee prioritizes additional resources to strengthen and highlight 

the importance of the teaching profession. 

The Committee also notes the role Title II–A funds can play in 

helping educators incorporate vital social and emotional learning 

(SEL) strategies. For instance, Title II–A can be used to develop 

educator competencies in supporting student social, emotional, and 

cognitive development into licensing and accreditation requirements for teachers, school leaders, administrators, and counseling 

staff. In addition, LEAs can use Title II–A funds for professional 

development that helps educators continually build on and refine 

student-centered practices that support student social, emotional, 

and academic learning. These can include learning to use data 

about school climate and a wide range of student outcomes to undertake continuous improvement, problem solving around the 

needs of individual students and engaging in schoolwide initiatives 

in collegial teams and professional learning communities, and 

learning from other schools through networks, site visits, and documentation of successes. 

The Committee is supportive of the Department’s recognition of 

effective teaching and SEL as a vital, evidence-based field and is 

interested in how its newly established Office of Effective Teaching 

and Social and Emotional Learning will provide technical assistance to State Educational Agencies (SEAs) and LEAs in implementing the Every Student Succeeds Act (ESSA). In addition, the 

Committee is interested in how the office will disseminate knowledge of evidence-based SEL strategies from the Department’s 

newly established Center to Improve Social and Emotional Learning and School Safety to external stakeholders and to Department 

offices responsible for competitive grant competitions. Therefore, 

within 60 days of enactment of this Act, the Committee directs the 

Department to brief the Committees on Appropriations on the Office of Effective Teaching and Social and Emotional Learning’s 

plans for disseminating the Center to Improve Social and Emotional Learning and School Safety’s clearinghouse of evidence-based 

strategies to internal and external stakeholders, including SEAs 

and LEAs, and the office’s plans for leveraging the Center’s knowledge of evidence-based SEL strategies to inform fiscal year 2020 

grant competitions. 

Supplemental Education Grants 

The Committee recommends $16,699,000 for Supplemental Education Grants to the Federated States of Micronesia and the Republic of the Marshall Islands, which is the same as both the fiscal 

year 2019 enacted level and the fiscal year 2020 budget request. 

The Compact of Free Association Amendments Act of 2003 (PL 

108–188) authorizes these entities to receive funding for general 

education assistance. 

21st Century Community Learning Centers 

The Committee recommends $1,321,673,000 for 21st Century 

Community Learning Centers, $100,000,000 more than the fiscal 

year 2019 enacted level. The fiscal year 2020 budget request proposes to eliminate this program. Funds are awarded by formula to 

States, which in turn distribute funds on a competitive basis to 

182 

local school districts, nonprofit organizations, and other public entities. 

The Committee notes that only one in three 21st Century Community Learning Centers grant applications is awarded, reflecting 

substantial unmet demand for these opportunities. The 

$100,000,000 increase over fiscal year 2019 will help communities 

providing after-school programs serve 1.5 million students, approximately 120,000 more than in fiscal year 2019. 

State Assessments 

The Committee recommends $378,000,000 for State Assessments, 

which is the same as the fiscal year 2019 enacted level and the fiscal year 2020 budget request. Funds are available to develop and 

implement academic standards and assessments. The program includes a set-aside for audits to identify and eliminate low-quality 

or duplicative assessments. 

Culturally Relevant Assessments.—The Committee supports efforts by the Department to ensure tribal populations have access 

to quality culturally relevant assessments. 

Education for Homeless Children and Youth 

The Committee recommends $100,000,000 for the Education for 

Homeless Children and Youth program, which is $6,500,000 more 

than the fiscal year 2019 enacted level and the 2020 budget request. Grants are allocated to States in proportion to the total each 

State receives under the Title I program. 

Training and Advisory Services 

The Committee recommends $6,575,000 for Training and Advisory Services authorized by Title IV–A of the Civil Rights Act, 

which is the same as both the fiscal year 2019 enacted level and 

the fiscal year 2020 budget request. Title IV-A authorizes technical 

assistance and training services for school districts to address problems associated with desegregation on the basis of race, sex, or national origin. The Department awards three-year grants to regional 

Equity Assistance Centers (EACs) located in each of the 10 Department of Education regions. The EACs provide services to school 

districts upon request. Typical activities include disseminating information on successful education practices and legal requirements 

related to nondiscrimination on the basis of race, sex, and national 

origin in educational programs. 

Education for Native Hawaiians 

The Committee recommends $40,000,000 for the Education for 

Native Hawaiian program, which is $3,603,000 more than the fiscal 

year 2019 enacted level. The fiscal year 2020 budget request proposes to eliminate this program. Funds are used to provide competitive awards for supplemental education services to the Native 

Hawaiian population. 

Alaska Native Education Equity 

The Committee recommends $36,453,000 for the Alaska Native 

Education Equity program, which is $1,000,000 more than the fiscal year 2019 level. The fiscal year 2020 budget request proposes 

to eliminate this program. Funds are used to provide competitive 

183 

awards for supplemental education services to the Alaska Native 

population. 

Rural Education 

The Committee recommends $180,840,000 for Rural Education 

programs, which is the same as the fiscal year 2019 enacted level 

and the fiscal year 2020 budget request. There are two programs 

to assist rural school districts with improving teaching and learning in their schools: the Small, Rural Schools Achievement program, which provides funds to rural districts that serve a small 

number of students; and the Rural and Low-Income Schools program, which provides funds to rural districts that serve concentrations of poor students, regardless of the number of students served 

by the district. Funds appropriated for Rural Education shall be divided equally between these two programs. 

Comprehensive Centers 

The Committee recommends $60,400,000 for Comprehensive Centers, which is $8,400,000 above the fiscal year 2019 enacted 

level. The fiscal year 2020 budget request proposes to eliminate 

this program. The Comprehensive Centers program includes support for regional centers that provide training, technical assistance, 

and professional development to build State capacity to provide 

high-quality education to all students. The Committee notes the 

critical role Comprehensive Centers play in helping States vet evidence and strategies to implement ESSA and provide children with 

a high-quality education. 

Student Support and Academic Enrichment State Grants 

The Committee recommends $1,320,000,000 for Student Support 

and Academic Enrichment (SSAE) State Grants, which is 

$150,000,000 above the fiscal year 2019 enacted level. The fiscal 

year 2020 budget request proposes to eliminate this program. 

SSAE grants provide SEAs and LEAs with flexible resources that 

provide students with access to a well-rounded education, including 

rigorous coursework, and improve school conditions and the use of 

technology. 

The Committee notes that SEAs and LEAs can use SSAE funds 

for activities that contribute to a well-rounded education, including 

supports for safe, culturally responsive classroom communities. The 

Committee also notes that SEAs and LEAs can use SSAE funds to 

support and expand school-based mental health services. 

Arming Teachers.—The Committee notes there is no evidence to 

suggest that arming teachers would make schools safer. Instead, 

there are serious concerns about the unintended consequences and 

negative impacts such a policy could have on the well-being and 

safety of students. The Committee is deeply concerned by the Department’s internal July 2018 memo that indicated its Office of the 

General Counsel believes the Secretary has discretion to interpret 

the ESEA ‘‘as to its permissiveness regarding the purchase of firearms and training on the use of firearms.’’ However, the memo also 

indicates that ‘‘it is reasonable for the Secretary not to allow this 

use of funds absent specific Congressional authorization, and it is 

unlikely that this interpretation would be subject to a successful 

legal challenge.’’ Seeing as Congress never intended for SSAE 

184 

funds to be used to purchase firearms or for firearms training in 

schools, and given the Department’s Office of the General Counsel 

view that it would be reasonable, and legally sound, for the Secretary to disallow such expenditures, the Committee directs the 

Secretary, within 30 days of enactment of this Act, to issue guidance clarifying that SSAE funds are not allowed to be used for the 

purchase of firearms or for firearms training. 

Digital Divide.—The Committee is concerned by the impact of 

the digital divide on low-income, minority, and historically underrepresented students. For instance, a recent analysis found that 54 

percent of households in Detroit, Michigan lacked fixed broadband 

connections. Lack of access to broadband for children and families 

places significant burdens on schools and libraries to help students 

connect in order to complete coursework. To address this challenge, 

the Committee notes that LEAs may use SSAE grants to help expand broadband technology in schools as a use of funds to build 

technological capacity and infrastructure. 

Engineering Education.—The Committee is aware that among 

science, technology, engineering and mathematics (STEM) topics, 

there is a relatively limited focus on engineering education; however, engineering is important in its application of scientific and 

mathematical principles to innovation, analysis, design, evaluation, 

and manufacturing processes and systems. Therefore, the Committee is supportive of efforts by LEAs to use SSAE funds to support rigorous academic coursework or educator professional learning in engineering education programs and encourages the expansion of engineering initiatives in elementary and secondary schools 

through public-private partnerships. 

Computer Science.—The Committee notes that States and school 

districts may use funds available under the SSAE Grant Program 

to strengthen instruction in science, technology, engineering, arts, 

and mathematics (STEAM) fields, including computer science, and 

improve access to Pre-K–12 computer science and STEAM programming for underserved students, such as minorities, girls, and 

youth from families living at or below the poverty line. The Committee recognizes that supporting education in the STEAM fields, 

particularly computer science, is critical to ensuring that our nation continues to lead in innovation. As computer science is a basic 

skill in the 21st century global economy, the Committee intends for 

investments in Title IV–A to reduce the computer science enrollment and achievement gaps. 

INDIAN EDUCATION

Appropriation, fiscal year 2019 ......................................................... $180,239,000 

Budget request, fiscal year 2020 ....................................................... 176,239,000 

Committee Recommendation ............................................................. 186,374,000 

Change from enacted level ............................................................. +6,135,000 

Change from budget request .......................................................... +10,135,000 

This account supports programs authorized by part A of title VI 

of the ESEA. 

Grants to Local Educational Agencies 

The Committee recommends $105,381,000 for Grants to Local 

Educational Agencies, which is the same as the fiscal year 2019 enacted level and the fiscal year 2020 budget request. This program 

185 

provides assistance through formula grants to school districts and 

schools supported or operated by the Bureau of Indian Education. 

The purpose of this program is to improve elementary and secondary school programs that serve American Indian students, including preschool children. Grantees must develop a comprehensive 

plan and ensure that the programs they carry out will help Indian 

students reach the same challenging standards that apply to all 

students. This program supplements the regular school program to 

help American Indian children sharpen their academic skills, bolster their self-confidence, and participate in enrichment activities 

that would otherwise be unavailable. 

Special Programs for Indian Children 

The Committee recommends $67,993,000 for Special Programs 

for Indian Children, which the same as the fiscal year 2019 enacted 

level and $4,000,000 more than the fiscal year 2020 budget request. 

These programs make competitive awards to improve the quality of 

education for American Indian students. The program also funds 

the American Indian Teacher Corps and the American Indian Administrator Corps to recruit and support American Indians as 

teachers and school administrators. 

National Activities 

The Committee recommends $13,000,000 for National Activities, 

which is $6,135,000 above the fiscal year 2019 enacted level and 

the fiscal year 2020 budget request. Within this account, no less 

than $4,340,000 is provided for grants to Tribes for education administrative planning, development, and coordination, and no less 

than $4,340,000 is provided for grants to support Native language 

immersion schools and programs. Funds under this authority also 

support research, evaluation and data collection to provide information about the educational status of Indian students and the effectiveness of Indian education programs. 

INNOVATION AND IMPROVEMENT

Appropriation, fiscal year 2019 ......................................................... $1,035,556,000 

Budget request, fiscal year 2020 ....................................................... 1,107,000,000 

Committee Recommendation ............................................................. 1,223,815,000 

Change from enacted level ............................................................. +188,259,000 

Change from budget request .......................................................... +116,815,000 

The Committee recommends $1,223,815,000 for programs within 

the Innovation and Improvement account. 

Education Innovation and Research 

The Committee recommends $300,000,000 for the Education Innovation and Research program. This amount is $170,000,000 

above the fiscal year 2019 enacted level and the same as the fiscal 

year 2020 budget request. This program makes competitive grants 

to support the replication and scaling-up of evidence-based education innovations. 

Within the total for EIR, the Committee recommendation includes $170,000,000 to provide grants for evidence-based, field-initiated innovations that address student social, emotional, and cognitive needs. 

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The competition is part of the Committee’s new initiative on SEL 

interventions and ‘‘whole child’’ approaches to education. The recently released National Commission on Social, Emotional and Academic Development report chronicles decades of research showing 

‘‘that the social, emotional, and cognitive dimensions of learning 

are deeply linked’’ and that educating the whole student involves 

integrating and sustaining these dimensions throughout the day. 

In addition, a recent study by the Collaborative for Academic, Social, and Emotional Learning found that students who received 

SEL interventions showed lasting positive impacts on variables 

such as high school graduation rates and college attendance and 

lower likelihoods of being arrested or being diagnosed with a clinical mental health disorder. Further, RAND Corporation finds that 

there are at least 60 SEL interventions that have been evaluated 

and meet ESSA evidence requirements. The Committee is encouraged by the robust, growing evidence base behind SEL strategies, 

trauma-informed services, and whole child approaches to learning, 

and makes funding for these interventions a top priority. Within 90 

days of enactment of this Act, the Department is directed to brief 

the Committees on Appropriations on plans for carrying out the 

SEL competition. In addition, the Department shall provide notice 

to the Committees at least seven days before grantees are announced. 

In addition, within the total for EIR, the Committee recommendation includes $125,000,000 for States, school districts, and 

school-based afterschool programs to provide or strengthen instruction in science, technology, engineering, arts, and mathematics 

(STEAM) fields, including computer science. In particular, these 

funds must be used by the Secretary to direct additional Pre-K–12 

computer science and STEAM grants to underrepresented students 

such as minorities, girls, and youth from families living at or below 

the poverty line to help reduce the enrollment and achievement 

gap. Supporting education in STEAM fields, particularly computer 

science, is critical to ensuring that our nation continues to lead in 

innovation. As computer science is a basic skill in the 21st century 

global economy, the Committee encourages the Department to support Pre-K–12 computer science education to schools across the 

country. 

Finally, within the total for EIR, the Committee includes 

$5,000,000 for the Department to fulfill dissemination and evaluation technical assistance contracts. 

The Committee rejects the Administration’s proposal to fund professional development vouchers for teachers and directs that no 

funds are to be used for that purpose. 

Teacher and School Leader Incentive Grants 

The Committee recommends $200,000,000 for the Teacher and 

School Leader Incentive Grants program, which is the same as the 

fiscal year 2019 enacted level and the 2020 budget request. This 

program provides grants to States, school districts, and partnerships to develop, implement, improve, or expand human capital 

management systems or performance-based compensation systems 

in schools. 

187 

American History and Civics Academies 

The Committee recommends $1,815,000 for American History 

and Civics Academies, which the same as the fiscal year 2019 enacted level. The fiscal year 2020 budget request proposes to eliminate this program. 

American History and Civics National Activities 

The Committee recommends $3,000,000 for American History 

and Civics National Activities, the same as the fiscal year 2019 enacted level. The fiscal year 2020 budget request proposes to eliminate this program. 

Competitive grants under Sections 2232 and 2233 of ESEA are 

the only dedicated Federal funding for civics and American history, 

helping to spur innovation and assist underserved students. The 

Committee urges the Secretary to conduct a competition and make 

awards in a timely manner. 

Supporting Effective Educator Development 

The Committee recommends $100,000,000 for the Supporting Effective Educator Development (SEED) grant program, which is 

$25,000,000 above the fiscal year 2019 level. The fiscal year 2020 

budget request proposes to eliminate this program. SEED provides 

competitive grants to support alternative certification and other 

professional development and enrichment activities for teachers, 

principals, and other school leaders. Funds are included to fully 

support continuation costs for grants made in prior years. Within SEED, $25,000,000 is provided for a new initiative to 

support professional development that helps educators incorporate 

SEL practices into teaching, and for pathways into teaching that 

provide a strong foundation in child development and learning, including skills for implementing SEL strategies in the classroom. 

The Committee recognizes the importance of integrating SEL into 

educator professional preparation and ongoing professional support 

and provides resources to expand access to these competencies. 

Within 90 days of enactment of this Act, the Department is directed to brief the Committees on Appropriations on plans for carrying out the SEL SEED competition. In addition, the Department 

shall provide notice to the Committees at least seven days before 

grantees are announced. 

Further, the Committee directs the Department to ensure that 

SEED grants are awarded to a diverse set of eligible entities, including national non-profit organizations implementing evidencebased activities (as defined in section 8101(21)(A)(i) of ESEA) 

across a number of sites which can help bring to scale evidencebased programs of national significance across the country. 

In addition, the Committee encourages the Department of Education, through the SEED program, to fund projects that increase 

the number of teachers with computer science certifications with a 

priority to increase the number of such teachers in rural public 

schools and public schools serving high percentages of Native students. 

Charter Schools Grants 

The Committee recommends $400,000,000 for Charter School 

Program (CSP) Grants, which is $40,000,000 below the fiscal year 

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2019 enacted level and $100,000,000 below the fiscal year 2020 

budget request. The Committee recommends an allocation of funds 

within this program that aligns with ESSA. 

CSP awards grants to SEAs or, if a State’s SEA chooses not to 

participate, to charter school developers to support the development and initial implementation of public charter schools. State 

Facilities Incentive Grants and Credit Enhancement for Charter 

School Facilities awards help charter schools obtain adequate 

school facilities. These programs work in tandem to support the development and operation of charter schools. 

The Committee is concerned by a recent report by the Network for Public Education, which finds that as much as $1,000,000,000 

of CSP funds have been wasted on schools that never opened or 

precipitously closed due to mismanagement. In particular, the 

Committee is concerned by the ED–OIG September 2018 report, 

‘‘Nationwide Audit of Oversight of Closed Charter Schools,’’ which 

found that the Department did not provide effective oversight of 

processes performed by the States that receive CSP funding when 

their charter schools close. The Committee is deeply concerned that 

the Department does not intend to be a responsible steward of taxpayer dollars when it comes to CSP funding, as it has rejected the 

multiple ED–OIG audit recommendations. Therefore, the Committee directs the Department, within 180 days of the enactment 

of this Act, to implement all of the recommendations included in 

the September 2018 ED–OIG report and brief the Committees on 

Appropriations on plans for implementation within 30 days of enactment of this Act. 

The Committee notes that ESSA requires the Department to conduct regular evaluations of State entity CSP grants. ESSA took 

critical steps toward strengthening oversight of charter schools by 

requiring State entities receiving grant funds to allocate not less 

than seven percent of funding received under the program to provide technical assistance to grantees to expand, open, and prepare 

for the operation of high-quality charter schools, including by increasing charter school and authorizer quality initiatives. ESSA reinforced that a vital part of being a high-quality charter school is 

‘‘demonstrated success in increasing student academic achievement 

. . . for each of the subgroups of students, as defined in section 

1111(c)(2) (20 U.S.C. 7221i).’’ ESSA also places responsibility on 

the State entity for ensuring that all charter schools receiving 

grants ‘‘meet the educational needs of their students, including 

children with disabilities.’’ The Committee directs the Department 

to include in their evaluation of State entity Charter School grant 

programs the extent to which State entities are utilizing this seven 

percent to ensure that charter schools receiving CSP grants are 

equipped to appropriately serve students with disabilities and, by 

extension, prepared to become high-quality charter schools. Further, the Committee directs the Department to include a summary 

of its findings in its fiscal year 2021 Congressional Budget Justification. 

In addition, the Committee notes widespread findings of waste 

and abuse in the for-profit virtual charter school sector and directs 

the Department to provide the Committees on Appropriations, 

within 180 days of enactment of this Act, the amount of CSP funding this sector received between fiscal years 2014 through fiscal 

189 

year 2019. In addition, the Department shall provide the total 

funding for all of the agency’s programs that goes to for-profit, virtual charter schools. 

Magnet Schools Assistance 

The Committee recommends $125,000,000 for the Magnet Schools Assistance program, which is $18,000,000 more than the 

fiscal year 2019 enacted level and the fiscal year 2020 budget request. This program makes competitive grants to support the establishment and operation of magnet schools that are a part of a 

court-ordered or Federally-approved voluntary desegregation plan. 

This year marks the 65th anniversary of the Supreme Court’s 

landmark ruling in Brown v. Board that declared separate but 

equal public schools to be unconstitutional. Yet according to a 2016 

GAO audit, public education is more segregated by race and class 

than at any time since 1960. The Committee is concerned by the 

resegregation of public schools and believes that the 2015 enactment of ESSA presents a valuable opportunity to support State and 

school district efforts to improve student diversity as a means of 

achieving equity of educational opportunity. Further, the evidence 

base in support of increasing student diversity as a means of school 

improvement is extensive, which is why the Committee supports 

the Magnet School Assistance program. 

The Committee recognized a longstanding barrier to the implementation of this work in the Department of Education Appropriations Act, 2019 when it removed two decades-old prohibitions on 

the use of federal funds for transportation costs to carry out school 

desegregation efforts. However, the Committee recognizes that barriers to this work persist due to Section 426 of the General Education Provisions Act. Therefore, the Committee urges the Secretary to work with Congress to rid the federal code of this outdated prohibition. 

Ready to Learn Programming 

The Committee recommends $30,000,000 for Ready to Learn Programming, which is $2,259,000 more than the fiscal year 2019 enacted level. The fiscal year 2020 budget request proposes to eliminate this program. This program supports the development and 

distribution of educational video programming for preschool and elementary school children and their parents, caregivers, and teachers. 

The Ready to Learn program’s broadcast mission remains vital, 

particularly for children in rural and low-income communities 

where access to broadband internet is often sparse or non-existent. 

For the program’s fiscal year 2020 grant competition, the Committee expects the Department to issue a Notice Inviting Applications as early in fiscal year 2020 as possible. The Committee is 

strongly supportive of programming specially designed for nationwide distribution over public television stations’ digital broadcasting channels. 

Arts in Education 

The Committee recommends $35,000,000 for Arts in Education, 

which is $6,000,000 more than the fiscal year 2019 level. The fiscal 

year 2020 budget request proposes to eliminate this program. This 

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program provides competitive grants to support professional development and the development of instructional materials and programming that integrate the arts into the curricula. 

Javits Gifted and Talented Education 

The Committee recommends $14,000,000 for the Javits Gifted 

and Talented Education Program, which is $2,000,000 more than 

the fiscal year 2019 enacted level. The fiscal year 2020 budget request proposes to eliminate this program. Funds are awarded 

through grants and contracts to States, schools districts, and other 

organizations to support a coordinated program of research, demonstration projects, innovative strategies, and other activities to 

help schools identify gifted and talented students and address their 

unique educational needs. 

The Committee encourages the Department to use funds to increase the number of grants that assist schools in the identification 

of, and provision of services to, gifted and talented students who 

may not be identified and served through traditional assessment 

methods, such as children with disabilities, English learners, children of color, and economically disadvantaged students. 

Statewide Family Engagement Centers 

The Committee recommends $15,000,000 for Statewide Family 

Engagement Center grants, which is $5,000,000 above fiscal year 

2019 enacted level. The fiscal year 2020 budget request proposes to 

eliminate the program. Funds are awarded through grants to organizations to provide technical assistance and training to State and 

local educational agencies in the implementation and enhancement 

of systemic and effective family engagement policies, programs, and 

activities that lead to improvements in student development and 

academic achievement. 

SAFE SCHOOLS AND CITIZENSHIP EDUCATION

Appropriation, fiscal year 2019 ......................................................... $190,754,000 

Budget request, fiscal year 2020 ....................................................... 200,000,000 

Committee Recommendation ............................................................. 240,000,000 

Change from enacted level ............................................................. +49,246,000 

Change from budget request .......................................................... +40,000,000 

The Committee recommends a total of $240,000,000 for activities 

to promote safe schools, healthy students, and citizenship education, which is $49,246,000 over the fiscal year 2019 enacted level 

and $40,000,000 over the fiscal year 2020 budget request. 

Promise Neighborhoods 

The Committee recommends $80,000,000 for Promise Neighborhoods, which is $1,746,000 more than the fiscal year 2019 enacted 

level. The fiscal year 2020 budget request proposes to eliminate 

this program. Promise Neighborhoods supports grants to nonprofit, 

community-based organizations for the development of comprehensive neighborhood programs designed to combat the effects of poverty and improve educational outcomes for children and youth, 

from birth through college. 

191 

School Safety National Activities 

The Committee recommends $120,000,000 for School Safety National Activities, $25,000,000 above the fiscal year 2019 enacted 

level, and $80,000,000 less than the fiscal year 2020 budget request. The Committee’s recommendation provides up to 

$10,000,000 for the Project School Emergency Response to Violence 

(Project SERV) program. 

Within School Safety National Activities, the Committee includes 

sufficient funding to continue a demonstration program initiated in 

fiscal year 2019 to test and evaluate innovative partnerships between institutions of higher education and States or high-need local 

educational agencies to train school counselors, social workers, psychologists, or other mental health professionals qualified to provide 

school-based mental health services, with the goal of expanding the 

pipeline of these workers into low-income public elementary schools 

and secondary schools in order to address the shortages of mental 

health service professionals in such schools. 

The Committee supports efforts to train school-based mental 

health professionals; however, more must be done to directly increase the number of well-trained mental health professionals in 

school districts across the country. Research shows that building 

the capacity of students to develop social and emotional skills, and 

take responsibility for their community, can reduce bullying, violence, and aggressive behaviors, making schools safer. Increasing 

the number of qualified mental health professionals in schools is 

central to this work. With the goal of immediately addressing this 

urgent national need, the Committee directs the Secretary to provide no less than $25,000,000 in awards to SEAs, LEAs, or consortia of LEAs to increase the number of well-trained school counselors, social workers, psychologists, or other mental health professionals qualified to provide school-based mental health services. 

This competition, which would expand the number of mental 

health and child development experts in schools, is part of the 

Committee’s new initiative to provide resources for SEL. To promote the sustainability of these services, the Secretary shall require that awards include a 25 percent match from grantees and 

require that the awards do not supplant existing mental health 

funding. Within 90 days of enactment of this Act, the Department 

is directed to brief the Committees on Appropriations on plans for 

carrying out the competition. In addition, the Department shall 

provide notice to the Committees at least seven days before grantees are announced. 

The Project SERV program provides counseling and referral to 

mental health services as well as other education-related services 

to LEAs and IHEs in which the learning environment has been disrupted by a violent or traumatic crisis. The Committee directs the 

Department to report to the Committees on Appropriations within 

180 days of enactment of this Act on how fiscal years 2017, 2018, 

and 2019 grant recipients used Project SERV funds; recommendations from grant recipients on how the program could be improved; 

and, information on how these funds helped them recover from a 

violent or traumatic crisis. The Department shall brief the Committees within 30 days of enactment of this Act on how it plans to 

carry out this directive. 

192 

The Committee is disappointed that the Department issued a 

Federal School Safety Commission Report about how to prevent 

school shootings that failed to look at the role of our nation’s permissive gun laws. Further, the Committee is dismayed that the Department relied on racially-biased conclusions to justify the rescission of the 2014 ‘‘Rethink School Discipline’’ guidance. The Committee directs the Department, within 30 days of enactment of this 

Act, to remove references to the report entitled: ‘‘Prior problem behavior accounts for the racial gap in school suspensions’’ from all 

materials on the Department’s website, guidance, or reports. Furthermore, the Committee directs the Department to reconsider the 

rescission of this guidance. 

Full-Service Community Schools 

The Committee recommends $40,000,000 for Full-Service Community Schools, which is $22,500,000 more than the fiscal year 

2019 level. The fiscal year 2020 budget request proposes to eliminate this program. This program makes competitive grants to support school-based comprehensive services for students, families, 

and communities. The Full-Service Community Schools program, 

which supports evidence-based models to meet the holistic needs of 

children and families, is part of the Committee’s new initiative to 

provide resources for SEL. The Committee is also encouraged by 

research that shows comprehensive community schools as a strategy that can improve educational quality and equity for students 

from diverse backgrounds. Therefore, the Committee urges the Department to provide technical assistance to SEAs and LEAs that 

are interested in leveraging Full-Service Community Schools 

grants to meet local school improvement needs. 

ENGLISH LANGUAGE ACQUISITION

Appropriation, fiscal year 2019 ......................................................... $737,400,000 

Budget request, fiscal year 2020 ....................................................... 737,400,000 

Committee Recommendation ............................................................. 980,400,000 

Change from enacted level ............................................................. +242,600,000 

Change from budget request .......................................................... +242,600,000 

This program provides formula grants to States to serve Limited 

English Proficient (LEP) students. Grants are based on each State’s 

share of the National LEP students and recent immigrant student 

population. Funds under this account also support professional development to increase the pool of teachers prepared to serve LEP 

students as well as evaluation activities. 

The Committee recommends $980,000,000 for English Language Acquisition in fiscal year 2020, a historic increase of $242,600,000 

over both the fiscal year 2019 enacted level and the fiscal year 

2020 budget request. Federal data shows that significant achievement gaps exist between English learners (ELs) and their peers; 

however, the funding to support these students has been flat for 

many years. This comes at a time when many States and school 

districts have experienced rapid growth in their EL populations. 

Providing increased resources to improve educational quality for 

EL students is a top priority for the Committee. 

The Committee is aware that the statutory formula used to make 

English Language Acquisition allotments to States, set forth in 

Section 3111(c) of ESEA, does not fully capture children and youth 

193 

who relocate from the U.S. territory of Puerto Rico, where Spanish 

is the primary language of instruction, to one of the 50 States or 

the District of Columbia. The Committee recommended funding is 

intended to help in addressing this need. 

SPECIAL EDUCATION

Appropriation, fiscal year 2019 ......................................................... $13,468,728,000 

Budget request, fiscal year 2020 ....................................................... 13,451,145,000 

Committee Recommendation ............................................................. 14,523,544,000 

Change from enacted level ............................................................. +1,054,816,000 

Change from budget request .......................................................... +1,072,399,000 

Of the total amount available, $4,975,709,000 is available for obligation on July 1, 2020, and $9,283,383,000 is available for obligation on October 1, 2020. These grants help States and localities pay 

for a free appropriate education for students with disabilities aged 

3 through 21. 

Grants to States 

This program provides formula grants to assist States in meeting 

the costs of providing special education and related services to children with disabilities. States generally transfer most of the funds 

to LEAs; however, they can reserve some funds for program monitoring, technical assistance, and other related activities. In order to 

be eligible for funds, States must make free appropriate public education available to all children with disabilities. 

The Committee recommends $13,364,392,000 for Part B Grants 

to States, which is $1,000,000,000 above the fiscal year 2019 enacted level and the fiscal year 2020 budget request, reflecting the 

largest increase to the program in more than a decade. The Committee is concerned that the federal share of the excess cost of educating students with disabilities has declined and notes the critical 

role this increase will play in helping to reverse this trend. 

In March 2019, the courts ruled that the Department’s delay of 

the 2016 Significant Disproportionality rule, which requires States 

to address racial disparities and discrimination in special education 

programs, was arbitrary and capricious, and thus illegal. The Committee is deeply concerned that the Department has not communicated to stakeholders or Congress how it is enforcing the rule, 

per the recent court decision. Therefore, within 30 days of enactment of this Act, the Committee directs the Department to submit 

a report to the Committees on Appropriations, the House Committee on Education and Labor, and the Senate Committee on 

Health, Education, Labor, and Pensions on how it is implementing 

the 2016 Significant Disproportionality rule. The report shall include which data the Department is collecting to ensure compliance 

and all detailed guidance provided by the Department to help 

States comply with provisions of the regulation. The Committee 

notes that its SEL initiative, as described in the School Improvement Programs, Innovation and Research, and Safe Schools and 

Citizenship Education accounts, aims to provide schools, school districts, and States with critical tools so that they can support all 

students and prevent misidentification. 

The Committee includes new bill language, as requested in the 

fiscal year 2020 budget request, that permits States to subgrant 

funds that they reserve under section 611(e)(2) of the IDEA to more 

194 

efficiently carry out authorized State-level activities. The Committee continues to include bill language excluding any amount by 

which a State’s allocation is reduced for failure to meet the maintenance of effort threshold from being used to calculate the State’s 

allocation under section 611(d) of the (IDEA) in subsequent years. 

The Committee also continues to include bill language directing the 

Secretary to distribute any reduction in a State’s allocation under 

said section to all other States based on the formula established 

under section 611(d), excluding those States that are penalized. 

Preschool Grants 

The Committee recommends $403,400,000 for Preschool Grants, 

which is $12,280,000 above the fiscal year 2019 enacted level and 

the fiscal year 2020 budget request. These funds provide additional 

assistance to States to help them make free, appropriate public 

education available to children with disabilities ages 3 through 5. 

Grants for Infants and Families 

The Committee recommends $491,300,000 for Grants for Infants 

and Families, which is $21,300,000 more than the fiscal year 2019 

enacted level and the fiscal year 2020 budget request. These funds 

provide additional assistance to States to help them make free, appropriate public education available to children with disabilities 

from birth through age 2. The Committee includes new bill language, as requested in the fiscal year 2020 budget request, to resolve implementation challenges related to funding for State Incentive Grants, a program that offers States the flexibility to expand 

services for children with disabilities beyond age 3. 

IDEA National Activities 

The Committee recommends $264,452,000 for the IDEA National 

Activities program, which is $21,236,000 above the fiscal year 2019 

enacted level and $38,819,000 above the fiscal year 2020 budget request. The IDEA National Activities programs support State efforts 

to improve early intervention and education results for children 

with disabilities. 

Educational Technology, Media, and Materials.—The Committee 

recommends $30,047,000 for Educational Technology, Media, and 

Materials, which is $2,000,000 more than the fiscal year 2019 enacted level and the fiscal year 2020 budget request. This program 

makes competitive awards to support the development, demonstration, and use of technology and educational media activities of educational value to children with disabilities. 

Parent Information Centers.—The Committee recommends 

$30,000,000 for Parent Information Centers, which is $2,589,000 

more than fiscal year 2019 enacted level and the fiscal year 2020 

budget request. 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. Technical assistance is also provided 

under this program for developing, assisting, and coordinating centers receiving assistance under this program. The Committee acVerDate Sep 11 2014 06:50 May 16, 2019 Jkt 036295 PO 00000 Frm 00198 Fmt 6659 Sfmt 6602 E:\HR\OC\HR062.XXX HR062
195 

knowledges States with significant rural areas can be harder to engage due to distance barriers and encourages the Department to 

assist with their efforts to support parents of children with disabilities. 

Personnel Preparation.—The Committee recommends 

$98,310,000 for Personnel Preparation, which is $11,110,000 above 

both the fiscal year 2019 enacted level and the fiscal year 2020 

budget request. This program supports competitive awards to help 

address State-identified needs for qualified personnel to work with 

children with disabilities, and to ensure that those personnel have 

the necessary skills and knowledge to serve children with special 

needs. Awards focus on addressing the need for leadership and personnel to serve low-incidence populations. Funds are included to 

fully support continuation costs for grants made in prior years. The 

Committee notes the critical role the Personnel Preparation program plays in helping to address the nation’s shortage of teachers 

for students with disabilities. 

State Personnel Development.—The Committee recommends 

$40,630,000 for State Personnel Development, which is $2,000,000 

more than the fiscal year 2019 enacted level and the fiscal year 

2020 budget request. This program supports grants to States to assist with improving personnel preparation and professional development related to early intervention and educational and transition 

services that improve outcomes for students with disabilities. 

Funds are included to fully support continuation costs for grants 

made in prior years. 

Technical Assistance and Dissemination.—The Committee recommends $65,465,000 for Technical Assistance and Dissemination, 

which is $3,537,000 above the fiscal year 2019 enacted level and 

$21,120,000 above the 2020 budget request. The increase over fiscal year 2019 is provided for the Special Olympics education programs, as authorized by the Special Olympics Sport and Empowerment Act of 2004, for which the Committee recommends a funding 

level of $21,120,000. The fiscal year 2020 budget request proposes 

to eliminate Special Olympics. The other programs within Technical Assistance and Dissemination provide funding for technical 

assistance, demonstration projects, and information dissemination. 

These funds support efforts by State and local educational agencies, IHEs, and other entities to build State and local capacity to 

make systemic changes and improve results for children with disabilities. Funds are included to fully support continuation costs for 

grants made in prior years. 

Outlying Areas and Freely Associated States.—The Committee is 

aware that the Outlying Areas (OA) and Freely Associated States 

(FAS) may experience significant challenges in funding the excess 

cost of educating students with disabilities. Therefore, the Committee directs the Department to explore how it could better support OA and FAS students with disabilities, including a consideration of how secretarial discretion is used to determine OA and 

FAS allocations. The Department shall update the Committee on 

its findings, along with data on OA and FAS allocations in the fiscal year 2021 Congressional Justification. 

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REHABILITATION SERVICES

Appropriation, fiscal year 2019 ......................................................... $3,657,189,000 

Budget request, fiscal year 2020 ....................................................... 3,719,527,000 

Committee Recommendation ............................................................. 3,752,076,000 

Change from enacted level ............................................................. +94,887,000 

Change from budget request .......................................................... +32,549,000 

The programs in this account are authorized by the Rehabilitation Act of 1973 and the Helen Keller National Center Act. 

Vocational Rehabilitation State Grants 

The Committee recommends $3,610,040,000 in mandatory funding for Vocational Rehabilitation (VR) State Grants, which is 

$88,050,000 above the fiscal year 2019 enacted level and the same 

as the fiscal year 2020 budget request. 

This program supports basic vocational rehabilitation services 

through formula grants to States. These grants support a wide 

range of services designed to help persons with physical and mental disabilities prepare for and engage in gainful employment to the 

extent of their capabilities. Emphasis is placed on providing vocational rehabilitation services to persons with the most significant 

disabilities. The Committee’s recommendation provides the cost-ofliving adjustment for Vocational Rehabilitation Grants to States, as 

authorized. 

Client Assistance State Grants 

The Committee recommends $15,000,000 for Client Assistance 

State Grants, which is $2,000,000 more than the fiscal year 2019 

enacted level and the fiscal year 2020 budget request. Client Assistance State Grants support services for eligible individuals and 

applicants of the VR State Grants program, and other programs, 

projects, and services funded under the Rehabilitation Act. These 

formula grants are used to help persons with disabilities overcome 

problems with the service delivery system and improve their understanding of services available to them under the Rehabilitation Act. 

Training 

The Committee recommends $30,188,000 for the Training program, which is $800,000 more than the fiscal year 2019 enacted 

level and the fiscal year 2020 budget request. The program supports long-term and short-term training, in-service personnel training, and training of interpreters for deaf persons. Projects in a 

broad array of disciplines are funded to ensure that skilled personnel are available to serve the vocational needs of persons with 

disabilities. Funds are included to fully support continuation costs 

for grants made in prior years. 

Demonstration and Training Programs 

The Committee recommends $7,333,000 for Demonstration and 

Training Programs, which is $1,537,000 more than the fiscal year 

2019 enacted level and the fiscal year 2020 budget request. 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. The Committee recommendation includes no less than the 

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fiscal year 2019 enacted level for parent information and training 

programs. 

Protection and Advocacy of Individual Rights 

The Committee recommends $17,650,000 for Protection and Advocacy of Individual Rights, which is the same as both the fiscal 

year 2019 enacted level and the fiscal year 2020 budget request. 

Grants are awarded to entities that have the authority to pursue 

legal, administrative, and other appropriate remedies to protect 

and advocate for the rights of persons with disabilities. 

Supported Employment State Grants 

The Committee recommends $22,548,000 for Supported Employment State Grants, which is the same as the fiscal year 2019 enacted level. The fiscal year 2020 budget request proposes to eliminate this program. These formula grants assist States in developing collaborative programs with public agencies and nonprofit 

agencies for training and post-employment services leading to supported employment. In supported employment programs, persons 

with the most significant disabilities are given special supervision 

and assistance to enable them to work in an integrated settings. 

Independent Living Services for Older Individuals Who Are Blind 

The Committee recommends $33,317,000 for Independent Living 

Services for Older Individuals Who Are Blind, which is the same 

as both the fiscal year 2019 enacted level and the fiscal year 2020 

budget request. Funds are distributed to States according to a formula based on the population of individuals who are 55 or older 

and provide support for services to persons 55 years old or over, 

whose severe visual impairment makes gainful employment extremely difficult to obtain, but for whom independent living goals 

are feasible. 

Helen Keller National Center 

The Committee recommends $16,000,000 for the Helen Keller 

National Center for Deaf-Blind Youth and Adults, which is 

$2,500,000 above the fiscal year 2019 enacted level and $5,664,000 

above the fiscal year 2020 budget request. These funds are used for 

the operation of a national center that provides intensive services 

for deaf-blind individuals and their families at Sands Point, New 

York, and a network of ten regional offices that provide referral, 

counseling, transition services, and technical assistance to service 

providers. 

SPECIAL INSTITUTIONS FOR PERSONS WITH DISABILITIES

Appropriation, fiscal year 2019 ......................................................... $242,292,000 

Budget request, fiscal year 2020 ....................................................... 216,722,000 

Committee Recommendation ............................................................. 257,361,000 

Change from enacted level ............................................................. +15,069,000 

Change from budget request .......................................................... +40,639,000 

The Committee recommends $257,361,000 for Special Institutions for Persons with Disabilities, which is $15,069,000 above the 

fiscal year 2019 enacted level and $40,639,000 above the fiscal year 

2020 budget request. 

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AMERICAN PRINTING HOUSE FOR THE BLIND

Appropriation, fiscal year 2019 ......................................................... $30,431,000 

Budget request, fiscal year 2020 ....................................................... 25,431,000 

Committee Recommendation ............................................................. 39,000,000 

Change from enacted level ............................................................. +8,569,000 

Change from budget request .......................................................... +13,569,000 

This funding subsidizes the production of educational materials 

for legally blind persons enrolled in pre-college programs. The 

American Printing House for the Blind (Printing House), which is 

chartered by the Commonwealth of Kentucky, manufactures and 

maintains an inventory of educational materials in accessible formats that are distributed free of charge to schools and States based 

on the number of blind students in each State. The Printing House 

also conducts research and field activities to inform educators 

about the availability of materials and how to use them. 

The Committee commends the Printing House for ensuring that 

students who are blind and visually impaired are able to benefit 

from the latest educational technologies. The Committee intends 

the recommended increase to assist in increasing the per-pupil expenditure. 

NATIONAL TECHNICAL INSTITUTE FOR THE DEAF

Appropriation, fiscal year 2019 ......................................................... $77,500,000 

Budget request, fiscal year 2020 ....................................................... 70,016,000 

Committee Recommendation ............................................................. 80,000,000 

Change from enacted level ............................................................. +2,500,000 

Change from budget request .......................................................... +9,984,000 

Congress established the National Technical Institute for the 

Deaf (Institute) in 1965 to provide a residential facility for postsecondary technical training and education for deaf persons with the 

purpose of promoting the employment of these individuals. The Institute also conducts applied research and provides training related 

to various aspects of deafness. The Secretary of Education administers these activities through a contract with the Rochester Institute of Technology in Rochester, New York. 

GALLAUDET UNIVERSITY

Appropriation, fiscal year 2019 ......................................................... $134,361,000 

Budget request, fiscal year 2020 ....................................................... 121,275,000 

Committee Recommendation ............................................................. 138,361,000 

Change from enacted level ............................................................. +4,000,000 

Change from budget request .......................................................... +17,086,000 

Gallaudet is a private, non-profit educational institution Federally chartered in 1864 providing elementary, secondary, undergraduate, and continuing education for deaf persons. In addition, 

the University offers graduate programs in fields related to deafness for deaf and hearing students, conducts research on deafness, 

and provides public service programs for deaf persons. 

CAREER, TECHNICAL, AND ADULT EDUCATION

Appropriation, fiscal year 2019 ......................................................... $1,925,686,000 

Budget request, fiscal year 2020 ....................................................... 1,842,159,000 

Committee Recommendation ............................................................. 2,003,133,000 

Change from enacted level ............................................................. +77,447,000 

Change from budget request .......................................................... +160,974,000 

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This account includes vocational education programs authorized 

by the Carl D. Perkins Career and Technical Education Act of 

2006, as recently reauthorized by the Strengthening Career and 

Technical Education for the 21st Century Act, and the Adult Education and Family Literacy Act (AEFLA). 

Career and Technical Education: State Grants 

The Committee recommends $1,310,000,000 for Career and Technical Education (CTE) State Grants, which is $47,402,000 above 

the fiscal year 2019 enacted level and the fiscal year 2020 budget 

request. Of these funds, $519,000,000 will become available on July 

1, 2020, and $791,000,000 will become available for obligation on 

October 1, 2020. 

State Grants support a variety of career and technical education 

programs developed in accordance with the State plan. This program focuses Federal resources on institutions with high concentrations of low-income students. The populations assisted by State 

Grants range from secondary students in prevocational courses to 

adults who need retraining to adapt to changing technological and 

labor markets. Funding for State Grants will continue support for 

state-of-the-art career and technical training to students in secondary schools and community and technical colleges. 

National Programs 

The Committee recommends $7,421,000 for National Programs, 

which is the same as the fiscal year 2019 enacted level and 

$12,579,000 less than the fiscal year 2020 budget request. In keeping with the purpose of the National Programs, the Committee recommendation includes sufficient funding to support the conduct 

and dissemination of research in career and technical education. 

Cybersecurity 

The Committee recognizes the cybersecurity threats facing our 

nation’s critical infrastructure sectors and the need for workers in 

these industries, including those who operate cyber physical systems, to be equipped with skills to keep systems secure. The Committee acknowledges that many of these operators are educated 

through CTE programs that prominently feature a culture of physical safety but do not incorporate cybersecurity skills. Therefore, 

the Committee encourages the Secretary to explore opportunities to 

support CTE programs that integrate cybersecurity into curricula 

used by students preparing for careers in critical infrastructure 

sectors. 

Adult Basic and Literacy Education State Grants 

The Committee recommends $672,000,000 for Adult Basic and 

Literacy Education State Grants, which is $30,045,000 more than 

the fiscal year 2019 enacted level and $186,151,000 above the fiscal 

year 2020 budget request. State formula-grants, authorized under 

the AEFLA, support programs to enable all adults to acquire basic 

literacy skills, to enable those who so desire to complete secondary 

education, and to make available to adults the means to become 

more employable, productive, and responsible citizens. 

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Adult Education National Leadership Activities 

The Committee recommends $13,712,000 for National Leadership 

Activities, which is the same as the fiscal year 2019 enacted level 

and $60,000,000 below the fiscal year 2020 budget request. This 

program supports applied research, development, dissemination, 

evaluation, and program improvement efforts to strengthen the 

quality of adult education services. The Committee recommendation does not include language or funding, as requested in the 

budget request, to support a new pre-apprenticeship grants initiative. It is unclear whether these programs would articulate to registered apprenticeship programs or another untested, low-quality 

apprenticeship model. 

STUDENT FINANCIAL ASSISTANCE

Appropriation, fiscal year 2019 ......................................................... $24,445,352,000 

Budget request, fiscal year 2020 ....................................................... 22,975,352,000 

Committee Recommendation ............................................................. 24,937,352,000 

Change from enacted level ............................................................. +492,000,000 

Change from budget request .......................................................... +1,962,000,000 

Pell Grants 

The Committee recommends $22,475,352,000 in discretionary 

funding for the Pell Grant program, which is the same as both the 

fiscal year 2019 enacted level and the fiscal year 2020 budget request. These funds will support Pell grants to students for the 

2020–2021 academic year. 

Combined with mandatory funding streams, the Committee recommendation supports a maximum Pell Grant in academic year 

2020–2021 of $6,345, a $150 increase over fiscal year 2019 and the 

fiscal year 2020 budget request to help the award keep up with inflation. 

Pell Grants help to ensure access to educational and economic 

opportunities for low- and middle-income students by providing 

need-based financial assistance. Grants are determined according 

to a statutory formula, which considers income, assets, household 

size, and the number of family members in college, among other 

factors. Pell Grants are the foundation of Federal postsecondary 

student aid programs. 

The Committee recognizes the importance of programs that support Pell-eligible community college students and offer non-academic support services, including comprehensive case management 

and strategic emergency financial assistance, to help them complete their education. The Committee encourages the Department 

to look for opportunities to support these types of programs and requests an update in the fiscal year 2021 Congressional Budget Justification on options available to provide support services for these 

students. 

The Committee is deeply concerned about high recidivism rates 

and a shortage of postsecondary education opportunities for low-income, incarcerated individuals in the U.S. Since 1994, States have 

been forced to reduce or permanently remove postsecondary correctional education programs. According to the American Correctional 

Association, States offering such postsecondary correctional education programs dropped from 37 in 1994 to only 12 in 2015. This 

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is particularly troubling as our nation’s federal prison population 

has increased by nearly 50 percent over the same period. 

The Committee recognizes that access to postsecondary correctional education programs significantly reduces recidivism, helps 

break down racial barriers that are a common cause of disciplinary 

problems in the prison system, and increases access to employment 

for individuals who have been incarcerated. The Committee supports the work of the Department’s Second Chance Pell Experiment, which is testing how expanding access to financial aid improves outcomes for individuals who are incarcerated. The Committee encourages the Department to continue the experiment and 

directs the Department to conduct a rigorous evaluation of the Second Chance Pell Experiment, so that Congress and stakeholders 

may examine the benefits of providing members of society a second 

chance through the Pell Grant program. To that end, the Committee recommendation includes up to $2,000,000 within the Research, Development and Dissemination program at the Institute of 

Education Sciences (IES) solely for the rigorous evaluation of the 

Second Chance Pell Experiment as announced in the Federal Register (Volume 80, Number 148 on Monday, August 3, 2015). The 

Committee directs the Department’s Policy and Program Studies 

Service to work with IES on this effort. 

Federal Supplemental Educational Opportunity Grants 

The Committee recommends $1,028,000,000 for this program, which is $188,000,000 more than the fiscal year 2019 enacted level. 

The fiscal year 2020 budget request proposes to eliminate this program. 

Supplemental Educational Opportunity Grants (SEOG) provide 

funds to postsecondary institutions for need-based grants of up to 

$4,000 to undergraduate students, with priority given to students 

who are Pell-eligible. Approximately 68 percent of dependent recipients have annual family incomes under $30,000 and nearly 71 

percent of independent SEOG recipients have annual family incomes under $20,000. Institutions must contribute a 25 percent 

match toward their SEOG allocation. 

Federal Work-Study 

The Committee recommends $1,434,000,000 for the Federal 

Work-Study program, which is $304,000,000 more than the fiscal 

year 2019 enacted level and $934,000,000 above the fiscal year 

2020 budget request. 

Federal Work-Study funds are provided through institutions to 

students who work part-time. The funds assist with paying for the 

cost of education. Approximately 3,200 colleges and universities receive funding, according to a statutory formula, and may allocate 

it for job location and job development centers. Work-study jobs 

must pay at least the Federal minimum wage and institutions 

must provide 25 percent of student earnings. 

The Committee recommendation continues funding for the Work 

Colleges program, which supports institutions that require all resident students to participate in a work-learning program. 

While the Federal Work-Study program currently requires participating institutions to set aside seven percent of funding for community service-based employment opportunities, the Committee is 

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aware that some institutions of higher education are not adequately informing their students about community service-based 

opportunities, nor making use of employment opportunities in this 

sector. The Committee encourages the Department to work with institutions of higher education to ensure that schools are providing 

this information to students and that community service jobs provide experiential education and college-credit for students preparing for careers working with community-based organizations in 

low- and middle-income communities. The Committee also encourages the Department to increase the number and scope of learning 

partnerships between community-based nonprofits, community 

and/or four-year colleges and other programs that offer educational 

pathways to careers in community organizing and community 

change, especially for first generation college students. 

Resources for First Generation College Students.—First generation students comprise nearly a third of all college students, yet 

there is a lack of dedicated support services to ensure successful 

outcomes for such students. Given the Department’s vested interest 

in ensuring successful outcomes for first generation students, the 

Committee directs the Department to provide a report to the Committees on Appropriations, within 180 days of enactment of this 

Act, on improving the effectiveness of current federal policy in supporting first generation students. 

For-Profit Colleges.—On March 12, 2019, the Subcommittee on 

Labor-HHS-Education-Related Agencies held an oversight hearing 

on predatory for-profit colleges. For-profit colleges receive nearly 14 

percent of all Pell Grant funding, and while accounting for only 9 

percent of all students enrolled in postsecondary education, they 

account for more than a third of all defaults. A 2012 Senate Committee on Health, Education, Labor and Pensions for-profit college 

investigation uncovered internal recruiting documents from institutions, including lists of who they targeted, such as ‘‘welfare moms 

with kids,’’ ‘‘pregnant ladies,’’ ‘‘military-active and retired,’’ those 

who ‘‘experienced a recent death’’ and those who were ‘‘physically/ 

mentally abused,’’ among other groups. Another document the investigation uncovered was a ‘‘pain funnel’’ that was used to train 

employees on techniques to wear down prospective students and coerce them into enrolling into their institutions. 

During the Subcommittee’s oversight hearing, a disabled veteran 

testified that a for-profit college assured him that he would not 

take out any student loans to enroll and would only use grant aid 

and GI Bill benefits to attend; however, he came to find out that 

he now owes approximately $100,000 in student loan debt and was 

unable to find employment in his field of study after graduating 

the for-profit institution. 

For-profit colleges prey on servicemembers and veterans with aggressive marketing and recruiting because of a loophole that allows 

for-profit colleges to exclude from the cap on federally derived institutional revenue any federal aid and educational benefits from 

sources other than the Department of Education. In addition, a recent study of for-profit institutions receiving GI Bill benefits found 

that these institutions spend little of their revenue on academic instruction, with the leading recipients spending fifteen percent or 

less of their revenue on instruction. The Committee directs the Secretary to submit a report to the Committees on Appropriations, 

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within 90 days of enactment of this Act, providing an analysis of 

all for-profit institutions who would exceed the 90/10 federal funding limits if revenue from the VA and DoD were included in the 

90/10 calculation, the same way that Title IV funds are included 

for the most recent academic year. In addition, the report should 

also include all schools that receive between 85 percent or more of 

their revenue from Title IV, VA and DoD sources in the most recent academic year. 

In addition, the Committee is deeply concerned with the Secretary’s efforts to undermine regulations designed to protect students and taxpayers, such as the Gainful Employment and Borrower Defense to Repayment regulations. While a Federal court determined that the Department illegally delayed implementation of 

the Borrower Defense to Repayment rule, the Committee is troubled by the Department’s failure to provide relief to students who 

were misled and defrauded by their respective institutions. 

To ensure implementation of the regulation and to provide sufficient oversight, the Committee directs the Secretary to update the 

Borrower Defense to Repayment Report on FSA’s Data Center on 

a monthly basis, beginning no later than 30 days after enactment 

of this Act. The Committee also directs the Secretary to submit a 

report to the Committees on Appropriations, within 60 days of enactment of this Act, providing the number of claims and the total 

amount of the loans covered by those claims by school and institutional type. 

Furthermore, the Committee is concerned with the Department’s 

failure to act in the face of precipitous school closures or to mitigate the resulting harm to students. While the Department has 

many tools at its disposal to prevent such closures (e.g., Heightened Cash Monitoring, letters of credit, pre-acquisition reviews, the 

denial of tax status conversions), it has made inadequate use of 

these tools. The Department failed to prevent the Dream Center 

Education Holdings’ (DCEH) acquisition of Argosy University and 

the Art Institutes, resulting in the loss of approximately 

$16,000,000 in federal student aid, shuttered campuses, and harm 

to students. It failed to protect taxpayers by returning a portion of 

a letter of credit for the continued operation of an institution that 

still shut its doors on students and their educational pursuits, and 

it failed to protect students when it did not require a teach-out 

agreement for every school covered by the DCEH acquisition but 

still permitted continued access to taxpayer funding for these 

schools. 

To correct these errors, the Committee directs the Department to 

submit a report to the Committees on Appropriations, within 90 

days of enactment of this Act, outlining its plan to prevent precipitous closures in the for-profit sector. In addition, the Committee directs the Department to publish, on FSA’s Data Center, the list of 

schools with a letter of credit in fiscal years 2017 through 2019. 

The Committee also directs the Department to issue a report to the 

Committees on Appropriations, within 90 days of enactment of this 

Act, outlining the process through which it approves or disapproves 

of a for-profit institution’s conversion to not-for-profit status and a 

list of any staff involved in such decisions. The report must also include all institutions of higher education that have changed their 

for-profit status in the past three fiscal years and any action the 

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Department has made with respect to those institutions. The Committee directs the Department to begin, within 90 days of enactment of this Act, maintaining a list of for-profit institution conversions on FSA’s Data Center and to update that list on a quarterly 

basis. 

FEDERAL DIRECT STUDENT LOAN PROGRAM ACCOUNT

The Committee recommendation includes $350,000,000 for the 

Federal Direct Student Loan Program Account program (also 

known as Temporary Expanded Public Service Loan Forgiveness or 

TEPSLF). Congress created the Public Service Loan Forgiveness 

(PSLF) program in 2007 to provide relief to borrowers pursuing careers in public service. After making 120 qualifying payments, the 

equivalent of ten years, borrowers first became eligible for forgiveness under the program in 2017. While 53,749 borrowers believed 

they qualified for forgiveness and submitted applications, as of December 2018, only 338 borrowers have had their discharges processed by the Department. 

TEPSLF was established to address the administrative failures 

of the Department and student loan servicers, who did not provide 

accurate information to borrowers seeking to qualify under the 

PSLF program. This account provides funding for loan forgiveness 

for borrowers who were led to believe they qualified for PSLF by 

their loan servicers but were denied forgiveness. Unfortunately, the 

Department has failed to effectively administer this program as 

well. According to recent data from the Department, over 38,000 

borrowers applied for relief under TEPSLF, but only 262 applications were approved. 

The Committee is also concerned with the Department’s reversal 

of employment certifications under the program. The Committee directs the Department to develop comprehensive guidance and instructions regarding PSLF and require loan servicers in the current servicing environment to provide consistent and accurate information to borrowers. Furthermore, the Committee directs the 

Department to refrain from reversing qualifying employment determinations, except for administrative error, and further directs the 

Department to calculate multiple payments made to a loan 

servicer, within 15 days of the scheduled payment due date, that 

combine to result in the payment amount total required for the 

payment period, to be counted as a qualifying payment toward the 

120 payments required by the program. 

The Committee directs the Secretary to update the PSLF Report 

on FSA’s Data Center on a monthly basis within 30 days after enactment of this Act. The Committee also directs the Secretary to 

include updates for TEPSLF within the updated reports. 

To help improve implementation of the program, the Committee 

recommendation includes new bill language to ease a bureaucratic 

hurdle that requires borrower’s most recent monthly payments and 

the monthly payments made a year before they applied be greater 

than what their monthly payment would have been under an income-driven repayment plan. The bill also requires the Secretary 

to increase awareness of the program and inform all borrowers repaying their loans under PSLF and in the incorrect repayment program about TEPSLF requirements. 

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STUDENT AID ADMINISTRATION

Appropriation, fiscal year 2019 ......................................................... $1,678,943,000 

Budget request, fiscal year 2020 ....................................................... 1,812,000,000 

Committee Recommendation ............................................................. 1,678,943,000 

Change from enacted level ............................................................. – – – 

Change from budget request .......................................................... ¥133,057,000 

Programs administered under the Student Aid Administration 

(SAA) include Pell Grants, campus-based programs, Teacher Education Assistance for College and Higher Education grants, and 

Federal student loan programs. 

Salaries and Expenses.—Within the total provided for SAA, the Committee recommends $698,943,000 for salaries and expenses, 

which is the same as the fiscal year 2019 enacted level and 

$582,338,000 below the fiscal year 2020 request. 

Loan Servicing Activities.—Within the total provided for SAA, the Committee recommends $980,000,000 for Loan Servicing Activities, which is the same as the fiscal year 2019 enacted level and 

$449,281,000 above the fiscal year 2020 request. 

On March 6, 2019, the Subcommittee on Labor-HHS-Related 

Agencies held an oversight hearing on loan servicing, during which 

the Subcommittee heard from a panel of experts, including the Assistant Inspector General for Audit in the Office of the Inspector 

General at the Department. The Assistant Inspector General testified regarding its February 2019 audit report on Federal Student 

Aid (FSA) that between 2015 and 2017, loan servicers were out of 

compliance in 61 percent of the monitoring reports analyzed. According to the OIG report, ‘‘FSA management rarely used available 

contract accountability provisions to hold servicers accountable for 

instances of noncompliance,’’ and ‘‘by not holding servicers accountable for instances of noncompliance with Federal loan servicing requirements, FSA did not provide servicers with an incentive to take 

actions to mitigate the risk of continued servicer noncompliance 

that could harm students.’’ 

Noncompliance has serious consequences for borrowers. Such 

noncompliance includes loan servicers failing to provide borrowers 

with accurate information about their repayment options, miscalculating how much students should be paying through income-driven 

repayment, and putting borrowers into forbearance without first informing them of other, less costly options. 

The Committee is concerned regarding FSA’s lack of rigorous 

oversight of student loan servicers and that FSA does not utilize 

all tools at its disposal to safeguard taxpayer dollars nor prioritize 

the best interests of student loan borrowers. Therefore, the Committee recommendation includes new bill language requiring the 

Department to award student loan servicer contracts on the basis 

of their past performance and compliance with Federal and state 

law. It also requires the Department to prioritize services to help 

borrowers avoid delinquency or default in the FSA Next Generation 

Processing and Servicing Environment. New bill language is also 

included to require the Department to include accountability measures that account for the performance of the portfolio and contractor compliance with FSA guidelines. 

As outlined in the Department’s July 2016 memorandum on Federal student loan servicing policy direction (also known as the 

Mitchell memo), the Committee directs the Department to require 

206 

that servicers ‘‘take the necessary steps to ensure internal processes support robust oversight and accountability,’’ ‘‘that borrowers 

can expect their servicers to support external compliant handling 

functions administered by other federal and state agencies,’’ and to 

strengthen ‘‘transparency through expanded publication of aggregate data on student loan and servicer performance.’’ As part of the 

Department’s efforts to strengthen transparency, the Committee directs the Department to work with the National Center for Education Statistics (NCES) to create a public-facing website—similar 

to the NCES DataLab—that allows for the automatic 

crosstabulation of data and the calculation of other statistics, including aggregate student loan outcomes, portfolio composition, repayment rates, and the disposition of complaints. 

As the Department continues to implement its new servicing environment, the Committee also directs FSA to develop new oversight procedures for loan servicers’ communications with borrowers, 

including e-mail and text message interactions, and online chat 

functions. 

In addition, the Committee directs the Secretary, within 90 days 

of enactment of this Act, to make publicly available on its website 

a detailed list of all individual requests made to the Department 

under the ‘‘Enforcement Disclosure’’ provision of the Statement of 

Records Notice for the Direct Loan Program (Common Services For 

Borrowers, 18–11–16), the Department’s policy that governs this 

disclosure, and a description of the Department’s response to those 

requests, including the number of days it took the Department to 

acknowledge such a request and the number of days it took the Department to respond to such a request in full. 

Federal Student Loan Consolidation to Private Loans.—The Committee is concerned by the aggressive marketing materials private 

lenders send to Federal student loan borrowers that advertise loan 

consolidation services without also mentioning the repayment and 

forgiveness benefits that may be lost by consolidating a Federal 

student loan into a private loan. The Committee encourages the 

Department to examine this issue and submit a report to the Committees on Appropriations within 90 days of enactment of this Act, 

containing language for possible disclaimers that the Department 

may include in its materials, alerting Federal student loan borrowers to the potential loss of benefits should they consolidate Federal loans with a private lender. 

Federal Perkins Loan Cancellations.—The Committee is concerned with the Department’s implementation of the wind-down of 

the Federal Perkins Loan program and directs the Department to 

issue guidance to institutions of higher education regarding loan 

cancellations and reimbursements no later than January 1, 2020. 

State and Nonprofit Subcontracting—The Committee believes 

that State and nonprofit organizations can assist the current federal student loan servicers in providing important services to struggling borrowers who need access to more specialized support services throughout their postsecondary education to help them understand their financial decisions, and can appropriately act as advocates to help struggling borrowers understand the student loan repayment process and options that may be available to them to help 

mitigate delinquencies and defaults. The Committee urges the Department of Education to explore incentives for federal student 

207 

loan servicers to subcontract with qualified State and nonprofit organizations as well as small businesses. 

HIGHER EDUCATION

Appropriation, fiscal year 2019 ......................................................... $2,312,356,000 

Budget request, fiscal year 2020 ....................................................... 1,534,487,000 

Committee Recommendation ............................................................. 2,748,533,000 

Change from enacted level ............................................................. +436,177,000 

Change from budget request .......................................................... +1,214,046,000 

Strengthening Institutions 

The Committee recommends $110,000,000 for the Part A, 

Strengthening Institutions program, which is $10,125,000 more 

than the fiscal year 2019 enacted level. The fiscal year 2020 budget 

request proposes to eliminate this program. Funding supports competitive grants for general operating subsidies to institutions with 

below average educational and general expenditures per student 

and significant percentages of low-income students. Funds may be 

used for faculty and academic program development, management, 

joint use of libraries and laboratories, acquisition of equipment, 

and student services. 

Developing Hispanic-Serving Institutions 

The Committee recommends $150,000,000 for the Hispanic-Serving Institutions program, which is $25,585,000 more than the fiscal 

year 2019 enacted level. The fiscal year 2020 budget request does 

not include funding for this program and proposes to consolidate it 

and the following programs into a single grant program for Minority Serving Institutions (MSI): (1) Strengthening Alaska Native 

and Native Hawaiian Serving Institutions, (2) Strengthening Predominantly Black Institutions, (3) Strengthening Asian American 

and Native American Pacific Islander Serving Institutions, (4) 

Strengthening Native American Serving Nontribal Institutions, 

and (6) Promoting Postbaccalaureate Opportunities for Hispanic 

Americans. The Committee rejects this budget proposal and does 

not include funds for such purpose. 

The Hispanic-Serving Institutions program provides operating 

subsidies to schools that serve at least 25 percent Hispanic students. Funds may be used for faculty and academic program development, management, joint use of libraries and laboratories, acquisition of equipment, and student services. 

Promoting Postbaccalaureate Opportunities for Hispanic Americans 

The Committee recommends $30,000,000 for the Promoting 

Postbaccalaureate Opportunities for Hispanic Americans program, 

which is $18,837,000 more than the fiscal year 2019 enacted level. 

The fiscal year 2020 budget request does not include funding for 

this program and proposes to consolidate it into a single MSI grant 

program, which the Committee does not support. This program provides expanded postbaccalaureate educational opportunities for the 

academic attainment of Hispanic and low-income students. In addition, it expands academic offerings and enhances program quality 

at IHEs educating the majority of Hispanic college students. 

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Strengthening Historically Black Colleges and Universities 

The Committee recommends $375,000,000 for Strengthening Historically Black Colleges and Universities (HBCUs), which is 

$92,580,000 more than the fiscal year 2019 enacted level and the 

fiscal year 2020 budget request. This program provides operating 

subsidies to accredited HBCUs that were established prior to 1964, 

with the principal mission of educating black Americans. Funds are 

distributed through a formula grant based on the enrollment of 

Pell Grant recipients, number of graduates, and the number of 

graduates entering graduate or professional schools in which blacks 

are underrepresented. 

Physician Assistant Education.—The Committee encourages the 

Secretary to explore strategies for expanding Physician Assistant 

(PA) programs at HBCUs, Predominantly Black Institutions (PBIs) 

and HSIs. Developing PA programs at these higher education institutions will ensure a more diverse PA workforce to promote health 

equity and more effectively provide care in recognition of the 

changing demographics of the nation’s patient populations. The 

Committee directs the Secretary to provide a report to Committees 

on Appropriations, no later than 180 days after enactment of this 

Act, detailing recommendations for promoting PA programs at 

HBCUs, PBIs, and HSIs through the Department’s grant initiatives. 

Strengthening Historically Black Graduate Institutions 

The Committee recommends $125,000,000 for the Strengthening 

Historically Black Graduate Institutions (HBGIs) program, which 

is $51,963,000 more than the fiscal year 2019 enacted level and the 

fiscal year 2020 budget request. The program provides five-year 

grants to 18 postsecondary institutions that are specified in section 

326(e)(1) of the Higher Education Act. Institutions may use funds 

to build endowments, provide scholarships and fellowships, and to 

assist students with the enrollment and completion of 

postbaccalaureate and professional degrees. 

The Committee is concerned with the historic decline of AfricanAmericans pursuing doctorate degrees in the health professions. 

HBGIs have awarded the vast majority of all doctoral degrees in 

medicine, dentistry, pharmacy, veterinary medicine, and engineering to African Americans and are well poised to mitigate the adverse effects stemming from the lack of African American doctors. 

The Committee urges the Department, through the White House 

Initiative on HBCUs, to convene a summit of HBGI grantees to assess how to increase the number of African Americans receiving 

doctoral level degrees in the health sciences. The Committee urges 

the Secretary to develop a plan for increasing such representation, 

including how it will assist HBGI stakeholders in carrying out this 

work, and to submit this plan to the Committees on Appropriations 

within 180 days after enactment of this Act. 

Strengthening Predominantly Black Institutions 

The Committee recommends $22,000,000 for the Strengthening 

Predominantly Black Institutions (PBIs) program, which is 

$10,525,000 more than the fiscal year 2019 enacted level. The fiscal 

year 2020 budget request does not include funding for this program 

and proposes to consolidate it into a single MSI grant program, 

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which the Committee does not support. This program provides 

grants to PBIs to increase their capacity to serve the academic 

needs of students. 

Strengthening Asian American and Native American Pacific-Islander-Serving Institutions 

The Committee recommends $17,864,000 for the Asian American 

Pacific-Islander program, which is $14,000,000 more than the fiscal 

year 2019 enacted level. The fiscal year 2020 budget request does 

not include funding for this program and proposes to consolidate it 

into a single MSI grant program, which the Committee does not 

support. This program provides grants to undergraduate institutions that have an undergraduate student enrollment of at least 10 

percent Asian American or Native American Pacific-Islander. 

Strengthening Alaska Native and Native Hawaiian-Serving Institutions 

The Committee recommends $18,100,000 for the Strengthening 

Alaska Native and Native Hawaiian-Serving Institutions program, 

which is $2,170,000 more than the fiscal year 2019 enacted level. 

The fiscal year 2020 budget request does not include funding for 

this program and proposes to consolidate it into a single MSI grant 

program, which the Committee does not support. Through the 

Strengthening Alaska Native and Native Hawaiian-Serving Institutions program, the Department provides grants to assist institutions of higher education in serving Alaska Native and Native Hawaiian students. 

Native American Serving Non-Tribal Institutions 

The Committee recommends $5,000,000 for the Native American 

Serving Non-Tribal Institutions program, which is $1,136,000 more 

than the fiscal year 2019 enacted level. The fiscal year 2020 budget 

request does not include funding for this program and proposes to 

consolidate it into a single MSI grant program, which the Committee does not support. This program makes grants to IHEs at 

which enrollment is at least 10 percent Native American students 

and that are not Tribally Controlled Colleges or Universities. 

Strengthening Tribally Controlled Colleges and Universities 

The Committee recommends $51,000,000 for the Strengthening 

Tribally Controlled Colleges and Universities (TCCUs) program, 

which is $19,146,000 more than the fiscal year 2019 enacted level 

and $23,401,000 above the fiscal year 2020 budget request. This 

program makes grants to TCCUs to increase their capacity to serve 

the academic needs of students. 

Strengthening HBCU Masters Programs 

The Committee recommends $13,500,000 for the Strengthening 

HBCU Masters Programs, which is $4,843,000 more than the fiscal 

year 2019 enacted level and the fiscal year 2020 budget request. 

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. 

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International Education and Foreign Language Studies 

Domestic Programs.—The Committee recommends $80,400,000 

for the Domestic Programs of the International Education and Foreign Languages Studies program, which is $15,297,000 more than 

the fiscal year 2019 enacted level. The fiscal year 2020 budget request proposes to eliminate this program. Authorized by title VI of 

the Higher Education Act, these programs include National resource centers, foreign language and area studies fellowships, undergraduate international studies and foreign language programs, 

international research and studies projects, business and international education projects, international business education centers, language resource centers, American overseas research centers, and technological innovation and cooperation for foreign information access. 

Overseas Programs.—The Committee recommends $8,730,000 for 

the Overseas Programs, which is $1,669,000 more than the fiscal 

year 2019 enacted level. The fiscal year 2020 budget request proposes to eliminate this program. Funding for these programs support group projects, faculty research, special bilateral research, and 

doctoral dissertation research conducted abroad. 

The Committee recognizes the importance of study abroad programs for the necessary preparation and development of American 

students enrolled in institutions of higher education to be effective 

members of a globally competitive 21st century workforce. Study 

abroad programs provide these students with critical knowledge, 

skills, and experiences in leadership, intercultural understanding, 

global learning, and foreign languages. 

Postsecondary Programs for Students with Intellectual Disabilities 

The Committee recommends $11,800,000 for Postsecondary Programs for Students with Intellectual Disabilities, which is the same 

as both the fiscal year 2019 enacted level and the fiscal year 2020 

budget request. This program supports grants to create model transition programs into higher education for students with intellectual 

disabilities. 

Minority Science and Engineering Improvement 

The Committee recommends $13,000,000 for the Minority 

Science and Engineering Improvement Program, which is 

$1,865,000 more than the fiscal year 2019 enacted level and 

$3,352,000 above the fiscal year 2020 budget request. This program 

awards grants to improve mathematics, science, and engineering 

programs at institutions serving primarily minority students and to 

increase the number of minority students who pursue advanced degrees and careers in those fields. 

Tribally Controlled Postsecondary Career and Technical Institutions 

The Committee recommends $10,000,000 for this program, which 

is $436,000 more than the fiscal year 2019 enacted level and 

$1,714,000 above the fiscal year 2020 budget request. This program 

provides competitive grants to Tribally controlled postsecondary career and technical institutions to provide career and technical education to Native American students. 

211 

Federal TRIO Programs 

The Committee recommends $1,160,000,000 for TRIO programs, which is $100,000,000 above the fiscal year 2019 enacted level and 

$210,000,000 above the fiscal year 2020 budget request. The TRIO 

programs provide a variety of outreach and support services to encourage low-income, often first-generation college students to enter 

and complete college. Discretionary grants of up to four or five 

years are awarded competitively to IHEs and other nonprofit organizations. At least two thirds of the eligible participants in TRIO 

must be low-income, first-generation college students. 

The Committee rejects the fiscal year 2020 budget proposal to 

move the TRIO programs from competitive grant programs to a 

single State formula program. Further, the Committee directs the 

Department to allocate funds such that all current grantees receive 

an increase in their grant award and to avoid imposing additional 

requirements as a condition for grantees to receive such increases. 

Additionally, the Department is directed to allocate a substantial 

portion of the funding to increase the number and size of the new 

grants awarded in the Student Services Support competition that 

will occur in fiscal year 2020. 

Gaining Early Awareness and Readiness for Undergraduate Programs 

The Committee recommends $395,000,000 for Gaining Early 

Awareness and Readiness for Undergraduate Programs (GEAR 

UP), which is $35,000,000 more than the fiscal year 2019 enacted 

level. The fiscal year 2020 budget request proposes no funds for 

this program and to consolidate it into a new State formula-based 

TRIO program. The Committee rejects this proposal. GEAR UP 

provides grants to States and partnerships of low-income middle 

and high schools, IHEs, and community organizations to target entire grades of students and give them the skills, encouragement, 

and scholarships to pursue successfully postsecondary education. 

The Committee continues bill language allowing the Department 

to maintain the GEAR UP evaluation set-aside at 1.5 percent 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 

The Committee recommends $24,047,000 for the Graduate Assistance in Areas of National Need (GAANN) program, which is 

$1,000,000 more than the fiscal year 2019 enacted level. The fiscal 

year 2020 budget request proposes to eliminate this program. 

GAANN provides fellowships through grants to degree granting 

postsecondary institutions, for students of high financial need 

studying in areas of national need. The Department consults with 

appropriate other agencies and organizations to designate the fields 

of study ‘‘in areas of national need.’’ Recent examples include computer and informational sciences, engineering, nursing, and physics. 

Teacher Quality Partnership Grants 

The Committee recommends $53,092,000 for the Teacher Quality 

Partnerships (TQP) program, which is $10,000,000 more than the 

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fiscal year 2019 enacted level. The fiscal year 2020 budget proposes 

to eliminate this 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. 

The Committee recognizes the importance of state teaching fellowship programs and encourages the Department to continue to 

work with eligible state teaching fellowship programs that wish to 

apply for Teacher Quality Partnership program. 

The Committee recognizes the needs of the nation’s growing 

English learner (EL) student population, including a robust teacher 

workforce equipped to teach them. The Committee is concerned by 

the shortage of EL teachers in the majority of States, as well the 

academic achievement gap between ELs and their native Englishspeaking peers and the Committee encourages the Secretary to 

work with grantees in strengthening and developing high-quality 

teacher preparation programs that enable graduates to meet the 

needs of EL students. 

Child Care Access Means Parents in School 

The Committee recommends $60,000,000 for the Child Care Access Means Parents in School program, which is $10,000,000 more 

than the fiscal year 2019 enacted level and $44,866,000 above the 

fiscal year 2020 budget request. This program makes competitive 

grants to colleges and universities to support or establish a campus-based childcare program, primarily serving the needs of low-income students enrolled at these institutions. 

Fund for the Improvement of Postsecondary Education 

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

Centers of Excellence for Veterans Student Success Program, as 

authorized by section 873 of the Higher Education Act. Funding 

will support the first competition for this program since fiscal year 

2015. The fiscal year 2020 budget request does not include funding 

for this program. Over one million veterans attend college every 

year and often need assistance receiving their benefits or 

transitioning to student life. Veteran Student Centers provide a 

one-stop-shop for academic support, networking opportunities, peer 

mentorship, financial assistance, counseling, and career services. 

Of these funds, the Committee directs the Secretary to issue 

grants to institutions of higher education or consortia of institutions of higher education seeking to establish, maintain, or improve 

Veteran Student Centers—a dedicated physical meeting space on 

the campus of an institution of higher education that provides student veterans, members of the Armed Forces serving on active 

duty, or members of a reserve component of the Armed Forces with 

a centralized office for veteran student support services, including 

comprehensive academic and tutoring services, peer-to-peer tutoring and academic mentorship, and is staffed by at-least one trained 

veteran employee. 

Such centers must also provide student-veterans with assistance 

relating to transitioning from the military to student life or civilian 

workforce, networking opportunities with other veterans in the 

community, understanding and obtaining benefits provided by the 

institution of higher education, federal government, and State for 

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which such students may be eligible, understanding how to succeed 

in the institution of higher education, including by understanding 

academic policies, the course selection process, and institutional 

policies and practices related to the transfer of academic credits, 

and provide an understanding of disability-related rights and protections under the Americans with Disabilities Act of 1990 and section 504 of the Rehabilitation Act of 1973. The Committee directs 

the Department to brief the Committees on Appropriations no later 

than 60 days after enactment of this Act on its plan to carry out 

this competition and to notify the Committees no later than 15 

days in advance of making awards to grantees. 

In additon, the Committee includes $5,000,000 to continue the 

Open Textbooks Pilot program. The Secretary is directed to award 

funds through a new competition, with individual grants amounting to not less than $100,000 and not more than $1,000,000. 

HOWARD UNIVERSITY

Appropriation, fiscal year 2019 ......................................................... $236,518,000 

Budget request, fiscal year 2020 ....................................................... 221,821,000 

Committee Recommendation ............................................................. 250,000,000 

Change from enacted level ............................................................. +13,482,000 

Change from budget request .......................................................... +28,179,000 

Howard University is a ‘‘Research I’’ university located in the 

District of Columbia and provides undergraduate liberal arts, graduate and professional instruction to students. 

Within the amount provided, the Committee recommends 

$27,325,000 for the Howard University Hospital, which is the same 

as both the fiscal year 2019 enacted level and the fiscal year 2020 

budget request. The hospital serves as a major acute and ambulatory care center for the District of Columbia, and functions as a 

teaching facility. 

COLLEGE HOUSING AND ACADEMIC FACILITIES LOANS PROGRAM

Appropriation, fiscal year 2019 ......................................................... $435,000 

Budget request, fiscal year 2020 ....................................................... 435,000 

Committee Recommendation ............................................................. 435,000 

Change from enacted level ............................................................. – – – 

Change from budget request .......................................................... – – – 

Previously, these programs helped to ensure that postsecondary 

institutions were able to make necessary capital improvements to 

maintain and increase their ability to provide a high-quality education. Since 1994, no new loans have been made, and the Department’s role has been to manage the outstanding loans. 

HISTORICALLY BLACK COLLEGE AND UNIVERSITY CAPITAL FINANCING

PROGRAM ACCOUNT

Appropriation, fiscal year 2019 ......................................................... $40,484,000 

Budget request, fiscal year 2020 ....................................................... 40,484,000 

Committee Recommendation ............................................................. 50,484,000 

Change from enacted level ............................................................. +10,000,000 

Change from budget request .......................................................... +10,000,000 

The Committee recommends $50,484,000 for the HBCU Capital 

Financing program, which is $10,000,000 above the fiscal year 2019 

enacted level and the fiscal year 2020 budget request. This program is authorized under part D of Title III of the HEA and makes 

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214 

torically black colleges and universities. In exceptional circumstances, capital provided under the program can be used for 

construction or acquisition of facilities. 

Within the total provided for this program, the Committee rec- ommendation includes $334,000 for the administrative expenses to 

carry out the program and $20,150,000 for loan subsidy costs that 

will be sufficient to guarantee up to $212,100,000 in new loans in 

fiscal year 2020. The Committee recommendation also includes $20,000,000 to 

continue loan deferments requested in fiscal year 2018 for private 

HBCUs and includes new bill language and an increase of 

$10,000,000 over fiscal year 2019 enacted level and the fiscal year 

2020 budget request to provide loan deferments for public HBCUs. 

INSTITUTE OF EDUCATION SCIENCES

Appropriation, fiscal year 2019 ......................................................... $615,462,000 

Budget request, fiscal year 2020 ....................................................... 521,563,000 

Committee Recommendation ............................................................. 650,000,000 

Change from enacted level ............................................................. +34,538,000 

Change from budget request .......................................................... +128,437,000 

The Committee recommends $650,000,000 for the Institute of 

Education Sciences (IES), an increase of $34,538,000 over the fiscal 

year 2019 enacted level and $128,437,000 more than the fiscal year 

2020 budget request. 

Research, Development, and Dissemination 

The Committee recommends $205,400,000 for Research, Develop- ment, and Dissemination, which is $12,705,000 more than the fiscal year 2019 enacted level and $17,900,000 above the fiscal year 

2020 budget request. Of the increase, the Committee recommendation includes up to $2,000,000 solely for the rigorous evaluation of 

the Second Chance Pell Experiment as announced in the Federal 

Register (Volume 80, Number 148 on Monday, August 3, 2015). The 

Committee also directs IES to work with the Department’s Policy 

and Program Studies on this effort. The Committee also directs 

IES to submit the evaluation to the Committees on Appropriations, 

within 30 days of completing the evaluation. This account supports 

research, development, and national dissemination activities that 

are aimed at expanding fundamental knowledge of education and 

promoting the use of research and development findings in the design of efforts to improve education. 

Statistics 

The Committee recommends $117,500,000 for the activities of the 

National Center for Education Statistics (NCES), which is 

$8,000,000 more than the fiscal year 2019 enacted level and 

$5,000,000 more than the fiscal year 2020 budget request. Statistics activities are authorized under title I of the Education Sciences 

Reform Act of 2002. The Center collects, analyzes, and reports statistics on all levels of education in the United States. Activities are 

carried out directly and through grants and contracts and include 

projections of enrollments, teacher supply and demand, and educational expenditures. NCES also provides technical assistance to 

State and local educational agencies and postsecondary institutions. 

215 

Data for Puerto Rico.—The Committee recommends that NCES 

collect and publish data for Puerto Rico in the same manner it collects and publishes data for States. 

Regional Educational Laboratories 

The Committee recommends $60,400,000 for Regional Edu- cational Laboratories (RELs), which is $4,977,000 more than the 

fiscal year 2019 enacted level. The fiscal year 2020 budget request 

proposes to eliminate this program. This program supports a network of 10 laboratories that promote the use and development of 

knowledge and evidence to increase student learning and further 

school improvement efforts. 

The Committee notes the critical role RELs play in helping to 

translate education research to policymakers and practitioners, 

which assists SEAs and LEAs in implementing ESSA and providing a high-quality education for more children. 

Research in Special Education 

The Committee recommends $61,000,000 for Research in Special Education, which is $5,000,000 more than the fiscal year 2019 enacted level and $7,000,000 above the fiscal year 2020 budget request. This program supports competitive awards to produce and 

advance the use of knowledge to improve services and results for 

children with disabilities. The program focuses on producing new 

knowledge, integrating research and practice, and improving the 

use of knowledge. 

Special Education Studies and Evaluations 

The Committee recommends $11,674,000 for Special Education Studies and Evaluations, which is $856,000 more than the fiscal 

year 2019 enacted level and the fiscal year 2020 budget request. 

This program awards competitive grants, contracts and cooperative 

agreements to assess the implementation of the IDEA and the effectiveness of State and local efforts to provide special education 

and early intervention programs and services to infants, toddlers, 

and children with disabilities. 

Statewide Data Systems 

The Committee recommends $35,281,000 for Statewide Data Systems, which is $3,000,000 more than the fiscal year 2019 enacted 

level. The fiscal year 2020 budget proposes to eliminate this program. Competitive grants under this authority are made to SEAs 

to help them manage, analyze, disaggregate and use student data 

consistent with the ESEA. 

Assessment 

The Committee recommends $158,745,000 for Assessment, which 

is the same as the fiscal year 2019 enacted level and $2,000,000 

above the fiscal year 2020 budget request. This amount includes 

$7,745,000 for the National Assessment Governing Board (NAGB), 

which is the same as both the fiscal year 2019 enacted level and 

the fiscal year 2020 budget request. 

The National Assessment of Educational Progress (NAEP) is the 

only nationally representative and continuing survey of educational 

ability and achievement of American students. The primary goal of 

216 

the assessment is to determine and report the status and trends 

of the knowledge and skills of students, subject by subject. Subject 

areas assessed in the past have included reading, writing, mathematics, science, history, citizenship, literature, art, and music. The 

NAEP is operated by contractors through competitive awards made 

by the NCES. The NAGB formulates the policy guidelines for the 

program. 

DEPARTMENTAL MANAGEMENT

Appropriation, fiscal year 2019 ......................................................... $616,143,000 

Budget request, fiscal year 2020 ....................................................... 635,418,000 

Committee Recommendation ............................................................. 623,418,000 

Change from enacted level ............................................................. +7,275,000 

Change from budget request .......................................................... ¥12,000,000 

These activities are authorized by the Department of Education 

Organization Act (P.L. 96–88) and include costs associated with the 

management and operation of the Department as well as separate 

costs associated with the Office for Civil Rights and the Office of 

Inspector General. 

Program Administration 

The Committee recommends $430,000,000 for Program Administration, which is the same as the fiscal year 2019 enacted level and 

$17,000,000 below the fiscal year 2020 budget request. These funds 

support the staff and other costs of administering programs and activities at the Department. Items include personnel compensation, 

health, retirement, and other benefits as well as travel, rent, telephones, utilities, postage fees, data processing, printing, equipment, supplies, technology training, consultants, and other contractual services. 

Communication with the Committee.—There are concerns about 

the breakdown of the normal flow of information from some areas 

of the Department to the Committee. The Committee expects the 

Department to correct these shortcomings. If no improvement is 

made, the Committee will evaluate the resources spent on the offices and staff involved in the unacceptable delays regarding the 

transmission of information to the Committee and whether the resources are better allocated to other areas of the bill. 

Acting Inspector General.—The Committee is concerned by the 

Department’s recent effort to replace its Acting Inspector General 

(IG) with a career attorney from the Department, especially when 

that attorney served as the Acting Secretary of Education. While 

this decision was reversed after the Administration received correspondence from Members of Congress, questions about the process by which the replacement of the Acting IG occurred remain. 

The Committee directs the Department to respect the independence 

of the OIG, to refrain from influencing or undermining any audit 

or investigation conducted by the OIG, and to respond promptly to 

all Congressional inquiries concerning the replacement of the Acting IG. 

Accrediting Council for Independent Colleges and Schools.—Accrediting agencies provide an important role in guarding access to 

federal student aid and ensuring that students receive a quality 

education. The Committee is therefore deeply concerned with the 

Secretary’s decision to recognize the Accrediting Council for IndeVerDate Sep 11 2014 06:50 May 16, 2019 Jkt 036295 PO 00000 Frm 00220 Fmt 6659 Sfmt 6602 E:\HR\OC\HR062.XXX HR062
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pendent Colleges and Schools (ACICS). ACICS has a history of certifying predatory for-profit institutions, and an extensive review 

conducted in 2018 by Department staff showed that ACICS failed 

to meet 57 of 93 federal standards. Within 90 days of enactment 

of this Act, the Committee directs the Secretary to certify in a report to the Committees on Appropriations, with detailed justifications, citing relevant supporting documents, that ACICS demonstrated compliance with all 57 of those standards before recognizing ACICS beyond the current 12-month conditional period. 

Advertising Contracts.—The Committee understands that, as the 

largest advertiser in the United States, the Federal Government 

should work to ensure fair access to its advertising contracts for 

small disadvantaged businesses and businesses owned by minorities and women. The Committee directs the Department to include 

the following information in its fiscal year 2021 Congressional 

Budget Justification: Expenditures for fiscal year 2019 and expected expenditures for fiscal years 2020 and 2021, respectively, for 

(1) all contracts for advertising services; and (2) contracts for the 

advertising services of (I) socially and economically disadvantaged 

small business concerns (as defined in section 8(a)(4) of the Small 

Business Act (15 U.S.C. 637(a)(4)); and (II) women- and minorityowned businesses. 

Randolph-Sheppard Act.—The Committee is aware that the Department is facing challenges in meeting its responsibilities to administer and oversee the Randolph-Sheppard program as prescribed by the Randolph-Sheppard Act of 1936. These challenges 

include convening arbitration panels in a timely manner, reviewing 

and approving state licensing agencies’ policy changes, and working 

with state licensing agencies to approve routine expenditures associated with the program. The Department shall report to the Committees on Appropriations no later than one year from the date of 

enactment of this Act on the status of all pending arbitration, state 

licensing agency policy reviews, and prior approval procedures. 

Open Data Reporting.—The Committee encourages the Secretary, 

to the extent practicable, to disclose information through the College Navigator website, or its successor website, and to publish 

such information using an open source description language for the 

purpose of comparing institutions of higher education, programs 

and credentials. 

Teacher Shortages.—The Committee is concerned by the wideranging teacher shortages experienced in many States and districts 

across the country. In particular, the Committee is concerned by 

national research which shows that rural districts, where salaries 

are lower and districts are forced to rely on provisionally licensed 

teachers, can be hit particularly hard by teacher shortages. Similarly, in school districts with higher minority student populations, 

shortages have necessitated lower standards for teacher certification and other professional qualifications. Accordingly, the Committee directs the Policy and Program Studies Service of the Department, in partnership in the Department of Labor, to provide no 

later than 270 days after enactment of this Act, a report on teacher 

shortages. The report should examine trends in teacher shortages 

and factors contributing to challenges with teacher recruitment and 

retention. The analysis should include, but not be limited to an examination of the following factors: personnel to support students 

218 

with disabilities; geography; the characteristics of communities impacted, including student demographics, area median income, or 

per-pupil spending; the diversity of the educator workforce; and 

issues related to licensure. The report shall also include information on shortages of educational support staff, which may include 

school leaders. The report shall also identify areas of chronic teacher shortages and their underlying causes. The report shall examine 

ways to improve the effectiveness of current federal policy in preventing and responding to teacher shortages as well as make recommendations on potential federal interventions to improve teacher recruitment and retention. 

Lead Testing in Schools.—The Committee strongly agrees with 

recommendations from a 2018 GAO report, Lead Testing of School 

Drinking Water Would Benefit from Improved Federal Guidance, 

that the Assistant Secretary for Elementary and Secondary Education should collaborate with the Environmental Protection Agency (EPA) to disseminate guidance related to lead testing and remediation in schools. The Committee is aware that EPA has made 

available updated guidance and web-based toolkits for lead testing 

and remediation in schools. The Committee is also aware that EPA 

is soliciting applications from education officials to provide grant 

funds to assist States and local education agencies with testing and 

remediation efforts. The Committee directs the Department to coordinate with EPA in disseminating this new guidance and resources within 90 days of enactment of this Act. Further, the Committee encourages the Department to assist school systems seeking 

to remediate lead contamination in working with EPA. Further, the 

Committee is aware that many States and local jurisdictions may 

have their own requirements and guidance in place regarding lead 

testing in schools. The Committee encourages the Department to 

coordinate and assist in the sharing of best practices among States 

and local school systems. The Committee expects the Department 

to provide biannual reports on the Department’s efforts in these regards. 

Military Student Identifier—The Committee notes that ESSA recognized military-connected students as a distinct subgroup of students. More than 80 percent of military-connected children attend 

public schools. Students with parents/guardians who serve full time 

in the military move and change schools frequently. In addition, 

they experience separations from a parent/guardian due to their 

parents’ service to the U.S. Military. The Military Student Identifier provides educators, school leaders and policy makers with critical information to personalize attention and direct resources to 

better support military dependent children. Current law directs the 

military student identifier towards the children of active duty families, leaving out the nearly one-half million children of the reserve 

component, both National Guard and Reserves. The Committee 

supports efforts to address the unique needs of children whose parents/guardians serve in the National Guard and reserve component. 

Youth Apprenticeship Programs.—The Committee directs the Department to submit a report to the Committees on Appropriations 

on high school youth apprenticeship programs within 180 days of 

enactment of this Act. The report should include a focus on registered apprenticeship programs that have a documented industry 

219 

partnership, that incorporate practical and classroom-based instruction oriented towards industry standards, and that culminate 

in a portable, industry-recognized credential or postsecondary credit. The report should also be made publicly available on the Department’s website. 

Evidence-based Grant Making.—The Committee is supportive of 

efforts by the Department to consider evidence of effectiveness in 

grant competitions. 

Investments in Impoverished Areas.—The Committee supports 

targeted investments in impoverished areas, particularly in persistent poverty counties and in other high-poverty census tracts. To 

understand how programs funded through the Department are 

serving these particular areas, the Committee directs the Department to submit a report to the Committees on Appropriations on 

the percentage of funds allocated by all competitive grant programs 

and other anti-poverty programs in fiscal years 2017, 2018 and 

2019 and estimates for fiscal year 2020 to serve students living in 

persistent poverty counties, as defined as a county that has had 20 

percent or more of its population living in poverty over the past 30 

years, as measured by the 1990 and 2000 decennial censuses and 

the most recent Small Area Income and Poverty estimates, and 

high-poverty areas, as defined as any census tract with a poverty 

rate of at least 20 percent as measured by the 2013–2017 5-year 

data series available from the American Community Survey of the 

Census Bureau. The Department shall report this information to 

the Committees within 90 days of such data being available and 

provide a briefing to the Committees not later than 180 days of enactment of this Act on how the Department is carrying out this directive. 

Customer Service.—The Committee continues to support efforts 

to improve customer service in accordance with Executive Order 

13571—Streamlining Service Delivery and Improving Customer 

Service. The Committee directs the Secretary to develop standards 

to improve customer service and incorporate the standards into the 

performance plans required under 31 U.S.C. 1115. 

Performance Measures.—The Committee directs the Department 

to comply with title 31 of the United States Code, including the development of organizational priority goals and outcomes such as 

performance outcome measures, output measures, efficiency measures, and customer service measures. 

Resources for Foster and Homeless Youth—The Committee understands that foster and homeless youth experience increased burdens in accessing and completing higher education. The Committee 

is deeply concerned that access to the Free Application for Federal 

Student Aid (FAFSA), federal financial aid, and other existing resources and programs, including TRIO and the Chafee Education 

and Training Voucher program, are not consistently available and 

that many children are not aware of these resources. Therefore, the 

Committee urges the Department of Education and the Department of HHS to work together with State and tribal welfare systems and runaway and homeless youth programs to conduct further outreach and disseminate information on financial aid, TRIO, 

and the Chafee program to these audiences. The Committee also 

requests that these resources be made available online so that foster youth can also access them. 

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OFFICE FOR CIVIL RIGHTS

Appropriation, fiscal year 2019 ......................................................... $125,000,000 

Budget request, fiscal year 2020 ....................................................... 125,000,000 

Committee Recommendation ............................................................. 130,000,000 

Change from enacted level ............................................................. +5,000,000 

Change from budget request .......................................................... +5,000,000 

The Office for Civil Rights (OCR) is responsible for enforcing 

laws that prohibit discrimination on the basis of race, color, national origin, sex, disability, and age in all programs and institutions that receive funds from the Department. These laws extend 

to State educational agencies, local educational agencies, and institutions of higher education, including proprietary schools. They 

also extend to State rehabilitation agencies, libraries, museums, 

and other institutions receiving Federal funds. The Committee recommendation includes $130,000,000, an increase of $5,000,000 over the fiscal year 2019 enacted level and fiscal year 2020 budget request. The Committee directs OCR to use 

this appropriation to increase its level of full-time equivalent (FTE) 

employment in order to effectively and timely investigate complaints; execute and accurately report the civil rights data collection; thoroughly monitor corrective actions of institutions and meet 

other critical workloads. 

The Joint Statement accompanying the Department of Education 

Appropriations Act, 2019, directed the Department to submit quarterly reports on FTE levels and attrition. The first report was submitted to the Committees on Appropriations on February 11, 2019. 

In the report, OCR showed 510 FTE for the first quarter of 2019. 

Yet, the fiscal year 2020 budget request shows the number of FTE 

in fiscal year 2019 at 625. The Committee is concerned about this 

discrepancy and expects the Department to explain how it 

onboarded 115 FTE between the time the first report was submitted and the end of fiscal year 2019 in the fiscal year 2021 Congressional Budget Justification. 

FTE and Attrition Report.—The Committee directs the Department to provide the Committees on Appropriations a report, not 

later than 30 days after the conclusion of each quarter, detailing 

the number of full-time equivalent employees and attrition by principal office and appropriations account. 

Expulsions and Suspensions.—The Committee is deeply concerned about expulsions and suspensions that occur in preschool 

settings and K–3 classrooms, particularly given the racial and gender disparities that exist. These outcomes are problematic given 

the research that indicates these practices can adversely affect development, health, and education outcomes. The Committee strongly urges the Office for Civil Rights (OCR) to collect data annually 

on expulsions and suspensions in preschool, elementary and secondary school settings, disaggregated by race/ethnicity, sex, disability status, and English Learner status. 

OCR should also submit to the Committees on Appropriations, no 

later than 180 days after the enactment of this Act, and annually 

thereafter, a report detailing school discipline in all preschool and 

K–3 classrooms, including disaggregated data and any disparities 

by subgroup in disciplinary rates. The report should also include 

specific recommendations given to schools on expulsions and suspensions—including evidence-based interventions, consumer eduVerDate Sep 11 2014 06:50 May 16, 2019 Jkt 036295 PO 00000 Frm 00224 Fmt 6659 Sfmt 6602 E:\HR\OC\HR062.XXX HR062
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cation specific to each school, and opportunities to improve school 

climate. The Committee urges OCR to provide technical assistance 

to help prevent or severely limit expulsion and suspension practices 

in preschool settings and K–3 classrooms, eliminate disparities in 

the provision of discipline, and ensure the safety and well-being of 

all young children. 

Data Collection on Access to Computer Science Education in K– 

12.—The Committee encourages OCR to obtain data through the 

Civil Rights Data Collection on access to K–12 computer science 

education and computational thinking education, and to submit a 

report of its findings, within 180 days of enactment of this Act, to 

the Committees on Appropriations and the authorizing committees 

of jurisdiction. The data obtained should include the number of 

computer science and computational thinking classes offered in elementary and secondary schools, the number of students enrolled in 

these classes disaggregated by race, sex, disability according to the 

Individuals with Disabilities Education Act, and English Learner 

status, and the number of teachers in elementary and secondary 

schools with computer science certifications. 

Title IX.—The Committee recognizes that the Department failed 

to fully estimate the burden of the Notice of Proposed Rulemaking 

on Title IX, Nondiscrimination on the Basis of Sex in Education 

Programs or Activities Receiving Federal Financial Assistance, as 

required by law, and omitted significant costs to students and 

schools. The Committee further recognizes that OCR failed to engage in required consultation with stakeholders. The proposed 

changes to Title IX go against Congressional intent of the civil 

rights law and the mission of the OCR. 

English Learners.— The Committee encourages the Department 

to conduct and publish a study, within 180 days of enactment of 

this Act, on the effectiveness of English Learner (EL) programs in 

delivering adequate services and accommodations to qualified students as guaranteed under civil rights provisions. The Committee 

encourages the Department, within 180 days of enactment of this 

Act, to report outcomes in English language acquisition, proficiency 

levels in math and reading nationwide, and other State accountability indicators in each of the 50 States, the District of Columbia, 

and the U.S. Territories, as required through Section 1111(h)(1)(C) 

of the ESEA, with data disaggregated by the major race and ethnicity categories in the Decennial Census as compared to students 

never eligible for EL designation. Where such data is available, the 

Committee encourages the Department to include disaggregated 

data by EL subgroups (current, long-term, former, opt-out, recent 

arriving and late arriving ELs) and note in which States gaps in 

the data exist. The Committee is also concerned about the high volume of Title VI complaints related to ELs. 

OFFICE OF INSPECTOR GENERAL

Appropriation, fiscal year 2019 ......................................................... $61,143,000 

Budget request, fiscal year 2020 ....................................................... 63,418,000 

Committee Recommendation ............................................................. 63,418,000 

Change from enacted level ............................................................. +2,275,000 

Change from budget request .......................................................... – – – 

This Office has authority to inquire into all program and administrative activities of the Department as well as into related activiVerDate Sep 11 2014 06:50 May 16, 2019 Jkt 036295 PO 00000 Frm 00225 Fmt 6659 Sfmt 6602 E:\HR\OC\HR062.XXX HR062
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ties of grant and contract recipients. It conducts audits and investigations to determine compliance with applicable laws and regulations, to check alleged fraud and abuse, efficiency of operations, 

and effectiveness of results. 

Use of Resources.—The Committee urges the Office of Inspector 

General to ensure its focus remains on the primary missions of the 

Office. The Committee cautions the Office, when receiving requests 

from the Department for investigations, to consider the most effective and best use of its resources. 

GENERAL PROVISIONS

Sec. 301. The Committee continues a provision related to the implementation of programs of voluntary prayer and meditation in 

public schools. 

(TRANSFER OF FUNDS)

Sec. 302. The Committee modifies a provision providing the Secretary of Education with the authority to transfer up to one percent 

of discretionary funds between appropriations, provided that no appropriation is increased by more than three percent by any such 

transfer. This transfer authority is available only to meet emergency needs, and may not be used to create any new program or 

fund a project or activity that is not otherwise funded in this Act. 

All transfers are subject to notification to the Committees on Appropriations of the House of Representatives and the Senate. 

Sec. 303. The Committee modifies a provision allowing ESEA 

funds consolidated for evaluation purposes to be available from 

July 1, 2020 through September 30, 2021. 

Sec. 304. The Committee continues a provision allowing certain 

institutions to continue to use endowment income for student scholarships. 

Sec. 305. The Committee modifies a provision extending the authorization of the National Advisory Committee on Institutional 

Quality and Integrity. 

Sec. 306. The Committee modifies a provision extending the authority to provide account maintenance fees to guaranty agencies 

for Federal student loans. 

Sec. 307. The Committee continues a provision allowing administrative funds to cover outstanding Perkins loans servicing costs. 

(RESCISSION)

Sec. 308. The Committee modifies a provision rescinding fiscal 

year 2020 mandatory funding to offset the mandatory costs of increasing the discretionary Pell award. 

Sec. 309. The Committee continues a provision clarifying current 

law regarding data sharing with organizations assisting students 

in applying for financial aid. 

Sec. 310. The Committee modifies a provision regarding Public 

Service Loan Forgiveness. 

Sec. 311. The Committee continues a provision regarding outreach to borrowers and the Public Service Loan Forgiveness program. 

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TITLE IV—RELATED AGENCIES 

COMMITTEE FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR

SEVERELY DISABLED

SALARIES AND EXPENSES

Appropriation, fiscal year 2019 ......................................................... $8,250,000 

Budget request, fiscal year 2020 ....................................................... 9,400,000 

Committee Recommendation ............................................................. 9,000,000 

Change from enacted level ............................................................. +750,000 

Change from budget request .......................................................... ¥400,000 

The Committee believes oversight is necessary to ensure the program is operating in accordance with statutory requirements that 

blind or other severely disabled individuals provide at least 75 percent of hours or direct labor required for the production or provision of the products or services to Federal government agencies. To 

ensure the Committee for Purchase from People Who Are Blind or 

Severely Disabled (AbilityOne Commission) maintains its oversight 

capacity, the Committee continues bill language requiring the 

AbilityOne Commission to establish written agreements with central nonprofit agencies. The written agreements ensure the 

AbilityOne Commission can conduct appropriate audit, oversight, 

and reporting functions in accordance with standard Federal procurement policies. 

The Committee supports opportunities for the Commission to assert its authority in the oversight of the AbilityOne program, however, is concerned about language in the cooperative agreements 

between the Commission and the Central Nonprofit Agencies 

(CNAs) requiring CNAs to report to the Commission any meetings 

with key stakeholders, including Congressional members and staff. 

The Committee requests additional information on the justification 

for and necessity of this language. 

Requested Reports.—The Committee continues to request the reports listed under this heading in House Report 115–244. Such reports shall be submitted to the Committee no later than 60 days 

after the end of each fiscal quarter. 

Office of Inspector General.—The Committee recommends not 

less than $1,650,000 for the Office of Inspector General. 

CORPORATION FOR NATIONAL AND COMMUNITY SERVICE

OPERATING EXPENSES

Appropriation, fiscal year 2019 ......................................................... $1,082,958,000 

Budget request, fiscal year 2020 ....................................................... 103,663,000 

Committee Recommendation ............................................................. 1,138,106,000 

Change from enacted level ............................................................. +55,148,000 

Change from budget request .......................................................... +1,034,443 

Volunteers in Service to America 

The Committee recommends $95,000,000 for Volunteers in Service to America (VISTA), which is an increase of $2,636,000 over the 

fiscal year 2019 enacted level and $90,335,000 above the fiscal year 

2020 budget request. This program provides capacity building for 

small, community-based organizations with a mission of combating 

poverty. VISTA members raise resources, recruit, and organize volVerDate Sep 11 2014 06:50 May 16, 2019 Jkt 036295 PO 00000 Frm 00227 Fmt 6659 Sfmt 6602 E:\HR\OC\HR062.XXX HR062
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unteers, and establish and expand programs in housing, employment, health, and economic development. 

National Senior Volunteer Corps 

The Committee recommends $221,517,000 for the National Senior Volunteer Corps programs, which is $13,400,000 more than the 

fiscal year 2019 enacted level and $221,184,000 above the fiscal 

year 2020 budget request. Senior Corps is 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. 

The Committee intends for all funding to be used to support programs and volunteers. The recommendation provides sufficient 

funding to increase the stipend for the Foster Grandparents Program and Senior Companion Program to $3.00/hour for the first 

time. The Committee notes that the last stipend increase to the 

current level of $2.65/hour occurred in 2002. 

The funding breakout by program is as follows: 

National Senior Volunteer Corps: FY 2020 

Committee 

Foster Grandparents Program ........................................................................................................................ $118,799,000 

Senior Companion Program ............................................................................................................................ 50,863,000 

Retired Senior Volunteer Program .................................................................................................................. 51,855,000 

AmeriCorps State and National Grants 

The Committee recommends $450,010,000 for AmeriCorps State 

and National Grants, which is $25,000,000 more than the fiscal 

year 2019 enacted level and $447,786,000 above the fiscal year 

2020 budget request. This program provides funds to local and national organizations and agencies to address community needs in 

education, public safety, health, and the environment. 

Innovation, Assistance, and Other Activities 

The Committee recommends $8,600,000 for Innovation, Assistance, and Other Activities, which is $1,000,000 more than the fiscal 

year 2019 enacted level and $8,600,000 more than the fiscal year 

2020 budget request. 

The Committee acknowledges the value of the Volunteer Generation Fund (VGF) in supporting State service commissions to identify effective approaches to increase the number of volunteers, 

strengthening the capacity of volunteer connector organizations to 

recruit and retain volunteers, and prioritizing support for servicelearning and youth service opportunities from kindergarten to college, and develop strategies to effectively engage volunteers to solve 

local problems. The Committee recommendation includes an additional $1,000,000 for the VGF. 

The Committee continues to support the September 11 National 

Day of Service and Remembrance and the Martin Luther King, Jr. 

National Day of Service—two important national events. 

Evaluation 

The Committee recommends $4,000,000 for evaluation, which is 

the same as the fiscal year 2019 enacted level. The fiscal year 2020 

budget request does not include funding for this purpose and proVerDate Sep 11 2014 06:50 May 16, 2019 Jkt 036295 PO 00000 Frm 00228 Fmt 6659 Sfmt 6602 E:\HR\OC\HR062.XXX HR062
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poses to eliminate the agency. These funds support research on 

program effectiveness. 

National Civilian Community Corps 

The Committee recommends $33,000,000 for National Civilian 

Community Corps, which is $1,000,000 more than the fiscal year 

2019 enacted level and $10,117,000 above the fiscal year 2020 

budget request. This program supports residential, team-based 

service opportunities for individuals aged 18–24. 

State Commission Administrative Grants 

The Committee recommends $17,538,000 for State Commission 

Support Grants, which is the same as the fiscal year 2019 enacted 

level and $17,538,000 above the fiscal year 2020 budget request. 

Funds are used for formula grants to support State oversight of 

service programs. 

PAYMENT TO THE NATIONAL SERVICE TRUST

Appropriation, fiscal year 2019 ......................................................... $206,842,000 

Budget request, fiscal year 2020 ....................................................... 10,000,000 

Committee Recommendation ............................................................. 218,691,000 

Change from enacted level ............................................................. +11,849,000 

Change from budget request .......................................................... +208,691,000 

The National Service Trust makes payments for Segal education 

awards, pays interest that accrues on qualified student loans for 

AmeriCorps participants during terms of service in approved national service positions, and makes other payments entitled to 

members who serve in the programs of the Corporation for National and Community Service. 

SALARIES AND EXPENSES

Appropriation, fiscal year 2019 ......................................................... $83,737,000 

Budget request, fiscal year 2020 ....................................................... 59,300,000 

Committee Recommendation ............................................................. 83,737,000 

Change from enacted level ............................................................. – – – 

Change from budget request .......................................................... +24,437,000 

Evidence-based Grant Making.—The Committee is supportive of 

efforts by the Corporation to consider evidence of effectiveness in 

grant competitions. 

Transformation and Sustainability Plan.—The Committee remains concerned over the Corporation’s plan to drastically alter 

and consolidate 46 State offices into eight regional offices. The 

Committee has heard many concerns from various stakeholders, including Members of Congress, about the hasty implementation of 

the plan and the disruption of support for grantees and services in 

local communities. 

The Committee is deeply concerned that such a significant undertaking is occurring at a time when the fiscal year 2020 budget 

request proposes to eliminate the Corporation, which the Committee rejects. The fiscal years 2019 and 2020 budget requests do 

not provide sufficient explanation or rationale for the restructuring, 

making it difficult to conduct oversight. The Committee notes that 

the Corporation’s OIG also has concerns regarding the Corporation’s capacity to execute the proposed changes in the 18 month 

timeframe and the risks of doing so. In a separate message to the 

226 

Committees on Appropriations regarding the fiscal year 2020 budget request, the OIG stated, ‘‘Aspects of this plan present heightened 

risks of fraud, waste and mismanagement that warrant particularly close oversight.’’ 

The Committee is disappointed that the Corporation is moving 

forward with its regionalization plan despite opposition among 

stakeholders and serious concerns from the OIG. The Committee 

directs the Corporation to cease implementation of the regionalization plan until it participates in meaningful engagement with those 

impacted; conducts a cost-benefit analysis of piloting the regionalization plan compared to full-scale implementation; and, conducts 

an analysis of the impact of State office closures on grantees, current services and staff in each respective State where a closure occurs, including an analysis of whether there is reasonable proximity between each State that has experienced a closure and the 

new regional office serving that State and submits the information, 

including details on further stakeholder engagement, to the Committees on Appropriations within 30 days of enactment of this Act. 

OFFICE OF INSPECTOR GENERAL

Appropriation, fiscal year 2019 ......................................................... $5,750,000 

Budget request, fiscal year 2020 ....................................................... 4,258,000 

Committee Recommendation ............................................................. 6,013,000 

Change from enacted level ............................................................. +263,000 

Change from budget request .......................................................... +1,755,000 

ADMINISTRATIVE PROVISIONS

Sec. 401. The Committee continues a provision requiring CNCS 

to make any significant changes to program requirements or policy 

through rulemaking. 

Sec. 402. The Committee continues a provision related to National Service Trust minimum share requirements. 

Sec. 403. The Committee continues a provision related to donations. 

Sec. 404. The Committee continues a provision related to veterans. 

Sec. 405. The Committee continues a provision related to criminal history background checks. 

Sec. 406. The Committee continues a provision related to 1,200 

hour service positions. 

CORPORATION FOR PUBLIC BROADCASTING

Appropriation, fiscal year 2021 ......................................................... $445,000,000 

Budget request, fiscal year 2022 ....................................................... – – – 

Committee Recommendation ............................................................. 495,000,000 

Change from enacted level ............................................................. +50,000,000 

Change from budget request .......................................................... +495,000,000 

The Committee recommends $495,000,000 as an advance appro- priation for fiscal year 2022, an increase of $50,000,000 over the 

fiscal year 2021 advance. The fiscal year 2020 budget request proposes to eliminate the Corporation for Public Broadcasting (CPB) 

and requests $30,000,000 for this purpose. In addition, the Committee recommendation includes $20,000,000 in fiscal year 2020 for 

continued support of CPB in replacing and upgrading the public 

broadcasting interconnection system and further investing in system-wide infrastructure and services. 

227 

National Minority Consortia.—According to the Public Broadcasting Act, one of the greatest priorities of public broadcasting is 

to address the ‘‘needs of unserved and underserved audiences, particularly children and minorities.’’ Programming that reflects the 

histories and perspectives of diverse racial and ethnic communities 

is a core value and responsibility of public broadcasting, therefore 

the Committee supports continued investment in the National Minority Consortia to help accomplish this goal. 

Continued Access to Public Broadcasting.—The Committee recognizes the importance of continued access to public broadcasting in 

local communities. The Committee encourages federally-funded 

public radio stations to engage in public-private partnerships with 

state and local entities, including nonprofits, in this effort. The 

Committee requests CPB include in its fiscal years 2021/2023 Congressional Budget Justification information on how public private 

partnerships may be used to ensure continued access to public 

broadcasting in underserved areas. 

Historic Preservation.—The Committee encourages the Corporation to provide opportunities for documentaries that promote the 

importance of and educate the public on the historic preservation 

process. 

FEDERAL MEDIATION AND CONCILIATION SERVICE

SALARIES AND EXPENSES

Appropriation, fiscal year 2019 ......................................................... $46,650,000 

Budget request, fiscal year 2020 ....................................................... 47,200,000 

Committee Recommendation ............................................................. 48,200,000 

Change from enacted level ............................................................. +1,550,000 

Change from budget request .......................................................... +1,000,000 

The Federal Mediation and Conciliation Service promotes labormanagement cooperation through mediation and conflict resolution 

services to industry, government agencies, and communities. 

FEDERAL MINE SAFETY AND HEALTH REVIEW COMMISSION

SALARIES AND EXPENSES

Appropriation, fiscal year 2019 ......................................................... $17,184,000 

Budget request, fiscal year 2020 ....................................................... 17,184,000 

Committee Recommendation ............................................................. 17,184,000 

Change from enacted level ............................................................. – – – 

Change from budget request .......................................................... – – – 

The Federal Mine Safety and Health Review Commission is an 

independent adjudicative agency that provides administrative trial 

and appellate review of legal disputes arising under the Federal 

Mine Safety and Health Act of 1977. 

INSTITUTE OF MUSEUM AND LIBRARY SERVICES

OFFICE OF MUSEUM AND LIBRARY SERVICES: GRANTS AND

ADMINISTRATION

Appropriation, fiscal year 2019 ......................................................... $242,000,000 

Budget request, fiscal year 2020 ....................................................... 23,000,000 

Committee Recommendation ............................................................. 267,000,000 

Change from enacted level ............................................................. +25,000,000 

Change from budget request .......................................................... +244,000,000 

228 

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

Budget Activity FY 2020 

Committee 

Library Services Technology Act: 

Grants to States .................................................................................................................................... $177,803,000 

Native American Library Services ......................................................................................................... 5,063,000 

National Leadership: Libraries .............................................................................................................. 13,406,000 

Laura Bush 21st Century Librarian ...................................................................................................... 10,000,000 

Museum Services Act: 

Museums for America ........................................................................................................................... 28,899,000 

Native American/Hawaiian Museum Service ......................................................................................... 1,772,000 

National Leadership: Museums ............................................................................................................. 8,313,000 

African American History and Culture Act: 

Museum Grants for African American History and Culture .................................................................. 2,731,000 

Museum and Library Services Act General Provisions: 

Research, Analysis and Data Collection ............................................................................................... 3,013,000 

Program Administration ................................................................................................................................. 15,000,000 

Library Services and Technology 

The Grants to State Library Agencies program provides funds to 

State Library Administrative Agencies using a population-based 

formula. 

Program Administration 

The Committee recommends $15,000,000 for Program Administration, which is the same as the fiscal year 2019 enacted level. 

The fiscal year 2020 budget request proposes to eliminate IMLS. 

These funds provide administrative and management support for 

all programs administered by IMLS. The Committee also includes 

$3,013,000 for IMLS’ activities in policy, research, and data collection, including functions formerly conducted by the National Commission on Libraries and Information Science. 

Women in the Arts.—The Committee encourages IMLS to provide 

assistance to major, independent, non-profit organizations that are 

qualified to support and whose sole purpose is dedicated to promoting women in the arts. To remain independent, such organizations should be unaffiliated with universities or their museums and 

should have a proven track record of advocating for women in the 

arts through the receipt of private funds. 

Holocaust Education and Survivor Stories.—The Committee acknowledges that preserving and presenting the living memories of 

Holocaust survivors in an interactive format can educate future 

generations about the atrocities of the Holocaust. The Committee 

is aware that the number of survivors in the United States is diminishing every month due to the advanced age of the survivors, 

and studies have shown that memories and understanding of the 

Holocaust are fading from culture. Given the rising trends of hate 

and intolerance, the Committee commends and supports the work 

Museums are doing across the country to preserve the memories 

and to educate the public of the Holocaust. 

Community Wellbeing.—The Committee recognizes the reach and 

impact of libraries and museums in their communities. Programs 

such as the Community Catalyst Initiative, Applying Promising 

Practices for Small Libraries, Museums Inspired, and the Understanding the Social Wellbeing Impacts of the Nation’s Libraries 

and Museums, provide essential and actionable information so that 

229 

more Americans are able to benefit from the economic, social, and 

educational services of museums and libraries. The Committee encourages the Institute of Museum and Library Services to continue 

its essential grantmaking, research, and evaluation activities in a 

manner that improves community wellbeing, especially in rural 

and under-served areas. 

MEDICARE PAYMENT ADVISORY COMMISSION

SALARIES AND EXPENSES

Appropriation, fiscal year 2019 ......................................................... $12,545,000 

Budget request, fiscal year 2020 ....................................................... 12,645,000 

Committee Recommendation ............................................................. 12,645,000 

Change from enacted level ............................................................. +100,000 

Change from budget request .......................................................... – – – 

The Medicare Payment Advisory Commission (MedPAC) is an 

independent agency tasked with advising the Congress on issues 

affecting the Medicare program. In addition to advising on payments to private health plans participating in Medicare and providers in Medicare’s traditional fee-for-service program, MedPAC is 

also responsible for providing analysis on access to care, quality of 

care, and other issues affecting Medicare. 

MEDICAID AND CHIP PAYMENT AND ACCESS COMMISSION

SALARIES AND EXPENSES

Appropriation, fiscal year 2019 ......................................................... $8,480,000 

Budget request, fiscal year 2020 ....................................................... 9,000,000 

Committee Recommendation ............................................................. 8,480,000 

Change from enacted level ............................................................. – – – 

Change from budget request .......................................................... ¥520,000 

The Medicaid and CHIP Payment and Access Commission 

(MACPAC) is an independent agency tasked with advising the Congress on issues affecting Medicaid and the State Children’s Health 

Insurance Program (CHIP). MACPAC conducts policy and data 

analysis on Medicaid and CHIP to support policymakers and support program accountability. 

NATIONAL COUNCIL ON DISABILITY

SALARIES AND EXPENSES

Appropriation, fiscal year 2019 ......................................................... $3,250,000 

Budget request, fiscal year 2020 ....................................................... 3,450,000 

Committee Recommendation ............................................................. 3,450,000 

Change from enacted level ............................................................. +200,000 

Change from budget request. ......................................................... – – – 

The National Council Disability (NCD) is an independent Federal 

agency charged with advising the President, Congress, and other 

Federal agencies regarding policies, programs, practices, and procedures that affect people with disabilities. NCD is comprised of a 

team of Presidential and Congressional appointees, an Executive 

Director appointed by the Chair, and a full-time professional staff. 

230 

NATIONAL LABOR RELATIONS BOARD

SALARIES AND EXPENSES

Appropriation, fiscal year 2019 ......................................................... $274,224,000 

Budget request, fiscal year 2020 ....................................................... 241,550,000 

Committee Recommendation ............................................................. 341,500,000 

Change from enacted level ............................................................. +67,276,000 

Change from budget request .......................................................... +99,950,000 

The National Labor Relations Board (NLRB) is an independent 

agency responsible for enforcing U.S. labor law related to collective 

bargaining and unfair labor practices, including the National Labor 

Relations Act (NLRA) of 1935. 

The Committee is concerned that NLRB field staff have declined 

by 17 percent over just two years. Further, the Committee is concerned that multiple regional director positions remain unfilled. To 

restore the ability of the NLRB to fulfill its statutory mission, the 

Committee provides an increase of $67,276,000 over fiscal year 

2019 and $99,950,000 over the fiscal year 2020 budget request. 

With this increase, the Committee directs the NLRB to hire at 

least 300 additional regional field staff and fill all open regional director positions. 

The Committee is also concerned by questions of conflicts of interest surrounding NLRB board members. The Committee requests 

a report no less than 90 days from the enactment of this Act from 

the NLRB on the findings, recommendations, and implementation 

of its Comprehensive Internal Ethics and Recusal Review, specifically all actions that have been taken to ensure case decisions and 

rulemakings are compliant with all applicable ethics standards and 

any failures to comply with those standards. 

To protect public trust in NLRB’s work and decision-making, the 

Committee directs the board to make board member recusal obligations publicly available within 60 days of the enactment of this Act 

and updated monthly thereafter. In addition, within the funding increase for NLRB, $1,000,000 above amounts provided in fiscal year 

2019 is directed to the NLRB Office of Inspector General (OIG) to 

investigate the process, findings, and recommendations surrounding the board’s comprehensive internal ethics and recusal review. The Committee expects the increase in funds to help support 

an additional FTE to assist with this investigation. 

The Committee is deeply concerned that the current board majority routinely breaks with the NLRB’s traditional practice of providing public notice and an invitation to file briefs before reconsidering significant precedent. To restore public participation in critical NLRB matters and to promote informed-decision making, the 

Board shall immediately resume its long-standing practice of providing public notice and an invitation to file briefs before issuing 

decisions unless, within 90 days of enactment of this Act, it provides a report to the Committees on Appropriations with an explanation of the Board’s current method for deciding to invite public 

notice and briefing. 

On March 13, 2019, the NLRB Office of the General Counsel 

(OGC) issued Operations-Management Memorandum 19–05, which 

discouraged Regional Directors from issuing subpoenas when investigating whether to issue a complaint. The General Counsel has a 

Congressional mandate to investigate unfair labor practices by colVerDate Sep 11 2014 06:50 May 16, 2019 Jkt 036295 PO 00000 Frm 00234 Fmt 6659 Sfmt 6602 E:\HR\OC\HR062.XXX HR062
231 

lecting documentary evidence, summoning witnesses, and taking 

testimony—a statutory responsibility, which includes and often requires the issuance of subpoenas. Therefore, within 90 days of enactment of this Act, the Committee directs the General Counsel, 

along with the Divisions of Operations Management and Legal 

Counsel, to provide the Committees on Appropriations with an impact analysis of the memorandum’s policies on the quality of NLRB 

investigations of charges. 

The Committee is deeply concerned about the impact of Presidential Executive Order 13843 on the judicial independence of administrative law judges (ALJs). The Order eliminates the competitive hiring process for ALJs and has the potential impact of converting independent adjudicators to political appointees, undermining longstanding principles of fair and unbiased consideration 

of matters of vital importance to the American people. ALJs must 

be independent decision-makers and it is the Committee’s expectation that NLRB maintain the highest standards for appointment of 

ALJs. Within 60 days of enactment of this Act, NLRB is directed 

to provide to the Committees on Appropriations and Oversight and 

Government and Reform of the House of Representatives a report 

explaining the process, qualification standards, and criteria used to 

recruit, evaluate and hire ALJs under the executive order. 

The Committee is deeply concerned by several recent decisions 

that weaken workers’ collective bargaining rights. PCC Structurals 

(365 NLRB No. 160; Dec. 15, 2017) allows employers to more easily 

gerrymander union elections by requiring the NLRB to include employees who did not previously express an interest in the union. 

Further, SuperShuttle DRW, (367 NLRB No. 75; Jan. 25, 2019) allows employers to more easily classify their workers as independent contractors instead of employees by deviating from the 

common law standard for determining an employee and instead focusing on whether the worker has ‘‘entrepreneurial opportunity.’’ 

This test has no basis in the NLRA or the common law. In addition, the Committee is concerned by the NLRB’s joint employer proposed rulemaking, which will make it easier for unscrupulous employers to sidestep their legal responsibility to bargain with their 

employees. The Committee strongly urges the NLRB to abandon 

any proposal that weakens workers’ rights while protecting bad actors from liability. The Committee is also deeply concerned that the 

NLRB failed to hold any public hearings as part of its joint employer rulemaking process and strongly urges the Board to do so 

prior to publishing any final rule. 

NATIONAL MEDIATION BOARD

SALARIES AND EXPENSES

Appropriation, fiscal year 2019 ......................................................... $13,800,000 

Budget request, fiscal year 2020 ....................................................... 13,800,000 

Committee Recommendation ............................................................. 15,800,000 

Change from enacted level ............................................................. +2,000,000 

Change from budget request .......................................................... +2,000,000 

The National Mediation Board is an independent agency that coordinates labor-management relations within the U.S. railroads 

and airlines industries. 

232 

The Committee recognizes the continued success of the National 

Mediation Board in mediating collectively bargained contracts in 

the rail and air travel industries. The Committee is concerned that 

there is a lag in mediating cases, increasing the length of time 

cases are being addressed and cleared. The Committee recommends 

an additional $2,000,000 over the fiscal year 2019 enacted level 

and the fiscal year 2020 budget request, of which $1,000,000 is directed for the administration of the agency and its staffing needs. 

The remaining $1,000,000 is to be used specifically to supplement, 

not supplant, existing resources devoted to Section 3 arbitrator salaries and expenses and address the backlog of Section 3 arbitration 

cases at the NMB. The Committee has prioritized these additional 

funds in order to allow the Board to accomplish its statutory mission in a timelier manner. The funding increase is not intended to 

support rulemaking activities or the development of regulatory 

changes. 

OCCUPATIONAL SAFETY AND HEALTH REVIEW

COMMISSION

SALARIES AND EXPENSES

Appropriation, fiscal year 2019 ......................................................... $13,225,000 

Budget request, fiscal year 2020 ....................................................... 13,225,000 

Committee Recommendation ............................................................. 13,225,000 

Change from enacted level ............................................................. – – – 

Change from budget request .......................................................... – – – 

The Occupational Safety and Health Review Commission is an 

independent Federal agency, providing administrative trial and appellate review, created to decide contests of citations or penalties 

resulting from OSHA inspections of American work places. 

RAILROAD RETIREMENT BOARD

DUAL BENEFITS PAYMENTS ACCOUNT

Appropriation, fiscal year 2019 ......................................................... $19,000,000 

Budget request, fiscal year 2020 ....................................................... 16,000,000 

Committee Recommendation ............................................................. 16,000,000 

Change from enacted level ............................................................. ¥3,000,000 

Change from budget request .......................................................... – – – 

This appropriation is authorized by the Railroad Retirement Act 

of 1974 to fund vested dual benefits received by railroad retirees 

who, under prior law, would have become covered by both the railroad retirement system and the Social Security system because 

railroad retirement was not fully coordinated with Social Security 

from 1937 to 1974. The Committee includes a provision permitting 

a portion of these funds to be derived from income tax receipts on 

dual benefits as authorized by law. The Railroad Retirement Board 

estimates that approximately $1,000,000 may be derived in this 

manner. 

FEDERAL PAYMENT TO THE RAILROAD RETIREMENT ACCOUNTS

Appropriation, fiscal year 2019 ......................................................... $150,000 

Budget request, fiscal year 2020 ....................................................... 150,000 

Committee Recommendation ............................................................. 150,000 

Change from enacted level ............................................................. – – – 

Change from budget request .......................................................... – – – 

233 

LIMITATION ON ADMINISTRATION

Appropriation, fiscal year 2019 ......................................................... $123,500,000 

Budget request, fiscal year 2020 ....................................................... 137,216,000 

Committee Recommendation ............................................................. 135,500,000 

Change from enacted level ............................................................. +12,000,000 

Change from budget request .......................................................... ¥1,716,000 

The Committee includes $13,460,000 for the implementation of 

information technology systems modernization efforts. Within 180 

days of enactment of this Act, the Railroad Retirement Board is directed to submit a comprehensive update to the Committees on Appropriations of the House of Representatives and the Senate on 

project status, timelines to completion, and total cost of development. 

LIMITATION ON THE OFFICE OF INSPECTOR GENERAL

Appropriation, fiscal year 2019 ......................................................... $11,000,000 

Budget request, fiscal year 2020 ....................................................... 11,000,000 

Committee Recommendation ............................................................. 11,500,000 

Change from enacted level ............................................................. +500,000 

Change from budget request .......................................................... +500,000 

SOCIAL SECURITY ADMINISTRATION

PAYMENTS TO SOCIAL SECURITY TRUST FUNDS

Appropriation, fiscal year 2019 ......................................................... $11,000,000 

Budget request, fiscal year 2020 ....................................................... 11,000,000 

Committee Recommendation ............................................................. 11,000,000 

Change from enacted level ............................................................. – – – 

Change from budget request .......................................................... – – – 

This appropriation provides reimbursement to the Social Security 

trust funds for non-trust fund activities. 

SUPPLEMENTAL SECURITY INCOME PROGRAM

Appropriation, fiscal year 2019 ......................................................... $41,366,203,000 

Budget request, fiscal year 2020 ....................................................... 41,832,000,000 

Committee Recommendation ............................................................. 41,938,540,000 

Change from enacted level ............................................................. +572,337,000 

Change from budget request .......................................................... +106,540,000 

The Committee recommends $19,900,000,000 in advance funding 

for the first quarter of fiscal year 2021, as requested. 

Research and Demonstration 

Section 1110 of the Social Security Act provides authority to the 

Social Security Administration (SSA) for conducting research and 

demonstration projects related to SSA’s programs. 

Within the appropriation for Supplemental Security Income 

(SSI), the Committee recommends $101,000,000 for research and 

demonstration activities, which is the same as the fiscal year 2019 

enacted level and the fiscal year 2020 budget request. 

Administration 

Within the appropriation for SSI, the Committee recommends 

$4,510,540,000, which is $412,663,000 below the fiscal year 2019 

enacted level and $106,540,000 above the fiscal year 2020 budget 

request. This funding is for payment to the Social Security trust 

funds for SSI’s share of the administrative expenses of SSA. 

234 

LIMITATION ON ADMINISTRATIVE EXPENSES

Appropriation, fiscal year 2019 ......................................................... $11,058,945,000 

Budget request, fiscal year 2020 ....................................................... 11,060,000,000 

Committee Recommendation ............................................................. 11,358,945,000 

Change from enacted level ............................................................. +300,000,000 

Change from budget request .......................................................... +298,945,000 

The Limitation on Administrative Expenses (LAE) funds the administrative and operational costs for administering the Old Age 

and Survivors Insurance, Disability Insurance, and Supplemental 

Security Income programs, and associated costs for support to the 

Centers for Medicare and Medicaid Services in administering their 

programs. The Committee includes an increase of $300,000,000 for additional hires and resources to improve public service at SSA field offices and direct service operations, with $22,000,000 specifically for 

hiring at teleservice center operations. The Committee remains 

concerned about the excessive waiting times, benefit delays, and 

service problems faced every day by Americans who are trying to 

access their earned benefits. It is the Committee’s expectation that 

this funding will be sufficient to replace all losses in the field offices, teleservice and processing centers, and build additional capacity so that offices can function at appropriate levels. 

The Committee acknowledges SSA’s progress in reducing excessive and harmful delays for people waiting for a hearing before an 

Administrative Law Judge and is pleased to hear that SSA is on 

track to eliminate its hearing backlog in fiscal year 2021. This 

progress has been facilitated by $290,000,000 in dedicated funding 

provided in fiscal years 2017 through 2019, and the Committee designates $50,000,000 in this bill for activities that will continue to 

address the disability hearing backlog. 

The bill continues to provide $45,000,000 in dedicated funding 

for Information Technology Modernization. 

Administrative Law Judge Selection.—The Committee is deeply 

concerned about the impact of Presidential Executive Order 13843 

on the judicial independence of administrative law judges (ALJs). 

The Order eliminates the competitive hiring process for ALJs and 

has the potential impact of converting independent adjudicators to 

political appointees, undermining longstanding principles of fair 

and unbiased consideration of matters of vital importance to the 

American people. ALJs must be independent decision-makers and 

it is the Committee’s expectation that SSA maintain the highest 

standards for appointment of ALJs. The Committee directs SSA to 

submit a report within 60 days of enactment of this Act to the 

Committees on Appropriations, Ways and Means, and Oversight 

and Reform, explaining the process, qualification standards, and 

criteria used to recruit, evaluate and hire ALJs under the executive 

order. 

Beneficiary Education.—The Committee recommends SSA include more complete information on the basic coverage decision individuals must make when turning age 65 and enrolling in Medicare. Notifications and informational materials shared with individuals as they become Medicare-eligible or re-enroll in Medicare 

should clearly explain the basic decision that must be made when 

electing Medicare coverage. This information currently presents information on Medicare Parts A and B (or ‘‘Original Medicare’’) but 

235 

falls short in explaining the full options available to beneficiaries 

under Medicare, such as the opportunity to enroll in Part C and 

D, as well as supplemental coverage options (Medigap) should 

beneficiaries select Original Medicare. The Committee also recommends SSA include additional language to clarify the basic coverage options available to individuals provided on its website, 

www.ssa.gov/benefits/medicare and refer beneficiaries to CMS for 

more information on the benefits and limitations of coverage options. 

Collective Bargaining.—The Committee strongly supports the 

rights of federal employees to bargain collectively. Presidential Executive Orders 13836, 13837, and 13839 undermine those rights, 

which is why a Federal court invalidated many provisions of those 

executive orders and enjoined Federal agencies from implementing 

them. The Committee is very concerned about reports that SSA, 

during recent contract negotiations with its union, insisted on proposals that closely resemble the invalidated provisions of the executive orders. The Committee understands that several of the articles 

still in dispute have been referred to the Federal Service Impasses 

Panel (FSIP) and are awaiting a final determination. Within 30 

days of enactment of this Act, the Committee directs SSA to submit 

a report and brief the Committees on Appropriations, Ways and 

Means, and Oversight and Reform on all articles in dispute with 

the unions as of April 16, 2019. The report shall include the modifications SSA made to each of the articles in dispute in order to 

comply with the court order. 

Additionally, it is the Committee’s understanding that parties 

can continue to discuss open matters while awaiting a final determination from FSIP. The Committee directs SSA to do so and to 

engage the Federal Mediation and Conciliation Service (FMCS) in 

order to address these issues through mediation. 

SSA is directed to resume contract negotiations with its union in 

good faith and to present proposals that do not mirror District 

Court discredited provisions of the aforementioned executive orders. If after a reasonable period of good faith bargaining has been 

conducted, FMCS determines that a contract impasse exists, the 

parties will jointly select an independent mediator-arbitrator from 

a list of mediators-artibrators supplied by the FMCS. Such mediator-arbitrator will conduct mediatiion and, if needed, an arbitration hearing with the authority to decide the final contract. 

Headache Disorders.—The Committee supports efforts to ensure 

consistent decision-making with regard to how to appropriately and 

correctly apply the current Listing of Impairments to headache disorders-related impairments. 

Information Technology.—The Committee continues to monitor 

the Information Technology Modernization Plan and remains concerned that while SSA undertakes information technology upgrades 

and improvements, the agency must also maintain an appropriate 

balance between SSA’s various service delivery options. As the 

agency continues to focus on modernizing information technology 

and systems, the Committee strongly encourages SSA to focus on 

enhancements that positively affect service to the public and add 

efficiency to administration of its programs. In addition, the Committee encourages involvement of agency front-line staff, those 

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velopment, testing and deployment. The Committee requests an 

update of the plan referenced under this heading in House Report 

114–699. 

Mailing Paper Statements.—The Committee is concerned that 

SSA is not mailing Social Security benefits and earning statements 

to all contributors aged 25 and older not yet receiving benefits, in 

accordance with Section 1143 of the Social Security Act (42 U.S.C. 

1320b–13). The Administration is directed to brief the Committee 

within 60 days of enactment of this Act on progress to date on implementing the law as written, and to include in its fiscal year 

2021 Congressional Budget Justification an estimate of costs associated with the mailing of paper statements as required by law. 

Muscular Dystrophy.— The Committee requests SSA include in 

the fiscal year 2021 Congressional Budget Justification the rate at 

which persons with Duchenne and Becker Muscular Dystrophy utilize SSA programs, particularly those focused on promoting employment and community independence such as the Ticket to Work 

Program. 

Occupational Information System.—SSA is developing a new Occupational Information System (OIS) that will replace the Dictionary of Occupational Titles as the primary source of occupational 

information used in SSA’s disability adjudication process. The Committee directs SSA to continue to include in its annual Report on 

the Occupational Information System Project the estimated costs 

for each future fiscal year until the project is expected to be completed, as well as the estimated cost for a five-year data refresh 

cycle. 

Pilot Program Metrics.—The Committee appreciates the information on pilot program metrics provided in the fiscal year 2020 Congressional Budget Justification. The Committee expects that, prior 

to undertaking any new pilots, SSA will ensure that it has developed a research design that identifies a clear purpose for the pilot, 

key objectives and an evaluation plan, including adequate metrics 

to determine the pilot’s effectiveness. Metrics should be specific, 

quantifiable measures—accompanied by specific goals for the measures—that can be used to evaluate success. The Committee reminds SSA that it uses the term ‘‘pilot’’ to encompass all efforts to 

test the effects of process changes, including ‘‘initiatives’’ and 

‘‘tests.’’ 

The Committee directs SSA to submit a report to the Committees 

on Appropriations, the Committee on Ways and Means, and the 

Committee on Finance not later than 90 days after the enactment 

of this Act with a description of all pilots conducted in fiscal years 

2019 and 2020, or proposed for fiscal year 2021; the purpose and 

key objectives of each pilot; its start date and timeline; which SSA 

components are involved in the pilot; the evaluation plan; the 

measures or metrics the SSA will use to evaluate the pilot; and a 

specific goal for each metric that will be used to determine the pilot’s effectiveness. Similar information should be provided in the 

fiscal year 2021 Congressional Budget Justification. All SSA pilots 

should be included in the requested report and justification, including those undertaken as part of the Compassionate and Responsive 

Service (CARES) plan and in other parts of the agency. The report 

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237 

grammatic demonstrations, such as those involving changes in program eligibility rules. 

Reconsideration.—The Committee is concerned that SSA is reinstating reconsideration in ten States despite bipartisan, bicameral 

concern about the quality of the reconsideration process and the 

delays it causes, and without any plan to improve decision-making 

at the initial or reconsideration levels. The Committee directs SSA 

to provide a plan to the Committee on Appropriations and the 

Committee on Ways and Means within 180 days of enactment of 

this Act to improve the Disability Determination Services processes, including research topics and potential pilots to improve the 

disability process, including the reconsideration appeal step, to 

help ensure the correct decision is made as early as possible, avoiding the need for eligible individuals to seek a hearing in order to 

receive the benefits for which they are eligible. 

Replacement Card Fees.—The Committee considers the proposal 

to charge a fee to replace a lost or stolen Social Security card incomplete and ill-considered. It is an inappropriate attempt to circumvent the Federal rulemaking process and the agency is directed 

not to move forward with this proposal. 

Report on LAE Expenditures.—The Committee continues to request that the data referenced under this heading in House Report 

114–699 be included in future budget justifications. In addition, the 

Committee requests the fiscal year 2021 Congressional Budget Justification include a historical table of costs and fiscal year 2021 requests for personnel and benefits, by major SSA component to include Operations (field offices, teleservice centers, processing centers, and regional offices); Office of Hearings Operations; Systems; 

Office of Analytics, Review, and Oversight; and Headquarters. 

Social Media.—The Committee is concerned about the proposal 

in the budget request to permit SSA disability adjudicators to use 

social media postings and other Internet-based sources as part of 

evaluating whether the individual meets the disability eligibility 

criteria. The reliability of social media is often low and hard to determine and SSA adjudicators lack the time, resources, and expertise to properly review, evaluate, and corroborate social media 

posts. SSA should not pursue this strategy, but instead continue 

with its existing process of referring cases of suspected fraud to investigators at SSA’s Office of Inspector General, who are trained to 

investigate information found on the Internet or social media and 

corroborate it against other sources. 

Video Hearings.—The Committee is concerned that SSA’s proposal in the Notice of Proposed Rulemaking ‘‘Setting the Manner 

for the Appearance of Parties and Witnesses at a Hearing’’ (83 Fed. 

Reg. 57368, November 15, 2018) eliminates an individual’s right to 

an in-person hearing before an SSA Administrative Law Judge 

(ALJ). This change would deprive millions of Americans of their 

right to due process and could result in hearings which are less fair 

and less efficient. The Committee strongly urges SSA to maintain 

its current policy, which allows claimants to choose to use video 

hearings on a voluntary basis or to have an in-person hearing or 

proceeding if the party chooses to do so. 

Vocational Experts.—The Committee directs SSA to provide an 

update to the Committee on Appropriations and the Committee on 

Ways and Means within 90 days of enactment of this Act on the 

238 

status of its plans to strengthen Vocational Expert (VE) qualification standards and to pay fees that are sufficient to hire VEs with 

the necessary expertise and current knowledge. The Committee directs SSA to ensure that anyone testifying as a vocational expert 

under a Blanket Purchase Agreement meets the qualification 

standards; and explain how SSA’s new fees will reflect VE qualification standards and take into account the fees paid for VE services by other Federal agencies and the private sector. The plan 

should be developed in consultation with knowledgeable stakeholders, including VEs. 

Vocational Factors.—The Committee considers the recent Notice 

of Proposed Rulemaking ‘‘Removing Inability to Communicate in 

English as an Education Category’’ (84 Fed. Reg 1006, February 1, 

2019) to be a harmful and unjustified attempt to deny Social Security and SSI disability benefits to older workers with long-term or 

fatal medical impairments who are severely limited in their functional capacity and who cannot communicate in English. The rule 

does not provide any valid evidence that there is a sufficient occupational base of jobs that this narrow group of severely disabled individuals can perform despite their pervasive limitations. The Committee understands that of the 157 organizations who submitted or 

signed comments, all but one commented in opposition to the rule. 

In light of the harm that would be caused by this policy change, 

the Committee strongly urges SSA to withdraw this proposed rule. 

Social Security Advisory Board 

The Committee recommends $2,400,000 for the Social Security 

Advisory Board (SSAB), equal to the fiscal year 2019 enacted level 

and the fiscal year 2020 budget request. 

User Fees 

In addition to the other amounts provided, the Committee rec- ommends $131,000,000 for administrative activities funded from 

user fees. Of this amount, $130,000,000 is derived from fees collected from States that request SSA to administer State SSI supplementary payments. The remaining $1,000,000 is derived from 

fees charged to non-attorneys who apply for certification to represent claimants under titles II and XVI of the Social Security Act. 

Continuing Disability Reviews and Redeterminations 

The Committee recommends $1,582,000,000 for program integrity activities. This includes the maximum cap adjustment authorized in the Budget Control Act. The Committee continues bill language allowing for the transfer of up to $10,000,000 to the Office 

of the Inspector General for the cost of jointly operating co-operative disability investigation units. 

OFFICE OF THE INSPECTOR GENERAL

Appropriation, fiscal year 2019 ......................................................... $105,500,000 

Budget request, fiscal year 2020 ....................................................... 105,500,000 

Committee Recommendation ............................................................. 105,500,000 

Change from enacted level ............................................................. – – – 

Change from budget request .......................................................... – – – 

The Office of the Inspector General (OIG) is responsible for meeting the statutory mission of promoting economy, efficiency, and efVerDate Sep 11 2014 06:50 May 16, 2019 Jkt 036295 PO 00000 Frm 00242 Fmt 6659 Sfmt 6602 E:\HR\OC\HR062.XXX HR062
239 

fectiveness in the administration of SSA programs and operations 

and to prevent and detect fraud, waste, abuse, and mismanagement in such programs and operations. To accomplish this mission, 

the OIG directs, conducts, and supervises audits, evaluations, and 

investigations relating to SSA’s programs and operations. In addition, the OIG searches for and reports on systemic weaknesses in 

SSA programs and operations, and makes recommendations for 

needed improvements and corrective actions. 

TITLE V—GENERAL PROVISIONS 

(TRANSFER OF FUNDS)

Sec. 501. The Committee continues a provision allowing the Secretaries of Labor, Health and Human Services, and Education to 

transfer unexpended balances of prior appropriations to accounts 

corresponding to current appropriations to be used for the same 

purposes and for the same periods of time for which they were 

originally appropriated. 

Sec. 502. The Committee continues a provision prohibiting the 

obligation of funds beyond the current fiscal year unless expressly 

so provided. 

Sec. 503. The Committee continues a provision prohibiting funds 

from being used to support or defeat legislation. 

Sec. 504. The Committee continues a provision limiting the 

amount available for official reception and representation expenses 

for the Secretaries of Labor and Education, the Director of the Federal Mediation and Conciliation Service, and the Chairman of the 

National Mediation Board. 

Sec. 505. The Committee continues a provision requiring grantees receiving Federal funds to clearly state the percentage of the 

total cost of the program or project that will be financed with Federal money. 

Sec. 506. The Committee continues a provision prohibiting the 

use of federal funds for abortion services. 

Sec. 507. The Committee continues a provision providing exceptions to section 506 if the pregnancy is the result of an act of rape 

or incest, or in the case of a threat to the life of the woman; a provision to clarify that section 506 does not apply to State, locality, 

or private funds; and a provision to ensure that health care entities 

are not required to cover abortion services. 

Sec. 508. The Committee continues a provision prohibiting use of 

funds for certain research involving human embryos. 

Sec. 509. The Committee continues a provision prohibiting use of 

funds for any activity that promotes the legalization of any drug or 

substance included in schedule I of the schedules of controlled substances. 

Sec. 510. The Committee continues a provision prohibiting use of 

funds to promulgate or adopt any final standard providing for a 

unique health identifier until legislation is enacted specifically approving the standard. 

Sec. 511. The Committee continues a provision related to annual 

reports to the Secretary of Labor. 

Sec. 512. The Committee continues a provision prohibiting transfer of funds made available in this Act except by authority provided 

in this Act or another appropriations Act. 

240 

Sec. 513. The Committee continues a provision to limit funds in 

the bill for public libraries to those that comply with the requirements of the Children’s Internet Protection Act. 

Sec. 514. The Committee modifies a provision regarding procedures for reprogramming of funds. 

Sec. 515. The Committee continues a provision pertaining to appointments to scientific advisory committees. 

Sec. 516. The Committee continues a provision requiring each department and related agency funded through this Act to submit an 

operating plan within 45 days of enactment, detailing any funding 

allocations that are different than those specified in this Act, the 

accompanying detailed table, or budget request. 

Sec. 517. The Committee modifies a provision requiring the Secretaries of Labor, Health and Human Services, and Education to 

submit a quarterly report to the Committees on Appropriations 

containing certain information on noncompetitive contracts, grants, 

and cooperative agreements exceeding $500,000 in value. 

Sec. 518. The Committee continues a provision prohibiting the 

use of funds to process claims for credit for quarters of coverage 

based on work performed under a Social Security number that was 

not the claimant’s number, where the performance of such work 

under such number has formed the basis for a conviction of the 

claimant of a violation of section 208(a)(6) or (7) of the Social Security Act. 

Sec. 519. The Committee continues a provision prohibiting the 

use of funds to implement a Social Security totalization agreement 

with Mexico. 

Sec. 520. The Committee continues a provision prohibiting the 

use of funds for the downloading or exchanging of pornography. 

Sec. 521. The Committee continues a provision relating to reporting requirements for conference expenditures. 

Sec. 522. The Committee continues a provision relating to disclosure of U.S. taxpayer funding for programs used in advertising. 

Sec. 523. The Committee modifies a provision relating to performance partnership pilots. 

Sec. 524. The Committee continues provision requesting quarterly reports on the status of balances of appropriations from the 

Departments of Labor, Health and Human Services and Education. 

Sec. 525. The Committee includes a new provision making funds 

from the Children’s Health Insurance Program Performance Bonus 

Fund unavailable for obligation in fiscal year 2020. 

Sec. 526. The Committee includes a new provision requiring that 

H–2B visas be allocated on a quarterly basis, with varying allotments by quarter and in proportion to need in certain circumstances. 

Sec. 527. The Committee includes a new provision prohibiting 

funds from being used to replace or diminish the quality of care 

provide by Medicare Advantage or TRICARE. 

HOUSE OF REPRESENTATIVES REPORTING REQUIREMENTS

The following materials are submitted in accordance with various 

requirements of the Rules of the House of Representatives: 

241 

STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES

Pursuant to clause 3(c)(4) of rule XIII of the Rules of the House 

of Representatives, the following is a statement of general performance goals and objectives for which this measure authorizes funding: The Committee on Appropriations considers program performance, including a program’s success in developing and attaining 

outcome-related goals and objectives, in developing funding recommendations. 

RESCISSION OF FUNDS

Pursuant to clause 3(f)(2) of rule XIII of the Rules of the House 

of Representatives, the following lists the rescissions of unexpended 

balances included in the accompanying bill: 

RESCISSIONS RECOMMENDED IN THE BILL 

Account Amount 

Department of Health and Human Services 

Children’s Health Insurance Program ................................................................................................... $4,300,000,000 

Department of Education 

Pell Grants ............................................................................................................................................. 50,000,000 

TRANSFER OF FUNDS

Pursuant to clause 3(f)(2) of rule XIII of the Rules of the House 

of Representatives, the following lists the transfers of unexpended 

balances included in the accompanying bill: 

TITLE I 

Language is included under ‘‘Job Corps’’ permitting the transfer 

of funds for Job Corps Center construction, rehabilitation and acquisition to meet the operational needs of Job Corps Centers or to 

achieve administrative efficiencies. 

Language is included under ‘‘Special Benefits’’ which provides for 

the transfer of such sums as necessary from the ‘‘Postal Service’’ 

account. 

Language is included under ‘‘Black Lung Disability Trust Fund’’ 

which provides for the transfer of funds to the ‘‘Department of 

Labor, Office of Workers’ Compensation Program, Salaries and Expenses.’’ 

Language is included under ‘‘Black Lung Disability Trust Fund’’ 

which provides for the transfer of funds to the ‘‘Department of 

Labor, Departmental Management, Salaries and Expenses.’’ 

Language is included under ‘‘Black Lung Disability Trust Fund’’ 

which provides for the transfer of funds to the ‘‘Department of 

Labor, Departmental Management, Office of Inspector General.’’ 

Language is included under ‘‘Black Lung Disability Trust Fund’’ 

which provides for the transfer of funds to the ‘‘Department of the 

Treasury.’’ 

Language is included under ‘‘Departmental Management, Salaries and Expenses’’ authorizing the transfer of funds available for 

program evaluation to any other account within the Department to 

carry out evaluation activities. 

A general provision is included permitting up to one percent of 

any discretionary appropriation to be transferred between a proVerDate Sep 11 2014 06:50 May 16, 2019 Jkt 036295 PO 00000 Frm 00245 Fmt 6659 Sfmt 6602 E:\HR\OC\HR062.XXX HR062
242 

gram, project, or activity of the Department of Labor, provided that 

no such program, project, or activity is increased by more than 

three percent by any such transfer. 

A general provision is included that provides for the transfer of 

funds from the ‘‘Employment and Training Administration’’ for 

technical assistance services to grantees to ‘‘Program Administration’’. The provision does not apply to section 171 of the WIOA. The 

general provision also authorizes the transfer of up 0.5 percent of 

each discretionary appropriation for ‘‘Employment and Training 

Administration’’ to carry out program integrity activities subject to 

certain limitations related to ‘‘Job Corps.’’ 

A general provision is included that provides for the transfer of 

up to 0.75 percent of appropriated funds to carry out program evaluations of ‘‘Training and Employment Services’’, ‘‘Job Corps’’, 

‘‘Community Service Employment for Older Americans,’’ ‘‘State Unemployment Insurance and Employment Service Operations’’, ‘‘Employee Benefits Security Administration’’, ‘‘Office of Workers Compensation Programs’’, ‘‘Wage and Hour Division’’, ‘‘Office of Federal 

Contract Compliance Programs’’, ‘‘Office of Labor-Management 

Standards’’, ‘‘Occupational Safety and Health Administration’’, 

‘‘Mine Safety and Health Administration’’, ‘‘Office of Disability Employment Policy’’, funding made available to the ‘‘Bureau of International Labor Affairs’’ and ‘‘Women’s Bureau’’ within the Departmental Management, Salaries and Expenses’’ account, and ‘‘Veterans Employment and Training’’ for use by the Office of the Chief 

Evaluation Officer. 

TITLE II 

Language is included under ‘‘Centers for Disease Control and 

Prevention, Buildings and Facilities’’ to allow the transfer of prior 

year unobligated Individual Learning Account funds to be transferred to this account to carry out the purpose of this account. 

Language is included under ‘‘Centers for Disease Control and 

Prevention, Buildings and Facilities’’ for funds to be transferred 

from the HHS Nonrecurring Expenses Fund. 

Language is included under ‘‘Centers for Disease Control and 

Prevention, CDC-Wide Activities and Program Support’’ for funds 

to be transferred to and merged with the Infectious Disease Rapid 

Response Reserve Fund. 

Language is included under ‘‘National Institutes of Health, Innovation Account’’ to allow the transfer of funds to other Institutes 

and Centers to support activities authorized in the 21st Century 

Cures Act (PL 114–255). 

Language is included under ‘‘Administration for Community Living, Aging and Disability Services Programs’’ for transfer to the 

Secretary of Agriculture to carry out section 311 of the Older Americans Act of 1965. 

A general provision is included that allows not to exceed one percent of any discretionary funds to be transferred between appropriation accounts of the ‘‘Department of Health and Human Services’’, provided that no appropriation account is increased by more 

than three percent by such transfer. 

A general provision is included that allows the transfer of up to 

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243 

stitutes of Health’’ from amounts identified as pertaining to the 

human immunodeficiency virus. 

A general provision is included that allows the transfer of funding determined to be related to the human immunodeficiency virus 

to the ‘‘Office of AIDS Research’’. 

A general provision is included that transfers one percent of the 

amount made available for ‘‘National Research Service Awards’’ at 

the ‘‘National Institutes of Health’’ to the ‘‘Health Resources and 

Services Administration’’. 

A general provision is included to direct the transfer of the ‘‘Prevention and Public Health Fund’’ as specified in the committee report accompanying this Act. 

TITLE III 

A general provision is included that allows not to exceed one percent of any discretionary funds to be transferred between appropriation accounts of the Department of Education, provided that no 

appropriation account is increased by more than three percent by 

such transfer. 

TITLE IV 

Language is included under Payment to the National Service 

Trust authorizing the transfer of funds from the ‘‘Corporation for 

National and Community Service, Operating Expenses’’ to support 

the activities of national service participants. 

Language is included under ‘‘Social Security Administration’’ authorizing the transfer funds from the Social Security Administration’s ‘‘Limitation on Administration Expenses’’ account to be available for purposes of the Office of Inspector General. 

TITLE V 

A general provision is included that allows the Secretaries of 

Labor, Health and Human Services, and Education to transfer balances of prior appropriation to accounts corresponding to current 

appropriations. 

DISCLOSURE OF EARMARKS AND CONGRESSIONALLY DIRECTED

SPENDING ITEMS

Neither the bill nor the report contains any Congressional earmarks, limited tax benefits, or limited tariff benefits as defined in 

clause 9 of rule XXI. 

COMPLIANCE WITH RULE XIII, CL. 3(e) (RAMSEYER RULE) 

In compliance with clause 3(e) of rule XIII of the Rules of the 

House of Representatives, changes in existing law made by the bill, 

as reported, are shown as follows (existing law proposed to be omitted is enclosed in black brackets, new matter is printed in italics, 

existing law in which no change is proposed is shown in roman): 

HIGHER EDUCATION ACT OF 1965 

* * * * * * * 

244 

TITLE I—GENERAL PROVISIONS 

* * * * * * * 

PART B—ADDITIONAL GENERAL PROVISIONS 

* * * * * * * 

SEC. 114. NATIONAL ADVISORY COMMITTEE ON INSTITUTIONAL QUALITY AND INTEGRITY. 

(a) ESTABLISHMENT.—There is established in the Department a 

National Advisory Committee on Institutional Quality and Integrity (in this section referred to as the ‘‘Committee’’) to assess the 

process of accreditation and the institutional eligibility and certification of institutions of higher education (as defined in section 102) 

under title IV. 

(b) MEMBERSHIP.— (1) IN GENERAL.—The Committee shall have 18 members, of 

which— 

(A) six members shall be appointed by the Secretary; 

(B) six members shall be appointed by the Speaker of 

the House of Representatives, three of whom shall be appointed on the recommendation of the majority leader of 

the House of Representatives, and three of whom shall be 

appointed on the recommendation of the minority leader of 

the House of Representatives; and 

(C) six members shall be appointed by the President pro 

tempore of the Senate, three of whom shall be appointed 

on the recommendation of the majority leader of the Senate, and three of whom shall be appointed on the recommendation of the minority leader of the Senate. 

(2) QUALIFICATIONS.—Individuals shall be appointed as 

members of the Committee— 

(A) on the basis of the individuals’ experience, integrity, 

impartiality, and good judgment; 

(B) from among individuals who are representatives of, 

or knowledgeable concerning, education and training beyond secondary education, representing all sectors and 

types of institutions of higher education (as defined in section 102); and 

(C) on the basis of the individuals’ technical qualifications, professional standing, and demonstrated knowledge 

in the fields of accreditation and administration in higher 

education. 

(3) TERMS OF MEMBERS.—Except as provided in paragraph 

(5), the term of office of each member of the Committee shall 

be for six years, except that any member appointed to fill a vacancy occurring prior to the expiration of the term for which 

the member’s predecessor was appointed shall be appointed for 

the remainder of such term. 

(4) VACANCY.—A vacancy on the Committee shall be filled in 

the same manner as the original appointment was made not 

later than 90 days after the vacancy occurs. If a vacancy occurs 

in a position to be filled by the Secretary, the Secretary shall 

publish a Federal Register notice soliciting nominations for the 

245 

position not later than 30 days after being notified of the vacancy. 

(5) INITIAL TERMS.—The terms of office for the initial members of the Committee shall be— 

(A) three years for members appointed under paragraph 

(1)(A); 

(B) four years for members appointed under paragraph 

(1)(B); and 

(C) six years for members appointed under paragraph 

(1)(C). 

(6) CHAIRPERSON.—The members of the Committee shall select a chairperson from among the members. 

(c) FUNCTIONS.—The Committee shall— 

(1) advise the Secretary with respect to establishment and 

enforcement of the standards of accrediting agencies or associations under subpart 2 of part H of title IV; 

(2) advise the Secretary with respect to the recognition of a 

specific accrediting agency or association; 

(3) advise the Secretary with respect to the preparation and 

publication of the list of nationally recognized accrediting agencies and associations; 

(4) advise the Secretary with respect to the eligibility and 

certification process for institutions of higher education under 

title IV, together with recommendations for improvements in 

such process; 

(5) advise the Secretary with respect to the relationship between— 

(A) accreditation of institutions of higher education and 

the certification and eligibility of such institutions; and 

(B) State licensing responsibilities with respect to such 

institutions; and 

(6) carry out such other advisory functions relating to accreditation and institutional eligibility as the Secretary may prescribe by regulation. 

(d) MEETING PROCEDURES.— 

(1) SCHEDULE.— 

(A) BIANNUAL MEETINGS.—The Committee shall meet not 

less often than twice each year, at the call of the Chairperson. 

(B) PUBLICATION OF DATE.—The Committee shall submit 

the date and location of each meeting in advance to the 

Secretary, and the Secretary shall publish such information in the Federal Register not later than 30 days before 

the meeting. 

(2) AGENDA.— 

(A) ESTABLISHMENT.—The agenda for a meeting of the 

Committee shall be established by the Chairperson and 

shall be submitted to the members of the Committee upon 

notification of the meeting. 

(B) OPPORTUNITY FOR PUBLIC COMMENT.—The agenda 

shall include, at a minimum, opportunity for public comment during the Committee’s deliberations. 

(3) SECRETARY’S DESIGNEE.—The Secretary shall designate 

an employee of the Department to serve as the Secretary’s desVerDate Sep 11 2014 06:50 May 16, 2019 Jkt 036295 PO 00000 Frm 00249 Fmt 6659 Sfmt 6601 E:\HR\OC\HR062.XXX HR062
246 

ignee to the Committee, and the Chairperson shall invite the 

Secretary’s designee to attend all meetings of the Committee. 

(4) FEDERAL ADVISORY COMMITTEE ACT.—The Federal Advisory Committee Act (5 U.S.C. App.) shall apply to the Committee, except that section 14 of such Act shall not apply. 

(e) REPORT AND NOTICE.— (1) NOTICE.—The Secretary shall annually publish in the 

Federal Register— 

(A) a list containing, for each member of the Committee— 

(i) the member’s name; 

(ii) the date of the expiration of the member’s term 

of office; and 

(iii) the name of the individual described in subsection (b)(1) who appointed the member; and 

(B) a solicitation of nominations for each expiring term 

of office on the Committee of a member appointed by the 

Secretary. 

(2) REPORT.—Not later than the last day of each fiscal year, 

the Committee shall make available an annual report to the 

Secretary, the authorizing committees, and the public. The annual report shall contain— 

(A) a detailed summary of the agenda and activities of, 

and the findings and recommendations made by, the Committee during the fiscal year preceding the fiscal year in 

which the report is made; 

(B) a list of the date and location of each meeting during 

the fiscal year preceding the fiscal year in which the report 

is made; 

(C) a list of the members of the Committee; and 

(D) a list of the functions of the Committee, including 

any additional functions established by the Secretary 

through regulation. 

(f) TERMINATION.—The Committee shall terminate on September 

30, ø2019¿ 2020. 

* * * * * * * 

TITLE IV—STUDENT ASSISTANCE 

PART A—GRANTS TO STUDENTS IN ATTENDANCE AT INSTITUTIONS OF

HIGHER EDUCATION

* * * * * * * 

Subpart 1—Federal Pell Grants 

SEC. 401. FEDERAL PELL GRANTS: AMOUNT AND DETERMINATIONS; 

APPLICATIONS. 

(a) PROGRAM AUTHORITY AND METHOD OF DISTRIBUTION.—(1) For 

each fiscal year through fiscal year 2017, the Secretary shall pay 

to each eligible institution such sums as may be necessary to pay 

to each eligible student (defined in accordance with section 484) for 

each academic year during which that student is in attendance at 

an institution of higher education, as an undergraduate, a Federal 

Pell Grant in the amount for which that student is eligible, as deVerDate Sep 11 2014 06:50 May 16, 2019 Jkt 036295 PO 00000 Frm 00250 Fmt 6659 Sfmt 6601 E:\HR\OC\HR062.XXX HR062
247 

termined pursuant to subsection (b). Not less than 85 percent of 

such sums shall be advanced to eligible institutions prior to the 

start of each payment period and shall be based upon an amount 

requested by the institution as needed to pay eligible students until 

such time as the Secretary determines and publishes in the Federal 

Register with an opportunity for comment, an alternative payment 

system that provides payments to institutions in an accurate and 

timely manner, except that this sentence shall not be construed to 

limit the authority of the Secretary to place an institution on a reimbursement system of payment. 

(2) Nothing in this section shall be interpreted to prohibit the 

Secretary from paying directly to students, in advance of the beginning of the academic term, an amount for which they are eligible, 

in cases where the eligible institution elects not to participate in 

the disbursement system required by paragraph (1). 

(3) Grants made under this subpart shall be known as ‘‘Federal 

Pell Grants’’. 

(b) PURPOSE AND AMOUNT OF GRANTS.—(1) The purpose of this 

subpart is to provide a Federal Pell Grant that in combination with 

reasonable family and student contribution and supplemented by 

the programs authorized under subparts 3 and 4 of this part, will 

meet at least 75 percent of a student’s cost of attendance (as defined in section 472), unless the institution determines that a 

greater amount of assistance would better serve the purposes of 

this section. 

(2) 

(A) The amount of the Federal Pell Grant for a student eligible under this part shall be— 

(i) the maximum Federal Pell Grant, as specified in the 

last enacted appropriation Act applicable to that award 

year, plus 

(ii) the amount of the increase calculated under paragraph (7)(B) for that year, less 

(iii) an amount equal to the amount determined to be 

the expected family contribution with respect to that student for that year. 

(B) In any case where a student attends an institution of higher 

education on less than a full-time basis (including a student who 

attends an institution of higher education on less than a half-time 

basis) during any academic year, the amount of the Federal Pell 

Grant to which that student is entitled shall be reduced in proportion to the degree to which that student is not so attending on a 

full-time basis, in accordance with a schedule of reductions established by the Secretary for the purposes of this division, computed 

in accordance with this subpart. Such schedule of reductions shall 

be established by regulation and published in the Federal Register 

in accordance with section 482 of this Act. 

(3) No Federal Pell Grant under this subpart shall exceed the difference between the expected family contribution for a student and 

the cost of attendance (as defined in section 472) at the institution 

at which that student is in attendance. If, with respect to any student, it is determined that the amount of a Federal Pell Grant plus 

the amount of the expected family contribution for that student exceeds the cost of attendance for that year, the amount of the Federal Pell Grant shall be reduced until the combination of expected 

248 

family contribution and the amount of the Federal Pell Grant does 

not exceed the cost of attendance at such institution. 

(4) No Federal Pell Grant shall be awarded to a student under 

this subpart if the amount of that grant for that student as determined under this subsection for any academic year is less than ten 

percent of the maximum amount of a Federal Pell Grant award determined under paragraph (2)(A) for such academic year. 

(5) Notwithstanding any other provision of this subpart, the Secretary shall allow the amount of the Federal Pell Grant to be exceeded for students participating in a program of study abroad approved for credit by the institution at which the student is enrolled 

when the reasonable costs of such program are greater than the 

cost of attendance at the student’s home institution, except that the 

amount of such Federal Pell Grant in any fiscal year shall not exceed the maximum amount of a Federal Pell Grant award determined under paragraph (2)(A), for which a student is eligible during such award year. If the preceding sentence applies, the financial aid administrator at the home institution may use the cost of 

the study abroad program, rather than the home institution’s cost, 

to determine the cost of attendance of the student. 

(6) No Federal Pell Grant shall be awarded under this subpart 

to any individual who is incarcerated in any Federal or State penal 

institution or who is subject to an involuntary civil commitment 

upon completion of a period of incarceration for a forcible or nonforcible sexual offense (as determined in accordance with the Federal Bureau of Investigation’s Uniform Crime Reporting Program). 

(7) ADDITIONAL FUNDS.— (A) IN GENERAL.—There are authorized to be appropriated, and there are appropriated (in addition to any 

other amounts appropriated to carry out this section and 

out of any money in the Treasury not otherwise appropriated) the following amounts— (i) $2,030,000,000 for fiscal year 2008; 

(ii) $2,090,000,000 for fiscal year 2009; 

(iii) to carry out subparagraph (B) of this paragraph, 

such sums as may be necessary for fiscal year 2010 

and each subsequent fiscal year to provide the amount 

of increase of the maximum Federal Pell Grant required by clauses (ii) and (iii) of subparagraph (B); and 

(iv) to carry out this section— 

(I) $13,500,000,000 for fiscal year 2011; 

(II) $13,795,000,000 for fiscal year 2012; 

(III) $7,587,000,000 for fiscal year 2013; 

(IV) $588,000,000 for fiscal year 2014; 

(V) $0 for fiscal year 2015; 

(VI) $0 for fiscal year 2016; 

(VII) $1,320,000,000 for fiscal year 2017; 

(VIII) $1,334,000,000 for fiscal year 2018; 

(IX) $1,370,000,000 for fiscal year 2019; 

(X) ø$1,430,000,000¿ $1,380,000,000 for fiscal 

year 2020; and 

(XI) $1,145,000,000 for fiscal year 2021 and 

each succeeding fiscal year. 

(B) INCREASE IN FEDERAL PELL GRANTS.—The amounts 

made available pursuant to clauses (i) through (iii) of subVerDate Sep 11 2014 06:50 May 16, 2019 Jkt 036295 PO 00000 Frm 00252 Fmt 6659 Sfmt 6601 E:\HR\OC\HR062.XXX HR062
249 

paragraph (A) of this paragraph shall be used to increase 

the amount of the maximum Federal Pell Grant for which 

a student shall be eligible during an award year, as specified in the last enacted appropriation Act applicable to 

that award year, by— (i) $490 for each of the award years 2008–2009 and 

2009–2010; 

(ii) $690 for each of the award years 2010–2011, 

2011–2012, and 2012–2013; and 

(iii) the amount determined under subparagraph (C) 

for each succeeding award year. 

(C) ADJUSTMENT AMOUNTS.— 

(i) AWARD YEAR 2013–2014.—For award year 2013– 

2014, the amount determined under this subparagraph for purposes of subparagraph (B)(iii) shall be 

equal to— 

(I) $5,550 or the total maximum Federal Pell 

Grant for the preceding award year (as determined under clause (iv)(II)), whichever is greater, 

increased by a percentage equal to the annual adjustment percentage for award year 2013–2014, 

reduced by 

(II) $4,860 or the maximum Federal Pell Grant 

for which a student was eligible for the preceding 

award year, as specified in the last enacted appropriation Act applicable to that year, whichever is 

greater; and 

(III) rounded to the nearest $5. 

(ii) AWARD YEARS 2014–2015 THROUGH 2017–2018.—For 

each of the award years 2014–2015 through 2017– 

2018, the amount determined under this subparagraph for purposes of subparagraph (B)(iii) shall be 

equal to— 

(I) the total maximum Federal Pell Grant for 

the preceding award year (as determined under 

clause (iv)(II)), increased by a percentage equal to 

the annual adjustment percentage for the award 

year for which the amount under this subparagraph is being determined, reduced by (II) $4,860 or the maximum Federal Pell Grant 

for which a student was eligible for the preceding 

award year, as specified in the last enacted appropriation Act applicable to that year, whichever is 

greater; and (III) rounded to the nearest $5. 

(iii) SUBSEQUENT AWARD YEARS.—For award year 

2018–2019 and each subsequent award year, the 

amount determined under this subparagraph for purposes of subparagraph (B)(iii) shall be equal to the 

amount determined under clause (ii) for award year 

2017–2018. 

(iv) DEFINITIONS.—For purposes of this subparagraph— 

(I) the term ‘‘annual adjustment percentage’’ as 

applied to an award year, is equal to the estiVerDate Sep 11 2014 06:50 May 16, 2019 Jkt 036295 PO 00000 Frm 00253 Fmt 6659 Sfmt 6601 E:\HR\OC\HR062.XXX HR062
250 

mated percentage change in the Consumer Price 

Index (as determined by the Secretary, using the 

definition in section 478(f)) for the most recent 

calendar year ending prior to the beginning of 

that award year; and 

(II) the term ‘‘total maximum Federal Pell 

Grant’’ as applied to a preceding award year, is 

equal to the sum of— 

(aa) the maximum Federal Pell Grant for 

which a student is eligible during an award 

year, as specified in the last enacted appropriation Act applicable to that preceding 

award year; and 

(bb) the amount of the increase in the maximum Federal Pell Grant required by this 

paragraph for that preceding award year. 

(D) PROGRAM REQUIREMENTS AND OPERATIONS OTHERWISE UNAFFECTED.—Except as provided in subparagraphs 

(B) and (C), nothing in this paragraph shall be construed 

to alter the requirements and operations of the Federal 

Pell Grant Program as authorized under this section, or 

authorize the imposition of additional requirements or operations for the determination and allocation of Federal 

Pell Grants under this section. 

(E) RATABLE INCREASES AND DECREASES.—The amounts 

specified in subparagraph (B) shall be ratably increased or 

decreased to the extent that funds available under subparagraph (A) exceed or are less than (respectively) the 

amount required to provide the amounts specified in subparagraph (B). 

(F) AVAILABILITY OF FUNDS.—The amounts made available by subparagraph (A) for any fiscal year shall be available beginning on October 1 of that fiscal year, and shall 

remain available through September 30 of the succeeding 

fiscal year. 

(8)(A) Effective in the 2017–2018 award year and thereafter, 

the Secretary shall award an eligible student not more than 

one and one-half Federal Pell Grants during a single award 

year to permit such student to work toward completion of an 

eligible program if, during that single award year, the student— 

(i) has received a Federal Pell Grant for an award 

year and is enrolled in an eligible program for one or 

more additional payment periods during the same 

award year that are not otherwise fully covered by the 

student’s Federal Pell Grant; and 

(ii) is enrolled on at least a half-time basis while receiving any funds under this section. 

(B) In the case of a student receiving more than one 

Federal Pell Grant in a single award year under subparagraph (A), the total amount of Federal Pell Grants awarded to such student for the award year may exceed the 

maximum basic grant level specified in the appropriate appropriations Act for such award year. 

251 

(C) Any period of study covered by a Federal Pell Grant 

awarded under subparagraph (A) shall be included in determining a student’s duration limit under subsection 

(c)(5). 

(D) In any case where an eligible student is receiving a 

Federal Pell Grant for a payment period that spans two 

award years, the Secretary shall allow the eligible institution in which the student is enrolled to determine the 

award year to which the additional period shall be assigned, as it determines is most beneficial to students. 

(c) PERIOD OF ELIGIBILITY FOR GRANTS.—(1) The period during 

which a student may receive Federal Pell Grants shall be the period required for the completion of the first undergraduate baccalaureate course of study being pursued by that student at the institution at which the student is in attendance except that any period 

during which the student is enrolled in a noncredit or remedial 

course of study as defined in paragraph (2) shall not be counted for 

the purpose of this paragraph. 

(2) Nothing in this section shall exclude from eligibility courses 

of study which are noncredit or remedial in nature (including 

courses in English language instruction) which are determined by 

the institution to be necessary to help the student be prepared for 

the pursuit of a first undergraduate baccalaureate degree or certificate or, in the case of courses in English language instruction, to 

be necessary to enable the student to utilize already existing 

knowledge, training, or skills. Nothing in this section shall exclude 

from eligibility programs of study abroad that are approved for 

credit by the home institution at which the student is enrolled. 

(3) No student is entitled to receive Pell Grant payments concurrently from more than one institution or from the Secretary and an 

institution. 

(4) Notwithstanding paragraph (1), the Secretary may allow, on 

a case-by-case basis, a student to receive a basic grant if the student— 

(A) is carrying at least one-half the normal full-time work 

load for the course of study the student is pursuing, as determined by the institution of higher education; and 

(B) is enrolled or accepted for enrollment in a 

postbaccalaureate program that does not lead to a graduate degree, and in courses required by a State in order for the student to receive a professional certification or licensing credential that is required for employment as a teacher in an elementary school or secondary school in that State, 

except that this paragraph shall not apply to a student who is enrolled in an institution of higher education that offers a baccalaureate degree in education. 

(5) 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 received a Federal Pell Grant for a term but was enrolled at a fraction of fulltime, that only that same fraction of such semester or equivalent 

shall count towards such duration limits. 

252 

(d) APPLICATIONS FOR GRANTS.—(1) The Secretary shall from 

time to time set dates by which students shall file applications for 

Federal Pell Grants under this subpart. 

(2) Each student desiring a Federal Pell Grant for any year shall 

file an application therefor containing such information and assurances as the Secretary may deem necessary to enable the Secretary 

to carry out the functions and responsibilities of this subpart. 

(e) DISTRIBUTION OF GRANTS TO STUDENTS.—Payments under 

this section shall be made in accordance with regulations promulgated by the Secretary for such purpose, in such manner as will 

best accomplish the purpose of this section. Any disbursement allowed to be made by crediting the student’s account shall be limited to tuition and fees and, in the case of institutionally owned 

housing, room and board. The student may elect to have the institution provide other such goods and services by crediting the student’s account. 

(f) CALCULATION OF ELIGIBILITY.—(1) Each contractor processing 

applications for awards under this subpart (including a central 

processor, if any, designated by the Secretary) shall, in a timely 

manner, furnish to the student financial aid administrator (at each 

institution of higher education which a student awarded a Federal 

Pell Grant under this subpart is attending), as a part of its regular 

output document, the expected family contribution for each such 

student. Each such student financial aid administrator shall— 

(A) examine and assess the data used to calculate the expected family contribution of the student furnished pursuant to 

this subsection; 

(B) recalculate the expected family contribution of the student if there has been a change in circumstances of the student 

or in the data submitted; 

(C) make the award to the student in the correct amount; 

and 

(D) after making such award report the corrected data to 

such contractor and to a central processor (if any) designated 

by the Secretary for a confirmation of the correct computation 

of amount of the expected family contribution for each such 

student. 

(2) Whenever a student receives an award under this subpart 

that, due to recalculation errors by the institution of higher education, is in excess of the amount which the student is entitled to 

receive under this subpart, such institution of higher education 

shall pay to the Secretary the amount of such excess unless such 

excess can be resolved in a subsequent disbursement to the institution. 

(3) Each contractor processing applications for awards under this 

subpart shall for each academic year after academic year 1986– 

1987 prepare and submit a report to the Secretary on the correctness of the computations of amount of the expected family contribution, and on the accuracy of the questions on the application form 

under this subpart for the previous academic year for which the 

contractor is responsible. The Secretary shall transmit the report, 

together with the comments and recommendations of the Secretary, 

to the Committee on Appropriations of the Senate, the Committee 

on Appropriations of the House of Representatives, and the authorizing committees. 

253 

(g) INSUFFICIENT APPROPRIATIONS.—If, for any fiscal year, the 

funds appropriated for payments under this subpart are insufficient to satisfy fully all entitlements, as calculated under subsection (b) (but at the maximum grant level specified in such appropriation), the Secretary shall promptly transmit a notice of such 

insufficiency to each House of the Congress, and identify in such 

notice the additional amount that would be required to be appropriated to satisfy fully all entitlements (as so calculated at such 

maximum grant level). 

(h) USE OF EXCESS FUNDS.—(1) If, at the end of a fiscal year, the 

funds available for making payments under this subpart exceed the 

amount necessary to make the payments required under this subpart to eligible students by 15 percent or less, then all of the excess 

funds shall remain available for making payments under this subpart during the next succeeding fiscal year. 

(2) If, at the end of a fiscal year, the funds available for making 

payments under this subpart exceed the amount necessary to make 

the payments required under this subpart to eligible students by 

more than 15 percent, then all of such funds shall remain available 

for making such payments but payments may be made under this 

paragraph only with respect to entitlements for that fiscal year. 

(i) TREATMENT OF INSTITUTIONS AND STUDENTS UNDER OTHER

LAWS.—Any institution of higher education which enters into an 

agreement with the Secretary to disburse to students attending 

that institution the amounts those students are eligible to receive 

under this subpart shall not be deemed, by virtue of such agreement, a contractor maintaining a system of records to accomplish 

a function of the Secretary. Recipients of Pell Grants shall not be 

considered to be individual grantees for purposes of subtitle D of 

title V of Public Law 100–690. 

(j) INSTITUTIONAL INELIGIBILITY BASED ON DEFAULT RATES.— (1) IN GENERAL.—No institution of higher education shall be 

an eligible institution for purposes of this subpart if such institution of higher education is ineligible to participate in a loan 

program under part B or D as a result of a final default rate 

determination made by the Secretary under part B or D after 

the final publication of cohort default rates for fiscal year 1996 

or a succeeding fiscal year. 

(2) SANCTIONS SUBJECT TO APPEAL OPPORTUNITY.—No institution may be subject to the terms of this subsection unless the 

institution has had the opportunity to appeal the institution’s 

default rate determination under regulations issued by the 

Secretary for the loan program authorized under part B or D, 

as applicable. This subsection shall not apply to an institution 

that was not participating in the loan program authorized 

under part B or D on the date of enactment of the Higher Education Amendments of 1998, unless the institution subsequently participates in the loan programs. 

* * * * * * * 

PART D—WILLIAM D. FORD FEDERAL DIRECT 

LOAN PROGRAM 

* * * * * * * 

254 

SEC. 458. FUNDS FOR ADMINISTRATIVE EXPENSES. 

(a) ADMINISTRATIVE EXPENSES.— 

(1) MANDATORY FUNDS FOR FISCAL YEAR 2006.—For fiscal year 

2006, there shall be available to the Secretary, from funds not 

otherwise appropriated, funds to be obligated for— 

(A) administrative costs under this part and part B, including the costs of the direct student loan programs under 

this part; and 

(B) account maintenance fees payable to guaranty agencies under part B and calculated in accordance with subsections (b) and (c), 

not to exceed (from such funds not otherwise appropriated) 

$820,000,000 in fiscal year 2006. 

(3) AUTHORIZATION FOR ADMINISTRATIVE COSTS BEGINNING IN

FISCAL YEARS 2007 THROUGH 2014.—For each of the fiscal years 

2007 through 2014, there are authorized to be appropriated 

such sums as may be necessary for administrative costs under 

this part and part B, including the costs of the direct student 

loan programs under this part. 

(4) CONTINUING MANDATORY FUNDS FOR ACCOUNT MAINTENANCE FEES.—For each of the fiscal years 2007 through ø2019¿ 

2020, 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). 

(5) ACCOUNT MAINTENANCE FEES.—Account maintenance fees 

under paragraph (3) shall be paid quarterly and deposited in 

the Agency Operating Fund established under section 422B. 

(6) TECHNICAL ASSISTANCE TO INSTITUTIONS OF HIGHER EDUCATION.— 

(A) PROVISION OF ASSISTANCE.—The Secretary shall provide institutions of higher education participating, or seeking to participate, in the loan programs under this part 

with technical assistance in establishing and administering such programs. 

(B) FUNDS.—There are authorized to be appropriated, 

and there are appropriated, to carry out this paragraph (in 

addition to any other amounts appropriated to carry out 

this paragraph and out of any money in the Treasury not 

otherwise appropriated), $50,000,000 for fiscal year 2010. 

(C) DEFINITION.—In this paragraph, the term ‘‘assistance’’ means the provision of technical support, training, 

materials, technical assistance, and financial assistance. 

(7) ADDITIONAL PAYMENTS.— 

(A) PROVISION OF ASSISTANCE.—The Secretary shall provide payments to loan servicers for retaining jobs at locations in the United States where such servicers were operating under part B on January 1, 2010. 

(B) FUNDS.—There are authorized to be appropriated, 

and there are appropriated, to carry out this paragraph (in 

addition to any other amounts appropriated to carry out 

this paragraph and out of any money in the Treasury not 

otherwise appropriated), $25,000,000 for each of the fiscal 

years 2010 and 2011. 

255 

(8) CARRYOVER.—The Secretary may carry over funds made 

available under this section to a subsequent fiscal year. 

(b) CALCULATION BASIS.—Account maintenance fees payable to 

guaranty agencies under subsection (a)(4) shall be calculated on 

the basis of 0.06 percent of the original principal amount of outstanding loans on which insurance was issued under part B. 

(c) BUDGET JUSTIFICATION.—No funds may be expended under 

this section unless the Secretary includes in the Department of 

Education’s annual budget justification to Congress a detailed description of the specific activities for which the funds made available by this section have been used in the prior and current years 

(if applicable), the activities and costs planned for the budget year, 

and the projection of activities and costs for each remaining year 

for which administrative expenses under this section are made 

available. 

* * * * * * * 

IMMIGRATION AND NATIONALITY ACT 

* * * * * * * 

TITLE II—IMMIGRATION 

* * * * * * * 

CHAPTER 2—QUALIFICATIONS FOR ADMISSION OF ALIENS; TRAVEL

CONTROL OF CITIZENS AND ALIENS

* * * * * * * 

ADMISSION OF NONIMMIGRANTS

SEC. 214. (a)(1) The admission to the United States of any alien 

as a nonimmigrant shall be for such time and under such conditions as the Attorney General may by regulations prescribe, including when he deems necessary the giving of a bond with sufficient 

surety in such sum and containing such conditions as the Attorney 

General shall prescribe, to insure that at the expiration of such 

time or upon failure to maintain the status under which he was admitted, or to maintain any status subsequently acquired under section 248, such alien will depart from the United States. No alien 

admitted to Guam or the Commonwealth of the Northern Mariana 

Islands without a visa pursuant to section 212(l) may be authorized 

to enter or stay in the United States other than in Guam or the 

Commonwealth of the Northern Mariana Islands or to remain in 

Guam or the Commonwealth of the Northern Mariana Islands for 

a period exceeding 45 days from date of admission to Guam or the 

Commonwealth of the Northern Mariana Islands. No alien admitted to the United States without a visa pursuant to section 217 

may be authorized to remain in the United States as a nonimmigrant visitor for a period exceeding 90 days from the date of 

admission. 

(2)(A) The period of authorized status as a nonimmigrant described in section 101(a)(15)(O) shall be for such period as the Attorney General may specify in order to provide for the event (or 

events) for which the nonimmigrant is admitted. 

256 

(B) The period of authorized status as a nonimmigrant described 

in section 101(a)(15)(P) shall be for such period as the Attorney 

General may specify in order to provide for the competition, event, 

or performance for which the nonimmigrant is admitted. In the 

case of nonimmigrants admitted as individual athletes under section 101(a)(15)(P), the period of authorized status may be for an 

initial period (not to exceed 5 years) during which the nonimmigrant will perform as an athlete and such period may be extended by the Attorney General for an additional period of up to 

5 years. 

(b) Every alien (other than a nonimmigrant described in subparagraph (L) or (V) of section 101(a)(15), and other than a nonimmigrant described in any provision of section 101(a)(15)(H)(i) except subclause (b1) of such section) shall be presumed to be an immigrant until he establishes to the satisfaction of the consular officer, at the time of application for a visa, and the immigration officers, at the time of application for admission, that he is entitled to 

a nonimmigrant status under section 101(a)(15). An alien who is an 

officer or employee of any foreign government or of any international organization entitled to enjoy privileges, exemptions, and 

immunities under the International Organizations Immunities Act, 

or an alien who is the attendant, servant, employee, or member of 

the immediate family of any such alien shall not be entitled to 

apply for or receive an immigrant visa, or to enter the United 

States as an immigrant unless he executes a written waiver in the 

same form and substance as is prescribed by section 247(b). 

(c)(1) The question of importing any alien as a nonimmigrant 

under subparagraph (H), (L), (O), or (P)(i) of section 101(a)(15) (excluding nonimmigrants under section 101(a)(15)(H)(i)(b1)) in any 

specific case or specific cases shall be determined by the Attorney 

General, after consultation with appropriate agencies of the Government, upon petition of the importing employer. Such petition 

shall be made and approved before the visa is granted. The petition 

shall be in such form and contain such information as the Attorney 

General shall prescribe. The approval of such a petition shall not, 

of itself, be construed as establishing that the alien is a nonimmigrant. For purposes of this subsection with respect to nonimmigrants described in section 101(a)(15)(H)(ii)(a), the term ‘‘appropriate agencies of Government’’ means the Department of Labor 

and includes the Department of Agriculture. The provisions of section 218 shall apply to the question of importing any alien as a 

nonimmigrant under section 101(a)(15)(H)(ii)(a). 

(2)(A) The Attorney General shall provide for a procedure under 

which an importing employer which meets requirements established by the Attorney General may file a blanket petition to import aliens as nonimmigrants described in section 101(a)(15)(L) instead of filing individual petitions under paragraph (1) to import 

such aliens. Such procedure shall permit the expedited processing 

of visas for admission of aliens covered under such a petition. 

(B) For purposes of section 101(a)(15)(L), an alien is considered 

to be serving in a capacity involving specialized knowledge with respect to a company if the alien has a special knowledge of the company product and its application in international markets or has an 

advanced level of knowledge of processes and procedures of the 

company. 

257 

(C) The Attorney General shall provide a process for reviewing 

and acting upon petitions under this subsection with respect to 

nonimmigrants described in section 101(a)(15)(L) within 30 days 

after the date a completed petition has been filed. 

(D) The period of authorized admission for— 

(i) a nonimmigrant admitted to render services in a managerial or executive capacity under section 101(a)(15)(L) shall not 

exceed 7 years, or 

(ii) a nonimmigrant admitted to render services in a capacity 

that involves specialized knowledge under section 101(a)(15)(L) 

shall not exceed 5 years. 

(E) In the case of an alien spouse admitted under section 

101(a)(15)(L), who is accompanying or following to join a principal 

alien admitted under such section, the Attorney General shall authorize the alien spouse to engage in employment in the United 

States and provide the spouse with an ‘‘employment authorized’’ 

endorsement or other appropriate work permit. 

(F) An alien who will serve in a capacity involving specialized 

knowledge with respect to an employer for purposes of section 

101(a)(15)(L) and will be stationed primarily at the worksite of an 

employer other than the petitioning employer or its affiliate, subsidiary, or parent shall not be eligible for classification under section 101(a)(15)(L) if— 

(i) the alien will be controlled and supervised principally by 

such unaffiliated employer; or 

(ii) the placement of the alien at the worksite of the unaffiliated employer is essentially an arrangement to provide labor 

for hire for the unaffiliated employer, rather than a placement 

in connection with the provision of a product or service for 

which specialized knowledge specific to the petitioning employer is necessary. 

(3) The Attorney General shall approve a petition— 

(A) with respect to a nonimmigrant described in section 

101(a)(15)(O)(i) only after consultation in accordance with 

paragraph (6) or, with respect to aliens seeking entry for a motion picture or television production, after consultation with 

the appropriate union representing the alien’s occupational 

peers and a management organization in the area of the alien’s 

ability, or 

(B) with respect to a nonimmigrant described in section 

101(a)(15)(O)(ii) after consultation in accordance with paragraph (6) or, in the case of such an alien seeking entry for a 

motion picture or television production, after consultation with 

such a labor organization and a management organization in 

the area of the alien’s ability. 

In the case of an alien seeking entry for a motion picture or television production, (i) any opinion under the previous sentence shall 

only be advisory, (ii) any such opinion that recommends denial 

must be in writing, (iii) in making the decision the Attorney General shall consider the exigencies and scheduling of the production, 

and (iv) the Attorney General shall append to the decision any such 

opinion. The Attorney General shall provide by regulation for the 

waiver of the consultation requirement under subparagraph (A) in 

the case of aliens who have been admitted as nonimmigrants under 

section 101(a)(15)(O)(i) because of extraordinary ability in the arts 

258 

and who seek readmission to perform similar services within 2 

years after the date of a consultation under such subparagraph. 

Not later than 5 days after the date such a waiver is provided, the 

Attorney General shall forward a copy of the petition and all supporting documentation to the national office of an appropriate labor 

organization. 

(4)(A) For purposes of section 101(a)(15)(P)(i)(a), an alien is described in this subparagraph if the alien— 

(i)(I) performs as an athlete, individually or as part of a 

group or team, at an internationally recognized level of performance; 

(II) is a professional athlete, as defined in section 204(i)(2); 

(III) performs as an athlete, or as a coach, as part of a team 

or franchise that is located in the United States and a member 

of a foreign league or association of 15 or more amateur sports 

teams, if— 

(aa) the foreign league or association is the highest level 

of amateur performance of that sport in the relevant foreign country; 

(bb) participation in such league or association renders 

players ineligible, whether on a temporary or permanent 

basis, to earn a scholarship in, or participate in, that sport 

at a college or university in the United States under the 

rules of the National Collegiate Athletic Association; and 

(cc) a significant number of the individuals who play in 

such league or association are drafted by a major sports 

league or a minor league affiliate of such a sports league; 

or 

(IV) is a professional athlete or amateur athlete who performs individually or as part of a group in a theatrical ice skating production; and 

(ii) seeks to enter the United States temporarily and solely 

for the purpose of performing— 

(I) as such an athlete with respect to a specific athletic 

competition; or 

(II) in the case of an individual described in clause 

(i)(IV), in a specific theatrical ice skating production or 

tour. 

(B)(i) For purposes of section 101(a)(15)(P)(i)(b), an alien is described in this subparagraph if the alien— 

(I) performs with or is an integral and essential part of the 

performance of an entertainment group that has (except as 

provided in clause (ii)) been recognized internationally as being 

outstanding in the discipline for a sustained and substantial 

period of time, 

(II) in the case of a performer or entertainer, except as provided in clause (iii), has had a sustained and substantial relationship with that group (ordinarily for at least one year) and 

provides functions integral to the performance of the group, 

and 

(III) seeks to enter the United States temporarily and solely 

for the purpose of performing as such a performer or entertainer or as an integral and essential part of a performance. 

(ii) In the case of an entertainment group that is recognized nationally as being outstanding in its discipline for a sustained and 

259 

substantial period of time, the Attorney General may, in consideration of special circumstances, waive the international recognition 

requirement of clause (i)(I). 

(iii)(I) The one-year relationship requirement of clause (i)(II) 

shall not apply to 25 percent of the performers and entertainers in 

a group. 

(II) The Attorney General may waive such one-year relationship 

requirement for an alien who because of illness or unanticipated 

and exigent circumstances replaces an essential member of the 

group and for an alien who augments the group by performing a 

critical role. 

(iv) The requirements of subclauses (I) and (II) of clause (i) shall 

not apply to alien circus personnel who perform as part of a circus 

or circus group or who constitute an integral and essential part of 

the performance of such circus or circus group, but only if such personnel are entering the United States to join a circus that has been 

recognized nationally as outstanding for a sustained and substantial period of time or as part of such a circus. 

(C) A person may petition the Attorney General for classification 

of an alien as a nonimmigrant under section 101(a)(15)(P). 

(D) The Attorney General shall approve petitions under this subsection with respect to nonimmigrants described in clause (i) or (iii) 

of section 101(a)(15)(P) only after consultation in accordance with 

paragraph (6). 

(E) The Attorney General shall approve petitions under this subsection for nonimmigrants described in section 101(a)(15)(P)(ii) only 

after consultation with labor organizations representing artists and 

entertainers in the United States. 

(F)(i) No nonimmigrant visa under section 101(a)(15)(P)(i)(a) 

shall be issued to any alien who is a national of a country that is 

a state sponsor of international terrorism unless the Secretary of 

State determines, in consultation with the Secretary of Homeland 

Security and the heads of other appropriate United States agencies, that such alien does not pose a threat to the safety, national 

security, or national interest of the United States. In making a determination under this subparagraph, the Secretary of State shall 

apply standards developed by the Secretary of State, in consultation with the Secretary of Homeland Security and the heads of 

other appropriate United States agencies, that are applicable to the 

nationals of such states. 

(ii) In this subparagraph, the term ‘‘state sponsor of international 

terrorism’’ means any country the government of which has been 

determined by the Secretary of State under any of the laws specified in clause (iii) to have repeatedly provided support for acts of 

international terrorism. 

(iii) The laws specified in this clause are the following: 

(I) Section 6(j)(1)(A) of the Export Administration Act of 1979 

(50 U.S.C. App. 2405(j)(1)(A)) (or successor statute). 

(II) Section 40(d) of the Arms Export Control Act (22 U.S.C. 

2780(d)). 

(III) Section 620A(a) of the Foreign Assistance Act of 1961 

(22 U.S.C. 2371(a)). 

(G) The Secretary of Homeland Security shall permit a petition 

under this subsection to seek classification of more than 1 alien as 

a nonimmigrant under section 101(a)(15)(P)(i)(a). 

260 

(H) The Secretary of Homeland Security shall permit an athlete, 

or the employer of an athlete, to seek admission to the United 

States for such athlete under a provision of this Act other than section 101(a)(15)(P)(i) if the athlete is eligible under such other provision. 

(5)(A) In the case of an alien who is provided nonimmigrant status under section 101(a)(15)(H)(i)(b) or 101(a)(15)(H)(ii)(b) and who 

is dismissed from employment by the employer before the end of 

the period of authorized admission, the employer shall be liable for 

the reasonable costs of return transportation of the alien abroad. 

(B) In the case of an alien who is admitted to the United States 

in nonimmigrant status under section 101(a)(15)(O) or 101(a)(15)(P) 

and whose employment terminates for reasons other than voluntary resignation, the employer whose offer of employment 

formed the basis of such nonimmigrant status and the petitioner 

are jointly and severally liable for the reasonable cost of return 

transportation of the alien abroad. The petitioner shall provide assurance satisfactory to the Attorney General that the reasonable 

cost of that transportation will be provided. 

(6)(A)(i) To meet the consultation requirement of paragraph 

(3)(A) in the case of a petition for a nonimmigrant described in section 101(a)(15)(O)(i) (other than with respect to aliens seeking 

entry for a motion picture or television production), the petitioner 

shall submit with the petition an advisory opinion from a peer 

group (or other person or persons of its choosing, which may include a labor organization) with expertise in the specific field involved. 

(ii) To meet the consultation requirement of paragraph (3)(B) in 

the case of a petition for a nonimmigrant described in section 

101(a)(15)(O)(ii) (other than with respect to aliens seeking entry for 

a motion picture or television production), the petitioner shall submit with the petition an advisory opinion from a labor organization 

with expertise in the skill area involved. 

(iii) To meet the consultation requirement of paragraph (4)(D) in 

the case of a petition for a nonimmigrant described in section 

101(a)(15)(P)(i) or 101(a)(15)(P)(iii), the petitioner shall submit with 

the petition an advisory opinion from a labor organization with expertise in the specific field of athletics or entertainment involved. 

(B) To meet the consultation requirements of subparagraph (A), 

unless the petitioner submits with the petition an advisory opinion 

from an appropriate labor organization, the Attorney General shall 

forward a copy of the petition and all supporting documentation to 

the national office of an appropriate labor organization within 5 

days of the date of receipt of the petition. If there is a collective 

bargaining representative of an employer’s employees in the occupational classification for which the alien is being sought, that representative shall be the appropriate labor organization. 

(C) In those cases in which a petitioner described in subparagraph (A) establishes that an appropriate peer group (including a 

labor organization) does not exist, the Attorney General shall adjudicate the petition without requiring an advisory opinion. 

(D) Any person or organization receiving a copy of a petition described in subparagraph (A) and supporting documents shall have 

no more than 15 days following the date of receipt of such documents within which to submit a written advisory opinion or comVerDate Sep 11 2014 06:50 May 16, 2019 Jkt 036295 PO 00000 Frm 00264 Fmt 6659 Sfmt 6601 E:\HR\OC\HR062.XXX HR062
261 

ment or to provide a letter of no objection. Once the 15-day period 

has expired and the petitioner has had an opportunity, where appropriate, to supply rebuttal evidence, the Attorney General shall 

adjudicate such petition in no more than 14 days. The Attorney 

General may shorten any specified time period for emergency reasons if no unreasonable burden would be thus imposed on any participant in the process. 

(E)(i) The Attorney General shall establish by regulation expedited consultation procedures in the case of nonimmigrant artists 

or entertainers described in section 101(a)(15)(O) or 101(a)(15)(P) to 

accommodate the exigencies and scheduling of a given production 

or event. 

(ii) The Attorney General shall establish by regulation expedited 

consultation procedures in the case of nonimmigrant athletes described in section 101(a)(15)(O)(i) or 101(a)(15)(P)(i) in the case of 

emergency circumstances (including trades during a season). 

(F) No consultation required under this subsection by the Attorney General with a nongovernmental entity shall be construed as 

permitting the Attorney General to delegate any authority under 

this subsection to such an entity. The Attorney General shall give 

such weight to advisory opinions provided under this section as the 

Attorney General determines, in his sole discretion, to be appropriate. 

(7) If a petition is filed and denied under this subsection, the Attorney General shall notify the petitioner of the determination and 

the reasons for the denial and of the process by which the petitioner may appeal the determination. 

(8) The Attorney General shall submit annually to the Committees on the Judiciary of the House of Representatives and of the 

Senate a report describing, with respect to petitions under each 

subcategory of subparagraphs (H), (O), (P), and (Q) of section 

101(a)(15) the following: 

(A) The number of such petitions which have been filed. 

(B) The number of such petitions which have been approved 

and the number of workers (by occupation) included in such 

approved petitions. 

(C) The number of such petitions which have been denied 

and the number of workers (by occupation) requested in such 

denied petitions. 

(D) The number of such petitions which have been withdrawn. 

(E) The number of such petitions which are awaiting final 

action. 

(9)(A) The Attorney General shall impose a fee on an employer 

(excluding any employer that is a primary or secondary education 

institution, an institution of higher education, as defined in section 

101(a) of the Higher Education Act of 1965 (20 U.S.C. 1001(a), a 

nonprofit entity related to or affiliated with any such institution, 

a nonprofit entity which engages in established curriculum-related 

clinical training of students registered at any such institution, a 

nonprofit research organization, or a governmental research organization) filing before a petition under paragraph (1)— 

(i) initially to grant an alien nonimmigrant status described 

in section 101(a)(15)(H)(i)(b); 

262 

(ii) to extend the stay of an alien having such status (unless 

the employer previously has obtained an extension for such 

alien); or 

(iii) to obtain authorization for an alien having such status 

to change employers. 

(B) The amount of the fee shall be $1,500 for each such petition 

except that the fee shall be half the amount for each such petition 

by any employer with not more than 25 full-time equivalent employees who are employed in the United States (determined by including any affiliate or subsidiary of such employer). 

(C) Fees collected under this paragraph shall be deposited in the 

Treasury in accordance with section 286(s). 

(10) An amended H–1B petition shall not be required where 

the petitioning employer is involved in a corporate restructuring, including but not limited to a merger, acquisition, or 

consolidation, where a new corporate entity succeeds to the interests and obligations of the original petitioning employer and 

where the terms and conditions of employment remain the 

same but for the identity of the petitioner. 

(11)(A) Subject to subparagraph (B), the Secretary of Homeland 

Security or the Secretary of State, as appropriate, shall impose a 

fee on an employer who has filed an attestation described in section 

212(t)— 

(i) in order that an alien may be initially granted nonimmigrant status described in section 101(a)(15)(H)(i)(b1); or 

(ii) in order to satisfy the requirement of the second sentence 

of subsection (g)(8)(C) for an alien having such status to obtain 

certain extensions of stay. 

(B) The amount of the fee shall be the same as the amount imposed by the Secretary of Homeland Security under paragraph (9), 

except that if such paragraph does not authorize such Secretary to 

impose any fee, no fee shall be imposed under this paragraph. 

(C) Fees collected under this paragraph shall be deposited in the 

Treasury in accordance with section 286(s). 

(12)(A) In addition to any other fees authorized by law, the Secretary of Homeland Security shall impose a fraud prevention and 

detection fee on an employer filing a petition under paragraph (1)— 

(i) initially to grant an alien nonimmigrant status described 

in subparagraph (H)(i)(b) or (L) of section 101(a)(15); or 

(ii) to obtain authorization for an alien having such status to 

change employers. 

(B) In addition to any other fees authorized by law, the Secretary 

of State shall impose a fraud prevention and detection fee on an 

alien filing an application abroad for a visa authorizing admission 

to the United States as a nonimmigrant described in section 

101(a)(15)(L), if the alien is covered under a blanket petition described in paragraph (2)(A). 

(C) The amount of the fee imposed under subparagraph (A) or (B) 

shall be $500. 

(D) The fee imposed under subparagraph (A) or (B) shall only 

apply to principal aliens and not to the spouses or children who are 

accompanying or following to join such principal aliens. 

(E) Fees collected under this paragraph shall be deposited in the 

Treasury in accordance with section 286(v). 

263 

(13)(A) In addition to any other fees authorized by law, the Secretary of Homeland Security shall impose a fraud prevention and 

detection fee on an employer filing a petition under paragraph (1) 

for nonimmigrant workers described in section 101(a)(15)(H)(ii)(b). 

(B) The amount of the fee imposed under subparagraph (A) shall be $150. 

(14)(A) If the Secretary of Homeland Security finds, after notice 

and an opportunity for a hearing, a substantial failure to meet any 

of the conditions of the petition to admit or otherwise provide status to a nonimmigrant worker under section 101(a)(15)(H)(ii)(b) or 

a willful misrepresentation of a material fact in such petition— 

(i) the Secretary of Homeland Security may, in addition to 

any other remedy authorized by law, impose such administrative remedies (including civil monetary penalties in an amount 

not to exceed $10,000 per violation) as the Secretary of Homeland Security determines to be appropriate; and 

(ii) the Secretary of Homeland Security may deny petitions 

filed with respect to that employer under section 204 or paragraph (1) of this subsection during a period of at least 1 year 

but not more than 5 years for aliens to be employed by the employer. 

(B) The Secretary of Homeland Security may delegate to the Secretary of Labor, with the agreement of the Secretary of Labor, any 

of the authority given to the Secretary of Homeland Security under 

subparagraph (A)(i). 

ø(C) In determining the level of penalties to be assessed under 

subparagraph (A), the highest penalties shall be reserved for willful failures to meet any of the conditions of the petition that involve harm to United States workers.¿ 

(C) In determining the level of penalties to be assessed under subparagraph (A), the highest penalties shall be reserved for— 

(i) willful failures to meet any of the conditions of the petition 

that involve harm to United States workers; and 

(ii) willful misrepresentations of the number of necessary nonimmigrants in an application for temporary labor certification 

in support of a petition for nonimmigrants described in section 

101(a)(15)(H)(ii)(b). 

(D) In this paragraph, the term ‘‘substantial failure’’ means the 

willful failure to comply with the requirements of this section that 

constitutes a significant deviation from the terms and conditions of 

a petition. 

(d)(1) A visa shall not be issued under the provisions of section 

101(a)(15)(K)(i) until the consular officer has received a petition 

filed in the United States by the fiance ́e or fiance ́ of the applying 

alien and approved by the Secretary of Homeland Security. The petition shall be in such form and contain such information as the 

Secretary of Homeland Security shall, by regulation, prescribe. 

Such information shall include information on any criminal convictions of the petitioner for any specified crime described in paragraph (3)(B) and information on any permanent protection or restraining order issued against the petitioner related to any specified crime described in paragraph (3)(B)(i). It shall be approved 

only after satisfactory evidence is submitted by the petitioner to establish that the parties have previously met in person within 2 

years before the date of filing the petition, have a bona fide intenVerDate Sep 11 2014 06:50 May 16, 2019 Jkt 036295 PO 00000 Frm 00267 Fmt 6659 Sfmt 6601 E:\HR\OC\HR062.XXX HR062
264 

tion to marry, and are legally able and actually willing to conclude 

a valid marriage in the United States within a period of ninety 

days after the alien’s arrival, except that the Secretary of Homeland Security in his discretion may waive the requirement that the 

parties have previously met in person. In the event the marriage 

with the petitioner does not occur within three months after the 

admission of the said alien and minor children, they shall be required to depart from the United States and upon failure to do so 

shall be removed in accordance with sections 240 and 241. 

(2)(A) Subject to subparagraphs (B) and (C), the Secretary of 

Homeland Security may not approve a petition under paragraph (1) 

unless the Secretary has verified that— 

(i) the petitioner has not, previous to the pending petition, 

petitioned under paragraph (1) with respect to two or more applying aliens; and 

(ii) if the petitioner has had such a petition previously approved, 2 years have elapsed since the filing of such previously 

approved petition. 

(B) The Secretary of Homeland Security may, in the Secretary’s 

discretion, waive the limitations in subparagraph (A) if justification 

exists for such a waiver. Except in extraordinary circumstances 

and subject to subparagraph (C), such a waiver shall not be granted if the petitioner has a record of violent criminal offenses against 

a person or persons. 

(C)(i) The Secretary of Homeland Security is not limited by the 

criminal court record and shall grant a waiver of the condition described in the second sentence of subparagraph (B) in the case of 

a petitioner described in clause (ii). 

(ii) A petitioner described in this clause is a petitioner who has 

been battered or subjected to extreme cruelty and who is or was 

not the primary perpetrator of violence in the relationship upon a 

determination that— 

(I) the petitioner was acting in self-defense; 

(II) the petitioner was found to have violated a protection 

order intended to protect the petitioner; or 

(III) the petitioner committed, was arrested for, was convicted of, or pled guilty to committing a crime that did not result in serious bodily injury and where there was a connection 

between the crime and the petitioner’s having been battered or 

subjected to extreme cruelty. 

(iii) In acting on applications under this subparagraph, the Secretary of Homeland Security shall consider any credible evidence 

relevant to the application. The determination of what evidence is 

credible and the weight to be given that evidence shall be within 

the sole discretion of the Secretary. 

(3) In this subsection: 

(A) The terms ‘‘domestic violence’’, ‘‘sexual assault’’, ‘‘child 

abuse and neglect’’, ‘‘dating violence’’, ‘‘elder abuse’’, and ‘‘stalking’’ have the meaning given such terms in section 3 of the Violence Against Women and Department of Justice Reauthorization Act of 2005. 

(B) The term ‘‘specified crime’’ means the following: 

(i) Domestic violence, sexual assault, child abuse and neglect, dating violence, elder abuse, stalking, or an attempt 

to commit any such crime. 

265 

(ii) Homicide, murder, manslaughter, rape, abusive sexual contact, sexual exploitation, incest, torture, trafficking, 

peonage, holding hostage, involuntary servitude, slave 

trade, kidnapping, abduction, unlawful criminal restraint, 

false imprisonment, or an attempt to commit any of the 

crimes described in this clause. 

(iii) At least three convictions for crimes relating to a 

controlled substance or alcohol not arising from a single 

act. 

(e)(1) Notwithstanding any other provision of this Act, an alien 

who is a citizen of Canada and seeks to enter the United States 

under and pursuant to the provisions of Annex 1502.1 (United 

States of America), Part C—Professionals, of the United States– 

Canada Free–Trade Agreement to engage in business activities at 

a professional level as provided for therein may be admitted for 

such purpose under regulations of the Attorney General promulgated after consultation with the Secretaries of State and Labor. 

(2) An alien who is a citizen of Canada or Mexico, and the spouse 

and children of any such alien if accompanying or following to join 

such alien, who seeks to enter the United States under and pursuant to the provisions of Section D of Annex 1603 of the North 

American Free Trade Agreement (in this subsection referred to as 

‘‘NAFTA’’) to engage in business activities at a professional level as 

provided for in such Annex, may be admitted for such purpose 

under regulations of the Attorney General promulgated after consultation with the Secretaries of State and Labor. For purposes of 

this Act, including the issuance of entry documents and the application of subsection (b), such alien shall be treated as if seeking 

classification, or classifiable, as a nonimmigrant under section 

101(a)(15). The admission of an alien who is a citizen of Mexico 

shall be subject to paragraphs (3), (4), and (5). For purposes of this 

paragraph and paragraphs (3), (4), and (5), the term ‘‘citizen of 

Mexico’’ means ‘‘citizen’’ as defined in Annex 1608 of NAFTA. 

(3) The Attorney General shall establish an annual numerical 

limit on admissions under paragraph (2) of aliens who are citizens 

of Mexico, as set forth in Appendix 1603.D.4 of Annex 1603 of the 

NAFTA. Subject to paragraph (4), the annual numerical limit— 

(A) beginning with the second year that NAFTA is in force, 

may be increased in accordance with the provisions of paragraph 5(a) of Section D of such Annex, and 

(B) shall cease to apply as provided for in paragraph 3 of 

such Appendix. 

(4) The annual numerical limit referred to in paragraph (3) may 

be increased or shall cease to apply (other than by operation of 

paragraph 3 of such Appendix) only if— 

(A) the President has obtained advice regarding the proposed 

action from the appropriate advisory committees established 

under section 135 of the Trade Act of 1974 (19 U.S.C. 2155); 

(B) the President has submitted a report to the Committee 

on the Judiciary of the Senate and the Committee on the Judiciary of the House of Representatives that sets forth— 

(i) the action proposed to be taken and the reasons 

therefor, and 

(ii) the advice obtained under subparagraph (A); 

266 

(C) a period of at least 60 calendar days that begins on the 

first day on which the President has met the requirements of 

subparagraphs (A) and (B) with respect to such action has expired; and 

(D) the President has consulted with such committees regarding the proposed action during the period referred to in 

subparagraph (C). 

(5) During the period that the provisions of Appendix 1603.D.4 

of Annex 1603 of the NAFTA apply, the entry of an alien who is 

a citizen of Mexico under and pursuant to the provisions of Section 

D of Annex 1603 of NAFTA shall be subject to the attestation requirement of section 212(m), in the case of a registered nurse, or 

the application requirement of section 212(n), in the case of all 

other professions set out in Appendix 1603.D.1 of Annex 1603 of 

NAFTA, and the petition requirement of subsection (c), to the extent and in the manner prescribed in regulations promulgated by 

the Secretary of Labor, with respect to sections 212(m) and 212(n), 

and the Attorney General, with respect to subsection (c). 

(6) In the case of an alien spouse admitted under section 

101(a)(15)(E), who is accompanying or following to join a principal 

alien admitted under such section, the Attorney General shall authorize the alien spouse to engage in employment in the United 

States and provide the spouse with an ‘‘employment authorized’’ 

endorsement or other appropriate work permit. 

(f)(1) Except as provided in paragraph (3), no alien shall be entitled to nonimmigrant status described in section 101(a)(15)(D) if 

the alien intends to land for the purpose of performing service on 

board a vessel of the United States (as defined in section 2101(46) 

of title 46, United States Code) or on an aircraft of an air carrier 

(as defined in section 40102(a)(2) of title 49, United States Code) 

during a labor dispute where there is a strike or lockout in the bargaining unit of the employer in which the alien intends to perform 

such service. 

(2) An alien described in paragraph (1)— 

(A) may not be paroled into the United States pursuant to 

section 212(d)(5) unless the Attorney General determines that 

the parole of such alien is necessary to protect the national security of the United States; and 

(B) shall be considered not to be a bona fide crewman for 

purposes of section 252(b). 

(3) Paragraph (1) shall not apply to an alien if the air carrier or 

owner or operator of such vessel that employs the alien provides 

documentation that satisfies the Attorney General that the alien— 

(A) has been an employee of such employer for a period of 

not less than 1 year preceding the date that a strike or lawful 

lockout commenced; 

(B) has served as a qualified crewman for such employer at 

least once in each of 3 months during the 12-month period preceding such date; and 

(C) shall continue to provide the same services that such 

alien provided as such a crewman. 

(g)(1) The total number of aliens who may be issued visas or otherwise provided nonimmigrant status during any fiscal year (beginning with fiscal year 1992)— 

(A) under section 101(a)(15)(H)(i)(b), may not exceed— 

267 

(i) 65,000 in each fiscal year before fiscal year 1999; 

(ii) 115,000 in fiscal year 1999; 

(iii) 115,000 in fiscal year 2000; 

(iv) 195,000 in fiscal year 2001; 

(v) 195,000 in fiscal year 2002; 

(vi) 195,000 in fiscal year 2003; and 

(vii) 65,000 in each succeeding fiscal year; or 

(B) under section 101(a)(15)(H)(ii)(b) may not exceed 66,000. 

(2) The numerical limitations of paragraph (1) shall only apply 

to principal aliens and not to the spouses or children of such aliens. 

(3) Aliens who are subject to the numerical limitations of paragraph (1) shall be issued visas (or otherwise provided nonimmigrant status) in the order in which petitions are filed for such 

visas or status. If an alien who was issued a visa or otherwise provided nonimmigrant status and counted against the numerical limitations of paragraph (1) is found to have been issued such visa or 

otherwise provided such status by fraud or willfully misrepresenting a material fact and such visa or nonimmigrant status is revoked, then one number shall be restored to the total number of 

aliens who may be issued visas or otherwise provided such status 

under the numerical limitations of paragraph (1) in the fiscal year 

in which the petition is revoked, regardless of the fiscal year in 

which the petition was approved. 

(4) In the case of a nonimmigrant described in section 

101(a)(15)(H)(i)(b), the period of authorized admission as such a 

nonimmigrant may not exceed 6 years. 

(5) The numerical limitations contained in paragraph (1)(A) shall 

not apply to any nonimmigrant alien issued a visa or otherwise 

provided status under section 101(a)(15)(H)(i)(b) who— 

(A) is employed (or has received an offer of employment) at 

an institution of higher education (as defined in section 101(a) 

of the Higher Education Act of 1965 (20 U.S.C. 1001(a))), or a 

related or affiliated nonprofit entity; 

(B) is employed (or has received an offer of employment) at 

a nonprofit research organization or a governmental research 

organization; or 

(C) has earned a master’s or higher degree from a United 

States institution of higher education (as defined in section 

101(a) of the Higher Education Act of 1965 (20 U.S.C. 1001(a)), 

until the number of aliens who are exempted from such numerical limitation during such year exceeds 20,000. 

(6) Any alien who ceases to be employed by an employer described in paragraph (5)(A) shall, if employed as a nonimmigrant 

alien described in section 101(a)(15)(H)(i)(b), who has not previously been counted toward the numerical limitations contained in 

paragraph (1)(A), be counted toward those limitations the first time 

the alien is employed by an employer other than one described in 

paragraph (5). 

(7) Any alien who has already been counted, within the 6 years 

prior to the approval of a petition described in subsection (c), toward the numerical limitations of paragraph (1)(A) shall not again 

be counted toward those limitations unless the alien would be eligible for a full 6 years of authorized admission at the time the petition is filed. Where multiple petitions are approved for 1 alien, that 

alien shall be counted only once. 

268 

(8)(A) The agreements referred to in section 101(a)(15)(H)(i)(b1) 

are— 

(i) the United States-Chile Free Trade Agreement; and 

(ii) the United States-Singapore Free Trade Agreement. 

(B)(i) The Secretary of Homeland Security shall establish annual 

numerical limitations on approvals of initial applications by aliens 

for admission under section 101(a)(15)(H)(i)(b1). 

(ii) The annual numerical limitations described in clause (i) shall 

not exceed— 

(I) 1,400 for nationals of Chile (as defined in article 14.9 of 

the United States-Chile Free Trade Agreement) for any fiscal 

year; and 

(II) 5,400 for nationals of Singapore (as defined in Annex 1A 

of the United States-Singapore Free Trade Agreement) for any 

fiscal year. 

(iii) The annual numerical limitations described in clause (i) shall 

only apply to principal aliens and not to the spouses or children of 

such aliens. 

(iv) The annual numerical limitation described in paragraph 

(1)(A) is reduced by the amount of the annual numerical limitations established under clause (i). However, if a numerical limitation established under clause (i) has not been exhausted at the end 

of a given fiscal year, the Secretary of Homeland Security shall adjust upwards the numerical limitation in paragraph (1)(A) for that 

fiscal year by the amount remaining in the numerical limitation 

under clause (i). Visas under section 101(a)(15)(H)(i)(b) may be 

issued pursuant to such adjustment within the first 45 days of the 

next fiscal year to aliens who had applied for such visas during the 

fiscal year for which the adjustment was made. 

(C) The period of authorized admission as a nonimmigrant under 

section 101(a)(15)(H)(i)(b1) shall be 1 year, and may be extended, 

but only in 1-year increments. After every second extension, the 

next following extension shall not be granted unless the Secretary 

of Labor had determined and certified to the Secretary of Homeland Security and the Secretary of State that the intending employer has filed with the Secretary of Labor an attestation under 

section 212(t)(1) for the purpose of permitting the nonimmigrant to 

obtain such extension. 

(D) The numerical limitation described in paragraph (1)(A) for a 

fiscal year shall be reduced by one for each alien granted an extension under subparagraph (C) during such year who has obtained 5 

or more consecutive prior extensions. 

(9)(A) Subject to subparagraphs (B) and (C), an alien who has already been counted toward the numerical limitation of paragraph 

(1)(B) during fiscal year 2013, 2014, or 2015 shall not again be 

counted toward such limitation during fiscal year 2016. Such an 

alien shall be considered a returning worker. 

(B) A petition to admit or otherwise provide status under section 

101(a)(15)(H)(ii)(b) shall include, with respect to a returning worker— 

(i) all information and evidence that the Secretary of Homeland Security determines is required to support a petition for 

status under section 101(a)(15)(H)(ii)(b); 

(ii) the full name of the alien; and 

269 

(iii) a certification to the Department of Homeland Security 

that the alien is a returning worker. 

(C) An H–2B visa or grant of nonimmigrant status for a returning worker shall be approved only if the alien is confirmed to be 

a returning worker by— 

(i) the Department of State; or 

(ii) if the alien is visa exempt or seeking to change to status 

under section 101 (a)(15)(H)(ii)(b), the Department of Homeland Security. 

ø(10) The numerical limitations of paragraph (1)(B) shall be allocated for a fiscal year so that the total number of aliens subject to 

such numerical limits who enter the United States pursuant to a 

visa or are accorded nonimmigrant status under section 

101(a)(15)(H)(ii)(b) during the first 6 months of such fiscal year is 

not more than 33,000.¿ 

(11)(A) The Secretary of State may not approve a number of initial applications submitted for aliens described in section 

101(a)(15)(E)(iii) that is more than the applicable numerical limitation set out in this paragraph. 

(B) The applicable numerical limitation referred to in subparagraph (A) is 10,500 for each fiscal year. 

(C) The applicable numerical limitation referred to in subparagraph (A) shall only apply to principal aliens and not to the 

spouses or children of such aliens. 

(h) The fact that an alien is the beneficiary of an application for 

a preference status filed under section 204 or has otherwise sought 

permanent residence in the United States shall not constitute evidence of an intention to abandon a foreign residence for purposes 

of obtaining a visa as a nonimmigrant described in subparagraph 

(H)(i)(b) or (c), (L), or (V) of section 101(a)(15) or otherwise obtaining or maintaining the status of a nonimmigrant described in such 

subparagraph, if the alien had obtained a change of status under 

section 248 to a classification as such a nonimmigrant before the 

alien’s most recent departure from the United States. 

(i)(1) Except as provided in paragraph (3), for purposes of section 

101(a)(15)(H)(i)(b), section 101(a)(15)(E)(iii), and paragraph (2), the 

term ‘‘specialty occupation’’ means an occupation that requires— 

(A) theoretical and practical application of a body of highly 

specialized knowledge, and 

(B) attainment of a bachelor’s or higher degree in the specific 

specialty (or its equivalent) as a minimum for entry into the 

occupation in the United States. 

(2) For purposes of section 101(a)(15)(H)(i)(b), the requirements 

of this paragraph, with respect to a specialty occupation, are— 

(A) full state licensure to practice in the occupation, if such 

licensure is required to practice in the occupation, 

(B) completion of the degree described in paragraph (1)(B) 

for the occupation, or 

(C)(i) experience in the specialty equivalent to the completion 

of such degree, and (ii) recognition of expertise in the specialty 

through progressively responsible positions relating to the specialty. 

(3) For purposes of section 101(a)(15)(H)(i)(b1), the term ‘‘specialty occupation’’ means an occupation that requires— 

270 

(A) theoretical and practical application of a body of specialized knowledge; and 

(B) attainment of a bachelor’s or higher degree in the specific 

specialty (or its equivalent) as a minimum for entry into the 

occupation in the United States. 

(j)(1) Notwithstanding any other provision of this Act, an alien 

who is a citizen of Canada or Mexico who seeks to enter the United 

States under and pursuant to the provisions of Section B, Section 

C, or Section D of Annex 1603 of the North American Free Trade 

Agreement, shall not be classified as a nonimmigrant under such 

provisions if there is in progress a strike or lockout in the course 

of a labor dispute in the occupational classification at the place or 

intended place of employment, unless such alien establishes, pursuant to regulations promulgated by the Attorney General, that the 

alien’s entry will not affect adversely the settlement of the strike 

or lockout or the employment of any person who is involved in the 

strike or lockout. Notice of a determination under this paragraph 

shall be given as may be required by paragraph 3 of article 1603 

of such Agreement. For purposes of this paragraph, the term ‘‘citizen of Mexico’’ means ‘‘citizen’’ as defined in Annex 1608 of such 

Agreement. 

(2) Notwithstanding any other provision of this Act except section 

212(t)(1), and subject to regulations promulgated by the Secretary 

of Homeland Security, an alien who seeks to enter the United 

States under and pursuant to the provisions of an agreement listed 

in subsection (g)(8)(A), and the spouse and children of such an 

alien if accompanying or following to join the alien, may be denied 

admission as a nonimmigrant under subparagraph (E), (L), or 

(H)(i)(b1) of section 101(a)(15) if there is in progress a labor dispute 

in the occupational classification at the place or intended place of 

employment, unless such alien establishes, pursuant to regulations 

promulgated by the Secretary of Homeland Security after consultation with the Secretary of Labor, that the alien’s entry will not affect adversely the settlement of the labor dispute or the employment of any person who is involved in the labor dispute. Notice of 

a determination under this paragraph shall be given as may be required by such agreement. 

(k)(1) The number of aliens who may be provided a visa as nonimmigrants under section 101(a)(15)(S)(i) in any fiscal year may 

not exceed 200. The number of aliens who may be provided a visa 

as nonimmigrants under section 101(a)(15)(S)(ii) in any fiscal year 

may not exceed 50. 

(2) The period of admission of an alien as such a nonimmigrant 

may not exceed 3 years. Such period may not be extended by the 

Attorney General. 

(3) As a condition for the admission, and continued stay in lawful 

status, of such a nonimmigrant, the nonimmigrant— 

(A) shall report not less often than quarterly to the Attorney 

General such information concerning the alien’s whereabouts 

and activities as the Attorney General may require; 

(B) may not be convicted of any criminal offense punishable 

by a term of imprisonment of 1 year or more after the date of 

such admission; 

(C) must have executed a form that waives the nonimmigrant’s right to contest, other than on the basis of an apVerDate Sep 11 2014 06:50 May 16, 2019 Jkt 036295 PO 00000 Frm 00274 Fmt 6659 Sfmt 6601 E:\HR\OC\HR062.XXX HR062
271 

plication for withholding of removal, any action for removal of 

the alien instituted before the alien obtains lawful permanent 

resident status; and 

(D) shall abide by any other condition, limitation, or restriction imposed by the Attorney General. 

(4) The Attorney General shall submit a report annually to the 

Committee on the Judiciary of the House of Representatives and 

the Committee on the Judiciary of the Senate concerning— 

(A) the number of such nonimmigrants admitted; 

(B) the number of successful criminal prosecutions or investigations resulting from cooperation of such aliens; 

(C) the number of terrorist acts prevented or frustrated resulting from cooperation of such aliens; 

(D) the number of such nonimmigrants whose admission or 

cooperation has not resulted in successful criminal prosecution 

or investigation or the prevention or frustration of a terrorist 

act; and 

(E) the number of such nonimmigrants who have failed to report quarterly (as required under paragraph (3)) or who have 

been convicted of crimes in the United States after the date of 

their admission as such a nonimmigrant. 

(l)(1) In the case of a request by an interested State agency, or 

by an interested Federal agency, for a waiver of the 2-year foreign 

residence requirement under section 212(e) on behalf of an alien 

described in clause (iii) of such section, the Attorney General shall 

not grant such waiver unless— 

(A) in the case of an alien who is otherwise contractually obligated to return to a foreign country, the government of such 

country furnishes the Director of the United States Information Agency with a statement in writing that it has no objection to such waiver; 

(B) in the case of a request by an interested State agency, 

the grant of such waiver would not cause the number of waivers allotted for that State for that fiscal year to exceed 30; 

(C) in the case of a request by an interested Federal agency 

or by an interested State agency— 

(i) the alien demonstrates a bona fide offer of full-time 

employment at a health facility or health care organization, which employment has been determined by the Attorney General to be in the public interest; and 

(ii) the alien agrees to begin employment with the health 

facility or health care organization within 90 days of receiving such waiver, and agrees to continue to work for a 

total of not less than 3 years (unless the Attorney General 

determines that extenuating circumstances exist, such as 

closure of the facility or hardship to the alien, which would 

justify a lesser period of employment at such health facility or health care organization, in which case the alien 

must demonstrate another bona fide offer of employment 

at a health facility or health care organization for the remainder of such 3-year period); and 

(D) in the case of a request by an interested Federal agency 

(other than a request by an interested Federal agency to employ the alien full-time in medical research or training) or by 

an interested State agency, the alien agrees to practice priVerDate Sep 11 2014 06:50 May 16, 2019 Jkt 036295 PO 00000 Frm 00275 Fmt 6659 Sfmt 6601 E:\HR\OC\HR062.XXX HR062
272 

mary care or specialty medicine in accordance with paragraph 

(2) for a total of not less than 3 years only in the geographic 

area or areas which are designated by the Secretary of Health 

and Human Services as having a shortage of health care professionals, except that— 

(i) in the case of a request by the Department of Veterans Affairs, the alien shall not be required to practice 

medicine in a geographic area designated by the Secretary; 

(ii) in the case of a request by an interested State agency, the head of such State agency determines that the 

alien is to practice medicine under such agreement in a facility that serves patients who reside in one or more geographic areas so designated by the Secretary of Health and 

Human Services (without regard to whether such facility 

is located within such a designated geographic area), and 

the grant of such waiver would not cause the number of 

the waivers granted on behalf of aliens for such State for 

a fiscal year (within the limitation in subparagraph (B)) in 

accordance with the conditions of this clause to exceed 10; 

and 

(iii) in the case of a request by an interested Federal 

agency or by an interested State agency for a waiver for 

an alien who agrees to practice specialty medicine in a facility located in a geographic area so designated by the 

Secretary of Health and Human Services, the request shall 

demonstrate, based on criteria established by such agency, 

that there is a shortage of health care professionals able 

to provide services in the appropriate medical specialty to 

the patients who will be served by the alien. 

(2)(A) Notwithstanding section 248(a)(2), the Attorney General may change the status of an alien who qualifies under this 

subsection and section 212(e) to that of an alien described in 

section 101(a)(15)(H)(i)(b). The numerical limitations contained 

in subsection (g)(1)(A) shall not apply to any alien whose status is changed under the preceding sentence, if the alien obtained a waiver of the 2-year foreign residence requirement 

upon a request by an interested Federal agency or an interested State agency. 

(B) No person who has obtained a change of status under 

subparagraph (A) and who has failed to fulfill the terms of the 

contract with the health facility or health care organization 

named in the waiver application shall be eligible to apply for 

an immigrant visa, for permanent residence, or for any other 

change of nonimmigrant status, until it is established that 

such person has resided and been physically present in the 

country of his nationality or his last residence for an aggregate 

of at least 2 years following departure from the United States. 

(3) Notwithstanding any other provision of this subsection, 

the 2-year foreign residence requirement under section 212(e) 

shall apply with respect to an alien described in clause (iii) of 

such section, who has not otherwise been accorded status 

under section 101(a)(27)(H), if— 

(A) at any time the alien ceases to comply with any 

agreement entered into under subparagraph (C) or (D) of 

paragraph (1); or 

273 

(B) the alien’s employment ceases to benefit the public 

interest at any time during the 3-year period described in 

paragraph (1)(C). 

(m)(1) An alien may not be accorded status as a nonimmigrant 

under clause (i) or (iii) of section 101(a)(15)(F) in order to pursue 

a course of study— 

(A) at a public elementary school or in a publicly funded 

adult education program; or 

(B) at a public secondary school unless— 

(i) the aggregate period of such status at such a school 

does not exceed 12 months with respect to any alien, and 

(ii) the alien demonstrates that the alien has reimbursed 

the local educational agency that administers the school 

for the full, unsubsidized per capita cost of providing education at such school for the period of the alien’s attendance. 

(2) An alien who obtains the status of a nonimmigrant under 

clause (i) or (iii) of section 101(a)(15)(F) in order to pursue a course 

of study at a private elementary or secondary school or in a language training program that is not publicly funded shall be considered to have violated such status, and the alien’s visa under section 

101(a)(15)(F) shall be void, if the alien terminates or abandons 

such course of study at such a school and undertakes a course of 

study at a public elementary school, in a publicly funded adult education program, in a publicly funded adult education language 

training program, or at a public secondary school (unless the requirements of paragraph (1)(B) are met). 

(n)(1) A nonimmigrant alien described in paragraph (2) who was 

previously issued a visa or otherwise provided nonimmigrant status 

under section 101(a)(15)(H)(i)(b) is authorized to accept new employment upon the filing by the prospective employer of a new petition on behalf of such nonimmigrant as provided under subsection 

(a). Employment authorization shall continue for such alien until 

the new petition is adjudicated. If the new petition is denied, such 

authorization shall cease. 

(2) A nonimmigrant alien described in this paragraph is a nonimmigrant alien— 

(A) who has been lawfully admitted into the United States; 

(B) on whose behalf an employer has filed a nonfrivolous petition for new employment before the date of expiration of the 

period of stay authorized by the Attorney General; and 

(C) who, subsequent to such lawful admission, has not been 

employed without authorization in the United States before the 

filing of such petition. 

(o)(1) No alien shall be eligible for admission to the United States 

under section 101(a)(15)(T) if there is substantial reason to believe 

that the alien has committed an act of a severe form of trafficking 

in persons (as defined in section 103 of the Trafficking Victims Protection Act of 2000). 

(2) The total number of aliens who may be issued visas or otherwise provided nonimmigrant status during any fiscal year under 

section 101(a)(15)(T) may not exceed 5,000. 

(3) The numerical limitation of paragraph (2) shall only apply to 

principal aliens and not to the spouses, sons, daughters, siblings, 

or parents of such aliens. 

274 

(4) An unmarried alien who seeks to accompany, or follow to join, 

a parent granted status under section 101(a)(15)(T)(i), and who was 

under 21 years of age on the date on which such parent applied 

for such status, shall continue to be classified as a child for purposes of section 101(a)(15)(T)(ii), if the alien attains 21 years of age 

after such parent’s application was filed but while it was pending. 

(5) An alien described in clause (i) of section 101(a)(15)(T) shall 

continue to be treated as an alien described in clause (ii)(I) of such 

section if the alien attains 21 years of age after the alien’s application for status under such clause (i) is filed but while it is pending. 

(6) In making a determination under section 

101(a)(15)(T)(i)(III)(aa) with respect to an alien, statements from 

State and local law enforcement officials that the alien has complied with any reasonable request for assistance in the investigation or prosecution of crimes such as kidnapping, rape, slavery, or 

other forced labor offenses, where severe forms of trafficking in persons (as defined in section 103 of the Trafficking Victims Protection 

Act of 2000) appear to have been involved, shall be considered. 

(7)(A) Except as provided in subparagraph (B), an alien who is 

issued a visa or otherwise provided nonimmigrant status under section 101(a)(15)(T) may be granted such status for a period of not 

more than 4 years. 

(B) An alien who is issued a visa or otherwise provided nonimmigrant status under section 101(a)(15)(T) may extend the period of such status beyond the period described in subparagraph 

(A) if— 

(i) a Federal, State, or local law enforcement official, prosecutor, judge, or other authority investigating or prosecuting 

activity relating to human trafficking or certifies that the presence of the alien in the United States is necessary to assist in 

the investigation or prosecution of such activity; 

(ii) the alien is eligible for relief under section 245(l) and is 

unable to obtain such relief because regulations have not been 

issued to implement such section; or 

(iii) the Secretary of Homeland Security determines that an 

extension of the period of such nonimmigrant status is warranted due to exceptional circumstances. 

(C) Nonimmigrant status under section 101(a)(15)(T) shall be extended during the pendency of an application for adjustment of status under section 245(l). 

(p) REQUIREMENTS APPLICABLE TO SECTION 101(a)(15)(U) 

VISAS.— 

(1) PETITIONING PROCEDURES FOR SECTION 101(a)(15)(U)

VISAS.—The petition filed by an alien under section 

101(a)(15)(U)(i) shall contain a certification from a Federal, 

State, or local law enforcement official, prosecutor, judge, or 

other Federal, State, or local authority investigating criminal 

activity described in section 101(a)(15)(U)(iii). This certification 

may also be provided by an official of the Service whose ability 

to provide such certification is not limited to information concerning immigration violations. This certification shall state 

that the alien ‘‘has been helpful, is being helpful, or is likely 

to be helpful’’ in the investigation or prosecution of criminal activity described in section 101(a)(15)(U)(iii). 

(2) NUMERICAL LIMITATIONS.— 

275 

(A) The number of aliens who may be issued visas or 

otherwise provided status as nonimmigrants under section 

101(a)(15)(U) in any fiscal year shall not exceed 10,000. 

(B) The numerical limitations in subparagraph (A) shall 

only apply to principal aliens described in section 

101(a)(15)(U)(i), and not to spouses, children, or, in the 

case of alien children, the alien parents of such children. 

(3) DUTIES OF THE ATTORNEY GENERAL WITH RESPECT TO ‘‘U’’ 

VISA NONIMMIGRANTS.—With respect to nonimmigrant aliens 

described in subsection (a)(15)(U)— 

(A) the Attorney General and other government officials, 

where appropriate, shall provide those aliens with referrals to nongovernmental organizations to advise the aliens 

regarding their options while in the United States and the 

resources available to them; and 

(B) the Attorney General shall, during the period those 

aliens are in lawful temporary resident status under that 

subsection, provide the aliens with employment authorization. 

(4) CREDIBLE EVIDENCE CONSIDERED.—In acting on any petition filed under this subsection, the consular officer or the Attorney General, as appropriate, shall consider any credible evidence relevant to the petition. 

(5) NONEXCLUSIVE RELIEF.—Nothing in this subsection limits 

the ability of aliens who qualify for status under section 

101(a)(15)(U) to seek any other immigration benefit or status 

for which the alien may be eligible. 

(6) DURATION OF STATUS.—The authorized period of status of 

an alien as a nonimmigrant under section 101(a)(15)(U) shall 

be for a period of not more than 4 years, but shall be extended 

upon certification from a Federal, State, or local law enforcement official, prosecutor, judge, or other Federal, State, or local 

authority investigating or prosecuting criminal activity described in section 101(a)(15)(U)(iii) that the alien’s presence in 

the United States is required to assist in the investigation or 

prosecution of such criminal activity. The Secretary of Homeland Security may extend, beyond the 4-year period authorized 

under this section, the authorized period of status of an alien 

as a nonimmigrant under section 101(a)(15)(U) if the Secretary 

determines that an extension of such period is warranted due 

to exceptional circumstances. Such alien’s nonimmigrant status 

shall be extended beyond the 4-year period authorized under 

this section if the alien is eligible for relief under section 

245(m) and is unable to obtain such relief because regulations 

have not been issued to implement such section and shall be 

extended during the pendency of an application for adjustment 

of status under section 245(m). The Secretary may grant work 

authorization to any alien who has a pending, bona fide application for nonimmigrant status under section 101(a)(15)(U). 

(7) AGE DETERMINATIONS.— (A) CHILDREN.—An unmarried alien who seeks to accompany, or follow to join, a parent granted status under section 101(a)(15)(U)(i), and who was under 21 years of age 

on the date on which such parent petitioned for such status, shall continue to be classified as a child for purposes 

276 

of section 101(a)(15)(U)(ii), if the alien attains 21 years of 

age after such parent’s petition was filed but while it was 

pending. 

(B) PRINCIPAL ALIENS.—An alien described in clause (i) 

of section 101(a)(15)(U) shall continue to be treated as an 

alien described in clause (ii)(I) of such section if the alien 

attains 21 years of age after the alien’s application for status under such clause (i) is filed but while it is pending. 

(q)(1) In the case of a nonimmigrant described in section 

101(a)(15)(V)— 

(A) the Attorney General shall authorize the alien to engage 

in employment in the United States during the period of authorized admission and shall provide the alien with an ‘‘employment authorized’’ endorsement or other appropriate document signifying authorization of employment; and 

(B) the period of authorized admission as such a nonimmigrant shall terminate 30 days after the date on which any 

of the following is denied: 

(i) The petition filed under section 204 to accord the 

alien a status under section 203(a)(2)(A) (or, in the case of 

a child granted nonimmigrant status based on eligibility to 

receive a visa under section 203(d), the petition filed to accord the child’s parent a status under section 203(a)(2)(A)). 

(ii) The alien’s application for an immigrant visa pursuant to the approval of such petition. 

(iii) The alien’s application for adjustment of status 

under section 245 pursuant to the approval of such petition. 

(2) In determining whether an alien is eligible to be admitted to 

the United States as a nonimmigrant under section 101(a)(15)(V), 

the grounds for inadmissibility specified in section 212(a)(9)(B) 

shall not apply. 

(3) The status of an alien physically present in the United States 

may be adjusted by the Attorney General, in the discretion of the 

Attorney General and under such regulations as the Attorney General may prescribe, to that of a nonimmigrant under section 

101(a)(15)(V), if the alien— 

(A) applies for such adjustment; 

(B) satisfies the requirements of such section; and 

(C) is eligible to be admitted to the United States, except in 

determining such admissibility, the grounds for inadmissibility 

specified in paragraphs (6)(A), (7), and (9)(B) of section 212(a) 

shall not apply. 

(r)(1) A visa shall not be issued under the provisions of section 

101(a)(15)(K)(ii) until the consular officer has received a petition 

filed in the United States by the spouse of the applying alien and 

approved by the Attorney General. The petition shall be in such 

form and contain such information as the Attorney General shall, 

by regulation, prescribe. Such information shall include information on any criminal convictions of the petitioner for any specified 

crime described in paragraph (5)(B) and information on any permanent protection or restraining order issued against the petitioner 

related to any specified crime described in subsection (5)(B)(i). 

(2) In the case of an alien seeking admission under section 

101(a)(15)(K)(ii) who concluded a marriage with a citizen of the 

277 

United States outside the United States, the alien shall be considered inadmissible under section 212(a)(7)(B) if the alien is not at 

the time of application for admission in possession of a valid nonimmigrant visa issued by a consular officer in the foreign state in 

which the marriage was concluded. 

(3) In the case of a nonimmigrant described in section 

101(a)(15)(K)(ii), and any child of such a nonimmigrant who was 

admitted as accompanying, or following to join, such a nonimmigrant, the period of authorized admission shall terminate 30 

days after the date on which any of the following is denied: 

(A) The petition filed under section 204 to accord the principal alien status under section 201(b)(2)(A)(i). 

(B) The principal alien’s application for an immigrant visa 

pursuant to the approval of such petition. 

(C) The principal alien’s application for adjustment of status 

under section 245 pursuant to the approval of such petition. 

(4)(A) The Secretary of Homeland Security shall create a database for the purpose of tracking multiple visa petitions filed for 

fiance ́(e)s and spouses under clauses (i) and (ii) of section 

101(a)(15)(K). Upon approval of a second visa petition under section 101(a)(15)(K) for a fiance ́(e) or spouse filed by the same United 

States citizen petitioner, the petitioner shall be notified by the Secretary that information concerning the petitioner has been entered 

into the multiple visa petition tracking database. All subsequent 

fiance ́(e) or spouse nonimmigrant visa petitions filed by that petitioner under such section shall be entered in the database. 

(B)(i) Once a petitioner has had two fiance ́(e) or spousal petitions 

approved under clause (i) or (ii) of section 101(a)(15)(K), if a subsequent petition is filed under such section less than 10 years after 

the date the first visa petition was filed under such section, the 

Secretary of Homeland Security shall notify both the petitioner and 

beneficiary of any such subsequent petition about the number of 

previously approved fiance ́(e) or spousal petitions listed in the 

database. 

(ii) To notify the beneficiary as required by clause (i), the Secretary of Homeland Security shall provide such notice to the Secretary of State for inclusion in the mailing to the beneficiary described in section 833(a)(5)(A)(i) of the International Marriage 

Broker Regulation Act of 2005 (8 U.S.C. 1375a(a)(5)(A)(i)). 

(5) In this subsection: 

(A) The terms ‘‘domestic violence’’, ‘‘sexual assault’’, ‘‘child 

abuse and neglect’’, ‘‘dating violence’’, ‘‘elder abuse’’, and ‘‘stalking’’ have the meaning given such terms in section 3 of the Violence Against Women and Department of Justice Reauthorization Act of 2005. 

(B) The term ‘‘specified crime’’ means the following: 

(i) Domestic violence, sexual assault, child abuse and neglect, dating violence, elder abuse, stalking, or an attempt 

to commit any such crime. 

(ii) Homicide, murder, manslaughter, rape, abusive sexual contact, sexual exploitation, incest, torture, trafficking, 

peonage, holding hostage, involuntary servitude, slave 

trade, kidnapping, abduction, unlawful criminal restraint, 

false imprisonment, or an attempt to commit any of the 

crimes described in this clause. 

278 

(iii) At least three convictions for crimes relating to a 

controlled substance or alcohol not arising from a single 

act. 

* * * * * * * 

CHANGES IN THE APPLICATION OF EXISTING LAW

Pursuant to clause 3(f)(1)(A) of rule XIII of the Rules of the 

House of Representatives, the following statements are submitted 

describing the effect of provisions in the accompanying bill that directly or indirectly change the application of existing law. 

TITLE I—DEPARTMENT OF LABOR 

Language is included under ‘‘Employment and Training Administration’’ providing that allotments to outlying areas are not required to be made through competitive grants as provided by section 127 of the Workforce Innovation and Opportunity Act (WIOA). 

Language is included under ‘‘Employment and Training Administration’’ providing amounts made available for dislocated workers 

may be used for State activities or across multiple local areas 

where workers remain dislocated. 

Language is included under ‘‘Employment and Training Administration’’ providing that technical assistance and demonstration 

projects may provide assistance to new entrants in the workforce 

and incumbent workers. 

Language is included under ‘‘Employment and Training Administration’’ providing that the Department of Labor may take no action to limit the number or proportion of eligible applicants receiving related assistance services in the migrant and seasonal farmworkers programs. 

Language is included under ‘‘Job Corps’’ providing that amounts 

made available for construction and rehabilitation may include acquisition and maintenance of major items of equipment. 

Language is included under ‘‘Job Corps’’ providing authority to 

transfer up to 15 percent of construction and rehabilitation funds 

for operational needs with prior written notice to the Committee 

and that any such transfers are available for obligation through 

June 30, 2021. 

Language is included under ‘‘Job Corps’’ providing that no funds 

from any other appropriation may be used for meal services at Job 

Corps. 

Language is included under ‘‘Community Service Employment for 

Older Americans’’ allowing funds to be recaptured and reobligated. 

Language is included under ‘‘Federal Unemployment Benefits 

and Allowances’’ providing that funding may be available beyond 

the current year in accordance with section 245(c) of the Trade Act 

of 1974. 

Language is included under ‘‘State Unemployment Insurance and 

Employment Service Operations’’ providing for reemployment services and eligibility assessments. 

Language is included under ‘‘State Unemployment Insurance and 

Employment Service Operations’’ providing funds to States to improve operations and modernize State Unemployment Insurance 

systems. 

279 

Language is included under ‘‘State Unemployment Insurance and 

Employment Service Operations’’ providing for additional administrative funds from the Unemployment Trust Fund if unemployment 

claims exceed certain levels. 

Language is included under ‘‘State Unemployment Insurance and 

Employment Service Operations’’ providing authority for States to 

use funds to assist other States to carry out authorized activities 

in cases of a major disaster declared by the President under the 

Robert T. Stafford Disaster Relief and Emergency Assistance Act. 

Language is included under ‘‘State Unemployment Insurance and 

Employment Service Operations’’ providing that the Department of 

Labor may make payments on behalf of States for the use of the 

National Directory of New Hires. 

Language is included under ‘‘State Unemployment Insurance and 

Employment Service Operations’’ providing that the Department of 

Labor may make payments from funds appropriated for States’ 

grants on behalf of States to the entity operating the State Information Data Exchange System. 

Language is included under ‘‘State Unemployment Insurance and 

Employment Service Operations’’ providing that the Department of 

Labor may make payments from funds appropriated for States’ 

grants on behalf of States to the entity operating the Unemployment Insurance Integrity Center of Excellence. 

Language is included under ‘‘State Unemployment Insurance and 

Employment Service Operations’’ providing that appropriations for 

establishing a national one-stop career system may be obligated in 

contracts, grants or agreements with States or non-State entities. 

Language is included under ‘‘State Unemployment Insurance and 

Employment Service Operations’’ providing that States awarded 

grants to support national activities of the Federal-State unemployment insurance system may award subgrants to other States. 

Language is included under ‘‘State Unemployment Insurance and 

Employment Service Operations’’ providing that funds available for 

integrated Unemployment Insurance and Employment Service automation may be used by States notwithstanding cost allocation 

principles prescribed under the Office of Management and Budget 

‘‘Uniform Administrative Requirements, Cost Principles, and Audit 

Requirements for Federal Awards.’’ 

Language is included under ‘‘State Unemployment Insurance and 

Employment Service Operations’’ providing that the Department of 

Labor may reallot funds among States participating in a consortium. 

Language is included under ‘‘State Unemployment Insurance and 

Employment Service Operations’’ allowing the Secretary to collect 

fees for the costs associated with additional data collection, analyses, and reporting services related to the National Agricultural 

Workers Survey. 

Language is included under ‘‘Pension Benefit Guarantee Corporation’’ providing for additional administrative funds if participants with plans terminated during the period exceed a certain 

level. 

Language is included under ‘‘Pension Benefit Guarantee Corporation’’ providing that obligations may exceed amounts provided 

for unforeseen and extraordinary pre-termination or termination 

280 

expenses or unforeseen and extraordinary multiemployer program 

expenses if approved by the Office of Management and Budget. 

Language is included under ‘‘Special Benefits’’ providing that the 

Department of Labor may use authority to reimburse an employer 

who is not the employer at the time of injury for portions of the 

salary of a re-employed, disabled beneficiary. 

Language is included under ‘‘Special Benefits’’ providing that unobligated balances of reimbursements shall remain available until 

expended for the payment of compensation, benefits, and expenses. 

Language is included under ‘‘Special Benefits’’ providing that 

funds shall be transferred to the appropriation from entities required under 5 U.S.C. 8147(c) as determined by the Department of 

Labor. 

Language is included under ‘‘Special Benefits’’ providing that 

funds transferred from entities under 5 U.S.C 8147(c), specified 

amounts may be used by the Department of Labor for maintenance 

and data and communications systems, workload processing, roll 

disability management and medical review, and program integrity 

with remaining amounts paid into the Treasury. 

Language is included under ‘‘Special Benefits’’ providing that the 

Secretary may prescribe regulations requiring identification for the 

filing of benefit claims. 

Language is included under ‘‘Administrative Expenses, Energy 

Employees Occupational Illness Compensation Fund’’ providing 

that the Secretary may prescribe regulations for requiring identification for the filing of benefit claims. 

Language is included under ‘‘Occupational Safety and Health Administration’’ providing that up to a certain amount of fees collected from the training institute may be retained and used for related training and education. 

Language is included under ‘‘Occupational Safety and Health Administration’’ providing that fees collected from Nationally Recognized Testing Laboratories may be used to administer laboratory 

recognition programs that ensure safety of equipment used in the 

workplace. 

Language is included under ‘‘Mine Safety and Health Administration’’ providing that a specific amount may be collected by the 

National Mine Health and Safety Academy and made available for 

mine safety and health education and training. 

Language is included under ‘‘Mine Safety and Health Administration’’ providing that a specific amount may be collected from the 

approval and certification of equipment and materials and made 

available for other such activities. 

Language is included under ‘‘Mine Safety and Health Administration’’ providing that the Department of Labor may accept lands, 

buildings, equipment, and other contributions from public and private sources for cooperative projects. 

Language is included under ‘‘Mine Safety and Health Administration’’ providing that the Department of Labor may promote 

health and safety education and training through cooperative 

agreements with States, industry and safety associations. 

Language is included under ‘‘Mine Safety and Health Administration’’ providing that the Department of Labor may recognize the 

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281 

ciation and may provide funds or personnel as officers in local 

chapters or the national organization. 

Language is included under ‘‘Mine Safety and Health Administration’’ providing that the Department of Labor may use appropriated funds to provide for costs associated with mine rescue and 

survival operations in the event of a major disaster. 

Language is included under ‘‘Departmental Management—Salaries and Expenses’’ providing that the Bureau of International 

Labor Affairs may administer international labor activities through 

grants, subgrants or other arrangements. 

Language is included under ‘‘Departmental Management—Salaries and Expenses’’ providing that funds available for program 

evaluation may be used to administer grants for evaluation purposes subject to certain conditions. 

Language is included under ‘‘Departmental Management—Salaries and Expenses’’ providing that funds available to the Women’s 

Bureau may be used for grants to service and promote the interests 

of women in the workplace. 

Language is included under ‘‘Departmental Management—Salaries and Expenses’’ providing that certain amounts made available 

to the Women’s Bureau shall be used for grants authorized by the 

Women in Apprenticeship and Nontraditional Occupations Act. 

Language is included under ‘‘Veterans Employment and Training’’ providing that up to three percent of States’ grants may be 

used for federal expenditures for data systems and contract support. 

Language is included under ‘‘Veterans Employment and Training’’ providing that funds may be used for support specialists providing intensive services to wounded service members. 

Language is included under ‘‘Veterans Employment and Training’’ providing that Department of Labor may reallocate up to three 

percent of funds provided among appropriated accounts. 

Language is included under ‘‘Veterans Employment and Training’’ providing that the Department may award grants under section 2023 of Title 38, United States Code. 

Language is included under ‘‘Veterans Employment and Training’’ providing that services may be provided to certain homeless or 

recently incarcerated veterans under section 2021, 2021A, and 

2023 of Title 38, United States Code. 

Language is included under ‘‘Veterans Employment and Training’’ providing that funds made available to assist homeless veterans may be used for data systems and contract support track 

participant and performance information. 

Language is included under ‘‘Veterans Employment and Training’’ providing that the fees assessed pursuant to the HIRE Vets 

Medallion Award Fund shall be available to the Secretary for expenses of the HIRE Vets Medallion Award Program and that the 

start date prescribed in the Act shall not apply. 

Language is included under ‘‘General Provisions’’ prohibiting the 

use of Job Corps funds to pay the salaries and bonuses at a rate 

in excess of Executive Level II. 

Language is included under ‘‘General Provisions’’ prohibiting the 

use funds for procurement of goods or services rendered by forced 

or indentured child labor. 

282 

Language is included under ‘‘General Provisions’’ prohibiting the 

use of any funds appropriated for grants under section 414(c) of the 

American Competitiveness and Workforce Improvement Act of 

1998, for purposes other than competitive grants for training individuals over the age of 16 who are not currently enrolled in school 

in the occupations and industries for which employers are using H– 

1B visa to hire foreign workers. 

Language is included under ‘‘General Provisions’’ prohibiting the 

use of any funds appropriated for Employment and Training Administration programs to be used to pay the salaries and bonuses 

at a rate in excess of Executive Level II except under specific exclusions. 

Language is included under ‘‘General Provisions’’ providing certain authorities related to the Secretary’s security detail. 

TITLE II—DEPARTMENT OF HEALTH AND HUMAN 

SERVICES 

Language is included under ‘‘Health Resources and Services Administration—Health Workforce’’ overriding the proportional funding requirements in the Public Health Service Act for sections 751 

and 762. 

Language is included under ‘‘Health Resources and Services Administration—Health Workforce’’ providing permissive authority to 

the Secretary to waive requirements for entities awarded funds 

from sections 751(d)(2)(A) and 751(d)(2)(B). 

Language is included under ‘‘Health Resources and Services Administration—Health Workforce’’ prohibiting the use of Health 

Workforce appropriations to carry out section 340G–1. 

Language is included under ‘‘Health Resources and Services Administration—Health Workforce’’ providing that fees collected for 

the disclosure of information under the information reporting requirement program authorized by section 1921 of the Social Security Act shall be sufficient to recover the full costs of the operation 

program and shall remain available until expended to carry out 

that Act. 

Language is included under ‘‘Health Resources and Services Administration—Health Workforce’’ allowing funds for the Nurse 

Corps and National Health Service Corps Scholarship and Loan 

programs to be used to make prior year adjustments. 

Language is included under ‘‘Health Resources and Services Administration—Health Workforce’’ providing funding under the National Health Service Corps Loan Repayment Program for substance use disorder counselors and placement in Indian Health 

Service facilities. 

Language is included under ‘‘Health Resources and Services Administration—Health Workforce’’ to provide funds for the purpose 

of supporting graduate education for physicians provided by public 

institutions of higher education and shall remain available until 

expended. 

Language is included under ‘‘Health Resources and Services Administration—Ryan White HIV/AIDS Program’’ to make funds 

available to the Secretary to carry out grants and contracts under 

title XXVI or 311(c) for the purposes of ending the HIV/AIDS epidemic. 

283 

Language is included under ‘‘Health Resources and Services Administration—Rural Health’’ to provide funding for State Offices of 

Rural Health notwithstanding section 338J(k), which terminates 

the program after an aggregate funding amount. 

Language is included under ‘‘Health Resources and Services Administration—Family Planning’’ to require the Secretary to carry 

out section 1001 solely in accordance with regulations or other conditions in effect as of January 18, 2017. 

Language is included under ‘‘Health Resources and Services Administration—Family Planning’’ placing additional restrictions on 

the use of funds. 

Language is included under ‘‘Centers for Disease Control and 

Prevention—CDC-Wide Activities and Program Support’’ permitting CDC to operate and maintain an aircraft. 

Language is included under ‘‘Centers for Disease Control and 

Prevention—Buildings and Facilities’’ providing the use of funds to 

support acquisition, renovation, or replacement, of the National Institute Occupational Safety and Health’s underground and surface 

coal mining research capacity. 

Language is included under ‘‘Centers for Disease Control and 

Prevention—Buildings and Facilities’’ providing funds from former 

employees with existing Individual Learning Accounts unobligated 

to be available to support acquisition, renovation, or replacement, 

of the National Institute for Occupational Safety and Health’s underground and surface coal mining research capacity. 

Language is included under ‘‘Substance Abuse and Mental 

Health Services Administration—Mental Health’’ requiring states 

to spend 10 percent of the Mental Health Block Grant for programs 

for individuals with early serious mental illness. 

Language is included under ‘‘Substance Abuse and Mental 

Health Services Administration—Mental Health’’ requiring states 

to spend five percent of the Mental Health Block Grant for programs for crisis care programs for individuals with early serious 

mental illness and children with serious mental and emotional disturbances. 

Language is included under ‘‘Substance Abuse and Mental 

Health Services Administration—Mental Health’’ exempting the 

Mental Health Block Grant from the evaluation set-aside in section 

241 of the Public Health Service Act. 

Language is included under ‘‘Substance Abuse and Mental 

Health Services Administration—Substance Abuse Treatment’’ exempting the Substance Abuse Prevention and Treatment Block 

Grant from the evaluation set-aside in section 241 of the Public 

Health Service Act. 

Language is included under ‘‘Centers for Medicare and Medicaid 

Services—Program Management’’ limiting the amount of funding 

available under that heading for quality improvement organizations. 

Language is included under ‘‘Centers for Medicare and Medicaid 

Services—Program Management’’ directing the Secretary to obligate funds collected through user fees to carry out the navigator 

program, as well as outreach, education, and advertising related to 

the Affordable Care Act Exchange open enrollment period. 

Language is included under ‘‘Centers for Medicare and Medicaid 

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284 

viding funds to support the cost of the Senior Medicare Patrol program. 

Language is included under ‘‘Administration for Children and 

Families—Low Income Home Energy Assistance’’ modifying the formula distribution of funds. 

Language is included under ‘‘Administration for Children and 

Families—Refugee and Entrant Assistance’’ to specify the purposes 

of specified funds. 

Language is included under ‘‘Administration for Children and 

Families—Refugee and Entrant Assistance’’ prohibiting use of 

funds for certain purposes. 

Language is included under ‘‘Administration for Children and 

Families—Refugee and Entrant Assistance’’ requiring the Secretary 

of Health and Human Services to submit a spend plan to the Committee. 

Language is included under ‘‘Administration for Children and 

Families—Payments to States for the Child Care and Development 

Block Grant’’ increasing the tribal set-aside. 

Language is included under ‘‘Administration for Children and 

Families—Children and Families Services Programs’’ providing for 

payments under the Head Start Act for a cost of living adjustment, 

the calculation of a base grant, quality improvement funding, and 

the re-establishment of a Head Start Partnership program. 

Language is included under Administration for Community Living continuing an assistive technology alternative financing program. 

Language is included under Administration for Community Living prohibiting the use of the funds provided in the bill to pursue 

legal action on behalf of a protection and advocacy system described in section 103 of the Protection and Advocacy for Individuals with Mental Illness Act unless public notice has been provided 

within 90 of instituting action to the named person or their legal 

guardian. 

Language is included under Administration for Community Living waiving the public notice requirement for individuals without 

a guardian, who are not competent to consent, who are wards of 

the State or subject to public guardianship. 

Section 201 limits the amount available for official reception and 

representation expenses. 

Section 202 limits the salary of an individual through an HHS 

grant or other extramural mechanism to not more than the rate of 

Executive Level II. 

Section 203 prohibits the Secretary from using evaluation setaside funds until the Committees on Appropriations of the House 

of Representatives and the Senate receive a report detailing the 

planned use of such funds. 

Section 204 sets the PHS evaluation set-aside to 2.5 percent. 

Section 205 permits the Secretary of HHS to transfer up to one 

percent of any discretionary funds between appropriations, provided that no appropriation is increased by more than three percent by any such transfer to meet emergency needs. Notification 

must be provided to the Committees on Appropriations at least 15 

days in advance of any transfer. 

Section 206 modifies the 60 day flexibility for National Health 

Service Corps contract terminations to provide more flexibility. 

285 

Section 207 prohibits the use of Title X funds unless the applicant for the award certifies to the Secretary that it encourages family participation in the decision of minors to seek family planning 

services and that it provides counseling to minors on how to resist 

attempts to coerce minors into engaging in sexual activities. 

Section 208 states that no provider of services under Title X shall 

be exempt from any state law requiring notification or the reporting of child abuse, child molestation, sexual abuse, rape, or incest. 

Section 209 prohibits the Secretary from denying participation in 

the Medicare Advantage program to entities who do not provider 

coverage or referrals for abortion services. 

Section 210 prohibits funds from being used to advocate or promote gun control. 

Section 211 limits assignments of Public Health Service staff to 

assist in child survival activities to not more than 60 employees. 

Section 212 permits funding for HHS international HIV/AIDS 

and other infectious disease, chronic and environmental disease, 

and other health activities abroad to be spent under the State Department Basic Authorities Act of 1956. 

Section 213 provides the Director of NIH, jointly with the Director of the Office of AIDS Research, the authority to transfer up to 

three percent of human immunodeficiency virus funds. 

Section 214 makes NIH funds available for human immunodeficiency virus research available to the Office of AIDS Research. 

Section 215 grants authority to the Office of the Director of the 

NIH to enter directly into transactions in order to implement the 

NIH Common Fund for medical research and permitting the Director to utilize peer review procedures, as appropriate, to obtain assessments of scientific and technical merit. 

Section 216 clarifies that funds appropriated to NIH institutes 

and centers may be used for minor repairs or improvements to 

their buildings, up to $3,500,000 per project with a total limit for 

NIH of $45,000,000. 

Section 217 transfers one percent of the funding made available 

for National Institutes of Health National Research Service Awards 

to the Health Resources and Services Administration and Agency 

for Healthcare Research and Quality. 

Section 218 continues the Biomedical Advanced Research and 

Development Authority ten year contract authority. 

Section 219 requires HHS to include certain information concerning the number of full-time federal employees and contractors 

working on the ACA in the fiscal year 2020 budget request. 

Section 220 includes specific report requirements for CMS’s marketplaces activities in the fiscal year 2020 budget request. 

Section 221 prohibits CMS Program Account from being used to 

support risk corridor payments. 

Section 222 directs the spending and transfer of amount in the 

Prevention and Public Health fund. 

Section 223 modifies a provision relating to breast cancer screening. 

Section 224 requires the NIH to continue to use existing guidance for calculating indirect cost negotiated rates. 

Section 225 permits transfer authority within NIH, to the Director of NIH for activities related to opioid addiction, opioid alternatives, pain management, and addiction treatment. 

286 

Section 226 includes certain Congressional notification requirements. 

Section 227 includes a provision related to a report on staffing. 

Section 228 allows HHS to cover travel expenses when necessary 

for employees to obtain medical care when they are assigned to 

duty in a location with a public health emergency. 

Section 229 allows certain donations for unaccompanied alien 

children. 

Section 230 rescinds unobligated funds from prior-year Children’s Health Insurance Program State allotments. 

Section 231 modifies a provision relating to Members of Congress 

and oversight of facilities responsible for the care of unaccompanied 

alien children. 

Section 232 requires the Department to make efforts to place unaccompanied alien children who are siblings together. 

Section 233 prohibits funds from being used to facilitate the Secretary of Homeland Security taking certain actions against sponsors of unaccompanied alien children, except under certain conditions. 

Section 234 prohibits funds from being used to house unaccompanied alien children in certain facilities, unless the Secretary 

grants limited-duration waivers. 

Section 235 requires a weekly report on unaccompanied alien 

children who were separated from their parents or legal guardians 

and transferred to the care of the Office of Refugee Resettlement. 

Section 236 prohibits funds from being awarded to an organization that does not comply with Federal nondiscrimination regulations. 

Section 237 allows for primary and secondary school costs for eligible dependents of HHS personnel stationed in the Commonwealth 

of Puerto Rico, the Commonwealth of the Northern Mariana Islands, and other territories or possessions of the United States. 

Section 238 prohibits funds from being used to implement, enforce, or otherwise give effect to certain revisions of the Code of 

Federal Regulations published on July 7, 2018. 

Section 239 prohibits funds from being used to publish a proposed rule relating to a nonemergency medical transportation benefit for Medicaid beneficiaries. 

Section 240 prohibits funds from being used to finalize, implement, or enforce a rule related to conscience rights. 

TITLE III—DEPARTMENT OF EDUCATION 

Language is included under ‘‘Impact Aid’’ allowing continued eligibility for students affected by the deployment or death of their 

military parent so long as the children attend school in the same 

local education agency they attended prior to the parent’s death or 

deployment. 

Language is included under ‘‘School Improvement Programs’’ allowing the Secretary of Education to reserve up to 5 percent of 

Supplemental Education Grants funds to provide technical assistance for these grants. 

Language is included under ‘‘Special Education’’ clarifying the 

amounts required to be transferred to the Department of the Interior under the Grants to States program. 

287 

Language is included under ‘‘Special Education’’ outlining procedures for reducing a State’s award because of a failure to meet the 

maintenance of State financial support requirements of the Individuals with Disabilities Education Act. 

Language is included under ‘‘Special Education’’ authorizing the 

Department to use certain funds to provide technical assistance 

and support to States to improve data collection capacity. 

Language is included under ‘‘Special Education’’ authorizing the 

Department to use funds appropriated for the State Personnel Development Grants program to evaluate program performance. 

Language is included under ‘‘Special Education’’ permitting 

States to subgrant funds that they reserve for ‘‘Other State-level 

activities’’ under the Grants to States and Preschool Grants to 

States programs. 

Language is included under ‘‘Special Education’’ allowing the Department to provide all States that apply for the State Incentive 

Grants program, in years in which five or fewer States apply for 

funding, 20 percent of the funds reserved for the program. 

Language is included under ‘‘Rehabilitation Services’’ allowing 

the Secretary to use amounts that remain available after the reallotment of funds to States under the Vocational Rehabilitation 

State Grants program for innovative activities designed to improve 

the outcomes of individuals with disabilities. 

Language is included under ‘‘Special Institutions for Persons 

with Disabilities’’ allowing the National Technical Institute for the 

Deaf to use, at its discretion, funds for the endowment program as 

authorized under section 207 of the Education of the Deaf Act of 

1986. 

Language is included under ‘‘Special Institutions for Persons 

with Disabilities’’ allowing Gallaudet University to use, at its discretion, funds for the endowment program as authorized under section 207 of the Education of the Deaf Act of 1986. 

Language is included under ‘‘Student Aid Administration’’ requiring the Secretary to allocate new student loan borrower accounts 

to eligible student loan servicers on the basis of their past performance and their compliance with Federal and State law. 

Language is included under ‘‘Student Aid Administration’’ requiring the Secretary to allow student loan borrowers to have their consolidated Federal student loans serviced by any student loan 

servicer. 

Language is included under ‘‘Student Aid Administration’’ requiring any new servicing environment, including FSA Next Generation Processing and Servicing Environment, to include the participation of multiple student loan servicers. 

Language is included under ‘‘Student Aid Administration’’ requiring any new servicing environment, including FSA Next Generation Processing and Servicing Environment, to include accountability measures that account for the performance of the portfolio 

and contractor compliance with Federal Student Aid (FSA) guidelines. 

Language is included under ‘‘Student Aid Administration’’ requiring any new servicing environment, including FSA Next Generation Processing and Servicing Environment, to incentivize more 

support to borrowers at risk of delinquency or default. 

288 

Language is included under ‘‘Higher Education’’ allowing funds 

to carry out Title VI of the Higher Education Act and section 

102(b)(6) of the Mutual Educational and Cultural Exchange Act of 

1961 to be used to support visits and study in foreign countries for 

participants in foreign countries by individuals who are participating in advanced foreign language training and international 

studies in areas that are vital to United States national security 

and who plan to apply their language skills and knowledge of these 

countries in the fields of government, the professions, or international development. 

Language is included under ‘‘Higher Education’’ allowing one 

percent of funds to carry out Title VI of the Higher Education Act 

and section 102(b)(6) of the Mutual Educational and Cultural Exchange Act of 1961 to be used for program evaluation, national outreach, and information dissemination activities. 

Language is included under ‘‘Higher Education’’ allowing up to 

one-and-one-half percent of the funds made available under chapter 

2 of subpart 2 of part A of Title IV of the Higher Education Act 

to be used for evaluation. 

Language is included under ‘‘Historically Black College and University Capital Financing Program Account’’ allowing for the 

deferment of loans made under part D of Title III of the Higher 

Education Act for private Historically Black Colleges and Universities who meet certain conditions. 

Language is included under ‘‘Historically Black College and University Capital Financing Program Account’’ allowing for the 

deferment of loans made under part D of Title III of the Higher 

Education Act for public Historically Black Colleges and Universities who meet certain conditions. 

Language is included under ‘‘Departmental Management’’ restricting the Department from dissolving the Budget Service of the 

Department of Education, relative to the organization and operation of the Budget Service as in effect on January 1, 2018. 

Language is included under ‘‘General Provisions’’ authorizing the 

transfer of up to one percent of discretionary funds between programs, projects, or activities as long as the transfer does not increase any program, project, or activity by more than three percent 

and no new program, project, or activity is created by such transfer. 

Language is included under ‘‘General Provisions’’ allowing ESEA 

funds consolidated for evaluation purposes to be available from 

July 1, 2020 through September 30, 2021. 

Language is included under ‘‘General Provisions’’ allowing certain institutions to continue to use endowment income for student 

scholarships. 

Language is included under ‘‘General Provisions’’ extending the 

authorization of the National Advisory Committee on Institutional 

Quality and Integrity. 

Language is included under ‘‘General Provisions’’ extending the 

authority to provide account maintenance fees to guaranty agencies 

for Federal student loans. 

Language is included under ‘‘General Provisions’’ allowing funds 

to be made available for payments for student loan servicing to an 

institution of higher education for loans under part E of Title IV 

of the Higher Education Act of 1965. 

289 

Language is included under ‘‘General Provisions’’ allowing institutions of higher education, in certain conditions, to share data to 

a designated scholarship granting organizations, or other eligible 

organizations, to assist a student in applying for and receiving student financial assistance. 

Language is included under ‘‘General Provisions’’ providing funds 

for loan cancellation for certain borrowers of loans under part D of 

title IV of the Higher Education Act. 

Language is included under ‘‘General Provisions’’ providing funds 

for outreach to certain borrowers of loans made under part D of 

title IV of the Higher Education Act. 

TITLE IV—RELATED AGENCIES 

Language is included under ‘‘The Committee for Purchase from 

People Who are Blind or Severely Disabled’’ requiring that written 

agreements, with certain oversight provisions, be in place in order 

for authorized fees to be charged by certified nonprofit agencies. 

Language is included under ‘‘Corporation for National and Community Service’’ requiring the Corporation to make awards on a 

competitive basis pursuant to section 501(a)(4)(F) of the 1990 Act, 

section 198P notwithstanding. 

Language is included under ‘‘Corporation for National and Community Service’’ regarding changes to program requirements or policy through rulemaking. 

Language is included under ‘‘Corporation for National and Community Service’’ regarding National Service Trust minimum share 

requirements. 

Language is included under ‘‘Corporation for National and Community Service’’ limiting the use of an educational award under 

section 148(a)(4) to individuals who are veterans. 

Language is included under ‘‘Corporation for National and Community Service’’ related to criminal background checks. 

Language is included under ‘‘Corporation for National and Community Service’’ related to 1,200 hour service positions. 

Language is included under ‘‘Federal Mediation and Conciliation 

Service—Salaries and Expenses’’ providing that fees charged for 

special training and other services and be retained and used for authorized purposes, that fees for arbitration services may only be 

used for training agency personnel, and that the Director may accept gifts and services in aid of any projects under the Director’s 

jurisdiction. 

TITLE V—GENERAL PROVISIONS 

Section 501 permits the Secretaries of Labor, Health and Human 

Services, and Education to transfer unexpended balances of prior 

appropriations to accounts corresponding to current appropriations 

to be used for the same purpose and for the same periods of time 

for which they were originally appropriated. 

Section 502 prohibits the obligation of funds beyond the current 

fiscal year unless expressly so provided. 

Section 503 prohibits funds from being used to support or defeat 

legislation. 

Section 504 limits the amount available for official reception and 

representation expenses for the Secretaries of Labor and EduVerDate Sep 11 2014 06:50 May 16, 2019 Jkt 036295 PO 00000 Frm 00293 Fmt 6659 Sfmt 6602 E:\HR\OC\HR062.XXX HR062
290 

cation, the Director of the Federal Mediation and Conciliation Service, and the Chairman of the National Mediation Board. 

Section 505 requires grantees receiving Federal funds to clearly 

state the percentage of the total cost of the program or project that 

will be financed with Federal money. 

Section 506 prohibits the use of funds for abortion services. 

Section 507 provides exceptions to section 506 if the pregnancy 

is the result of an act of rape or incest, or is a threat to the life 

of the woman; clarifies that section 506 does not apply to State, locality, or private funds; and ensures that health care entities are 

not required to cover abortion services. 

Section 508 prohibits use of funds for certain research involving 

human embryos. 

Section 509 prohibits use of funds for any activity that promotes 

the legalization of any drug or substance included in schedule I of 

the schedules of controlled substances. 

Section 510 prohibits use of funds to promulgate or adopt any 

final standard providing for a unique health identifier until legislation is enacted specifically approving the standard. 

Section 511 prohibits funds to be obligated or expended on a contract with an entity that has not submitted a report on qualified 

veteran employees as required under 38 U.S.C. 4212(d). 

Section 512 prohibits any transfer of funds made available in 

this Act except by the authority provided in this Act or another appropriation Act. 

Section 513 limits funds in the bill for public libraries to those 

that comply with the requirements of the Children’s Internet Protection Act. 

Section 514 dictates the procedures for the reprogramming of any 

funds provided in the bill. 

Section 515 continues a provision pertaining to appointments to 

federal scientific advisory committees to prevent the disclosure of 

information like political affiliation of candidates for appointment. 

Section 516 requires each department and related agency funded 

through this Act to submit an operating plan within 45 days of enactment, detailing any funding allocations that are different than 

those specified in this Act, the accompanying detailed table, or 

budget request. 

Section 517 requires the Secretaries of Labor, Health and 

Human Services, and Education to submit a quarterly report to the 

Committees on Appropriations of the House of Representatives and 

the Senate containing certain information on noncompetitive contracts, grants, and cooperative agreements exceeding $500,000 in 

value. 

Section 518 prohibits use of funds to process claims for credit for 

quarters of coverage based on work performed under a Social Security number that was not the claimant’s number, where the performance of such work under such number has formed the basis for 

a conviction of the claimant of a violation of section 208(a)(6) or (7) 

of the Social Security Act. 

Section 519 prohibits use of funds to implement a Social Security 

totalization agreement with Mexico. 

Section 520 prohibits the use of funds for the downloading or exchanging of pornography. 

291 

Section 521 directs certain reporting requirements for conference 

expenditures. 

Section 522 requires disclosure of U.S. taxpayer funding for programs used in advertising. 

Section 523 authorizes performance partnership pilots. 

Section 524 requires quarterly reports on the status of balances 

of appropriations from the Departments of Labor, Health and 

Human Services and Education. 

Section 525 makes funds from the Children’s Health Insurance 

Program Performance Bonus Fund unavailable for obligation in fiscal year 2020. 

Section 526 requires that H-2B visas be allocated on a quarterly 

basis, with varying allotments by quarter and in proportion to need 

in certain circumstances. 

Section 527 prohibits funds from being used to replace or diminish the quality of care provide by Medicare Advantage or 

TRICARE. 

APPROPRIATIONS NOT AUTHORIZED BY LAW

Pursuant to clause 3(f)(1)(B) of rule XIII of the Rules of the 

House of Representatives, the following table lists the appropriations in the accompanying bill which are not authorized by law for 

the period concerned: 

292 

Agency 

Program 

Last Year of 

Authorization 

Authorization 

Level 

Appropriations 

in Last Year of 

Authorization 

Appropriations 

in this Bill 

DEPARTMENT OF LABOR: 

ETA: 

Community Service Employment for Older Americans ........................................................................................... FY 2019 ........... $463,809,605 .. $400,000,000 $463,800,000 

VETERANS’ EMPLOYMENT AND TRAINING SERVICE: 

Homeless Veterans Program ............................................................................................................................................ FY 2019 ........... 50,000,000 ...... 50,000,000 60,000,000 

DEPARTMENT OF HEALTH AND HUMAN SERVICES: 

HRSA: 

Health Careers Opportunity Program ...................................................................................................................... FY 2014 ........... Such Sums ...... 14,153,000 20,000,000 Faculty Loan Repayment ......................................................................................................................................... FY 2014 ........... 5,000,000 ........ 1,187,000 1,190,000 Scholarships for Disadvantaged Students ............................................................................................................. FY 2014 ........... Such Sums ...... 44,857,000 53,470,000 Primary Care Training and Enhancement .............................................................................................................. FY 2014 ........... Such Sums ...... 36,831,000 48,924,000 Oral Health Training Programs ............................................................................................................................... FY 2012 ........... 25,000,000 ...... 40,673,000 40,673,000 Area Health Education Centers .............................................................................................................................. FY 2014 ........... 125,000,000 .... 30,250,000 41,250,000 

Education & Training—Geriatrics 

(Workforce Development) ........................................................................................................................................ FY 2014 ........... 10,800,000 ...... 33,237,000 43,384,000 (Career Incentive Awards) ...................................................................................................................................... FY 2013 ........... 10,000,000 ......Loan Repayment Program for Substance Use Disorder Treatment Workforce ....................................................... N/A .................. N/A .................. N/A 25,000,000 Mental and Substance Use Disorder Workforce Training Demonstration .............................................................. N/A .................. N/A .................. N/A 10,000,000 National Center for Workforce Analysis .................................................................................................................. FY 2014 ........... 7,500,000 ........ 4,651,000 5,663,000 Nurse Education, Practice, Quality and Retention Program .................................................................................. FY 2016 ........... Such Sums ...... 41,913,000 43,590,000 Nurse Practitioner Residency Training ................................................................................................................... N/A .................. N/A .................. N/A 20,000,000 Nursing Education Loan Repayment ...................................................................................................................... FY 2007 ........... Such Sums ...... 31,055,000 90,620,000 NURSE Corps Scholarship and Loan Repayment Program .................................................................................... FY 2007 ........... Such Sums ...... 87,135,000 90,620,000 Nurse Faculty Loan Program .................................................................................................................................. FY 2014 ........... Such Sums ...... 24,500,000 29,640,000 Graduate Medical Education .................................................................................................................................. N/A .................. ......................... N/A 30,000,000 Healthy Start ........................................................................................................................................................... FY 2013 ........... Formula ........... 100,746,000 130,500,000 Emergency Relief—Part A ...................................................................................................................................... FY 2013 ........... 789,471,000 .... 649,373,000 677,535,000 Comprehensive Care—Part B ................................................................................................................................ FY 2013 ........... 1,562,169,000 1,314,446,000 1,331,665,000 Early Intervention—Part C ..................................................................................................................................... FY 2013 ........... 285,766,000 .... 205,544,000 207,567,000 Coordinated Services and Access to Research for Women, Infants, Children and Youth—Part D ..................... FY 2013 ........... 87,273,000 ...... 75,088,000 76,047,000 Dental Reimbursement—Part F ............................................................................................................................. FY 2013 ........... 15,802,000 ...... 12,991,000 13,296,000 AIDS Education and Training Centers—Part F ...................................................................................................... FY 2013 ........... 42,178,000 ...... 33,275,000 34,047,000 Special Projects of National Significance—Part F ................................................................................................ FY 2013 ........... 25,000,000 ...... 25,000,000 25,000,000 Ending HIV/AIDS Initiative ...................................................................................................................................... N/A .................. N/A .................. N/A 70,000,000 Organ Transplantation ............................................................................................................................................ FY 1993 ........... Such Sums ...... 2,767,000 32,049,000 Rural Health Outreach Grants ................................................................................................................................ FY 2012 ........... 45,000,000 ...... 55,553,000 84,609,000 Rural Hospital Flexibility Grants ............................................................................................................................. FY 2012 ........... Such Sums ...... 41,040,000 59,000,000 

293 

State Offices of Rural Health ................................................................................................................................. FY 2002 ........... Such Sums ...... 4,000,000 12,500,000 Telehealth ................................................................................................................................................................ FY 2006 ........... Such Sums ...... 6,814,000 28,500,000 Family Planning Grants .......................................................................................................................................... FY 1985 ........... 158,400,000 .... 142,500,000 400,000,000 

CDC: 

Sexually Transmitted Diseases Grants ................................................................................................................... FY 1998 ........... Such Sums ...... 113,671,000 167,310,000 National Cancer Registries ..................................................................................................................................... FY 2003 ........... Such Sums ...... N/A 51,440,000 National Center for Health Statistics ..................................................................................................................... FY 2003 ........... Such Sums ...... 125,899,000 160,397,000 WISEWOMAN ............................................................................................................................................................ FY 2003 ........... Such Sums ...... 12,419,000 46,770,000 Asthma (Environmental) ......................................................................................................................................... FY 2005 ........... Such Sums ...... 32,422,000 34,000,000 Folic Acid ................................................................................................................................................................ FY 2005 ........... Such Sums ...... 2,188,000 3,150,000 Injury Prevention and Control ................................................................................................................................. FY 2005 ........... Such Sums ...... 138,237,000 697,559,000 Oral Health Promotion ............................................................................................................................................ FY 2005 ........... Such Sums ...... 11,204,000 20,000,000 Safe Motherhood/Infant Health Promotion ............................................................................................................. FY 2005 ........... Such Sums ...... 44,738,000 58,000,000 Grants to Promote Childhood Nutrition and Physical Activity ............................................................................... FY 2005 ........... Such Sums ...... 26,835,000 58,920,000 Screening, Referrals, and Education Regarding Lead Poisoning .......................................................................... FY 2005 ........... 40,000,000 ...... 36,474,000 40,000,000 Birth Defects, Developmental Disability, Disability and Health ............................................................................ FY 2007 ........... Such Sums ...... 122,242,000 161,560,000 Developmental Disabilities Surveillance and Research Program (Autism) ........................................................... FY 2011 ........... 21,000,000 ...... 21,380,000 23,100,000 Breast and Cervical Cancer ................................................................................................................................... FY 2012 ........... 275,000,000 .... 204,779,000 245,000,000 Johanna’s Law ........................................................................................................................................................ FY 2014 ........... 18,000,000 ...... 4,972,000 12,000,000 Epidemiology Laboratory Capacity Grants .............................................................................................................. FY 2014 ........... 190,000,000 .... 32,424,000 40,000,000 National TB Strategy/Grants ................................................................................................................................... FY 2013 ........... 243,101,000 .... 132,997,000 152,256,000 Public Health Workforce and Career Development ................................................................................................. FY 2013 ........... 39,500,000 ...... 64,000,000 56,000,000 National Diabetes Prevention Program ................................................................................................................... FY 2014 ........... Such Sums ...... 10,000,000 30,000,000 Section 317 Immunization ...................................................................................................................................... FY 2014 ........... Such Sums ...... 610,847,000 650,000,000 Congenital Heart Disease Programs ....................................................................................................................... FY 2015 ........... Such Sums ...... 4,000,000 8,000,000 Young Women’s Breast Health Awareness and Support of Young Women Diagnosed with Breast Cancer 

(PHSA 399NN).

FY 2019 ........... 4,900,000 ........ 4,960,000 4,960,000 

SAMHSA: 

State Opioid Response Grants ................................................................................................................................ N/A .................. N/A .................. N/A 1,500,000,000 

AHRQ: 

Research on Health Costs, Quality, and Outcomes ............................................................................................... FY 2005 ........... Such Sums ...... 324,000,000 358,217,000 

ACF: 

Low Income Home Energy Assistance Program ...................................................................................................... FY 2007 ........... 5,100,000,000 2,161,170,000 3,840,304,000 Children and Families Services Programs ............................................................................................................. ................... ...................Adoption and Legal Guardianship Incentive Payments ......................................................................................... FY 2016 ........... 43,000,000 ...... 37,943,000 75,000,000 Native American Programs ..................................................................................................................................... FY 2002 ........... Such Sums ...... 45,826,000 60,000,000 Community Services Block Grant ........................................................................................................................... FY 2003 ........... Such Sums ...... 645,762,000 760,000,000 Head Start ............................................................................................................................................................... FY 2012 ........... Such Sums ...... 7,968,544,000 11,563,095,000 Runaway and Homeless Youth Programs ............................................................................................................... FY 2013 ........... Such Sums ...... 107,852,000 125,280,000 CAPTA programs ..................................................................................................................................................... FY 2015 ........... Such Sums ...... 143,981,000 179,000,000 

294 

Agency 

Program 

Last Year of 

Authorization 

Authorization 

Level 

Appropriations 

in Last Year of 

Authorization 

Appropriations 

in this Bill 

Family Violence Programs ....................................................................................................................................... FY 2015 ........... 178,500,000 .... 139,500,000 175,000,000 Child Welfare Services ............................................................................................................................................ FY 2016 ........... 325,000,000 .... 268,735,000 268,735,000 Refugee and Entrant Assistance Transitional and Medical Services .................................................................... FY 2002 ........... Such Sums ...... 227,243,000 354,000,000 Social Services ........................................................................................................................................................ FY 2002 ........... Such Sums ...... 158,600,000 155,000,000 Preventive Health .................................................................................................................................................... FY 2002 ........... Such Sums ...... 4,835,000 4,600,000 Targeted Assistance ................................................................................................................................................ FY 2002 ........... Such Sums ...... 49,477,000 47,601,000 Victims of Torture ................................................................................................................................................... FY 2007 ........... 25,000,000 ...... 9,817,000 19,000,000 

ACL: 

Alzheimer’s Diseases Demonstration ...................................................................................................................... FY 2002 ........... Such Sums ...... 11,483,000 27,500,000 

Lifespan Respite Care ............................................................................................................................................ FY 2011 ........... 94,810,000 ...... 2,495,000 5,500,000 State Health Insurance Assistance Program .......................................................................................................... FY 1996 ........... 10,000,000 ...... N/A 55,000,000 Developmental Disabilities ..................................................................................................................................... FY 2007 ........... Such Sums ...... 155,115,000 187,582,000 Voting Access for People with Disabilities ............................................................................................................. FY 2005 ........... 17,410,000 ...... 13,879,000 8,119,000 Elder Justice/Adult Protective Services ................................................................................................................... FY 2014 ........... 129,000,000 .... 0 20,874,000 Assistive Technology ............................................................................................................................................... FY 2010 ........... Such Sums ...... 25,000,000 36,000,000 

PHSSEF: 

National Disaster Medical System .......................................................................................................................... FY 2018 ........... 52,700,000 ...... 57,404,000 57,404,000 

Medical Reserve Corps ........................................................................................................................................... FY 2018 ........... 11,200,000 ...... 6,000,000 6,000,000 Hospital Preparedness Program ............................................................................................................................. FY 2018 ........... 374,700,000 .... 254,555,000 316,555,000 BARDA ..................................................................................................................................................................... FY 2018 ........... 415,000,000 .... 536,700,000 566,700,000 Project BioShield ..................................................................................................................................................... FY 2018 ........... 2,800,000,000 710,000,000 735,000,000 Strategic National Stockpile ................................................................................................................................... FY 2018 ........... 533,800,000 .... 610,000,000 620,000,000 

DEPARTMENT OF EDUCATION: 

National Technical Institute for the Deaf .............................................................................................................. FY 2015 ........... Such Sums ...... 67,016,000 80,000,000 Gallaudet University ................................................................................................................................................ FY 2015 ........... Such Sums ...... 120,275,000 138,361,000 Aid for Institutional Development ........................................................................................................................... FY 2015 ........... Such Sums ...... 429,762,000 917,464,000 Aid for Hispanic-Serving Institutions ..................................................................................................................... FY 2015 ........... Such Sums ...... 109,223,000 150,000,000 International Education And Foreign Language ..................................................................................................... FY 2015 ........... Such Sums ...... 72,164,000 89,130,000 Teacher Quality Partnerships .................................................................................................................................. FY 2011 ........... Such Sums ...... 43,000,000 53,092,000 Federal TRIO Programs ........................................................................................................................................... FY 2015 ........... Such Sums ...... 839,752,000 1,160,000,000 GEAR UP .................................................................................................................................................................. FY 2015 ........... Such Sums ...... 301,639,000 395,000,000 Child Care Access Means Parents in School ......................................................................................................... FY 2015 ........... Such Sums ...... 15,134,000 60,000,000 Federal Work-Study Programs ................................................................................................................................. FY 2015 ........... Such Sums ...... 989,728,000 1,434,000,000 Federal Supplemental Educational Opportunity Grants ......................................................................................... FY 2015 ........... Such Sums ...... 733,130,000 1,028,000,000 Discretionary Federal Pell Grant ............................................................................................................................. FY 2018 ........... Such Sums ...... 22,475,352,000 22,475,352,000 Postsecondary Program for Students with Intellectual Disabilities ....................................................................... FY 2015 ........... Such Sums ...... 11,800,000 11,800,000 Graduate Assistance in Areas of National Need .................................................................................................... FY 2015 ........... 35,000,000 ...... 29,293,000 24,047,000 

295 

Fund for the Improvement of Postsecondary Education ........................................................................................ FY 2015 ........... Such Sums ...... 67,775,000 10,000,000 Institute of Education Sciences .............................................................................................................................. FY 2009 ........... Such Sums ...... 658,247,000 650,000,000 Student Aid Administration .................................................................................................................................... FY 2015 ........... Such Sums ...... 1,396,924,000 1,678,943,000 Special Programs for Migrant Students ................................................................................................................. FY 2015 ........... Such Sums ...... 37,474,000 50,000,000 Comprehensive Centers .......................................................................................................................................... FY 2009 ........... Such Sums ...... 57,113,000 60,400,000 IDEA Grants for Infants and Families .................................................................................................................... FY 2011 ........... Such Sums ...... 438,548,000 491,300,000 IDEA National Activities .......................................................................................................................................... FY 2011 ........... Such Sums ...... 240,734,000 264,452,000 

RELATED AGENCIES: 

Corporation for Public Broadcasting ...................................................................................................................... FY 1996 ........... 425,000,000 .... 275,000,000 465,000,000 Corporation for National and Community Service .................................................................................................. FY 2014 ........... Such Sums ...... 1,049,954,000 1,138,106,000 

296 

PROGRAM DUPLICATION

Pursuant to clause 3(c)(5) of rule XIII of the Rules of the House 

of Representatives, no provision of this bill establishes or reauthorizes a program of the Federal Government known to be duplicative 

of another Federal program, a program that was included in any 

report from the Government Accountability Office to Congress pursuant to section 21 of Public Law 111–139, or a program related 

to a program identified in the most recent Catalog of Federal Domestic Assistance. 

COMMITTEE HEARINGS

For the purposes of section 103(i) of H. Res. 6 of the 116th Congress— 

The following hearings were used to develop or consider the Departments of Labor, Health and Human Services, and Education, 

and Related Agencies Appropriations Act, 2020: 

The Subcommittee on Labor, Health and Human Services, Education, and Related Agencies (Subcommittee) held an oversight 

hearing on February 6, 2019, entitled ‘‘Impact of the Administration’s Policies Affecting the Affordable Care Act.’’ The Subcommittee received testimony from: 

Aviva Aron-Dine, Ph.D., Vice President for Health Policy, Center 

on Budget and Policy Priorities. 

Ed Haislmaier, Senior Research Fellow, The Heritage Foundation. 

Peter Morley, Patient Advocate. 

Joshua Peck, Co-Founder, Get America Covered. 

The Subcommittee held an oversight hearing on February 27, 

2019, entitled ‘‘Reviewing the Administration’s Unaccompanied 

Children Program.’’ The Subcommittee received testimony from: 

Altha Stewart, M.D., President, American Psychiatric Association. 

Michelle Brane, Director of the Migrant Rights and Justice Program, Women’s Refugee Commission. 

Jennifer Podkul, Senior Director for Policy and Advocacy, Kids in 

Need of Defense. 

Andrew Arthur, Resident Fellow in Law and Policy, Center for 

Immigration Studies. 

The Subcommittee held an oversight hearing on March 6, 2019, 

entitled ‘‘Protecting Student Loan Borrowers: Loan Servicing Oversight.’’ The Subcommittee received testimony from: 

Colleen Campbell, Director, Postsecondary Education, Center for 

American Progress 

Preston Cooper, Research Analyst in Higher Education Policy, 

American Enterprise Institute 

Joanna Darcus, Massachusetts Legal Assistance Corporation Racial Justice Fellow, National Consumer Law Center 

Bryon Gordon, Assistant Inspector General for Audit, Department of Education Office of Inspector General 

Shennan Kavanaugh, Deputy Chief of the Consumer Protection 

Division, Office of Massachusetts Attorney General Maura Healy 

The Subcommittee held an oversight hearing on March 7, 2019, 

entitled ‘‘Addressing the Public Health Emergency of Gun Violence.’’ The Subcommittee received testimony from: 

297 

Andrew Morral, Ph.D., Senior Behavioral Scientist, RAND Corporation 

Ronald Stewart, M.D., FACS, Director of Trauma Programs, 

American College of Surgeons Committee on Trauma 

Daniel Webster, Sc.D., Director, Johns Hopkins Center for Gun 

Policy and Research 

John Lott, Ph.D., President, Crime Prevention Research Center 

The Subcommittee held an oversight hearing on March 12, 2019, 

entitled ‘‘Oversight of For-Profit Colleges: Protecting Students and 

Taxpayer Dollars from Predatory Practices.’’ The Subcommittee received testimony from: 

The Honorable Richard J. Durbin, United States Senator 

Kevin Carey, Vice President, Education Policy and Knowledge 

Management, New America 

Marc Jerome, President, Monroe College 

Eric Longo, Former For-Profit College Student 

Robert Shireman, Director, Higher Education Excellence and 

Senior Fellow, The Century Foundation 

The Subcommittee held a budget hearing on March 13, 2019, entitled ‘‘Department of Health and Human Services Budget Request 

for Fiscal Year 2020.’’ The Subcommittee received testimony from: 

The Honorable Alex M. Azar II, Secretary, Department of Health 

and Human Services 

The Subcommittee held a budget hearing on March 26, 2019, entitled ‘‘Department of Education Fiscal Year 2020 Budget Request.’’ 

The Subcommittee received testimony from: 

The Honorable Betsy Devos, Secretary, Department of Education 

The Subcommittee held a budget hearing on March 27, 2019 entitled ‘‘Member Day Hearing.’’ The Subcommittee received testimony from: 

The Honorable Brian K. Fitzpatrick, Member of Congress 

The Honorable Debra A. Haaland, Member of Congress 

The Honorable Jim Hagedorn, Member of Congress 

The Honorable Sheila Jackson Lee, Member of Congress 

The Honorable Ro Khanna, Member of Congress 

The Honorable Betty McCollum, Member of Congress 

The Honorable Christopher H. Smith, Member of Congress 

The Honorable Thomas R. Suozzi, Member of Congress 

The Honorable Peter J. Visclosky, Member of Congress 

The Honorable Susan Wild, Member of Congress 

The Subcommittee held a budget hearing on April 2, 2019, entitled ‘‘National Institutes of Health Fiscal Year 2020 Budget Request.’’ The Subcommittee received testimony from: 

Francis Collins, M.D., Ph.D., Director, National Institutes of 

Health 

Diana Bianchi, M.D., Director, Eunice Kennedy Shriver National 

Institute of Child Health and Human Development 

Anthony Fauci, M.D., Director, National Institute of Allergy and 

Infectious Diseases 

Gary Gibbons, M.D., Director, National Heart, Lung, and Blood 

Institute 

Doug Lowy, M.D., Deputy Director, National Cancer Institute 

Nora Volkow, M.D., Director, National Institute on Drug Abuse 

298 

The Subcommittee held a budget hearing on April 3, 2019, entitled ‘‘Department of Labor Fiscal Year 2020 Budget Request.’’ The 

Subcommittee received testimony from: 

The Honorable Alexander Azar, Secretary, Department of Labor 

The Subcommittee held an oversight hearing on April 9, 2019, 

entitled ‘‘Combatting Wage Theft.’’ The Subcommittee received testimony from: 

Paul DeCamp, Member, Epstein, Becker & Green 

Laura Huizar, Senior Staff Attorney, National Employment Law 

Project 

Daniel Katz, Senior Counsel, Washington Lawyers’ Committee 

for Civil Rights and Urban Affairs 

The Honorable Kwame Raoul, Attorney General of the State of 

Illinois 

The Subcommittee held a budget hearing on April 9, 2019, entitled ‘‘Public Witness Hearing.’’ The Subcommittee received testimony from: 

Kathy Bates, National Spokesperson, LE&RN, Lymphatic Education & Research Network (LE&RN) 

Terri Bissonette, National Indian Education Association 

Mairead Bernadita Brennan, Evolutions After School Program 

Student/Yale Peabody Museum of Natural History, New Haven, 

Connecticut, on behalf of the American Alliance of Museums 

Lucero Castaneda, National Council for Community and Education Partnerships (NCCEP) 

Sancia Celestin, National College Access Network 

Clare Coleman, National Family Planning & Reproductive 

Health Association 

Rachel Conant, Senior Director, Federal Affairs, Alzheimer’s Association and Alzheimer’s Impact Movement 

Amanda Peel Crowley, Founding Board Member, Mending Minds 

Foundation 

Brandy Dailey, Council for Opportunity in Education 

Shawn Dougherty, AFSCME Council 4 member and Substance 

Abuse Counselor, American Federation of State County and Municipal Employees (AFSCME) 

Dr. Herman Felton, Wiley College 

Marilyn Geller, CEO, Celiac Disease Foundation 

Janet Hamilton, Director of Science and Policy, Council of State 

and Territorial Epidemiologists (CSTE) 

Timothy Haylon, Myotonic Dystrophy Foundation 

Donna Jones, Spina Bifida Association (SBA) 

Myra Jones-Taylor, Ph.D., ZERO TO THREE 

Brian Lovell, Assistant Superintendent, Union County Public 

Schools (KY) 

Melinda Mack, Executive Director, New York Association of 

Training and Employment Professionals (NYATEP) 

Jesse Milan, Jr., AIDS United 

J. Carter Ralphe, M.D., Chief of the Division of Pediatric Cardiology within the University of Wisconsin School of Medicine and 

Public Health and co-director of UW Health, American Heart Association 

Valerie Montgomery Rice, M.D., FACOG, President & Dean, 

Morehouse School of Medicine, Association of Minority Health Professions Schools 

299 

Nate Smith, M.D., M.P.H., Director and State Health Officer for 

the Arkansas Department of Health. President-elect ASTHO, Association of State and Territorial Health Officials (ASTHO) 

Shawonda Swain, VP & COO, Boys & Girls Clubs of Hartford, 

CT 

Brian Walach, I AM ALS 

BUDGETARY IMPACT OF FY 2020 LABOR, HEALTH AND HUMAN SERVICES, EDUCATION AND RELATED AGENCIES APPROPRIATIONS BILL

PREPARED IN CONSULTATION WITH THE CONGRESSIONAL BUDGET

OFFICE PURSUANT TO SEC. 308(a), PUBLIC LAW 93–344, AS AMENDED

[In millions of dollars] 

COMPARISON WITH BUDGET RESOLUTION

Section 308(a)(1)(A) of the Congressional Budget Act requires the 

report accompanying a bill providing new budget authority to contain a statement comparing the levels in the bill to the suballocations submitted under section 302(b) of the Act for the most recently agreed to concurrent resolution on the budget for the applicable fiscal year. 

[In millions of dollars] 

302(b) Allocation This Bill 

Budget 

Authority Outlays Budget Authority Outlays 

Comparison of amounts in the bill with Committee allocations to its subcommittees: Subcommittee on 

Labor, Health and Human Services, Education, and 

Related Agencies 

General Purpose Discretionary .............................. 189,876 193,000 1 191,718 191,631 

Mandatory .............................................................. 830,578 829,945 1 830,578 829,945 

1 Includes outlays from prior-year budget authority. 

Note.—Consistent with the funding recommended in the bill for program integrity initiatives, in accordance with section 251(b)(2) of the 

Balanced and Emergency Deficit Control Act of 1985, and after the bill is reported to the House, the Chairman of the Committee on the 

Budget will provide a revised section 302(a) allocation reflecting an additional $1,842,000,000 in discretionary budget authority and 

$1,481,000 in associated outlays. That new allocation will eliminate the technical difference prior to Floor consideration. 

In addition, the amounts in this report do not include $492,000,000 in discretionary budget authority and $945,000,000 in associated outlays provided for the purposes specified in the 21st Century Cures Act (Public Law 114–255). Pursuant to title I of that act, such funding 

does not count for the purposes of the Congressional Budget Act of 1974 or the Balanced Budget and Emergency Deficit Control Act of 1985. 

FIVE-YEAR OUTLAY PROJECTIONS

In compliance with section 308(a)(1)(B) of the Congressional 

Budget and Impoundment Control Act of 1974 (Public Law 93– 

344), as amended, the following table contains five-year projections 

associated with the budget authority provided in the accompanying 

bill. 

[In millions of dollars] 

Outlays 

Projection of outlays associated with the recommendation: 

2020 ...................................................................... ........................ ........................ ........................ 1 910,504 

2021 ...................................................................... ........................ ........................ ........................ 90,036 

2022 ...................................................................... ........................ ........................ ........................ 25,309 

2023 ...................................................................... ........................ ........................ ........................ 4,869 

2024 and future years .......................................... ........................ ........................ ........................ 1,386 

1 Excludes outlays from prior-year budget authority. 

300 

FINANCIAL ASSISTANCE TO STATE AND LOCAL GOVERNMENTS

In accordance with section 308(a)(1)(C) of the Congressional 

Budget Act of 1974, as amended, the Congressional Budget Office 

has provided the following estimates of new budget authority and 

outlays provided by the accompanying bill for financial assistance 

to State and local governments. 

[In millions of dollars] 

Budget 

Authority Outlays 

Financial assistance to State and local governments for 2020 ............................................ 483,277 1 455,836 

1 Excludes outlays from prior-year budget authority. 

301 


Insert offset folio 089 here HR62.001

FULL COMMITTEE VOTES 

Pursuant to the provisions of clause 3(b) of rule XIII of the House of Representatives. the results 

of each roll call vote on an amendment or on the motion to report, together with the names of those voting 

for and those voting against, are printed below: 

Roll Calli 

Date: May 8, 20 19 

Measure: Labor, Health and Human Services, Education, and Related Agencies Appropriations Bill, FY 

2020 

Motion by: Mr. Cole 

Description of Motion: Prohibit funds to an entity that provides abortions if, in the case of an abortion or 

attempted abortion that results in a child born alive, a health care practitioner does not act to preserve the 

life of the child, or such entity does not certifY it has protocols to follow such actions and report any 

violations. 

Results: Defeated 23 yeas to 29 nays 

Members Voting Yea 

Mr. Aderholt 

Mr. Amodei 

Mr. Calvert 

Mr. Carter 

Mr. Cole 

Mr. Cuellar 

Mr. Diaz-Balart 

Mr. Fleischmann 

Mr. Fortenberry 

Ms. Granger 

Mr. Graves 

Dr. Harris 

Ms. Herrera Beutler 

Mr. Hurd 

Mr. Joyce 

Mr. Moolenaar 

Mr. Palazzo 

Mrs. Roby 

Mr. Rogers 

Mr. Rutherford 

Mr. Simpson 

Mr. Stewart 

Mr. Womack 

Members Voting Nay 

Mr. Aguilar 

Mr. Bishop 

Mrs. Bustos 

Mr. Cartwright 

Mr. Case 

Ms. Clark 

Mr. Crist 

Ms. DeLauro 

Ms. Frankel 

Ms. Kaptur 

Mr. Kilmer 

Mrs. Kirkpatrick 

Mrs. Lawrence 

Ms. Lee 

Mrs. Lowey 

Ms. McCollum 

Ms. Meng 

Ms. Pingree 

Mr. Pocan 

Mr. Price 

Mr. Quigley 

Ms. Roybal-Allard 

Mr. Ruppersberger 

Mr. Ryan 

Mr. Serrano 

Mrs. Torres 

Mr. Visclosky 

Ms. Wasserman Schultz 

Mrs. Watson Coleman 
302 


Insert offset folio 90 here HR62.002

FULL COMMITTEE VOTES 

Pursuant to the provisions of clause 3(b) of rule XIII of the House of Representatives, the results 

of each roll call vote on an amendment or on the motion to report, together with the names of those voting 

for and those voting against, are printed below: 

Roll Ca112 

Date: May 8, 20 19 

Measure: Labor, Health and Human Services, Education, and Related Agencies Appropriations Bill, FY 

2020 

Motion by: Mr. Moolenaar 

Description of Motion: Prohibit funds for changes to rules related to Short-term Limited Duration 

Insurance or Association Health Plans unless the Secretary of Labor certifies that such changes would 

increase the number of individuals who have health insurance. 

Results: Defeated 23 yeas to 29 nays 

Members Voting Yea 

Mr. Aderholt 

Mr.Amodei 

Mr. Bishop 

Mr. Calvert 

Mr. Carter 

Mr. Cole 

Mr. Diaz-Balart 

Mr. Fleischmann 

Mr. Fortenberry 

Ms. Granger 

Mr. Graves 

Dr. Harris 

Ms. Herrera Beutler 

Mr. Hurd 

Mr. Joyce 

Mr. Moolenaar 

Mr. Palazzo 

Mrs. Roby 

Mr. Rogers 

Mr. Rutherford 

Mr. Simpson 

Mr. Stewart 

Mr. Womack 

Members Voting Nay 

Mr. Aguilar 

Mrs. Bustos 

Mr. Cartwright 

Mr. Case 

Ms. Clark 

Mr. Crist 

Mr. Cuellar 

Ms. DeLauro 

Ms. Frankel 

Ms. Kaptur 

Mr. Kilmer 

Mrs. Kirkpatrick 

Mrs. Lawrence 

Ms. Lee 

Mrs. Lowey 

Ms. McCollum 

Ms. Meng 

Ms. Pingree 

Mr. Pocan 

Mr. Price 

Mr. Quigley 

Ms. Roybal-Allard 

Mr. Ruppersberger 

Mr. Ryan 

Mr. Serrano 

Mrs. Torres 

Mr. Visclosky 

Ms. Wasserman Schultz 

Mrs. Watson Coleman 
303 


Insert offset folio 91 here HR62.003

FULL COMMITTEE VOTES 

Pursuant to the provisions of clause 3(b) of rule XIII of the House of Representatives, the results 

of each roll call vote on an amendment or on the motion to report, together with the names of those voting 

for and those voting against, are printed below: 

Roll Call3 

Date: May 8, 20 19 

Measure: Labor, Health and Human Services, Education, and Related Agencies Appropriations Bill, FY 

2020 

Motion by: Mr. Hurd 

Description of Motion: Increase funding in fiscal year 2020 by $2.38 billion, under an emergency 

designation, to carry out section 462 of the Homeland Security Act of2002 and section 235 of the 

William Wilberforce Trafficking Victims Protection Reauthorization Act of2008. 

Results: Defeated 22 yeas to 30 nays 

Members Voting Yea 

Mr. Aderholt 

Mr.Amodei 

Mr. Calvert 

Mr. Carter 

Mr. Cole 

Mr. Diaz-Balart 

Mr. Fleischmann 

Mr. Fortenberry 

Ms. Granger 

Mr. Graves 

Dr. Harris 

Ms. Herrera Beutler 

Mr. Hurd 

Mr. Joyce 

Mr. Moolenaar 

Mr. Newhouse 

Mr. Palazzo 

Mrs. Roby 

Mr. Rutherford 

Mr. Simpson 

Mr. Stewart 

Mr. Womack 

Members Voting Nay 

Mr. Aguilar 

Mr. Bishop 

Mrs. Bustos 

Mr. Cartwright 

Mr. Case 

Ms. Clark 

Mr. Crist 

Mr. Cuellar 

Ms. DeLauro 

Ms. Frankel 

Ms. Kaptur 

Mr. Kilmer 

Mrs. Kirkpatrick 

Mrs. Lawrence 

Ms. Lee 

Mrs. Lowey 

Ms. McCollum 

Ms. Meng 

Ms. Pingree 

Mr. Pocan 

Mr. Price 

Mr. Quigley 

Ms. Roybal-Allard 

Mr. Ruppersbcrger 

Mr. Ryan 

Mr. Serrano 

Mrs. Torres 

Mr. Visclosky 

Ms. Wasserman Schultz 

Mrs. Watson Coleman 
304 


Insert offset folio 92 here HR62.004

FULL COMMITTEE VOTES 

Pursuant to the provisions of clause 3(b) of rule XIII of the House of Representatives, the results 

of each roll call vote on an amendment or on the motion to report, together with the names of those voting 

for and those voting against, arc printed below: 

Roll Call4 

Date: May 8, 2019 

Measure: Labor, Health and Human Services, Education, and Related Agencies Appropriations Bill, FY 

2020 

Motion by: Ms. Lee 

Description of Motion: Prohibit funds from being used to finalize, implement, or enforce the rule entitled, 

''Protecting Statutory Conscience Rights in Healthcare; Delegations of Authority.'' 

Results: Adopted 30 yeas to 23 nays 

Members Voting Yea 

Mr. Aguilar 

Mr. Bishop 

Mrs. Bustos 

Mr. Cartwright 

Mr. Case 

Ms. Clark 

Mr. Crist 

Mr. Cuellar 

Ms. DeLauro 

Ms. Frankel 

Ms. Kaptur 

Mr. Kilmer 

Mrs. Kirkpatrick 

Mrs. Lawrence 

Ms. Lee 

Mrs. Lowey 

Ms. McCollum 

Ms. Meng 

Ms. Pingree 

Mr. Pocan 

Mr. Price 

Mr. Quigley 

Ms. Roybal-Allard 

Mr. Ruppersberger 

Mr. Ryan 

Mr. Serrano 

Mrs. Torres 

Mr. Visclosky 

Ms. Wasserman Schultz 

Mrs. Watson Coleman 

Members Voting Nay 

Mr. Aderholt 

Mr. Amodei 

Mr. Calvert 

Mr. Carter 

Mr. Cole 

Mr. Diaz-Balart 

Mr. Fleischmann 

Mr. Fortenberry 

Ms. Granger 

Mr. Graves 

Dr. Harris 

Ms. Herrera Beutler 

Mr. Hurd 

Mr. Joyce 

Mr. Moolenaar 

Mr. Newhouse 

Mr. Palazzo 

Mrs. Roby 

Mr. Rogers 

Mr. Rutherford 

Mr. Simpson 

Mr. Stewart 

Mr. Womack 
305 


Insert offset folio 93 here HR62.005

FULL COMMITTEE VOTES 

Pursuant to the provisions of clause 3(b) of rule XIII of the House of Representatives, the results 

of each roll call vote on an amendment or on the motion to report, together with the names of those voting 

for and those voting against, are printed below: 

Roll CaliS 

Date: May 8, 2019 

Measure: Labor, Health and Human Services, Education, and Related Agencies Appropriations Bill, FY 

2020 

Motion by: Mr. Graves 

Description of Motion: Prohibit funds from being used to implement a universal basic income. 

Results: Defeated 23 yeas to 30 nays 

Members Voting Yea 

Mr. Aderholt 

Mr.Amodei 

Mr. Calvert 

Mr. Carter 

Mr. Cole 

Mr. Diaz-Balart 

Mr. Fleischmann 

Mr. Fortenberry 

Ms. Granger 

Mr. Graves 

Dr. Harris 

Ms. Herrera Beutler 

Mr. Hurd 

Mr. Joyce 

Mr. Moolenaar 

Mr. Newhouse 

Mr. Palazzo 

Mrs. Roby 

Mr. Rogers 

Mr. Rutherford 

Mr. Simpson 

Mr. Stewart 

Mr. Womack 

Members Voting Nay 

Mr. Aguilar 

Mr. Bishop 

Mrs. Bustos 

Mr. Cartwright 

Mr. Case 

Ms. Clark 

Mr. Crist 

Mr. Cuellar 

Ms. DeLauro 

Ms. Frankel 

Ms. Kaptur 

Mr. Kilmer 

Mrs. Kirkpatrick 

Mrs. Lawrence 

Ms. Lee 

Mrs. Lowey 

Ms. McCollum 

Ms. Meng 

Ms. Pingree 

Mr. Pocan 

Mr. Price 

Mr. Quigley 

Ms. Roybal-Allard 

Mr. Ruppersberger 

Mr. Ryan 

Mr. Serrano 

Mrs. Torres 

Mr. Visclosky 

Ms. Wasserman Schultz 

Mrs. Watson Coleman 
306 


Insert offset folio 94 here HR62.006

FULL COMMITTEE VOTES 

Pursuant to the provisions of clause 3(b) of rule X Ill of the House of Representatives, the results 

of each roll call vote on an amendment or on the motion to report, together with the names of those voting 

for and those voting against, are printed below: 

Roll Call6 

Date: May 8, 2019 

Measure: Labor, Health and Human Services, Education, and Related Agencies Appropriations Bill, FY 

2020 

Motion by: Ms. Kaptur 

Description of Motion: Report the bill to the House, as amended. 

Results: Adopted 30 yeas to 23 nays 

Members Voting Yea 

Mr. Aguilar 

Mr. Bishop 

Mrs. Bustos 

Mr. Cartwright 

Mr. Case 

Ms. Clark 

Mr. Crist 

Mr. Cuellar 

Ms. DeLauro 

Ms. Frankel 

Ms. Kaptur 

Mr. Kilmer 

Mrs. Kirkpatrick 

Mrs. Lawrence 

Ms. Lee 

Mrs. Lowey 

Ms. McCollum 

Ms. Meng 

Ms. Pingree 

Mr. Pocan 

Mr. Price 

Mr. Quigley 

Ms. Roybal-Allard 

Mr. Ruppersberger 

Mr. Ryan 

Mr. Serrano 

Mrs. Torres 

Mr. Visclosky 

Ms. Wasserman Schultz 

Mrs. Watson Coleman 

Members Voting Nay 

Mr. Aderholt 

Mr. Amodei 

Mr. Calvert 

Mr. Carter 

Mr. Cole 

Mr. Diaz-Balart 

Mr. Fleischmann 

Mr. Fortenberry 

Ms. Granger 

Mr. Graves 

Dr. Harris 

Ms. Herrera Beutler 

Mr. Hurd 

Mr. Joyce 

Mr. Moolenaar 

Mr. Newhouse 

Mr. Palazzo 

Mrs. Roby 

Mr. Rogers 

Mr. Rutherford 

Mr. Simpson 

Mr. Stewart 

Mr. Womack 

Insert offset folio 95 here HR62.007

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

TITLE I--DEPARTMENT OF LABOR 

EMPLOYMENT AND TRAINING ADMINISTRATION 

Training and Employment Services 

Grants to States: 

Adult Training, current year. D 

Advance from prior year .... NA 

FY 2021 ...... . D 

Subtotal . 

Youth Training. ................................ D 

Dislocated Worker Assistance, current year. D 

Advance from prior year .. ............ NA 

FY 2021 ....... ..... . .. ' ............ D 

Subtotal ........... ..... 

Subtotal, Grants to States ...... .... .... 

Current Year ......... .... ' '' .. . .... 

FY 2021 ... , ... .,, . ' . '''. '' '''' 

FY 2019 

Enacted 

FY 2020 

Request Bi 11 

Bill vs. Bill vs. 

Enacted Request 

133,556 133,556 188,000 +54,444 +54,444 FF 

(712,000) (712,000) (712,000) 

712,000 712,000 712,000 

-

- W W - M W 

845,556 845,556 900,000 +54,444 +54. 444 

903,416 903,416 964,000 +60,584 +60,584 FF 

180,860 180,860 243,360 +62,500 +62,500 FF 

( 860. 000) (860,000) (860,000) 

860,000 860,000 860,000 

MWMMWWMMMWM.MW WMWMMWMWWMWMMw wwwwwwMwwMwMWW MWWMWMW•wwwwww MWWMMWWWWMMMM 

1. 040.860 1,040,860 1 ,103' 360 +62,500 +62,500 

- - - - - - - --- -- - - •• - - - - - - - - - * • - - - -- - - - - - - - - - - - • - - - - - - - - - - - - -- - - - - - - - -- -

2,789,832 2,789,832 2,967,360 +177. 528 +177,528 

(1,217,832) (1,217,832) (1,395,360) (+177 ,528) (+177,528) 

(1 ,572,000) (1,572,000) (1,572,000) 

Insert offset folio 96 here HR62.008

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS ANO AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

National Programs: 

Dislocated Worker Assistance National Reserve: 

Current year ............ ........ . ..... D 

Advance from prior year ...................... NA 

FY 2021 . ' ....... ''. '' ........ D 

Subtotal . ..... . .......... '' 

Subtotal, Dislocated Worker Assistance. 

Native American programs .... '' '''. '' ... D 

Migrant and Seasonal Farmworker programs. D 

YouthBuild activities ... .... . ....... D 

Reintegration of Ex-Offenders .............. D 

Workforce Data Quality Initiative .. .. ... D 

Apprenticeship programs ........ ..... . .... .... D 

Total, National Programs ........ ...... 

Current Year .. ..... . .... ''' ... ' 

FY 2021 .. '' ...... . ... 

FY 2019 

Enacted 

20,859 

(200,000) 

200,000 

FY 2020 

Request 

20,859 

(200,000) 

113,858 

Bi 11 

170,859 

(200,000) 

200,000 

Bill vs. Bill vs. 

Enacted Request 

+150,000 +150,000 

--- ---

--- +86' 142 

~~~~~~~~~~~~~~ ~~ -~-~~~---·~ ~~~~--- ~~~~~- ~·~~~ w W M W M W M M - M • 

220,859 134,717 370,859 +150,000 +236 '142 

-------------- -------------- -------------- -------------- -------------

1,261 '719 1,175,577 1,474,219 +212,500 +298,642 

54,500 --· 55,000 +500 +55,000 

88' 896 -- 98,896 +10,000 +98,896 

89.534 84,534 127,500 +37 '966 +42,966 

93,079 78,324 100,000 +6,921 +21 ,676 

6,000 --- 8,000 +2,000 +8,000 

160,000 160,000 250,000 +90,000 +90,000 

~~~~W~WWMW~W~ M 8 M 8 W- M M H W M M - - ~~W ~MMWMMMMW~W~~- W W W W M- M 

712,868 457,575 1 ,010,255 +297,387 +552,680 

(512,868) (343,717) (810,255) ( +297' 387) (+466,538) 

(200' 000) (113,858) (200,000) --- (+86, 142) 

FF 

FF 

FF 

FF 

Insert offset folio 97 here HR62.009

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

Total, Training and Employment Services (TES) ... 

Current Year. ............... '' ... 

FY 2021 . '' ....... ' ...... '"'' ....... 

Job Corps 

Ope rat ions .. ..... ' ........... D 

Construction, Rehabilitation and Acquisition ........ D 

Admi ni strat ion ........ ' .... . ........ D 

Total, Job Corps ..... .......... 

Current Year. .......... 

Community Service Employment For Older Americans ..... 0 

Federal Unemployment .Benefits and Allowances 

(indefinite) ................... ··················· M 

FY 2019 

Enacted 

FY 2020 

Request Bi 11 

Bill vs. Bill vs. 

Enacted Request 

-------------- -------------- -------------- -------------- -------------

3,502,700 3,247,407 3' 977 '615 +474,915 +730,208 

(1 ,730' 700) (1,561,549) (2,205,615) (+474,915) (+644,066) 

(1,772,000) (1,685,858) ( 1 '772 ,000) --- (+86' 142) 

1 ,603, 325 908,457 1,603,325 --- +694,868 

83,000 75,016 233,000 +150,000 +157,984 

32, 330 32,110 32,330 --- +220 

-------------- -------------- -------------- -------------- -------------

1,718,655 1,015,583 1 '868' 655 +150,000 +853,072 

(1 '718,655) (1,015,583) (1,868,655) (+150,000) (+853,072) 

400,000 --- 463,800 +63,800 +463,800 

790,000 680,000 680,000 -110,000 

FF 

FF 

FF 

Insert offset folio 98 here HR62.010

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

State Unemployment Insurance and Employment 

Service Operations 

Unemployment Compensation (UI): 

State Operations ..... 

Reemployment eligibility assessments--UI 

Permissible cap adjustment. . ......... . 

UI Integrity Center of Excellence. 

.. TF 

integrity TF 

TF 

TF 

Subtotal, Unemployment Compensation ...... . 

Federal-State UI National Activities .... ... . TF 

Employment Service (ES): 

Grants to States: 

Federal Funds ........... ...... D 

Trust Funds .... '' .... . . . . . . . . . . . . TF 

Subtotal, Gra~ts to States ... ····· 

ES National Activities ................... ..... TF 

Subtotal, Employment Service ....... 

Federal Funds ........... •• < ••••• ' 

Trust Fu~ds ..... 

FY 2019 

Enacted 

2,356,816 

117,000 

33.000 

9,000 

2,515,816 

12,000 

21 ,413 

641,639 

FY 2020 

Request 

2,434,230 

117,000 

58.000 

6,000 

2,615,230 

46,000 

21,413 

641,639 

Bill 

2,434,230 

117,000 

58,000 

9,000 

2,618,230 

12,000 

21 ,413 

658,587 

Bi 11 vs 

Enacted 

+77,414 

+25,000 

+102,414 

... 

... 

+16,948 

Bill vs. 

Request 

+3,000 

+3 ,000 

-36,000 

... 

+16,948 ~~~~~w~~~~~~~~ ~~~~~~--~~~·~- -•~w-•~~~·~~·~ --~~~~-- ---~· •~~---~-~-~~~ 663,052 663,052 680,000 +16.948 +16,948 

19,818 19,818 22 .. 318 +2,500 +2,500 

- ----------- - --------- --- - -------------- -------------- ------

. 

- ----

682,870 682,870 702,318 +19,448 +19,448 

(21 ,413) (21 ,413) (21 ,413) --- --

(661 ,457) (661 ,457) (680,905) (+19,448) (+19,448) 

FF 

FF 

FF 

Insert offset folio 99 here HR62.011

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

Foreign Labor Certifications and Related Activities: 

Federal Administration. 

Grants to States. 

Subtotal, Foreign Labor Certification ..... 

One-Stop Career Centers/labor Market Information. 

Total, State Ul and ES. 

Federal Funds. 

Trust Funds ..... 

TF 

TF 

D 

FY 2019 

Enacted 

48,028 

14,282 

FY 2020 

Request 

56,278 

14,282 

Bi 11 

56,278 

14,282 ~W~~·*~ ~~~~ -~~~~~W*WWWW** -~~W~W~-~W~~~ 62,310 70,560 70,560 

62,653 59,326 62,653 

Bi 11 vs. Bill VS. 

Enacted Request 

+8,250 - W * W A - - - - w * w w w w * 

+8,250 

. .. +3,327 

-------------- -------------- -------------- -------------- -------------

3,335,649 3,475,986 3,465,761 +130,112 -10,225 

(84,066) (80,739) (84,066) (+3 ,327) 

(3' 251 '583) (3,395,247) (3,381,695) (+130, 112) ( -13 ,552) 

FF 

Insert offset folio 100 here HR62.012

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

Program Administration 

Training and Employment .... 

Trust Funds ...... . 

Employment Security ...... . 

Trust Funds .... 

Apprenticeship Services .... 

Executive Direction. 

Trust Funds .... 

Total, Program Administration. 

Federal Funds .. 

Trust Funds ..... . 

Total, Employment and Training Administration .. 

Federal Funds ........... . 

Current Year ........ . 

FY 2021 ... . 

Trust Funds ..... . 

D 

TF 

D 

TF 

D 

D 

TF 

FY 2019 

Enacted 

62,040 

8,639 

3,440 

39.264 

36,160 

7,034 

2,079 

FY 2020 

Request 

59,973 

8. 351 

3. 317 

37,864 

35,914 

6,828 

2,018 

Bi 11 

62,040 

8,639 

3,440 

39,264 

36,160 

7,034 

2,079 ~~w ~~~~~~~ ~~~~~~ ~~ ~~~ -~~*~~~~ --

158,656 154,265 158' 656 

(108,674) ( 106.032) (108,674) 

(49,982) (48,233) (49,982) 

==~;~========= ============== ============== 

9,905,660 8,573,241 10,614,487 

6,604,095 5,129' 761 7,182,810 

(4,832,095) (3,443,903) (5,410,810) 

(1,772,000) (1,685,858) (1 '772 ,000) 

3,301,565 3,443,480 3,431,677 

Bi 11 vs. 

Enacted 

+708,827 

+578,715 

(+578,715) 

+130, 112 

Bi 11 VS. 

Request 

+2,067 

+288 

+123 

+1 ,400 

+246 

+206 

+61 

+4' 391 

(+2,642) 

(+1 '749) 

+2,041 ,246 

+2,053,049 

(+1 ,966,907) 

(+86,142) 

-11 ,803 

Insert offset folio 101 here HR62.013

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

EMPLOYEE BENEFITS SECURITY ADMINISTRATION (EBSA) 

Salaries and Expenses 

Enforcement and Participant Assistance. 

Po 1 icy and Comp 1 i a nee Assistance ... 

Executive Leadership, Program Oversight and Administration ............ ,. 

Total , EBSA .... 

PENSION BENEFIT GUARANTY CORPORATION (PBGC) 

Pension Benefit Guaranty Corporation Fund 

Consolidated Administrative budget ... 

WAGE AND HOUR DIVISION, Salaries and Expenses ..... . 

OFFICE OF LABOR-MANAGEMENT STANDARDS, Salaries and 

Expenses. 

D 

D 

D 

0 

NA 

D 

D 

FY 2019 

Enacted 

147' 400 

26,901 

6,699 

FY 2020 

Request 

157,696 

29,105 

6,699 

Bi 11 

147,400 

26,901 

8,854 

Bill vs. Bill vs. 

Enacted Request 

--- -10' 296 

--- -2,204 

+2, 155 +2, 155 

·······------- -------------- -------------- -------------- -------------

181,000 

(445,363) 

229,000 

41.187 

193,500 

(452,858) 

232,568 

49,134 

183,155 

(452,858) 

298,131 

40.187 

+2, 155 ·10, 345 

(+7,495) 

+69, 131 +65,563 

-1,000 -8.947 

Insert offset folio 102 here HR62.014

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

OFFICE OF FEDERAL CONTRACT COMPLIANCE PROGRAMS, 

Salaries and Expenses .. ............................ D 

OFFICE OF WORKERS' COMPENSATION PROGRAMS D 

Salaries and Expenses. .. . '.' .. . ..... ...... , . D 

Trust Funds. ..... . ....... . .... TF 

Total, Salaries and Expenses .. ...... 

Federal Funds. ' ..... ' ............ 

Trust Funds ............... ............. '' 

Special Benefits 

Federal Employees' Compensation Benefits ... .... ,,, ' M 

Longshore and Harbor Workers' Benefits ......... M 

Total, Special Benefits .... ····· ...... ..... 

FY 2019 

Enacted 

103' 476 

115,424 

2.177 

FY 2020 

Request 

103,576 

115,609 

2,173 

Bi 11 

120,000 

118,609 

2,173 

Bill vs. Bi 11 vs. 

Enacted Request 

+16,524 +16,424 

+3' 185 +3,000 

-4 

-----··------- ·-···--------- -------------- -------------- -------------

117' 601 117,782 120,782 +3, 181 +3,000 

(115' 424) (115,609) (118 ,609) (+3' 185) (+3,000) 

(2' 177) (2, 173) (2, 173) ( -4) 

227' 000 232,600 232,600 +5' 600 

3.000 2,000 2,000 -1 ,000 

-

--

- -

-

--- ---- - -

-

--

-- -

-

-

--

. 

- -- ---------- -- ----- -- ------ - ------------ -

230' 000 234,600 234,600 +4 ,600 

Insert offset folio 103 here HR62.015

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

Special Benefits for Disabled Coal Miners 

Benefit Payments. 

Administration .... 

Subtotal, FY 2020 program level. 

Less funds advanced in prior year. 

Total. Current Year ... 

New advances, 1st quarter, FY 2021 .... 

Total, Special Benefits for Disabled Coal Miners 

Administrative Expenses, Energy Employees Occupational 

Illness Compensation Fund 

Admi ni strati ve Expenses ......... . 

M 

FY 2019 

Enacted 

20,000 

5,319 

FY 2020 

Request 

30,000 

4,970 

Bill 

30,000 

4,970 

Bill vs. Bill vs. 

Enacted Request 

+10,000 

-349 

~-~-~----~~---

-~------------

-------------- -------------- -------------

25,319 34,970 34,970 +9,651 

-15,000 -14,000 -14,000 +1 ,000 

---------- ~--- -------------- -------------- ----------- ~-- -------- -----

10,319 20,970 20,970 +1 0' 651 

14,000 14,000 14,000 

24,319 34,970 34,970 +10 ,651 

59,098 59,846 59,846 +748 

Insert offset folio 104 here HR62.016

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

Black Lung Disability Trust Fund 

Benefit Payments and Interest on Advances ........ . 

WOrkers' Compensation Programs, Salaries and Expenses. M Departmental Management, Sal aries and Expenses ........ M 

Departmental Management, Inspector General.... . .... M 

Subtotal, Black Lung Disability ..... . 

Treasury Department Administrative Costs. 

Total, Black Lung Disability Trust Fund .... 

Total , Workers' Compensation Programs ...... . 

Federal Funds ... 

Current year. 

FY 2020 ... 

Trust Funds .. 

M 

FY 2019 

Enacted 

257,256 

38,246 

31,994 

330 

FY 2020 

Request 

293,464 

38,246 

32,844 

330 

Bi 11 

293,464 

38,246 

32,844 

330 

Bill vs. Bill vs. 

Enacted Request 

+36,208 

---

+850 

-------------- -------------- -------------- -------------- -------------

327,826 364,884 364,884 +37,058 

356 356 356 

------ -- --- -------------- - --- ---- -------- ----- - ----

328,182 365,240 365,240 +37,058 

============== ============== ============== ============== ============= 

759,200 812,438 815,438 +56,238 +3,000 

757,023 810,265 813,265 +56,242 +3,000 

(743,023) (796,265) (799,265) (+56,242) (+3,000) 

(14,000) (14,000) (14,000) ---

2' 177 2,173 2,173 -4 

Insert offset folio 105 here HR62.017

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION (OSHA) 

Salaries and Expenses 

Safety and Health Standards. . . . . . . ..... 

Federal Enforcement ..... . 

Whistleblower enforcement .. 

State Programs. 

Technical Support.. . ..... . 

Compliance Assistance: 

Federal Assistance. 

State Consultation Grants ... . 

Training Grants ............ . 

Subtotal, Compliance Assistance. 

Safety and Health Statistics. 

Executive Direction and Administration. 

Total, OSHA ........ . 

D 

D 

D 

D 

D 

D 

D 

0 

D 

D 

D 

FY 2019 

Enacted 

18,000 

209,000 

17' 500 

102,350 

24,469 

73,481 

59,500 

10,537 

FY 2020 

Request 

18,000 

212,780 

18,624 

102,350 

24,469 

73,914 

59,500 

""" 

Bill 

23,100 

246,383 

18,809 

123,233 

30,597 

86,623 

64,687 

12,690 

Bill vs. Bill vs. 

Enacted Request 

+5, 100 +5' 100 

+37,383 +33,603 

+1,309 +185 

+20,883 +20,883 

+6, 128 +6, 128 

+13, 142 +12,709 

+5' 187 +5, 187 

+2, 153 +12,690 

--------------

-------------- -------------- -------------- -------------

143,518 133,414 164,000 +20,482 +30,586 

32 '900 38,400 41 '168 +8,268 +2,768 

10,050 9,496 13,618 +3,568 +4, 122 ~=~:;;;~;===== ;;~;;;;;;;;;;; ~;;;;;~;;;;;;; ============;; ;;;;;;;;;;;;~ 557,787 557,533 660,908 +103, 121 +103,375 

Insert offset folio 106 here HR62.018

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

MINE SAFETY AND HEALTH ADMINISTRATION 

Salaries and Expenses 

Coal Enforcement .... 

Metal/Non-Metal Enforcement. 

Mine Safety and Health Enforcement .. 

Standards Development. 

Assessments . .......... . 

Educational Policy and Development 

Technical Support... . ... 

Program Evaluation and Information Resources (PEIR). 

Program Administration. 

Total, Mine Safety and Health Administration .... 

Total, Worker Protection Agencies ...... . 

Federal Funds .... 

Trust Funds. 

0 

0 

D 

D 

D 

D 

D 

D 

D 

FY 2019 

Enacted 

160' 000 

94,500 

---

4,500 

6,627 

39' 320 

35,041 

17,990 

15,838 

FY 2020 

Request 

---

---

252,640 

5,382 

7,445 

38,559 

34,079 

21,583 

16,355 

Bi 11 

178,608 

105,490 

---

5,023 

7,398 

43,893 

39,116 

20,082 

17,680 

Bill vs. Bi 11 VS. 

Enacted Request 

+18,608 +178 ,608 

+10,990 +105,490 

--- -252,640 

+523 -359 

+771 -47 

+4,573 +5,334 

+4,075 +5,037 

+2,092 -1.501 

+1,842 +1 ,325 

============== ============== ============== ============== ============= 

373,816 376,043 417,290 +43,474 +41 ,247 

============== ============== ============== ============== ============= 

1,603,867 1 '630, 136 1,840,453 +236,586 +210,317 

(1,601 ,690) (1 ,627,963) (1 ,838,280) (+236,590) (+210,317) 

(2,177) (2,173) (2,173) (-4) 

Insert offset folio 107 here HR62.019

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

BUREAU OF LABOR STATISTICS 

Salaries and Expenses 

Employment and Unemployment Statistics. 

Labor Market Information.. . ........ . 

Prices and Cost of Living ......... . 

Compensation and Working Conditions. 

Productivity and Technology ....... . 

Executive Direction and Staff Services. 

Total, Bureau of Labor Statistics., ..... 

Feder a 1 Funds .. . 

Trust Funds .. . 

OFFICE OF DISABILITY EMPLOYMENT POLICY 

Salaries and Expenses .. 

D 

TF 

D 

0 

0 

D 

........ 0 

FY 2019 

Enacted 

211 '000 

65,000 

210' 000 

83,500 

10,500 

35,000 

615,000 

550' 000 

65,000 

38,203 

FY 2020 

Request 

211,000 

65,000 

210,000 

83,500 

10,500 

75,000 

Bi 11 

237,900 

65,000 

222,900 

88,400 

14,200 

47,400 

;;:=========== ============== 

655,000 675,800 

590,000 610,800 

65,000 65,000 

27,000 38,500 

Bi 11 vs. Bill vs. 

Enacted Request 

+26,900 +26,900 

... ... 

+12,900 +12,900 

+4,900 +4,900 

+3' 700 +3,700 

+12,400 -27,600 

=========::::::::::::::::::: 

+60,800 +20,800 

+60,800 +20,800 

+297 +11 ,500 

Insert offset folio 108 here HR62.020

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS ANO AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

DEPARTMENTAL MANAGEMENT 

Salaries and Expenses 

Executive Direction. 

Departmental Program Evaluation .. 

Legal Services ..... 

Trust Funds .. 

International Labor Affairs. 

Administration and Management .. 

Adjudication. . .... . 

Women's Bureau ...... . 

Civil Rights Activities .. . 

Chief Financial Officer .. .. 

.,, ' ..... 

........ , 

Total, Departmental Management Salaries and 

expenses . ....... . 

Federal Funds .. 

Trust Funds .... 

D 

D 

D 

TF 

D 

D 

D 

D 

0 

D 

FY 2019 

Enacted 

30,250 

8,040 

123,745 

308 

86,125 

28,450 

35,000 

13,750 

6,880 

5,516 

FY 2020 

Request 

32,027 

8,040 

128,066 

308 

18,500 

29,004 

35,000 

3,525 

6,880 

5,516 

Bi 11 

30,250 

8,040 

128,066 

308 

122,125 

29.004 

35,000 

17 '750 

6,880 

5,516 

-

- -- -- -- --

-

------------- ----- -- ---- ---

338,064 

(337,756) 

(308) 

266,866 

(266,558) 

(308) 

382,939 

(382,631) 

(308) 

Bill vs. 

Enacted 

+4,321 

+36,000 

+554 

+4,000 

+44,875 

(+44,875) 

Bi 11 vs. 

Request 

·1 '777 

+103,625 

+14,225 

+116,073 

(+116,073) 

Insert offset folio 109 here HR62.021

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

Veterans Employment and Training 

State Administration, Grants .... '' ... . . . . ' ' . TF 

Transition Assistance Program ........................ TF 

Federal Administration. ........... . ... . ..... TF 

Nat-ional Veterans' Employment and Training Services 

Institute .... . . . . . . . . . '' ... TF 

Homeless Veterans Programs. . '. , ...... D 

Total, Veterans Employment and Training. 

Federal Funds ..... '''' ..... 

Trust Funds ......... . ' . . . ''''' .. '' .... 

IT Modernization 

Departmental support systems ........ ....... 0 

Infrastructure technology modernization. ..... D 

Total, IT Modernization ...... . '' .. 

FY 2019 

Enacted 

180,000 

23' 379 

43,248 

3,414 

50,000 

--------------

300 '041 

50,000 

250' 041 

4,889 

18,380 

FY 2020 

Request 

180,000 

29,379 

43,248 

3,414 

50,000 

Bi 11 

180,000 

29,379 

43,548 

3,414 

60,000 

Bill vs. Bi 11 vs. 

Enacted Request 

+6,000 

+300 +300 

+10,000 +10.000 

-------------- -------------- -------------- -------------

306,041 316,341 +16,300 +10,300 

50,000 60,000 +10,000 +10,000 

256,041 256,341 +6,300 +300 

4,889 4,889 

32,111 32,111 +13 ,731 

·~~--~--~-~--- -------------· 

···---~-------

-------------- -------------

23,269 37,000 37,000 +13 ,731 

Insert offset folio 110 here HR62.022

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

Office of Inspector General 

Program Activities. 

Trust Funds ... 

Total, Office of Inspector General 

Total, Departmental Management .. 

Federal Funds .... 

Current Year. 

Trust Funds .... 

Total, Workforce Investment Act Programs .. 

Current Year. 

FY 2021 .. 

Total, Title I, Department of Labor., 

Federal Funds. . . . . . . . . . . . ............ . 

Current Year. 

FY 2021 ... . 

Trust Funds ... . 

D 

TF 

FY 2019 

Enacted 

83' 487 

5,660 

FY 2020 

Request 

84,461 

5,660 

Bi 11 vs. 

Bill Enacted 

90,461 +6,974 

5,660 M~~~~ ~~~~---- ~~MW~~~~~~~~~~ WMMM~~MWW~~~~~ MM~M~M ~~ ~~~W 89,147 90,121 96,121 +6,974 

Bi 11 VS. 

Request 

+6,000 

- W- M M 

+6' 000 ~============= ============== ============== ============== ============= 

750' 521 700,028 832,401 +81 ,880 +132.373 

494,512 438,019 570,092 +75,580 +132,073 

(494,512) (438,019) (570,092) (+75,580) (+132,073) 

256,009 262,009 262,309 +6,300 +300 

============== ============== ============== ============== ============= 

5,221,355 4,262,990 5,846,270 +624,915 +1,583,280 

(3' 449, 355) (2, 577' 132) (4,074,270) (+624,915) (+1 ,497' 138) 

( 1 '772, 000) (1,685,858) (1 '772 ,000) --- (+86,142) 

============== ============== ======:::::::::::::::::::::::::::::: 

13,554,850 12' 280' 061 14,696,297 +1 '141 ,447 +2,416,236 

9,930,099 8,507,399 10 '935' 138 +1,005,039 +2,427,739 

(8' 144,099) (6,807,541) (9' 149' 138) (+1 ,005,039) (+2' 341 '597) 

(1,786,000) (1,699,858) (1 '786,000) --- (+86, 142) 

3,624,751 3,772,662 3,761,159 +136,408 -11,503 

Insert offset folio 111 here HR62.023

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

TITLE II --DEPARTMENT OF HEALTH AND HUMAN SERVICES 

HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) 

Primary Health Care 

Community Health Centers......... . ........... D 

Mandatory budget authority (Public Law 115-123)(NA). M 

Health Center Tort Claims............ .. ............. D 

Total, Community Health Centers. 

Free Clinics Medical Malpractice .. 

Total, Primary Health Care (excluding 

mandatory funds) ... 

Health Workforce 

National Health Service Corps. 

Training for Diversity: 

Centers of Excellence. 

Health Careers Opportunity Program 

Faculty Loan Repayment. 

Scholarships for Disadvantaged Students .. 

Total, Training for Diversity. 

D 

D 

D 

D 

D 

D 

FY 2019 

Enacted 

1 '505' 522 

(4,000,000) 

120,000 ~~WW~WW~M~WWA- (5,625,522) 

1 ,000 

FY 2020 

Request 

1,505.522 

(4,000,000) 

120,000 

Bi 11 

1,555,522 

(4,000,000) 

120,000 

Bill vs. 

Enacted 

+50,000 

Bi 11 VS 

Request 

+50,000 --•~w~ - - --~~W~WWW~~--~ w~w--- ----~~~ w•w~W-~AWww~- (5,625,522) (5,675,522) (+50,000) (+50,000) 

1 ,000 1 ,000 

-------------- ·------------- -------------- -------------- -------------

1,626,522 1,626,522 1,676,522 +50,000 +50,000 

105,000 105,000 120,000 +15,000 +15,000 

23,711 ·-- 25,000 +1 ,289 +25,000 

14' 189 ... 20,000 +5,811 +20,000 

1 '190 ·-- 1 '190 --- +1 '190 

48,970 -·- 53,470 +4' 500 +53,470 

-------------- -------------- -------------- -------------- -------------

88,060 --· 99,660 +11 ,600 +99,660 

Insert offset folio 112 here HR62.024

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

Primary Care Training and Enhancement. .... ... . D 

Oral Health Training. ..................... D 

Interdisciplinary Community-Based Linkages: 

Area Health Education Centers ..................... D 

Geriatric Programs. . ' ... ··················· D 

Mental and Behavorial Health .. . . . . . .. . . . . . . . . . . . . 0 

Behavioral Health Workforce Education and Training 0 

Loan Repayment Program for Substance Use Disorder 

Treatment Work ............ .................... D 

Mental and Substance Use Disorder Workforce 

Training Demonstration ..... . '. '"' ''' '' 

Total, Interdisciplinary Community Linkages .. 

Workforce Assessment .. ' ...... '' .......... D 

Public Health and Preventive Medicine programs .... D 

Subtotal, Health Professions Education and 

Training ............................. ..... 

FY 2019 

Enacted 

48,924 

40,673 

39,250 

40,737 

36,916 

75,000 

---

---

FY 2020 

Request 

---

... 

- -

---

36,916 

75,000 

---

Bi 11 

48,924 

40,673 

41 ,250 

43,384 

36,916 

85,000 

25,000 

10,000 

Bill vs. Bil I vs. 

Enacted Request 

... +48,924 

--- +40,673 

+2,000 +41 ,250 

+2,647 +43,384 

--- ---

+10,000 +10,000 

+25,000 +25,000 

+10,000 +1 0,000 ~------------- ~-----~----~~- ~----------·-- -------------- -------------

191,903 111,916 241,550 +49,647 +129,634 

5,663 4,663 5,663 --- +1 ,000 

17,000 --- 19,000 +2,000 +19 ,000 

----- ~-------- -------.------ -------------- -------------- -----------.-

392,223 116,579 455,470 +63,247 +338 ,891 

Insert offset folio 113 here HR62.025

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

Nursing Programs: 

Advanced Education Nursing ...................... . 

Nurse Education, Practice, and Retention. . .... . 

Nurse Practitioner Residency Training Initiative .. 

Nursing Workforce Diversity .... 

Nursing Corps Scholarship and loan Repayment 

Program.. .. ..... 

Nursing Faculty Loan Program .. 

Subtotal, Nursing programs. 

Total, Nursing programs. 

Children's Hospitals Graduate Medical 

Graduate Medical Education 

National Practitioner Data Bank. 

User Fees. 

Total, Health Workforce ... 

Education ...... 

D 

D 

D 

D 

D 

D 

D 

0 

D 

FY 2019 

Enacted 

74,581 

41 ,913 

... 

17.343 

87' 135 

28,500 

FY 2020 

Request 

---

---

... 

---

83,135 

---

Bi 11 

77,585 

43,590 

20,000 

18,037 

90,620 

29,640 

Bill vs. Bill vs. 

Enacted Request 

+3,004 +77. 585 

+1 ,677 +43 ,590 

+20,000 +20 ,000 

+694 +18 ,037 

+3,485 +7 ,485 

+1 '140 +29 ,640 ~------~--~-M- --~-- MMMMMMM~ ----~~--~----- MMMMMWMMMMMMMM MMMMMMMMMWMMM 

249,472 83,135 279,472 +30,000 +196,337 

M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M - - M M W M M M M M M M M M M M M - M M M M - M M M M M M M 

249' 472 83,135 279,472 +30,000 +196,337 

325,000 --- 350,000 +25,000 +350,000 

25,000 ... 40,000 +15,000 +40,000 

18,814 18,814 18,814 

-18,814 -18,814 -18,814 ~*~~~~~~~~ ~~~~w•~~~~·-~~ ~-M~~~•• - ~--~~·~~~·--~~ ··-*~~---~~~- 1,096,695 304,714 1,244,942 +148,247 +940,228 

Insert offset folio 114 here HR62.026

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

Maternal and Child Health 

Maternal and Chi 1 d Health 81 ock Grant.. D 

Sickle Cell Disease Treatment Program........... D 

Autism and Other Developmental Disabilities........ D 

Heritable Disorders in Newborns and Children....... D 

Healthy Start........ . . . . .. . . . . . . .. .. . . . . . . . . .. D 

Universal Newborn Hearing Screening ................... D 

Emergency Medical Services for Children ............... D 

Screening and Treatment for Maternal Depression... D 

Pediatric Mental Health Care Access................ D 

Total, Maternal and Child Health ..... . 

Ryan White HIV/AIDS Program 

Emergency Assistance (Part A) .. 

Comprehensive Care Programs (Part B). 

AIDS Drug Assistance Program (ADAP) (NA) .. . 

Early Intervention Program (Part C) ........... . 

Children, Youth, Women, and Families (Part D) .. 

AIDS Dental Services (Part F). 

Education and Training Centers (Part F). 

Special Projects of National Significance. 

Ending HIV/AIDS Initative .... 

Total, Ryan White HIV/AIDS program ... 

D 

D 

NA 

D 

0 

D 

D 

D 

FY 2019 

Enacted 

677' 700 

4,455 

50,599 

16' 383 

122,500 

17,818 

22' 334 

5,000 

10,000 

926,789 

655,876 

1,315,005 

(900.313) 

201,079 

75' 088 

13,122 

33,611 

25,000 

2,318, 781 

FY 2020 

Request 

660,700 

122,500 

783,200 

655,876 

1,315,005 

(900,313) 

201,079 

75,086 

13,122 

33,611 

25,000 

70,000 

2,366,761 

Bi 11 

705,000 

7,000 

53,099 

22,000 

130,500 

17,816 

22,334 

5,000 

10,000 

972,751 

677,535 

1,331,665 

(912,017) 

207,567 

76,047 

13,296 

34,047 

25,000 

70,000 

2,435,157 

Bill vs. 

Enacted 

+27,300 

+2,545 

+2,500 

+5 ,617 

+8,000 

+45,962 

+21 ,659 

+16,660 

(+11,704) 

+6,488 

+959 

+174 

+436 

+70,000 

+116,376 

Bil I VS. 

Request 

+44 '300 

+7 ,000 

+53 ,099 

+22 ,000 

+8,000 

+17,818 

+22,334 

+5,000 

+10,000 

+189,551 

+21 '659 

+16,660 

(+11 '704) 

+6 ,488 

+959 

+174 

+436 

+46,376 

Insert offset folio 115 here HR62.027

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

Health Care Systems 

Organ Transpl an tat ion .. ...... ..... . .... 0 

National Cord Blood Inventory .... .... . ... ' . . ' . . 0 

C.W. Bill Young Cell Transplantation ...... D 

340B Drug Pricing program/Office of Pharmacy Affairs. D 

Poison Control Centers ... .... . ...... D 

Hansen's Oi sease Program . ..... ................... D 

Hansen's Disease Program Buildings and Facilities .. D 

Payment to Hawaii , Treatment of Hansen's .. ........ D 

Total, Health Care Systems ... .. ,,,' ,,, 

Rural Health 

Rural Outreach Grants. '' ... ·········· ····· D Rural Health Research/Policy Development ..... ..... 0 

Rural Hospital Flexibility Grants .. ' ....... D 

State Offices of Rural Health ...... ......... D 

Black Lung Clinics .............. 0 

Radiation Exposure Screening and Education Program .. D 

Telehealth ..... '' ..... ' ......... D 

Rural Communities Opioid Response ............... D 

Rural Residency Program ............... ..... .. .. D 

Total, Rural Health ........................ 

M M 

FY 2019 

Enacted 

25,549 

16,266 

24,609 

10,238 

22,846 

13,706 

122 

1 ,857 ~~~~* MNM~~ 115' 193 

77,500 

9,351 

53,609 

10,000 

11 ,000 

1 ,834 

24,500 

120,000 

10,000 

FY 2020 

Request 

27,549 

12,266 

24,609 

10,238 

22,846 

11,653 

---

1,857 

111 ,018 

40,811 

5,000 

---

---

11,000 

1,834 

10,000 

120,000 

---

Bil 

32,049 

16,266 

24,609 

10,238 

24,846 

13,706 

122 

1,857 

- W M M * M--

123,693 

84,609 

9,351 

59,000 

12,500 

12,000 

1 ,834 

28,500 

100,000 

10,000 

Bill vs. Bill vs. 

Enacted Request 

+6,500 +4,500 

--- +4. 000 

+2,000 +2 ,000 

--- +2 ,053 

--- +122 

*WM~W~*MN~M*~~ N 

+8,500 +12,675 

+7 ,109 +43. 798 

--- +4,351 

+5,391 +59,000 

+2,500 +12. 500 

+1 ,000 +1 ,000 

--- ---

+4,000 +18,500 

-20,000 -20.000 

--- +10,000 

~NNM~~~·~---~~ -NN*NNNNNNN**-

--------~-~·--

----------~---

NNNNNNN~---~-

317.794 188,645 317,794 --- +129' 149 

Insert offset folio 116 here HR62.028

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

Family Planning .. , ... ...... '' ... .. ............. D 

Program Management. ········' ··········· .. .... 0 

Total, Health resources and services (HRS) ..... 

Vaccine Injury Compensation Program Trust Fund 

Post-FY 1988 Claims .. ...... . ... ' M 

HRSA Administrative expenses. ........ . .......... TF 

Total, Vaccine Injury Compensation Trust Fund ... 

Total, Health Resources and Services 

Administration ....... ... , 

. '. '"' ...... 

FY 2019 

Enacted 

286' 479 

155' 250 

FY 2020 

Request 

286,479 

151,993 

Bi 11 

400,000 

155' 250 

Bill vs. Bill vs. 

Enacted Request 

+113,521 +113 ,521 

.. +3,257 -~M~~~~~~ ~~-MM~M~ ~MM. ~-- ---- MMM.M ~~MMM~MMMM~-M· M.MM-MM ---· 

6 '843' 503 5,841 ,352 7,326,109 +482 '606 +1 ,484, 757 

308,000 308,000 308,000 

9,200 11,200 11,200 +2,000 

M M M M M M W M M M M M - - M M M M M M M M M M M M M - M M M ... - - M - M M - M M M M M A M M M N - - - W M M M 

317' 200 319,200 319,200 +2,000 ~============= ============== ============== ============== ============= 

7' 160,703 6,160,552 7,645,309 +484,606 +1 ,484,757 

Insert offset folio 117 here HR62.029

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

CENTERS FOR DISEASE CONTROL AND PREVENTION 

Immunization and Respiratory Diseases . .... ..... D 

Prevention and Public Health Fund 1/ .. .... NA 

Subtotal .. ' ... .... ' .,,,, ..... . ...... . . . . ' 

HIV/AIDS. Viral Hepatitis, Sexually Transmitted 

Diseases, and Tuberculosis Prevention . ............ D 

Emerging and Zoonotic Infectious Diseases. ' ..... D 

Prevention and Public Health Fund 1/ ........... NA 

Subtotal .................... 

Chronic Disease Prevention and Health Promotion ...... D 

Prevention and Public Health Fund 1 I ... . .. . . .. .. . NA 

Subtotal ........................................ 

FY 2019 

Enacted 

477 '855 

(320 ,550) 

FY 2020 

Request 

577' 386 

(152,845) 

Bi 11 

499,758 

(347,800) 

Bill vs. Bill vs. 

Enacted Request 

+21 ,903 -77,628 

(+27,250) (+194,955) 

-- • --- ~~~ M~~MMMMM~~~~~¥ MMMMM~MMMMMMMM MNMMMM M - M M M M M W M M M 

(798,405) (730 ,231) (847,558) (+49,153) (+117 ,327) 

1 '132 '278 1,318,056 1,335,197 +202,919 +17' 141 

568,372 372,472 592,622 +24,250 +220' 150 

(52,000) (137,000) (52,000) --- ( -85 ,000) 

-- -

. 

-- -

--- -- - ------- ------- -------------- -- ------------ ------------ -

620,372 509,472 644,622 +24,250 +135' 150 

932,821 347,145 1 ,080,121 +147,300 +732,976 

( 254 '950) (604, 105) (277,450) (+22,500) ( -326 ,655) 

---- --------- ---- -------- -------- -- -- ---- ---

1 '187 '771 951,250 1,357,571 +169,800 +406 '321 

Insert offset folio 118 here HR62.030

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

Birth Defects, Developmental Disabilities, 

Di sabi 1 it i es and Health ............................ D 

Subtotal ....... ... ' ....... ''' ''. '' ....... NA 

Public Health Scientific Services ... . , .... ...... D 

Evaluation Tap Funding. .... ,. NA 

Subtota 1 .. .......... . ........... ······ 

Environmental Health ................. ' ...... ' D 

Prevention and Public Health Fund 1 I ... .... NA 

Subtotal ..................... '' ... ,,,. 

Injury Prevention and Control ... ............... 0 

National Institute for Occupational Safety and Health. D 

Energy Employees Occupational Illness 

Compensation Program ................. ' ... ' '' .... M 

FY 2019 

Enacted 

155,560 

FY 2020 

Request 

112,000 

Bi 11 

161,560 

Bill vs. Bi 11 vs. 

Enacted Request 

+6,000 +49,560 ~~~~~-~MMM~~·~ ~MMMM~MM~~-~~~ MM~MM~--~~~·~M -~-~~~-~~·WMMM ~WMMMMM~M-~MM 155,560 112,000 161,560 +6,000 +49,560 

496,397 45,000 603,897 +107,500 +558,897 

--- (423,000) --- --- (-423,000) 

M M w * w w w M M & M M w M M w M M w * M M M M * * M * M M M M M M M M M M M W M M M M M M M M M M M w M * * • • * * * M M M w M M M 

(496,397) (468,000) (603,897) (+107,500) (+135,897) 

192,350 157' 000 226,350 +34,000 +69' 350 

(17,000) --- (17 ,000) --- (+17,000) ~~M~M•ww~-~--· --·-•-www•M«w• •••••••••••••• •••••••••----• ------------

209,350 157,000 243,350 +34 ,000 +86,350 

648,559 628,839 697,559 +49 ,000 +68' 720 

336,300 190,000 346,300 +10,000 +156,300 

55,358 55,358 55,358 

Insert offset folio 119 here HR62.031

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

Global Health .......... .... ' ........... D 

Public Health Preparedness and Response ............... D Buildings and Facilities. .................... 0 

Transfers from Nonrecurring Expenses Fund. .... NA 

Subtotal. .... . ............ ........ 

CDC-Wide Activities and Program Support 

Prevention and Public Health Fund 11 ...... NA 

Office of the Director ... ... ' .. ' ..... '' ... D 

Infectious Diseases Rapid Response Reserve Fund. D 

Subtotal .. .. ... ' ..... . . . . ' . . . . . 

Total, Centers for Disease Control. ......... 

Discretionary .............. ........... 

Prevention and Public Health Fund 11 ............ NA 

Transfers from Nonrecurring Expenses Fund ....... NA 

Total, Centers for Disease Control Program Level 

FY 2019 

Enacted 

488' 621 

855,200 

30.000 

---

FY 2020 

Request 

456,984 

825,000 

30,000 

... 

Bill vs. Bill vs. 

Bill Enacted Request 

523,621 +35,000 +66,637 

880,200 +25,000 +55,200 

30,000 

(225,000) (+225,000) (+225,000) 

·------------- -------------- -------------- -------------- -------------

30,000 30,000 255,000 +225,000 +225,000 

( 160.000) ... (160,000) . .. (+160,000) 

113,570 105,000 113,570 +8,570 

50,000 50,000 50,000 

.. 

-

.. 

-

-.. . --- ----. -.. --- -. ---- -------- ----------- -- - ------------ . 

(323. 570) (155,000) (323,570) ... (+168,570) 

============== ============== ============== ============== ============= 

6. 533.241 5,270,240 7,196,113 +662,872 +1 ,925,873 

6. 477.883 5,214,882 7' 140.755 +662,872 +1 .925,873 

(804, 500) (893,950) (854,250) (+49,750) (-39,700) 

... . .. (225,000) (+225,000) (+225,000) 

--- -- -

- - - - - ¥ - - -

-- --------

(7 ,337, 741) (6,587,190) (8,275,363) (+937,622) ( +1 . 688 . 173) 

Insert offset folio 120 here HR62.032

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

NATIONAL INSTITUTES OF HEALTH 

National Cancer Institute (NCI) .............. D 

NIH Innovation Account, CURES Act21. ' ' . . . ' D 

Subtotal , NCI .. . ...... .. ,, .......... . ... 

National Heart, Lung, and Blood Institute (NHLBI). D 

National Institute of Dental and Craniofacial Research 

(NIOCR). ' ' . . . ' . ' ..... '' ' .... .. .. D 

National Institute of Diabetes and Digestive and 

Kidney Diseases ( NIDOK) .......... , . D 

Juvenile Diabetes (mandatory) ........... ,, .. NA 

Subtotal, NIDDK program level ................ 

National Institute of Neurological Disorders and 

Stroke (NINDS) ............. ' ... '.'.' .... .. .... D 

NIH Innovation Account, CURES Act2/ .. . . . . ' ..... D 

Subtotal, NINDS. ' ... ' ...... 

National Institute of Allergy and Infectious Diseases 

(NIAID) .. .. ,,, '' ...... ' .......... ... . ...... ' D 

FY 2019 

Enacted 

5' 743' 892 

400,000 

FY 2020 

Request 

5,051,737 

195,000 

-· ~~~~~-~~8 ~~~~-~ *M~M*M 6,143,892 5,246,737 

3 '488' 335 3,002,696 

461 '781 397,493 

2,029,823 1, 746,493 

( 150 ,000) ( 150,000) 

Bill vs. Bi 1 I vs. 

Bil Enacted Request 

6,249' 165 +505,273 +1 '197 ,428 

195,000 -205,000 

• M - - - -W~~ ~~M M~M~ -- 8 W M M W M W 

6,444' 165 +300,273 +1 '197 ,428 

3,658,822 +170,487 +656, 126 

484,350 +22,569 +86,857 

2,129,027 +99,204 +382,534 

(150,000) 

-------------- -------------- -------------- -------------- -------------

2,179,823 1. 896.493 2,279,027 +99,204 +382. 534 

2,216,913 1,956,031 2,315,571 +98,658 +359. 540 

57.500 70,000 70,000 +12,500 

-------------- -------------- -------------- -------------- -------------

2,274,413 2,026,031 2,385,571 +111 '158 +359. 540 

5,523,324 4,754,379 5,808,268 +284,944 +1 ,053,889 

Insert offset folio 121 here HR62.033

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

National Institute of General Medical Sciences (NIGMS) D 

Evaluation Tap Funding ........................... NA 

Subtotal, NIGMS program level 

Eunice Kennedy Shriver National Institute of Child 

Health and Human Development (NICHD).... D 

National Eye Institute (NEI)........... . . . . .. D 

National Institute of Environmental Health Sciences 

(NIEHS).................. . . . . . . . . . . . . . D 

National Institute on Aging (NIA) .................... D 

National Institute of Arthritis and Musculoskeletal 

and Skin Diseases (NIAMS)... .. . . . . . . . ....... , . . D 

National Institute on Deafness and Other Communication 

Disorders (NIDCD)........... .. . . .. . . . . . D 

National Institute of Nursing Research (NINR). D 

National Institute on Alcohol Abuse and Alcoholism 

(NIAAA). . . . . . . . . . . . . . . . . . . . . . D 

National Institute on Drug Abuse (NIDA). . . . . D 

National Institute of Mental Health (NIMH)......... D 

NIH Innovation Account, CURES Act21........ ........ D 

Subtotal, NIMH, 

National Human Genome Research Institute (NHGRI) ..... D 

National Institute of Biomedical Imaging and 

Bioengineering (NIBIB). . . .. . . . . . . . . . D 

FY 2019 

Enacted 

1,725,959 

(1.146,821) 

2,872,780 

1,506,458 

796,536 

774' 707 

3,083,410 

605,065 

474,404 

162,992 

525,591 

1 ,419,844 

1 ,812, 796 

57' 500 

1 '870' 296 

575,579 

389,464 

FY 2020 

Request 

1,731,838 

(741,000) 

2,472,836 

1,296,732 

685,644 

666,854 

2,654,144 

520,829 

408,358 

140,301 

452,419 

296,379 

1,560,442 

70,000 

1,630,442 

495,448 

335,986 

Bi 11 

1,886,362 

(1 '146,821) 

3,033,183 

1 ,580,084 

835,465 

812,570 

3,286,107 

634' 637 

497,590 

170,958 

551,278 

1,489,237 

1 ,891 '704 

70,000 

1 .961 '704 

603,710 

408,498 

Bi 11 vs. 

Enacted 

+160,403 

+160,403 

+73,626 

+38,929 

+37,863 

+202,697 

+29,572 

+23,186 

+7 '966 

+25,687 

+69,393 

+78,908 

+12,500 

+91 ,408 

+28, 131 

+19,034 

Bi 11 vs. 

Request 

+154,524 

(+405,821) 

+560,345 

+283,352 

+149,821 

+145,716 

+631 ,963 

+113,808 

+89,232 

+30,657 

+98,859 

+192,858 

+331 ,262 

+331 ,262 

+108,262 

+72,512 

Insert offset folio 122 here HR62.034

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

National Center for Complementary and Integrative 

Health (NCCIH) .................................... D 

National Institute on Minority Health and Health 

Disparities (NIMHD) ..... '' '"' ........ .... D 

John E. Fogarty International Center (FIC) ..... .... D 

National, Library of Medicine (NLM). ............. D 

National Center for Advancing Translational Sciences 

(NCATS) ............... ...... D 

National Institute for Research on Safety and Quality 

(NIRSQ)31 ............... ... '' .................. D 

Office of the Director ....... .. '''' ........ ' ..... D 

Common Fund (non-add). '' ............ .. .... NA 

Gabriella Miller Kids First Research Act (Common 

Fund add) ............ . ... .... D 

NIH Innovation Account, CURES Act21. D 

Buildings and Facilities. ........ . .... D 

Total, National Institutes of Health (NIH). 

(Evaluation Tap Funding) ............... .... 

Total, NIH Program Level ........... ' . . . . . . ' 

FY 2019 

Enacted 

146,473 

314,679 

78' 109 

441.997 

806,373 

-·-

1 '909, 075 

(606,566) 

12,600 

196,000 

200,000 

FY 2020 

Request 

126,081 

270,870 

67,235 

380,463 

694,112 

255,960 

1 '756,544 

(520,367) 

12,600 

157,000 

200,000 

Bi 11 

153,632 

341 ,244 

84,926 

463,599 

845,783 

---

2,049,992 

(617' 761) 

12,600 

157,000 

200,000 

Bill vs. Bill vs. 

Enacted Request 

+7' 159 +27' 551 

+26,565 +70,374 

+6, 817 +17 ,691 

+21 ,602 +83, 136 

+39,410 +151,671 

-255,960 

+140,917 +293,448 

(+11 '195) (+97,394) 

-39,000 

============== ============== ============== ============== ============= 

37,937,179 33,410,068 39,937,179 +2,000,000 +6,527,111 

(1 '146, 821) (741,000) (1 '146,821) --- (+405,821) 

- ·~~ ~*~~~~·w~~ ~w~~- *~ ww•w~ ~~www~w~ ww•ww•~wM~w~~ (39,084,000) (34, 151 ,068) (41,084,000) (+2,000,000) (+6,932,932) 

Insert offset folio 123 here HR62.035

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES 

ADMINISTRATION (SAMHSA) 

Mental Health 

Programs of Regional and National Significance .. 

Prevention and Public Health Fund 1/ .. 

Subtotal .. 

Community Mental Health Services Block Grant (MHBG). 

Evaluation Tap Funding... . ................ . 

Subtotal ................. . 

Certified Community Behavioral Health Clinics .. 

National Child Traumatic Stress Initiative. 

Children's Mental Health Services ... 

Projects for Assistance in Transition from 

Homelessness (PATH)........... . .... 

Protection and Advocacy for Individuals with Mental 

Illness (PAlMI). 

Subtotal, Mental Health .. 

(Evaluation Tap Funding). (Prevention and Public Health Fund 1/). 

Subtotal, Mental Health program level. 

D 

NA 

D 

NA 

0 

D 

D 

D D 

FY 2019 

Enacted 

383. 774 

(12,000) 

FY 2020 

Request 

365,847 

---

Bill 

432,774 

(12,000) 

Bill vs. Bill vs. 

Enacted Request 

+49,000 +66,927 

--- (+12,000) 

------

---- ----.----- -------------- -------------- -------------

395,774 365,847 444,774 +49,000 +78,927 

701 '532 701,532 736,532 +35,000 +35,000 

(21 ,039) (21 ,039) (21 ,039) 

-----------·-- -------------- -------------- -------------· -------------

(722, 571) (722,571) (757,571) (+35,000) (+35,000) 

150,000 150,000 150,000 

63' 887 63,887 70,887 +7,000 +7 '000 

125,000 125,000 130,000 +5,000 +5,000 

64,635 64,635 66,635 +2,000 +2,000 

36,146 14,146 36,146 --- +22,000 

--------------

-------------- -------------- -------------- -------------

1 '524, 974 1,485,047 1 ,622,974 +98,000 +137,927 

(21.039) (21,039) (21 ,039) --- ---

(12.000) --- (12,000) --- (+12,000) 

-----

-------- -------------- -------------- -------------- -------------

(1 ,558.013) (1,506,086) (1 ,656,013) (+98,000) (+149,927) 

Insert offset folio 124 here HR62.036

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

Substance Abuse Treatment 

Programs of Regional and National Significance. D 

Evaluation Tap Funding... . ........ . NA 

Subtotal ..... 

Substance Abuse Prevention and Treatment Block Grant .. D 

Evaluation Tap Funding ........................ NA 

Subtotal. block grant .. 

State Opioid Response grants. 0 

Subtotal, Substance Abuse Treatment .... . 

(Evaluation Tap Funding) .............. . 

Subtotal, Program level., .............. . 

FY 2019 

Enacted 

458' 677 

(2,000) 

FY 2020 

Request 

429,888 

. .. 

Bill 

482,177 

(2,000) 

Bi 11 vs. Bi 11 VS. 

Enacted Request 

+23,500 +52' 289 

. .. (+2 ,000) -~-~~~-~-·-~~- ~~--~--------- --------·----- -------------- -------------

(460,677) 

1,778,879 

(79,200) 

(1 ,858,079) 

1,500,000 

(429,888) 

1,778,879 

(79,200) 

(1,858,079) 

1,500,000 

(484, 177) 

1 '778' 879 

(79,200) 

(1 ,858,079) 

1,500,000 

(+23,500) (+54,289) 

-------------- -------------- -------------- -------------- -------------

3,737,556 3,708,767 3,761,056 +23,500 +52' 289 

(81 ,200) (79.200) (81 ,200) .. (+2' 000) 

(3,818,756) (3,787,967) (3,842,256) (+23,500) (+54,289) 

Insert offset folio 125 here HR62.037

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

Substance Abuse Prevention 

Programs of Regional and National Significance. 

Health Surveillance and Program Support. 

Evaluation Tap Funding (NA) ..... 

Subtotal ...... . 

Total, SAMHSA. 

(Evaluation Tap Funding). 

(Prevention and Public Health Fund 1/). 

Total, SAMHSA Program Level ..... 

D 

D 

NA 

FY 2019 

Enacted 

205,469 

128,830 

(31 ,428) 

FY 2020 

Request 

244,090 

97,004 

(42,453) 

Bi 11 

212,469 

128,830 

(31 ,428) 

Bill VS, 

Enacted 

+7,000 

·--

... 

Bill YS, 

Request 

-31 ,621 

+31 ,826 

( -11 ,025) 

-------------- -------------- -------------- -------------- -------------

160,258 139,457 160,258 ... +20,801 

============== ============== ============== ============== ============= 

5,596,829 5,534,908 5,725,329 +128,500 +190,421 

( 133,667) (142,692) (133,667) --- (-9,025) 

(12,000) --· (12,000) --- (+12,000) 

---- --------- ---

-- ------- --------- ---- -------------- -----------

-

(5,742,496) (5,677 ,600) (5,870,996) (+128,500) (+193,396) 

Insert offset folio 126 here HR62.038

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

AGENCY FOR HEALTHCARE RESEARCH AND QUALITY (AHRQ)31 

Healthcare Research and Quality 

Research on Health Costs, Quality, and Outcomes: 

Federal Funds ............ . 

Evaluation Tap funding .. 

Medical Expenditures Panel Surveys: 

Federal Funds .. 

Program Support: 

Federal Funds .. 

Total, AHRQ (Federal funds)3/ ... 

Total, Public Health Service (PHS) appropriation 

Total, Public Health Service Program Level .... 

D 

NA 

D 

FY 2019 

Enacted 

196,709 

69,991 

71,300 

338,000 

57,565,952 

(59,662,940) 

FY 2020 

Request Bi 11 

196,709 

(18 ,408) 

71,800 

71,300 

Bill vs. Bi 11 VS. 

Enacted Request 

--- +196, 709 

(+18,408) (+18,408) 

+1,809 +71 ,800 

... +71 ,300 ~-~~---~··~*~~ w•~~*WW~H~~~~- ~W~Hw•ww••- - w • w w - w - w -

358,217 +20,217 +358. 217 

============== ============== ============== ============= 

50.375,768 60,843,739 +3,277,787 +10,467 ,971 

(52,576,410) (63,233,885) (+3,570,945) (+10,657,475) 

Insert offset folio 127 here HR62.039

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

CENTERS FOR MEDICARE AND MEDICAID SERVICES 

Grants to States for Medicaid 

Medicaid Current Law Benefits. 

State and Local Administration. 

Vaccines for Children. 

Subtotal, Medicaid Program Level. 

Less funds advanced in prior year ... 

Total, Grants to States for Medicaid ..... 

New advance, 1st quarter, FY 2020 .. 

Payments to Health Care Trust Funds 

Supplemental Medical Insurance ... .... , 

Federal Uninsured Payment ............. 

Program Management. ... ,. . ....... ' 

General Revenue for Part 0 Benefit ..... 

General Revenue for Part 0 Administration .... 

HCFAC Reimbursement .......................... 

M 

M 

M 

M 

M 

M 

M 

..... M 

..... M 

M 

H 

State Low-Income Determination for Part D. ..... M 

Total, Payments to Trust Funds, Program Level ... 

FY 2019 

Enacted 

384,882,625 

21,474,885 

4,726,461 

FY 2020 

Request 

383,836,264 

22,522,603 

4,761 '408 

Bil I VS. 

Bill Enacted 

383,836,264 -1 ,046' 361 

22,522,603 +1,047,718 

4,761 '408 +34,947 

-------------- -------------- -------------- --------------

411,083,971 411 '120,275 411 '120' 275 +36,304 

-134,847,759 -137,931,797 -137' 931 '797 -3,084,038 

------- ----------- -- -------------- ------ -

276,236,212 273,188,478 273' 188' 478 -3,047,734 

137,931 '797 139,903,075 139,903,075 +1,971 ,278 

284,288,300 304,044,600 304,044,600 +19,756,300 

127,000 109,000 109,000 -18,000 

898,000 913,000 913,000 +15,000 

92,070,000 104,539,500 1 04' 539' 500 +12,469,500 

642 '000 861 ,000 861 '000 +219,000 

315,000 324,000 324,000 +9,000 

3,500 5,000 5,000 +1 ,500 

Bill vs. 

Request 

~~~~~-~~ ~~ ~~-~-~~ ~~M~•**~-~-~ 

~~~----~-~M~M~ *~ ~~~~~~M~W~ 

378,343,800 410,796' 100 410,796' 100 +32,452,300 

Insert offset folio 128 here HR62.040

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

Program Management 

Research, Demonstration, Evaluation. 

Program Operations ..... 

State Survey and Certification. 

Federal Administration ....... . 

Total, Program management. 

Health Care Fraud and Abuse Control Account 

Centers for Medicare and Medicaid Services. 

HHS Office of Inspector General .. 

Department of Justice ....... . 

Total, Health Care Fraud and Abuse Control., 

Total, Centers for Medicare and Medicaid Services 

Federal funds ...... . 

Current year. 

New advance, FY 2020. 

Trust Funds ..... , . 

TF 

TF 

TF 

TF 

TF 

TF 

TF 

FY 2019 

Enacted 

20,054 

2,519,823 

397,334 

732.533 

FY 2020 

Request 

---

2,389,702 

442,192 

747,533 

Bi 11 

20,054 

2,824,823 

407,334 

732,533 

Bi 11 vs. Bill vs. 

Enacted Request 

--- +20,054 

+305,000 +435 ,121 

+10,000 -34,858 

--- -15,000 

-

--

-

-

--. - . ---- -- -- -- --- ------ --- ----- --- ---- ------- --- -- --------

3,669,744 3,579,427 3,984,744 +315,000 +405,317 

599,389 614,000 610,000 +10,611 -4,000 

87 '230 98,000 93,000 +5' 770 -5,000 

78,381 80,000 83,000 +4,619 +3,000 

-------------- --------------

-------------- -------------- -------------

765,000 792,000 786,000 +21,000 -6,000 

===========;== ============== ====~==~===;:: ====;~======= 796,946,553 828,259,080 828,658,397 +31 • 711 '844 +399,317 

792,511,809 823,887,653 823,687,653 +31,375,844 

(654, 580 .012) (683,984,578) (683,984,578) (+29,404,566) 

(137,931 '797) (139,903,075) (139,903,075) (+1,971,278) 

4,434,744 4,371 ,427 4,770,744 +336,000 +399' 317 

Insert offset folio 129 here HR62.041

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

ADMINISTRATION FOR CHILDREN AND FAMILIES (ACF) 

Payments to States for Child Support Enforcement and 

Family Support Programs 

Payments to Territories .. 

Repatriation ..... . 

Subtotal ... 

Child Support Enforcement: 

State and Local Administration., ......... . 

Federal Incentive Payments. 

Access and Visitation ......... . 

Subtotal, Child Support Enforcement. 

Total. Fami 1 y Support Payments Program Level .. 

M 

M 

M 

M 

M 

Less funds advanced in previous years ....... M 

Total, Family Support Payments, current year ... 

New advance. 1st quarter. FY 2021. . . . . . . . . . M 

FY 2019 

Enacted 

33,000 

1 .000 

34,000 

3,689,574 

588,673 

10,000 

FY 2020 

Request 

33,000 

1,000 

34,000 

3,648,494 

597,506 

10,000 

Bi 11 

33,000 

1 .000 

34,000 

3,648,494 

597,506 

10,000 

-------------- -------------- --------------

4,288,247 4,256,000 4,256,000 

-------------- -------------- --------------

4,322,247 4,290,000 4,290,000 

·1 ,400,000 -1,400,000 ·1 ,400,000 

- --------- ----- - ------ ---------- ---

2,922,247 2,890,000 2,B90,000 

1,400,000 1 ,400,000 1,400,000 

Bi 11 VS' 

Enacted 

·41 ,080 

+8,833 

·32,247 

-32,247 

-32,247 

Bi 11 vs. 

Request 

Insert offset folio 130 here HR62.042

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

Low Income Home Energy Assistance Program 

(LIHEAP) 

Formula Grants ..... . . ........... D 

Refugee and Entrant Assistance 

Transitional and Medical Services. 0 

Refugee Support Services ........ . D 

Victims of Trafficking ....... . D 

Unaccompanied Alien Children (UAC). D 

Victims of Torture... .. ............. . D 

Total, Refugee and Entrant Assistance .. 

FY 2019 

Enacted 

3,690,304 

354,000 

207' 201 

26,755 

1,303,245 

14,000 

FY 2020 

Request 

319,000 

150,821 

17,000 

1,303,245 

14,000 

Bi 11 

3,840,304 

354,000 

207,201 

28,255 

1,803,245 

19,000 

Bi 11 vs. Bi 11 vs. 

Enacted Request 

+150,000 +3,840,304 

--- +35,000 

--- +56,380 

+1,500 +11 ,255 

+500,000 +500,000 

+5,000 +5,000 

------------. -------------- -------------- -------------- ------.------

1,905,201 1 '804, 066 2,411,701 +506,500 +607,635 

Insert offset folio 131 here HR62.043

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

Payments to States for the Child Care and Development Block Grant .............. ' ........ '' ..... '"'' .. D 

Social Services Block Grant (Title XX) ................ M 

Children and Families Services Programs 

Programs for Children, Youth and Families: 

Head Start ... ..................... . .... D 

Preschool Development Grants .................... D 

Runaway and Homeless Youth Program. ........ D 

Service Connection for Youth on the Streets .... 0 

Child Abuse State Grants. ........... ... , .. D 

Child Abuse Discretionary Activities ..... D 

Community Based Child Abuse Prevention ......... D 

Child Welfare Services. ······ .......... D 

Child Welfare Training, Research, or Demonstration 

projects ............. ............ D 

Adoption Opportunities ....... ........ D 

Adoption Incentive Grants. .. .. .... .... D 

FY 2019 

Enacted 

5,276,000 

1,700,000 

10,063,095 

250,000 

110.280 

17,141 

85,310 

33,000 

39,764 

268,735 

17' 984 

39,100 

75,000 

FY 2020 

Request 

5,276,000 

---

10,063,095 

---

119,121 

---

85,310 

33,000 

39,764 

268,735 

17,984 

39,100 

37,943 

Bi 11 

7,676,000 

1,700,000 

11,563,095 

350.000 

125,280 

22,141 

90,000 

34,000 

75,000 

268,735 

17,984 

42,100 

75,000 

Bill vs. Bill vs. 

Enacted Request 

+2,400,000 +2,400,000 

--- +1 ,700,000 

+1,500,000 +1 ,500,000 

+100,000 +350,000 

+15,000 +6,159 

+5,000 +22 ,141 

+4,690 +4,690 

+1 ,000 +1 ,000 

+35,236 +35,236 

+3,000 +3,000 

--- +37,057 

Insert offset folio 132 here HR62.044

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

Social Services and Income Maintenance Research ... D 

Native American Programs ...... '' .......... D 

Community Services: 

Community Services Block Grant Act programs: 

Grants to States for Community Services. 0 

Economic Development ........................ D 

Rural Community Facilities ..... ' ..... D 

Subtotal, Community Services. ' ... ' ...... 

Domestic Violence Hotline .... '' '' ..... ..... D 

Family Violence Prevention and Services .... . ' ....... D 

Chafee Education and Training Vouchers ........ 0 

Disaster Human Services Case Management. 0 

Program Direction ........ . . . . . . ' . . . . . . .... ,. D 

Total, Children and Families Services Programs. 

FY 2019 

Enacted 

6,512 

54,550 

725,000 

19,883 

9,000 

FY 2020 

Request 

6,512 

52,050 

---

---

---

Bill 

7,012 

60,000 

760,000 

25,000 

11,000 

Bill vs. Bill vs. 

Enacted Request 

+500 +500 

+5,450 +7,950 

+35,000 +760,000 

+5, 117 +25,000 

+2,000 +11 ,000 

- - - w - - W - - ~-- M - - • - - - - • - - - -- - - • - - - - - - - - - - -- - • - • - • • • • • - - - - - • • - - - - - - - - - -

753,883 --- 796,000 +42, 117 +796,000 

10,250 10,250 12,000 +1 '750 +1 ,750 

164,500 164,500 175,000 +10,500 +10,500 

43,257 43,257 43,257 

1,864 1,864 1 ,864 

205,000 205,000 209,000 +4,000 +4,000 

--.------- ~--- -------------- -------------- -------------- -------------

12,239,225 11,187,485 13,967,468 +1 ,728,243 +2,779,983 

Insert offset folio 133 here HR62.045

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

Promoting Safe and Stable Families. ..... ........ M 

Discretionary Funds ... ......... ..... D 

Total, Promoting Safe and Stable Families ....... 

Payments for Foster Care and Permanency 

Foster Care ........ .......... . ........ M 

Adoption Assistance ...... ...... ' .... M 

Guardianship ......... ' .... ..... . .... ' M 

Independent Living .. ' ..... . ' . ' . ' ............... M 

Total, Payments to States. ..... ····· Less Advances from Prior Year ................. M 

Total, payments, current year .. ..... 

New Advance, 1st quarter, FY 2021. ... ' ... M 

Total, ACF .. '''' .. ' .. ,, ' ...... 

Current year .. .. ' .. ' ............ 

FY 2021 . ...... ' ..... ...... 

. '''' 

Total, ACF Program Level ... ..... .... 

FY 2019 

Enacted 

345,000 

99' 765 

FY 2020 

Request 

345,000 

59,765 

Bill VS. 

Bi 11 Enacted 

345,000 

79,765 -20,000 ~-~M --¥~MM~M~ ~~~N~WM~M~~~M- ~~~ -MN MMM -¥MMMM-MM 

444,765 404,765 424,765 -20,000 

5,329,000 5,253,000 5,253,000 -76,000 

3,063,000 2,931,000 2,931,000 -132,000 

203,000 217,000 217,000 +14,000 

140,000 143,000 143,000 +3,000 ~~-~---~- ~--- --~-~--~---*· M M M M M M M M M M M M M M M M 

8,735,000 8,544,000 8,544,000 -191 '000 

-2,700,000 -2,800,000 -2,800,000 -100,000 

Bill VS. 

Request 

+20,000 

-- M M M M M M 

+20,000 

MMMMMMMMM MMM 

--- -- -- - - --

-- -

--

-

--

--

- ------ -- ------ --- ---------- - ---------

-

---

6,035,000 5,744,000 5,744,000 -291 ,000 

2,800,000 2,800,000 3,000,000 +200,000 +200,000 

:============= ============== ============== ============== ============= 

38,412,742 31,506,316 43,054,238 +4,641 ,496 +11,547,922 

(34,212,742) (27,306,316) (38,654,238) (+4,441 ,496) (+11,347,922) 

(4,200,000) (4,200,000) (4,400,000) (+200,000) (+200,000) 

-------------

---- --------- -------------- --- --------- -------------

38,412,742 31,506,316 43,054,238 +4,641 ,496 +11 ,547,922 

Insert offset folio 134 here HR62.046

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

ADMINISTRATION FOR COMMUNITY LIVING 

Aging and Disability Services Programs 

Grants to States: 

Home and Community-based 

Preventive Health .. 

Protection of Vulnerable 

Supportive Services. . . . D 

.... D 

Older Americans-Title VII D 

Subtotal ........ . 

Family Caregivers. ' ......... ' .... D 

Native American Caregivers Support .......... D 

Subtotal, Caregivers ............... .... 

Nutrition: 

Congregate Meals ......... .. ......... D 

Home Delivered Meals. D 

Nutrition Services Incentive Program .. ......... D 

Subtotal .................................. 

Subtotal, Grants to States ................ 

FY 2019 

Enacted 

385' 074 

24,848 

21,658 

431 '580 

181 '186 

10,056 

FY 2020 

Request 

385,074 

24,848 

20,628 

430,550 

150' 586 

7,556 

Bi 11 

422,000 

24,848 

23,658 

470,506 

200,000 

12,056 

Bill vs. Bi 11 vs. 

Enacted Request 

+36,926 +36,926 

+2,000 +3,030 

+38,926 +39,956 

+18,814 +49,414 

+2 ,000 +4,500 ~-~-~~-~------ -------------- -------------- -------------- -------------

191,242 158,142 212,056 +20,814 +53,914 

495,342 495,342 525,000 +29,658 +29,658 

251 '342 251,342 305,000 +53,658 +53,658 

160' 069 160,069 170,000 +9,931 +9. 931 ~~~~ ~~~~·~· ~~~~~~·M~ ~·~M~~~~~~·~-~ ~~~ ·~~·~-·~· -~-~~~·~· .. 

906,753 906,753 1 '000. 000 +93,247 +93,247 

MMMMMMMMMMMMMM MMMMMM••M•MMMM MMMMMMMMMMMMMM MMMMMMMMMMMMMM MMMMMMMMMM••• 

1,529,575 1,495,445 1,682,562 +152,987 +187,117 

Insert offset folio 135 here HR62.047

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

Grants for Native Americans. 

Aging Network Support Activities .. 

Alzheimer's Disease Program ..... 

Prevention and Public Health Fund 11 .. 

Lifespan Respite Care .......... . 

Chronic Disease Self-Management Program ... . 

Prevention and Public Health Fund 1 I .. . 

Elder Falls Prevention ... 

Prevention and Public Health Fund 1 I ....... . 

Elder Rights Support Activities. 

Aging and Disability Resources .. 

State Health Insurance Program .. 

Paralysis Resource Center. 

Limb Loss Resource Center ....... . 

Traumatic Brain Injury ...................... .. 

D 

D 

0 

NA 

0 

0 

NA 

D 

NA 

D 

D 

TF 

0 

D 

D 

FY 2019 

Enacted 

34,208 

17,461 

8,800 

(14, 700) 

4,110 

---

(8.000) 

---

(5,000) 

15,874 

8,119 

49,115 

8,700 

3,500 

11 ,321 

FY 2020 

Request 

34,208 

11,503 

19,490 

3,360 

13,874 

6,119 

36,115 

9,321 

Bi 11 

37,208 

12,461 

12,800 

(14,700) 

5,500 

(8,000) 

(5,000) 

20,874 

8,119 

55,000 

8,700 

4,000 

12,321 

Bill vs. 

Enacted 

+3,000 

-5,000 

+4. 000 

+1 .390 

+5,000 

+5,885 

+500 

+1 ,000 

Bill vs. 

Request 

+3 '000 

+958 

-6,690 

(+14,700) 

+2,140 

(+8,000) 

(+5,000) 

+7,000 

+2,000 

+18,885 

+8,700 

+4 ,000 

+3,000 

Insert offset folio 136 here HR62.048

COMPARATIVE STATEMENT OF NEW BUDGET {OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

Developmental Disabilities Programs 

State Councils. .... ...... D 

Protection and Advocacy .. . , ... ......... 0 

Voting Access for Individuals with Disabilities .. 0 

Developmental Disabilities Projects of National D 

Significance ... D 

University Centers for Excellence in Developmental D 

Di sab i l it i es . .......... '' ......... D 

Subtotal, Developmental Disabilities Programs ... 

Workforce Innovation and Opportunity Act 

Independent Living ...... ......... ........... D 

National Institute on Disability, Independent 

Living, and Rehabilitation Research ...... .. .. D 

Assistive Technology ..... .... ... ,,,,,,,,,,' D 

Subtotal, Workforce Innovation and Opportunity 

Act ....... , .......... ''' '' ''' ... '., ...... 

FY 2019 

Enacted 

76' 000 

40,734 

6,963 

12,000 

40,619 

. .. "' --. .. -.. 

176 '316 

116,183 108,970 

36,000 

FY 2020 

Request 

56,000 

38,734 

4,963 

1 ,050 

32,546 

................... 

133,293 108,646 

90,371 31,939 

Bill 

80,000 

43,000 

8,963 

13,000 

41,619 

. 

-

. 

-

.... 

- ----

186' 582 116,183 

108,970 

37,000 

Bi 1l vs. Bill vs. 

Enacted Request 

+4,000 +24,000 

+2,266 +4 '266 

+2,000 +4 ,000 +1 ,000 +11 ,950 +1 ,000 +9,073 

... .. 

+10,266 +53,289 

··- +7,537 

--- +18,599 

+1 ,000 +5,061 

_____________ .. 

-------------

261 ,153 230,956 262' 153 +1,000 +31 '197 

Insert offset folio 137 here HR62.049

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

Program Administration. . ,, ... '' .. ' ......... ' ..... D 

Total, Administration for Community Living (ACL) 

Federal funds ... ' . ' . . . . . . ' . . . ' . ······ Trust Funds ...... ... ..... ' ..... ' ....... 

(Prevention and Public Health Fund 11) ......... 

Total, ACL program 1 evel ...... ......... 

OFFICE OF THE SECRETARY 

General Departmental Management 

General Departmental Management, Federal Funds .. D 

Departmental Appeals Board ........................... D 

Teen Pregnancy Prevention Community Grants ...... D 

Evaluation Tap Funding ................... .... NA 

Subtotal, Grants ..... '' ............. "''' 

FY 2019 

Enacted 

41,063 

FY 2020 

Request 

38,987 

Bi 11 

41 ,063 

Bill vs. Bi 11 vs. 

Enacted Request 

... +2,076 

============== ============== ============== ============== ============= 

2' 169,315 2,032,671 2,349,343 +180,028 +316,672 

(2' 120' 200) (1,996,556) (2,294,343) (+174, 143) (+297,787) 

(49, 115) (36,115) (55,000) (+5,885) (+18,885) 

(27' 700) --- (27,700) -- (+27,700) 

--

... --------. 

--

--------

_________ ,. ____ 

2,197,015 2.032,671 2,377,043 +180,028 +344,372 

186,919 183,895 193,169 +6,250 +9,274 

14,000 23,000 20,000 +6,000 -3,000 

101,000 --- 110,000 +9,000 +110,000 

(6,800) --- (6,800) --. (+6,800) 

.................. 

--

--------

.......... .. .............. 

--

-

.... 

--

.......... 

-

.. .. 

-----

.......... 

(107' 800) --- (116,800) (+9,000) (+116,800) 

Insert offset folio 138 here HR62.050

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

Sexual Risk Avoidance ......... 

... ''' ''' D 

Office of Minority Health ..... ' . . . . . . ' 0 

Office on Women's Health. 

.... ·············· D Minority HlVIAIDS prevention and treatment .... D 

Embryo Adoption Awareness Campaign. ...... 0 

Planning and Evaluation, Evaluation Tap Funding. NA 

Total, General Departmental Management .... 

Federal Funds. '' .. '·················· .... (Evaluation Tap Funding). ' . . . . . . . ' . . ' . 

Total, General Departmental Management Program .. 

Office of Medicare Hearings and Appeals. ............ TF 

Office of the National Coordinator for Health 

Information Technology ......... . '.' .. .... D 

Evaluation Tap Funding .... '''' . ' . . . . . D 

Total , Program Level .. ' . . ' . . . . . . ........ 

FY 2019 

Enacted 

35,000 

56,670 

32' 140 

53,900 

1,000 

{58,028) 

FY 2020 

Request 

---

51,798 

27,316 

53,900 

---

(68,840) 

Bi 11 

---

65,000 

36,000 

60,000 

1,000 

(58,028) 

Bill vs. Bill vs. 

Enacted Request 

-35,000 

+6,330 +13,202 

+3,860 +8,684 

+6' 100 +6, 100 

--- +1 ,000 

- - ( -10,812) -~--------~-- .. --~ ... ~~-------- __ ,. ___________ -------- ----- -------------

480,629 339,909 485' 169 +4,540 +145,260 

(480,629) (339,909) (485' 169) (+4,540) (+145,260) 

(64, 828) (68,840) (64,828) --- ( -4,012) 

.. .. 

--

--- "' .. -.. -.... - .... - ............ *----- - .. ~.... - .. -........ .. ...... .............. 

545,457 408,749 549,997 +4,540 +141 '248 

182,381 182,381 182,381 

60,387 43,000 --- -60,367 -43,000 

... --- (60,367) (+60,367) (+60,367) 

..... 

--

...... 

-

.... 

-

........ 

--

... 

----------

.. 

- ----------- ----

.. 

-

.. 

-----

.. 

- -------

.. 

--

(60, 367) (43,000) (60,367) --- (+17 ,367) 

Insert offset folio 139 here HR62.051

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

Office of Inspector General 

Inspector General Federal Funds ..... , ..... . ..... D 

HCFAC funding (NA).,., .•.... ,. ············· .... NA 

Total. Inspector General Program Level ..... 

Office for Civil Rights 

Federal Funds. ' ..... ' ..... ' . ' . . ' ' ' . . . . . D 

Retirement Pay and Medical Benefits for 

Commissioned Officers 

Retirement Payments ... , .... , ..... . ....... M 

Survivors Benefits. ...... ''' , ..... M 

Dependents' Medical Care. ...... . ... ..... M 

Total, Benefits for Commissioned Officers .. , .... 

FY 2019 

Enacted 

80,000 

(334,097) 

FY 2020 

Request 

80,000 

---

Bi 11 

85,000 

---

Bi 11 vs. Bill vs. 

Enacted Request 

+5,000 +5,000 

(-334,097} 

,.WM .. ,. ___ -w-- .. - -- ... -.. ---.-.. -.... ---------- -----------·-

(414,097) (80,000) (85,000) (-329,097) (+5,000) 

38,798 30,286 38,798 --- +8,512 

469,246 491,090 491,090 +21 ,844 

31,756 31,650 31,650 -106 

128,207 100,851 100,851 ·27,356 

.. 

--

.. 

--

.. 

---

-

.. 

- --

.. 

--

---

-

.. 

-- -

-- ____ .. ______________ ., ____ 

------------

629,209 623,591 623,591 -5,618 

Insert offset folio 140 here HR62.052

COMPARATIVE STATEMENT OF BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

Public Health and Social Services Emergency Fund 

(PHSSEF) 

Assistant Secretary for Preparedness and Response 

Operations ... ' ' . . . . ' ' . ' . . . ............. D 

Preparedness and Emergency Ope rat ions ..... ...... D 

National Disaster Medical System .. . '. ,,, D 

Hospital Preparedness Cooperative Agreement Grants: D 

Formula Grants ................................. D 

Biomedical Advanced Research and Development D 

Authority (BARDA) ...... .. ,,,,,,,,,,. . .... D 

Pol icy and Planning ................ ' . . ' . ' . . . D 

Project BioShield. . ' ' ' . . . . ... . . . . . 0 

Strategic National Stockpile ..... D 

Medical Reserve Corps ................ , ........ 

Subtotal, Preparedness and Response .... ... D 

FY 2019 

Enacted 

30,938 

24,654 

57' 404 

264,555 

561 '700 

14,877 

735,000 

610,000 

6,000 

. 

---- ---- -

2, 305,128 

FY 2020 

Request 

30,938 

24,654 

77,404 

257,555 

561,700 

19,877 

735,000 

620,000 

3,900 

a; 11 

30,938 

24,654 

57,404 

316,555 

566,700 

14,877 

735,000 920,000 

6,000 

Bill vs. Bi 11 vs. 

Enacted Request 

--- -20,000 

+52,000 +59,000 

+5,000 +5,000 

--- -5,000 

--- ---

+310,000 +300,000 

+2, 100 

-----

.. 

---- M--• ---- •-------.. - -------------

2,331,028 2,672' 128 +367,000 +341,100 

Insert offset folio 141 here HR62.053

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

Assistant Secretary for Administration 

Assistant Secretary for Administration, Cybersecurity. 0 

Office of Security and Strategic Information....... D 

Public Health and Science 

Pandemic Influenza Preparedness .. 

Subtotal. Non-pandemic flu/BioShieldiSNS. 

Total , PHSSEF .. 

Total, Office of the Secretary ... 

Federal Funds .. , .. 

Trust Funds ..... 

(Evaluation Tap Funding) ... 

Total, Office of the Secretary Program Level. 

0 

D 

FY 2019 

Enacted 

58,860 

7,470 

260,000 

FY 2020 

Request 

68,093 

7,470 

260,000 

-

.... 

-

.. 

-

.. 

- -- - -

.. ¥ - -- - - - -- -

1,026,458 1,051 '591 

Bill 

58,860 

7,470 

270,000 

Bill vs. 

Enacted 

+10,000 

-----

.. 

-------- ------ -- ----

1 ,083,458 +57,000 

Bi 11 vs. 

Request 

-9,233 

+10,000 

-------

+31 ,867 

--- --- ------ --------- -- -----·------- -------------- --

_______ .. 

2,631,458 2,666,591 3,008,458 +377,000 +341 ,867 

============== ====:========= ============== ============= 

4,102,842 3, 965,758 4,423,397 +320,555 +457,639 

3, 920,461 3,783,377 4,241,016 +320,555 +457,639 

182,381 182 '381 182,381 . .. 

(64,828) (68,840) (125, 195) (+60,367) (+56,355) 

.. 

--

...... 

-*--- -

---- - ----- -- ---

4' 167,670 4,034,598 4,548,592 +380,922 +513,994 

Insert offset folio 142 here HR62.054

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

Total. Title II, Health and Human Services .. 

Federal Funds. 

Current year ..... . 

FY 2021 ............ . 

Trust Funds ....... . 

Total. CURES Act2/ ... . Total, Prevention and Public Health Fund 11. Total, Transfers from Nonrecurring Expenses Fund 

Title II Footnotes: 

11 Sec.4002 of Public Law 111-148 

21 21St Century CURES Act (Public Law 114-255) 

3/ FY2020 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 

FY 2019 

Enacted 

FY 2020 

Request Bi 11 

Bi 11 vs. Bi 11 vs. 

Enacted Request 

==========;=== ============== ============== ============== ============= 899,197,404 916,139,593 939,329,114 +40, 131 '710 +23 ,189' 521 

894. 521 '964 911,538,470 934,309,789 +39,787,825 +22' 771 '319 

(752,390,167) (767,435,395) (790.006,714) (+37,616,547) (+22,571 ,319) 

(142,131,797) (144,103,075) (144,303,075) (+2,171,278) (+200,000) 

4,675,440 4,601,123 5,019,325 +343,885 +418,202 

(711 ,000) (492.000) (492,000) ( -219. 000) (844, 200) (893,950) (893,950) (+49,750) 

(225,000) (+225,000) (+225,000) 

Insert offset folio 143 here HR62.055

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUOGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

TITLE III · DEPARTMENT OF EDUCATION 

EDUCATION FOR THE DISADVANTAGED 

Grants to Local Educational Agencies (LEAs) 

Basic Grants: 

Advance from prior year .. 

Forward funded ... . 

Current funded .... . 

Subtotal, Basic grants current year approp. 

Subtotal, Basic grants total funds available 

Basic Grants FY 2021 Advance. 

Subtotal, Basic grants, program level. 

Concentration Grants: 

Advance from prior year. 

FY 2021 Advance. 

Subtotal, 

NA 

D 

D 

D 

NA 

D 

FY 2019 

Enacted 

(1 ,540,776) 

5,013,625 

5,000 

FY 2020 

Request 

(1,440,776) 

4, 172,904 

5,000 

Bill 

( 1 '440 '776) 

6,013,625 

5,000 

Bill vs. 

Enacted 

(·100,000) 

+1,000,000 

Bill vs 

Request 

+1 '840' 721 

- -- -------------- --

............ 

-----·-·····-

5,018,625 4,177,904 6,018,625 +1,000,000 +1,840,721 

(6,559,401) (5,618,680) (7,459,401) (+900,000) (+1 '840' 721) 

1 '440' 776 2,281,497 440,776 ·1,000,000 ·1 ,840' 721 

- - - - • '"w • '"M M M M M M M M - M .. - M • '"• • '"• M M M M M M M M - M M M - • • •'" • • - - - M M M - M M M M '"'" • • • • H M M 

6 '459' 401 6' 459 '401 6,459,401 

(1 ,362,301) (1,362,301) (1,362,301) 

1 '362, 301 1 '362, 301 1,362,301 

-------------- -·------------ ------------

_____________ ,. 

--------

1,362,301 1,362,301 1,362,301 

FF 

Insert offset folio 144 here HR62.056

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

Targeted Grants: 

Advance from prior year .. ' . . . . .... NA 

FY 2021 Advance. ' ' . . . . ... D 

Subtota 1 ................. , . . . . ' . ' . . ' . ' . 

Education Finance Incentive Grants: 

Advance from prior year ........ ..... NA 

FY 2021 Advance. ' ..... . ....... D 

Subtotal ..... . ' . . ' ' . . . . ..... 

Subtotal, Grants to LEAs, program level ..... 

Student-Centered Funding Incentive Grants ....... D 

Innovative Approaches to Literacy ............ .... D 

Comprehensive literacy development grants. .......... D 

State Agency Programs: 

Migrant. ... .. ' .. , ....... ,,,, D 

Neglected and Delinquent/High Risk Youth ....... D 

Subtotal, State Agency programs ........... 

FY 2019 

Enacted 

( 3 ' 969' 050) 

4, 019,050 

FY 2020 

Request 

(4,019,050) 

4,019,050 

Bi 11 

(4,019,050) 

4,519,050 

Bill vs. Bill vs. 

Enacted Request 

(+50,000) 

+500,000 +500,000 

... ... 

-

.... ........................ 

----

... 

--

...... 

___________ 

4,019,050 4,019,050 4,519,050 +500,000 +500,000 

( 3 ' 969 '050) (4,019,050) (4,019,050) (+50,000) 

4,019,050 4,019,050 4,519,050 +500,000 +500,000 

---------- -

..... 

-

-------- - ----- --------- ------ --

.... 

--

.. 

-

,. 

----- -- ---

4,019,050 4,019,050 4,519,050 +500,000 +500,000 

============== ============== ============== ============== ============= 

15,859,802 15,859,802 16,859,802 +1 ,000,000 +1 ,000,000 

--- 50,000 --- --- -50,000 

27,000 --- 29,000 +2,000 +29,000 

190,000 --- 195,000 +5,000 +195,000 

374,751 374,751 380,000 +5,249 +5,249 

47,614 47,614 50,000 +2,386 +2,386 

.. 

-·-··----

... ··· .......... --·--· 

422,365 422,365 430,000 +7,635 +7,635 

FF 

FF FF FF 

Insert offset folio 145 here HR62.057

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

Special Programs for Migrant Students ...... ........ D 

Total, Education for the disadvantaged .... '''' 

Current Year .......... ' ' . . . . .... 

FY 2021 ..... . ' ..... ,,. ,,, '. '''' '' ...... 

Subtotal, Forward Funded. ....... 

IMPACT AID 

Basic Support Payments. .......... ........ , .... D Payments for Children with Disabilities. ,,,,,,' .... D 

Facilities Maintenance (Sec. 8008) .... '' ''''' D 

Construction (Sec. 8007) ...... , ...... . ..... D 

Payments for Federal Property (Sec. 8002) ....... 0 

Total, Impact aid ............. '' ..... 

FY 2019 

Enacted 

44,623 

FY 2020 

Request 44,623 

Bi 11 

50,000 

Bill vs. Bill vs. 

Enacted Request 

+5,377 +5' 377 

============== ============== ============== ============= 

16,543,790 16,376,790 17,563,802 +1 ,020,012 +1 ,187,012 

(5, 702,613) (4,694,892) (6,722,625) (+1 ,020,012) (+2,027,733) 

(10,841 '177) (11 ,681 ,898) (10,841.177) --- (-840,721) 

(5,625,990) (4,595,269) (6,638,625) (+1 ,012,635) (+2,043,356) 

1 '301 '242 1. 301 '242 1,351.242 +50,000 +50,000 

48,316 48,316 48,316 

4,835 4,835 4,835 

17,406 17,406 17,406 

74,313 --- 76,313 +2,000 +76,313 

:;::;========= ======;======= ==========;=== ============== ==•========== 

1 '446, 112 1,371 '799 1 ,498,112 +52,000 +126,313 

Insert offset folio 146 here HR62.058

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

SCHOOL IMPROVEMENT PROGRAMS 

Supporting Effective Instruction State Grants. 0 

Advance from prior year ............ , ....... ,,,. NA 

FY 2021 .................. ........................ 0 

Subtotal, Supporting Effective Instruction 

State Grants, program level. 

Supplemental Education Grants .............. ...... D 

21st Century Community Learning Centers .. ... ". 0 

State Assessments ..................... ........ 0 

Education for Homeless Children and Youth ..... 0 

Training and Advisory Services (Civil Rights). D 

Education for Native Hawaiians .... , .. D 

Alaska Native Education Equity .... D 

Rural Education ... .......... ' .... . . . . ' . . . D 

Comprehensive Centers ..... ...... ' . . . . . . . . . . . . . . D 

Student Support and Academic Enrichment grants ........ D 

Total, School Improvement Programs. 

Current Year .................. 

FY 2021 . ' . . . ' . . . ' . ' ..... . , '' '''''' 

Subtotal, Forward Funded ......... .... ,, .. 

FY 2019 

Enacted 

374,389 

(1 ,681,441) 

1 ,681 ,441 

FY 2020 

Request 

---

(1 ,681,441) 

---

Bi 11 

874,389 

(1 ,681,441) 

1 ,681 ,441 

Bi 11 VS. 

Enacted 

+500,000 

---

--

Bill VS 

Request 

+874' 389 

---

+1 ,681,441 

.. "'"'"'"'"'"'*"'"'"'*"'** ., ........ .,.,.., .... .,,. .. ., ••••••••••••• 

2,055,830 --- 2,555,830 +500,000 +2,555,830 

16,699 16,699 16,699 

1 ,221 '673 --- 1,321,673 +100,000 +1,321,673 

378,000 378,000 378,000 --- ---

93,500 93,500 100,000 +6,500 +6,500 

6,575 6,575 6,575 --- ---

36,397 --- 40,000 +3,603 +40,000 

35,453 --- 36,453 +1 ,000 +36,453 

180,840 180,840 180,840 -- ---

52,000 --- 60,400 +6,400 +60,400 

1 ,170,000 --- 1,320,000 +150,000 +1,320,000 

============== ============== ============== ============= 

5,246,967 675,614 6,016,470 +769,503 +5,340,856 

(3,565.526) (675,614) (4,335,029) (+769,503) (+3,659,415) 

(1 ,681 ,441) --- (1 ,681 ,441) --- (+1 ,681,441) 

(3,418,402) (652,340) (4,174,902) (+756,500) (+3,522,562) 

FF 

FF 

FF 

FF FF 

FF 

Insert offset folio 147 here HR62.059

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 ANO BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

INDIAN EDUCATION 

Grants to Local Educational Agencies 

Federal Programs: 

Special Programs for Indian Children ... 

National Activities .. 

Subtotal, Federal Programs .... 

Total, Indian Education. 

INNOVATION AND IMPROVEMENT 

D D 

0 

Education Innovation and Research.. . . . . . . . . . D 

American History and Civics Academies. . ............ 0 

American History and Civics National Activities ....... D 

Charter Schools Grants..... .. .. . .. . .. . D 

Magnet Schools Assistance.. . .......... D 

Teacher and School Leader Incentive Grants...... D 

Ready-to-Learn Television.... .. . . .. . . . . . . . . .. 0 

Supporting Effective Educator Development (SEED). D 

Arts in Education...... .. .. . .. . .. .. .. D 

FY 2019 

Enacted 

105,381 

67,993 

6,865 

FY 2020 

Request 

105,381 

63,993 

6,865 

Bi 11 

105,381 

67,993 

13,000 

Bi 11 vs. Bill vs. 

Enacted Request 

--· +4,000 

+6 '135 +6' 135 

.. ... ... 

-

.. 

------- ---- -------------

74' 858 70,858 80,993 +6, 135 +10' 135 

;::=========== ============== =====;======== ============= 

180,239 176,239 186,374 +6, 135 +10, 135 

130' 000 300,000 300,000 +170,000 

1,815 --- 1 ,815 ·-- +1 ,815 

3,000 --· 3,000 --- +3,000 

440,000 500,000 400,000 -40,000 -100,000 

107,000 107,000 125,000 +18,000 +18,000 

200.000 200,000 200,000 --- -·-

27' 741 --- 30,000 +2,259 +30,000 

75,000 --- 100,000 +25,000 +100,000 

29,000 ·-- 35,000 +6,000 +35' 000 

Insert offset folio 148 here HR62.060

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

Javits Gifted and Talented Students. ,, .. D 

Statewide Family Engagement Centers. ' . . . . . . . ' ..... D 

Total, Innovation and Improvement ............. , 

Current Year ........ ,, ................ 

SAFE SCHOOLS AND CITIZENSHIP EDUCATION 

Promise Neighborhoods .................. ..... D 

School Safety National Activities .. .. , .. ""'" 0 

Full-Service Community Schools ....... , . ............ D 

Total. Safe Schools and Citizenship Education. 

ENGLISH LANGUAGE ACQUISITION 

Current funded ..... . ,.,. .......... . .... D 

Forward funded .. . ... .......... .. ...... D 

Total, English Language Acquisition ............ 

FY 2019 

Enacted 

12,000 10,000 

FY 2020 

Request 

... 

... 

Bi 11 

14,000 

15,000 

Bi 11 vs, 

Enacted 

+2,000 +5,000 

Bill vs. 

Request 

+14,000 +15,000 

============== ============== :;============ ============= 1,035,556 1,107,000 1 .223,815 +168,259 +116,815 

( 1 '035' 556) (1,107,000) (1 ,223,815) (+188,259) (+116,615) 

78,254 ... 80,000 +1,746 +80,000 

95,000 200,000 120.000 +25,000 -80,000 

17,500 40,000 +22,500 +40,000 

============== ============== ============== ============= 

190,754 200,000 240,000 +49,246 +40. 000 

47,931 47,931 63,700 +15,769 +15,769 

689,469 689,469 916,300 +226 ,831 +226,831 

============== ============== ============== ============== 

737,400 737,400 980,000 +242 '600 +242,600 

FF 

Insert offset folio 149 here HR62.061

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

SPECIAL EDUCATION 

State Grants: 

Grants to States Part B current year .......... 0 

Part B advance from prior year. ' .... ..... NA 

Grants to States Part B (FY 2021) ............. D 

Subtotal, program 1 evel ........................ 

Preschool Grants ... ' ...... . . . . . ' . . . ' ..... D 

Grants for Infants and Families. .... D 

Subtotal, program 1 evel ....... ............ ,. 

IOEA National Activities (current funded): 

State Personnel Development ....... .,,, ...... D 

Technical Assistance and Dissemination (including 

Special Olympics Education). .. , ...... 0 

Personnel Preparation ............. . ,, ' D 

Parent Information Centers ... ' ... '.' ....... D 

FY 2019 

Enacted 

3,081,009 

{9,283,383) 

9,283,383 

FY 2020 

Request 

2,240,2B9 

(9,283,383) 

10,124,103 

Bill 

4,081,009 

{9.283,383) 

9,283,383 

Bill vs. Bill vs. 

Enacted Request 

+1,000,000 +1,840,720 

--- ------ -840,720 

.. 

--- -------------

12,364,392 12,364,392 13,364,392 +1 ,000,000 +1 ,000,000 

391 '120 391 '120 403,400 +12,280 +12,280 

470,000 470,000 491 ,300 +21,300 +21 ,300 

••••••••••••• 

13,225,512 13,225,512 14,259,092 +1,033,580 +1 ,033.580 

38,630 38,630 40,630 +2,000 +2,000 

61,928 44,345 65,465 +3,537 +21 '120 

87,200 87,200 98,310 +11 '110 +11 '110 

27,411 27,411 30,000 +2,589 +2,589 

FF FF FF 

Insert offset folio 150 here HR62.062

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

Educational Technology, Media, and Materials. 

Subtotal, IDEA National Activities ...... . 

Total, Special education. 

Current Year ... . 

FY 2021 ..... . 

Subtotal, Forward Funded .. 

REHABILITATION SERVICES 

Vocational Rehabilitation State Grants. 

Client Assistance State grants ......... . 

Training ......... , .. . 

D M 

D 

D 

Demonstration and Training 

Protection and Advocacy of 

Supported Employment State 

Independent Living: 

programs........ . ...... D 

Individual Rights (PAIR). D 

grants ..... , . , . . . . . . . . . . D 

Services for Older Blind Individuals. 

Helen Keller National Center for Deaf/Blind Youth 

Adults, . , ................ , ........ , ........ . 

Tot a 1 , Rehabi 1 i tat ion services, ..... . 

and 

0 0 

D 

FY 2019 

Enacted 28,047 

243' 216 

13,468,728 

(4' 185.345) (9,283,383) 

(3' 942' 129} 

3,521,990 

13,000 

29,388 

5,796 

17' 650 

22,548 

33,317 

13,500 

3,657,189 

FY 2020 

Request 

28,047 

225,633 

13,451,145 

(3,327,042) 

(10,124, 103) 

(3,101,409) 

3,610,040 

13,000 

29,388 

5,796 

17,650 

33,317 

10,336 

3,719,527 

Bi 11 

30,047 

264,452 

14,523,544 

(5 ,240,161) 

(9,283,383) (4,975,709) 

3,610,040 

15,000 

30,188 

7,333 

17,650 

22,548 

33' 317 

16,000 

3,752,076 

Bill vs. 

Enacted 

+2,000 

+21 ,236 

+1,054,816 

(+1,054,816) 

(+1,033,580) 

+88,050 

+2,000 

+800 

+1 ,537 

+2,500 

+94,887 

Bill vs. 

Request +2,000 

+38,819 

+1 ,072,399 

(+1 ,913,119) 

( -840' 720) 

(+1,874,300} 

+2,000 

+800 

+1 ,537 

+22,548 

+5,664 

+32. 549 

Insert offset folio 151 here HR62.063

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

SPECIAL INSTITUTIONS FOR PERSONS WITH DISABILITIES 

American Printing House for the Blind ...... D 

National Technical Institute for the Deaf (NTID): 

Operations ..... , ........ ... ' . . . . . . . .. , .... D 

Gallaudet University: 

Operations ... ,. ' . ' . . . . . . . . . . . . . . . ' . . . ' ..... D 

Total, Special Institutions for Persons with 

Disabilities ..... , ...... ... .. ......... 

CAREER, TECHNICAL, AND ADULT EDUCATION 

Career Education: 

Basic State Grants/Secondary & Technical Education 

State Grants, current funded .. .... D 

Advance from prior year. . ... , ........ NA 

FY 2021 ................................. D 

Subtotal, Basic State Grants, program level. 

National Programs ........... .. ''. ..... D 

Subtotal, Career Education .... , .. , '' '''' 

FY 2019 

Enacted 

30,431 

77' 500 

134,361 

FY 2020 

Request 

25,431 

70,016 

121,275 

Bi 11 

39,000 

80,000 

138,361 

Bi 1l vs. 

Enacted 

+8,569 +2,500 +4,000 

Bi 1 I vs 

Request 

+13,569 

+9,984 

+17' 086 

============== ============== ============== ============== ============= 

242,292 216,722 257,361 +15,069 +40,639 

471,598 471,598 519,000 +47,402 +47,402 

(791 ,000) (791,000) (791,000) 

791 '000 791,000 791,000 

wwwwwwWwWWO,H -------------

1 ,262,598 1,262,598 1 ,310,000 +47,402 +47 ,402 

7,421 20,000 7,421 --- -12,579 

-

.. 

---- ----- ... W- w W W W W W W W W W W W W W W W W w w w W W W W W W W W W W H.., w w W w W W W W W W W W W W ---

1,270,019 1,282,598 1,317,421 +47,402 +34,823 

FF 

FF 

Insert offset folio 152 here HR62.064

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

Adult Education: 

State Grants/Adult Basic and Literacy Education: D 

State Grants, current funded. ' ..... . ' ... D 

National leadership Activities ........ .... ' ... D 

Subtotal, Adult education ....................... 

Total, Career, Technical, and Adult Education ... 

Current Year .. ' . . . ' . . . . . . . ' . . ..... 

FY 2021 ',,, ..... .... ',,,,. ,,. ' ' .... 

Subtotal, Forward Funded .... ' ... 

STUDENT FINANCIAL ASSISTANCE 

Pe11 Grants-- maximum grant (NA) .. ................ NA Pall Grants .... ' .... ........ ' ... '' ''' ... D Federal Supplemental Educational Opportunity Grants .. D Federal Work Study . ' ...... . ' . . . ' . D 

Total, Student Financial Assistance (SFA). 

FEDERAL DIRECT STUDENT LOAN PROGRAM ACCOUNT. . ...... CH 

FY 2019 

Enacted 

641,955 

13,712 

FY 2020 

Request 

485,849 

73,712 

Bill VS. 

Bill Enacted 

672,000 +30,045 

13,712 ---

-------------- ------------

655,667 559,561 685,712 +30,045 

Bill vs. 

Request 

+186, 151 

-60,000 

-------------

+126, 151 

============== ============== ============== ============= 

1,925,686 1 ,842,159 2,003,133 +77,447 +160,974 

(1 '134,686) (1 ,051 '159) (1 ,212, 133) (+77' 447) (+160,974) 

(791 '000) (791,000) (791,000) --- ---

(1 '134,686) (1 ,051 '159) (1 ,212, 133) (+77,447) (+160,974) 

(5, 135) (5, 135) (5,285) (+150) (+150) 

22,475,352 22,475,352 22,475,352 ---

840,000 --- 1,028,000 +186,000 +1 ,028,000 

1 '130 ,000 500,000 1,434,000 +304,000 +934,000 

============== ============== ============== ============== ============= 

24,445,352 22,975,352 24,937,352 +492,000 +1 ,962,000 

350,000 --- 350,000 -·- +350,000 

FF FF 

Insert offset folio 153 here HR62.065

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

STUDENT AID ADMINISTRATION 

Salaries and Expenses., .......... ... , .. , .... 0 

Servicing Activities ....... .. , ······ ,,., .. 0 

Total, Student Aid Administration ............... 

HIGHER EDUCATION 

Aid for Institutional Development: 

Strengthening Institutions ........................ 0 

Hispanic Serving Institutions ..................... 0 

Promoting Post-Baccalaureate Opportunities for D 

Hispanic Americans ............... . ····· 0 

Cons 1 i dated MSI Grant .. .......... ' 

Strengthening Historically Black Colleges (H8CUs). D 

Strengthening Historically Black Graduate D 

Institutions ...... ' .. ······ ············ D 

Strengthening Predominantly Black Institutions .. 0 

Asian American Pacific Islander .................. 0 

Strengthening Alaska Native and 0 

Native Hawaiian-Serving Institutions. ....... 0 

Strengthening Native American-Serving Nontriba1 0 

Institutions .... . ' .......... . .. , .. D 

Strengthening Tribal Colleges ............... D 

Strengthening HBCU Masters programs ......... D 

Subtotal, Aid for Institutional development .. 

FY 2019 

Enacted 

698,943 

980,000 

FY 2020 

Request 

1. 281 ,281 

530,719 

Bi 11 

698,943 

980,000 

Bill vs. Bi 11 vs. 

Enacted Request 

... -582,338 

... +449,281 

============== ============== ===:========== ============== ============= 

1,678,943 1,612,000 1 .678,943 - . ·133,057 

99.875 ... 110,000 +10, 125 +110. 000 

124,415 ... 150,000 +25,585 +150,000 

11,163 --- 30,000 +18,837 +30,000 

--- 147,906 ... --- -147.906 

282,420 282,420 375,000 +92,580 +92,580 

73' 037 73,037 125,000 +51 ,963 +51' 963 

11 ,475 ··- 22.000 +10,525 +22,000 

3,864 .. 17,864 +14,000 +17. 864 

15,930 --- 18,100 +2,170 +18, 100 

3,864 --- 5,000 +1,136 +5,000 

31,854 27,599 51,000 +19, 146 +23. 401 

8,657 8,657 13,500 +4,843 +4,843 

-

-

----

. 

- -

. 

-- ------------

----

... 

--- --------- fi -- .. -------- .. ----

666,554 539,619 917,464 +250,910 +377,845 

Insert offset folio 154 here HR62.066

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS ANO AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

International Education and Foreign Language: 

Domestic Programs ... 

Overseas Programs .. 

Subtotal, International Education & Foreign Lang 

Postsecondary Program for Students with Intellectual 

Disabilities........ . ........... . 

Minority Science and Engineering Improvement ...... . 

Tribally Controlled Postsec Voc/Tech Institutions .. . 

Federal TRIO Programs ........ . 

GEAR UP ........ , .. 

0 

0 

D 

D 

D 

D 

D 

D 

Graduate Assistance in Areas of National Need ........ D 

Teacher Quality Partnerships. . .. .. .. .. .......... 0 

Child Care Access Means Parents in School. D 

Fund for the Improvement of Postsecondary Ed. (FIPSE). D 

Total, Higher Education. 

FY 2019 

Enacted 

65,103 

7,061 

72,164 

11,800 

11 '135 

9,564 

1,060,000 

360,000 

23,047 

43,092 

50,000 

5,000 

FY 2020 

Request 

11,800 

9,648 

8,286 

950,000 

15,134 

Bi 11 

80,400 

8,730 

89,130 

11 ,800 

13,000 10,000 

1,160,000 

395,000 

24,047 

53,092 

60,000 

15,000 

Bill vs. 

Enacted 

+15,297 

+1 .669 

+16,966 

+1,865 

+436 

+100,000 

+35,000 

+1,000 

+10,000 +10,000 

+10,000 

Sill vs. 

Request 

+80 ,400 

+8 '730 

+89, 130 

+3,352 

+1 '714 

+210,000 +395 ,000 

+24,047 +53,092 

+44,866 +15.000 

=========:==== ============== ============== ============= 

2,312,356 1,534,487 2,748,533 +436' 177 +1 ,214,046 

Insert offset folio 155 here HR62.067

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

HOWARD UNIVERSITY 

Academic Program ... 

Endowment Program. 

Howard University Hospital. 

Total, Howard University ... 

0 

0 

D 

COLLEGE HOUSING AND ACADEMIC FACILITIES LOANS PROGRAM. 0 

HISTORICALLY BLACK COLLEGE AND UNIVERSITY (HBCU) 

CAPITAL FINANCING PROGRAM ACCOUNT 

HBCU Federal Administration ...... . HBCU Loan Subsidies ................ . 

Total, HBCU Capital Financing Program ....... . 

0 

D 

FY 2019 

Enacted 

205,786 

3,405 

27,325 

236,518 

435 

334 

40,150 40,484 

FY 2020 

Request 

191,091 

3,405 

27,325 

221,821 

435 

334 

40,150 

40,484 

Bill 

219,270 

3,405 

27,325 

250,000 

435 

334 

50,150 50,484 

Bill vs. Bi 11 VS. 

Enacted Request 

+13,482 +28' 179 

+13,482 +28' 179 +10,000 +10,000 +10,000 +10,000 

Insert offset folio 156 here HR62.068

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

INSTITUTE OF EDUCATION SCIENCES (IES) 

Research, Development and Dissemination. D 

Statistics ................. . D 

Regional Educational Laboratories .. . 0 

Research in Special Education ...... . D 

Special Education Studies and Evaluations .. D 

Statewide Data Systems ....................... . D 

Assessment: 

National Assessment ..... D 

National Assessment Governing Board .. 0 

Subtotal, Assessment .. 

Total, IES ... 

.. ~. FY 2019 Enacted 192,695 109,500 55,423 56,000 10,818 32,281 151,000 7,745 FY 2020 Request 187,500 112,500 . .. 54,000 10,818 . .. 149,000 7,745 Bill VS. Bi 11 VS. Bill Enacted Request 205,400 +12,705 +17. 900 117' 500 +8,000 +5,000 60,400 +4,977 +60,400 61,000 +5,000 +7,000 11 ,674 +856 +856 35,281 +3,000 +35,281 151 ,000 . .. +2,000 7,745 ~~-~··~ ~-- .. -~-~----~~ -M----------~~ *---~-~~ ........... -~- ________ .. 

158,745 156,745 158,745 ... +2,000 

============== ============== =====~======== ============== ============= 

615,462 521,563 650,000 +34,538 +128,437 

Insert offset folio 157 here HR62.069

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

DEPARTMENTAL MANAGEMENT 

Program Administration: 

Salaries and Expenses ...... . 

Building Modernization ... . 

Total, Program administration. 

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

Office of Inspector General .. 

Total , Departmental management 

Total, Title III, Department of Education ...... . 

Current Year ....... . 

FY 2021 .. 

D 

D 

D 

0 

FY 2019 

Enacted 

430,000 430,000 

125,000 

61,143 

616,143 

74,970,406 

(52 ' 3 73 '405) (22,597,001) 

FY 2020 

Request 

433,500 

13,500 

447,000 

125 '000 

63,418 

635,418 

67,615,955 

(45,018,954) (22.597,001) 

Bill 

430,000 

430,000 

130,000 

63,418 

623,418 

79,533,852 

(56,936,851) (22,597,001) 

Bill VS. Bill vs. 

Enacted Request 

-3,500 

-13,500 -17,000 

+5,000 +5 '000 +2,275 +7,275 -12,000 

+4,563,446 +11 ,917,897 

(+4,563,446) (+11 ,917,897) 

Insert offset folio 158 here HR62.070

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

TITLE IV--RELATED AGENCIES 

COMMITTEE FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR 

SEVERELY OISABLED. 

(Office of Inspector General). 

CORPORATION FOR NATIONAL AND COMMUNITY SERVICE 

Operating Expenses 

Domestic Volunteer Service Programs: 

Volunteers in Service to America (VISTA). 

National Senior Volunteer Corps: 

Foster Grandparents Program .. . 

Senior Companion Program ..... . 

Retired Senior Volunteer Program. 

Subtotal, Senior Volunteers .. 

Subtotal, Domestic Volunteer Service. 

0 

NA 

0 0 

0 

D 

FY 2019 

Enacted 

8,250 

(1 ,250) 

92,364 

110,899 

46,863 

50,355 

208' 117 

300' 481 

FY 2020 

Request 

9,400 

(1 ,650) 

4,665 

111 

111 

111 

333 

4,998 

Bi 11 

9,000 

(1,650) 

95,000 

118,799 

50,863 

51 ,855 

221,517 

316,517 

Bi 11 VS, 

Enacted 

+750 

(+400} 

+2,636 +7,900 +4,000 +1,500 

+13,400 +16,036 

Bill vs. 

Request 

-400 

+90,335 

+118,688 

+50' 752 

+51 ,744 

+221,184 

+311 ,519 

Insert offset folio 159 here HR62.071

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL} AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands} 

National and Community Service Programs: 

AmeriCorps State and National Grants. ...... D 

Innovation, Assistance, and Other Activities .... D 

Evaluation ......... .. '' ... . ... D 

National Civilian Community Corps (NCCC)(subtitle 

E) .......... ...... ' . .......... ..... D 

State Commission Support Grants ..... ...... D 

Subtotal, National and Community Service .. ..... 

Total. Operating expenses. ', .. 

National Service Trust .......... . '' ,.,.' D 

Salaries and Expenses .... ' ..... D 

Office of Inspector General ........... . '''' .... D 

Total, Corp. for National and Community Service. 

FY 2019 

Enacted 

425,010 

7,600 

4,000 

32,000 

17,538 

.. 

--

.. . 

--- -

486' 148 

FY 2020 

Request 

2,224 

---

---

22,883 

.,. __________ 

---

25,107 

Bill vs. Bill vs. 

Bi 11 Enacted Request 

450,010 +25,000 +447,786 

8,600 +1,000 +8,600 

4,000 --- +4,000 

33,000 +1 ,000 +10' 117 

17,538 --· +17' 538 

.. 

-

. 

-

... 

--

- --

.. 

---

----

.. -. - --.. ---------

513,148 +27,000 +488 ,041 

......................... ... ........ M ....... ,..,..,.,.,..,..,..,..,..,..,..,..,..,. _.,. .. 

786,629 30,105 829,665 +43,036 +799 '560 

206,842 10,000 218,691 +11 ,849 +208,691 

83' 737 59,300 83,737 --- +24,437 

5,750 4,258 6,013 +263 +1 ,755 

:============= ============== ============== ============== ============= 

1,082,958 103,663 1 ,138,106 +55' 148 +1 ,034,443 

Insert offset folio 160 here HR62.072

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

CORPORATION FOR PUBLIC BROADCASTING: 

FY 2022 (current) with FY 2020 comparable. ... . D 

FY 2021 advance with FY 2019 comparable (NA) ...... NA 

Rescission of FY 2021 funds ( NA) .............. NA 

Subtotal, FY 2021 program level ........ ' .... 

FY 2020 advance with FY 2018 comparable (NA) ... NA 

Rescission of FY 2020 funds (NA). ...... NA 

Subtotal, FY 2020 program level. .... . .... 

Public television interconnection system (current) D 

FY 2019 

Enacted 

445,000 

(445,000) 

... 

FY 2020 

Request 

... 

(445,000) 

(·415,000) 

Bill vs. 

Bi 11 Enacted 

495,000 +50,000 

(445,000) ... 

. .. . .. 

----N- ------N-- --- -----------

445,000 30,000 445,000 ... 

( 445,000) (445,000) (445,000) 

... (-415,000) . .. . .. 

Bill VS. 

Request 

+495,000 

. .. 

(+415,000) 

-------------

+415,000 

(+415,000) 

-------------- -------------- ------

____ ,..,_ 

- * 

445,000 30,000 445,000 ... +415,000 

20,000 ... 20,000 . .. +20,000 

Insert offset folio 161 here HR62.073

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

FEDERAL MEDIATION AND CONCILIATION SERVICE. 

FEDERAL MINE SAFETY AND HEALTH REVIEW COMMISSION. 

INSTITUTE OF MUSEUM AND LIBRARY SERVICES ........ . 

MEDICAID AND CHIP PAYMENT AND ACCESS COMMISSION .. 

MEDICARE PAYMENT ADVISORY COMMISSION ..... . 

NATIONAL COUNCIL ON DISABILITY .. . NATIONAL LABOR RELATIONS BOARD ........... . 

NATIONAL MEDIATION BOARD. . . ... . 

OCCUPATIONAL SAFETY AND HEALTH REVIEW COMMISSION. 

RAILROAD RETIREMENT BOARD 

Dual Benefits Payments Account .. 

Less Income Tax Receipts on Dual Benefits .. 

Subtotal, Dual Benefits ..... 

D 

D D D 

TF 

D 

D D 

D 

D D 

Federal Payments to the Railroad Retirement Accounts. M 

Limitation on Administration.... . . . . . . . TF Limitation on the Office of Inspector General....... TF 

FY 2019 

Enacted 

46,650 

17' 184 

242,000 

8,480 

12,545 

3.250 

274.224 

13.800 13.225 

19,000 

-1 ,000 

18.000 

150 

123' 500 

11.000 

FY 2020 

Request 

47,200 

17,184 

23.000 

9,000 

12,645 

3,450 

241.550 

13,800 13,225 

16,000 

-1,000 

15,000 

150 

116.225 

11,000 

Bi 11 

48.200 

17.184 

267.000 

8,460 

12,645 

3,450 

341,500 

15,800 13,225 

16,000 

-1 ,000 

15,000 

150 

135,500 

11,500 

Bill vs. 

Enacted 

+1 ,550 

+25,000 

+100 +200 

+67,276 

+2,000 

·3,000 

·3,000 

+12,000 

+500 

Bi 11 vs. 

Request +1 ,000 

+244,000 

-520 

+99.950 

+2,000 

+19,275 

+500 

Insert offset folio 162 here HR62.074

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

SOCIAL SECURITY ADMINISTRATION 

Payments to Social Security Trust Funds 

Supplemental Security Income Program 

Federal Benefit Payments .. 

Beneficiary Services ......... . 

Research and Demonstration ... . 

Administration ................. . 

Subtotal, SSI program level 

Less funds advanced in prior year. 

Subtotal. regular SSI current year ..... 

New advance, 1st quarter, FY 2021 .. 

Total, SSI program. 

.. M 

H 

H 

M 

D 

M 

FY 2019 

Enacted 

11 ,000 

55,716,000 

126.000 101,000 

4,923,203 

FY 2020 

Request 

11,000 

56,982,000 

45,000 

101 ,000 

4,404,000 

""" -

60,866,203 61,532,000 

-19,500,000 -19,700,000 

Bi 11 

11,000 

56,982,000 

45,000 

101 ,000 

4,510,540 

-

........ ,. 

-

.... 

-

.. 

61.638,540 

-19,700,000 

Bill vs. Bi 11 vs. 

Enacted Request 

+1 '266. 000 

·81,000 

""" 

-412,663 +106,540 

.................. --------

+772,337 +106. 540 

·200,000 

---------

_______ , __ 

---

_______ .. _____ 

-------------

41,366,203 41,832,000 41,938,540 +572,337 +106,540 

19,700,000 19,900,000 19,900,000 +200,000 

•-w- •••••••• ... 

61,066,203 61,732,000 61,838,540 +772,337 +106,540 

Insert offset folio 163 here HR62.075

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL} AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

Limitation on Administrative Expenses 

OASI/DI Trust Funds .. TF 

HI/SMI Trust Funds ....... . TF 

Social Security Advisory Board. TF 

SSI................. . .......... . TF 

Subtotal, regular LAE. 

User Fees: 

SSI User Fee activities .... . 0 

CBO adjustment ......... . D 

SSPA User Fee Activities .. . D 

CBO adjustment. 0 

Subtotal, User fees .. Subtotal, Limitation on administrative expenses. 

FY 2019 

Enacted 

5, 119,748 

2' 321,594 

2,400 

3,615,203 

FY 2020 

Request 

5,507,400 

2,451,200 

2,400 

3,099,000 

Bill 

5,642,498 

2,508,507 

2,400 

3,205,540 

Bill vs. Bi 11 vs. 

Enacted Request 

+522,750 +135,098 

+186,913 +57,307 

. .. ·-· 

-409,663 +106,540 

- - • - w- - - -- - - - .. -- - - - - - --- - - - -- - - - -- - - - - - - - -- - - - - - - - - - -- - - -- - - - - -

11 '058. 945 11 '060, 000 11 ,358,945 +300,000 +298,945 

134,000 130,000 130.000 -4,000 

-5,000 ·-- -- +5,000 

1,000 1,000 1,000 

-1 ,000 -1,000 -1 ,000 

-- --------

.. 

-- -------------- -------

-

.. 

-- ------------

.. 

- -------------

129,000 130,000 130,000 +1 ,000 - - - - - -- - - - - -- - ... - - - -- - - - - - -- - - - - - - - - -- - - - - - - • - - - - .. - - - .. - - M - - - - - - -- W 

11,187,945 11,190,000 11 ,488,945 +301 ,000 +298,945 

Insert offset folio 164 here HR62.076

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

Program Integrity: 

OASDI Trust Funds. 

SSI ..... 

Subtotal, Program integrity funding .. 

Base Program Integrity ... 

Total, limitation on Administrative Expenses 

(less Base program integrity). 

Total, Limitation on Administrative Expenses. 

Total, Limitation on Administrative Expenses 

(less user fees) .................. . 

TF 

TF 

FY 2019 

Enacted 

375' 000 

1 '308, 000 

FY 2020 

Request 

277 '000 

1,305,000 

Bi 11 

277,000 

1,305,000 

Bill vs. 

Enacted 

-98,000 

-3,000 

Bill vs, 

Request ~~~~~~~~~~~-~~ ~~~~~~~~-~~~·~ ~~-~-~~----~-- ------~------- -------------

1,683,000 1,582,000 1,582,000 -101 ,000 

(273,000) (273,000) (273,000) 

-------------- -------------- -------------- -------------- -------------

1,410,000 1,309,000 1 ,309,000 -101 ,000 

============== ============== ============== ============== 

12' 870' 945 12,772,000 13,070,945 +200,000 +298,945 

============== ============== ============== ============== ============= 

12,741,945 12,642,000 12,940,945 +199,000 +298,945 

Insert offset folio 165 here HR62.077

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

Office of Inspector General 

Federal Funds .. . 

Trust Funds ............. . 

Total, Office of Inspector General .. 

D 

TF 

Adjustment: Trust fund transfers from general revenues TF 

Total, Social Security Administration .. 

Federal funds.. . .......... .. 

Current year. . ....... . 

New advances, 1st quarter. FY 2021. 

Trust funds. 

Total, Title IV, Related Agencies. 

Federal Funds .......... . 

Current Year ......... . 

FY 2021 Advance ..... . FY 2022 Advance .. 

Trust Funds .. 

FY 2019 

Enacted 

30.000 75,500 

FY 2020 

Request 

30,000 75,500 

Bi 11 

30,000 

75,500 

Bill vs. Bi l 1 vs. 

Enacted Request 

------------·- ---------····- -------------

105,500 105,500 105,500 

-4.923' 203 -4,404,000 -4,510,540 +412,663 -106 '540 

:============= ;;;=========== ============== ============= 

69' 130,445 70,216,500 70,515,445 +1,385,000 +298,945 

61,236,203 61,903,000 62,009,540 +773,337 +106,540 

(41 ,536,203) (42,003,000) (42,109,540) (+573,337) (+106,540) 

(19, 700,000) (19,900,000) (19,900,000) (+200,000) ---

7,894,242 8,313,500 8,505,905 +611 ,663 +192.405 

============== ============== ============== ============= 

71,470,661 70,852,992 73,067,185 +1,596,524 +2. 214,193 

63,429,374 62,399,622 64,401,635 +972,261 +2,002,013 

(43, 284, 374) (42,499,622) (44,006,635) (+722,261) (+1,507,013) (19, 700,000) ( 19.900.000) (19,900,000) (+200,000) ---

( 445. 000) --- (495,000) (+50,000) (+495,000) 

8. 041 '287 8,453,370 8,665,550 +624,263 +212' 180 

Insert offset folio 166 here HR62.078

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

RECAP 

Mandatory, tota 1 in t>i 11 .. 

Less advances for subsequent years. 

Plus advances provided in prior years ..... 

Total. mandatory, current year .. 

Discretionary, total in bill ... 

Less advances for subsequent years .... 

Plus advances provided in prior years. 

Subtotal, discretionary, current year ..... 

Discretionary Scorekeeping adjustments: 

Average Weekly Insured Unemployment (AWIU) 

Contingent .......... . 

Medicare Eligible Accruals 

(permanent,indefinite)1/. 

Surplus property (Department of Labor) .... 

TF 

D 

CH 

FY 2019 

Enacted 

869,814,362 

-161,845,797 

158,462,759 

FY 2020 

Request 

900,377,448 

-164,017,075 

161,845,797 

Bi 11 

902,277,448 

-164,217,075 

161 ,845, 797 

Bill vs. Bill vs. 

Enacted Request 

+32,463,086 +1,900.000 

-2,371,278 -200,000 

+3,383,038 ~~~~~--------- -------------- ---- -~-·-- -------------- --·----------

666,431,324 898,206,170 899,906,170 +33,474,846 +1 '700' 000 

189 ' 3 78 '959 166,511,153 204,349,000 +14,970,041 +37,837,847 

-24 '814' 001 -24,282,859 -24,864,001 -50,000 -581 '142 

24,814,001 24,814,001 24,814,001 

-------------- -------------- ----------- -- -- ~----- ... -,..-.. -------------

189,378,959 167,042,295 204,299,000 +14,920,041 +37,256,705 

10,000 25,000 25,000 +15,000 

30,041 30,000 30,000 -41 

2,000 2,000 2,000 

Insert offset folio 167 here HR62.079

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

Dislocated Workers assistance National Reserve 

(rescission). .. .. . . .. .. .. .. .. .. .. .. .. . D 

Foreign labor Certification Processing (DOL). TF 

H-1B (rescission)............. .. .. .. .. .. ... CH 

Nonrecurring expenses fund (rescission). D 

CMS program management reclassification (sec. 235) 

Childrens Health Insurance Program performance 

bonus (rescission)......... .. .. .. .. . CH 

Childrens Health Insurance Program Annual 

Allotment to States (rescission).......... CH 

Child Enrollment contingency fund (rescission). CH 

Student loan medical deferment ................... CH 

Pell unobligated balances (rescission) ............ D 

FY 2019 

Enacted 

-53,000 

8,250 

·8,250 

·400.000 

-2.061,000 

-5,654,000 

5,000 

-600,000 

FY 2020 

Request 

-86,142 

-400,000 

3,000 

-10,052,881 

·5,298,763 

-4,396,000 

... 

·2,000,000 

Bill vs. Bill vs. 

Bi 11 Enacted Request 

.. +53,000 +86' 142 

·8,250 

+8,250 

--- +400,000 +400' 000 

.. 

-

... -3,000 

-7,715,000 -7,715,000 +2,337,881 

·4,300,000 ·2,239,000 +998,763 

... +5,654,000 +4' 396 '000 

... ·5,000 .. . 

... +600,000 +2,000,000 

Insert offset folio 168 here HR62.080

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR 2019 AND BUDGET REQUESTS AND AMOUNTS RECOMMENDED IN THE BILL FOR 

(Amounts in Thousands) 

Pell: Increase maximum award ..... . , , ............. CH 

Pell mandatory funds (rescission) ........ , .. , .. CH 

SSA proposed fee for issuance of new Social 

Security charge ......... ·············' SSI User Fee Collection.,, .... '' . . ' . . . ' D 

CBO adjustment ................. ""'""''''" 0 

SSA SSPA User Fee Collection ...................... 0 

CBO adjustment ..... ' .... . ..... "'" 0 

Traditional Medicare program. .... . ... .... D 

CNCS National Service Trust unobligated balances 

(rescission) ... . . . . . . . . . . '' ',,, .. ......... D 

Corporation for Public Broadcasting FY2020 advance 

(rescission) ... ······ """'""'""""'" 0 21ST Century Cures Act adjustment (PL 114-255) .... D 

Total, discretionary ......... . '' ...... 

Grand Total , current year ... , . ·············· ..... 

FY 2019 

Enacted 

39,000 

·39,000 

---

-134,000 

5,000 

-1,000 

1 ,0()0 

305,000 

-150,000 

-·-

-711 ,000 

FY 2020 

Request 

---

... 

-68,000 

-130,000 

-1 ,000 

-1,000 

1,000 

. 

--

·40,000 

-415,000 -492,000 

Bi 11 vs. Bill vs. 

Bill Enacted Request 

50,000 +11 ,000 +50,000 

-50,000 ·11 ,000 -50,000 

-- ·-· +68,000 

-130,000 +4,000 

·1 ,000 -6,000 

-1,000 

1,000 

--- ·305,000 

. 

-- +150,000 +40,000 

.. 

-

--- +415,000 

-492,000 +219,000 

.. .. 

-----

................. ...... 

179' 973' 000 143,722,509 191,716,000 +11 ,745,000 +47. 995,491 

............ _________ ------· ... ------ ________ ............ .. ·----

1,046,404,324 1,041,928,679 1,091,624,170 +45,219,646 +49,695,491 

============== =====;======== ============= 
381 

MINORITY VIEWS 

We appreciate the efforts of the Majority in producing a Labor, 

Health and Human Services, Education, and Related Agencies 

(Labor-HHS) Appropriations bill that addresses priorities of Members on both sides of the aisle. We also want to thank the Chair 

for accepting Republican amendments in our Committee markup. 

We are also pleased that the bill continues longstanding provisions that protect human life, the free exercise of conscience, and 

other constitutional rights. Retention of such important protections 

is vital to ensuring a successful conference agreement that can be 

approved by both bodies and signed into law by the President. Unfortunately, despite the many positive initiatives funded across the 

bill, we are unable to support it as written at this time. 

The House Democrats’ budget framework would raise the discretionary spending caps by more than $350 billion in fiscal years 

2020 and 2021 and does not reflect a House-passed budget resolution or a bipartisan, bicameral agreement. This would put the Federal government on track to add nearly $2 trillion in deficits over 

ten years, while the national debt is already above $22 trillion and 

rising. 

In addition, the House Democrats’ framework continues the misguided notion that increases to defense spending must be matched 

or exceeded by increases to non-defense spending. The bills under 

consideration provide more than twice as much additional funding 

in fiscal year 2020 for non-defense programs than for defense programs. 

The Labor-HHS bill increases funding by $11.8 billion, or almost 

seven percent above the fiscal year 2019 level. We know the Senate 

is certainly not going to include this magnitude of increase, nor will 

this Administration support it. We fear this is setting us up for a 

scenario that could end in a year-long continuing resolution at 

best—or another protracted government shutdown at worst. 

We need to come together, House and Senate, Republicans and 

Democrats, with the Administration to hammer out a deal on the 

topline funding level before we can move forward with cutting up 

the pieces of the pie. We need to see how the Labor-HHS bill will 

fit into the bigger picture before moving forward. 

We are also disappointed to see language inserted throughout the 

bill that ties the hands of the Administration in many ways. The 

bill restricts the abilities of Cabinet Secretaries to reorganize agencies and transfer and reprogram funds. These changes will hinder 

the Administration’s ability to improve operational efficiencies and 

respond quickly to changing resource needs. Such constraints are 

unreasonable, and we believe are being done purely to limit the 

ability of an Administration from an opposing political party to fulfill its responsibilities. 

The bill forces a return to the policies of the previous Administration in the title X family program and prevents implementation 

of a new rule that would ensure compliance with statutory title X 

program integrity provisions, particularly the prohibition on funding programs where abortion is used as a method of family planning. 

The bill ties the hands of the Administration by not allowing 

them to process waivers that protect deeply-held religious beliefs of 

382 

institutions that provide vital services related to child welfare programs funded in this bill. As amended in Committee, the bill will 

also block essential tools the Administration can use to enforce protections for healthcare workers who face discrimination due to the 

practice of their deeply-held religious beliefs. 

The bill micromanages the Centers for Medicare & Medicaid 

Services, even going so far as to prescribe specific dollar amounts 

and specific types of media that must be used in providing outreach 

on Obamacare plans. The bill forces the Administration to continue 

the unauthorized Teen Pregnancy Prevention grants awarded to 

controversial grantees during the Obama Administration. The bill 

eliminates a program to encourage abstaining from risky nonmarital sexual activity. The bill restricts funding and intervenes in 

HHS’ operation of the unaccompanied alien children program. 

These provisions will need to be addressed in a bipartisan manner as the process moves forward to avoid a presidential veto. 

In addition, the bill as reported includes other language of concern to Members on our side of the aisle. The bill eliminates a longstanding provision relating to syringe exchange. The bill includes 

a new provision limiting rulemaking pertaining to Medicaid reimbursement and union dues. The bill includes a new provision limiting rulemaking related to nonemergency medical transportation. 

The bill provides $50 million for gun research, five times more than 

what President Obama requested. The bill removes longstanding 

language exempting small farms and businesses from certain Occupational Safety and Health Administration oversight. The report 

accompanying the bill expresses support for a liver donation policy 

that could limit access to life saving organ donations in our rural 

communities. The change could deplete liver transplants in some 

states by as much as 30 to 50 percent. We hope to address these 

concerns as the bill moves forward. 

In closing, we remain concerned that this bill has been developed 

in a vacuum that will not be sustainable in the long run. 

We do pledge to work with the Majority in good faith as we proceed through the legislative process. Working together, we have 

passed this bill through the Congress and avoided a year-long continuing resolution for the past four years. It is our sincere hope we 

can do so again this year. 

KAY GRANGER. 

TOM COLE. 

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