30–509 PDF 

Calendar No. 497 

115TH CONGRESS REPORT " ! SENATE 2d Session 115–289 

DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND RELATED AGENCIES APPROPRIATION BILL, 2019 

JUNE 28, 2018.—Ordered to be printed 

Mr. BLUNT, from the Committee on Appropriations, 

submitted the following 

R E P O R T 

[To accompany S. 3158] 

The Committee on Appropriations reports the bill (S. 3158) making appropriations for Departments of Labor, Health and Human 

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

ending September 30, 2019, and for other purposes, reports favorably thereon without amendment and recommends that the bill do 

pass. 

Amounts to new budget authority 

Total of bill as reported to the Senate................. $1,059,220,321,000 

Amount of 2018 appropriations............................ 1,007,992,626,000 

Amount of 2019 budget estimate ......................... 1,043,734,903,000 

Bill as recommended to Senate compared to: 

2018 appropriations .............................................. ∂51,227,695,000 

2019 budget estimate ............................................ ∂15,485,418,000 
(2) 

C O N T E N T S 

Page 

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

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

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

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

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

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

Strengthening the Workforce for a Stronger Economy ................................. 11 

Increasing Access to High-Quality Early Childhood Care and Education ... 12 

Rural America ................................................................................................... 13 

Alzeimer’s Disease ............................................................................................ 14 

Investing in Public Health Preparedness ....................................................... 15 

Improving Fiscal Accountability ...................................................................... 16 

Increasing the Efficiency and Cost Effectiveness of Government ................ 16 

Bill-Wide Directives .......................................................................................... 18 

Other Highlights of the Bill ............................................................................. 18 

Title I: Department of Labor: 

Employment and Training Administration .................................................... 21 

Employee Benefits Security Administration .................................................. 30 

Pension Benefit Guaranty Corporation .......................................................... 31 

Wage and Hour Division .................................................................................. 32 

Office of Labor-Management Standards ......................................................... 32 

Office of Federal Contract Compliance Programs .......................................... 32 

Office of Workers’ Compensation Programs ................................................... 33 

Occupational Safety and Health Administration ........................................... 35 

Mine Safety and Health Administration ........................................................ 36 

Bureau of Labor Statistics ............................................................................... 37 

Office of Disability Employment Policy .......................................................... 38 

Departmental Management ............................................................................. 38 

General Provisions ........................................................................................... 42 

Title II: Department of Health and Human Services: 

Health Resources and Services Administration ............................................. 44 

Centers for Disease Control and Prevention .................................................. 61 

National Institutes of Health .......................................................................... 85 

Substance Abuse and Mental Health Services Administration .................... 126 

Agency for Healthcare Research and Quality ................................................ 136 

Centers for Medicare and Medicaid Services ................................................. 138 

Administration for Children and Families ..................................................... 146 

Administration for Community Living ........................................................... 159 

Office of the Secretary ...................................................................................... 165 

General Provisions ........................................................................................... 176 

Title III: Department of Education: 

Education for the Disadvantaged .................................................................... 178 

Impact Aid ......................................................................................................... 180 

School Improvement Programs ........................................................................ 181 

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

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

Safe Schools and Citizenship Education ......................................................... 189 

English Language Acquisition ......................................................................... 190 

Special Education ............................................................................................. 190 

Rehabilitation Services .................................................................................... 193 

Special Institutions for Persons With Disabilities: 

American Printing House for the Blind ................................................... 194 

National Technical Institute for the Deaf ............................................... 194 

Gallaudet University ................................................................................. 195 
Page

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Title III—Continued 

Career, Technical, and Adult Education ........................................................ 195 

Student Financial Assistance .......................................................................... 196 

Federal Direct Student Loan Program Account ............................................. 197 

Student Aid Administration ............................................................................ 198 

Higher Education ............................................................................................. 202 

Howard University ........................................................................................... 207 

College Housing and Academic Facilities Loans Program ............................ 207 

Historically Black College and University Capital Financing Program 

Account .......................................................................................................... 207 

Institute of Education Sciences ....................................................................... 208 

Departmental Management: 

Program Administration ........................................................................... 210 

Office for Civil Rights ............................................................................... 212 

Office of the Inspector General ................................................................ 213 

General Provisions ........................................................................................... 213 

Title IV: Related Agencies: 

Committee for Purchase From People Who Are Blind or Severely Disabled ............................................................................................................... 215 

Corporation for National and Community Service ........................................ 215 

Corporation for Public Broadcasting ............................................................... 218 

Federal Mediation and Conciliation Service .................................................. 219 

Federal Mine Safety and Health Review Commission .................................. 219 

Institute of Museum and Library Services ..................................................... 220 

Medicaid and CHIP Payment and Access Commission ................................. 220 

Medicare Payment Advisory Commission ...................................................... 221 

National Council on Disability ........................................................................ 221 

National Labor Relations Board ...................................................................... 221 

National Mediation Board ............................................................................... 221 

Occupational Safety and Health Review Commission ................................... 222 

Railroad Retirement Board .............................................................................. 222 

Social Security Administration ........................................................................ 223 

Title V: General Provisions ..................................................................................... 228 

Compliance With Paragraph 7, Rule XVI of the Standing Rules of the Senate .......................................................................................................................... 230 

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

Senate ................................................................................................................... 231 

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

Senate ................................................................................................................... 232 

Budgetary Impact of Bill ......................................................................................... 233 

Comparative Statement of New Budget Authority ............................................... 234 
(4) 

LIST OF ABBREVIATIONS 

ACA—Patient Protection and Affordable Care Act 

ACL—Administration for Community Living 

ADAP—AIDS Drug Assistance Program 

AHEC—Area Health Education Center 

AHRQ—Agency for Healthcare Research and Quality 

AP—Advanced Placement 

APH—American Printing House for the Blind 

ASH—Assistant Secretary for Health 

ASPR—Assistant Secretary for Preparedness and Response 

BARDA—Biomedical Advanced Research and Development Authority 

BCA—Budget Control Act of 2011 

BLS—Bureau of Labor Statistics 

CAN—Cures Acceleration Network 

CCAMPIS—Child Care Access Means Parents in School 

CCDBG—Child Care and Development Block Grant 

CDC—Centers for Disease Control and Prevention 

CHAFL—College Housing and Academic Facilities Loans 

CHC—Community Health Center 

CHGME—Children’s Hospitals Graduate Medical Education 

CJ—Congressional Justification of Estimates for Appropriations 

Committees 

CMS—Centers for Medicare and Medicaid Services 

CNCS—Corporation for National and Community Service 

CPB—Corporation for Public Broadcasting 

CSAP—Center for Substance Abuse Prevention 

CSAT—Center for Substance Abuse Treatment 

CSBG—Community Services Block Grant 

CSEOA—Community Service Employment for Older Americans 

DOD—Department of Defense 

DOL—Department of Labor 

DRA—Delta Regional Authority 

EBSA—Employee Benefits Security Administration 

EEOICPA—Energy Employees Occupational Illness Compensation Program Act 

ERISA—Employee Retirement Income Security Act of 1974 

ESEA—Elementary and Secondary Education Act 

ETA—Employment and Training Administration 

FDA—Food and Drug Administration 

FEMA—Federal Emergency Management Agency 

FIC—Fogarty International Center 

FIE—Fund for the Improvement of Education 

FIPSE—Fund for the Improvement of Postsecondary Education 

FMCS—Federal Mediation and Coalition Service 

FMSHRC—Federal Mine Safety and Health Review Commission 

FTE—full-time equivalent 
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FWS—Federal Work Study 

GAANN—Graduate Assistance in Areas of National Need 

GAO—Government Accountability Office 

GEAR UP—Gaining Early Awareness and Readiness for Undergraduate Programs 

HBCUs—Historically Black Colleges and Universities 

HCFAC—Health Care Fraud and Abuse Control 

HEA—Higher Education Act 

HELP—Health, Education, Labor, and Pensions 

HHS—Health and Human Services 

HRSA—Health Resources and Services Administration 

IC—Institute and Center 

IDeA—Institutional Development Award 

IDEA—Individuals with Disabilities Education Act 

IES—Institute of Education Sciences 

IMLS—Institute of Museum and Library Services 

IOM—Institute of Medicine 

LEA—local educational agency 

LIHEAP—Low Income Home Energy Assistance Program 

MACPAC—Medicaid and CHIP Payment and Access Commission 

MCH—Maternal and Child Health 

MedPAC—Medicare Payment Advisory Commission 

MSHA—Mine Safety and Health Administration 

NAEP—National Assessment of Educational Progress 

NAGB—National Assessment Governing Board 

NCATS—National Center for Advancing Translational Sciences 

NCBDDD—National Center on Birth Defects and Developmental 

Disabilities 

NCES—National Center for Education Statistics 

NCHS—National Center for Health Statistics 

NCI—National Cancer Institute 

NEI—National Eye Institute 

NHGRI—National Human Genome Research Institute 

NHLBI—National Heart, Lung, and Blood Institute 

NIA—National Institute on Aging 

NIAAA—National Institute on Alcohol Abuse and Alcoholism 

NIAID—National Institute of Allergy and Infectious Disease 

NIAMS—National Institute of Arthritis and Musculoskeletal and 

Skin Diseases 

NIBIB—National Institute of Biomedical Imaging and Bioengineering 

NICHD—Eunice Kennedy Shriver National Institute of Child 

Health and Human Development 

NIDA—National Institute on Drug Abuse 

NIDCD—National Institute on Deafness and Other Communication Disorders 

NIDCR—National Institute of Dental and Craniofacial Research 

NIDDK—National Institute of Diabetes and Digestive and Kidney Disease 

NIDRR—National Institute on Disability and Rehabilitation Research 

NIEHS—National Institute of Environmental Health Sciences 

NIGMS—National Institute of General Medical Sciences 

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

NIMHD—National Institute on Minority Health and Health Disparities 

NINDS—National Institute of Neurological Disorders and Stroke 

NINR—National Institute of Nursing Research 

NLM—National Library of Medicine 

NLRB—National Labor Relations Board 

NSF—National Science Foundation 

NSIP—Nutrition Services Incentives Program 

NTID—National Technical Institute for the Deaf 

NFP—Not-for-Profit 

OAR—Office of AIDS Research 

OCR—Office for Civil Rights 

ODEP—Office of Disability Employment Policy 

OFCCP—Office of Federal Contract Compliance Programs 

OIG—Office of the Inspector General 

OLMS—Office of Labor-Management Standards 

OMB—Office of Management and Budget 

OMH—Office of Minority Health 

OMHA—Office of Medicare Hearings and Appeals 

ONC—Office of the National Coordinator for Health Information 

Technology 

ORR—Office of Refugee Resettlement 

ORWH—Office of Research on Women’s Health 

OSEP—Office of Special Education Programs 

OSHA—Occupational Safety and Health Administration 

OWCP—Office of Workers’ Compensation Programs 

OWH—Office of Women’s Health 

PAIMI—protection and advocacy for individuals with mental illness 

PATH—Projects for Assistance in Transition From Homelessness 

PBGC—Pension Benefit Guaranty Corporation 

PHS—Public Health Service 

PPH Fund—Prevention and Public Health Fund 

PRNS—Programs of Regional and National Significance 

PROMISE—Promoting School Readiness of Minors in SSI 

RSA—Rehabilitation Services Administration 

SAMHSA—Substance Abuse and Mental Health Services Administration 

SAPT—Substance Abuse Prevention and Treatment 

SEA—State educational agency 

SEOG—Supplemental Educational Opportunity Grant 

SIG—School Improvement Grants 

SPRANS—Special Projects of Regional and National Significance 

SSA—Social Security Administration 

SSBG—Social Services Block Grant 

SSI—Supplemental Security Income 

STEM—science, technology, engineering, and mathematics 

TB—tuberculosis 

TBI—traumatic brain injury 

TIF—Teacher Incentive Fund 

TIVAS—Title IV Additional Servicers 

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

Disabilities 

UI—unemployment insurance 

USAID—U.S. Agency for International Development 

VETS—Veterans’ Employment and Training Services 

VISTA—Volunteers in Service to America 

VR—Vocational Rehabilitation 

WANTO—Women in Apprenticeship and Non-Traditional Occupations 

WHD—Wage and Hour Division 

WIA—Workforce Investment Act 

WIOA—Workforce Innovation and Opportunity Act 

WIF—Workforce Innovation Fund 

WISEWOMAN—Well-Integrated Screening and Evaluation for 

Women Across the Nation 
(8) 

SUMMARY OF BUDGET ESTIMATES AND COMMITTEE 

RECOMMENDATIONS 

For fiscal year 2019, the Committee recommends total budget au- thority of $1,059,220,321,000 for the Departments of Labor, Health 

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

amount includes $179,289,000,000 in current year discretionary 

funding subject to discretionary spending caps and $1,897,000,000 

in cap adjustments for healthcare fraud and abuse control, Unemployment Insurance Trust Fund program integrity, and for program integrity at the Social Security Administration, in accordance 

with the allocation for this bill. 

Fiscal year 2018 levels cited in this report reflect the enacted 

amounts in Public Law 115–141, the Consolidated Appropriations 

Act, 2018, adjusted for comparability where noted. 

OVERVIEW

The Labor, Health and Human Services, and Education, and Related Agencies [Labor-HHS–Education] appropriations bill constitutes the largest share of non-defense discretionary spending, 30 

percent of the total in fiscal year 2019. Total spending in this bill 

subject to discretionary spending caps is $2,189,000,000 above the 

comparable fiscal year 2018 level. In addition, the bill includes 

$6,743,000,000 in spending offset by savings from changes in mandatory programs, $28,613,000 less than the fiscal year 2018 level. 

This funding level has required the Committee to make difficult 

funding decisions and consider the appropriate role and jurisdiction 

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

NATIONAL INSTITUTES OF HEALTH

The Committee recommendation includes $39,084,000,000 for the 

NIH, an increase of $2,000,000,000 or 5.4 percent. The Committee 

continues to prioritize funding for medical research because it has 

provided millions of Americans and their families with hope. NIHfunded research has raised life expectancy and improved the quality of life for all Americans. In addition, it has lowered healthcare 

costs and spurred economic growth by supporting jobs in research 

and generating biomedical innovations. 

Over the past 4 years, funding for NIH has increased $9,000,000,000 or 30 percent. This investment has nearly quadrupled funding for Alzheimer’s research, started the All of Us precision medicine initiative, and targeted resources to such revolutionary projects as the BRAIN Initiative, a universal flu vaccine, 

and efforts to combat antibiotic resistance. The National Academy 

of Sciences published a report this year that showed that NIH 

funding contributed to every one of the 210 new drugs approved by 

the Food and Drug Administration [FDA] from 2010–2016. The 
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Committee’s commitment to an increased investment in medical research has allowed the best researchers in the country to have 

their research funded to discover the next breakthrough. 

Finally, in addition to supporting specific research priorities, the 

Committee continues to place a high value on support for all Institutes and Centers and allowing NIH to maintain flexibility to pursue unplanned scientific opportunities and address unforeseen public health needs. The Committee recommendation is estimated to 

support over 11,400 new and competing grants in fiscal year 2019. 

COMBATING OPIOID ABUSE

Opioid abuse and misuse continues to be a nationwide epidemic. 

More than 11.0 million Americans abused prescription opioids in 

2016, the latest year recorded, and more than 42,000 individuals 

died that same year of an opioid overdose, more than any year on 

record. Even more troubling, prescription opioid abuse is a risk factor for heroin use, another form of opioids. The Department of 

Health and Human Services reported that nearly 80 percent of heroin users reported abusing prescription opioids prior to heroin. To 

stop the spread of further opioid abuse, the bill provides 

$3,722,000,000, an increase of $3,452,000,000, or 1,275 percent, 

over the past 4 years, in discretionary funding to fight both prescription opioid and heroin abuse: 

State Opioid Response Grants.—The Committee provides 

$1,500,000,000 for flexible grants dedicated to State responses to 

opioid abuse, for a total of $3,000,000,000 over the past two fiscal 

years. The bill continues the 15 percent set-aside for States with 

the highest age-adjusted mortality rate related to opioid use disorders as well as the $50,000,000 for grants to Indian tribes or tribal organizations. 

Centers for Disease Control and Prevention.—The Committee includes $475,579,000 for improved prevention and surveillance efforts in all 50 states. In addition, the Committee includes 

$5,000,000 for a new initiative to address the alarming trend of increased infectious diseases associated with the opioid epidemic. 

National Institutes of Health.—The Committee includes 

$500,000,000 for research related to opioid addiction, development 

of opioid alternatives, pain management, and addiction treatment. 

Community Health Centers.—The Committee provides $200,000,000 for grants to expand services for the treatment, prevention, and awareness of opioid abuse. This funding will help 

health centers support 220,000 patients with accessing substance 

abuse services. 

Rural Opioid Workforce Initiative.—The Committee includes 

$5,000,000 of the funds available for career and workforce training 

services for the Appalachian Regional Commission [ARC] and Delta 

Regional Authority [DRA] regions to assist individuals affected by 

an opioid abuse disorder. 

Certified Community Behavioral Health Clinics.—The bill includes $150,000,000, an increase of $50,000,000, to provide grants 

to clinics certified by their State to provide treatment for those 

with mental health illness. The Committee expects SAMHSA will 

continue to provide competitive grants to those areas also impacted 

by the opioid crisis. 
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Plans of Infant Safe Care.—The Committee includes $60,000,000 

to States under the Child Abuse Prevention and Treatment Act to 

help States develop and implement plans of safe care and improve 

services for infants affected by substance use disorder, and their 

families. 

Preventive Services for Children At-Risk of Entering Foster 

Care.—The Committee provides $20,000,000 in continued funding 

for Kinship Navigator Programs. This program improves services 

available to grandparents and other relatives taking primary responsibility for children because the child’s parent is struggling 

with opioid addition or substance use disorder. The recommendation also includes $20,000,000 for Regional Partnership Grants and 

family-focused residential treatment programs, to improve the coordination of services for children and families affected by opioid 

and other substance use disorders and help families remain together during treatment. Funding for both of these programs will 

help build the evidence-base of what works for children and families to prevent children from entering the foster care system, consistent with changes made in the Family First Prevention Services 

Act. 

In addition, States have access to the Substance Abuse Prevention and Treatment Block Grant, funded at $1,858,079,000 in fiscal 

year 2019. 

PROMOTING COLLEGE AFFORDABILITY AND COMPLETION

The Committee continues and builds on the significant investments included last year to promote college affordability and completion. These investments help students of all backgrounds enter 

and complete college, further their post-secondary education, develop the skills needed for the in-demand jobs of today and the future, and graduate with less debt. 

Pell Grants.—The Committee increases the maximum Pell grant award to $6,195 for the 2019–20 school year, an increase of 1.6 percent, or $100. This is the second consecutive increase in the discretionary maximum award, building on the 3 percent, $175, increase 

provided in fiscal year 2018. The Committee recommendation also 

includes more than sufficient funding to continue Year Round Pell, 

which will help approximately one million students annually stay 

continuously enrolled, complete their program faster, graduate with 

less debt, and enter or re-enter the workforce sooner. 

Campus-Based Student Aid Programs.—The Committee maintains the significant increases in fiscal year 2018 by including 

$1,130,000,000 for Federal Work Study and $840,000,000 for Supplemental Educational Opportunity Grants. These programs allow 

individual colleges and universities to allocate need-based financial 

aid to students and design financial aid packages that work best 

for them. 

Federal TRIO Program.—The Committee includes $1,010,000,000 

for TRIO, which helps low-income and first-generation students 

prepare for and complete college. This maintains the significant investments in TRIO in recent years, which has been increased by 

more than 20 percent since fiscal year 2015. 

Child Care Access Means Parents in School.—The Committee recommendation includes $50,000,000 to help colleges and universities 
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meet the child care needs of students. This maintains the almost 

tripling of funding for the program in fiscal year 2018. 

Public Service Loan Forgiveness [PSLF].—The Committee recommendation includes $350,000,000, continuing the level of funding and authority from fiscal year 2018, to address eligibility issues 

in the PSLF program related to students being enrolled in ineligible repayment plans. The additional funding provided this year 

will ensure that even more students can qualify for loan forgiveness under this program and reduces concerns that funding availability would limit eligibility in the immediate future. 

STRENGTHENING THE WORKFORCE FOR A STRONGER ECONOMY

The U.S. economy continues to grow following the recession. The 

national unemployment rate fell below 4 percent in April 2018 for 

the first time in 18 years, and the number of underemployed and 

long-term unemployed workers has also decreased. For its part, the 

Committee has recognized the changing needs of employers and the 

evolving nature of the workforce. In particular, the disparity between the skills job seekers have and the skills employers need to 

fill available positions, also known as the ‘‘skills gap,’’ can hinder 

employers from expanding, innovating, and improving productivity 

and limit workers’ ability to obtain well-paying jobs in in-demand 

industries. The Committee has provided critical funding for workforce training and employment services and has encouraged the 

Department of Labor to reduce occupational barriers and prepare 

workers for in-demand occupations. 

Apprenticeship Grants.—The Committee recommendation includes $160,000,000 for continued support for the apprenticeship 

program created in fiscal year 2016. The Committee continues to 

support the funding and development of industry or sector partnerships as a means of closing the skills gap and expanding apprenticeships in in-demand industries. 

WIOA State Grants.—The bill includes $2,789,832,000 for employment training grants distributed by formula to States under 

the Workforce Innovation and Opportunity Act. These grants, 

which provide flexibility to State and local governments to meet 

their own unique job training needs, form the bedrock of the Federal workforce development effort. 

Veterans Employment and Training Service.—The Committee 

recommendation includes $300,041,000, for programs targeted towards employment needs of recently separating service members 

and veterans. Within this amount, the Committee includes 

$50,000,000 to support the Homeless Veteran’s Reintegration Program [HVRP]. HVRP provides an array of specialized services to 

help homeless veterans, such as job training, social services, clothing, substance abuse treatment, transportation, and housing referrals. 

Occupational Licensing.—The Committee started an initiative in 

2016 to reduce barriers created by a lack of interstate reciprocity 

for occupational licenses, for which the Department of Labor is encouraged to continue to work with the consortia of States, with 

technical and other types of assistance, to evaluate and pursue cooperative approaches to enhance reciprocity or portability of occupational licenses across State lines. Such agreements would signifi-
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cantly ease barriers to opportunity and reemployment for thousands of Americans, especially for military spouses, dislocated 

workers from various industries, and transitioning service members. 

Governor’s Statewide Reserve.—The bill continues to allow the 

full 15 percent State training grant funding reserve for governors 

to address a variety of statewide or regional training needs, 

projects, expanded partnerships, emergency response, and other 

services as needed throughout their State. 

Targeted Youth Training.—The Committee maintains funding 

from fiscal year 2018 for both the Job Corps and Youthbuild programs to provide at-risk youth with the opportunity to gain educational and occupational skills. 

Career and Technical Education [CTE].—The Committee recommendation includes $1,200,019,000 for CTE, the same as the fiscal year 2018 level. This maintains the $75,000,000 increase for 

CTE in fiscal year 2018 to help States develop, expand, and improve their career and technical education programs in high school 

and post-secondary settings, and create pathways beginning in 

high-school to in-demand jobs and careers. 

STEM Education.—The Committee recommendation includes 

$65,000,000, an increase of $15,000,000, in dedicated funding for 

STEM education, including computer science education, through 

the Education Innovation and Research program. This funding will 

expand access to high-quality STEM education for students, including students in rural schools, and build on the evidence-base of 

what works to improve student outcomes. In addition to this dedicated funding, several other programs, including formula grants to 

school districts through the Student Support and Academic Enrichment program, which is increased by $125,000,000, can also be 

used for STEM education activities. 

INCREASING ACCESS TO HIGH–QUALITY EARLY CHILDHOOD CARE AND

EDUCATION

The Committee recommendation continues and expands record 

increases in funding included in fiscal year 2018 to increase access 

to high-quality early childhood care and education, and help provide safe, affordable, stable, and quality child care options for 

working families. 

Child Care and Development Block Grant [CCDBG].—The fiscal 

year 2018 Consolidated Appropriations Act included a 

$2,370,000,000 increase for CCDBG, the largest 1 year increase in 

the history of the program. The Committee recommendation continues this funding in fiscal year 2019 which will help States meet 

the requirements and goals of the CCDBG Act to improve the 

health, safety, and quality of child care programs, including increasing provider reimbursement rates, and expand working families’ access to child care. 

Head Start.—The Committee recommendation includes an increase of $250,000,000 including $215,000,000 to help all Head 

Start programs keep up with rising costs, recruit and retain highqualified staff, and otherwise ensure the quality of their programs, 

and $35,000,000 in additional funding to extend the duration of 

Head Start services by increasing the number of full day/full-year 
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slots. This builds off of the $610,000,000 increase provided for Head 

Start in fiscal year 2018, which also included funding to expand 

Early Head Start, including through Early Head Start-Child Care 

Partnerships which will be awarded early in calendar year 2019. 

Overall since fiscal year 2015 funding for Head Start has increased 

$1,515,000,000 or 18 percent. 

RURAL AMERICA

Approximately 60.0 million people, or one in five Americans, live 

in rural America. Rural communities face obstacles, including access to healthcare and job opportunities, unique and often significantly different than those faced by urban and suburban communities. The Committee continues its investments in programs 

throughout the bill that target funding towards rural America and 

their specific needs. 

Rural Health.—The Committee recommendation continues its 

commitment to funding HRSA’s rural health programs and includes $318,794,000 for Rural Health programs, an increase of 

$28,000,000 above fiscal year 2018. Included in that amount is 

$20,000,000 to support underserved rural communities in the DRA 

region identify and better address their healthcare needs and to 

help small rural hospitals improve their financial and operational 

performance. 

Rural Communities Opioid Response.—While the opioid epidemic 

has affected both urban and rural counties, the burden in rural 

areas is significantly higher. Rural communities face a number of 

challenges in gaining access to healthcare in general, and substance abuse treatment in particular. CDC has found that drug-related deaths are 45 percent higher in rural communities, and that 

rural states are more likely to have higher rates of overdose 

deaths. The Committee provides $120,000,000 to address substance 

abuse, including opioid abuse, and the overdose crisis in rural communities. Within the funding provided, the Committee includes 

$20,000,000 for the establishment of 3 rural centers of excellence 

on substance use disorders to support the dissemination of best 

practices related to the treatment for and prevention of substance 

use disorders within rural communities. The centers will focus on 

the current opioid crisis and developing methods to address future 

substance use disorder epidemics. This funding, in addition to the 

$100,000,000 provided last year, will continue efforts to allow communities to develop plans to address local needs. In addition, the 

Committee recommendation allows the Department of Labor to use 

a portion of career and training funding focused on the ARC and 

DRA regions to assist individuals who are returning, entering, or 

seeking to maintain participation in the workforce after being affected by an opioid abuse disorder. 

Telehealth.—The Committee continues to prioritize funding for 

telehealth and the impact it has on access to care for medically underserved and rural populations. The Committee provides 

$25,500,000, an increase of $2,000,000, for the Office for the Advancement of Telehealth [OAT]. Telehealth has become an increasingly important program for patients in rural communities to access specialty care. 
14 

Training Assistance to Appalachian Regional Commission [ARC] 

and Delta Regional Authority [DRA] Regions.—The Committee continues support for an initiative within the Dislocated Worker National Reserve for reemployment and training assistance to workers dislocated in rural areas of the country hardest hit by the recession. The bill devotes $30,000,000 to assist unemployed workers 

from any industry within the ARC and DRA regions to adapt existing skills and learn new ones demanded by growing industries. 

Rural Education.—The Committee recommendation includes a 

combined $250,000,000 increase for Title I Grants to LEAs and 

Student Support and Academic Enrichment Grants, flexible formula grants that allow school districts, including rural districts, to 

decide how to best use limited resources to meet the needs of their 

students. Further, the Committee recommendation includes 

$180,840,000, the same as the fiscal year 2018 level for the Rural 

Education program to specifically address the need of small rural 

school districts and schools. Finally, the Committee recommendation continues language requiring the Department to prioritize 

rural communities as part of all competitive grant programs, including funding for STEM education and charter schools. 

Rural Community Development Technical Assistance.—The Committee recommendation includes $8,000,000, level with fiscal year 

2018, for training and technical assistance in developing and maintaining safe drinking and waste water facilities to very small rural 

communities that otherwise would not have access to such assistance. 

ALZHEIMER’S DISEASE

In 2018, Medicare and Medicaid will spend an estimated $186,000,000,000 caring for those with Alzheimer’s and other dementias, 67 percent of total costs. It is the most expensive disease 

in America. Without a medical breakthrough to prevent, slow, or 

stop the disease, by 2050 the combined Medicare and Medicaid 

spending on people with Alzheimer’s disease will more than quadruple. 

Alzheimer’s Research.—The Committee recommendation includes 

an increase of $425,000,000 for Alzheimer’s disease research, bringing the total available in fiscal year 2019 to approximately 

$2,340,000,000, a 22 percent increase above fiscal year 2018. Over 

the last 4 years, funding for Alzheimer’s disease has increased 

$1,709,000,000, a 271 percent increase. 

Brain Research through Advancing Innovative Neurotechnologies 

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

BRAIN Initiative and provides $429,389,000 in fiscal year 2019. 

This is an increase of $29,000,000 above fiscal year 2018. The 

BRAIN Initiative is developing a more complete understanding of 

brain function and has the possibility of helping millions of people 

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

Alzheimer’s Disease Program.—The Committee continues to provide $23,500,000 in the Administration for Community Living for 

the Alzheimer’s Disease Program and maintains a streamlined 

flexible program that will allow States, communities, nonprofits, 
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and Indian tribes greater access to funding opportunities authorized under Title IV of the Older Americans Act. 

Alzheimer’s and Healthy Aging.—The Committee provides a $1,000,000 increase to continue supporting CDC activities through 

the Healthy Brain road map for State and national partnerships to 

monitor, evaluate, educate, and empower those fighting Alzheimer’s. 

Caregivers.—At any given time, more than 15.0 million Americans are providing informal care to an older relative with dementia. However, dementia caregivers experience considerable stress 

and depression; impaired subjective well-being, self-efficacy, and 

physical health, and perhaps even increased mortality. Studies 

have shown that coordinated support services can reduce caregiver 

depression, anxiety, and stress, and enable them to provide care 

longer, which avoids or delays the need for costly institutional care. 

This bill provides funding to a variety of programs to support caregivers, including research at the National Institute on Aging, the 

Lifespan Respite Care program, the National Family Caregiver 

Support program, and new funding to begin the Family Caregiver 

Council at the Administration for Community Living. 

INVESTING IN PUBLIC HEALTH PREPAREDNESS

The Committee continues to invest in HHS programs that help 

America’s communities prepare for, respond to, and recover from 

public health and medical disasters and emergencies. These events 

include natural disasters, pandemic diseases, and man made 

threats. Americans just experienced one of the deadliest flu seasons 

on record, and with outbreaks in Ebola, Zika, and recent natural 

disasters, the Committee believes it critical to continue investments in this area. The Committee provides $3,516,458,000 for 

HHS preparedness activities, a nearly 20 percent increase over the 

past 2 years. In fiscal year 2019, the Committee provides: 

Biomedical Advanced Research and Development Authority 

[BARDA].—The Committee provides $561,700,000, an increase of $25,000,000, to continue investments in developing late stage medical countermeasures and leading efforts to develop strategies to 

combat antibiotic resistant bacteria. 

Project BioShield.—The Committee includes $735,000,000 for 

Project BioShield, an increase of $25,000,000, to purchase critical 

medical countermeasures, such as vaccines, therapeutics, and 

diagnostics. 

Public Health Emergency and Hospital Preparedness.—The Committee provides $680,000,000 for CDC’s Public Health Emergency 

Preparedness program, an increase of $10,000,000, to continue preparing communities and hospitals to respond to public health emergencies. 

Pandemic Influenza.—The Committee provides $285,000,000 for 

Pandemic Influenza within the Office of the Secretary, an increase 

of $35,000,000, to improve the effectiveness of the flu vaccine and 

better respond to late changes to flu strains. 

IMPROVING FISCAL ACCOUNTABILITY

The Committee has an obligation to promote fiscal accountability 

and the effective use of U.S. taxpayer funds. The annual appropria-
16 

tions process affords Congress the opportunity to continuously improve and refine how Government works. Appropriations bills provide oversight of every discretionary program, every year, which 

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

unintended consequences in the intervening years of an authorization bill. 

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

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

Federal funds. The Committee expects each agency to include in 

their fiscal year 2020 CJ information detailing how much funding 

was spent on advertising in fiscal year 2019. 

Open Access to Federal Research.—The Committee has received 

reports from the Office of Science and Technology Policy [OSTP] on 

the progress of all Federal agencies in developing and implementing policies to increase public access to federally funded scientific research. The Committee commends the agencies funded in 

this bill who have issued plans in response to OSTP’s policy directive issued in 2013. The Committee urges the continued efforts towards full implementation of the plan, and directs agencies to provide an update on progress made in the fiscal year 2020 CJ. This 

will ensure that the Committee remains apprised of the remaining 

progress needed to make federally funded research accessible to the 

public as expeditiously as possible. 

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

Committee recommendation continues to ensure that in fiscal year 

2019, no funds will leave NIH via the transfer required by section 

241 of the PHS Act. 

INCREASING THE EFFICIENCY AND COST EFFECTIVENESS OF

GOVERNMENT

The Committee provides funding for a variety of activities aimed 

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

are fragmented or duplicative. The bill advocates that longstanding 

priority by reforming and transforming government in many small 

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

Fighting Healthcare Fraud and Abuse.—The Committee includes 

$765,000,000 for the Health Care Fraud and Abuse Control program at CMS. The Committee notes that the latest data demonstrates for every new $1.00 spent on fraud and abuse, $2.00 is 

recovered by the U.S. Treasury. 

Inspectors General.—The Committee recommendation provides 

$440,284,000 for the Inspectors General funded in this act to conduct additional audits and investigations of possible waste and 

fraud in Government programs. The Committee appreciates the 
17 

strong working relationships between the Inspectors General and 

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

The Committee reiterates the strong expectation that Inspectors 

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

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

data systems, or other materials related to their responsibilities 

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

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

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

particular electronic systems are clearly and explicitly protected 

from Inspectors General access by statute. 

Preventing Improper Social Security Payments.—The Committee 

recommendation includes $1,683,000,000 for the Social Security 

Administration to conduct continuing disability reviews and SSI 

program redeterminations of non-medical eligibility, and other program integrity efforts. Combined, these activities are estimated to 

save over $9,000,000,000 over 10 years in taxpayer dollars by reducing waste, fraud, abuse, and improper payments in the Social 

Security, Medicare, and Medicaid programs. 

Taxpayer Accountability.—Given the current fiscal environment, 

it is imperative for Government agencies to increase efficiencies, 

while fulfilling statutory requirements, to maximize the effectiveness of agency programs. Since 2011, GAO has published reports 

showing as many as 272 areas of potential duplication and overlap. 

GAO has identified 792 actions to reduce, eliminate, or better manage fragmentation, overlap, or duplication; achieve costs savings; or 

enhance revenue. While GAO has noted that the Nation has 

achieved $178,000,000,000 in savings based on these reports, many 

more efficiencies may be realized. The Committee directed each 

agency funded in the fiscal year 2018 bill to report to the Committee, within 1 year of enactment, on all efforts made to address 

the duplication identified by the annual GAO reports along with 

identifying substantive challenges and legal barriers to implementing GAO’s recommendations, as well as suggested legislative 

recommendations that could help the agency to further reduce duplication. The Committee looks forward to receiving the reports. 

Tribal Coordination.—The Committee directs all Departments 

with American Indian and Alaskan Native specific programs or 

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

Unemployment Insurance Trust Fund Integrity.—The Committee 

provides $150,000,000 for Reemployment Services and Eligibility 

Assessments [RESEA] for fiscal year 2019. The RESEA program 

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

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

barriers to reemployment, and others who have been difficult to 

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

reduced the total amount of benefits paid from the Unemployment 

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

reducing improper payments to ineligible claimants, thus helping 
18 

protect the fiscal solvency of the trust fund. The RESEA program 

is based on a service-delivery model that has demonstrated a return of $2.60 in savings for every $1.00 spent on the program. 

BILL–WIDE DIRECTIVES

Children Exposed to Trauma.—The Committee notes that childhood exposure to trauma, such as witnessing violence or substance 

abuse, can result in negative health, education, and employment 

outcomes, for which agencies funded in this bill seek to address. 

The Committee encourages the Departments and agencies funded 

in this bill to enhance coordination on activities that address child 

trauma, and to disseminate and promote through grant awards 

best practices for identifying, referring, and supporting children exposed to trauma. 

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

budget requests, agency performance, and resource requirements. 

The Committee expects the fiscal year 2020 congressional justifications to include sufficient detail to justify all programs, projects, 

and activities contained in each department, agency, board, corporation, or commission’s budget request. The justifications shall 

include a sufficient level of detailed data, exhibits, and explanatory 

statements to support the appropriations requests, including tables 

that outline each agency’s programs, projects, and activities for fiscal years 2019 and 2020. Specifically, every bill and report number 

included in either the House of Representatives or Senate Appropriations bill or report or the final appropriations bill or explanatory statement of the fiscal year should be reflected within these 

justifications. 

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

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

support each increase, decrease, and staffing change proposed in 

the fiscal year 2020 budget. When requesting additional resources, 

reduced funding, or eliminations of programs, changes should be 

outlined with an adequate justification. Should the final fiscal year 

2019 appropriations bill be enacted within a timeframe that does 

not allow it to be reflected within the congressional justifications 

for fiscal year 2020, the Committee directs each department, agency, board, corporation, or commission funded in this act to submit 

within 30 days of enactment updated information to the Committee 

on funding comparisons to fiscal year 2019. 

OTHER HIGHLIGHTS OF THE BILL

Children’s Hospitals Graduate Medical Education [CHGME].— 

The Committee recommendation includes $325,000,000 for 

CHGME, an increase of $10,000,000 above fiscal year 2018. This 

funding supports 58 freestanding children’s teaching hospitals to 

provide Graduate Medical Education for physicians. 

Community Health Centers [CHC].—The Committee recommendation includes $1,625,222,000 for CHC’s, level with fiscal 

year 2018. The Committee’s recommendation is projected to support 26.0 million patients and continues quality improvement ac-
19 

tivities for more than 1,400 health centers operating over 11,000 

primary sites. 

Corporation for National and Community Service.—The Committee recommendation includes $415,010,000 for AmeriCorps 

State and National Grants, an increase of $3,000,000, and 

$32,000,000 for NCCC, $92,,364,000 for VISTA, and $202,117,000 

for Senior Corps, all the same as the fiscal year 2018 funding levels. 

Corporation for Public Broadcasting.—The bill continues advance 

funding in the amount of $445,000,000 for the Corporation for Public Broadcasting and an additional $20,000,000 to continue investments in system-wide infrastructure and services, including the 

interconnection project. 

Domestic Violence Programs.—The Committee recommendation 

includes $165,000,000, an increase of $5,000,000 for Family Violence Prevention and Services programs, and $10,250,000, an increase of $1,000,000, for the National Domestic Violence Hotline. 

Institute for Museum and Library Services [IMLS].—The Committee recommendation includes $242,000,000 for IMLS, an increase of $2,000,000 above fiscal year 2018. This funding supports 

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

services. 

Low Income Home Energy Assistance Program [LIHEAP].—The 

Committee recommendation includes $3,690,304,000, an increase of 

$50,000,000. 

Medicare Appeals Backlog.—The Committee continues to be concerned that the Office of Medicare Hearing and Appeals has a current case backlog of approximately 500,000 cases. The bill continues the investment provided in fiscal year 2018 and expects that 

the Department will make significant progress in addressing the 

backlog in the next few years. 

Social Security Administration.—The Committee recommendation includes $12,945,945,000 for SSAs administrative expenses, an 

increase of $77,000,000. Accounting for one-time funding provided 

for IT modernization efforts in fiscal year 2018, this increase will 

help SSA continue to improve service to the public and work down 

backlogs in critical workloads. 
20 

Supporting Local Control and Investments in Elementary and 

Secondary Education.—The Committee continues to prioritize funding for elementary and secondary education programs that provide 

the most flexibility for states, school districts, schools, and parents 

to make education decisions impacting students and families. —$15,884,802,000, an increase of $125,000,000 for title I grants 

to LEAs 

—$1,225,000,000, an increase of $125,000,000 for title IV Student Support and Academic Enrichment Grants —$12,402,848,000, an increase of $125,000,000 for IDEA Grants 

to States (Part B, Section 611) 

—$1,439,112,000, an increase of $25,000,000 for Impact Aid 

—$445,000,000, an increase of $45,000,000 for the Charter 

Schools Program 
(21) 

TITLE I 

DEPARTMENT OF LABOR 

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

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

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

EMPLOYMENT AND TRAINING ADMINISTRATION

TRAINING AND EMPLOYMENT SERVICES

Appropriations, 2018 ............................................................................. $3,486,200,000 

Budget estimate, 2019 ........................................................................... 3,220,549,000 

Committee recommendation ................................................................. 3,501,200,000 

The Training and Employment Services account provides funding 

primarily for activities under the Workforce Innovation and Opportunity Act, and is a decentralized, integrated system of skill training and related services designed to enhance the employment and 

earnings of economically disadvantaged and dislocated workers. 

Funds provided for many training programs for fiscal year 2019 

will support the program from July 1, 2019, through June 30, 2020. 

A portion of this account’s funding, $1,772,000,000, is available on 

October 1, 2019, for the 2019 program year. 

The Committee strongly encourages the Department to continue 

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

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

should include recommendations and specific proposals for consolidation of programs. 

Building a skilled workforce pipeline is critical to the success of 

the American economy in the 21st Century. The Committee encourages DOL to identify and invest in national workforce development 

partnerships that target youth and teens for soft-skills development, career exploration and exposure, and on-the-job work experiences including internships, first jobs, and pre-apprenticeships, to 

prepare youth for the jobs of today and tomorrow. In building these 

partnerships, the Committee encourages the Department to support organizations with a national reach that serve both youth and 

teens, to provide the maximum number of young people the opportunity to build the skills necessary to be prepared for their future 

and to be full participants in our economy. The Committee also encourages DOL to support partnerships between workforce investment boards and youth-serving organizations to further address 

the skills gap. 

The Committee encourages the Employment and Training Administration to expand its collaborative work with the Institute of 

Museum and Library Services to assist in the implementation of 

WIOA to help States and local boards integrate the education, em-
22 

ployment, and training services provided by public libraries into 

the workforce investment system. The Committee also encourages 

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

with public libraries. 

Grants to States 

The Committee recommends $2,789,832,000 for Training and 

Employment Services Grants to States. 

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

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

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

that may be reserved by Governors. 

Although the national unemployment rate hit an 18-year low in 

May 2018, the Committee is concerned that unemployment remains high in some States and regions around the Nation. WIOA 

State grant funding continues to serve critical functions, including 

to assist States that continue to experience high unemployment 

and to address the disparity between the skills job seekers have 

and the skills employers need to fill available positions. 

Adult Employment and Training.—For adult employment and training activities, the Committee recommends $845,556,000. 

Formula funding is provided to States and further distributed to 

local workforce investment areas through one-stop centers. The 

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

Funds are made available in this bill for adult employment and 

training activities in program year 2019, which occurs from July 1, 

2019, through June 30, 2020. The bill provides that $133,556,000 

is available for obligation on July 1, 2019, and that $712,000,000 

is available on October 1, 2019. Both categories of funding are 

available for obligation through June 30, 2020. 

Youth Training.—For youth training activities, the Committee 

recommends $903,416,000. The purpose of this program is to provide low-income youth facing barriers to employment with services 

that prepare them to succeed in the knowledge-based economy. 

Funds are made available for youth training activities in program 

year 2019, which occurs from April 1, 2019, through June 30, 2020. 

The Committee recognizes that employment between ages 14 and 

24 can significantly improve adult employment outcomes, including 

higher earnings, lower poverty rates, and better overall health. 

Youth workforce development programs can also decrease violent 

crime arrests among youth living in areas with high rates of community violence. The Committee supports the dedicated funding 

stream for these activities as authorized under WIOA to ensure 

Federal job training support for out-of-school and low-income, inschool youth. 

Dislocated Worker Assistance.—For dislocated worker assistance, 

the Committee recommends $1,040,860,000. This program is a 

State-operated effort that provides training services and support to 
23 

help permanently separated workers return to productive unsubsidized employment. In addition, States must use State-wide reserve funds for rapid response assistance to help workers affected 

by mass layoffs and plant closures. States must also use these 

funds to carry out additional State-wide employment and training 

activities such as providing technical assistance to certain low-performing local areas, evaluating State programs, and assisting with 

the operation of one-stop delivery systems. States may also use 

funds for implementing innovative training programs. 

Funds made available in this bill support activities in program 

year 2019, which occurs from July 1, 2019, through June 30, 2020. 

The bill provides that $180,860,000 is available for obligation on 

July 1, 2019, and that $860,000,000 is available on October 1, 

2019. Both categories of funding are available for obligation 

through June 30, 2020. 

The Committee is aware of allegations that federally-funded local 

workforce development boards in Florida were improperly reporting 

inflated job placement numbers. The Committee understands the 

Department is investigating the allegations and requests a briefing 

upon conclusion of the investigation. The Committee also encourages the Department to take action to ensure that there are sufficient practices in place to deter fraud and abuse in workforce development boards receiving Federal funding through WIOA. 

Federally Administered Programs 

Dislocated Worker Assistance National Reserve.—The Committee 

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

National Reserve, which is available to the Secretary for activities 

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

well as for technical assistance, training, and demonstration 

projects. 

Funds made available for the National Reserve in this bill support activities in program year 2019. The bill provides that 

$20,859,000 is available for obligation on July 1, 2019, and that 

$200,000,000 is available on October 1, 2019. Both categories of 

funding are available for obligation through September 30, 2020. 

The Committee bill makes $30,000,000 available for obligation on 

October 1, 2018, through September 30, 2020, to provide enhanced 

dislocated worker training to promote economic recovery in the Appalachian and Delta regions. The initiative will include projects for 

dislocated workers within the Delta Regional Authority [DRA] and 

Appalachian Regional Commission [ARC] areas. These regions 

have been particularly hard hit by industrial downsizing and closures, and funding is provided to target these underserved areas. 

The Department is strongly urged to engage proactively with Workforce Development Boards and other appropriate entities at the 

State and local levels, including those typically involved in applying for and administering National Dislocated Worker Grants or 

Dislocated Worker demonstration projects to ensure that they are 

aware of the availability of the targeted funds so they will be 

sought and utilized promptly and effectively to assist workers in 

areas hardest hit by job loss. The Department, DRA, and ARC are 

directed to jointly continue to update the Committee quarterly on 
24 

the community engagement and progress made on this program 

until all funds are expended. 

In addition, the Committee directs the Department to use at least $5,000,000 of the funds made available for the DRA and ARC 

areas for projects to provide career and training services to assist 

individuals who have been affected by an opioid or other substance 

use disorder and who are returning, entering, or seeking to maintain participation in the workforce. The career and training services supported by these funds should be reflective of allowable services described in the Training and Employment Guidance Letter 

No. 19–16. In awarding the funds, the Committee encourages the 

Department to give priority to States with the highest age-adjusted 

mortality rate related to opioid overdose deaths. 

The Committee encourages the Department to use funds provided to carry out sections 168(b) and 169(c) of WIOA, which may 

be used for technical assistance and demonstration projects, to support demonstration programs that allow at-risk youth who are outof-school and have limited work experience to participate in the 

workforce. 

Advances in automation and artificial intelligence have the potential to alter the workplace. These changes in the nature of work 

will require new approaches to job training. The Committee encourages DOL to support demonstration projects on workforce development activities that will assist workers in sectors, particularly in 

transportation, most at risk of job dislocation due to automation 

and artificial intelligence. The Committee requests a briefing not 

later than 120 days after enactment of this act regarding how DOL 

is assessing and addressing the needs of the workforce most at risk 

of dislocation. 

Indian and Native American Programs.—The Committee recommends $54,000,000 for Indian and Native American Programs. 

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

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

adult basic education, GED attainment, literacy training, English 

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

The Committee directs the Department to obligate funding at the 

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

D of title I of the WIOA. 

Migrant and Seasonal Farmworker Programs.—The Committee 

recommends $87,896,000 for migrant and seasonal farmworkers 

programs, which serve members of economically disadvantaged 

families whose principal livelihood is derived from migratory and 

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

Enrollees and their families are provided with employment, training, and related services intended to prepare them for stable, yearround employment within and outside of the agriculture industry. 

The Committee recommendation provides that $81,447,000 be 

used for State service area grants. The Committee recommendation 

also includes bill language directing that $5,922,000 be used for migrant and seasonal farmworker housing grants, of which not less 

than 70 percent shall be for permanent housing. The principal pur-
25 

pose of these funds is to continue the network of local farmworker 

housing organizations working on permanent housing solutions for 

migrant and seasonal farmworkers. The Committee recommendation also includes $527,000 to be used for section 167 training, 

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

YouthBuild.—The Committee supports the YouthBuild program and recommends $89,534,000 to support its work to target at-risk 

high school dropouts and prepare them with the skills and knowledge they need to succeed in a knowledge-based economy. 

The Committee is aware of the OIG findings (Report 04–18–002– 

03–001) that YouthBuild grantees did not adequately comply with 

standards set by the Department when reporting program outcomes. Given the enactment of WIOA, the Committee encourages 

the Department to clarify the program criteria for YouthBuild 

grantees. 

National Activities 

Reintegration of Ex-Offenders.—The Committee recommends 

$93,079,000 for the Reintegration of Ex-Offenders program. The 

Reintegration of Ex-Offenders program helps prepare and assist 

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

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

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

who would benefit from alternatives to incarceration or diversion 

from formal judicial proceedings. Programs are carried out directly 

through State and local governmental entities and community 

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

the comprehensive workforce development investment system. The 

Committee directs the Department to use funding to support efforts 

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

that are seeking to address relevant impacts and root causes of 

civil unrest and high levels of community violence. 

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

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

including the WIOA formula programs, Job Corps, Community 

Service Employment for Older Americans, the Employment Service, 

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

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

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

Workforce Data Quality Initiative.—The Committee recommends 

$6,000,000 for the Workforce Data Quality Initiative. Funds are 

used to assist States with incorporating comprehensive workforce 
26 

information into longitudinal data systems being developed in part 

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

and accessibility of performance data being produced by training 

providers. 

Apprenticeship Grants.—The recommendation includes 

$160,000,000, an increase of $15,000,000, for continued support for 

the apprenticeship program that the Committee created in fiscal 

year 2016. This funding shall be for making competitive contracts 

and to continue funding grants to States and industry partnerships. The Department is directed to ensure approval of apprenticeship opportunities that engage, recruit, and serve women and other 

under-represented populations and local communities that have 

high rates of unemployment and high levels of community violence. 

The Committee also directs the Department to use funding to support economic development strategies that generate new or leverage existing employer demand for apprenticeships. The Committee 

also directs the Department to collaborate with the DRA to develop 

a targeted apprenticeship and job training program to meet the 

unique needs of underserved rural communities in this region. The 

Committee recognizes the role that sector partnerships play in organizing key stakeholders in an industry cluster to address the 

shared goals and human resources needs of the industry cluster. 

The Committee supports the funding and development of industry 

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

is aware that Apprenticeship State Expansion grants have been 

used to positive effect in States with high unemployment. The Department is encouraged to prioritize the provision of grants to 

States with high unemployment and long-standing and effective 

partnerships between job training programs and employers who 

seek well-qualified employees in the healthcare, maritime, construction, and oil & gas industries. The Committee directs the Office of Apprenticeship to work with Congress to take steps to broaden the availability of apprenticeship opportunities by including 

non-traditional programs, such as craft-training programs and programs certified by the National Center for Construction Education 

and Research. 

JOB CORPS

Appropriations, 2018 ............................................................................. $1,718,655,000 

Budget estimate, 2019 ........................................................................... 1,296,938,000 

Committee recommendation ................................................................. 1,718,655,000 

The recommendation for operations of Job Corps centers is 

$1,603,325,000. 

The Committee remains concerned about the issue of student 

safety on Job Corps campuses across the country and recognizes 

the Department has taken important steps toward addressing 

these issues. The Committee strongly urges the Department to continue corrective actions to ensure the safety of students and staff. 

Job Corps Enrollment.—The Committee recognizes Job Corps 

plays a critical role in providing tens of thousands of underserved 

youth the skills they need to secure employment in high-growth industries. The Committee understands that in recent years student 
27 

enrollments in Job Corps have decreased resulting in unused capacity. This decrease has occurred even while it is estimated that 

nearly 5,000,000 young Americans are neither employed nor enrolled in school and likely eligible for Job Corps. The Committee directs the Department to provide quarterly accountability reports 

regarding the number of calls to Job Corps’ national enrollment 

hotline, the on-board strength of each Job Corps center, and the investments and steps Job Corps has made to improve both enrollment and on-board strength. 

The Committee recommendation for administrative costs is 

$32,330,000. 

The Committee also recommends a total of $83,000,000 in construction, renovation, and acquisition [CRA] funds. This amount is 

available from July 1, 2019, to June 30, 2020. The Committee continues bill language allowing the Secretary to transfer up to 15 percent of CRA funds, if necessary, to meet the operational needs of 

Job Corps centers or to achieve administrative efficiencies. The bill 

continues to require the Secretary to notify the Committees on Appropriations of the House of Representatives and the Senate at 

least 15 days in advance of any transfer. The Committee expects 

any notification to include a justification. 

The Committee reminds the Department of the directive included 

in the Joint Explanatory Statement accompanying the Consolidated 

Appropriations Act, 2018, to support and incentivize center operators to build and enhance partnerships between centers and other 

training sites to enhance opportunity and work experiences for students in underserved rural or remote communities as well as urban 

settings, with a priority for communities that have experienced Job 

Corps center closures. 

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

Corps Center, including the completion of the ‘‘Scope of Work’’ for 

the design phase of the project and the issuance of a Request for 

Proposal for architecture and engineering services. The Committee 

expects this proposal will be expeditiously awarded. The Committee 

expects the Department to remain diligently committed to ensuring 

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

number of young people that it once served while, in the meantime, 

reserving sufficient funds for the restoration of the facility consistent with the expectations of the Committee. The Committee 

continues to direct the Department to prioritize the Gulfport Job 

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

COMMUNITY SERVICE EMPLOYMENT FOR OLDER AMERICANS

Appropriations, 2018 ............................................................................. $400,000,000 

Budget estimate, 2019 ........................................................................... ........................... 

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

Community Service Employment for Older Americans [CSEOA] 

provides part-time employment in community service activities for 

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

recommendation includes $400,000,000 for CSEOA. 
28 

FEDERAL UNEMPLOYMENT BENEFITS AND ALLOWANCES

Appropriations, 2018 ............................................................................. $790,000,000 

Budget estimate, 2019 ........................................................................... 790,000,000 

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

The Committee recommendation includes mandatory funds for 

the Federal unemployment benefits and allowances program that 

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

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

jobs, improve earnings, and increase credential and education 

rates. The Committee recommendation provides for the full operation of the Trade Adjustment Act program in fiscal year 2019 consistent with current law. 

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

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

STATE UNEMPLOYMENT INSURANCE AND EMPLOYMENT SERVICE

OPERATIONS

Appropriations, 2018 ............................................................................. $3,464,691,000 

Budget estimate, 2019 ........................................................................... 3,325,298,000 

Committee recommendation ................................................................. 3,339,010,000 

The Committee recommendation includes $3,254,944,000 authorized to be drawn from the Employment Security Administration account of the Unemployment Trust Fund and $84,066,000 to be provided from the general fund of the Treasury. 

The funds in this account are used to provide administrative 

grants and assistance to State agencies that administer Federal 

and State unemployment compensation laws and operate the public 

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

improving economy, fewer unemployment applications are being 

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

The Committee recommends a total of $2,527,816,000 for UI activities. For UI State operations, the Committee recommends 

$2,515,816,000. Of these funds, the Committee includes 

$150,000,000 to expand intensive, individualized reemployment assistance and to help address and prevent long-term unemployment 

and reduce improper payments through the Reemployment Services and Eligibility Assessments [RESEA] initiative. This includes 

$117,000,000 in base funding and $33,000,000 in cap adjustment 

funding allowed under the Bipartisan Budget Act of 2018. 

As State consortia continue work to modernize their UI information technology systems, the Committee expects the Department 

will continue to closely support and oversee the consortia’s efforts 

and to keep the Committee informed on how funds are utilized and 

progress on system development. 

The Committee recommendation includes $9,000,000 for the UI 

Integrity Center of Excellence, including supporting an integrated 

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

States reduce fraud. 
29 

The Committee recommendation provides for a contingency reserve amount should the unemployment workload exceed an average weekly insured claims volume of 2,030,000. 

The Committee recommends $12,000,000 for UI national activities, which will support activities that benefit the entire FederalState UI system, including supporting the continuation of IT upgrades and technical assistance. 

For the Employment Service allotments to States, the Committee 

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

general funds together with an authorization to spend 

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

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

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

training to States. 

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

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

is available to the Department for costs associated with processing 

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

same as the fiscal year 2018 enacted level, is available for related 

State grants. 

The Committee remains concerned about efficient, effective management of the H–2B and H–2A programs. Processing delays in the 

past 2 years have degraded the effectiveness of the programs for 

those who depend on them for meeting short-term, seasonal surges 

in demand. Authority was included in fiscal year 2018 to utilize H– 

1B fee receipts through fiscal year 2019 to augment processing capacity. This short-term authority was intended to prevent excessive 

labor certification and wage determination delays while the Department develops improved administrative procedures for the 

longer term. The Committee expects the Department to provide 

timely updates about the use of the fee authority and Department’s 

longer-term plans to improve the efficiency of these programs. 

In fiscal year 2017, the Committee urged the Department to engage with all stakeholders to assess the impacts of the H–2B mobile housing policy in industries requiring a mobile workforce found 

in the 2015 Interim Final Rule [IFR]. The Committee is aware that 

the Department has not fully assessed the impacts of the housing 

policy outlined in the IFR in industries requiring a mobile workforce. The Department is directed to provide the Committee with 

a detailed report within 120 days of enactment with an assessment 

of the impacts of the housing policy in industries requiring a mobile workforce, a justification for the housing policy, and details regarding any consultation with industries requiring a mobile workforce. 

In the determination of prevailing wage for the purposes of the 

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

even in instances where Occupational Employment Statistics [OES] 

survey data are available unless the Secretary determines that the 

methodology and data in the provided survey are not statistically 
30 

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

For one-stop career centers and labor market information, the Committee recommends $62,653,000. 

Occupational Licensing.—The Committee has provided $17,500,000 since fiscal year 2016 to establish occupational licensing grants for State consortia to identify, explore, and address 

areas where licensing requirements create an unnecessary barrier 

to labor market entry or labor mobility across State lines. The 

Committee appreciates the Secretary’s support of pursuing cooperative approaches to reduce barriers to employment for thousands of 

Americans, especially for military spouses, dislocated workers, and 

transitioning service members. The Committee appreciates the Department’s recent report and looks forward to additional updates 

on the progress and outcomes of the occupational licensing initiative. 

ADVANCES TO THE UNEMPLOYMENT TRUST FUND AND OTHER FUNDS

The Committee bill continues language providing such sums as 

necessary in mandatory funds for this account. The appropriation 

is available to provide advances to several accounts for purposes 

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

PROGRAM ADMINISTRATION

Appropriations, 2018 ............................................................................. $158,656,000 

Budget estimate, 2019 ........................................................................... 154,265,000 

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

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

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

of the Unemployment Trust Fund. 

General funds in this account pay for the Federal staff needed 

to administer employment and training programs under WIOA, 

Older Americans Act [OAA], the Trade Act of 1974, and the National Apprenticeship Act. Trust funds provide for the Federal administration of employment security, training and employment, 

and executive direction functions. 

EMPLOYEE BENEFITS SECURITY ADMINISTRATION

SALARIES AND EXPENSES

Appropriations, 2018 ............................................................................. $181,000,000 

Budget estimate, 2019 ........................................................................... 189,500,000 

Committee recommendation ................................................................. 186,500,000 

The Committee recommends $186,500,000 for the Employee Benefits Security Administration. EBSA is responsible for the enforcement of title I of ERISA in both civil and criminal areas and for 

enforcement of sections 8477 and 8478 of the Federal Employees’ 

Retirement Security Act of 1986. EBSA administers an integrated 

program of regulation, compliance assistance and education, civil 

and criminal enforcement, and research and analysis. Bill language 

continues to allow EBSA to obligate up to $3,000,000 for two fiscal 
31 

years, as proposed in the budget. The authority will be useful in 

situations where services may be needed for cases extending beyond the end of the fiscal year. 

The Committee understands there has been an increase in enforcement actions taken by the Department against employee stock 

ownership plan [ESOP] companies. Congress has encouraged the 

creation and operation of ESOPs since 1973, including a section of 

the Tax Reform Act of 1976, which declared ESOPs strengthen the 

free enterprise system The Committee requests a report on the reasons for the increased enforcement actions in the fiscal year 2020 

CJ. 

The Committee recommendation includes an increase of 

$5,500,000 for the update and replacement components of the 

ERISA Filing Acceptance System, EFAST, as requested by the Department. 

PENSION BENEFIT GUARANTY CORPORATION

The Pension Benefit Guaranty Corporation’s estimated obligations for fiscal year 2019 include single-employer benefit payments 

of $7,212,000,000, multi-employer financial assistance of 

$204,000,000, and consolidated administrative expenses of 

$445,363,000. Administrative expenses are comprised of three activities: pension insurance activities, pension plan termination expenses, and operational support. These expenditures are financed 

by permanent authority. Previously, the Committee accepted the 

PBGC’s proposal to reform the previous administrative apportionment classifications from three budget activities to one budget activity to make operations more efficient and improve stewardship 

of resources. That consolidated approach for the three activities is 

continued, but PBGC is directed to continue providing detail every 

year on the three activities in its annual CJ. 

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

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

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

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

pension plan benefits to participants if covered defined benefit 

plans fail or go out of existence. 

The bill continues authority for a contingency fund for the PBGC 

that provides additional administrative resources when the number 

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

September 30, 2020, for every 20,000 additional participants in terminated plans. The Committee bill also continues authority allowing the PBGC additional obligation authority for unforeseen and 

extraordinary pre-termination expenses, after approval by OMB 

and notification of the Committees on Appropriations of the House 

of Representatives and the Senate. 
32 

WAGE AND HOUR DIVISION

SALARIES AND EXPENSES

Appropriations, 2018 ............................................................................. $227,500,000 

Budget estimate, 2019 ........................................................................... 230,068,000 

Committee recommendation ................................................................. 229,000,000 

The Committee recommends $229,000,000 for the Wage and 

Hour Division. 

WHD is responsible for administering and enforcing laws that 

provide minimum standards for wages and working conditions in 

the United States. The Fair Labor Standards Act, employment 

rights under the Family and Medical Leave Act, and the Migrant 

and Seasonal Agricultural Worker Protection Act are several of the 

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

The Committee directs WHD to submit a report to the Committee no later than 12 months after the date of this act detailing 

the outcomes of the Payroll Audit Independent Determination pilot 

program. The report shall include, at minimum, the number of employers that voluntarily participated in the program, the number of 

and reason employers were denied participation, and the amount 

of back wages paid back to employees. 

OFFICE OF LABOR–MANAGEMENT STANDARDS

SALARIES AND EXPENSES

Appropriations, 2018 ............................................................................. $40,187,000 

Budget estimate, 2019 ........................................................................... 46,634,000 

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

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

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

for union democracy and financial integrity. They also require public disclosure by unions, union officers, employers, and others. In 

addition, the Office administers employee protections under federally sponsored transportation programs. 

OFFICE OF FEDERAL CONTRACT COMPLIANCE PROGRAMS

SALARIES AND EXPENSES

Appropriations, 2018 ............................................................................. $103,476,000 

Budget estimate, 2019 ........................................................................... 91,100,000 

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

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

This Office protects workers and potential employees of Federal 

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

and the Vietnam Era Veterans’ Readjustment Assistance Act of 

1974. 
33 

OFFICE OF WORKERS’ COMPENSATION PROGRAMS

SALARIES AND EXPENSES

Appropriations, 2018 ............................................................................. $117,601,000 

Budget estimate, 2019 ........................................................................... 115,282,000 

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

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

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

Harbor Workers’ Compensation Act. 

OWCP administers four distinct compensation programs: the 

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

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

Special Benefits for Disabled Coal Miners and Black Lung Disability Trust Fund.—The Committee notes that the decline in appropriations for the Special Benefits for Disabled Coal Miners 

[SBDCM] is a result of the significantly increased use of unobligated balances to meet its obligations to beneficiaries. The Committee believes OWCP should take no action that could potentially 

disrupt the ability of the program to ensure all beneficiaries receive 

promised benefits. The Committee directs the Secretary to include 

in annual CJs the number of beneficiaries, total benefit payments 

and budgetary resources and expenditures within the SBDCM program dating back at least 5 years. The Committee also notes that 

the decline in appropriations for the Black Lung Disability Trust 

Fund [BLDTF] corresponds with an estimated decline in the Fund’s 

Payment toward Bond Interest, slightly offset by an increase in the 

Payment of Interest on Advances. The Committee directs the Secretary to include in its annual CJ a detailed explanation of changes 

in interest costs and the impact on the BLDTF. 

SPECIAL BENEFITS

Appropriations, 2018 ............................................................................. $220,000,000 

Budget estimate, 2019 ........................................................................... 230,000,000 

Committee recommendation ................................................................. 230,000,000 

The Committee recommends $230,000,000 for this account. This 

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

The Committee continues to provide authority to require disclosure of Social Security numbers by individuals filing claims under 

FECA or the Longshore and Harbor Workers’ Compensation Act 

and its extensions. 

The Committee continues language that provides authority to 

use FECA funds to reimburse a new employer for a portion of the 

salary of a newly reemployed injured Federal worker. FECA funds 

will be used to reimburse new employers during the first 3 years 

of employment, not to exceed 75 percent of salary in the worker’s 

first year, and declining thereafter. 

The Committee continues language that allows carryover of unobligated balances to be used in the following year and that provides authority to draw such sums as are needed after August 15 
34 

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

The Committee continues language to provide authority to deposit into the special benefits account of the employees’ compensation fund those funds that the Postal Service, the Tennessee Valley 

Authority, and other entities are required to pay to cover their fair 

share of the costs of administering the claims filed by their employees under FECA. 

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

stating that, along with the other compensation statutes already 

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

appropriation is deposited in the Employees’ Compensation Fund 

and assumes its attributes, namely availability without time limit 

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

SPECIAL BENEFITS FOR DISABLED COAL MINERS

Appropriations, 2018 ............................................................................. $54,319,000 

Budget estimate, 2019 ........................................................................... 10,319,000 

Committee recommendation ................................................................. 10,319,000 

The Committee recommends a mandatory appropriation of 

$10,319,000 in fiscal year 2019 for special benefits for disabled coal 

miners. This is in addition to the $15,000,000 appropriated last 

year as an advance for the first quarter of fiscal year 2019, for a 

total program level of $25,319,000 in fiscal year 2019. The decrease 

in this account below the fiscal year 2018 level reflects a declining 

beneficiary population. 

These mandatory funds are used to provide monthly benefits to 

coal miners disabled by black lung disease and their widows and 

certain other dependents, as well as to pay related administrative 

costs. 

The Committee also recommends an advance appropriation of 

$14,000,000 for the first quarter of fiscal year 2020. These funds 

will ensure uninterrupted benefit payments to coal miners, their 

widows, and dependents. 

DIVISION OF ENERGY EMPLOYEES OCCUPATIONAL ILLNESS

COMPENSATION

SALARIES AND EXPENSES

Appropriations, 2018 ............................................................................. $59,846,000 

Budget estimate, 2019 ........................................................................... 59,098,000 

Committee recommendation ................................................................. 59,098,000 

The Committee recommends $59,098,000 for the Division of Energy Employees Occupational Illness Compensation. This is a mandatory appropriation. 

The Division administers the Energy Employees Occupational Illness Compensation Program Act, which provides benefits to eligible 

employees and former employees of the Department of Energy 

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

such individuals. The mission also includes delivering benefits to 

certain beneficiaries of the Radiation Exposure Compensation Act. 

The Division is part of OWCP. 
35 

In fiscal year 2019, the volume of incoming claims under part B 

of EEOICPA is estimated at about 5,207 from DOE employees or 

survivors and private companies under contract with DOE, who 

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

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

nuclear weapons. 

Under part E, approximately 4,738 new claims will be received 

during fiscal year 2019. Under this authority, the Department provides benefits to eligible DOE contractor employees who were found 

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

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

The Committee is concerned that positions remain vacant on the 

Advisory Board on Toxic Substances and Worker Health. The Committee directs the Department to ensure the Board has sufficient 

funding and staffing to meet its obligations as defined by the 

EEOICPA. 

BLACK LUNG DISABILITY TRUST FUND

Appropriations, 2018 ............................................................................. $416,561,000 

Budget estimate, 2019 ........................................................................... 328,182,000 

Committee recommendation ................................................................. 328,182,000 

The Committee bill provides an estimated $328,182,000 as requested for this mandatory appropriations account. This estimate 

is comprised of $70,926,000 for administrative expenses and an estimated $257,256,000 for benefit payment and interest costs. 

The Committee bill continues to provide indefinite authority for 

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

fund for administrative expenses for the following Department 

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

Division of Coal Mine Workers’ Compensation Programs; up to 

$31,994,000 for Departmental Management, Salaries and Expenses; and up to $330,000 for Departmental Management, Inspector General. The bill also allows a transfer of up to $356,000 for 

the Department of the Treasury. 

The Trust Fund pays all black lung compensation/medical and 

survivor benefit expenses when no responsible mine operation can 

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

are incurred in administering the benefits program and operating 

the trust fund. 

OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION

SALARIES AND EXPENSES

Appropriations, 2018 ............................................................................. $552,787,000 

Budget estimate, 2019 ........................................................................... 549,033,000 

Committee recommendation ................................................................. 556,787,000 

The Committee recommends $556,787,000 for the Occupational 

Safety and Health Administration, which is responsible for enforcing the Occupational Safety and Health Act of 1970 in the Nation’s 

workplaces. 

The Committee continues bill language to allow OSHA to retain 

course tuition and fees for training institute courses used for occu-
36 

pational safety and health training and education activities in the 

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

as current law. 

The Committee continues bill language to exempt farms employing 10 or fewer people from the provisions of the act with the exception of those farms having a temporary labor camp. The Committee also continues language exempting small firms in industry 

classifications having a lost workday injury rate less than the national average from general schedule safety inspections. 

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

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

The continued exemption for small farms and recognition of limits 

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

is also important the Department of Agriculture be consulted in 

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

the small farm exemption. 

The Committee recommends $102,850,000 for grants to States 

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

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

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

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

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

the costs of State plans approved by the agency. 

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

OSHA Susan Harwood Training Grant Program, including not less 

than $4,500,000 to continue the set aside for capacity building development grants required by this act. The Committee also directs 

OSHA to dedicate no less than $3,500,000 per year for the purpose 

of administering the Voluntary Protection Program [VPP] in its 

Federal Compliance Assistance budget. OSHA shall not reduce 

funding levels or the number of employees administering the VPP, 

the Safety and Health Achievement Recognition Program, or Federal Compliance Assistance, and shall not collect any monies from 

participants for the purpose of administering these programs. 

The Committee recognizes the importance of disclosing workplace 

injury, illness, and fatality data to the public. Accordingly, the 

Committee instructs OSHA to resume timely and public reporting 

on its website of fatalities that occur at workplaces, regardless if 

a citation is issued. Making this information and data publicly 

available furthers OSHA’s mission by ensuring businesses, workers, and the public know about and have access to timely and complete information on workplace safety, including enforcement actions, injuries, illnesses, and deaths. 

MINE SAFETY AND HEALTH ADMINISTRATION

SALARIES AND EXPENSES

Appropriations, 2018 ............................................................................. $373,816,000 

Budget estimate, 2019 ........................................................................... 375,906,000 

Committee recommendation ................................................................. 373,816,000 
37 

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

Mine Safety and Health Administration. 

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

promulgating mandatory safety and health standards, cooperating 

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

The Committee continues language authorizing MSHA to use up to $2,000,000 for mine rescue and recovery activities. It also retains 

the provision allowing the Secretary to use any funds available to 

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

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

an actual emergency, the Committee also directs MSHA to continue 

to devote sufficient resources toward a competitive grant activity 

for effective emergency response and recovery training in various 

types of mine conditions. 

In addition, bill language is included to allow the National Mine Health and Safety Academy to collect not more than $750,000 for 

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

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

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

these activities. 

The Committee supports the significant advances MSHA has 

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

MSHA to continue to devote sufficient resources towards mine rescue technology by fully equipping and maintaining the existing 

MSHA mine rescue stations. In addition, the Committee directs 

MSHA to continue to provide all necessary technical assistance regarding mine rescue communications to State and private mine 

rescue teams and to ensure that all relevant MSHA grant programs prioritize mine rescue communications technology. 

BUREAU OF LABOR STATISTICS

SALARIES AND EXPENSES

Appropriations, 2018 ............................................................................. $612,000,000 

Budget estimate, 2019 ........................................................................... 609,386,000 

Committee recommendation ................................................................. 615,000,000 

The Committee recommends $615,000,000 for the Bureau of 

Labor Statistics, an increase of $3,000,000, to support the improvement of the quality and accuracy of labor force statistics. This 

amount includes $65,000,000 from the Employment Security Administration account of the Unemployment Trust Fund and 

$550,000,000 in Federal funds. 

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

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

BLS. The Committee is concerned by inaccurate, preliminary data 

released in December 2017 that showed the largest over-the-year 

percentage decrease in employment occurred in Cape Girardeau, 
38 

Missouri. Inaccurate economic data can have damaging effects on 

local employers and communities, such as Cape Girardeau. The Department and BLS are directed to review the practice of releasing 

preliminary economic data; take steps to improve the reliability, accuracy, and timeliness of economic statistical data; and provide an 

update on the actions taken in the fiscal year 2020 CJ. 

The Committee is pleased BLS is reporting on the contingent 

workforce during the current fiscal year. The Committee directs 

BLS to continue capturing data on contingent work and alternative 

work arrangements by conducting the Contingent Worker Supplement to the Current Population Survey on a biennial basis. 

The Committee is concerned that there continues to be insufficient data on the impact technology is having on the American 

workforce. The Committee encourages BLS to develop a strategy to 

better understand how automation, digitization, and artificial intelligence are changing the employment landscape. BLS is directed to 

submit a report to the Committees on Appropriations of the House 

of Representatives and the Senate no later than 90 days after enactment of this act detailing the steps taken to develop the data 

strategy as directed. 

The Committee believes that the Current Population Survey 

lacks critical occupational data on career and technical occupations 

that would be beneficial to Congress as it develops policies related 

to workforce and higher education. The Committee requests BLS 

prepare a report on improvements to the Current Population Survey that would allow greater reporting on career and technical occupations. This report should be submitted to the Committees on 

Appropriations of the House of Representatives and Senate and the 

Committees on Education and the Workforce and Health, Education, Labor and Pensions of the House of Representatives and 

Senate not later than 90 days of enactment of this act. 

OFFICE OF DISABILITY EMPLOYMENT POLICY

Appropriations, 2018 ............................................................................. $38,203,000 

Budget estimate, 2019 ........................................................................... 27,000,000 

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

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

2018, for the Office of Disability Employment Policy to provide 

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

to design and implement research and technical assistance grants 

and contracts to develop policy that reduces barriers to competitive, 

integrated employment for youth and adults with disabilities. 

DEPARTMENTAL MANAGEMENT

SALARIES AND EXPENSES

Appropriations, 2018 ............................................................................. $337,844,000 

Budget estimate, 2019 ........................................................................... 261,035,000 

Committee recommendation ................................................................. 337,844,000 

The Committee recommendation includes $337,844,000 for the 

Departmental Management account. Of this amount, $337,536,000 

is available from general funds and $308,000 is available by trans-
39 

fer from the Employment Security account of the Unemployment 

Trust Fund. In addition, $31,994,000 is available by transfer from 

the Black Lung Disability Trust Fund. 

The Departmental Management appropriation pays the salaries 

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

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

involved in departmental management functions, but for which 

other appropriations for salaries and expenses are not suitable. The Committee recommendation includes $86,125,000 for the Bureau of International Labor Affairs [ILAB], of which $59,825,000 is 

available for obligation through December 31, 2019. ILAB’s appropriation is available to help improve working conditions and labor 

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

statutory mandates and international responsibilities including in 

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

continue to oversee 66 active grant projects totaling over 

$332,000,000 in 54 countries around the world in fiscal year 2019 

in addition to new grants in fiscal year 2018 which have not yet 

been awarded. 

The Committee directs the Department to report to the Committees on Appropriations of the House of Representatives and the 

Senate no later than 180 days following the enactment of this act, 

on the obligation of all funds expended by the Department to combat human trafficking, child labor, workers’ rights, and forced labor 

for fiscal year 2018 and fiscal year 2019. The report shall include 

a breakdown of funds by project, country, and purpose. The Committee recommendation provides $8,040,000 for program 

evaluation and allows these funds to be available for obligation 

through September 30, 2020. The Committee bill also continues the 

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

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

evaluation officer. The Committee expects to be notified of the 

planned uses of funds derived from this authority. 

The Committee also notes that, in addition to this appropriation, 

the Department has reserved under its evaluation set-aside authority an average of $17,000,000 for each of the past 5 years for implementing the Department’s annual evaluation plan and making important contributions to building and using evidence. While each of 

the Department’s agencies develops a learning agenda and many 

benefit from evaluation set-aside resources, the set-aside has largely been funded in these years from ETA programs. The Committee 

requests that the Department evaluation plan required by this act 

include a discussion of options for developing greater agency contributions to the set-aside, such as a mechanism that would require 

agencies to contribute to the set-aside unless such action would 

cause it to be unable to meet its statutory obligations. 

The recommendation includes $23,534,000 for the Office of the 

Assistant Secretary for Administration and Management. The 

Committee directs the Department to provide quarterly reports 

identifying the number of full time equivalent employees and attri-
40 

tion by principal office, and appropriation account not later than 30 

days after the end of each quarter. The recommendation includes $35,000,000 for the Adjudication 

activity. The Committee recommendation provides $13,530,000 for the 

Women’s Bureau. The Committee continues bill language allowing 

the Bureau to award grants. The Committee disapproves of the Department’s reprogramming of funds from the Women’s Bureau in 

fiscal year 2017 and fiscal year 2018. The Committees on Appropriations of the House of Representatives and the Senate provided 

funding increases for the purpose of supporting the programs and 

activities administered by the Women’s Bureau and is disappointed 

that the Department has taken a sizable portion of those funds to 

support unrelated activities within the Department. The Committee expects $13,530,000 to be used by the Women’s Bureau for 

important issues facing women in the labor force. 

VETERANS EMPLOYMENT AND TRAINING

Appropriations, 2018 ............................................................................. $295,041,000 

Budget estimate, 2019 ........................................................................... 281,595,000 

Committee recommendation ................................................................. 300,041,000 

The Committee recommendation of $300,041,000 for the Veterans Employment and Training Service [VETS] includes 

$50,000,000 in general revenue funding and $250,041,000 to be expended from the Employment Security Administration account of 

the Unemployment Trust Fund. 

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

including protecting their employment rights. VETS carries out its 

mission through a combination of grants to States, competitive 

grants, and Federal enforcement and oversight. The Committee provides $180,000,000 for the Jobs for Veterans 

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

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

members early in their separation from military service; wounded 

warriors recuperating in military treatment facilities or transition 

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

has income to provide sufficient support. The Committee maintains 

language providing authority for JVSG funding to be used for data 

systems and contract support to allow for the tracking of participant and performance information. 

The Committee provides $24,500,000 for the Transition Assistance Program [TAP], an increase of $5,000,000 over fiscal year 

2018, to support employment workshops at military installations 

and in virtual classrooms worldwide for exiting servicemembers 

and spouses. 

The Committee recommendation includes $42,127,000 for Federal 

administration costs. This funding level will support oversight and 

administration of the VETS grant programs, TAP employment 

workshops, and compliance and enforcement activities. 

The Committee recommends $50,000,000 for the Homeless Veterans’ Reintegration Program [HVRP], level with fiscal year 2018, 
41 

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

services to over 18,000 homeless veterans nationwide, including 

homeless women veterans. The bill allows Incarcerated Veterans’ 

Transition funds to be awarded through September 30, 2019, and 

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

The Committee recognizes the role of HVRP in decreasing veterans’ homelessness by helping homeless veterans or veterans who 

are at risk of homelessness through job training, counseling, and 

placement services. The Committee directs the Secretary to conduct 

a pilot to demonstrate the use of regional, multi-community awards 

to national organizations to test service delivery efficiencies, improve outcomes, and target underserved subpopulations. 

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

funding to facilitate the Department’s implementation of the Honoring Investments in Recruiting and Employing American Military 

Veterans Act of 2018 [HIRE Vets Act]. 

INFORMATION TECHNOLOGY MODERNIZATION

Appropriations, 2018 ............................................................................. $20,769,000 

Budget estimate, 2019 ........................................................................... ........................... 

Committee recommendation ................................................................. 20,769,000 

The Committee recommends $20,769,000 for the Information 

Technology [IT] Modernization account. Funds available in this account have been used for two primary activities. The first is departmental support systems, for which $4,889,000 is provided. The second activity, IT Infrastructure Modernization, supports necessary 

activities associated with the Federal Data Center Consolidation 

Initiative. 

The Committee includes new bill language making the appropriation for IT Modernization available until expended. The Committee requests the Department submit a report to the Committees 

on Appropriations of the House of Representatives and the Senate 

not later than 90 days after enactment of this act that includes a 

description of each project to be funded, planned activities and associated timeline, expected benefits, and planned expenditures. Future reports should provide an update on each project, including 

completed activities, remaining activities and associated timeline, 

actual and remaining expenditures, explanation of any cost overruns and delays, and corrective actions, as necessary, to keep the 

project on track and within budget. While the bill does not include 

requested authorities modifying the Working Capital Fund, the 

Committee looks forward to the progress the Department will make 

with greater certainty provided with this extended availability and 

its expressed support for maintaining the current level of investments in the Department’s IT Modernization efforts. New language 

proposed in the budget that would have allowed IT modernization 

funding to be generated through changes to the Working Capital 

Fund at the Department is not included in the bill. 
42 

OFFICE OF THE INSPECTOR GENERAL

Appropriations, 2018 ............................................................................. $89,147,000 

Budget estimate, 2019 ........................................................................... 87,721,000 

Committee recommendation ................................................................. 89,147,000 

The Committee recommends $89,147,000 for the DOL OIG. The 

bill includes $83,487,000 in general funds and authority to transfer 

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

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

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

Trust Fund. 

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

The Department has reported improper payments, including 

fraud, in the UI and Employee Compensation programs totaling approximately $4,100,000,000 and $57,200,000 respectively for fiscal 

year 2017. The Committee strongly supports and commends the efforts of the OIG to identify and prosecute those who defraud the 

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

GENERAL PROVISIONS

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

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

Section 102. The bill continues a provision providing for general 

transfer authority. 

Section 103. The bill continues a provision prohibiting funding 

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

by the Department in accordance with Executive Order 13126. 

Section 104. The bill continues a provision requiring that funds 

available under section 414(c) of the American Competitiveness 

and Workforce Innovation and Opportunity Act may only be used 

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

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

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

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

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

Section 106. The bill continues a provision providing the ETA 

with authority to transfer funds provided for technical assistance 

services to grantees to ‘‘Program Administration’’ when it is determined that those services will be more efficiently performed by 

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

the WIOA. In addition, authority is provided for program integrityrelated activities as requested by the administration. 

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

percent of discretionary appropriations provided in this act for all 

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

conditions in this act applicable to such office. 
43 

Section 108. The bill continues a provision related to section 147 

of WIOA authorizing the competitive procurement of certain Job 

Corps Centers. 

Section 109. The bill continues a longstanding provision regarding the application of the Fair Labor Standards Act after the occurrence of a major disaster. 

Section 110. The bill continues a provision rescinding advance 

appropriations in the Dislocated Workers’ National Reserve account. 

Section 111. The bill continues a provision that provides flexibility with respect to the crossing of H–2B nonimmigrants. 

Section 112. The bill continues a provision related to the wage 

methodology under the H–2B program. 

Section 113. The bill continues a provision regarding the threefourths guarantee and definitions of corresponding employment 

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

Section 114. The bill continues a provision providing authority 

related to the disposition of excess property related to the training 

of apprentices. 

Section 115. The bill continues a provision related to funds available to State Unemployment Insurance information technology consortia. 

Section 116. The bill continues a provision related to the Secretary’s security detail. 

Section 117. The bill continues a provision related to Job Corps 

property. 
(44) 

TITLE II 

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

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

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

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

HEALTH RESOURCES AND SERVICES ADMINISTRATION

HRSA activities support programs to provide healthcare services 

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

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

care, healthcare provider training, and healthcare delivery systems 

and facilities. 

BUREAU OF PRIMARY HEALTH CARE

Appropriations, 2018 ............................................................................. $1,626,522,000 

Budget estimate, 2019 ........................................................................... 5,091,522,000 

Committee recommendation ................................................................. 1,626,522,000 

The Committee recommendation for the activities of the Bureau 

of Primary Health Care is $1,626,522,000. 

Community Health Centers 

The Committee provides $1,625,522,000 in this bill for Community Health Centers, equal to the amount provided last year. 

Programs supported by this funding include community health 

centers, migrant health centers, healthcare for the homeless, 

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

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

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

frontier areas. The Committee includes $200,000,000 to support, 

enhance, and expand behavioral health, mental health, or substance use disorder services. 

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

available until expended. These funds are used to pay judgments 

and settlements, occasional witness fees and expenses, and related 

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

services included within the health centers’ federally approved 

scope of project. 

Home Visiting.—Enhanced integration between healthcare providers and community programs helps transform the lives of vulnerable infants and first-time mothers. Research has shown that 

partnering first-time mothers with registered nurses or other pro-
45 

fessionals that provide ongoing home visits dramatically improves 

the health and well-being of these families. The Committee encourages HRSA to expand partnerships between health centers and evidence-based home visiting programs in high need areas to improve 

pregnancy, child health and development, and other health outcomes, all while reducing costs. 

Technical Assistance.—The Committee believes that enhanced 

funding for the technical assistance and networking functions 

available for health centers through national and State cooperative 

agreements and grants is critical to the successful operation and 

expansion of the health centers program. Funds are available within the amount provided to enhance technical assistance and training activities, further quality improvement initiatives, and continue 

the development of and support for health center-controlled networks so that new and existing centers can improve patient access 

to quality health services. 

Native Hawaiian Health Care.—The Committee provides no less 

than $17,500,000 for the Native Hawaiian Health Care Program. 

Perinatal Transmission of Hepatitis B.—The Committee is aware 

that the 2017 National Academies of Sciences Engineering and 

Medicine [NASEM] report titled, ‘‘A National Strategy for the 

Elimination of Hepatitis B and C’’ reported that only half of the 

hepatitis B infected women who give birth each year are identified 

for case management, a proportion unchanged since 2000. The 

NASEM report also noted that, without intervention, about 90 percent of the infants born to hepatitis B virus infected women contract the virus at birth and are therefore at greater risk of premature death from liver cancer or cirrhosis later in life. The Committee is pleased that HRSA has implemented a strategy to increase the capacity of HRSA-funded clinics to address perinatal 

hepatitis B transmission, including the use of telehealth to link experts with clinic providers around the U.S. The Committee requests a report within 90 days of enactment of HRSA’s findings 

and recommendations on the effectiveness of this intervention. 

Free Clinics Medical Malpractice Coverage 

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

the FTCA to be made available for free clinic health professionals 

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

This appropriation extends FTCA coverage to medical volunteers 

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

individuals in medically underserved areas. 

BUREAU OF HEALTH PROFESSIONS

Appropriations, 2018 ............................................................................. $1,060,695,000 

Budget estimate, 2019 ........................................................................... 457,798,000 

Committee recommendation ................................................................. 1,072,695,000 

The Committee recommendation for the activities of the Bureau 

of Health Professions is $1,072,695,000. 

The Bureau of Health Professions provides policy leadership and 

grant support for health professions workforce development. The 

mission of the Bureau is to identify shortage areas while working 

to make them obsolete. Its programs are intended to ensure that 
46 

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

where they are needed. 

To accurately prepare for physician workforce demands, HHS 

needs high quality projections by specialty, factoring in population 

changes (i.e., aging population), geographic location (i.e., rural 

versus urban), utilization trends, and delivery system changes. For 

these reasons, Congress urges HRSA, to study access by underserved populations to general surgeons and provide a report to the 

Committee 18 months after enactment detailing potential surgical 

shortages, especially as it relates to geographic location (i.e., rural, 

urban, and suburban). For the report to the Committee, HHS 

should consult with relevant stakeholders, including medical societies, organizations representing surgical facilities, organizations 

with expertise in general surgery, and organizations representing 

patients. 

National Health Service Corps 

The Committee provides $105,000,000 for the National Health 

Service Corps [Corps] to continue improving access to quality 

opioid and substance use disorder treatment in rural and underserved areas nationwide. The Committee continues language that 

expands eligibility for loan repayment awards through the Corps to 

include substance use disorder counselors. Of the amount provided, 

the Committee directs that $30,000,000 shall be available for the 

Rural Communities Opioid Response initiative within the Office of 

Rural Health. 

The Committee continues to include section 206 of this act to 

modify the rules governing the Corps to allow every Corps member 

60 days to cancel their contract. 

Training for Diversity 

Centers of Excellence 

The Committee recommends $23,711,000 for the Centers of Excellence Program. 

The Committee supports collaborative efforts to address American Indian and Alaskan Native health, including programs to increase the number of Native Americans and Alaska Natives in the 

U.S. health professions workforce. 

Health Careers Opportunity Program 

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

career an opportunity to develop the skills needed to successfully 

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

or allied health professions. 

Faculty Loan Repayment 

The Committee provides $1,190,000 for the Faculty Loan Repayment Program. This amount is the same as the fiscal year 2018 enacted level. 
47 

Scholarships for Disadvantaged Students 

The Committee provides $48,970,000 for Scholarships for Disadvantaged Students, equal to the fiscal year 2018 level. The Committee supports diversity among health professionals. This program 

provides grants to eligible health professions and nursing schools 

to award scholarships to students from disadvantaged backgrounds 

who have financial need. 

Primary Care Training and Enhancement 

The Committee provides $48,924,000 for Primary Care Training 

and Enhancement programs, which support the expansion of training in internal medicine, family medicine, pediatrics, and physician 

assistance. Funds may be used for developing training programs or 

providing direct financial assistance to students and residents. 

Clinical Training Sites.—The Committee directs HRSA to ensure 

that not less than 15 percent of funds provided for this program 

are used to support training of physician assistants [PAs]. The 

Committee is aware of a clinical training site shortage for primary 

care professionals, including PAs and other health professionals. 

The Committee is aware of a clinical training site shortage for primary care, as well as mental and behavioral health, caused by the 

increasing demand for PAs that has created shortages of preceptors 

and clinical training sites among PAs and other health professionals. The Committee recognizes that this is particularly acute in 

the face of an opioid crisis that requires greater focus on Medication Assisted Treatment training and pain management skills that 

often become the responsibility of primary care clinicians. The 

Committee recommends that the Secretary leverage currently convened Advisory Committee(s), as applicable, to study clinical training site availability in primary care and mental and behavioral 

health for PAs. The Committee encourages the Advisory Committee(s) to develop recommendations to enhance clinical education 

through inter-professional team-based education, address the shortage in preceptors willing to provide clinical site training, and explore reimbursement incentives to increase the number of available 

clinical training sites. The Committee also urges the integration of 

evidence-based trainings for health professionals to screen, access, 

intervene, and refer patients to specialized treatment for the severe 

mental illness of eating disorders as authorized under section 

13006 of the 21st Century Cures Act (Public Law 114–255). 

Training in Oral Health Care 

The Committee provides $40,673,000 for Training in Oral Health Care programs, which includes not less than $10,000,000 each for 

general and pediatric dentistry. Funds may be used to expand 

training in general dentistry, pediatric dentistry, public health dentistry, dental hygiene, and other oral health access programs. 

Funds may also be used to plan and operate training programs, as 

well as to provide financial assistance to students and residents. 

The agency is directed to provide continuation funding for 

predoctoral and postdoctoral training grants initially awarded in 

fiscal year 2015, and for Section 748 Dental Faculty Loan Program 

grants initially awarded in fiscal year 2016, with preference for pediatric dentistry faculty supervising dental students or residents 
48 

and providing clinical services in dental clinics located in dental 

schools, hospitals, and community-based affiliated sites. 

Funds may be used to expand training in general dentistry, pediatric dentistry, public health dentistry, and dental hygiene. Funds 

may also be used to plan and operate training programs, as well 

as to provide financial assistance to students and residents. 

The Committee continues long-standing bill language that prohibits funding for section 340G–1 of the PHS Act. 

Interdisciplinary, Community-Based Linkages 

Area Health Education Centers 

The Committee provides $40,250,000, an increase of $2,000,000 

for Area Health Education Centers. 

The program links university health science centers with community health service delivery systems to provide training sites for 

students, faculty, and practitioners. The program supports three 

types of projects: core grants to plan and implement programs; special initiative funding for schools that have previously received 

AHEC grants; and model programs to extend AHEC programs with 

50 percent Federal funding. The AHEC community-training model 

provides a uniquely appropriate opportunity to bring the training 

of community health workers to scale. HRSA is encouraged to provide technical assistance on and disseminate best practices for 

training community health workers to existing AHECs. The Committee is pleased with AHEC’s efforts to improve access to quality 

healthcare in America’s rural and underserved areas by increasing 

the number of primary healthcare professionals who practice in 

those areas. 

Geriatric Programs 

The Committee provides $40,737,000 for Geriatric Programs. 

Behavioral Health Workforce Education and Training Program 

The Committee provides $75,000,000 for Behavioral Health 

Workforce Education and Training [BHWET] Program. The 

BHWET Program is focused on developing and expanding the mental health and substance abuse workforce serving populations 

across the lifespan. HRSA will continue to leverage SAMHSA’s subject matter expertise in formatting new investments in fiscal year 

2019. 

In light of the recent expanded eligibility for the BHWET program and the need for the full continuum of professions to be involved, the Committee continues to direct HRSA to take steps in 

the solicitation process and the timing of it to ensure that the grant 

competition results in program funding being distributed relatively 

equally among the participating health professions. 

The Committee is increasingly concerned that the Nation remains unprepared for the looming provider shortage and recognizes 

that training these postgraduate Nurse Practioners [NPs] in federally qualified health centers [FQHCs] across the country will address this problem in a positive way. Patients need expert providers prepared to manage the social and clinical complexities that 
49 

exist in FQHCs. Academic literature supports the need for postgraduate training of new NPs. The Committee is confident that 

this program will provide newly graduated NPs with the depth, 

breadth, volume, and intensity of clinical training capable of preparing them for accomplishment and fulfilling careers. 

Mental and Behavioral Health Education Training Programs 

The Committee provides $36,916,000 for Mental and Behavioral 

Health Education Training Programs. The programs provide grants 

to higher education institutions and accredited training programs 

to recruit and train professionals and faculty in the fields of social 

work, psychology, psychiatry, marriage and family therapy, substance abuse prevention and treatment, and other areas of mental 

and behavioral health. 

The Committee continues to support funding to expand the mental health and substance abuse workforce, including, but not limited to, master’s level social workers, psychologists, counselors, 

marriage and family therapists, psychiatric mental health nurse 

practitioners, occupational therapists, psychology doctoral interns, 

and behavioral health paraprofessionals. 

Graduate Psychology Education [GPE].—The Committee supports interprofessional GPE and increasing the number of health 

service psychologists trained to provide integrated services to highneed, underserved populations in rural and urban communities. In 

addressing the opioid epidemic, the Committee recognizes the 

growing need for highly trained mental and behavioral health professionals to deliver evidence-based behavioral interventions for 

pain management. The Committee urges HRSA to explore evidence-based approaches to leverage workforce capacity through this 

program (including through geropsychology training programs). 

The Committee encourages HRSA to help integrate health services 

psychology trainees at FQHCs. The Committee also urges HRSA to 

utilize cost-effective methods, such as Project ECHO, to help train 

and support health service psychologists across the country. 

Health Professions Workforce Information and Analysis 

The Committee provides $5,663,000 for health professions workforce information and analysis. The program provides for the collection and analysis of targeted information on the Nation’s 

healthcare workforce, research on high-priority workforce questions, the development of analytic and research infrastructure, and 

program evaluation and assessment. 

Public Health Workforce Development 

The Committee provides $17,000,000 for Public Health Workforce 

Development. This program line, also called Public Health and Preventive Medicine, funds programs that are authorized in titles III 

and VII of the PHS Act and support awards to schools of medicine, 

osteopathic medicine, public health, and integrative medicine programs. 

Nursing Workforce Development Programs 

The Committee provides $249,472,000 for Nursing Workforce Development programs. These programs provide funding to address 
50 

all aspects of nursing workforce demand, including education, practice, recruitment, and retention. 

The Nurse Education, Practice, Quality and Retention Program’s 

Veteran’s Bachelor of Science Degree in Nursing [BSN] is important to helping our nation’s veterans progress and graduate with 

a BSN degree. The Committee supports these efforts aimed at helping veterans transition to civilian life, removing barriers, and 

building our nursing workforce. HRSA should continue to support 

these veterans moving to nursing careers and train nurses to support the unique needs of veterans, returning servicemembers, and 

their families, including trauma-informed care and substance use 

disorder prevention and treatment. The Committee encourages 

HRSA to consider the successful past practice of entities that have 

received funding from the Veterans to BSN program in making 

new awards. 

Advanced Education Nursing 

The Committee recommends $74,581,000 for the Advanced Education Nursing programs, which increases the number of qualified 

nurses in the workforce by improving nursing education through 

curriculum and faculty development. 

The Committee provides $8,000,000 to award grants for the clinical training of sexual assault nurse examiners to administer medical forensic examinations and treatments to victims of sexual assault in hospitals, health centers, and other emergency healthcare 

service provider settings referenced in Senate Report 115–150. 

Children’s Hospitals Graduate Medical Education 

The Committee provides $325,000,000, an increase of 

$10,000,000, for the Children’s Hospitals Graduate Medical Education [CHGME] program. The Committee strongly supports the 

CHGME program, which provides support for graduate medical 

education training programs in both ambulatory and in-patient settings within freestanding children’s teaching hospitals. CHGME 

payments are determined by a per-resident formula that includes 

an amount for direct training costs added to a payment for indirect 

costs. Payments support training of resident physicians as defined 

by Medicare in both ambulatory and inpatient settings. 

National Practitioner Data Bank 

The Committee provides $18,814,000 for the National Practitioner Data Bank. As mandated by the Health Care Quality Improvement Act, the National Practitioner Data Bank does not receive appropriated funds, but instead is financed by the collection 

of user fees. 

The National Practitioner Data Bank collects certain adverse information, medical malpractice payment history, and information 

related to healthcare fraud and abuse. The data bank is open to 

healthcare agencies and organizations that make licensing and employment decisions. 
51 

MATERNAL AND CHILD HEALTH

Appropriations, 2018 ............................................................................. $886,789,000 

Budget estimate, 2019 ........................................................................... 1,136,200,000 

Committee recommendation ................................................................. 924,789,000 

The Committee recommendation for the Maternal and Child 

Health [MCH] Bureau is $924,789,000. The mission of the Bureau 

is to improve the physical and mental health, safety, and wellbeing of the Nation’s women, infants, children, adolescents, and 

their families. This population includes fathers and children with 

special healthcare needs. 

Maternal and Child Health Block Grant 

The Committee provides $677,700,000 for the MCH Block Grant, 

which provides a flexible source of funding that allows States to 

target their most urgent maternal and child health needs. The program supports a broad range of activities including: providing prenatal care, well child services, and immunizations; reducing infant 

mortality; preventing injury and violence; expanding access to oral 

healthcare; addressing racial and ethnic disparities; and providing 

comprehensive care through clinics, home visits, and school-based 

health programs. 

Children’s Health and Development.—Evidence shows that experiences in early childhood have long-term health consequences over 

the course of a person’s life. These experiences are critical for a 

child’s educational, social, physical, and economic well-being. Children living in States with persistently high child poverty rates experience more negative health outcomes than their peers elsewhere. Therefore, the Committee provides $3,500,000 within the 

Special Projects of Regional and National Significance program for 

the HRSA-funded initiative focused on improving child health 

through a statewide system of early childhood developmental 

screenings and interventions. This funding shall be used to continue the currently funded project for another year. 

Hemophilia.—The Committee has included funding for the Regional Hemophilia Network Program, which provides grant funding 

to the national network of Hemophilia Treatment Centers [HTCs]. 

This comprehensive care program supports HTCs in providing 

multi-disciplinary care services, such as physical therapy assessments, social work, and case management, which are vital to manage rare bleeding disorders. 

Maternal, Infant, and Early Childhood Home Visiting Program.—The Committee encourages HRSA and ACF to continue 

their collaboration and partnerships to improve health and development outcomes for at-risk pregnant women, parents, and young 

children through evidence-based home visiting programs. 

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 provides $23,000,000 within Special Projects of Regional and National Significance [SPRANS] for State Maternal 

Health Innovation Grants to establish demonstrations to implement evidence-based interventions to address critical gaps in ma-
52 

ternity 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, and HRSA is encouraged to work with States to collect comprehensive data associated with all pregnancy-associated and pregnancy-related deaths, regardless of the outcome of the pregnancy. 

In addition, the Committee includes $3,000,000 within SPRANS to 

expand implementation of the Alliance for Innovation in Maternal 

Health Initiative’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, straightforward, and 

evidence-based practices, that, when reliably implemented, improve 

patient outcomes and reduce maternal mortality and severe maternal morbidity. 

Sickle Cell Anemia 

The Committee provides $4,455,000 for grants and contracts to 

help coordinate service delivery for individuals with sickle cell disease, including genetic counseling and testing; training of health 

professionals; and coordination of education, treatment, and continuity of care programs. 

Autism and Other Developmental Disorders 

The Committee provides $49,099,000 for the Autism and Other 

Developmental Disorders program. The program supports surveillance, early detection, education, and intervention activities on autism and other developmental disorders, as authorized in the Combating Autism Act of 2006. 

Children and families living in rural, underserved areas have 

limited access to healthcare professionals trained in effective early 

interventions for Autism Spectrum Disorder [ASD]. Most of these 

children’s services are provided through the federally mandated 

Part C early intervention system and do not incorporate effective, 

autism-specific interventions. Often, Part C is the only portal to 

services for toddlers and their families, particularly those living in 

rural and underserved communities. Training Part C Early Interventionists and other healthcare professionals in rural health clinics (at all levels of training) on a parent-mediated intervention, 

Project ImPACT, can serve to fill this gap in access and provide 

care for ASD children. Following training, researchers will measure 

the early interventionists’ and healthcare providers’ adherence to 

Project ImPACT strategies with a client on their caseload. Successful fidelity will indicate a step toward reducing the disparity that 

exists for children with ASD living in underserved communities. 

The Committee encourages HRSA to enhance current efforts to determine whether a parent-centered approach to providing care for 

ASD children can be an effective intervention in a rural care setting. 

Newborn Screening for Heritable Disorders 

The Committee provides $15,883,000 for the Newborn Heritable 

Disorders Screening program, as described in section 1109 of the 

Newborn Screening Saves Lives Act of 2008. This program provides 

funding to improve States’ ability to provide newborn and child 
53 

screening for heritable disorders. Newborn screening provides early 

identification and follow-up for treatment of infants affected by certain genetic, metabolic, hormonal, and/or functional conditions. 

The Committee continues to support the goals of this important 

program, which helps to improve State capacity to provide newborn 

screening for heritable disorders that could result in disability or 

death if left undetected. In recognizing that newborn screening provides timely and early identification and follow-up for treatment of 

infants affected by certain genetic, metabolic, hormonal, or functional conditions, the Committee applauds the efforts of the Advisory Committee on Heritable Disorders in Newborns and Children 

in advising the Secretary on the most appropriate use of all aspects 

of newborn screening to help reduce morbidity and mortality in 

newborns. The Committee also encourages States in their ongoing 

efforts to add conditions as recommended by the Recommended 

Uniform Screening Panel. 

Healthy Start 

The Committee provides $122,500,000 for the Healthy Start infant mortality initiative. The primary purpose of Healthy Start is 

to reduce infant mortality and generally improve maternal and infant health in at-risk communities. Grants are awarded to State 

and local health departments and nonprofit organizations to conduct an infant mortality review, develop a package of innovative 

health and social services for pregnant women and infants, and 

evaluate these efforts. 

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 $12,000,000 for the 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. 

Universal Newborn Hearing Screening and Early Intervention 

The Committee provides $17,818,000 for universal newborn hearing screening and early intervention activities. This program 

awards grants to 53 States and territories that support statewide 

systems of newborn hearing screening, audiologic diagnostic testing 

before 3 months of age, and enrollment in early intervention programs before the age of 6 months. 

Emergency Medical Services for Children 

The Committee provides $22,334,000 for the Emergency Medical 

Services for Children [EMSC] program which focuses on improving 

the pediatric components of the emergency medical services system 

and improving the quality of care provided to children in the prehospital setting. Funding is available to every State emergency 
54 

medical services office to improve the quality of emergency care for 

children and to pay for research and dissemination of best practices. 

The Committee recognizes the vital and unique nature of this 

program that focuses specifically on improving the pediatric components of the emergency medical services system and improving the 

quality of emergency care provided to children. The Committee 

supports continuation of all components of the EMSC program in 

its mission to provide every child with access to the best possible 

emergency care regardless of where they live or travel within the 

United States. 

Screening and Treatment for Maternal Depression 

The Committee provides $5,000,000 for Screening and Treatment 

for Maternal Depression. HRSA is directed to make grants to 

States to establish, improve, or maintain programs to train professionals to screen, assess, and treat for maternal depression in 

women who are pregnant or who have given birth within the preceding 12 months. 

Pediatric Mental Health Care Access 

The Committee provides $10,000,000 to expand access to behavioral health services in pediatric primary care by supporting the 

development of pediatric mental healthcare telehealth access programs. 

HIV/AIDS BUREAU

Appropriations, 2018 ............................................................................. $2,318,781,000 

Budget estimate, 2019 ........................................................................... 2,260,170,000 

Committee recommendation ................................................................. 2,318,781,000 

The Committee recommendation includes $2,318,781,000 for the 

HIV/AIDS Bureau. 

The mission of the Bureau is to address the unmet care and 

treatment needs of persons living with HIV/AIDS. The Bureau administers the Ryan White Care Act, which provides a wide range 

of community-based services, including primary and home 

healthcare, case management, substance abuse treatment, mental 

health, and nutritional services. 

Screening for Sexually Transmitted Diseases [STDs].—The Committee continues to support HRSA’s efforts to include screening and 

treatment for STDs as a part of the comprehensive clinical care 

provided to HIV infected individuals. The Committee requests that 

HIV/AIDS and Primary Health Care Bureaus submit to the House 

and Senate Appropriations Committees a report outlining the level 

of STD screening and testing for the current and previous 2 fiscal 

years. 

Emergency Assistance 

The Committee provides $655,876,000 for emergency assistance 

grants to eligible metropolitan areas disproportionately affected by 

the HIV/AIDS epidemic. 

Grants are provided to metropolitan areas meeting certain criteria. Two-thirds of the funds are awarded by formula, and the remainder is awarded through supplemental competitive grants. 
55 

Comprehensive Care Programs 

The Committee provides $1,315,005,000 for HIV healthcare and 

support services. 

Funds are awarded to States to support HIV service delivery consortia, the provision of home- and community-based care services 

for individuals with HIV disease, continuation of health insurance 

coverage for low-income persons with HIV disease, and support for 

State AIDS drug assistance programs [ADAP]. The Committee provides $900,313,000 for AIDS medications in ADAP. 

Early Intervention Services 

The Committee provides $201,079,000 for early intervention 

grants. These funds are awarded competitively to primary 

healthcare providers to enhance healthcare services available to 

people at risk of HIV and AIDS. Funds are used for comprehensive 

primary care, including counseling, testing, diagnostic, and therapeutic services. 

Children, Youth, Women, and Families 

The Committee provides $75,088,000 for grants for coordinated 

services to women, infants, children, and youth. 

Funds are awarded to a variety of providers, including community health centers, comprehensive hemophilia centers, county and 

municipal health departments, and other nonprofit communitybased programs that provide comprehensive primary healthcare 

services to populations with or at risk for HIV. 

AIDS Dental Services 

The Committee provides $13,122,000 for the AIDS Dental Services program. This program provides grants to dental schools, dental hygiene schools, and postdoctoral dental education programs to 

assist with the cost of providing unreimbursed oral healthcare to 

patients with HIV. 

The Ryan White Part F program provides for the Dental Reimbursement Program which covers the unreimbursed costs of providing dental care to persons living with HIV/AIDS. Programs 

qualifying for reimbursement are dental schools, hospitals with 

postdoctoral dental education programs, and colleges with dental 

hygiene programs. 

AIDS Education and Training Centers 

The Committee provides $33,611,000 for AIDS Education and 

Training Centers [AETCs]. AETCs train healthcare practitioners, 

faculty, and students who care for AIDS patients outside of the traditional health professions education venues and support curriculum development on the diagnosis and treatment of HIV infection for health professions schools and training organizations. 

Special Projects of National Significance 

The Committee provides $25,000,000 for the Special Projects of 

National Significance program. This program supports the development, evaluation and dissemination of innovative models of HIV 

care to improve the retention and health outcomes of Ryan White 

HIV/AIDS Program clients. 
56 

HEALTH CARE SYSTEMS

Appropriations, 2018 ............................................................................. $111,693,000 

Budget estimate, 2019 ........................................................................... 100,518,000 

Committee recommendation ................................................................. 113,693,000 

The Committee recommendation for the Health Care Systems 

Bureau is $113,693,000. 

The Health Care Systems Bureau protects the public health and 

improves the health of individuals through efforts to support and 

enhance the systems by which healthcare is delivered in America. 

Organ Donation and Transplantation 

The Committee provides $25,549,000 for organ donation and 

transplantation activities. 

Funds support a scientific registry of organ transplant recipients 

and the National Organ Procurement and Transplantation Network to match donors and potential recipients of organs. A portion 

of the appropriated funds may be used to educate the public and 

health professionals about organ donations and transplants and to 

support clearinghouse and technical assistance functions. 

National Cord Blood Inventory 

The Committee provides $15,266,000 for the National Cord Blood 

Inventory [NCBI]. The purpose of this program is to provide funds 

to cord blood banks to build an inventory of the highest quality 

cord blood units for transplantation. 

The National Cord Blood Inventory builds a racially and ethnically diverse inventory of high-quality umbilical cord blood for 

transplantation. The Committee applauds HRSA for increasing the 

number of units collected and maintained under NCBI. The Committee urges the agency to consider establishing a mechanism for 

reallocation of NCBI contract funds to cord blood banks that have 

reached their specified goals for bankable units from cord blood 

banks that are unable or unlikely to meet such specified goals during the contract period. The Committee strongly supports the collection of umbilical cord blood, which may be used to treat many 

blood and bone marrow disorders such as leukemia, lymphoma, and 

sickle cell disease. To expand access to life-saving transplants, the 

Committee urges HRSA to fund public cord blood bank pilot demonstrations that are focused on increasing recruitment of donors 

and banking of cord blood units from diverse populations. In addition, the Committee looks forward to the report required in the authorization bill due in June 2019 that will review the state of the 

science of using adult stem cells to develop new types of therapies 

for patients. 

C.W. Bill Young Cell Transplantation Program 

The Committee provides $24,109,000 for the C.W. Bill Young 

Cell Transplantation Program. 

The Committee continues to support cell transplantation with 

cord blood, bone marrow, peripheral blood stem cells, and other 

sources of stem cells that may be available in the future. The Committee appreciates HRSA’s efforts to increase the diversity of the 

adult volunteer donors’ registry and encourages HRSA to continue 
57 

to improve the availability, efficiency, and safety of transplants and 

improve outcomes for all blood stem cell transplant recipients regardless of their genetic variability. 

Office of Pharmacy Affairs 

The Committee provides $10,238,000 for the Office of Pharmacy 

Affairs [OPA]. OPA administers the 340B drug pricing program, 

which requires drug manufacturers to provide discounts or rebates 

to a set of programs and hospitals that serve a disproportionate 

share of low-income patients. 

Poison Control Centers 

The Committee provides $22,846,000, an increase of $2,000,000 

from fiscal year 2018, for poison control activities. The Poison Control Centers [PCCs] program is a national network of 55 PCCs that 

prevent and treat poison exposures by providing cost effective, 

quality healthcare advice to the general public and healthcare providers. 

In 2016, more than 1,150,000 human exposure calls managed by 

PCCs involved opioids and medications. The Committee continues 

to recognize the role PCCs have played in the opioid crisis through 

management of opioid overdoses by assisting first responders and 

hospital personnel through the National Poison Help Line. 

National Hansen’s Disease Program 

The Committee includes $13,706,000 for the National Hansen’s 

Disease program. The program consists of inpatient, outpatient, 

long-term care as well as training and research in Baton Rouge, 

Louisiana; a residential facility at Carville, Louisiana; and 11 outpatient clinic sites in the continental United States and Puerto 

Rico. 

National Hansen’s Disease Program Buildings and Facilities 

The Committee provides $122,000 for the repair and maintenance of buildings at the Gillis W. Long Hansen’s Disease Center. 

Payment to Hawaii for Hansen’s Disease Treatment 

The Committee provides $1,857,000 to Hawaii for Hansen’s Disease treatment. Payments are made to the State of Hawaii for the 

medical care and treatment of persons with Hansen’s disease in 

hospital and clinic facilities at Kalaupapa, Molokai, and Honolulu. 

Expenses above the level of appropriated funds are borne by the 

State of Hawaii. 

RURAL HEALTH

Appropriations, 2018 ............................................................................. $290,794,000 

Budget estimate, 2019 ........................................................................... 74,911,000 

Committee recommendation ................................................................. 318,794,000 

The Committee recommendation for Rural Health programs is $318,794,000, an increase of $28,000,000 above the fiscal year 2018 

level. 

The Office of Rural Health Policy [ORHP] administers HHS rural 

health programs, coordinates activities related to rural healthcare 

within HHS, and analyzes the possible effects of policy on the more 
58 

than 60.0 million residents of rural communities. ORHP advises 

the Secretary on the effects of Medicare and Medicaid on rural citizens’ access to care, the viability of rural hospitals, and the availability of physicians and other health professionals. 

Rural Communities Opioids Response.—The bill provides 

$120,000,000 for a Rural Communities Opioids Response to support 

treatment for and prevention of substance use disorder, with a 

focus on rural communities at the highest risk for substance use 

disorder. This initiative would include improving access to and recruitment of new substance use disorder providers; building sustainable treatment resources, increasing use of telehealth; establishing cross-sector community partnerships, and implementing 

new models of care, including integrated behavioral health; and 

technical assistance. HRSA may also use funds for loan repayment 

through the National Health Service Corps. Within the funding 

provided, the Committee also includes $20,000,000 for the establishment of three Rural Centers of Excellence on Substance Use 

Disorders that will support the dissemination of best practices related to the treatment for and prevention of substance use disorders within rural communities, with a focus on the current opioid 

crisis and developing methods to address future substance use disorder epidemics. The Centers’ research and programming should 

include science-based prevention, treatment, and other risk reduction interventions, including community-based approaches that 

may be replicable in other rural communities and associated professional training. The Centers’ should provide scientific and technical assistance to county and State health departments seeking 

guidance on how to specifically address the substance use disorder 

challenges in their community. At least one such Center shall be 

established at an academic university, in a rural State where over 

60 percent of the population is defined as rural by the U.S. Census 

Bureau, which is connected to an associated medical school that is 

already utilizing a collaborative approach to behavioral health care, 

with partnerships between the university and medical school, and 

the State with an effective, systems-wide approach to addiction 

treatment, such as the hub and spoke model. This academic university shall have a demonstrated track record of: developing innovative and effective treatment interventions for opioids; a strong familiarity with rural workforce and service delivery challenges, including the requirements and challenges of rural health clinics, 

critical access hospitals and other rural providers; and effective engagement with rural populations and health care providers in general. Further, such a university and connected medical school shall 

have experience in clinical trials research and the dissemination 

and training in best practices in rural communities. Finally, this 

university should have experience evaluating the efficacy of comprehensive treatment of substance use disorders, including patientcentered and family-based approaches to address the generational 

impacts of substance abuse. 

Rural Health Outreach 

The Committee provides $77,500,000 for the Rural Health Outreach program, $6,000,000 above the fiscal year 2018 level. 
59 

This program supports projects that demonstrate new and innovative modes of outreach in rural areas, such as integration and coordination of health services. The Committee recommendation provides not more than $12,000,000 for Outreach Service Grants; not 

more than $15,300,000 for Rural Network Development Grants; not 

less than $20,000,000 for Delta States Network Grant Program; not 

less than $2,400,000 for Network Planning Grants; and not less 

than $6,400,000 for Small Healthcare Provider Quality Improvement Grants. 

Delta States Rural Development Network Grant Program.—The 

Committee encourages HRSA to continue to consult with the DRA 

on the awarding, implementing, administering, and monitoring 

grants under the Delta States Network Grant Program in fiscal 

year 2019. The Committee continues to encourage HRSA to align 

its awards as closely as possible with the DRA’s strategic vision 

and with DRA economic and community development plans. In addition, of the funds provided, the Committee provides $8,000,000 to 

support HRSA’s collaboration with the DRA to continue DRA’s program to help underserved rural communities identify and better 

address their healthcare needs and to help small rural hospitals 

improve their financial and operational performance. Within 90 

days of enactment of this act, the Committee directs HRSA and 

DRA, jointly, to brief the Committee on this program’s progress. 

Rural Outreach Grants.—The Committee is concerned by reports 

that some grant opportunities have been closed off to certain rural 

health centers due to necessary, collaborative arrangements with 

healthcare providers in non-rural areas. The Committee directs 

HRSA to review the criteria for rural healthcare services outreach 

grants and similar opportunities to ensure that rural health centers may engage in collaborative partnerships with health centers 

in non-rural locations. 

Rural Health Research 

The Committee provides $9,351,000 for the Rural Health Research program. Funds are used for rural health research centers, 

the National Advisory Committee on Rural Health, and a reference 

and information service. Supported activities focus on improving 

the delivery of health services to rural communities and populations. 

Rural Hospital Flexibility Grants 

The Committee provides $49,609,000 for Rural Hospital Flexibility grants and the Small Hospital Improvement Program. Under 

these grant programs, HRSA works with States to provide support 

and technical assistance to Critical Access Hospitals to focus on 

quality and performance improvement and to integrate emergency 

medical services. 

The Committee continues to recognize the importance of supporting hospitals located in rural or underserved communities and 

recommends HRSA give preference in grant awards to Critical Access Hospitals serving rural communities that create community 

health teams to better coordinate care among rural populations to 

create better outcomes in chronic disease management. 
60 

State Offices of Rural Health 

The Committee provides $10,000,000 for State Offices of Rural 

Health. These offices help States strengthen rural healthcare delivery systems by enabling them to coordinate care and improve support and outreach in rural areas. 

Black Lung Clinics 

The Committee provides $10,000,000 for the Black Lung Clinics 

program. This program funds clinics that treat respiratory and pulmonary diseases of active and retired coal miners, steel mill workers, agricultural workers, and others with occupationally related 

respiratory and pulmonary impairments. These clinics reduce the 

incidence of high-cost inpatient treatment for these conditions. 

The Committee continues to direct the Secretary to evaluate 

funding levels for applicants based on the needs of the populations 

those applicants will serve and the ability of those applicants to 

provide healthcare services to miners with respiratory illnesses, 

with preference given to State agency applications over other applicants in that State, without regard to the funding tiers and overall 

per-applicant funding cap established by the Secretary in fiscal 

year 2014. 

Radiation and Exposure Screening and Education Program 

The Committee provides $1,834,000 for activities authorized by 

the Radiation Exposure Compensation Act. This program provides 

grants for the education, prevention, and early detection of 

radiogenic cancers and diseases resulting from exposure to uranium during mining and milling at nuclear test sites. 

Telehealth 

The Committee provides $25,500,000, an increase of $2,000,000 

above the fiscal year 2018 level, for the Office for the Advancement 

of Telehealth [OAT], which promotes the effective use of technologies to improve access to health services for people who are isolated from healthcare and to provide distance education for health 

professionals. The Committee strongly supports OAT and their 

mission to expand high quality medical care to rural communities 

that do not have adequate access to medical providers including 

many medical specialties. 

Behavioral Health.—The Committee provides $2,000,000 to support an evidence-based tele-behavioral health system to focus on 

opioids, with an emphasis on behavioral health services. This program will provide both increased access to behavioral healthcare 

services in rural communities as well as build the evidence-base for 

effectiveness of tele-behavioral healthcare for patients, providers, 

and payers. 

Telehealth.—Access to health professionals and services to address the mental and behavioral health needs of adolescents remains an important challenge. According to the CDC, early diagnosis and appropriate services for children and their families can 

make a difference in the lives of children with mental health disorders. The Committee recognizes that telehealth is effective to improve care, allows providers opportunities to reach underserved patients, and train providers. 
61 

Telehealth Centers of Excellence [COEs].—The Committee supports the continued development of the Telehealth COEs. 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. Many states have invested in 

telehealth networks to provide rural, medically underserved areas 

with access to primary and emergency care. Specialists from a central location can help rural providers with critical care for stroke 

and heart attack that can literally mean the difference between life 

and death. The Telehealth COEs serve to promote the adoption of 

telehealth programs across the country by validating technology, 

establishing training protocols, and providing a comprehensive 

template for States to integrate telehealth into their State health 

provider network. 

Telehealth Network Grant Program.—The Committee remains 

encouraged by the ability of telehealth services to provide access to 

vital care for patients in underserved areas. The Committee encourages HRSA to continue telehealth initiatives in school-based 

clinics, substance abuse treatment, and behavioral health treatment in the Telehealth Network Grant Program. 

FAMILY PLANNING

Appropriations, 2018 ............................................................................. $286,479,000 

Budget estimate, 2019 ........................................................................... 286,479,000 

Committee recommendation ................................................................. 286,479,000 

The Committee provides $286,479,000 for the title X Family 

Planning program. This program supports preventive and primary 

healthcare services at clinics nationwide. 

PROGRAM MANAGEMENT

Appropriations, 2018 ............................................................................. $155,000,000 

Budget estimate, 2019 ........................................................................... 151,993,000 

Committee recommendation ................................................................. 155,000,000 

The Committee provides $155,000,000 for program management 

activities. 

VACCINE INJURY COMPENSATION PROGRAM TRUST FUND

Appropriations, 2018 ............................................................................. $277,200,000 

Budget estimate, 2019 ........................................................................... 317,200,000 

Committee recommendation ................................................................. 317,200,000 

The Committee provides that $317,200,000 be released from the 

Vaccine Injury Compensation Trust Fund in fiscal year 2019. Of 

that amount, $9,200,000 is for administrative costs. 

The National Vaccine Injury Compensation program provides 

compensation for individuals with vaccine-associated injuries or 

deaths. Funds are awarded to reimburse medical expenses, lost 

earnings, pain and suffering, legal expenses, and death benefits. 

The Vaccine Injury Compensation Trust Fund is funded by excise 

taxes on certain childhood vaccines. 

CENTERS FOR DISEASE CONTROL AND PREVENTION

The Committee recommendation provides a program level of 

$7,868,141,000 in this bill for the Centers for Disease Control and 
62 

Prevention [CDC], which includes $55,358,000 in mandatory funds 

under the terms of the Energy Employees Occupational Illness 

Compensation Program Act [EEOICPA], and $808,300,000 in transfers from the Prevention and Public Health [PPH] Fund. 

The activities of CDC focus on several major priorities: providing 

core public health functions; responding to urgent health threats; 

monitoring the Nation’s health using sound scientific methods; assuring the Nation’s preparedness for emerging infectious diseases 

and potential pandemics; and providing leadership in the implementation of nationwide prevention strategies that are conducive to 

improving and maintaining health. 

IMMUNIZATION AND RESPIRATORY DISEASES

Appropriations, 2018 ............................................................................. $798,405,000 

Budget estimate, 2019 ........................................................................... 700,828,000 

Committee recommendation ................................................................. 798,405,000 

The Committee recommendation for the activities of the National 

Center for Immunization and Respiratory Diseases is $798,405,000, 

which includes $324,350,000 in transfers from the PPH Fund. 

The mission of the National Center for Immunization and Respiratory Diseases is the prevention of disease, disability, and death 

through immunization and by control of respiratory and related 

diseases. 

The Committee recommendation includes funding for the following activities in the following amounts: 

[In thousands of dollars] 

Budget activity Fiscal year 2018 

appropriation 

Committee 

recommendation 

Section 317 Immunization Program ............................................................................... 610,847 610,847 

National Immunization Survey (non–add) ............................................................. 12,864 12,864 

Influenza Planning and Response .................................................................................. 187,558 187,558 

Cost Estimates.—The Committee looks forward to reviewing the 

fiscal year 2019 report on estimated funding needs of the Section 

317 Immunization Program and requests that the report be updated and submitted no later than February 1, 2019, to reflect fiscal year 2020 cost estimates. The updated report should also include an estimate of optimum State and local operations funding, 

as well as a discussion of the evolving role of the 317 program as 

expanded coverage for vaccination becomes available from private 

and public sources over the next several years. 

Immunizations.—The Committee does not support the proposed 

reduction to the Section 317 Immunization Program and provides 

funding at last year’s level. The Committee believes a strong public 

health immunization infrastructure is critical for ensuring high 

vaccination coverage levels, preventing vaccine-preventable diseases, and responding to outbreaks. 

Vaccine Administration.—The Committee applauds the ongoing 

innovation of these important products for children, adolescents, 

and adults. As more life-saving vaccines are developed, and patient 

access continues to expand, the Committee aims to ensure that vaccines are properly administered. As such, the Committee encourages CDC to evaluate its outreach and provider education pro-
63 

grams and identify additional efforts CDC could undertake to ensure proper vaccine administration. 

HIV, VIRAL HEPATITIS, SEXUALLY TRANSMITTED DISEASES, AND

TUBERCULOSIS PREVENTION

Appropriations, 2018 ............................................................................. $1,127,278,000 

Budget estimate, 2019 ........................................................................... 1,117,278,000 

Committee recommendation ................................................................. 1,132,278,000 

The Committee recommendation for the activities of the National 

Center for HIV, Viral Hepatitis, Sexually Transmitted Diseases 

[STDs], and TB Prevention is $1,132,278,000. 

The Center administers CDC’s activities on HIV/AIDS, viral hepatitis, STDs, and TB, with the exception of the Global AIDS program, which is housed in the Center on Global Health. 

The Committee recommends funding for the following activities 

in the following amounts: 

[In thousands of dollars] 

Budget activity Fiscal year 2018 

appropriation 

Committee 

recommendation 

Domestic HIV/AIDS Prevention and Research ................................................................. 788,712 788,712 

HIV Prevention by Health Department ................................................................... 397,161 397,161 

HIV Surveillance ..................................................................................................... 119,861 119,861 

Activities to Improve Program Effectiveness ......................................................... 103,208 103,208 

National, Regional, Local, Community & Other Organizations ............................. 135,401 135,401 

School Health ......................................................................................................... 33,081 33,081 

Viral Hepatitis ................................................................................................................. 39,000 39,000 

Sexually Transmitted Infections ...................................................................................... 157,310 157,310 

Tuberculosis .................................................................................................................... 142,256 142,256 

Infectious Disease and Opioids ...................................................................................... ............................ 5,000 

Infectious Diseases and the Opioid Epidemic.—The Committee 

provides $5,000,000 to CDC to support a new initiative targeting 

infectious disease consequences of the opioid epidemic. The Committee directs CDC to focus efforts on improving surveillance, 

treatment, and education efforts around hepatitis B, hepatitis C, 

and HIV infections as it relates to the opioid epidemic. CDC is directed to prioritize funding for those areas most at risk for outbreaks of HIV and hepatitis due to injection drug use, including the 

220 counties CDC has previously identified. Further, CDC is encouraged to integrate interventions across its centers aimed at preventing, tracking, and treating infectious diseases with broader efforts to address the opioid epidemic. 

Liver Cancer Awareness Program.—The Committee notes that 

liver cancer remains one of the deadliest cancers and that some 

forms of liver cancer are preventable. CDC is encouraged to partner with stakeholder organizations to promote liver cancer awareness, appropriate screening, and proper prevention activities. 

Sexually Transmitted Infections [STIs].—The Committee is concerned about the continuing rise in STI rates and recognizes that 

direct funding to States and local health departments is critical in 

order to reverse this trend. The Committee recommends that CDC 

continue to provide State and local funding at or near the current 

percentage of total STI prevention funding to the extent possible 

given evolving public health needs. Additionally, CDC is encour-
64 

aged to collaborate with CMS for screening and treatment under 

Medicaid. 

Viral Hepatitis.—The Committee is concerned that even with a 

hepatitis B vaccine that is 95 percent effective, CDC estimates that 

there are nearly 850,000 Americans infected with hepatitis B, with 

an estimated 20,900 infections occurring in 2016. The Committee 

notes that in 2017 the National Academies of Sciences Engineering 

and Medicine [NASEM] report titled ‘‘A National Strategy for the 

Elimination of Hepatitis B and C’’ made a series of recommendations for vaccination, higher rates of diagnosis, and care and treatment which if implemented could eliminate hepatitis B as a public 

health concern by 2030. The Committee, therefore, encourages 

CDC, in cooperation with the leading national hepatitis B organizations, to develop a plan to implement the NASEM recommendations to achieve the goal of the elimination of hepatitis B. CDC is 

encouraged to provide an update in the fiscal year 2020 CJ on this 

effort. 

EMERGING AND ZOONOTIC INFECTIOUS DISEASES

Appropriations, 2018 ............................................................................. $614,572,000 

Budget estimate, 2019 ........................................................................... 508,328,000 

Committee recommendation ................................................................. 617,572,000 

The Committee recommendation for the activities of the National 

Center for Emerging and Zoonotic Diseases is $617,572,000, which 

includes $52,000,000 in transfers from PPH Fund. 

The National Center for Emerging and Zoonotic Infectious Diseases aims to detect, prevent, and control infectious diseases from 

spreading, whether they are naturally occurring, unintentional, or 

the result of terrorism. 

The Committee recommendation includes funding for the following activities in the following amounts: 

[In thousands of dollars] 

Budget activity Fiscal year 2018 

appropriation 

Committee 

recommendation 

Core Infectious Diseases ................................................................................................ 422,000 425,000 

Antibiotic Resistance Initiative .............................................................................. 168,000 168,000 

Lab Safety and Quality .......................................................................................... 8,000 8,000 

Vector–borne Diseases ........................................................................................... 38,603 38,603 

Lyme Disease ......................................................................................................... 10,700 10,700 

Prion Disease ......................................................................................................... 6,000 6,000 

Chronic Fatigue Syndrome ..................................................................................... 5,400 5,400 

Emerging Infectious Diseases ............................................................................... 155,457 158,457 

All Other Infectious Diseases ................................................................................ 29,840 29,840 

Food Safety ...................................................................................................................... 58,000 58,000 

National HealthCare Safety Network .............................................................................. 21,000 21,000 

Quarantine ....................................................................................................................... 31,572 31,572 

Advanced Molecular Detection ........................................................................................ 30,000 30,000 

Epidemiology and Lab Capacity Program ...................................................................... 40,000 40,000 

Healthcare–Associated Infections ................................................................................... 12,000 12,000 

Chronic Fatigue Syndrome [CFS].—The Committee applauds 

CDC’s efforts to collaborate with disease experts in its multi-site 

study to resolve the case definition issues and urges CDC to complete that effort. The Committee also commends the CDC’s recent 

update of its website informing the public about CFS, also known 
65 

as Myalgic Encephalomyelitis, and encourages CDC to work with 

disease experts and patients to continue to better educate 

healthcare providers about the disease and its appropriate management. However, the Committee is concerned that neither the 

website updates nor CDC’s current plans will address the continued medical stigma and misinformation about CFS and the critical 

lack of medical providers. CDC is encouraged to partner with HHS 

agencies and other experts to address these issues and find creative ways to bring additional clinicians into the field. 

Combating Antibiotic Resistant Bacteria [CARB].—The Committee continues to support the CARB initiative and provides 

$168,000,000 for this effort. The Committee recognizes the importance of addressing antibiotic-resistant bacteria through a ‘‘One 

Health’’ approach, simultaneously combating antibiotic resistance 

in human, animal, and environmental settings. The Committee encourages CDC to support funding for collaborations between entities such as academic medical centers, veterinary schools, schools 

of public health, State public health departments, and other academic institutions whose proposals are in line with CDC’s strategy 

for addressing antibiotic resistant bacteria. Further, the Committee 

notes that urinary tract infections are one of the most common diagnoses leading to antibiotic prescriptions and encourages CDC to 

continue to study the most effective strategies to improve antibiotic 

prescribing including nutritional alternatives in healthcare settings. CDC shall include an update on these efforts in the fiscal 

year 2020 CJ. 

Healthcare-Associated Infections [HAI].—The Committee acknowledges CDC has made significant progress on HAI prevention 

and data collection at acute-care hospitals, but gaps in data collection and reporting on HAI persist across outpatient, post-acute, 

and long-term care facilities. The Committee recognizes that voluntary participation in the National Healthcare Safety Network 

continues to grow among dialysis facilities, nursing homes, and ambulatory surgical centers, and encourages CDC to continue to expand its data collection efforts to these healthcare providers. 

Lyme Disease and Related Tick-Borne Illnesses.—The Committee 

recognizes the importance of prevention and control of Lyme disease and related tick-borne diseases and encourages CDC to support surveillance and prevention of Lyme disease and other highconsequence tick-borne diseases in endemic areas as well as areas 

not yet considered endemic. The Committee encourages CDC to coordinate with the National Institutes of Health, the National Institute of Mental Health, and NINDS on publishing reports that assess diagnostic advancements, methods for prevention, the state of 

treatment, and links between tick-borne disease and psychiatric illnesses. 

Responding to Emerging Threats.—The Epidemiology and Laboratory Capacity [ELC] for Infectious Diseases Program strengthens the epidemiologic and laboratory capacity in 50 States, 6 local 

health departments, and 8 territories. This funding provides critical support to epidemiologists and laboratory scientists who are instrumental in discovering and responding to various food and vector-borne outbreaks. The Committee provides funding for ELC 

grants to sustain core surveillance capacity and ensure that State 
66 

and local epidemiologists are equipped to respond rapidly to emerging threats including antimicrobial resistant superbugs and the 

Zika virus. 

Sepsis.—The Committee is encouraged that CDC continues to address sepsis as a priority and supports the implementation of the 

Get Ahead of Sepsis national initiative, which raises awareness 

about the importance of early recognition, treatment, and prevention. The Committee supports CDC’s goal of leveraging resources to 

better track and prevent disability and death from this devastating 

illness. In addition, the Committee is encouraged by CDC’s ongoing 

efforts to work with healthcare partners to establish innovative 

ways to perform sepsis surveillance and reporting using data from 

the patient’s electronic health record. 

Tropical Diseases.—The Committee recognizes the critical role 

the National Center for Emerging and Zoonotic Infectious Diseases 

and its Vector Borne Disease Program play in ongoing efforts to 

prepare for and fight tropical diseases emerging on U.S. soil, such 

as Dengue, Chikungunya and now Zika. 

CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION

Appropriations, 2018 ............................................................................. $1,162,896,000 

Budget estimate, 2019 ........................................................................... 939,250,000 

Committee recommendation ................................................................. 1,166,771,000 

The Committee recommendation for the activities of the National 

Center for Chronic Disease Prevention and Health Promotion is 

$1,166,771,000, which includes $254,950,000 in transfers from the 

PPH Fund. 

The mission of the National Center for Chronic Disease Prevention is to provide national leadership in promoting health and wellbeing through prevention and control of chronic diseases. Nearly 

one-half of all American adults have at least one chronic illness 

and such diseases account for nearly 70 percent of all U.S. deaths 

and three-quarters of all healthcare costs in the United States. 

The Committee does not include the administration’s proposal to 

create a new block grant and instead maintains the existing program line items, including funding mechanisms as they existed in 

fiscal year 2018. The Committee believes the existing funding 

structure allows for the greatest transparency, accountability, and 

measured outcomes for Congress and the taxpayer. Chronic diseases, such as arthritis, cancer, diabetes, heart disease, stroke, and 

obesity are the leading causes of death and disability in the United 

States and account for 86 cents of every dollar spent on healthcare. 

Therefore, a robust investment in the prevention and control of 

chronic diseases, including Alzheimer’s disease, epilepsy, lupus, 

and colorectal, prostate, and skin cancers, is essential to curb 

health spending and improve health and quality of life for millions 

of Americans. 

Within the total provided for the National Center for Chronic 

Disease Prevention and Health Promotion, the following amounts 

are available for the following categories of funding: 
67 

[In thousands of dollars] 

Budget activity Fiscal year 2018 

appropriation 

Committee 

recommendation 

Tobacco ........................................................................................................................... 210,000 210,000 

Nutrition, Physical Activity and Obesity ......................................................................... 54,920 56,920 

High Obesity Rate Counties (non–add) ................................................................. 15,000 15,000 

School Health .................................................................................................................. 15,400 15,400 

Health Promotion ............................................................................................................. 18,000 19,000 

Glaucoma ............................................................................................................... 4,000 4,000 

Visual Screening Education ................................................................................... 1,000 1,000 

Alzheimer’s Disease ............................................................................................... 4,500 5,500 

Inflammatory Bowel Disease ................................................................................. 1,000 1,000 

Interstitial Cystitis ................................................................................................. 1,000 1,000 

Excessive Alcohol Use ............................................................................................ 4,000 4,000 

Chronic Kidney Disease ......................................................................................... 2,500 2,500 

Prevention Research Centers .......................................................................................... 25,461 25,461 

Heart Disease and Stroke ............................................................................................... 140,062 140,062 

Diabetes .......................................................................................................................... 148,129 148,129 

National Diabetes Prevention Program ........................................................................... 25,300 25,300 

Cancer Prevention and Control ....................................................................................... 367,674 370,549 

Breast and Cervical Cancer .................................................................................. 218,000 218,000 

WISEWOMAN (non-add) ................................................................................. 21,120 21,120 

Breast Cancer Awareness for Young Women ........................................................ 4,960 4,960 

Cancer Registries ................................................................................................... 49,440 51,440 

Colorectal Cancer ................................................................................................... 43,294 43,294 

Comprehensive Cancer .......................................................................................... 19,675 19,675 

Johanna’s Law ....................................................................................................... 7,000 7,000

Ovarian Cancer ...................................................................................................... 9,500 9,500

Prostate Cancer ..................................................................................................... 13,205 13,205 

Skin Cancer ............................................................................................................ 2,125 3,000 

Cancer Survivorship Resource Center ................................................................... 475 475 

Oral Health ...................................................................................................................... 19,000 19,000 

Safe Motherhood/Infant Health ....................................................................................... 46,000 58,000 

Arthritis and Other Chronic Disease .............................................................................. 26,000 27,000 

Arthritis .................................................................................................................. 11,000 11,000 

Epilepsy .................................................................................................................. 8,500 8,500 

National Lupus Registry ........................................................................................ 6,500 7,500 

Racial and Ethnic Approach to Community Health ....................................................... 50,950 35,950 

Million Hearts .................................................................................................................. 4,000 4,000 

National Early Child Care Collaboratives ....................................................................... 4,000 4,000 

Hospitals Promoting Breastfeeding ................................................................................ 8,000 8,000 

Alzheimer’s and Healthy Aging.—The Committee includes 

$5,500,000, an increase of $1,000,000 for activities related to Alzheimer’s disease and commends the Healthy Brain Initiative for its 

leadership in bringing attention to the public health crisis of Alzheimer’s disease. The Committee encourages CDC to continue implementing the action steps listed in the updated Road Map, including working towards a consensus on the mortality burden of 

the disease. The Committee encourages CDC to assist States in collecting cognitive decline and caregiving data through the Behavioral Risk Factor Surveillance System. 

Breast and Cervical Cancer Screening.—The Committee encourages CDC to continue to strengthen access to preventive screenings 

for women who are uninsured or underinsured and at high risk for 

breast and cervical cancer through the Breast and Cervical Cancer 

program. Of women aged 21–64, 5,700,000 or 14.6 percent, will remain eligible for cervical cancer screening through this program. 

Breastfeeding.—The Committee has provided funding for CDC to 

continue supporting breastfeeding as a strategy to reduce obesity 
68 

and promote activities proven to increase breastfeeding through the 

State Physical Activity and Nutrition program. 

Cancer Survivorship.—Recognizing there are more than 

15,000,000 cancer survivors in the United States, the Committee is 

encouraged by CDC’s ongoing work with the Cancer Survivorship 

Resource Center in making cancer survivorship a public health priority. The Committee encourages CDC to work with public, nonprofit, and private organizations to evaluate and disseminate promising practices and interventions to promote health and improve 

the quality of life of cancer survivors. 

Childhood Cancer STAR Act.—The Committee has included an 

increase of $2,000,000 to be awarded to State cancer registries to 

enhance and expand infrastructure to track cancer in children, adolescents, and young adults. 

Children in Adversity.—The Committee recognizes that CDC is a 

key implementing partner of the United States Government Action 

Plan on Children in Adversity’s three principle objectives. The 

Committee fully supports the use of funds provided to CDC 

through this act for activities that the agency has identified as 

being necessary to link representative data to effective, sustainable, and scalable action and thus ensure that: (1) the percentage 

of children achieving age-appropriate growth and developmental 

milestones is increased; (2) the percentage of children living outside 

of family care is reduced; and (3) the percentage of children experiencing violence, exploitation, abuse, and neglect is reduced. The 

Committee continues to direct CDC to collaborate with USAID, 

PEPFAR, and DOL to ensure monitoring and evaluation is aligned 

for all of the Action Plan’s objectives. The Committee asks that the 

annual Public Law 109–95 report to Congress display the amount 

of funding by objective to the Action Plan on Children in Adversity. 

Chronic Obstructive Pulmonary Disease [COPD].—The Committee applauds CDC and NIH in leading a cross-agency effort to 

respond to COPD. The Committee encourages the agencies to move 

forward with a timely implementation of the COPD National Action plan to address the rising burden of COPD on patients, providers, and caregivers across the country. 

Diabetes Prevention Program.—The Committee recommendation 

includes $25,300,000, level with fiscal year 2018, for the Diabetes 

Prevention Program [DPP]. This program promotes lifestyle interventions proven to reduce the risk of developing diabetes by 58 percent in individuals at high risk. The Committee encourages CDC, 

in coordination with CMS, to develop a consumer facing program 

locator that includes all CDC and Medicare DPP programs. CDC 

is further encouraged to work with CMS to ensure that current 

CDC-recognized DPPs become certified Medicare DPP suppliers. 

Division of Diabetes Translation [DDT].—The Committee recognizes the work of CDC’s DDT to address the diabetes epidemic and 

encourages CDC to continue to ensure that the prevention needs of 

those Americans with, and at risk for, diabetes and prediabetes are 

met. The Committee believes these activities must include clear 

outcomes and ensure transparency and accountability that demonstrate how funding was used to support diabetes prevention and 

specifically how diabetes funding reached State and local communities. Additionally, the Committee encourages CDC to support the 
69 

translation of research into better prevention, care, and surveillance. The Committee encourages CDC to explore opportunities to 

expand virtual delivery of the National Diabetes Prevention Program’s lifestyle change program in rural areas where patients have 

provider care access challenges. 

Early Child Care Collaboratives.—The Committee recognizes 

that the early care and education setting is important for promoting healthy habits in young children. The Committee provides 

$4,000,000 to the National Early Child Care Collaboratives to enable training of early care and education providers in implementation of healthy eating and physical activity best practices, including 

strategies for engaging families. Funds will also support technical 

assistance for integration of healthy eating and physical activity 

best practices into existing State and local professional development systems’ early care and education settings, and health initiatives. The Committee also encourages the program to serve a mix 

of rural, suburban and urban areas, including areas with high 

childhood obesity rates. 

Endometriosis.—The Committee is aware that endometriosis is a 

serious chronic condition that impacts an estimated 1 in 10 women 

in the United States 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 encourages 

CDC, in collaboration with NICHD, to continue to support education, outreach, and awareness to promote early and accurate diagnosis of endometriosis. 

Epilepsy in Rural Areas.—The Committee encourages CDC to 

continue telehealth and educational training programs for rural 

and underserved areas that reach school nurses, child care personnel, first responders, and care providers for seniors to recognize 

and respond appropriately to seizures caused by epilepsy or resulting from trauma and other acute chronic illness. 

Farm-to-School.—The Committee notes that farm-to-school programs can be an effective way of improving the quality of school 

meals and increasing opportunities for nutrition education. The 

Committee includes $2,000,000 within Nutrition, Physical Activity, 

and Obesity for research and education activities related to farm 

to school programs that result in promoting healthy eating habits 

for students. 

Heart Disease and Stroke Prevention.—While largely preventable, 

cardiovascular disease, including heart disease and stroke, continues to inflict the highest burden on our Nation’s long-term 

health and economic stability. The Committee continues funding to 

support, strengthen, and expand heart disease and stroke prevention and control activities within State, local, and tribal public 

health departments and to enhance surveillance and research to 

target high burden populations and guide public health strategies. 

The Committee encourages CDC to prioritize these funds to communities with the highest disease burden of heart disease and 

stroke to identify and disseminate novel and innovative evidencebased strategies, including scientifically valid risk factor reduction 

measures, through competitive awards. 
70 

High Obesity Rate Counties.—The Committee remains concerned 

about the growing body of evidence suggesting that obesity is one 

of the most significant challenges facing the public health system. 

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. The Committee expects 

CDC to work with State and local public health departments to 

support measurable outcomes through evidenced-based obesity research, intervention, and prevention programs. Grants should combine basic, clinical, and population research to better understand 

and treat the metabolic, medical, surgical, environmental, and societal implications of obesity in cooperation with partners that have 

existing outreach capacity to develop and implement educational 

and intervention programs. Preference should be given to States 

where at least 10 percent of counties meet the requirements of this 

program. In addition, CDC shall focus its efforts in areas of the 

country with the highest burden of obesity and with the 

comorbidities of hypertension, cardiac disease, and diabetes from 

county level data in the Behavioral Risk Factor Surveillance System. The Committee encourages CDC to support only activities 

that are supported by scientific evidence. 

Inflammatory Bowel Diseases [IBD].—The Committee commends 

CDC for its commitment to the study of IBD epidemiology. The 

Committee is particularly concerned that IBD is increasingly recognized in minority and underserved communities and encourages 

CDC to complement its existing epidemiological study with a focus 

on these populations. The Committee encourages CDC to continue 

to identify innovative approaches, including mixed methods research, for determining the incidence and prevalence of IBD. 

Interstitial Cystitis.—The Committee recommendation for Interstitial Cystitis activities provides support for the ongoing epidemiology study, as well as education, outreach, and public awareness 

activities. 

Maternal Mortality.—The Committee recognizes the rising maternal mortality rate in the U.S. as a pressing public health issue. 

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. For this reason, the Committee 

has included $12,000,000 in the Safe Motherhood and Infant 

Health Program for CDC to continue and expand its technical assistance to 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 

MMRC’s. 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 data-driven actions 

for preventing these deaths. CDC is directed to provide a report, 

within 180 days of enactment, regarding how States currently account for maternal mortality and the additional steps required to 

achieve comprehensive surveillance and data collection in all States 

regarding maternal mortality for all pregnancy-associated and 
71 

pregnancy-related deaths, regardless of the outcome of the pregnancy. 

Million Hearts 2022.—The Committee is aware that Million 

Hearts, a public-private initiative, prevented an estimated 500,000 

heart attacks and strokes in the first 5 years. The Committee continues to support Million Hearts 2022 and its goal of preventing 

1,000,000 heart attacks and strokes over 5 years. Funding and resources shall be used to continue implementation of the ABCS (aspirin as appropriate, blood pressure control, cholesterol management, and smoking cessation); to develop innovative, scalable ways 

for communities and the healthcare sector to execute evidencebased prevention in the highest burden areas; and to expand focus 

on physical activity, cardiac rehabilitation, and people aged 35–64 

whose event rates are on the rise. 

Mississippi Delta Health Collaborative [MDHC].—Within the 

funds provided for Chronic Disease Prevention and Health Promotion, the Committee encourages CDC to build on its longstanding investment in MDHC by working to replicate the work in 

additional sites while maintaining the current strategy. CDC shall 

provide an update on these activities in the fiscal year 2020 CJ. 

Physical Activity.—Regular physical activity plays a critical role 

in chronic disease prevention, military readiness, academic success, 

workplace productivity, and lowers healthcare expenditures. The 

Committee is therefore pleased that the second edition of the Physical Activity Guidelines for Americans will be released in late 2018. 

The Committee encourages CDC to promote these Guidelines, once 

released, which should include consumer education about benefits 

of physical activity. In addition, the Committee applauds CDC for 

creating the new initiative, Active People, Healthy Nation and encourages CDC to strengthen its work. 

National Lupus Patient Registry.—The Committee includes 

$7,500,000, an increase of $1,000,000, to continue to support research efforts under the National Lupus Patient Registry program. 

Significant progress has been made to understand the epidemiology 

of lupus. The Committee encourages CDC to build on this work and 

focus on natural history studies of lupus to determine the lifetime 

impacts of the disease on children and others with lupus, including 

through CDC support for existing childhood lupus registries. The 

Committee also supports CDC’s work to establish the National Resource Center on Lupus and encourages CDC to continue to work 

with national lupus voluntary health agencies to enhance the Resource Center by developing lupus self-management programs and 

new tools for use by healthcare providers, caregivers and others to 

expand physician education and reduce time to diagnosis, which 

can lead to earlier interventions. 

Preterm Birth.—The Committee commends CDC for funding 

State-based Perinatal Collaboratives that focus on improving birth 

outcomes using known prevention strategies such as reducing early 

elective deliveries. CDC is encouraged to continue support for 

perinatal collaboratives particularly due to the rise in neonatal abstinence syndrome as a result of the opioid crisis. 

Psoriasis and Psoriatic Arthritis.—The Committee commends 

CDC for identifying opportunities for expanded research on psoriatic disease in its Public Health Agenda for Psoriasis and Psoriatic 
72 

Arthritis and encourages CDC to explore opportunities for research 

on the comorbidities of psoriatic disease that can be done in collaboration with or funded by other disease programs such as Arthritis, Cardiovascular Health, or Mental Illness. 

Pulmonary Hypertension [PH].—The Committee understands 

that PH causes heart failure and death. CDC is encouraged to support education, outreach, and awareness activities that promote 

early and accurate diagnosis of PH. 

Safe Motherhood Initiative.—Preterm birth affects more than 

500,000 babies each year in the United States and is the leading 

cause of neonatal mortality. The Committee commends CDC for 

funding State-based perinatal collaboratives that focus on improving birth outcomes using known preventative strategies such as reducing early elective deliveries. CDC is encouraged to improve the 

timeliness in data reporting by working with existing State biosurveillance tools to report on neonatal abstinence syndrome, hypertension, diabetes and other risk factors. 

Skin Cancer Education and Prevention.—The Committee is concerned with the growing number of people diagnosed with preventable forms of skin cancer, which is now the most commonly diagnosed cancer in the United States. The Committee has provided an 

increase for skin cancer education and prevention, and encourages 

CDC to increase its collaboration and partnership with local governments, business, health, education, community, nonprofit and 

faith-based sectors. 

Sleep Surveillance.—The Committee is pleased by CDC’s work on 

a national public health awareness campaign for sleep. The Committee encourages CDC to ensure that funding for surveillance activities on sleep disorders and sleep health is maintained in addition to these awareness efforts. 

Vision Health.—Vision impairment often occurs as a co-morbidity 

with other chronic illness, such as chronic heart disease, stroke, depression, and smoking, at substantially higher rates than individuals without vision impairment. CDC is encouraged to apply previous CDC vision and eye health research findings to develop effective prevention and early detection interventions, and to incorporate vision and eye health promotion activities into existing 

State and national public health chronic disease initiatives, with an 

initial focus on early detection of diabetic retinopathy. In addition, 

the Committee encourages CDC to update its reports on the estimated burden of keratitis and contact lens-related infections. 

WISEWOMAN.—The Committee lauds the WISEWOMAN program that helps uninsured and under-insured low-income women 

ages 40 to 64 decrease, prevent, or control heart disease and stroke 

by providing preventive health services, referrals to local 

healthcare providers, lifestyle programs, and health counseling 

services tailored to identified risk factors to promote lasting, 

healthy behavior change. From 2008 to 2016, WISEWOMAN provided 268,673 screenings to 192,391 women. Additionally, with 

WISEWOMAN’s new behavioral focus, participants received 81,653 

healthy behavior support services between 2013 and 2016. The 

Committee commends the Division for Heart Disease and Stroke 

Prevention for increasing the number of screenings by 27 percent 

in 1 year. 
73 

NATIONAL CENTER ON BIRTH DEFECTS, DEVELOPMENTAL

DISABILITIES, DISABILITY AND HEALTH

Appropriations, 2018 ............................................................................. $140,560,000 

Budget estimate, 2019 ........................................................................... 110,000,000 

Committee recommendation ................................................................. 153,560,000 

The Committee recommendation for the activities of the National 

Center on Birth Defects and Developmental Disabilities [NCBDDD] 

is $153,560,000. 

This Center improves the health of children and adults by preventing birth defects, developmental disabilities, and complications 

of heredity blood disorders and by promoting optimal child development and health and wellness among children and adults living 

with disabilities. 

Within the total provided, the following amounts are provided for 

the following categories of funding: 

[In thousands of dollars] 

Budget activity Fiscal year 2018 

appropriation 

Committee 

recommendation 

Total Birth Defects .......................................................................................................... 140,560 153,560 

Child Health and Development .............................................................................. 65,800 75,800 

Other Birth Defects ....................................................................................... 19,000 19,000 

Fetal Death ................................................................................................... 900 900 

Fetal Alcohol Syndrome ................................................................................. 11,000 11,000 

Folic Acid ...................................................................................................... 3,150 3,150 

Infant Health ................................................................................................. 8,650 8,650 

Autism ........................................................................................................... 23,100 23,100 

Surveillance for Emerging Threats to Mother and Babies ........................... ............................ 10,000 

Health and Development with Disabilities ............................................................ 59,660 62,660 

Disability and Health .................................................................................... 27,000 30,000 

Tourette Syndrome ........................................................................................ 2,000 2,000 

Early Hearing Detection and Intervention .................................................... 10,760 10,760 

Muscular Dystrophy ....................................................................................... 6,000 6,000 

Attention Deficit Hyperactivity Disorder ........................................................ 1,900 1,900 

Fragile X ........................................................................................................ 2,000 2,000 

Spina Bifida .................................................................................................. 6,000 6,000 

Congenital Heart Defects .............................................................................. 4,000 4,000 

Public Health Approach to Blood Disorders .......................................................... 4,400 4,400 

Hemophilia CDC Activities ..................................................................................... 3,500 3,500 

Hemophilia Treatment Centers .............................................................................. 5,100 5,100 

Thalassemia ........................................................................................................... 2,100 2,100 

Cerebral Palsy [CP].—The Committee encourages NCBDDD to 

use existing resources in infant health to improve CP surveillance, 

including but not limited to using existing data registries, the Autism and Developmental Disabilities Monitoring network, and other 

data sets available to estimate national prevalence. From this information, the Committee requests information in the fiscal year 

2020 CJ on the cause, earlier diagnosis, and treatment of CP across 

the lifespan. 

Congenital Heart Disease [CHD].—CHD is the most common and 

deadliest category of birth defects in the United States. The Committee notes that children and adults with CHD require ongoing, 

specialized cardiac care, and there remain gaps in data as children 

and adolescents transition to adult care. The Committee commends 

NCBDDD for its leadership in addressing CHD and adult CHD 

surveillance efforts and requests a report in the fiscal year 2020 CJ 
74 

on CDC surveillance and research efforts regarding CHD across the 

lifespan, age-specific prevalence, and factors associated with those 

patients who may have dropped out of appropriate specialty care. 

The report should address current gaps in surveillance of adults 

with CHDs and include action items. 

Duchenne Muscular Dystrophy.—The Committee is pleased by 

the publication of care standards updates for Duchenne Muscular 

Dystrophy and encourages the agency to continue supporting the 

widespread dissemination of these standards. The Committee is 

also aware of CDC’s efforts to develop an ICD 10 code for 

Duchenne and requests that CDC develop a plan to leverage the 

recently established ICD 10 code to shift the Muscular Dystrophy 

Surveillance, Tracking and Research Network [MD STARnet] toward a more passive surveillance effort enabling an expansion of 

MD STARnet to additional sites and States. Further, the Committee encourages CDC to continue its work to disseminate the revised Duchenne/Becker Muscular Dystrophy care standards, to expand surveillance of Duchenne/Becker via the MD STARnet, and 

support Duchenne newborn screening efforts. In addition, the Committee has provided sufficient funds to support a coordinated 

Duchenne newborn screening initiative through the National Center for Environmental Health Newborn Screening Quality Assurance Program. 

Emerging Threats to Mothers and Babies.—The Committee recommendation includes $10,000,000 to support CDC’s continued collaboration with State, tribal, territorial, and local health departments to monitor mothers and babies impacted by Zika virus during pregnancy in highest risk jurisdictions. This funding will allow 

CDC to pilot the Zika surveillance/registry system in additional jurisdictions to capture data on other emerging public health threats 

to mothers and babies, such as opioid use during pregnancy, natural disasters, and pandemic influenza. 

Fragile X [FX].—The Committee commends CDC’s efforts to identify and define the population impacted by FX and all conditions 

associated with the gene mutation with the goal of understanding 

the public health impact of these conditions. The Committee acknowledges the significant progress made by the NCBDDD Fragile 

X Clinical and Research Consortium in growing its FORWARD 

Database and Patient Registry, and is pleased that a new grant 

was awarded in 2015 to continue and expand upon this important 

work. The Committee also notes with approval the public-private 

partnership meeting to set the Public Health Research Agenda and 

the resulting focus on longitudinal data to characterize the natural 

history of FX, to in turn better inform the development of outcome 

measures and biomarkers for new drug treatments under development. The Committee encourages NCBDDD to explore cross-divisional funding opportunities to accelerate data-driven public health 

research to reduce the public health burdens of both FX and autism. 

Hemophilia.—The Committee includes sufficient funding for CDC 

hemophilia activities. These programs support inhibitor prevention 

and eradication, education programs on bleeding disorders, and Hemophilia Treatment Centers which have been critical to the ad-
75 

vancement of care for patients with Hemophilia and other bleeding 

disorders. 

Marfan Syndrome.—The Committee remains concerned that 

structural cardiovascular disorders, such as Marfan syndrome, continue to claim the lives of high school athletes across the country 

who received a sports physical prior to competition. CDC is encouraged to work with patient and professional stakeholders to develop 

minimum screening guidelines that ensure all young athletes are 

appropriately screened for potentially life-threatening structural 

cardiovascular disorders. 

Physical Activity for People With Disabilities.—The Committee 

includes an increase of $2,000,000 to continue to strengthen existing programs that address healthy athletes. The Committee encourages CDC to work with grant recipients to: (1) ensure that 

there are systems in place to help athletes and others with intellectual disabilities connect to care in their home communities; and (2) 

improve integration of best practices to the CDC’s State-based disability and health programs to increase access to these types of 

health benefits for those with intellectual disabilities. In addition, 

an increase of $1,000,000 is provided to continue to existing activities that improve physical activity and health promotion for people 

with mobility disabilities. Funds for this effort include a demonstration project to develop and implement strategies based on 

and informed by scientific evidence to reduce diabetes and obesity 

among the mobility-impaired. 

Sickle Cell Disease [SCD].—The Committee recognizes the importance of surveillance to better understand and address the long 

term health outcomes, complications, and healthcare access needs 

of people living with SCD. CDC shall report to the Committees on 

Appropriations of the House of Representatives and the Senate 

within 1 year after enactment of the act, regarding how it would 

expand its current sickle cell disease surveillance efforts in California and Georgia to additional States with the goal of covering 

the majority of the U.S. SCD population over the next 5 years. 

Spina Bifida.—While spina bifida and related neural tube defects 

are highly preventable through education and adequate daily folic 

acid consumption, they are the most common permanently disabling birth defect in the United States. The Committee supports 

the continuation of the spina bifida Clinical Care Monitoring and 

Tracking program and commends the National Spina Bifida Program in serving as a model for programs assisting other individuals living with similar complex conditions. The Committee encourages CDC to continue the dissemination of information to clinicians, parents, and families living with spina bifida. 

Thalassemia.—The Committee is aware of the thalassemia program at CDC and the critical work it does connecting patients with 

this rare genetic blood disorder to life-saving resources and treatment centers. Thalassemia patients experience serious 

comorbidities which can impact almost every aspect of their lives. 

The Committee requests that CDC continue collaborating with 

thalassemia treatment centers, non-profits, and patient advocates 

through this program. 
76 

Tuberous Sclerosis Complex [TSC].—The Committee encourages 

CDC to take into consideration all the major manifestations of TSC 

in its surveillance network. 

PUBLIC HEALTH SCIENTIFIC SERVICES

Appropriations, 2018 ............................................................................. $490,397,000 

Budget estimate, 2019 ........................................................................... 468,000,000 

Committee recommendation ................................................................. 492,397,000 

The Committee recommendation for Public Health Scientific 

Services is $492,397,000. 

This funding supports the work of all of the CDC Centers by 

compiling statistical information to inform public health policy. In 

particular, these activities assure the accuracy and reliability of 

laboratory tests; apply digital information technology to help detect 

and manage diseases, injuries, and syndromes; and develop and inform the public health community on sound public health surveillance, laboratory protocols, and epidemiological practices. 

The Committee recommendation includes funding for the following activities in the following amounts: 

[In thousands of dollars] 

Budget activity Fiscal year 2018 

appropriation 

Committee recommendation 

Health Statistics ............................................................................................................. 160,397 161,397 

Surveillance, Epidemiology, and PH Informatics ............................................................ 279,000 279,000 

Public Health Workforce .................................................................................................. 51,000 52,000 

Modernizing Vital Statistics.—The Committee encourages CDC 

to continue its efforts to modernize its surveillance infrastructure, 

which was started with the development of the Surveillance Data 

Platform [SDP]. By selecting the National Healthcare Safety Network [NHSN], CDC will take an important step forward in modernizing their critical data collection systems that will allow for better 

data sharing and analysis on a common platform while also helping 

to help reduce redundancy and maintenance. Further, CDC is encouraged to continue working with States to modernize electronic 

systems and improve vital statistics reporting. 

ENVIRONMENTAL HEALTH

Appropriations, 2018 ............................................................................. $205,750,000 

Budget estimate, 2019 ........................................................................... 157,000,000 

Committee recommendation ................................................................. 205,750,000 

The Committee recommendation for the National Center for Environmental Health is $205,750,000. The Committee recommendation includes $17,000,000 in transfers from the PPH Fund. 

The National Center for Environmental Health addresses emerging pathogens and environmental toxins that pose significant challenges to public health. The Center conducts surveillance and data 

collection to determine which substances in the environment are 

found in people and to what degree. The Center also determines 

whether and at what level of exposure these substances are harmful to humans. 
77 

The Committee recommendation includes funding for the following activities: 

[In thousands of dollars] 

Budget activity Fiscal year 2018 

appropriation 

Committee recommendation 

Environmental Health Laboratory ................................................................................... 63,150 63,150

Newborn Screening Quality Assurance Program ................................................... 13,400 13,400 

Newborn Screening for SCID .................................................................................. 1,250 1,250 

Other Environmental Health .................................................................................. 48,500 48,500 

Environmental Health Activities ..................................................................................... 44,600 44,600 

Safe Water .............................................................................................................. 8,600 8,600 

Amyotrophic Lateral Sclerosis Registry ................................................................. 10,000 10,000 

Climate Change ..................................................................................................... 10,000 10,000 

All Other Environmental Health ............................................................................. 16,000 16,000 

Environmental and Health Outcome Tracking Network .................................................. 34,000 34,000 

Asthma ............................................................................................................................ 29,000 29,000 

Childhood Lead Poisoning ............................................................................................... 18,000 18,000 

Lead Poisoning Prevention .............................................................................................. 17,000 17,000 

Amyotrophic Lateral Sclerosis [ALS] Registry.—The Committee 

continues to support the National ALS Registry and seeks to understand how to build upon current efforts to improve data collection. The Committee looks forward to seeing the report requested 

in fiscal year 2018 to determine compliance with Public Law 110– 

373. 

Asthma.—The Committee supports the work of the National 

Asthma Control Program, recognizing that asthma is one of the 

most common and costly health conditions in the United States. 

The Committee encourages CDC to continue its 6 «18 Initiative efforts which promote evidence-based asthma medical management 

and strategies aimed at improving access and adherence to the 

2007 National Asthma Education and Prevention Program. 

Newborn Screening.—The Committee requests CDC to provide an 

update in the fiscal year 2020 CJ on how CDC will use the additional funding provided in fiscal year 2018 to expand CDC’s quality 

assurance materials, as well as critical infrastructure and development of tests for rare conditions. Further, the update should note 

what steps can be taken to encourage States to adopt and implement new Recommended Uniform Screening Panel conditions within 1 year of their addition. Further, the Committee is aware of the 

successful pilot project in Ohio around Duchenne Muscular Dystrophy screening and CDC’s support of existing plans to conduct an 

additional state pilot. CDC is encouraged to develop a plan to foster 

development and use of disease-specific validation test panels and 

protocols that meet all required standards. The plan should also include capacity-building support for State laboratory staff to be able 

to interpret results and minimize false positives as well as a system to monitor performance of labs in this work. The Committee 

recommends that CDC develop working groups involving all stakeholders, including the newborn screening community, to address 

these and future concerns. 
78 

INJURY PREVENTION AND CONTROL

Appropriations, 2018 ............................................................................. $648,559,000 

Budget estimate, 2019 ........................................................................... 266,309,000 

Committee recommendation ................................................................. 648,559,000 

The Committee recommendation for the National Center for Injury Prevention and Control is $648,559,000. 

CDC is the lead Federal agency for injury prevention and control. 

Programs are designed to prevent premature death and disability 

and reduce human suffering and medical costs caused by fires and 

burns, poisoning, drowning, violence, and traffic accidents. The national injury control program at CDC encompasses non-occupational injury and applied research in acute care and rehabilitation 

of the injured. 

The Committee recommendation includes funding for the following activities: 

[In thousands of dollars] 

Budget activity Fiscal year 2018 

appropriation 

Committee 

recommendation 

Intentional Injury ............................................................................................................. 102,730 102,730 

Domestic Violence and Sexual Violence ................................................................ 32,700 32,700 

Child Maltreatment ....................................................................................... 7,250 7,250 

Youth Violence Prevention ..................................................................................... 15,100 15,100 

Domestic Violence Community Projects ................................................................. 5,500 5,500 

Rape Prevention ..................................................................................................... 49,430 49,430 

National Violent Death Reporting System ...................................................................... 23,500 23,500 

Unintentional Injury ......................................................................................................... 8,800 8,800 

Traumatic Brain Injury ........................................................................................... 6,750 6,750 

Elderly Falls ............................................................................................................ 2,050 2,050 

Injury Prevention Activities ............................................................................................. 28,950 28,950 

Opioid Overdose Prevention and Surviellance ................................................................ 475,579 475,579 

Injury Control Research Centers ..................................................................................... 9,000 9,000

Child Sexual Abuse Prevention.—It is estimated that 15 to 25 

percent of girls and 5 to 10 percent of boys will experience child 

sexual abuse. While the Federal Government has invested in treatment for victims and punishment for offenders, the Committee recognizes the value of also investing in prevention. The Committee 

requests that the Center for Injury Prevention and Control report 

on its current activities related to the development and evaluation 

of primary public health interventions targeting child sexual abuse. 

Additionally, the Committee asks that the Center identify gaps in 

research that can be filled to promote child sexual abuse primary 

prevention, as well as what resources would be needed to conduct 

such research. The Center shall provide a report to the Committee 

within 180 days of enactment of this act. 

Concussion Surveillance.—The 2013 NAS study ‘‘Sports-Related 

Concussions in Youth: Improving the Science, Changing the Culture’’ recommended that CDC establish and oversee a national surveillance system to accurately determine the incidence of sports-related concussions, including youth ages 5 to 21. The Committee encourages CDC to investigate the establishment of a national surveillance system to accurately determine the incidence of sportsand recreation-related concussions among youth aged 5 to 21 years. 
79 

Opioid Abuse in Native Communities.—The Committee understands that American Indians and Alaska Natives overdose on 

opioids at the highest rate in the United States and recognizes the 

importance of addressing the disproportionate impact of the opioid 

crisis in Native communities. The Committee directs CDC to work 

with the Indian Health Service to ensure federally-operated and 

tribally-operated healthcare facilities benefit from the Center’s 

PDMP efforts. 

Opioid Drug Overdose [PDO] Prevention.—The Committee includes $475,579,000, and reflects continued strong support of CDC 

PDO activities. CDC shall continue to use funds to advance the understanding of the opioid overdose epidemic and scale up prevention activities across all 50 States and the District of Columbia. 

The Committee expects that this will include the expansion of caselevel syndromic surveillance data, improvements of interventions 

that monitor prescribing and dispensing practices, better timeliness, and quality of morbidity and mortality data, as well as the 

enhancement of efforts with medical examiners and coroner offices. 

CDC shall promote the use of Prescription Drug Monitoring Programs [PDMPs], including implementation of activities described in 

the National All Schedules Prescription Electronic Reporting Act of 

2005 as amended by the Comprehensive Addiction and Recovery 

Act of 2016. This shall include continuing to expand efforts to enhance the utility of PDMPs in States and communities, making 

them more interconnected, real-time, and usable for public health 

surveillance and clinical decisionmaking. The Committee encourages CDC to ensure State PDMP implementation and improvements are coordinated with respective State alcohol and drug agencies. CDC shall also promote alternative surveillance programs for 

States and communities that do not have a PDMP. CDC is encouraged to work with the Office of the National Coordinator for Health 

Information Technology to enhance the integration of PDMPs and 

electronic health records. Further, the Committee is encouraged to 

ensure that Federal funding allocated to respond to the opioid epidemic flows from the States into communities and local health departments as practicable and encourages CDC to support local prevention activities to determine the effectiveness of naltrexone in 

treating heroin and prescription drug abuse as well as reducing diversion of buprenorphine for illicit purposes. Finally, CDC shall use 

$10,000,000 of the funds provided to conduct an opioid nationwide 

awareness and education campaign. 

Opioid Prescribing Guidelines.—The Committee applauds CDC’s 

Guidelines for Prescribing Opioids for Chronic Pain and encourages 

CDC to continue its work to support uptake and use of the Guidelines. The Committee understands that current guidelines do not 

distinguish between Schedule 3 and Schedule 2 opioids and encourages CDC to adopt guidelines to reduce the risk of addiction by 

starting with a Schedule 3 prescription before considering Schedule 

2. CDC is further directed to continue robust implementation of use 

of the electronic tool to train providers on incorporating and applying the CDC Guidelines in primary care settings and through efforts to increase continuing education. The Committee encourages 

CDC to coordinate with VA and DOD on implementation and any 

new developments in safe prescribing practices to ensure con-
80 

sistent, high-quality care standards across the Federal Government. The Committee notes that prescribing for acute pain remains 

a significant driver of initial opioid prescriptions, especially for 

youth, and that numerous States have established limits on initial 

opioid prescriptions, while substantial research has examined the 

use of non-opioid therapies for acute pain. The Committee encourages CDC to continue its leadership in prevention of the opioid epidemic by developing prescribing guidelines for acute pain, including 

those which are applicable to emergency physicians, surgeons, and 

dentists. 

Rape Prevention.—The Committee directs that at least 75 percent of the program’s funds go to States for State and local prevention activities. CDC activities should be coordinated with efforts at 

institutions to reduce the incidence of sexual assault on their own 

campus. 

Trauma Surveillance.—The Committee commends CDC for providing funding to States to conduct surveillance on youth and adult 

behavioral risk factors. The Committee encourages CDC to 

prioritize collection and reporting of data on adverse childhood experiences, including exposure to violence. The Committee also encourages CDC to report on the prevalence of adverse childhood experiences across geography, race and ethnicity, and socioeconomic 

status. 

Traumatic Brain Injury [TBI].—The Traumatic Brain Injury Act 

of 1996 and subsequent reauthorizations, supports a variety of activities related to TBI at several agencies within the Department. 

The Committee recognizes that the Federal TBI program supports 

prevention, education, surveillance, research, protection and advocacy services, as well as support to States and territories to help 

improve delivery of services and resources for people living with 

TBI and their families. The Committee applauds States for their efforts in securing supplemental resources to help further expand 

their TBI programs, and encourages them to continue improving 

their systems. In addition, the Committee urges CDC to continue 

its work in creating a National Concussion Surveillance System to 

provide in the future comprehensive incidence estimates of traumatic brain injury. 

Violence and Injury Prevention.—The Committee commends CDC 

for expansion of the Core State Violence and Injury Prevention Program [SVIPP] to 23 States and its focus on shared risk and protective factors. To further strengthen State decision-making, the Committee encourages CDC to allow States to utilize Core SVIPP funds 

to implement, evaluate, and disseminate effective violence and injury prevention programs and policies beyond the four core focus 

areas selected by CDC. Additional areas may include prevention of 

falls, homicides, and other areas that State deems to be high priorities. The Committee encourages CDC to prioritize program funding for youth violence prevention efforts in high-violence, high-poverty areas and, in particular, large urban communities that are 

seeking to address relevant impacts and root causes of community 

violence, and collective trauma. 
81 

OCCUPATIONAL SAFETY AND HEALTH

Appropriations, 2018 ............................................................................. $335,200,000 

Budget estimate, 2019 ........................................................................... ........................... 

Committee recommendation ................................................................. 335,300,000 

The Committee recommendation for National Institute for Occupational Safety and Health [NIOSH] programs is $335,300,000. 

NIOSH is the only Federal agency responsible for conducting research and making recommendations for the prevention of work-related illness and injury. The NIOSH mission is implemented by 

conducting basic and applied scientific research and translating the 

knowledge gained into products and services that impact workers 

in settings from corporate offices to construction sites to coal mines. 

The Committee does not include the administration’s proposal to 

consolidate NIOSH within NIH. Further, the Committee acknowledges that NIOSH continues to protect American workers through 

its work-related illness and injury research. The Committee encourages NIOSH to continue maintaining its objectivity so as to ensure the highest professional and ethical standards are maintained. 

The Committee recommendation includes funding for the following activities at the following amounts: 

[In thousands of dollars] 

Budget activity Fiscal year 2018 

appropriation 

Committee 

recommendation 

Total NIOSH ..................................................................................................................... 335,200 335,300 

National Occupational Research Agenda .............................................................. 116,000 116,000 

Agriculture, Forestry, Fishing (non–add) ...................................................... 25,500 25,500 

Education and Research Centers .......................................................................... 29,000 29,000 

Personal Protective Technology .............................................................................. 20,000 20,000 

Mining Research .................................................................................................... 59,500 59,500 

National Mesothelioma Registry and Tissue Bank ................................................ 1,100 1,200 

Other Occupational Safety and Health Research .................................................. 109,600 109,600 

Mesothelioma.—The Committee is aware that no formal registry 

exists to keep track of mesothelioma patients, their demographics, 

and other important information that could help develop and improve standards of care, as well as identify gaps in current treatment. The recommendation includes $100,000 for CDC to initiate 

a feasibility study for a patient registry which would include developing case finding methodology to determine incidence and prevalence, demographics and risk factors. The Committee expects a report from CDC after conclusion of the feasibility study. 

Total Worker Health.—The Committee commends CDC’s Total 

Worker Health Program. The Committee provides level funding for 

the program which aims to promote and protect the health and productivity of the American workforce through research and dissemination of innovative and cost-effective tools and interventions for 

American businesses. 

ENERGY EMPLOYEES OCCUPATIONAL INJURY COMPENSATION ACT

Appropriations, 2018 ............................................................................. $55,358,000 

Budget estimate, 2019 ........................................................................... ........................... 

Committee recommendation ................................................................. 55,358,000 
82 

The Committee recommendation for the Energy Employees Occupational Illness Compensation Program Act [EEOICPA] is 

$55,358,000. This mandatory funding supports NIOSH scientists 

who reconstruct radiation dose levels to inform compensation decisions. The Committee does not accept the administration’s proposal 

to move EEOICPA to NIH. 

GLOBAL HEALTH

Appropriations, 2018 ............................................................................. $488,621,000 

Budget estimate, 2019 ........................................................................... 408,762,000 

Committee recommendation ................................................................. 488,621,000 

The Committee recommends $488,621,000 for global health-related activities at CDC. 

The Center for Global Health leads international programs and 

coordinates CDC’s global efforts with the goal of promoting health 

and preventing disease in the United States and abroad. The Center has a particular focus on ensuring rapid detection and response 

to emerging health threats. 

The Committee recommendation includes funding for the following activities in the following amounts: 

[In thousands of dollars] 

Budget activity Fiscal year 2018 

appropriation 

Committee recommendation 

Global HIV/AIDS Program ................................................................................................ 128,421 128,421 

Global Immunization Program ........................................................................................ 226,000 226,000 

Polio Eradication .................................................................................................... 176,000 176,000 

Measles and Other Vaccine Preventable Diseases ............................................... 50,000 50,000 

Parasitic Diseases and Malaria. .................................................................................... 26,000 26,000 

Global Public Health Protection ...................................................................................... 108,200 108,200 

Global Disease Detection and Emergency Response ............................................ 98,400 98,400 

Global Public Health Capacity Development ......................................................... 9,800 9,800 

Global Health Security [GHS] Strategy.—The Committee reiterates strong support for the GHS strategy and notes that funding 

provided in the Ebola supplemental will expire at the end of fiscal 

year 2019. The Committee provides $98,400,000, level with fiscal 

year 2018, which will help CDC sustain its GHS work around the 

globe. The Committee looks forward to receiving the comprehensive 

inter-agency strategy requested in the Consolidated Appropriations 

Act, 2018 by September, 2018. 

Global Water Strategy.—The Committee encourages CDC to work 

with other Federal partners to initiate an effort to assess and support water sanitation and hygiene [WASH] improvements in 

healthcare facilities, aligned with the 2017 US Global Water Strategy. Further, the Committee urges CDC to increase its WASH efforts to contribute to the elimination of cholera as a public health 

threat as outlined by Ending Cholera—A Global Roadmap to 2030. 

Malaria and Parasitic Diseases.—The Committee recognizes the 

important role the Center for Global Health plays in the fight 

against malaria and parasitic diseases. CDC’s crucial monitoring 

and surveillance of transmission, evaluation of interventions for effectiveness and impact, and testing of tools in a real world setting 

are critical to understanding how to scale up global health programs and ensure that our global health investments are smarter, 
83 

better, and not wasteful. The Committee encourages CDC to continue to research, monitor, and evaluate efforts for malaria and 

parasitic disease in collaboration with other divisions and agencies. 

Polio.—CDC is the lead U.S. agency in the global effort to eradicate polio and currently works with various organizations by providing expertise in training, vaccines, epidemiology, laboratory capacity, and surveillance. Currently, polio is endemic in only three 

countries, Nigeria, Afghanistan, and Pakistan. The Committee 

commends CDC’s efforts to help eradicate this disease. 

Soil Transmitted Helminth [STH] and Related ‘‘Diseases of Poverty’’.—The Committee includes $1,500,000 for surveillance, source 

remediation, and clinical care aimed at reducing STH. These funds 

shall be used to extend the currently funded projects for another 

year. 

PUBLIC HEALTH PREPAREDNESS AND RESPONSE

Appropriations, 2018 ............................................................................. $1,450,000,000 

Budget estimate, 2019 ........................................................................... 800,000,000 

Committee recommendation ................................................................. 1,470,000,000 

The Committee recommendation for the Office of Public Health 

Preparedness and Response [PHPR] is $1,470,000,000. 

The mission of PHPR is to build and strengthen national preparedness for public health emergencies including natural, biological, chemical, radiological, and nuclear incidents. PHPR administers national response programs and assets, as well as grants to 

States and localities to enhance preparedness efforts across the 

country. 

The Committee recommendation includes funding for the following activities in the following amounts: 

[In thousands of dollars] 

Budget activity Fiscal year 2018 

appropriation 

Committee 

recommendation 

Public Health Emergency Preparedness Cooperative Agreement ................................... 670,000 680,000 

Academic Centers for Public Health Preparedness ........................................................ 8,200 8,200 

BioSense .......................................................................................................................... 23,000 23,000 

All Other CDC Preparedness ........................................................................................... 138,800 148,800 

Strategic National Stockpile ........................................................................................... 610,000 610,000 

Emergency Preparedness.—The Committee continues to request 

detailed information on how PHEP funding is distributed at the 

local level by States. CDC is encouraged to provide in the fiscal 

year 2020 CJ an update on how much of the Federal PHEP funding 

is being allocated to local health departments and what basis or 

formula each State is using to make such allocations. 

Strategic National Stockpile [SNS].—The Committee appreciates 

the Secretary’s efforts to improve the efficiency of the Department’s 

public health preparedness and response programs and looks forward to considering and evaluating the Department’s proposal to 

shift the funding and oversight of the SNS from CDC to ASPR, as 

submitted in the fiscal year 2019 budget request. The Committee 

notes that CDC has unique expertise in public health preparedness 

and response, science-based policy and decisionmaking, public 

health communications, and coordination with State and local part-
84 

ners. The Committee urges the Department to ensure that CDC 

has the resources necessary to continue SNS-related and other 

agency-wide activities as necessary if the SNS moves out of CDC. 

Should the proposed move be implemented, the Secretary is strongly urged to maintain a strong and central role for CDC in the medical countermeasures enterprise. Further, the Committee encourages HHS to continue to evaluate the latest approved advances in 

influenza prevention and antiviral treatment for inclusion in the 

SNS in preparation for pandemic influenza, and promising products in development that should be considered for purchase. The 

Committee requests a report within 90 days of enactment of this 

Act detailing the number of FDA approved Medical Countermeasures [MCMs] that will be needed in the SNS over the next 3 

fiscal years (including new products or products currently in the 

SNS that will require replenishment), and the anticipated costs to 

purchase these products while maintaining current SNS products. 

Strategic National Stockpile Inventory of Hemostatic Agents.— 

The Committee directs the CDC to ensure that the hemostatic 

dressings stockpile has not exceeded the recommended shelf life 

and replace any hemostatic dressings that have passed the labeled 

expiration date. 

BUILDINGS AND FACILTIIES

Appropriations, 2018 ............................................................................. $510,000,000 

Budget estimate, 2019 ........................................................................... 30,000,000 

Committee recommendation ................................................................. 30,000,000 

The Committee recommendation for Buildings and Facilities is 

$30,000,000. 

NIOSH Facility.—The Committee is aware that CDC plans to 

consolidate the NIOSH Cincinnati research facilities, which are 

more than 50 years old, into one modern laboratory to reduce operational costs and strengthen scientific collaboration. The Committee understands that CDC plans to support this facility replacement through the Department’s Nonrecurring Expenses Fund. The 

Secretary and CDC are directed to prioritize obligations for this facility and obligate such funds as quickly as possible. 

Replacement of the Lake Lynn Experimental Mine and Laboratory.—The Secretary is directed to provide quarterly reports to the 

Committees on Appropriations of the House of Representatives and 

Senate detailing activities to replace the Lake Lynn Laboratory. 

The Committee continues to support CDC efforts to find a replacement facility. 

CDC–WIDE ACTIVITIES

Appropriations, 2018 ............................................................................. $273,570,000 

Budget estimate, 2019 ........................................................................... 155,000,000 

Committee recommendation ................................................................. 273,570,000 

The Committee provides $273,570,000 for public health leadership and support activities at CDC. 

The recommendation includes $160,000,000 in transfers from the 

PPH Fund. 

The Committee recommendation includes funding for the following activities in the following amounts: 
85 

[In thousands of dollars] 

Budget activity Fiscal year 2018 

appropriation 

Committee 

recommendation 

Preventive Health and Health Services Block Grant ...................................................... 160,000 160,000 

Public Health Leadership and Support .......................................................................... 113,570 113,570 

Preventative Health and Health Services Block Grant.—The Committee provides $160,000,000, the same level as fiscal year 2018. 

These grants are crucial for States because they provide enough 

flexibility necessary to resolve any emerging health issues at the 

local level while tailoring those activities to best address the diverse, complex, and constantly changing local community. The 

Committee encourages CDC to enhance reporting and accountability for the Block Grant which could include providing technical 

assistance to States regarding using funds for core public health 

capacities that may not be supported through other CDC funding 

streams. Enhanced reporting requirements should include how 

much funding is directed to support public health needs at the local 

level. 

The Committee does not include bill language requested by the 

administration to provide additional transfer authority to the Director beyond that which is already provided to the Secretary. 

NATIONAL INSTITUTES OF HEALTH

The National Institutes of Health [NIH] is the global leader in 

medical research, and the Committee provides an increase of 

$2,000,000,000. Over the past 4 years, the Committee has provided 

a $9,000,000,000, or 30 percent, increase for NIH after a decade of 

stagnant funding. The influx of funding prior to this bill since fiscal 

year 2016 has restored half of the purchasing power lost since the 

peak year of fiscal year 2003. This year’s increase is estimated to 

support over 11,400 new and competing grants in fiscal year 2019. 

The Committee provides $39,084,000,000 for NIH activities within the jurisdiction of this bill, an increase of 5.4 percent above fiscal year 2018. This includes $1,018,321,000 in transfers available 

under section 241 of the PHS Act. The Committee continues a reform to section 241 allocations such that no NIH funding will be 

removed from NIH under this authority. This reform ensures that 

section 241 transfers are a benefit to NIH rather than a liability. 

In addition, it improves the transparency of NIH’s budget, so that 

the enacted total is truly the amount the Committee expects to be 

used for biomedical research. 

The Committee continues its commitment to funding research on 

Alzheimer’s disease and increases funding by $425,000,000 to a 

total of approximately $2,340,000,000 in fiscal year 2019; increases 

funding for the All of Us research program, part of the Precision 

Medicine Initiative, by $86,000,000; increases funding for antibiotic 

resistance research by $37,000,000; increases funding for the 

BRAIN Initiative by $29,000,000, and increases targeted funding 

for a universal flu vaccine by $20,000,000. 

In addition, every Institute and Center receives an increase 

above fiscal year 2018 to continue investments in innovative research that will advance fundamental knowledge and speed the de-
86 

velopment of new therapies, diagnostics, and preventive measures 

to improve the health of all Americans. The Committee recognizes 

that many revolutionary discoveries often come from unexpected, 

untargeted research. The Committee continues to support these 

basic advances through the general increase to all Institutes and 

Centers and also targets investment towards clinical and 

translational research that moves basic discoveries from ‘‘bench-tobedside.’’ 

The Committee rejects the budget’s request to create 3 new Institutes at the NIH: (1) the National Institute for Research on Safety 

and Quality; (2) the National Institute for Occupational Safety and 

Health; and (3) the National Institute on Disability, Independent 

Living, and Rehabilitation Research. The Committee also does not 

move the Energy Employees Occupational Illness Compensation 

Program from CDC to NIH. 

NATIONAL CANCER INSTITUTE

Appropriations, 2018 ............................................................................. $5,957,015,000 

Budget estimate, 2019 ........................................................................... 5,626,312,000 

Committee recommendation ................................................................. 6,147,125,000 

The Committee recommendation includes $6,147,125,000 for the 

National Cancer Institute [NCI], including $400,000,000 appropriated from the NIH Innovation Account. Of this amount, 

$30,000,000 is available for repairs and improvements to the NCI 

facility in Frederick, Maryland. 

Childhood Cancer STAR Act.—The Committee has included sufficient additional funding for implementation of the Childhood Cancer Survivorship, Treatment, Access, and Research [STAR] Act. 

The Committee has included additional funding for HHS operating 

divisions consistent with the various programs authorized in the 

bill. This includes funding for NCI to support childhood, adolescent, 

and young adult cancer survivorship research, as well as biospecimen research in these populations and funding for CDC to enhance 

pediatric, adolescent, and young adult cancer surveillance. 

Colorectal Cancer.—The Committee notes African-Americans 

have colorectal cancer incidence and mortality rates significantly 

higher than other racial groups. Furthermore, the Committee recognizes that research into systemic inflammation may be important 

for the prevention and treatment of colorectal cancer. 

Deadliest Cancers.—The Committee remains concerned that 

while more effective screening methods and treatments have lowered overall cancer incidence and death rates, there still are very 

few early detection and treatment tools for ‘‘recalcitrant cancers’’- 

defined in statute as those whose 5-year survival rate is 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, and stomach. Given the toll these types of cancer 

exact on society and the lack of tools currently available to help patients, the Committee urges NIH and NCI to continue to support 

research with an emphasis on developing improved screening and 

early detection tools and more effective treatments. The Committee 

requests an update on NCI-supported research to advance these 

goals in the fiscal year 2020 CJ. 
87 

Department of Energy [DOE] Collaboration.—In 2016, DOE and 

NCI began a collaboration to develop advanced computational 

solutionsapplied to specific areas of cancer research, including preclinical drug response, molecular dynamics, and population level 

surveillance. The Committee encourages NCI to continue this collaboration with DOE and its high performance computing facilities 

to bring state-of-the-art computational and data analytics capabilities to cancer research, and to continue discussions with potential 

future collaborators in the ATOM consortium. 

Diversity in Oncology.—The Committee is aware of the lack of diversity in the field of medicine and, particularly, in oncology, and 

is also aware of the program supported by the NCI to increase the 

diversity in this area. The Committee is supportive of these actions 

and encourages the Institute to continue and expand its work on 

this issue. 

Gastric Cancer.—The Committee continues to be concerned about 

the deadly outcomes of gastric cancer, particularly among young 

adults. The 5-year survival rate for stomach cancer is 30 percent. 

The Committee encourages NCI to consider developing a scientific 

framework for advancing stomach cancer research. 

Gynecologic Cancer Clinical Trials.—Clinical trials have significantly improved survival for women with gynecologic cancers, including ovarian, endometrial, cervical, and vulvar cancers. The 

Committee encourages NCI to work with stakeholders to address 

priorities for the gynecologic oncology clinical trials scientific agenda, including consideration of the availability of trials for these patients. The Committee requests that NCI provide an update to the 

Committee in the fiscal year 2020 CJ. 

Institutional Development Award [IDeA] State and Cancer 

Trials.—The Committee recognizes that NCI supports clinical trials 

across the country through its National Clinical Trials Network 

[NCTN] and the NCI Community Oncology Research Program 

[NCORP]. The Committee believes, however, that there are more 

opportunities for academic medical centers in IDeA States to become engaged in these networks. Therefore, the Committee encourages NCI to coordinate with NIGMS to help IDeA States that do 

not currently have NCORP or NCTN awards build capacity in 

these regions to conduct cancer clinical trials. The Committee also 

encourages NCI to continue to support NCORP in its mission to increase diversity among patients participating in NCI clinical trials, 

especially with regard to rural and minority populations. Finally, 

the Committee urges NCI, in consultation with NIGMS, to encourage collaboration between IDeA awardees and existing NCI designate cancer centers, NCTN lead sites, and NCORP sites. 

Immunotherapy.—The Committee continues to be encouraged by 

new breakthroughs in cancer immunotherapy, built upon decades 

of NCI-funded research on the immune system and the ways in 

which it can be harnessed to find and destroy tumors. This new 

wave of treatment options has the potential to revolutionize treatment for a growing number of cancers. Yet much remains unknown 

about how immunotherapy works on a cellular level, and especially 

why such treatments are successful for some patients, but not for 

others. Furthermore, some patients experience side effects that are 

far different than those associated with chemotherapy. Without a 
88 

better understanding of the immune system’s response to cancer, 

the knowledge of how cancer escapes immune-based therapy, the 

capacity to quickly recognize and manage side effects, and the ability to predict which patients are most likely to respond well to 

therapy, further advances in this field will be slowed. Therefore, 

the Committee urges NCI to continue to prioritize basic research 

on the mechanisms of action involved in immunotherapy, including 

a focus on tumor resistance to immunotherapy and the underlying 

mechanisms of cancer immunotherapy toxicities. The Committee 

also recognizes the need for more basic and clinical researchers 

who have the necessary education to develop new breakthroughs in 

immunotherapy. The Committee encourages NCI to continue to 

support training for both young and mid-career researchers interested in immunotherapy. 

Improving Patient Access to Cancer Clinical Trials.—The Committee supports NCI efforts to improve patient access to and participation in cancer clinical trials across the country. One of the 

underappreciated barriers to enrollment in cancer clinical trials is 

the ancillary costs associated with participating in clinical trials, 

especially for underserved and minority patients. NCI is encouraged to explore research opportunities to improve accrual and retention by collaborating with its NCTN and the NCORP. NCTN is 

the cornerstone of NCI’s clinical trials program that conducts phase 

II and III clinical trials, and NCORP is a national network that 

brings clinical trials and cancer care delivery studies to people in 

their own communities. These programs encompass over 3,000 clinical trials sites across the country, as well as collaborations with 

many NCI-Designated Cancer Centers. The Committee also supports the NCI-Designated Cancer Centers working with their local 

community organizations to encourage enrollment of underrepresented populations onto cancer trials. The Committee requests an 

update on these efforts in the fiscal year 2020 CJ. 

Liver Cancer.—The Committee commends the NCI on recent efforts to encourage more research focused on liver cancer, but urges 

greater priority to address the threat of liver cancer, which has a 

5-year survival rate of less than 20 percent. Unlike many other 

cancers, the rates of liver cancer deaths and incidence are rising. 

The Committee urges NCI to support liver cancer research across 

its portfolio using a variety of methods to stimulate research proposals. The Committee also notes that the link between hepatitis 

B infection and primary liver cancer is well established with up to 

60 percent of global liver cancer cases caused by the hepatitis B 

virus [HBV] and, therefore, urges collaboration with NIAID and 

NIDDK on issues related to HBV research. The Committee requests an update on these activities in the fiscal year 2020 CJ. 

Metastatic Cancer Research.—The Committee remains supportive 

of early detection and prevention activities, but also notes that research into controlling and eliminating cancer that has already disseminated is of critical importance to many affected individuals 

and families. The Committee recognizes recent breakthroughs and 

innovative treatments in this area, and requests an update in the 

fiscal year 2020 CJ. 

Pancreatic Cancer Research.—In 2016, pancreatic cancer rose to 

become the third leading cause of cancer-related death in the U.S., 
89 

claiming the lives of nearly 42,000 Americans. Despite progress in 

combatting other forms of cancer, the 5-year survival rate for pancreatic cancer is just nine percent, in large part because there are 

no reliable early detection methods or effective treatment options. 

To help turn the tide against this deadly cancer, Congress in 2012 

passed the Recalcitrant Cancer Research Act (Public Law 112–239), 

calling for the development of a scientific framework for certain recalcitrant cancers. The Committee requests an update on pancreatic cancer research in the fiscal year 2020 CJ. 

Pediatric Cancer.—The Committee recognizes that cancer is the 

leading cause of death by disease amongst children and, after accidents, cancer is the second leading cause of death in children ages 

1 to 14. In 2018 alone, cancer will affect over 17,000 children, and 

many of these diagnoses will be rare forms, which lack sufficient 

therapeutic options. Moreover, children with cancer can suffer more 

severe side effects from aggressive treatments than adult patients, 

and the majority of pediatric cancer survivors live with chronic conditions because of their treatments. Improvements in treatment are 

urgently needed to address this childhood health crisis. The Committee commends NCI for launching the novel pediatric Molecular 

Analysis for Therapy Choice [MATCH] study to address some of 

these challenges, and appreciates that it will add to the body of scientific evidence necessary to determine the molecular targets substantially relevant to the growth or progression of pediatric cancer 

as required by the FDA Reauthorization Act of 2017. The Committee looks forward to receiving the report requested in the fiscal 

year 2018 Omnibus regarding how NCI is focusing on the unique 

needs of children, and expects to receive the report in July 2018. 

The Committee appreciates that this report will include an update 

on the progress of the Pediatric MATCH trial, and that it will describe how NCI supports research across the cancer research enterprise to make progress against pediatric cancers. 

Precision Oncology.—The Committee recognizes the potential for 

significant advancements in cancer treatments from the NCIMATCH trial. It remains the central pillar of the precision medicine research focused on oncology for cancers that are unresponsive 

to standard interventions. NCI should also continue to focus on the 

important pediatric-MATCH trial as pediatric oncology mechanisms are very different from mutations seen in adults. The Committee requests an update in the fiscal year 2020 CJ. 

Psycho-Social Distress Complications.—According to the Institute 

of Medicine, nearly 50 percent of all cancer patients experience distress. Further, studies suggest that distress in cancer patients 

leads to higher healthcare costs, less compliance with treatment 

pathways, and poorer health outcomes. While significant advancements have been made in biomedical treatments in cancer care, the 

Committee is concerned that the unaddressed psycho-social needs 

of patients are adversely impacting the effectiveness and cost of 

care, as well as the individuals’ overall well-being. The Committee 

encourages NCI to continue to implement distress screenings in the 

NIH Clinical Center and in NCI-funded clinical trials as appropriate, coordinate and share information on this effort with the 

FDA, and to support the development of appropriate interventions 
90 

through the support of extramural grantees, including by encouraging extramural grantees to implement such screenings. 

Translational Research Program.—The Committee notes the Specialized Programs of Research Excellence [SPORE] program is one 

of NCI’s cornerstone efforts to promote collaborative, interdisciplinary translational cancer research. The Committee continues robust support for SPORE grant programs as it works to bring basic 

research into practical treatments. The Committee commends 

NCI’s investment in this area and notes that over 60 percent of the 

NCI SPOREs are multi-center, and that 37 percent of those multicenter sites involve more than two institutions. Likewise, the Committee notes that several of the existing SPOREs focus on related 

organ site diseases (such as the GI, Neuroendocrine, and Sarcoma 

SPOREs), and another SPORE focuses on a specific pathway called 

hyperactive RAS in the context of mutations in the NF1 gene. The 

Committee requests an update in the fiscal year 2020 CJ. 

NATIONAL HEART, LUNG, AND BLOOD INSTITUTE

Appropriations, 2018 ............................................................................. $3,382,232,000 

Budget estimate, 2019 ........................................................................... 3,112,032,000 

Committee recommendation ................................................................. 3,490,171,000 

The Committee recommendation includes $3,490,171,000 for the 

National Heart, Lung, and Blood Institute [NHLBI]. 

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 and their descendants over time, much can be learned 

about cognitive decline and early biomarkers that will help the understanding of the role of environmental versus genetic factors in 

disease development and progression. Therefore, the Committee 

commends NHLBI for its work to follow its current and future cohort study participants for the development and progression of risk 

factors and to detect signs of cognitive decline in order to provide 

new insights into risk identification and accelerated prevention efforts. 

Congenital Heart Disease [CHD].—The Committee commends 

NHLBI for its continued work to better understand causation, improve treatments and outcomes, and integrate registry data and research datasets to facilitate research on congenital heart disease 

across the lifespan. The Committee encourages NHLBI to prioritize 

CHD activities outlined in its strategic plan, including improving 

understanding of outcomes and co-morbidities, modifying treatment 

options across the lifespan, and accelerating discovery, analysis, 

and translation by leveraging CHD registries and networks. The 

Committee requests NHLBI include in its fiscal year 2020 CJ a report on steps being taken to close these research gaps. 

Fibrotic Diseases.—The Committee encourages NIH to vigorously 

support funding and research into fibrotic diseases affecting different organs, including the lungs, liver, kidneys, heart, skin, and 

bones, and to ensure enhanced coordination among its Institutes as 

they conduct necessary expanded single organ or cross-organ fibrotic disease research to save lives and reduce healthcare expenses in future years. The Committee also encourages NIH to ex-
91 

plore naturally occurring fibrotic disease in domestic animals to investigate opportunities to improve human and animal lives. Since 

many fibrotic diseases are individually rare diseases, a strategy 

that provides collaboration across disease and organ areas is recommended. The Committee requests a report on the current NIH 

Fibrosis Interest Group and its progress no later than 90 days after 

enactment. The Committee encourages the Fibrosis Interest Group 

to continue its efforts to bring together key stakeholders, at the 

NIH and elsewhere, to develop strategic paths forward to maximize 

efforts in fibrotic disease research. The Committee also directs NIH 

to include an update in its fiscal year 2020 CJ on its work relating 

to idiopathic pulmonary fibrosis following the November 2012 

NHLBI workshop, ‘‘Strategic Planning for Idiopathic Pulmonary Fibrosis.’’ The Committee commends CDC on its recent work identifying and studying clusters of pulmonary fibrosis in workers, including dentists and miners, and encourages NIH and CDC to collaborate on such findings to include further research efforts and 

data sharing that could lead to better understanding of this disease 

and life-saving treatments. As noted in previous years, the Committee directs NIH to report to the Committee on its progress in 

meeting the goals enumerated in the November 2014 NHLBI report on Future Directions in Idiopathic Pulmonary Fibrosis Research. The Committee applauds increases in funding for pulmonary fibrosis at the Institute, but remains concerned that funding lags in relation to the devastating impact of the disease and 

funding for other diseases with similar patient populations and 

morbidity rates. In addition, the Committee recommends that 

NHLBI continue to encourage the use of patient registries that are 

accessible to the pulmonary fibrosis research community and operates in coordination with major medical centers and patient organizations. 

Heart Disease.—Heart disease is our Nation’s leading cause of 

death and a key source of disability, yet NIH funding is not commensurate with its burden on long-term health outcomes, financial 

stability, and novel scientific opportunities. Concerned that NHLBI 

extramural heart research has dropped 17 percent in constant dollars since 2002, the Committee encourages NHLBI, to prioritize 

and implement robust investment to drastically spur, strengthen, 

accelerate and coordinate heart research. This investment shall 

focus on expediting innovative basic, clinical, population, and 

translational research through all pertinent mechanisms. The Committee urges NHLBI to intensify the implementation of heart research recommendations and priorities, including promotion of cardiovascular health and prevention of heart failure, high blood pressure, and vascular dementia in its Strategic Vision. On NHLBI’s 

70th anniversary, the Committee commends the Institute for leadership in advancing its mission of improving prevention and treatment of heart, lung, blood, and sleep disorders. 

Hemoglobinopathies.—The Committee acknowledges NHLBI’s 

leadership on gene therapy and gene editing research, and the Institute’s investment in using these transformative technologies to 

seek cures for patients with hemoglobinopathies and other genetic 

disorders. The Committee encourages NHLBI to continue to support multi-centered research for expanded treatments for thalas-
92 

semia, sickle cell disease, and other hemoglobinopathies, with specific attention paid to gene therapy and gene editing. 

Hereditary Hemorrhagic Telangiectasia [HHT].—The Committee 

encourages NHLBI to examine heart manifestations of HHT, including the correlation between liver arteriovenous malformations 

caused by HHT and heart failure. 

Lymphatic Research.—The Committee applauds NHLBI’s work 

on lymphatic diseases and encourages further collaboration and coordination amongst relevant Institutes and Centers conducting important research in this area. 

National Chronic Obstructive Pulmonary Disease [COPD] Action 

Plan.—The Committee commends NHLBI for leading the effort to 

craft the comprehensive National COPD Action Plan requested by 

Congress. The action plan outlines research, public health, patient 

care, and awareness activities that can be supported by Federal 

agencies and strategic partners. The Committee has provided additional funding for NHLBI to begin facilitating agency-wide implementation of the action plan by supporting research activities and 

collaborating with other PHS agencies to advance implementation 

of the plan’s recommendations. The Committee expects regular updates from NHLBI on the implementation of the COPD Action 

Plan. 

Postural Orthostatic Tachycardia Syndrome [POTS].—An estimated 1,000,000 to 3,000,000 Americans suffer from POTS, a debilitating neurological disorder that affects mostly adolescent and 

adult women. Recent research shows that POTS is associated with 

autoimmune antibodies that impact the neurologic and cardiovascular systems, but more research is needed to understand the 

role of these autoantibodies in POTS and identify treatments that 

may help patients with these antibodies. Due to the lack of effective treatments, many patients are unable to attend school or work, 

causing lost economic productivity and a financial strain on families. The Committee encourages NHLBI and NINDS to jointly host 

a symposium with participants from NIAID, NIDDK, NICHD, and 

leading external researchers and stakeholders to examine the current state of POTS research. The Committee directs NIH to provide 

a report to the House and Senate Committees on Appropriations 9 

months after enactment of this act that reflects participants’ findings on: (1) the current state of POTS research; (2) priority areas 

of focus for future POTS research through 2025; (3) a summary of 

ongoing or upcoming efforts by NIH to advance the scientific understanding of POTS; and (4) an estimate of the level of funding 

that would be needed annually to achieve objectives (2) and (3). 

Pulmonary Hypertension [PH].—The Committee recognizes the 

work NHLBI is doing to advance research into pulmonary hypertension especially with attention on idiopathic pulmonary arterial 

hypertension. The Committee encourages NHLBI to continue working with stakeholders to advance critical research priorities. 

Sickle Cell.—The Committee understands the burden sickle cell 

disease places on more than 100,000 Americans. Academic medical 

centers located in States with significant populations of sickle cell 

patients have made progress in treating the disease through NIHsponsored clinical trials and through blood and marrow transplantation for sickle cell disease, which is currently the only therapy 
93 

that can cure the disease. However, Federal research spending on 

sickle cell disease has been disproportionately lower than other 

medical conditions that affect fewer Americans. The Committee encourages the NHLBI to consider an increased focus and innovation 

in treatment of sickle cell disease and continued support for highly 

meritorious research on sickle cell disease. 

Sleep Disorders.—CDC estimates that between 50,000,000 and 

70,000,000 Americans suffer from sleep and wakefulness disorders. 

Insufficient sleep is associated with diseases including diabetes, 

cardiovascular disease, obesity, and depression. To address the 

public health burden of sleep deficiency and untreated sleep disorders, there is an urgent need to improve our understanding of 

these diseases, including the identification of biomarkers to predict 

and manage risks to individual health and public safety. The Committee urges the Institute to expand discovery science efforts into 

sleep and wakefulness disorders. 

NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL RESEARCH

Appropriations, 2018 ............................................................................. $447,735,000 

Budget estimate, 2019 ........................................................................... 413,196,000 

Committee recommendation ................................................................. 462,024,000 

The Committee recommendation includes $462,024,000 for the 

National Institute of Dental and Craniofacial Research [NIDCR]. 

Temporomandibular Disorders [TMD].—The Committee is concerned that over 36,000,000 people, primarily women in their childbearing years, are affected physically, financially, and emotionally 

by TMD. The Committee is aware that TMD are primarily a multisystem disorder with overlapping conditions influenced by multiple 

biological and environmental factors rather than solely an orofacial 

pain condition. Therefore, the Committee urges NIDCR to support 

multidisciplinary research and attract scientists across other disciplines to this research. At the same time, the Committee is encouraged by the scientific meetings between NIDCR, several Institutes and Centers as well as Temporomandibular Joint [TMJ] patient groups on an integrated systems approach of precision medicine related to cellular-molecular-genetic-epigenetic mechanisms related to diagnosis and treatment of TMD and its comorbid conditions. The Committee requests an update on initiatives that resulted from the recommendations that came forth from these meetings. Further, it applauds NIDCR’s involvement in the TMJ Patient RoundTable to advance collaboration to work toward the common end of providing safe and effective treatments that improve 

patient’s quality of life. The Committee encourages continued collaboration with governmental agencies and other stakeholders in 

the project. 

NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY

DISEASES

Appropriations, 2018 ............................................................................. $1,968,083,000 

Budget estimate, 2019 ........................................................................... 1,965,434,000 

Committee recommendation ................................................................. 2,030,892,000 

The Committee recommendation includes $2,030,892,000 for the 

National Institute of Diabetes and Digestive and Kidney Diseases 

[NIDDK]. 
94 

Biomarkers.—The Committee commends the efforts of NIDDK to 

prioritize the discovery and validation of biomarkers and urges 

NIDDK to continue to prioritize this important work that will accelerate the designing and conducting of clinical trials to prevent, 

treat, and cure type 1 diabetes. Given the growing prevalence of diabetes, the Committee is concerned that additional research is 

needed to determine how to improve the treatment of a common 

complication, diabetic foot ulcers to reduce amputations, and urges 

NIDDK to support such efforts. Further, given the aging population, the Committee urges NIDDK to work with NIA to explore 

the relationship between diabetes and neurocognitive conditions, 

such as dementia and Alzheimer’s disease. 

Diabetes.—The Committee recognizes the important work of 

NIDDK, the lead Federal agency conducting research to find a cure 

for diabetes and improve diabetes care. Individuals with and at 

risk for diabetes benefit from life-sustaining advancements in preventing and treating diabetes that result from NIDDK studies. The 

Committee also recognizes the success of the NIDDK supported research in the development of essential tools to manage diabetes, including insulin pumps and blood glucose monitors, ongoing development of artificial pancreas technologies, and new and better medications to treat diabetes. The Committee urges NIDDK to commit 

resources commensurate with the severity and escalating costs of 

the epidemic to further diabetes research that will build upon these 

past successes, improve prevention and treatment, and bring the 

Nation closer to a cure. 

End-Stage Renal Disease [ESRD].—The Committee recognizes 

the work in supporting critical kidney research that NIDDK has 

accomplished including ESRD. The Committee notes the recent 

GAO report on research funding and encourages NIDDK to continue working with stakeholders to disseminate critical information 

and discuss new opportunities for research. 

Hepatitis B Virus [HBV].—The Committee notes that infection 

with HBV is a serious public health threat and 1 in 20 Americans 

has been infected and more than 2,000,000 are chronically infected, 

increasing by 80,000 a year. Left undiagnosed and untreated, 1 in 

4 or over 500,000 of those with chronic HBV infection will die prematurely from cirrhosis, liver failure, and/or liver cancer. In view 

of this public health threat, the Committee remains concerned that 

NIH research spending on HBV research was only $48,000,000 in 

2013 and has remained flat funded since then. The Committee 

notes that both the World Health Organization in 2016 and the National Academies of Science, Engineering and Medicine in 2017 

have declared that the elimination of HBV is possible. Subsequently, the HBV research community convened a virtual consensus conference that resulted in articles published in 2018 in two 

peer reviewed scientific journals, Hepatology and Antiviral Research, identifying the most urgent research questions that must 

be answered to find a cure for HBV. NIDDK is urged to pursue 

multiple critical research opportunities toward improved treatments and a cure for Hepatitis B. 

Interstitial Cystitis.—The Committee is pleased with the progress 

of interstitial cystitis research and continues to encourage NIDDK 
95 

and stakeholders to collaborate on a comprehensive scientific conference to examine mechanisms for scientific opportunity. 

Inflammatory Bowel Diseases [IBD].—The Committee is pleased 

by NIDDK’s past support of research into inflammatory bowel diseases (i.e. Crohn’s disease and ulcerative colitis). The Committee 

encourages NIDDK to build upon this foundation by exploring 

‘‘bedside-to-bench’’ approaches to regenerative medicine by clearly 

defining the clinical need and subsequent research agenda and 

bringing multi-disciplinary experts together to advance progress toward new therapeutic benefit for IBD patients. 

National Commission on Digestive Disease.—The Committee applauds NIDDK for the implementation of the recommendations of 

the 2009 National Commission on Digestive Diseases and looks forward to hearing how these recommendations have led to new findings with respect to emerging research in digestive diseases. 

NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE

Appropriations, 2018 ............................................................................. $2,149,482,000 

Budget estimate, 2019 ........................................................................... 1,838,556,000 

Committee recommendation ................................................................. 2,275,580,000 

The Committee recommendation includes $2,275,580,000 for the 

National Institute of Neurological Disorders and Stroke [NINDS], 

including $57,500,000 appropriated from the NIH Innovation Account. This amount includes $250,000,000 in funding for research 

related to opioid addiction, development of opioid alternatives, pain 

management, and addiction treatment. 

Brain Research through Advancing Innovative Neurotechnologies 

[BRAIN] Initiative.—The Committee continues its strong support of 

the BRAIN Initiative, providing $429,380,000. Deciphering the 

complexity of the human brain is a tremendous endeavor that requires large-scale, collective efforts. The focus of the initiative, to 

accelerate technology development to show the brain’s structure 

and function at the level of its cellular components and the functional circuits they form, is a grand challenge that can only be approached as a Big Science effort. Like the Human Genome project 

and its impact on genetics, the Initiative will be transformative for 

neuroscience. The Committee encourages a continuation of this 

unique opportunity to do Big Science in which large, multi-disciplinary teams work together to generate and scale up innovative technologies to produce large, publicly available datasets. As the 

BRAIN Initiative moves from its early emphasis on development of 

technologies to greater investment in production and analysis of 

data, the Committee encourages NIH to work with its Federal, academic and private partners, as well as leaders in the technology 

sector, to continue to jointly develop and adequately fund integrated, scalable data analysis hubs for BRAIN data as well as 

methods for tool dissemination. The goal of such an effort would be 

a network that has at its core an interconnected open platform of 

imaging, neurophysiological, behavioral, clinical, and molecular 

data along with the metadata essential for its interpretation. This 

collaborative effort would guide development and sharing of best 

practices in data acquisition, analysis, and choices in computational pipelines. Open sharing on this scale would enable data 
96 

analysis and visualization across institutional boundaries to accelerate understanding of brain function and dysfunction. 

Dystonia.—The Committee encourages NINDS to work with 

stakeholders to revitalize and expand the dystonia research portfolio. The Committee understands the importance of a state of the 

science conference and continues to encourage NINDS to work with 

stakeholders and other IC’s that research forms of dystonia to examine collaborative research opportunities. 

Neuroscience Research.—The Committee recognizes the importance of neuroscience research funded by the NIH, which is fueling 

a vital scientific endeavor and is the essential foundation for understanding and treating diseases that impact over 100,000,000 Americans each year. The Committee also commends the NIH for its 

successful implementation of the BRAIN Initiative, and for its 5 

year partnership with an array of agencies. 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 our reach accessible. NIH should continue 

to build off its 5 years of success as a leader and partner on the 

BRAIN Initiative, bringing together various disciplines and funding 

meritorious research to advance our knowledge of the brain. 

Parkinson’s Disease.—The Committee commends NINDS for taking critical steps in identifying priority research recommendations 

to advance research on Parkinson’s disease, which impacts between 

500,000 and 1,500,000 Americans and is the second most prevalent 

neurodegenerative disease in the United States. The ultimate success of these recommendations will depend upon targeted research 

initiatives and increased research capacity, even if innovative support and funding mechanisms are required. The Committee recognizes that NINDS is prioritizing public health concerns with severe 

gaps in unmet medical needs and believes any funding increase for 

NINDS in fiscal year 2019 should support the research recommendations set forth by NINDS planning strategy towards better treatments and, ultimately, a cure for Parkinson’s disease. The 

Committee also encourages NINDS to submit a report of its 

progress on implementing these recommendations in the fiscal year 

2020 CJ. 

Peripheral Neuropathies.—The Committee is pleased at the continued progress of ongoing research into Guillain-Barre syndrome, 

chronic inflammatory demyelinating polyneuropathy, and related 

conditions. The Committee encourages NINDS to work with NIAID 

and stakeholders on a state of the science conference on evolving 

research and scientific mechanisms. 

Phelan-McDermid Syndrome.—The Committee continues to support a multi-Institute approach to support research into PhelanMcDermid Syndrome and encourages NIH to continue to examine 

the correlation between SHANK3 and neurological diseases and the 

mental health manifestations of Phelan-McDermid Syndrome. The 

Committee requests an update in the fiscal year 2020 CJ on the 

status of research related to this topic. 

Postural Orthostatic Tachycardia Syndrome [POTS].—An estimated 1,000,000 to 3,000,000 Americans suffer from POTS, a de-
97 

bilitating neurological disorder that affects mostly adolescent and 

adult women. Recent research shows that POTS is associated with 

autoimmune antibodies that impact the neurologic and cardiovascular systems, but more research is needed to understand the 

role of these autoantibodies in POTS and identify treatments that 

may help patients with these antibodies. Due to the lack of effective treatments, many patients are unable to attend school or work, 

causing lost economic productivity and a financial strain on families. The Committee encourages NHLBI and NINDS to jointly host 

a symposium with participants from NIAID, NIDDK, and NICHD 

and leading external researchers and stakeholders to examine the 

current state of POTS research. The Committee directs NIH to provide a report to the House and Senate Committees on Appropriations 9 months after enactment of this act that reflects participants’ findings on (1) the current state of POTS research; (2) priority areas of focus for future POTS research through 2025; (3) a 

summary of ongoing or upcoming efforts by NIH to advance the scientific understanding of POTS; and (4) an estimate of the level of 

funding that would be needed annually to achieve objectives (2) 

and (3). 

Stroke.—The Committee continues its concern that stroke inflicts 

a vast burden, including topping per capita spending for all chronic 

conditions in the Medicare fee-for-service program, yet NIH spends 

only one percent of its budget on stroke research. This funding 

level is not commensurate with its burden on U.S. long-term health 

outcomes, financial stability, and novel scientific opportunities. The 

Committee strongly encourages NINDS to prioritize and implement 

robust investment to drastically spur, strengthen, accelerate, and 

coordinate stroke research. This investment shall focus on expediting novel basic, clinical, and translational research by all available and appropriate mechanisms. The Committee expects NINDS 

to intensify enactment of top stroke priorities, including prevention, 

endovascular therapy, and early stroke recovery. 

Tuberous Sclerosis Complex [TSC].—The Committee is encouraged by NIH’s updated TSC Research Plan published in 2016. 

Building on this Research Plan, the Committee encourages the Director to coordinate the participation of multiple ICs on a research 

strategy aimed at addressing the numerous medical and neuropsychological burdens associated with TSC while deciphering the 

biology underlying phenotypic heterogeneity, applying recommendations from NIH’s Neurodevelopmental Disorders Biomarkers Workshop held in December 2017 involving TSC and related 

neurodevelopmental disorders, to take advantage of biomarker expertise and lessons learned across disease groups. Manifestations of 

TSC are highly variable among affected individuals, and TSC can 

be a model condition for developing precision medicine approaches 

to treat each individual’s symptoms to maximize the benefit-risk 

ratio. NINDS should encourage research opportunities in the five 

key areas prioritized by workshop participants: understanding 

phenotypic heterogeneity in TSC, gaining a deeper knowledge of 

TSC signaling pathways and the cellular consequences of TSC deficiency, improving TSC disease models, developing clinical biomarkers of TSC, and facilitating therapeutics and clinical trials research. 
98 

NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES

Appropriations, 2018 ............................................................................. $5,280,665,000 

Budget estimate, 2019 ........................................................................... 4,761,948,000 

Committee recommendation ................................................................. 5,506,190,000 

The Committee recommendation includes $5,506,190,000 for the 

National Institute of Allergy and Infectious Diseases [NIAID]. 

Autoimmune Neuropathies.—The Committee continues to encourage NIAID and NINDS to collaborate on a state-of-the-science of 

autoimmune neuropathies research into conditions like GuillainBarre syndrome and chronic inflammatory demyelinating 

polyneuropathy. The Committee is pleased that NIAID and NINDS 

are working with stakeholders on the importance of the patient 

perspective. 

Combatting Antibiotic Resistant Bacteria [CARB].—The Committee remains deeply troubled by the global rise of drug-resistant 

bacteria, and provides $550,000,000, an increase of $37,000,000 to 

expand efforts to develop new antimicrobials, rapid diagnostics, 

and other tools and strategies against drug-resistant bacterial infections. The Committee is encouraged by the potential for novel 

approaches to addressing antimicrobial resistance, such as vaccines, bacteriophages, and antitoxins, but aware that these may be 

best suited as adjuncts and not as replacements for antibiotics. In 

an analysis issued last September, the World Health Organization 

noted that, despite the efforts made in recent years, treatment options remain ‘‘lacking for the most critical resistant bacteria, especially for multidrug and extensively drug-resistant Gram-negative 

pathogens.’’ The Committee encourages NIAID to increase its efforts to support basic science, rapid point-of-need diagnostics, drug 

discovery, and clinical trials related to Gram-negative carbapenemresistant bacteria. It commends NIAID for its leadership to address 

the threat posed by antibiotic resistant bacteria, and its collaboration with Federal partners to increase antibiotic stewardship, including ASPR and CDC, as well as its support for efforts like 

CARB-X and its international partnerships. The Committee directs 

NIAID to track trends in Research Project Grants supporting 

CARB, and requests an update on these activities in the fiscal year 

2019 CJ, including an overall assessment of the progress to date 

of efforts to address the rising threat of drug-resistant bacteria. 

Food Allergies.—Food allergies affect 15,000,000 Americans, can 

be life threatening, and have no cure. Public research funding for 

food allergies occurs at a number of sites. Currently, the Consortium of Food Allergy Research [CoFAR] network includes seven 

clinical sites/centers. In addition, approximately 10 other NIH-supported centers are conducting basic, translational and clinical research on food allergy. Within the funds provided, the Committee 

directs NIH to expand its clinical research network to add new centers of excellence in food allergy clinical care. Such centers shall be 

selected from those with a proven expertise in food allergy research. 

Hepatitis B Virus [HBV].—The Committee notes that infection 

with HBV is a serious public health threat and 1 in 20 Americans 

have been infected, with more than 2,000,000 chronically infected, 

increasing by 80,000 a year. Left undiagnosed and untreated, 1 in 
99 

4 or over 500,000 of those with chronic HBV infection will die prematurely from cirrhosis, liver failure, and/or liver cancer. In view 

of this public health threat, the Committee remains concerned that 

NIH research spending on HBV research was only $48,000,000 in 

2013 and has remained flat funded since then. The Committee 

notes that both the World Health Organization in 2016 and the National Academies of Science, Engineering and Medicine in 2017 

have declared that the elimination of hepatitis B is possible. Subsequently, the hepatitis B research community convened a virtual 

consensus conference that resulted in articles published in 2018 in 

two peer reviewed scientific journals, Hepatology and Antiviral Research, identifying the most urgent research questions that must 

be answered to find a cure for hepatitis B. NIAID is urged to issue 

targeted calls for HBV research to pursue the many critical research opportunities identified by the scientific community and report to the Committee within 90 days of enactment of this Act the 

NIAID research plan to pursue a cure for HBV. 

Lyme Disease.—With an estimated 300,000 new cases of Lyme 

disease each year, especially in rural States across the United 

States, and tens of thousands more suffering from other tick-borne 

diseases, improved understanding and treatment of these diseases 

is essential for the health and well-being of Americans. The Committee encourages NIH to issue requests for grant applications for 

research to investigate causes of all forms and manifestations of 

Lyme disease and other high-consequence tick-borne diseases, including post-treatment symptoms, as well as research to develop 

diagnostics, preventions, and treatments for those conditions. The 

Committee notes that in patients who suffer from long-term complications associated with Lyme disease, clear treatment pathways 

are often missed as a result of inaccurate and incomplete testing. 

The Committee urges NIAID, in coordination with CDC, to study 

the long-term effects on patients suffering from post-treatment 

Lyme disease syndrome, or ‘‘chronic Lyme disease.’’ Specifically, 

the Committee urges NIAID to evaluate the effectiveness of laboratory tests associated with the detection of Borrelia burgdorferi to 

diagnose the disease early, which can improve the treatment of patients suffering from Lyme disease. The Committee also encourages 

NLM, in coordination with NIAID, to update its terminology in line 

with new research to more accurately reflect the long-term effects 

of chronic Lyme disease. 

Neglected Tropical Diseases [NTDs].—One-sixth of the world’s 

population suffers from one or more NTDs. In the United States, 

we have seen Chikungunya and Dengue emerge. Only 10 percent 

of global health science resources are directed towards 90 percent 

of the global disease burden, and as such, world-class research conducted by NIH is a key component to ensuring there are tools to 

treat, control, and eventually eradicate many neglected diseases. 

The Committee urges NIAID to continue its investment in NTD research, including work in late-stage and translational research for 

NTDs, and to work with other agencies to foster research and ensure that basic discoveries are translated into much needed solutions. 

Opioid-Related Infectious Diseases Research.—The Committee 

urges NIAID, NIDA, NHLBI, NICHD, and NIMHD to expand re-
100 

search on opioid-related infectious diseases to include endocarditis, 

osteomyelitis, bacteremia, skin and soft tissue infections, and cerebral infections, in addition to HIV and hepatitis B and C, and respond to the unique barriers to care and treatment for justice-involved individuals and rural populations. Implementation studies 

should be conducted in collaboration with CDC, AHRQ, and HRSA 

to understand the best approaches for preventing and treating 

opioid related infections. 

Translational Vaccine Research.—The Committee notes a very 

promising area in the field of vaccine and immunology is 

translational vaccinology, in which researchers use innovative principles of vaccine design and enhancement to generate novel, experimental vaccines suitable for assessment and development through 

pre-clinical studies and clinical trials. The Committee strongly encourages NIAID to continue to support universal flu vaccine research and to continue to support a robust portfolio of extramural, 

highly meritorious translational vaccine research that focuses on 

an interdisciplinary approach to this research. The Committee requests NIAID provide an update in the fiscal year 2020 CJ on expansion opportunities for interdisciplinary translational vaccinology 

research. 

Universal Influenza Vaccine.—The Committee appreciates the investments that NIAID has made and intends to make to improve 

our response to the seasonal influenza virus. In response to the severity of the 2017–2018 flu season, Congress encourages NIAID to 

continue to prioritize investment in the basic and clinical scientific 

research necessary to develop a universal influenza vaccine. The 

Committee directs NIAID to allocate not less than $100,000,000 in 

fiscal year 2019 to advance basic, translational, and clinical research necessary to develop a universal influenza vaccine. In response to the severity of the 2017–2018 influenza season, the 

agreement encourages NIAID to continue to prioritize investment 

in the basic and clinical scientific research necessary to develop a 

universal influenza vaccine. The Committee encourages the continued support of the long-standing NIAID Vaccine and Treatment 

Evaluation Units [VTEUs] program. The NIAID VTEUs continue to 

play a critical role in NIAID’s effort to respond to emerging and reemerging infectious disease threats to the public health through 

their ability to rapidly test new and improved vaccine and therapeutic candidates. The Committee encourages NIAID to develop 

universal influenza vaccine candidates by utilizing the research capacity of the VTEUs, including extended stay research units with 

experience in studying human lung responses, multi-platform ’omic 

analyses, and the development of t-cell targeting universal influenza vaccines. 

Vaccination Acceleration.—The Committee encourages NIH to 

promote vaccination acceleration through controlled human experimental infection models, particularly enteric challenge models. 

These models may enable vaccination testing to move more rapidly, 

and involve fewer subjects (smaller sample sizes), launching vaccinations in the public faster. Supporting these challenge models 

will support critical research that is advancing responses to such 

diseases as salmonellosis and cholera. 
101 

NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES

Appropriations, 2018 ............................................................................. $2,785,400,000 

Budget estimate, 2019 ........................................................................... 2,572,669,000 

Committee recommendation ................................................................. 2,874,292,000 

The Committee recommendation includes $2,874,292,000 for the 

National Institute of General Medical Sciences [NIGMS], which includes $1,756,471,000 in transfers available under section 241 of 

the PHS Act. 

Institutional Development Award [IDeA].—The Committee provides $361,763,000 for the IDeA program, an increase of 

$11,188,000. The Committee believes the IDeA program has made 

significant contributions to biomedical research and has led to the 

creation of a skilled workforce and made the IDeA program an essential component of NIH’s research portfolio. The Committee recognizes the IDeA program’s significant contributions to biomedical 

research and to the development of our Nation’s biomedical research infrastructure and workforce. The Committee supports efforts to update IDeA eligibility to be based on the median NIHfunding level for all States. The Committee continues to believe 

that Primarily Undergraduate Institutes in States that do not reside in an eligible State, but that have been eligible for the National Science Foundation’s Experimental Program to Stimulate 

Competitive Research program for the past 2 consecutive years, 

would benefit from being able to apply to an entity that currently 

holds an IDeA Networks of Biomedical Research Excellence award 

for inclusion in its IDeA network. 

EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH

AND HUMAN DEVELOPMENT

Appropriations, 2018 ............................................................................. $1,460,637,000 

Budget estimate, 2019 ........................................................................... 1,339,592,000 

Committee recommendation ................................................................. 1,507,251,000 

The Committee recommendation includes $1,507,251,000 for the 

Eunice Kennedy Shriver National Institute of Child Health and 

Human Development [NICHD]. 

Fragile X [FX].—The Committee commends NICHD for leading 

the effort to map the molecular, physiological, biological, and genetic connections between FX, the fragile X protein, and autism. 

The fragile X gene and its protein continue to present important 

insight into discovering the root cause of autism and disease modifying treatments for FX and autism. The Committee urges NIH to 

explore ways to utilize funding for FX and autism in tandem to accelerate the pace of research toward identification of the commonality between the two conditions and the development of disease modifying treatments that will reduce health burdens. 

Opioid Use Disorders During Pregnancy and Neonatal Abstinence 

Syndrome [NAS].—The Committee recognizes the growing burden 

of NAS and the health care costs associated with it. The Committee 

is aware of the need for more information regarding long-term 

health and developmental outcomes related to NAS, the wide variation in clinical practice and health systems support, as well as the 

challenges associated with post-discharge care. The Committee encourages NIH to coordinate with other agencies at HHS to support 
102 

additional research on prevention, identification, and treatment of 

prenatal opioid exposure and NAS, including the best methods for 

screening and treating pregnant women for opioid use disorder and 

the best methods for screening for NAS. Additionally, the Committee encourages NIH to build on the ACT NOW study to enhance 

understanding of the impact of pharmacological and non-pharmacological treatment techniques on costs and outcomes in the shortterm and longitudinally. The Committee further encourages NIH to 

coordinate with other agencies at HHS to support research on innovative care models to optimize care and long-term outcomes for 

families. NICHD is encouraged to coordinate with other agencies, 

including CDC and HRSA, to support additional research on preventing, screening, and treating NAS. The Committee supports research regarding long-term health and development outcomes related to NAS, best practices for screening and treating pregnant 

women for opioid use disorder, and challenges associated with postdischarge care. 

Cerebral Palsy [CP].—The Committee commends NINDS for developing the CP 5-year Strategic Plan and urges NINDS to implement Funding Opportunity Announcements in support of the top 

research priorities and increase its CP research efforts for prevention, treatment, and cure through the lifespan. The Committee encourages funding for basic, translational, and implementation research (including regenerative medicine and genomic research) for 

understanding mechanisms underlying CP and improving outcomes 

for patients with CP, and recommends collaboration with the research and advocacy community to accelerate clinical research in 

CP. Furthermore, the Committee recommends that NIH form a 

trans-NIH working group of program officers who manage their institute’s CP portfolio and that the group regularly interact with CP 

patient advocacy groups. 

Dual Use/Dual Benefit.—The Dual Purpose with Dual Benefit 

Research in Biomedicine and Agriculture Using Agriculturally Important Domestic Species is an interagency partnership grants program funded by NICHD and the U.S. Department of Agriculture 

[USDA]. Both USDA and NIH should be commended for developing 

this important interagency program. The Committee strongly urges 

continuation of this partnership because it sponsors use of farm 

animals as dual purpose models to better understand developmental origins of disease, fat regulation and obesity, stem cell biology, assisted reproductive technologies, and infectious disease 

which directly benefits both agriculture and biomedicine. This program also strengthens ties between human medicine, veterinary 

medicine, and animal sciences, which is key to success of the One 

Health Initiative. 

Fertility Issues for Rare Disease Patients.—Patients with rare diseases like thalassemia face a number of issues related to reproductive health, often due to complications from their conditions or 

treatments. As a consequence of improved treatment options, 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 report on current research and future 

initiatives to address these issues and provide an update in the fiscal year 2020 CJ. 
103 

Population Research.—The NICHD Population Dynamics Branch 

fosters scientific understanding of changes in human health and 

development at the population level by supporting research and research training in demographic or population research. Through 

the Population Dynamics Centers Research Infrastructure Program, the Branch promotes the development of young scientists, efficient use of scientific resources, development of new scientific 

methods, and identification and response to emerging public health 

crises, such as the increased incidence of maternal mortality in 

parts of the United States. The Committee encourages NICHD to 

continue its commitment to this program as well as other population research activities, including support for longitudinal studies 

and efforts to advance data sharing, all of which promote an understanding of how the demography and health of our Nation are fundamentally intertwined. 

Trans-NIH Pediatric Research Consortium.—Children face many 

challenges from illness, genetic diseases, and environmental influences. The Committee continues to support increased investment in 

pediatric research and it remains critical that pediatric researchers 

are part of the NIH peer-review panels and Advisory Committees. 

Further, the Committee commends NICHD for forming a TransNIH Pediatric Research Consortium to better coordinate pediatric 

research and identify gaps and opportunities for collaboration. This 

will help ensure that pediatric health research is harmonized 

across NIH’s 27 Institutes and Centers. The Committee requests 

regular reports from NICHD on this work going forward. 

NATIONAL EYE INSTITUTE

Appropriations, 2018 ............................................................................. $772,308,000 

Budget estimate, 2019 ........................................................................... 711,015,000 

Committee recommendation ................................................................. 796,955,000 

The Committee recommendation includes $796,955,000 for the 

National Eye Institute [NEI]. 

Audacious Goals Initiative [AGI].—The Committee commends 

NEI’s leadership through its AGI, which aims to restore vision 

through regeneration of the retina by replacing cells that have been 

damaged by disease and injury and restoring their visual connections to the brain. The Committee is pleased that, to-date, NEI has 

funded novel imaging technologies to help clinicians observe the 

function of individual neurons in human patients and follow them 

over time as they test new therapies, as well as identifying new 

factors that control regeneration and comparing the regenerative 

process among model organisms. The Committee is pleased that 

NEI has launched a third funding mechanism to stimulate development of models for evaluating survival and integration of regenerated photoreceptors and retinal ganglion cells in model systems 

that are closer to human visual anatomy and function than current 

models. 

Age-Related Macular Degeneration [AMD].—The Committee recognizes the tremendous strides in the treatment of patients with 

the ‘‘wet’’ form of AMD resulting from anti-Vascular Endothelial 

Growth Factor therapies—which emerged from initial NIH-funded 

research—that stabilize vision loss and may improve lost vision. 

The Committee commends NEI for establishing an AMD 
104 

Pathobiology Working Group within its National Advisory Eye 

Council to evaluate knowledge learned from its extensive AMD 

portfolio and identify what is still uncertain, such as the relationship between genes and biological pathways, therapies for the 

more-prevalent ‘‘dry’’ form of the disease, and how to diagnose and 

treat the disease much earlier. The Committee is pleased that NEI 

has launched a prospective international study of patients that 

uses the latest advances in retinal imaging to identify biomarkers 

of the disease and targets for early therapeutic interventions. 

Blepharospasm.—The Committee is pleased that NEI is expanding research on blepharospasm, a form of dystonia. The Committee 

encourages NEI to work with NINDS and stakeholders on cross 

cutting research opportunities that affect all forms of dystonia. 

Glaucoma.—The Committee commends the recent FDA approval 

of two new drug therapies emerging from decades of NEI research 

into the role of high intraocular pressure [IOP] as a causal risk factor for primary open-angle glaucoma, the most common form of the 

disease and a leading cause of vision loss and blindness. Targeting 

the eye’s trabecular meshwork—which is one of the pathways responsible for regulating fluid flow within the eye—the new generation of therapies reflects an expanding menu of drugs that lower 

IOP and better meet the needs of patients. 

National Eye Institute 50th Anniversary.—The Committee acknowledges that 2018 marks the 50th anniversary of Congress creating the NEI as NIH’s institute leading the Federal commitment 

to sight-saving and vision-restoring research. The Committee recognizes NEI’s role in basic research as a leader in determining the 

genetic basis of eye disease, having identified genes associated with 

both common and rare eye diseases. The Committee also recognizes 

NEI’s leadership in clinical research, such as with the current Diabetic Retinopathy Clinical Research Network, which has been instrumental in developing the standard of care for diabetic eye disease. 

NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES

Appropriations, 2018 ............................................................................. $751,143,000 

Budget estimate, 2019 ........................................................................... 693,199,000 

Committee recommendation ................................................................. 775,115,000 

The Committee recommendation includes $775,115,000 for the 

National Institute of Environmental Health Sciences [NIEHS]. 

NATIONAL INSTITUTE ON AGING

Appropriations, 2018 ............................................................................. $2,577,550,000 

Budget estimate, 2019 ........................................................................... 1,988,200,000 

Committee recommendation ................................................................. 3,084,809,000 

The Committee recommendation includes $3,084,809,000 for the 

National Institute on Aging [NIA]. 

Alzheimer’s Disease.—The Committee provides an increase of 

$425,000,000 for Alzheimer’s research, bringing the total funding 

level in fiscal year 2019 to $2,340,000,000, meeting and surpassing 

the $2,000,000,000 goal laid out in the National Plan to Address 

Alzheimer’s Disease 6 years earlier than the 2025 goal. The NIA 

is encouraged to continue addressing the research targets outlined 

in the fiscal year 2019 Professional Judgement Budget. Further, 
105 

the Committee applauds the work of NIH to support Alzheimer’s 

disease clinical trials and for recognizing the need to reduce the 

time and cost of such trials, including those involving patients who 

are asymptomatic or in the earliest stages of the disease. The Committee is concerned about the under-representation of minority 

populations in these trials and directs NIMHD to collaborate with 

the NIA and other Institutes to develop an action plan to address 

this gap. The action plan should include a review of the NIA’s current public reporting practices of the recruitment and retention of 

underrepresented populations in Alzheimer’s research. In addition, 

the Committee recognizes the Institute’s leadership in driving 

greater access to research data and investing in data infrastructure 

to accelerate the discovery of treatments for Alzheimer’s disease 

and related dementias. The Committee encourages NIA to consider 

a comprehensive approach to expand and enhance these efforts 

through policies that prioritize data sharing, new funding that supports data sharing and harmonization, and partnerships with other 

Alzheimer’s disease data efforts to promote a coordinated data ecosystem. 

Finally, 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 an enhanced risk for dementia, the value and application 

of these studies is enhanced when they include individuals from 

various geographic, ethnic, socio-economic and generational backgrounds. Therefore, the Committee directs NIA to diversify its cohort studies, with the specific goal of better understanding disease 

burden and biomarkers by race and geographic region. 

Alzheimer’s Vaccine.—Today, 5,700,000 Americans are living 

with Alzheimer’s disease, yet safe and effective treatments for the 

disease are still out of reach. More than 10 years ago, it was demonstrated in transgenic mouse models that vaccination may be a 

novel therapy for Alzheimer’s disease by preventing, delaying, or 

reversing the formation of associated pathologic lesions. Recent evidence suggests that the next generation of active or passive vaccines are promising therapies for efficacious treatment. With the 

number of Americans diagnosed with Alzheimer’s expected to rise 

to nearly 14,000,000 by 2050, the Committee encourages NIA to 

consider the development and testing of promising vaccine candidates a high priority. The Committee directs NIH to provide a report to the Committee on the progress related to a vaccine treatment no later than 180 days after enactment of this act. 

Caregiver Research.—At any given time, more than 15,000,000 

Americans are providing informal care to an older relative with dementia. However, dementia caregivers experience considerable 

stress and depression; impaired subjective well-being, self-efficacy, 

and physical health, and perhaps even increased mortality. The 

Committee encourages the NIA to fund a pilot community-based 

peer support program designed to develop an accessible, feasible, 

and sustainable program that capitalizes on the expertise of persons who best know the demands of dementia, caregiving—former 

caregivers themselves. Persons who previously cared for a person 

with dementia but have transitioned out of that role can provide 

one-on-one problem-solving, or coaching, for current dementia care-
106 

givers. Family care is preferred by both family members and people 

with dementia themselves, and removes a substantial burden from 

the U.S. healthcare system. 

Population Research.—The Committee applauds NIA for including the population sciences in its Alzheimer’s disease research portfolio. Specifically, the Committee is pleased to learn that NIA is 

collecting nationally representative data via the Health and Retirement Study to measure cognitive function, which will inform our 

understanding of national trends and differences. In addition to enhancing data collection, NIA is commended for developing a dementia care research agenda and adding an Alzheimer’s disease research component as part of the Roybal Centers of Translation Research in Behavioral and Social Sciences of Aging, Resource Centers for Minority Aging Research, and Demography and Economics 

of Aging Centers program. The Committee urges NIA to sustain 

these activities while also encouraging more research from the field 

related to the underlying causes of regional health disparities, including differences in U.S. adult mortality rates. 

NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN

DISEASES

Appropriations, 2018 ............................................................................. $586,661,000 

Budget estimate, 2019 ........................................................................... 545,494,000 

Committee recommendation ................................................................. 605,383,000 

The Committee recommendation includes $605,383,000 for the 

National Institute of Arthritis and Musculoskeletal and Skin Diseases [NIAMS]. 

Epidermolysis Bullosa.—The Committee recognizes the promising scientific gains and applauds private partners advancing research in pursuit of treatments for Epidermolysis Bullosa. The 

Committee encourages NIH to continue to support such research at 

NIAMS. 

NATIONAL INSTITUTE ON DEAFNESS AND OTHER COMMUNICATION

DISORDERS

Appropriations, 2018 ............................................................................. $459,974,000 

Budget estimate, 2019 ........................................................................... 423,992,000 

Committee recommendation ................................................................. 474,653,000 

The Committee recommendation includes $474,653,000 for the 

National Institute on Deafness and Other Communication Disorders [NIDCD]. 

Spasmodic Dysphonia.—The Committee continues to encourage 

NIDCD to expand research on spasmodic dysphonia, a form of 

dystonia. The Committee also encourages NIDCD to meet with 

stakeholders to link research with the needs of the community. 

NATIONAL INSTITUTE OF NURSING RESEARCH

Appropriations, 2018 ............................................................................. $158,033,000 

Budget estimate, 2019 ........................................................................... 145,842,000 

Committee recommendation ................................................................. 163,076,000 

The Committee recommendation includes $163,076,000 for the 

National Institute of Nursing Research [NINR]. 
107 

NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM

Appropriations, 2018 ............................................................................. $509,604,000 

Budget estimate, 2019 ........................................................................... 469,109,000 

Committee recommendation ................................................................. 525,867,000 

The Committee recommendation includes $525,867,000 for the 

National Institute on Alcohol Abuse and Alcoholism [NIAAA]. 

Moderate Alcohol and Cardiovascular Health Trial [MACH].— 

The Committee is deeply troubled by news reports, confirmed by 

NIH’s own internal review, that NIAAA senior leadership and staff 

colluded with potential underwriters in industry to fund a study of 

the benefits of moderate drinking. The review by the Advisory 

Committee to the Director [ACD] found there was early and frequent NIAAA engagement with industry that calls into question 

the impartiality of program managers, and would cast doubts about 

the credibility of any scientific knowledge that might be gained 

from the study. There were also interactions that appear to provide 

the eventual principal investigator with a competitive advantage 

not available to other applicants. Industry and NIAAA interactions 

appeared to intentionally bias the framing of the scientific premise 

in the direction of demonstrating a beneficial health effect of moderate alcohol consumption. Specifically, the study excluded some 

populations that could potentially be most harmed by alcohol consumption and did not include enough follow-up time to allow for 

meaningful assessment of cancer and heart disease endpoints. 

Thus, the trial could show benefits while missing harms. To its 

credit, NIH moved quickly to investigate and terminate the study, 

as well as to review research practices throughout the agency to 

identify whether there are other inappropriate relationships that 

might bias research findings. The credibility of NIH research is 

central to its mission, and it does not require many incidents like 

the failures related to the MACH trial to cause longstanding damage to its reputation. The Committee directs NIH to provide a report 30 days after enactment of this act describing in detail how 

it is implementing the ACD’s recommendations to strengthen its 

internal controls, including the costs associated with these efforts. 

The report should also highlight the steps NIH is taking to restore 

the public’s confidence. 

NATIONAL INSTITUTE ON DRUG ABUSE

Appropriations, 2018 ............................................................................. $1,376,657,000 

Budget estimate, 2019 ........................................................................... 1,137,403,000 

Committee recommendation ................................................................. 1,420,591,000 

The Committee recommendation includes $1,420,591,000 for the 

National Institute on Drug Abuse [NIDA]. This includes 

$250,000,000 in funding for research related to opioid addiction, development of opioid alternatives, pain management, and addiction 

treatment. 

Alcohol’s Role in Opioid Overdose.—The Committee is concerned 

that the role of alcohol in opioid and other drug overdoses is not 

receiving the attention it should. CDC estimates that alcohol contributes to over 8,000 annual overdose deaths that are primarily 

attributed to other substances, and that data suggest alcohol is 

commonly omitted from death certificates leading to under-
108 

reporting. To address the opioid crisis, all avenues of investigation 

must be addressed. The Committee directs NIAAA to work with 

NIDA and any other appropriate agencies to better understand 

these linkages and to support research that will help to address 

this aspect of the problem. 

Barriers to Research.—The Committee is concerned that restrictions associated with Schedule 1 of the Controlled Substance Act 

effectively limit the amount and type of research that can be conducted on certain Schedule 1 drugs, especially marijuana or its 

component chemicals and certain synthetic drugs. At a time when 

we need as much information as possible about these drugs, we 

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 1 substances. 

Marijuana Research.—The Committee is concerned by the lack of 

research on marijuana and marijuana products, especially increasing potency. The Committee is concerned with the rapidly changing 

landscape regarding the recreational use of marijuana—the effects 

that the drug can have on brain development; addiction; the longterm health effects in both youth and older individuals. The Committee directs NIH to coordinate a multi-Institute approach to increase research related to the effect of increasing delta-9- 

tetrahydrocannabinol levels on the human body as well as the effect of various delta-tetrahydrocannabinol levels on cognitive abilities that are required to, for example, operate motor vehicles. The 

Committee requests an update on the status of research related to 

these topics be included in the fiscal year 2020 CJ. Further, the 

Committee remains concerned that NIDA ceased funding for analysis of marijuana samples seized by law enforcement in 2014. 

Without dedicated funding for this activity, the number of analyzed 

seized samples has plummeted, meaning that available data is no 

longer current or robust. The Committee believes that such research, along with analysis of marijuana and marijuana-derived 

products sold commercially in dispensaries or online, is essential 

for informing substance misuse and addiction prevention efforts, 

public health policy, and law enforcement tactics across the Federal 

Government. The Committee continues to direct NIDA to coordinate efforts with the DEA and other law enforcement agencies to 

monitor Schedule I marijuana and marijuana-derived products. 

Neonatal Abstinence Syndrome [NAS].—The Committee is aware 

that the rising untreated use of opioids by pregnant mothers is one 

of the main causes for the Nation’s opioid epidemic and that it 

causes death or sometimes critical mental and physical health 

problems in babies who do survive. The Committee understands 

that until the need for interventions to reduce the use and abuse 

of opioids during pregnancy is addressed, the problem is likely to 

continue, with post-delivery effects on mothers and infants continuing to be a medical, social, and financial burden. The Committee encourages NIDA and NICHD to continue to support research that will help clinicians and academic research institutions 

to develop a comprehensive approach to the prevention and treatment of NAS. 
109 

Opioid Misuse and Addiction.—The bill includes $250,000,000 for 

targeted research related to opioid misuse and addiction, development of opioid alternatives, pain management, and addiction treatment. The Committee remains concerned about the growing epidemic of opioid misuse and addiction in this country. The widespread availability of prescription opioids has contributed to the 

millions of Americans who suffer from addiction disorders. Although NIH has studied the effectiveness and risks associated with 

long-term opioid use for chronic pain, little research has been done 

to investigate new and alternative treatment options to treating 

chronic pain, other than with highly addictive opioid painkillers 

and muscle relaxants. The Committee directs NIH to expand scientific activities related to research on medications used to treat 

and reduce chronic pain, and the transition from acute to chronic 

pain. Further, the Committee urges NIH to: (1) continue funding 

research on medication development to alleviate pain and to treat 

addiction, especially the development of medications with reduced 

misuse liability; (2) as appropriate, work with private companies to 

fund innovative research into such medications; (3) report on what 

we know regarding the transition from opioid analgesics to heroin 

and synthetic opioid use and addiction within affected populations; 

(4) conduct pilot studies to create a comprehensive care model in 

communities nationwide to prevent opioid misuse, expand treatment capacity, enhance access to overdose reversal medications, 

and enhance prescriber practice; (5) test interventions in justice 

system settings to expand the uptake of medication assisted treatment and methods to scale up these interventions for populationbased impact; and (6) develop evidence-based strategies to integrate screening and treatment for opioid use disorders in emergency department and primary care settings. In addition, NIH 

should continue to sponsor research to better understand the effects of long-term prescription opioid use, especially as it relates to 

the prevention and treatment of opioid misuse and addiction. 

Opioid Research Centers.—The Committee supports the creation 

of one or more research centers to study the effectiveness of policies 

related to combatting prescription opioid use. Preference should be 

given to research done in States with high levels of prescription 

opioid use, opioid overdose deaths, and racial and ethnic diversity. 

Raising Awareness and Engaging the Medical Community in 

Drug Abuse and Addiction Prevention and Treatment.—Education 

is a critical component of any effort to curb drug use and addiction, 

and it must target every segment of society, including healthcare 

providers (doctors, nurses, dentists, and pharmacists), patients, 

and families. Medical professionals must be in the forefront of efforts to curb the opioid crisis. The Committee continues to be 

pleased with the NIDAMeD initiative, targeting physicians-intraining, including medical students and resident physicians in primary care specialties (i.e. internal medicine). 

NATIONAL INSTITUTE OF MENTAL HEALTH

Appropriations, 2018 ............................................................................. $1,757,657,000 

Budget estimate, 2019 ........................................................................... 1,612,192,000 

Committee recommendation ................................................................. 1,871,250,000 
110 

The Committee recommendation includes $1,871,250,000 for the 

National Institute of Mental Health [NIMH], including $57,500,000 

appropriated from the NIH Innovation Account. 

Improving the Treatment of Mental Illness.—The Committee encourages NIMH to continue to ensure a diverse research portfolio 

of basic neuroscience, applied, and translational research, with a 

continued focus on excellent science. 

Post-Traumatic Stress Disorder [PTSD].—The Committee supports NIMH’s efforts to support a diverse portfolio of research on 

post-traumatic stress conditions, including research to identify risk 

and protective factors, develop and test interventions, and implement models for delivering care across settings. The Committee encourages NIMH to continue to support the Aurora study, a comprehensive 5-year study of mental health outcomes following trauma exposure to understand how mental illnesses like PTSD develop to understand modifiable factors that may be targets of new 

treatments. This and similar efforts have the potential to greatly 

impact care for individuals with and at-risk for PTSD. 

Suicide Prevention and Risk Detection Algorithms.—The Committee is alarmed by new data from CDC that indicates that suicide rates have increased nationwide by 30 percent since 1999. 

Data also shows that the suicide rate among children, and especially minority children, has significantly risen over the past decade. NIMH has had some encouraging breakthroughs in research 

on risk detection algorithms, and these tools can be made increasingly sophisticated now with the power of big data tools. The Committee urges NIMH to prioritize its suicide prevention research efforts to produce models that are interpretable, scalable, and practical for clinical implementation, including mental and behavioral 

health care interventions, to combat suicide in the United States. 

The Committee directs NIH to provide an update on these efforts, 

including its work with CDC, SAMHSA, and the Department of 

Education, in the fiscal year 2020 CJ. 

NATIONAL HUMAN GENOME RESEARCH INSTITUTE

Appropriations, 2018 ............................................................................. $558,072,000 

Budget estimate, 2019 ........................................................................... 512,979,000 

Committee recommendation ................................................................. 575,882,000 

The Committee recommendation includes $575,882,000 for the 

National Human Genome Research Institute [NHGRI]. 

Centers of Excellence in Genomic Sciences.—The Committee notes 

that as genomics becomes the pathway to new cures and therapeutics for many diseases, NHGRI and other Institutes must continue to look for new ways to build capacity at institutions that 

have strengthened their expertise in the field, but have yet to be 

able to compete for the current RM1 and UM1 awards. The Committee instructs NHGRI to conduct, and provide to the Committee, 

a portfolio analysis within 180 days of enactment. The analysis will 

assess the distribution of NHGRI’s funding through the RM1, UM1, 

and other grant mechanisms to ensure NHGRI is effectively supporting capacity-building in genomics research and supporting diverse and innovative institutions, especially in academic medical 

research institutions that are making significant investments in 
111 

genomics tools and research, but have not yet been the recipient of 

a RM1 or UM1 award. 

NATIONAL INSTITUTE OF BIOMEDICAL IMAGING AND BIOENGINEERING

Appropriations, 2018 ............................................................................. $377,618,000 

Budget estimate, 2019 ........................................................................... 346,550,000 

Committee recommendation ................................................................. 389,672,000 

The Committee recommendation includes $389,672,000 for the 

National Institute of Biomedical Imaging and Bioengineering 

[NIBIB]. 

Traumatic Brain Injury.—The Committee encourages the NIBIB 

to conduct state of the art translational research in the diagnosis, 

prognosis, and treatment of neurotrauma. Neurotrauma is the umbrella term for two primary pathologies, spinal cord injuries and 

traumatic brain injuries. These injuries are unique in that they affect how and who a person is, with incredible variation between patients. The sizable incidence of injury and prevalence of disability 

resulting from neurotrauma results in significant human and economic burden. As befits the complexity of the challenges from 

neurotrauma, multiple NIH Institutes and Centers coordinate research, which ranges across a wide spectrum, from understanding 

the cellular mechanisms of immediate and delayed damage, though 

development of better prevention, treatment, and rehabilitation, 

and engages scientists, engineers, and clinicians from a broad 

range of disciplines. The Committee recognizes the need for crossdisciplinary collaboration to meet these challenges and strongly encourages NIH to support such research through all appropriate 

support mechanisms. 

NATIONAL CENTER FOR COMPLEMENTARY AND INTEGRATIVE HEALTH

Appropriations, 2018 ............................................................................. $142,018,000 

Budget estimate, 2019 ........................................................................... 130,717,000 

Committee recommendation ................................................................. 146,550,000 

The Committee recommendation includes $146,550,000 for the 

National Center for Complementary and Integrative Health 

[NCCIH]. 

National Center for Complimentary and Integrative Health.—The 

Committee is encouraged by the ongoing collaboration between 

NCCIH, VA, DOD, and other Institutes across the NIH to develop 

and test efficacious non-pharmacological approaches to pain management and comorbidities—including opioid misuse, abuse, and 

disorder—in military personnel, veterans, and their families. The 

Committee is particularly encouraged by the ongoing studies that 

will assess provider adherence to CDC opioid prescribing practices 

and develop integrated pain care approaches to reduce pain and 

opioid use in patients enrolled in a large healthcare system. In addition, the Committee believes it is critical to support research on 

non-pharmacological treatments to ensure the best quality of care 

for our Nation’s veterans and servicemembers, and urges the NIH, 

VA, and DOD to continue this vital research. The Comprehensive 

Addiction and Recovery Act (Public Law 114–198) calls for an expansion of research and education on and delivery of complimentary and integrative health to veterans, and the NCCIH can play 

an important role in coordinating efforts with the VA, DOD, and 
112 

other relevant agencies. The Committee requests an update on 

these studies in the fiscal year 2020 CJ. 

NATIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH DISPARITIES

Appropriations, 2018 ............................................................................. $305,108,000 

Budget estimate, 2019 ........................................................................... 280,545,000 

Committee recommendation ................................................................. 314,845,000 

The Committee recommendation includes $314,845,000 for the 

National Institute on Minority Health and Health Disparities 

[NIMHD]. 

Focal Segmental Glomerulosclerosis [FSGS].—The Committee 

recognizes the work that NIMHD and NIDDK are doing to address 

the connection between certain genes, including the APOL1 gene, 

and the onset of FSGS. The Committee encourages NIMHD to 

work with community stakeholders to identify areas of collaboration. 

Hepatitis B Virus [HBV].—The Committee notes that HBV infection is a serious public health threat with 1 in 20 Americans infected and more than 2,000,000 chronically infected, increasing by 

80,000 a year. Left undiagnosed and untreated, 1 in 4, or over 

500,000, of those with chronic HBV infection will die prematurely 

from cirrhosis, liver failure, and/or liver cancer. The Committee 

notes that half of all hepatitis B patients in the U.S. are AsianAmerican immigrants or Pacific Islanders, though these groups 

only account for about 6 percent of the population. Further, among 

African immigrants, the prevalence of hepatitis B is about 10 percent. The Committee urges NIMHD to fund research to test scaleup model programs that increase hepatitis B awareness, knowledge, prevention through vaccination, testing, and treatment 

through linkage to care among the disproportionately hepatitis B 

impacted communities. 

JOHN E. FOGARTY INTERNATIONAL CENTER FOR ADVANCED STUDY IN

THE HEALTH SCIENCES

Appropriations, 2018 ............................................................................. $75,733,000 

Budget estimate, 2019 ........................................................................... 70,084,000 

Committee recommendation ................................................................. 78,150,000 

The Committee recommendation includes $78,150,000 for the 

Fogarty International Center [FIC]. 

John E. Fogarty International Center.—Recent disease outbreaks 

such as Ebola, Zika, and Dengue have shown the importance of the 

Center’s essential role in global infectious disease health research 

training to help developing countries advance their own research 

and health solutions and tools. FIC has developed important partnerships to not only fight malaria, neglected tropical diseases, and 

other infectious diseases but also to have the capabilities to detect 

and treat infectious diseases that are not endemic to the United 

States before they travel to the United States thus protecting 

Americans here at home. The Committee urges FIC to continue 

this important work building relationships with scientists abroad 

to foster a stronger and more effective science workforce and health 

research capacity on the ground, helping to detect infectious diseases and building the capacity to confront those diseases while im-
113 

proving the image of the U.S. though health diplomacy in their 

countries. 

NATIONAL LIBRARY OF MEDICINE

Appropriations, 2018 ............................................................................. $428,553,000 

Budget estimate, 2019 ........................................................................... 395,493,000 

Committee recommendation ................................................................. 442,230,000 

The Committee recommends $442,230,000 for the National Library of Medicine [NLM]. Of the funds provided, $4,000,000 is for 

the improvement of information systems, to remain available until 

September 30, 2020. 

NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCES

Appropriations, 2018 ............................................................................. $762,454,000 

Budget estimate, 2019 ........................................................................... 685,087,000 

Committee recommendation ................................................................. 806,787,000 

The Committee recommendation includes $806,787,000 for the 

National Center for Advancing Translational Sciences [NCATS]. 

The Committee includes bill language allowing up to $80,000,000 

of this amount to be used for the Cures Acceleration Network 

[CAN]. 

Clinical and Translational Science Awards [CTSA] Program.— 

The Committee encourages the NCATS to fund, through the existing CTSA Program hubs, expanded efforts to improve translational 

research that address health disparities and the significant burden 

of conditions that disproportionately affect minority and special 

populations. Accelerating translational research by making it more 

efficient and effective will reduce the burden of disease and promote health equity. Applying the CTSA model to address longstanding regional health disparities can provide innovative, multidisciplinary approaches to reducing the burden of disease among 

vulnerable populations. The Committee supports the goals of the 

NCATS program and believes the principles that serve as the foundation of NCATS; public-private partnerships, community outreach, 

faster access to clinical trials, have tremendous potential for addressing the long-standing diseases associated with health disparities. The Committee encourages NCATS to fund institutions with 

a history of serving health disparity populations. 

OFFICE OF THE DIRECTOR

Appropriations, 2018 ............................................................................. $1,814,745,000 

Budget estimate, 2019 ........................................................................... 1,808,306,000 

Committee recommendation ................................................................. 1,922,660,000 

The Committee recommendation includes $1,922,660,000 for the 

Office of the Director [OD]. Within this total, $606,885,000 is provided for the Common Fund and $12,600,000 is included for 

Gabriella Miller Kids First Research Act. 

Academic Research Enhancement Award [AREA] Program.—The 

Committee believes that biomedical discoveries can occur anywhere, and continues to support programs that foster biomedical 

research and opportunities for students at institutions who may 

not receive significant NIH funding. In particular, the Committee 

continues its long-standing support of the IDeA program. However, 
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the Committee notes that many institutions that may benefit from 

the IDeA program are ineligible because they reside in States that 

are not IDeA States. The Committee encourages NIH to enhance 

support for the AREA program and is urged to develop ways to improve ties between institutions that receive significant NIH funding 

and AREA-eligible institutions. 

Administrative Burdens in Grant Preparation.—The Committee 

recognizes that certain administrative tasks are critical to the research process and applauds the NIH’s efforts to identify and reduce sources of administrative burden for researchers. The Committee encourages NIH to identify additional ways to enable researchers to spend more productive time working on science, rather 

than applying for and reporting on grants. The Committee notes 

that the modular budget cap has not increased with inflation, and 

that grant applications with necessary costs above the modular 

budget cap incur additional administrative responsibilities. The 

Committee requests an update from NIH in the fiscal year 2020 CJ 

regarding the effect of modular budget cap increases on reducing 

administrative burdens while maintaining appropriate fiscal oversight of grant costs. 

All of Us Research Program, Part of the Precision Medicine Initiative.—The Committee recommendation strongly supports the All 

of Us Research Program, part of the Precision Medicine Initiative 

and has provided $376,000,000 in support of this Initiative. The 

Committee recognizes the potential that precision medicine holds 

for all populations, including children, and encourages NIH to 

prioritize timely and meaningful enrollment for the pediatric population, including healthy children and those with rare diseases, in 

the All of Us Research Program. The Committee is encouraged that 

NIH impaneled a Child Enrollment Scientific Vision Working 

Group, which released a report that identifies scientific opportunities relevant to child health. The Committee requests an update 

within 60 days after the enactment on the timing for the Special 

Populations Committee to provide recommendations regarding the 

practical considerations of child enrollment and data collection involving children. Additionally, the Committee requests that NIH 

provide an update on plans to ensure that the research cohort includes a sufficient number of children to make meaningful studies 

possible, the target date for enrollment to commence and how enrollment strategies will include input from pediatric stakeholders 

across the country with experience in pediatric clinical trial enrollment. 

Amyloidosis.—The Committee recommends that NIH expand its 

research efforts into amyloidosis, a group of rare diseases characterized by abnormally folded protein deposits in tissues. Amyloidosis is often fatal, and there is no known cure. Current methods 

of treatment are risky and unsuitable for many patients. The Committee directs NIH to 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. 

Biomedical Research Facilities.—The Committee believes that 

the Nation’s biomedical research infrastructure, including laboratories and research facilities at academic institutions, is out of date 
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and insufficient. Therefore, the Committee has provided 

$50,000,000 for grants or contracts to public, nonprofit, and not-forprofit entities to expand, remodel, renovate, or alter existing research facilities or construct new research facilities as authorized 

under 42 U.S.C. section 283k. The Committee urges NIH to consider recommendations made by the NIH Working Group on Construction of Research Facilities, including making awards that are 

large enough to underwrite the cost of a significant portion of 

newly constructed or renovated facilities. 

Brain Research Through Application of Innovative Neuro-technologies [BRAIN] Initiative.—The Committee continues to strongly 

support the BRAIN Initiative. The bill provides the full President’s 

request of $429,380,000, an increase of $29,000,000 above fiscal 

year 2018. 

Big Data.—Two years ago, the Committee tasked NIH with developing a strategic plan to outline how it will manage and make 

the most of the data it is producing. Although medical research 

benefits from the rise of unprecedented new tools, technologies, and 

computational power, it also faces the challenge of making the 

most of the staggering and ever-growing amount of data that NIH 

and its grantees produce. NIH recently finalized its strategic plan, 

which thoughtfully outlines key areas of focus. Initial drafts of the 

plan called for the agency to develop performance measures and 

specific milestones for the plan’s objectives during 2018, but subsequent versions dropped this goal. The Committee assumes NIH 

opted to defer making specific commitments until it fills the newly 

established position of Chief Data Strategist [CDS], which is understandable given that the CDS will have sweeping responsibilities. 

These include leading efforts to develop a next-generation technology platform to accelerate scientific discovery, implementing innovative new approaches to increase the skills of NIH researchers, 

and representing the agency in national and global data strategy 

matters. While the CDS will report directly to the NIH Director, 

the Committee wants to ensure that the CDS has the support and 

authority needed to successfully implement the plan. Success will 

require cooperation from all 27 of the agency’s Institutes and Centers and entail relinquishing some, perhaps much, of the autonomy 

they now have over data management, technology and tools, and 

training. To help ensure that happens, the Committee directs the 

CDS to provide quarterly briefings on NIH’s efforts to implement 

the strategic plan. In addition, the Committee directs NIH to finalize an initial set of metrics and milestones, recognizing that these 

may evolve as implementation of the plan proceeds, within 60 days 

of enactment of this act. Finally, the Committee has included 

$30,000,000 to support the CDS’ work in fiscal year 2019. 

BSL–4 Laboratory.—The Committee encourages NIH to evaluate 

the need for additional BSL–4 laboratory space for the purpose of 

addressing the growing threat posed by current and emerging infectious diseases. Priority should be given to organizations with a 

history of efficiently and successfully conducting this complex research. 

Chronic Disease Center.—Chronic diseases and conditions, such 

as heart disease, kidney diseases, stroke, cancer, type 2 diabetes, 

obesity, and arthritis/autoimmune diseases, are among the most 
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common, costly, and preventable of all health conditions. As of 

2012, about half of all adults had one or more chronic health conditions, with 25 percent of adults suffering with two or more chronic 

health problems. The Committee strongly believes that NIH needs 

to focus chronic disease efforts on those populations most affected. 

Therefore, the Committee directs the NIH Director to fund a transNIH initiative involving, at a minimum, NIDDK, NCI, NIAMS, 

NINDS, NIAID, and NHBLI to address the increasing burden of 

chronic diseases. The initiative will focus on heart and kidney diseases, stroke, obesity, cancer, diabetes, exercise medicine, and 

health disparities in these areas. Programs should have a strong 

existing track record of NIH funding in all these areas, such as a 

NIH-funded Nutrition Obesity Research Center, Diabetes Research 

Center, O’Brien Kidney Center, Center for Health Disparities Research, and Center for Exercise Medicine. Additionally, regional 

multi-institutional consortiums are strongly encouraged. The NIH 

Director will report to the Committee within 120 days on the structure, leadership, funding, and key areas of focus for one or more 

chronic disease centers. 

Chronic Fatigue Syndrome [ME/CFS].—The Committee is 

pleased that NIH has begun to expedite research into ME/CFS. 

However, NIH itself has acknowledged that there are too few centers and that 10 to 20 times more funding is required to make 

progress in the field. The Committee is concerned that NIH’s current plans to increase research activities and funding will take too 

long to produce the FDA-approved treatments and diagnostic tests 

critically needed by patients and their doctors. The Committee 

urges NIH to collaborate with disease experts and the patient community to identify additional opportunities to expedite progress on 

this understudied disease. Specifically, the Committee recommends 

that NIH increase research to: (1) identify underlying causes of the 

illness to enable therapies that would effectively prevent or treat 

the illness; (2) identify biological markers linked to the various 

forms of the illness to optimize selection of specific patient subgroups for trials; (3) increase investigator-initiated studies and 

early stage investigator awards; (4) develop mechanisms to 

incentivize researchers to enter the field. 

Chronic Overlapping Pain Conditions.—The Committee is concerned with the lack of progress in advancing a comprehensive initiative on Chronic Overlapping Pain Conditions, especially in light 

of recent findings from major studies funded by the agency demonstrating the significant prevalence and cost of Chronic Overlapping Pain Conditions, as well as the associated disability and detrimental health and quality of life outcomes for those with these debilitating disorders. The Committee strongly encourages the Director to continue to assess the state of science on Chronic Overlapping Pain Conditions and use the findings to continue to advance 

the scientific understanding of Chronic Overlapping Pain Conditions, as well as the development and discovery of safe and effective treatments. 

Coffin-Siris Syndrome.—The Committee recognizes the promising 

scientific gains and applauds private partners advancing research 

in pursuit of treatments for Coffin-Siris Syndrome. The Committee 

encourages NIH to continue to support such research at NIH. 
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Confucius Institutes.—The Committee has strong concerns with 

the growing influence of the People’s Republic of China’s [PRC] increasingly aggressive attempts to use ‘‘Confucius Institutes,’’ which 

are Chinese Government-run programs that use the teaching of 

Chinese language and culture as a tool to expand the political influence of the PRC. The PRC uses Confucius Institutes and other 

means to influence foreign academic institutions and critical analysis of China’s past history and present policies. Moreover, Confucius Institute instructors are almost always hired in China and 

trained by the Chinese Ministry of Education without any of the 

same employment and hiring protections that exist in the United 

States. Much more difficult to measure but no less insidious, however, is the self-censorship that often takes place in academic settings where there is a Chinese Government presence in the form 

of a Confucius Institute. Given the growing concerns with intellectual property protections, within 180 days, the NIH Director shall 

develop a publicly available list of Confucius Institutes that have 

received NIH funding since 2013, along with the amount each institute received. 

Data Sharing of Rare Diseases Research.—The Committee is 

aware that NIH funded projects require a data-sharing plan to encourage transparency and leverage Federal investments in research. At the same time, project leaders and their institutions 

often cite barriers to implementing these plans in a timely and 

cost-effective manner. The Committee believes that a focused initiative to show commitment and to improve data-sharing performance in rare disease research, including conditions that disproportionately impact the pediatric population, can create a model for 

the broader research community and recommends that the NIH develop this initiative in collaboration with patient, provider, and research organizations. 

Directors Advisory Committees.—The Committee is aware that 

there is a legal requirement of Federal statute (Title 42 of the US 

Code, Subchapter III; Part B, Subsection 284A) that all NIH Directors Advisory Councils have at least two representatives from the 

fields of public health and the behavioral or social sciences. There 

are a few Directors Advisory Councils that may not be adhering to 

this requirement. The Committee urges continued compliance with 

this statute and requests a report on compliance including a list of 

each Advisory Council’s behavioral, social sciences and public heath 

members. 

Fragile X [FX].—The Committee commends NIH for supporting 

research to understand the nature of 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 each Institute 

Director with Fragile X and autism portfolios to explore ways to 

create greater efficiency and synergy among these two research 
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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. 

Gabriella Miller Kids First Research Act.—The bill provides the full request of $12,600,000. The Committee requests that NIH provide information on how it has disbursed fiscal year 2016, fiscal 

year 2017, and fiscal year 2018 funding for the Gabriella Miller 

Kids First Research Act, including any personnel that are responsible for overseeing the allocation of designated research dollars, 

the criteria that NIH employed to ensure awards will advance the 

objectives of the act, and a description of the research projects that 

were funded at the end of fiscal year 2018. The criteria and process 

for grant awards that NIH intends to use for fiscal year 2019 and 

subsequent years of funding under the act should also be included. 

Gestational Diabetes.—The Committee recognizes the importance 

of research funded by NIH related to gestational diabetes, a disease 

affecting up to 9.2 percent of all pregnant women. Given that both 

women with gestational diabetes and their babies face long-term 

health consequences as a result of the disease, such as increased 

risk of developing type 2 diabetes, the Committee urges NIH to explore additional opportunities for research on gestational diabetes. 

Government-Wide Collaborations.—NIH, VA, and DOD collaborate frequently and successfully on various research activities. The 

Committee looks forward to the report in the fiscal year 2020 CJ 

focusing on the cooperative and strategic approach the agencies 

take in areas of biomedical research that overlap to maximize the 

potential of the research. 

Headache Disorders.—The Committee commends NIH for including consideration of disease burden as a ‘crucial’ factor for aligning 

its research priorities within the NIH-Wide Strategic Plan. The 

Committee notes that migraine is the top cause of global disability 

for people aged 15 to 49 years old in the 2016 Global Burden of 

Disease study, but that migraine and headache are among the very 

least funded disease categories, relative to disease burden, in the 

NIH ‘‘Research, Condition, and Disease Categorization.’’ The Committee, therefore, encourages NIH to prioritize substantial increases in fundamental, translational, and clinical research funding 

towards migraine, cluster headache, post-traumatic headache, and 

other headache disorders. 

Hepatitis B Virus [HBV].—The Committee notes that both the 

World Health Organization in 2016 and the National Academies of 

Science, Engineering and Medicine in 2017 declared that the elimination of hepatitis B is possible. Subsequent to that declaration, 

the hepatitis B research community convened a virtual consensus 

conference to prepare a ‘‘Roadmap for a Cure’’ that resulted in articles published in 2018 in two peer reviewed scientific journals, 

Hepatology and Antiviral Research, identifying the most urgent research questions that must be answered to find a cure for Hepatitis 

B. In the United States, 1 in 20 Americans have been infected, 

with more than 2,000,000 chronically infected, with acute infections 

rising by over 20 percent in 2015 primarily due to the opioid crisis. 

The Committee further notes that the link between HBV infection 

and primary liver cancer is well established with up to 60 percent 
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of global liver cancer cases caused by HBV. Therefore, the Committee requests that the Office of the Director develop and lead an 

inter-Institute working group to include representation from NCI, 

NIAID, NIDDK, and NIMHD to coordinate their research agendas 

and research infrastructure to fund the research necessary to find 

a cure for hepatitis B. The Committee further requests that it be 

kept informed of these efforts and that a status report be sent to 

the Committee within 90 days of enactment. 

Increasing Diversity in Clinical Trials.—Inclusivity in clinical 

trials is a critical solution to ensure that patients receive the 

safest, most efficacious and precise care possible. The Committee 

requests that the Director report to the Committee in the fiscal 

year 2020 CJ regarding the status of these efforts, also including 

major successes, barriers, and best practices. 

Induced Pluripotent Stem Cell [iPSC].—The Committee continues 

to stress iPSC technology as a critical tool in the realm of personalized medicine. The Committee notes that iPSCs are derived from 

adult skin cells, providing increased opportunities to develop 

sources of cells with great therapeutic value and potential for curing human diseases. The Committee recognizes that basic science 

leads to pre-clinical trials, cures, diagnostics, and treatments. It encourages NIH to further explore additional basic science opportunities. The Committee requests an update in the fiscal year 2020 CJ 

on NIH efforts to expand iPSC technology basic research, including 

through collaborative research activities. 

Inflammatory Bowel Diseases [IBD].—The Committee is pleased 

by NIH’s support of research into IBD and notes the increasing 

prevalence. The Committee encourages NIH to enhance support for 

research on IBD, including environmental triggers and epigenetics 

of IBD, identification of disease biomarkers in IBD, as well as 

interventions targeted at both pediatric and adult patients. 

Intellectual Property.—The Committee encourages the NIH Director to work with the HHS Assistant Deputy Secretary for National Security to improve the security of intellectual property derived from NIH-funded research. In particular, the NIH is encouraged to: improve the security of the peer review system; augment 

the application process to identify funding that applicants receive 

from a foreign government; and assist the HHS Inspector General 

and appropriate law enforcement agencies to identify violations of 

U.S. law or policy. 

Mitochondrial Disease Research.—The Committee understands 

that no fewer than 17 Institutes and Offices are involved in a variety of research efforts related to mitochondrial disease and dysfunction. The Committee appreciates NIH’s support of the trans-NIH 

Mitochondrial Disorders Working Group, the North American 

Mitochondrial Disease Consortium, the Mitochondrial Disease Sequence Data Resource Consortium, and its support for investigator 

initiated intramural and extramural studies, and urges NIH to continue its efforts to ensure that individuals with mitochondrial disease participate in the All of Us research program. The Committee 

understands that NIH is funding research relevant to 

mitochondrial disease through the Office of Research Infrastructure 

Programs [ORIP]. The Committee encourages the Director to promote mitochondrial disease research within ORIP and to provide 
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an update to the Committee in the fiscal year 2020 CJ on progress 

made through this research. The Committee applauds the efforts 

made by the agency’s Office of Dietary Supplements [ODS] on nutritional interventions for those with mitochondrial disease and requests the agency include mitochondrial disease as a focus of its future practices and to reengage its trans-NIH research through the 

ODS on these issues. 

Mucopolysaccharide Diseases [MPS].—MPS and mucolipidosis 

[ML] are inherited, with death occurring for many in early childhood. These systemic diseases cause progressive damage to the 

bones, heart, respiratory system, and brain. The Committee continues to urge NIH to put a high priority on better understanding 

and treating MPS and ML diseases. The Committee commends 

NIH for allocating funds to discover, develop, define, and make 

available for research animal models of human genetic disease. The 

Committee encourages expanded research of treatments for neurological, chronic inflammation, cardiovascular and skeletal manifestations of MPS, with an emphasis on gene therapy. The Committee thanks NINDS, NIDDK, and the Office of Rare Diseases Research for again funding the Lysosomal Disease Network through 

the Rare Disease Clinical Network and for funding lysosomal research meetings. The Committee encourages NIH to increase funding to grantees to incentivize MPS research, particularly given the 

age and small population of current researchers. Understanding 

the manifestations and treatments of both the skeletal and neurological disease continues to be the greatest areas of unmet need. 

Neurofibromatosis [NF].—The Committee supports efforts to increase funding and resources for NF research and treatment at 

multiple NIH Institutes, including NCI, NINDS, NIDCD, NHLBI, 

NICHD, NIMH, NCATS, and NEI. Children and adults with NF 

are at significant risk for the development of many forms of cancer; 

the Committee encourages NCI to increase its NF research portfolio in fundamental basic science, translational research and clinical trials focused on NF. The Committee also encourages the NCI 

to support NF centers, NF clinical trials consortia, NF preclinical 

mouse models consortia and NF-associated tumor sequencing efforts. Because NF causes brain and nerve tumors and is associated 

with cognitive and behavioral problems, the Committee urges 

NINDS to continue to aggressively fund fundamental basic science 

research on NF relevant to nerve damage and repair. Based on 

emerging findings from numerous researchers worldwide demonstrating that children with NF are at significant risk for autism, 

learning disabilities, motor delays, and attention deficits, the Committee encourages NINDS, NIMH, and NICHD to expand their investments in laboratory-based and clinical investigations in these 

areas. Since NF2 accounts for approximately 5 percent of genetic 

forms of deafness, the Committee encourages NIDCD to expand its 

investment in NF2 basic and clinical research. NF1 can cause vision loss due to optic gliomas, the Committee encourages NEI to 

expand its investment in NF1 basic and clinical research. 

Next Generation Researchers Initiative.—The Committee urges 

NIH to continue to prioritize robust implementation of the Next 

Generation Researchers Initiative within the Office, as established 

in the 21st Century Cures Act, and to continue to expand the ac-
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tivities under the Initiative to improve and accelerate transitions 

into independent careers and enhance workforce diversity. The 

Committee directs NIH to collect, evaluate, and disseminate data, 

including best practices, on implementation of the Initiative’s policies as well as programs and pilots across all Institutes and Centers aimed at promoting the next generation of researchers, and to 

coordinate with relevant agencies, professional and academic associations, and others to inform programs related to the training, recruitment, and retention of biomedical researchers, as required 

under the law. The Committee applauds the National Academy of 

Sciences publication of the study, the Next Generation of Biomedical and Behavioral Sciences Researchers: Breaking Through, 

and urges NIH to advance the recommendations in the study. 

Palliative Care.—The Committee recognizes the importance of 

palliative care research to strengthen clinical practice and improve 

healthcare delivery for patients with serious or life-threatening illness or multiple chronic conditions, as well as their families/caregivers. Research funding for palliative care, including pain and 

symptom management, comprises less than 0.1 percent of the NIH 

annual budget. Therefore, the Committee strongly urges NIH to develop and implement a trans-Institute strategy to expand and intensify national research programs in palliative care to address 

quality of care and quality of life for the rapidly growing population 

of individuals in the United States with serious or life-threatening 

illnesses. 

Pediatric Clinical Trials Authorized under Best Pharmaceuticals 

for Children Act.—The Committee directs that no less than 

$25,000,000 be used towards clinical trials authorized by the Best 

Pharmaceuticals for Children Act. 

Polycystic Ovary Syndrome [PCOS].—The Committee recognizes 

the significant health burden of PCOS, which has reproductive, 

metabolic, and mental health manifestations. The exact causes of 

PCOS are unknown at this time; however, PCOS is the most common cause of female infertility, affecting up to 10 to 15 percent of 

women, depending on diagnostic criteria used. To date, 70 percent 

of NIH’s investment in PCOS has focused on the reproductive implications of the syndrome, and the Committee commends NICHD 

for its leadership in PCOS research. The Committee requests that 

NIH also focus on comorbidities associated with PCOS, as they contribute to increased health care costs and negative health outcomes. Therefore, the Committee asks OD to direct the relevant 

NIH Institutes and Centers, including NIDDK, NHLBI, NCI, 

ORWH, NIMH, and NICHD, to report on the research that has 

been conducted on PCOS and its comorbidities to date, identify the 

gaps in the research, and develop a trans-NIH research action 

plan, in conjunction with PCOS researchers, clinicians, and patients, to be shared with the Committee. The Committee further 

urges NIH to support investigator-initiated studies and early stage 

investigator awards, and mechanisms to incentivize researchers to 

enter the field. 

Prenatal Opioid Use Disorders and Neonatal Abstinence Syndrome [NAS].—The Committee recognizes the growing burden of 

NAS and the health care costs associated with it. The Committee 

is aware of the need for more information regarding long-term 
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health and developmental outcomes related to NAS, the wide variation in clinical practice and health systems support, as well as the 

challenges associated with post-discharge care. The Committee encourages NIH to coordinate with other agencies at HHS to support 

additional research on prevention, identification, and treatment of 

prenatal opioid exposure and NAS, including the best methods for 

screening and treating pregnant women for opioid use disorder and 

the best methods for screening for NAS. Additionally, the Committee encourages NIH to build on the ACT NOW study to enhance 

understanding of the impact of pharmacological and non-pharmacological treatment techniques on costs and outcomes in the shortterm and longitudinally. The Committee further encourages NIH to 

coordinate with other agencies at HHS to support research on innovative care models to optimize care and long-term outcomes for 

families. 

Precision Medicine and the Pediatric Population.—The Committee recognizes the potential that precision medicine holds for all 

populations, including children, and encourages NIH to prioritize 

timely and meaningful enrollment for the pediatric population, including healthy children and those with rare disease, in the All of 

Us research program. The Committee is encouraged that NIH 

impaneled a Child Enrollment Scientific Vision Working Group, 

which released a report that identifies scientific opportunities relevant to child health. The Committee requests an update within 60 

days on the timing for the Special Populations Committee to provide recommendations regarding the practical considerations of 

child enrollment and data collection involving children. Additionally, the Committee directs that NIH provide an update on plans 

to ensure that the research cohort includes a sufficient number of 

children to make meaningful studies possible, the target date for 

enrollment to commence and how enrollment strategies will include 

input from pediatric stakeholders across the country with experience in pediatric clinical trial enrollment. 

Research Initiative on Ethnic and Racial Diversity in Cancer.— 

The Committee recognizes that NIH’s Cancer Moonshot initiative 

aims to accelerate the discovery of new ways to cure cancers, including through an understanding and application of cancer genetic 

information to the prevention and treatment of cancer. The Committee urges NIH to facilitate research on the causes, prevention, 

and treatment of cancer in populations with diverse cultural, racial, and ethnic composition. 

Research Transparency.—As shown over the past 4 years, the 

Committee remains committed to funding NIH research and ensuring that our Nation’s researchers, particularly those early in their 

career, have the support to make the scientific breakthroughs that 

may transform health care. It is critical that NIH can ensure funds 

are used to support the most meritorious research. Members of this 

Committee have raised concerns and provided examples of questionable research. Therefore, NIH is directed to justify, in writing 

made available on a publicly accessible website, that each grant or 

agreement promotes efforts to seek fundamental knowledge about 

the nature and behavior of living systems and/or the application of 

that knowledge to enhance health, lengthen life, and reduce illness 

and disability. The Committee continues to urge a focus on re-
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search that will yield further advancement in life-saving treatments and cures. 

Sexual Harassment Policies.—The Committee recognizes the report recently published by the National Academies of Sciences, Engineering, and Medicine regarding sexual harassment of women in 

academic sciences, engineering, and medicine. The Committee directs NIH to submit to the Committee within 180 days of enactment of this act its plans to remind the grantee research community of its obligation to report to NIH any changes of key personnel, 

such as when such staff are put on administrative leave, and its 

plans to identify and disseminate training or best practices that it 

is applying to its own employees to support a non-discriminatory 

research and research-related environment. The Committee commends NIH for instituting expectations in all conference awards 

that NIH-supported conferences must be conducted in a safe and 

respectful environment for all attendees by providing an environment free from discrimination and harassment, as well as its efforts to develop a new NIH anti-harassment policy to foster a safe 

and respectful work environment for all NIH employees. The Committee encourages NIH to make aggregate data of confirmed cases 

of harassment and their resolution available to the public on a routine basis. Finally, the Committee looks forward to the survey NIH 

intends to conduct this fall to determine the incidence and prevalence of harassment within NIH and the effects of workplace harassment on career trajectories and directs NIH to make that survey 

instrument available to research institutions so that comparable 

data can be collected on the field at large. 

Sleep Disorders.—The Committee continues to recognize sleep 

disorders as a public health concern, and is encouraged by the ongoing implementation of the NIH Sleep Disorders Research Plan. 

The Committee recognizes that sleep and circadian research play 

an important role across all Institutes and Centers, and notes that 

the 2017 Noble Prize in Physiology or Medicine was awarded to an 

NIH grantee for breakthroughs in studying the internal biological 

clock. The Committee encourages NIH to explore opportunities to 

appropriately incorporate cross-cutting efforts into activities supported by the Common Fund and the All of Us research program. 

Spina Bifida.—The Committee encourages NIA, NIDDK, 

NICHD, and NINDS to study the causes and care of the neurogenic 

bladder and kidney disease in order to improve the quality of life 

of children and adults with Spina Bifida; to support research to address issues related to the treatment and management of Spina 

Bifida and associated secondary conditions, such as hydrocephalus; 

and to invest in understanding the myriad co-morbid conditions experienced by individuals with Spina Bifida, including those associated with both paralysis and developmental delay. 

Temporomandibular Disorders [TMD].—The Committee understands that NIH-funded research has demonstrated that TMD are 

primarily a multisystem disorder with overlapping conditions influenced by multiple biological and environmental factors rather than 

solely an orofacial pain condition. However, diagnosis and care of 

patients have not changed to reflect this major paradigm shift, 

with many patients continuing to receive treatments solely focused 

on teeth and jaws. Moreover, the medical community lacks edu-
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cation regarding the complexity and systemic aspects of TMD as 

well as its many comorbid medical conditions. Patients are treated 

by a multitude of practitioners across numerous disciplines with 

treatments that have the potential to cause harm. The Committee 

is encouraged that NIH, led by NIDCR and in coordination with 

OD is leading an effort to provide to the Committee recommendations for a plan to most effectively study the state of TMD science, 

TMD education, examine the safety and efficacy of current clinical 

treatments of TMD, the burden and costs associated with TMD, develop policies related to the future scientific and clinical management of TMD patients. The Committee directs NIH to provide an 

update on development of such plan no later than 180 days after 

enactment. 

Transformative High Resolution Cryo-Electron Microscopy.—The 

Committee commends NIH on their initial investment in the 

Transformative High Resolution Cryo-Electron Microscopy [CryoEM] program. The recent Nobel Prize for chemistry was awarded 

for the development of Cryo-EM research funded by NIH. Access to 

this groundbreaking research method is necessary for the continued advancement of biomedical research. The Committee urges the 

NIH to expand the number of national service centers and training 

opportunities to further refine and advance Cryo-EM research and 

expects an update of these efforts in the NIH fiscal year 2020 CJ. 

Trisomy 21.—The Committee applauds the NIH for prioritizing 

its investment in the current pipeline of Down syndrome research 

and the NIH Director’s leadership in advancing the trans-NIH initiative recommended by the Committee in the fiscal year 2018 Omnibus bill. Through the trans-NIH Initiative and other NIH supported research efforts that involve cohorts of individuals with 

Down syndrome, the Committee urges NIH to continue to expand 

such cohorts and build its current pipeline of early-stage investigators focused on Down syndrome. NIH should prioritize funding for 

research to improve the health and neurodevelopment of individuals with Down syndrome and of typical individuals at risk for immune system dysregulation, Alzheimer’s disease, cancer, cardiovascular disease, and autism. 

Tuberous Sclerosis Complex [TSC].—The Committee is encouraged by NIH’s updated TSC Research Plan published in 2016. 

Building on this Research Plan, the Committee encourages the Director to coordinate the participation of multiple Institutes and 

Centers on a research strategy aimed at addressing the numerous 

medical and neuropsychological burdens associated with TSC while 

deciphering the biology underlying phenotypic heterogeneity. This 

effort should apply recommendations from NIH’s 

Neurodevelopmental Disorders Biomarkers Workshop held in December 2017 involving TSC and related neurodevelopmental disorders, to take advantage of biomarker expertise and lessons 

learned across disease groups. Manifestations of TSC are highly 

variable among affected individuals, and TSC can be a model condition for developing precision medicine approaches to treat each individual’s symptoms to maximize the benefit-risk ratio. NIH should 

encourage research opportunities in the five key areas prioritized 

by workshop participants: understanding phenotypic heterogeneity 

in TSC, gaining a deeper knowledge of TSC signaling pathways 
125 

and the cellular consequences of TSC deficiency, improving TSC 

disease models, developing clinical biomarkers of TSC, and facilitating therapeutics and clinical trials research. 

Undiagnosed Diseases.—The Committee supports the efforts of 

the Undiagnosed Diseases Network [UDN], funded through the 

Common Fund, to enhance access to patients, caregivers, and other 

stakeholders as well as make information obtained through the 

UDN available to Federal agencies and health-related agencies. To 

that end, the Committee urges the Director to ensure that information on diagnoses and patient populations identified by UDN is coordinated with the NCATS’ Office of Rare Disease Research and its 

Genetic and Rare Diseases Information Center. The Committee is 

pleased with the work of the UDN to advance patient care and 

treatment options. The Committee is particularly focused on ensuring that as research (produced at UDN or any of the Institutes) 

provides more information on treatments for rare, undiagnosed, 

and underdiagnosed diseases that this information is transitioned 

to become more readily accessible. This work is one example of the 

success of NIH and illustrates how the UDN program’s successes 

must be built upon. The Director is encouraged to identify successful work completed by UDN and disseminate it to the medical community, and continue to engage with patient advocacy organizations. 

BUILDINGS AND FACILITIES

Appropriations, 2018 ............................................................................. $128,863,000 

Budget estimate, 2019 ........................................................................... 200,000,000 

Committee recommendation ................................................................. 200,000,000 

The Committee recommendation includes $200,000,000 for NIH 

buildings and facilities. This funding will remain available for obligation for 5 years. 

NIH INNOVATION ACCOUNT, CURES ACT

Appropriations, 2018 ............................................................................. $110,000,000 

Budget estimate, 2019 ........................................................................... 196,000,000 

Committee recommendation ................................................................. 196,000,000 

The Committee recommendation includes $196,000,000 to be 

spent from the NIH Innovation Account for the following activities: 

All of Us.—$186,000,000. 

Regenerative Medicine.—$10,000,000. 

The Committee report reflects distribution of the remainder of 

funding from the NIH Innovation Account to NCI, NINDS, and 

NIMH and expects NIH to transfer funding shortly after enactment 

of this act. 

NATIONAL INSTITUTE FOR RESEARCH ON SAFETY AND QUALITY

Appropriations, 2018 ............................................................................. ........................... 

Budget estimate, 2019 ........................................................................... $255,960,000 

Committee recommendation ................................................................. ........................... 

The Committee recommendation does not provide funding for the 

National Institute for Research on Safety and Quality. 
126 

NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH

Appropriations, 2018 ............................................................................. ........................... 

Budget estimate, 2019 ........................................................................... $200,000,000 

Committee recommendation ................................................................. ........................... 

The Committee recommendation does not provide funding for the 

National Institute for Occupational Safety and Health. 

NATIONAL INSTITUTE ON DISABILITY, INDEPENDENT LIVING, AND

REHABILITATION RESEARCH

Appropriations, 2018 ............................................................................. ........................... 

Budget estimate, 2019 ........................................................................... $95,127,000,000 

Committee recommendation ................................................................. ........................... 

The Committee recommendation does not provide funding for the 

National Institute on Disability, Independent Living, and Rehabilitation Research. 

SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION

The Committee recommends $5,738,494,000 for the Substance 

Abuse and Mental Health Services Administration [SAMHSA]. The 

recommendation includes $133,667,000 in transfers available under 

section 241 of the PHS Act and $12,000,000 in transfers from the 

PPH Fund. 

SAMHSA is responsible for supporting mental health programs 

and alcohol and other drug abuse prevention and treatment services throughout the country, primarily through categorical grants 

and block grants to States. 

Eligible applicants under SAMHSA’s PRNS authorities include 

States, political subdivisions of States, Indian Tribes or tribal organizations, health facilities, or programs operated by or in accordance with a grant or contract with the Indian Health Service, and 

other public or private nonprofit entities. The Committee strongly 

encourages SAMHSA to exercise maximum flexibility allowed when 

developing funding opportunity announcements to ensure that all 

eligible applicants are included. 

The Committee recommendation continues bill language that instructs the Assistant Secretary of SAMHSA and the Secretary to 

exempt the Mental Health Block Grant [MHBG], the Substance 

Abuse Prevention and Treatment [SAPT] Block Grant, and the 

State Opioid Response Grant from being used as a source for the 

PHS evaluation set-aside in fiscal year 2019. 

MENTAL HEALTH

Appropriations, 2018 ............................................................................. $1,487,011,000 

Budget estimate, 2019 ........................................................................... 1,064,922,000 

Committee recommendation ................................................................. 1,566,011,000 

The Committee recommends $1,566,011,000 for mental health 

services. The recommendation includes $21,039,000 in transfers 

available under section 241 of the PHS Act and $12,000,000 in 

transfers from the PPH Fund. Included in the recommendation is 

funding for programs of regional and national significance [PRNS], 

the MHBG, children’s mental health services, Projects for Assistance in Transition from Homelessness [PATH], and Protection and 

Advocacy for Individuals with Mental Illness [PAIMI]. 
127 

Programs of Regional and National Significance 

The Committee recommends $442,659,000 for PRNS within the 

Center for Mental Health Services. The Committee recommendation includes $12,000,000 in transfers to PRNS from the PPH 

Fund. These programs address priority mental health needs by developing and applying evidence-based practices, offering training 

and technical assistance, providing targeted capacity expansion 

grants, and changing the delivery system through family, client-oriented, and consumer-run activities. 

Within the total provided for PRNS, the Committee recommendation includes funding for the following activities: 

[In thousands of dollars] 

Budget activity Fiscal year 2018 

appropriation 

Committee 

recommendation 

CAPACITY: 

Seclusion & Restraint ............................................................................................ 1,147 1,147 

Project AWARE State Grants .................................................................................. 71,001 71,001 

Mental Health First Aid ......................................................................................... 19,963 21,963 

Healthy Transitions ................................................................................................ 25,951 25,951 

National Traumatic Stress Network ....................................................................... 53,887 55,887 

Children and Family Programs .............................................................................. 7,229 7,229 

Consumer and Family Network Grants .................................................................. 4,954 4,954 

MH System Transformation and Health Reform .................................................... 3,779 3,779 

Project LAUNCH ...................................................................................................... 23,605 23,605 

Primary and Behavioral Health Care Integration .................................................. 49,877 49,877 

National Strategy for Suicide Prevention .............................................................. 11,000 11,000 

Suicide Lifeline ....................................................................................................... 7,198 7,198 

GLS—Youth Suicide Prevention—States .............................................................. 35,427 35,427 

GLS—Youth Suicide Prevention—Campus ........................................................... 6,488 6,488 

AI/AN Suicide Prevention Initiative ........................................................................ 2,931 2,931 

Homelessness Prevention Programs ...................................................................... 30,696 30,696 

Tribal Behavioral Grants ........................................................................................ 15,000 15,000 

Minority AIDS .......................................................................................................... 9,224 9,224 

Criminal and Juvenile Justice Programs ............................................................... 4,269 4,269 

Assisted Outpatient Treatment .............................................................................. 15,000 15,000 

Infant and Early Childhood Mental Health ........................................................... 5,000 5,000 

Assertive Community Treatment for Ind. With SMI ............................................... 5,000 5,000 

SCIENCE AND SERVICE: 

GLS—Suicide Prevention Resource Center ........................................................... 5,988 5,988 

Practice Improvement and Training ...................................................................... 7,828 7,828 

Primary and Behavioral Health Care Integration TA ............................................. 1,991 1,991 

Consumer & Consumer Support TA Centers ......................................................... 1,918 1,918 

Minority Fellowship Program .................................................................................. 8,059 8,059 

Disaster Response ................................................................................................. 1,953 1,953 

Homelessness ......................................................................................................... 2,296 2,296 

Certified Community Behavioral Health Clinics.—The Committee 

includes $150,000,000, an increase of $50,000,000. The Committee 

continues to direct SAMSHA to prioritize resources to entities within States that are part of the section 223(a) of the Protecting Access to Medicare Act of 2014 (Public Law 113–93) demonstration 

and to entities within States that were awarded planning grants. 

SAMHSA is directed to coordinate these resources with its efforts 

focusing on areas of high incidence of substance use disorders. 

SAMHSA shall conduct an evaluation of the program and provide 

a report to the Committees on Appropriations of the House of Representatives and the Senate not later than 15 months after the 

date of enactment of this act. 
128 

Child Traumatic Stress Network.—The Committee applauds the 

work of the National Child Traumatic Stress Initiative and includes an additional $2,000,000 for activities authorized under Section 582(c) and (d) of the PHS Act. 

Infant and Early Childhood Mental Health.—The Committee recognizes the importance of building mental health services for children under age 6. These young children can and do experience 

mental health disturbances, yet their unique needs, particularly for 

infants and toddlers, are often overlooked in mental health policy 

and healthcare delivery systems. These grants help fill that gap by 

investing in early mental health prevention, identification, and 

treatment, in order to reduce the need for treatment later in life 

when it becomes more difficult, time intensive, and expensive. The 

Committee recommends providing grants to entities such as State 

agencies, Tribal communities, or university or medical centers that 

are in different stages of developing infant and early childhood 

mental health services. These entities should have the capacity to 

lead partners in systems-level change as well as building or enhancing the basic components of such early childhood services, including an appropriately trained workforce. 

Mental Health Awareness Training.—The Committee provides $21,963,000, an increase of $2,000,000 to continue existing activities, including Mental Health First Aid. The Committee is pleased 

with the progress of the Mental Health First Aid program. Mental 

Health First Aid has trained more than 1,000,000 Americans to 

recognize the signs and symptoms of common mental disorders and 

the recent inclusion of the program in the International Association 

of Chiefs of Police One Mind Campaign. In continuing competitive 

funding opportunities, SAMHSA is directed to include as eligible 

grantees local law enforcement agencies, fire departments, and 

emergency medical units with a special emphasis on training for 

crisis de-escalation techniques. SAMHSA is also encouraged to 

allow training for veterans, armed services personnel and their 

family members within the Mental Health First Aid program. 

National Suicide Prevention Hotline.—The Committee is concerned with the growing number of suicide deaths in the United 

States. According to data released by CDC, nearly 45,000 lives 

were lost to suicide in 2016. Data also shows that suicide rates 

went up more than 30 percent in half of states since 1999 and that 

nearly every State saw a rate increase of some kind. The Committee recognizes the National Suicide Prevention Lifeline program’s important role in suicide prevention and encourages 

SAMHSA to continue its commitment to this program. 

Primary and Behavioral Healthcare Integration [PBHCI].—The 

Committee provides $49,877,000 for PBHCI to support communities to coordinate and integrate primary care services into community-based behavioral health settings. 

Project AWARE.—The Committee continues $71,001,000 for 

Project AWARE which increases awareness of mental health issues 

and connects young people that have behavioral health issues and 

their families with needed services. Of the amount provided for 

Project AWARE, the Committee directs SAMHSA to use 

$10,000,000 for discretionary grants to support efforts in highcrime, high-poverty areas and, in particular, communities that are 
129 

seeking to address relevant impacts and root causes of civil unrest, 

community violence, and collective trauma. These grants should 

maintain the same focus as fiscal year 2018 grants. The Committee 

requests a report on progress of fiscal year 2018 grantees 180 days 

after the enactment of this act 

Community Mental Health Services Block Grant 

The Committee recommends $747,571,000 for the MHBG. The 

recommendation includes $21,039,000 in transfers available under 

section 241 of the PHS Act. 

The MHBG distributes funds to 59 eligible States and territories 

through a formula based on specified economic and demographic 

factors. Grant applications must include an annual plan for providing comprehensive community mental health services to adults 

with a serious mental illness and children with a serious emotional 

disturbance. 

The Committee recommendation continues bill language requiring that at least 10 percent of the funds for the MHBG program 

be set-aside for evidence-based programs that address the needs of 

individuals with early serious mental illness, including psychotic 

disorders. The Committee commends SAMHSA for its collaboration 

with NIMH on the implementation of this set-aside. The Committee notes that it usually takes 14–17 years to translate research 

findings into practice and hopes that the joint effort between 

NIMH and SAMHSA may be a model for how to reduce this timeframe. The Committee directs SAMHSA to continue its collaboration with NIMH to ensure that funds from this set-aside are only 

used for programs showing strong evidence of effectiveness and 

that target the first episode of psychosis. SAMHSA shall not expand the use of the set-aside to programs outside of the first episode psychosis. The Committee directs SAMHSA to include in the 

fiscal year 2020 CJ a detailed table showing at a minimum each 

State’s allotment, name of the program being implemented, and a 

short description of the program. 

Children’s Mental Health Services 

The Committee recommends $125,000,000 for the Children’s 

Mental Health Services program. This program provides grants 

and technical assistance to support comprehensive, communitybased systems of care for children and adolescents with serious 

emotional, behavioral, or mental disorders. Grantees must provide 

matching funds and services must be coordinated with the educational, juvenile justice, child welfare, and primary healthcare systems. The Committee continues to include a 10 percent set-aside 

for an early intervention demonstration program with persons not 

more than 25 years of age at clinical high risk of developing a first 

episode psychosis. SAMHSA is directed to work with NIMH on the 

implementation of this set-aside. 

Projects for Assistance in Transition From Homelessness 

The Committee recommends $64,635,000 for PATH, which addresses the needs of individuals with serious mental illness who 

are experiencing homelessness or are at risk of homelessness. 

Funds are used to provide an array of services, such as screening 
130 

and diagnostic services, emergency assistance, case management, 

and referrals to the most appropriate housing environment. 

Protection and Advocacy for Individuals With Mental Illness 

The Committee recommends $36,146,000 for PAIMI. This program helps ensure that the rights of mentally ill individuals are 

protected while they are patients in all public and private facilities 

or while they are living in the community, including in their own 

homes. Funds are allocated to States according to a formula based 

on population and relative per capita incomes. 

SUBSTANCE ABUSE TREATMENT

Appropriations, 2018 ............................................................................. $3,263,506,000 

Budget estimate, 2019 ........................................................................... 2,113,397,000 

Committee recommendation ................................................................. 3,812,006,000 

The Committee recommends $3,812,006,000 for substance abuse 

treatment programs, including PRNS and the substance abuse prevention and treatment block grant to the States. The recommendation includes $81,200,000 in transfers available under section 241 

of the PHS Act. 

Programs of Regional and National Significance 

The Committee recommends $453,927,000 for PRNS within the 

Center for Substance Abuse Treatment [CSAT]. The recommendation includes $2,000,000 in transfers available under section 241 of 

the PHS Act. 

PRNS include activities to increase capacity by implementing 

service improvements using proven evidence-based approaches as 

well as science-to-services activities that promote the identification 

of practices thought to have potential for broad service improvement. 

Within the total provided for PRNS, the Committee recommendation includes funding for the following activities: 

[In thousands of dollars] 

Budget activity Fiscal year 2018 

appropriation 

Committee 

recommendation 

CAPACITY: 

Opioid Treatment Programs/Regulatory Activities ................................................. 8,724 8,724 

Screening, Brief Intervention, Referral, & Treatment ............................................ 30,000 30,000 

Target Capacity Expansion .................................................................................... 95,192 95,192 

Medicated Assisted Treatment for Prescription Drug and Opioid Addiction 

(non-add) .................................................................................................. 84,000 84,000 

First Responder Grants .......................................................................................... 36,000 36,000 

Grants to Prevent Prescription Drug/Opioid Overdose .......................................... 12,000 12,000 

Pregnant & Postpartum Women ............................................................................ 29,931 29,931 

Recovery Community Services Program ................................................................. 2,434 2,434 

Children and Families ........................................................................................... 29,605 29,605 

Treatment Systems for Homeless .......................................................................... 36,386 36,386 

Minority AIDS .......................................................................................................... 65,570 65,570 

Criminal Justice Activities ..................................................................................... 89,000 89,000 

Building Communities of Recovery ........................................................................ 5,000 5,000 

SCIENCE AND SERVICE: 

Addiction Technology Transfer Centers ................................................................. 9,046 9,046 

Minority Fellowship Program .................................................................................. 4,539 5,039 
131 

Building Communities of Recovery.—The Committee appreciates 

SAMHSA’s implementation of new funding for communities of recovery in fiscal year 2018 and continues to encourage SAMHSA to 

promote the expansion of recovery support services as well as reduce stigma associated with addictions. 

Combatting Opioid Abuse.—The Committee provides $12,000,000 

within PRNS for grants to prevent opioid overdose related deaths. 

This program will help States equip and train first responders and 

other community partners with the use of devices that rapidly reverse the effects of opioids. The agreement also provides 

$36,000,000 for First Responder Training grants. Of this amount, 

$18,000,000 is set aside for rural communities with high rates of 

substance abuse. SAMHSA is directed to ensure applicants outline 

how proposed activities in the grant would work with treatment 

and recovery communities in addition to first responders. The Committee has moved this program out of the PRNS account in the 

Center of Substance Abuse Prevention into the PRNS account of 

the Center for Substance Abuse Treatment. The Committee believes the funding should be in CSAT to best ensure that, after an 

overdose is reversed through the use of naloxone, these individuals 

are given access to a recovery coaching and referral to treatment. 

Drug Courts.—SAMHSA is directed to ensure that drug court 

funding is allocated to serve people diagnosed with a substance use 

disorder as their primary condition. SAMHSA is further directed to 

ensure that all drug court grant recipients work with the corresponding State substance abuse agency in the planning, implementation, and evaluation of the grant. SAMHSA should expand 

training and technical assistance to drug treatment court grant recipients to ensure evidence-based practices are fully implemented. 

Medication-Assisted Treatment for Prescription Drug and Opioid 

Addiction.—The Committee includes $84,000,000 for Medication 

Assisted Treatment. SAMHSA 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. SAMHSA is directed to give preference in grant awards 

to treatment regimens that are less susceptible to diversion for illicit purposes. These grants should target States with the highest 

age adjusted rates of admissions, including those that have demonstrated a dramatic age adjusted increase in admissions for the 

treatment of opioid use disorders. The Committee continues to direct CSAT to ensure that these grants include as an allowable use 

the support of medication assisted treatment and other clinically 

appropriate services to achieve and maintain abstinence from all 

opioids and heroin and prioritize treatment regimens that are less 

susceptible to diversion for illicit purposes. 

Minority Fellowship Program.—The Committee provides 

$5,039,000, a $500,000 increase above fiscal year 2018, and continues to include $1,000,000 for funding to grantees to develop and 

implement fellowships in psychology, addiction psychiatry, and addiction medicine with specific focus in addressing the needs of individuals with substance use disorders. 

Neonatal Abstinence Syndrome [NAS].—The Committee is 

pleased to see SAMHSA publish guidance for healthcare professionals for a clinical guide for national standard of evaluation, care, 
132 

and treatment of women with opioid use disorders and infants with 

NAS. The Committee supports the continued efforts of expanded 

implementation of Screening, Brief Intervention, and Referral to 

Treatment [SBIRT], and its possible impact on reducing the costs 

of NAS. 

Opioid Abuse in Rural Communities.—The Committee is aware 

that response to the opioid abuse crisis poses unique challenges for 

rural America. The Committee encourages SAMHSA to support initiatives to advance opioid abuse objectives in rural areas, specifically focusing on addressing the needs of individuals with substance use disorders in rural and medically-underserved areas, and 

programs that stress a comprehensive community-based approach 

involving academic institutions, health care providers, and local 

criminal justice systems. 

Opioid Grants.—The Committee recognizes the work moving forward under the SOR program and the State Targeted Response to 

the Opioid Abuse Crisis grant program. The Committee directs 

SAMHSA to ensure these resources are aligned with the State plan 

developed by each State’s alcohol and drug agency as defined by 

the agency that manages the SAPT Block Grant. This will ensure 

continuity of funding and coordination of efforts within each State 

system. 

Pregnant and Postpartum Women [PPW].—The Committee commends SAMHSA for funding three grants in fiscal year 2017 under 

the new PPW pilot program authorized under the Comprehensive 

Addiction and Recovery Act [CARA], which is designed to help 

State alcohol and drug agencies address treatment gaps for pregnant and postpartum women with substance use disorders, including opioid use disorders. The Committee looks forward to 

SAMHSA’s expansion of the pilot program in fiscal year 2018, and 

encourages the agency to prioritize States that support best-practice collaborative models for the treatment and support of pregnant 

women with opioid use disorders. 

Screening, Brief Intervention, Referral, and Treatment.— The 

Committee recognizes that SBIRT is still not widely adopted and 

has not yet permeated broader healthcare or social service networks, particularly in underserved communities most affected by 

the opioid epidemic. The Committee encourages SAMHSA to use 

funds for the adoption of SBIRT protocols in primary care and 

other appropriate settings that serve youth 12 to 21 years of age 

as well as on the adoption of system-level approaches to facilitate 

the uptake of SBIRT into routine health care visits for adults. 

State Opioid Response Grants.—The Committee provides 

$1,500,000,000 for grants to States to address the opioid crisis. Bill 

language continues to provide $50,000,000 for grants to Indian 

Tribes or Tribal organizations and a 15 percent set-aside for States 

with the highest age-adjusted mortality rate related to opioid overdose deaths. The Committee urges the Assistant Secretary to ensure the formula avoids a significant cliff between States with similar mortality rates. Activities funded with this grant may include 

bonafide treatment, prevention, and recovery support services. 

States receiving these grants should ensure that comprehensive, effective, universal prevention strategies, to stop the misuse of 

opioids before it starts, are a priority for these funds. SAMHSA is 
133 

directed to work with States to include recovery support services 

that may include career counseling or job placement to help individuals in recovery from a substance use disorder transition from 

treatment to the workforce. The Committee directs the agency to 

ensure funds reach local communities and counties to address the 

opioid crisis in areas of unmet need. SAMHSA is also directed to 

provide State agencies with technical assistance concerning how to 

enhance outreach and direct support to rural and underserved communities and providers in addressing this crisis. SAMHSA shall 

submit to the Committees on Appropriations of the House of Representatives and the Senate a work plan of the proposed allocation 

of funds not later than 15 days prior to publishing the funding opportunity announcment. In addition, not later than 1 year after the 

date of enactment of this Act, SAMHSA shall submit a report to 

the Committees on Appropriations of the House of Representatives 

and the Senate that includes a description of the activities for 

which each State has received funding and the ultimate recipients 

of the funds provided to States. In addition, SAMHSA shall submit 

an evaluation of the program not later than 2 years after the date 

of enactment of this Act. SAMHSA is directed to make the report 

and evaluation publicly available on SAMHSA’s website. 

Systems of Care Models in Opioid Response.—Evidence suggests 

that regional efforts to coordinate opioid abuse treatment across 

entities and locations can produce effective results. Successful examples include the development of ‘‘no wrong door’’ treatment models, mechanisms to scale-up training and numbers of peer coaches, 

and the use of mobile app technology to enhance access to services, 

successful treatment outcomes, and long-term relapse prevention. 

SAMHSA should encourage State and local grantees to prioritize 

the implementation of coordinated continuum of care approaches. 

Substance Abuse Prevention and Treatment Block Grant 

The Committee recommends $1,858,079,000 for the Substance 

Abuse Prevention and Treatment Block Grant [SABG]. The recommendation includes $79,200,000 in transfers available under 

section 241 of the PHS Act. The Committee recognizes the importance of the block grant given its flexibility to allow States to direct 

resources based on their own unique needs. This funding stream is 

also critical in assisting States to address all substance use disorders, including but not limited to those related to alcohol, cocaine 

and methamphetamine. The Committee also recognizes the importance of the block grant’s 20 percent primary prevention set-aside, 

which represents close to 70 percent of prevention dollars managed 

by State alcohol and drug agencies. The block grant provides funds 

to States to support alcohol and drug abuse prevention, treatment, 

and rehabilitation services. Funds are allocated to States according 

to a formula. 

SUBSTANCE ABUSE PREVENTION

Appropriations, 2018 ............................................................................. $248,219,000 

Budget estimate, 2019 ........................................................................... 220,885,000 

Committee recommendation ................................................................. 200,219,000 

The Committee recommends $200,219,000 for the Center for Substance Abuse Prevention [CSAP], the sole Federal organization 
134 

with responsibility for improving accessibility and quality of substance abuse prevention services. 

The Committee directs that all of the money appropriated explicitly for Substance Abuse Prevention purposes both in CSAP’s 

PRNS lines as well as the funding from the 20 percent prevention 

set-aside in the SABG be used only for bona fide substance abuse 

prevention activities and not for any other purpose to ensure the 

work in school-based settings is as robust as possible. 

Programs of Regional and National Significance 

The Committee provides $200,219,000 for PRNS within CSAP. 

Through these programs, CSAP supports: development of new practice knowledge on substance abuse prevention; identification of 

proven effective models; dissemination of science-based intervention information; State and community capacity building for implementation of proven, effective substance abuse prevention programs; and programs addressing new needs in the prevention system. 

Within the total provided for PRNS, the Committee recommendation includes funding for the following activities: 

[In thousands of dollars] 

Budget activity Fiscal year 2018 

appropriation 

Committee 

recommendation 

CAPACITY: 

Strategic Prevention Framework/Partnership for Success ..................................... 109,484 109,484 

Strategic Prevention Framework Rx ....................................................................... 10,000 10,000 

Improving Access to Overdose Treatment ............................................................. 1,000 1,000 

Mandatory Drug Testing ........................................................................................ 4,894 4,894 

Minority AIDS .......................................................................................................... 41,205 41,205 

Sober Truth on Preventing Underage Drinking (STOP Act) ................................... 7,000 7,000 

National Adult–Oriented Media Public Service Campaign .................................... 1,000 1,000 

Community-based Coalition Enhancement Grants ................................................ 5,000 5,000 

ICCPUD ................................................................................................................... 1,000 1,000 

Tribal Behavioral Health Grants ............................................................................ 15,000 15,000 

SCIENCE AND SERVICE: 

Center for the Application of Prevention Technologies ......................................... 7,493 7,493 

Science and Service Program Coordination .......................................................... 4,072 4,072 

Minority Fellowship Program .................................................................................. 71 71 

Best Practices for Opioid Abuse Prevention.—The Committee encourages SAMHSA to develop and educate States and communities 

on best practices for addressing the opioid abuse crisis as it relates 

to opioid prescribing, pain management, screening, and linkage to 

care. SAMHSA is further encouraged to develop training materials 

for health care providers and trainees in opioid use and other addictive disorders. 

Centers for the Application of Prevention Technology [CAPTs].— 

The Committee is aware that SAMHSA has changed the structure 

of the CAPTs to mirror that of the Addiction Technology Transfer 

Centers. In addition, SAMHSA has moved the management of the 

CAPTs outside of CSAP, a change that was not reflected in the fiscal year 2019 budget justification. The Committee directs SAMHSA 

to submit a report on this program, including the rationale behind 

the structural and organizational changes, by September 30, 2019. 
135 

First Responder Training.—The Committee notes that overdose 

reversal is a lifesaving strategy that reduces the harm of overdoses 

but does not prevent the initiation of drug use. For this reason the 

Committee has transferred $48,000,000 of overdose reversal funding out of the PRNS account in the Center of Substance Abuse Prevention into the PRNS account of the Center for Substance Abuse 

Treatment. The Committee believes the funding should be in CSAT 

to best ensure that, after an overdose is reversed through the use 

of naloxone, these individuals are given access to a recovery coaching and referral to treatment. 

Strategic Prevention Framework-Partnerships for Success Program.—This program supports States in addressing underage 

drinking among youth and young adults and allows States to 

prioritize State-identified top data-driven substance abuse target 

areas. Given that substance use disorders typically begin in adolescence and that preventing or delaying the age of first use is costeffective, the Committee provides last year’s funding level for this 

program. Of the provided amount, $109,484,000 shall support comprehensive, multi-sector substance use prevention strategies to stop 

or delay the age of initiation of the State’s top three substance use 

issues for 12 to 18 year old youth, as determined by State epidemiological data, and shall not be used for any programs or services 

to address substance use after it has already occurred. 

HEALTH SURVEILLANCE AND PROGRAM SUPPORT

Appropriations, 2018 ............................................................................. $160,258,000 

Budget estimate, 2019 ........................................................................... 147,348,000 

Committee recommendation ................................................................. 160,258,000 

The Committee recommends $160,258,000 for Health Surveillance and Program Support activities. The recommendation includes $31,428,000 in transfers available under section 241 of the 

PHS Act. 

This activity supports Federal staff and the administrative functions of the agency. It also provides funding to SAMHSA’s surveillance and data collection activities, including national surveys such 

as the National Survey on Drug Use and Health. 

Within the total provided for Health Surveillance and Program 

Support, the Committee recommendation includes funding for the 

following activities: 

[In thousands of dollars] 

Budget activity Fiscal year 2018 

appropriation 

Committee 

recommendation 

Health Surveillance ......................................................................................................... 57,258 57,258 

Program Management ..................................................................................................... 79,000 79,000 

Performance & Quality Information Systems ................................................................. 10,000 10,000 

Public Awareness and Support ....................................................................................... 13,000 13,000 

Behavioral Health Workforce Data .................................................................................. 1,000 1,000 

The Committee does not include bill language requested by the 

administration to provide additional transfer authority to the Director beyond that which is already provided to the Secretary. 

Technical Assistance.—The Committee notes that SAMHSA is 

changing how it provides technical assistance and training to 
136 

grantees, moving from a contractor-driven model to one that utilizes local expertise. The Committee directs the Assistant Secretary 

to provide a report to the Committee that explains the proposed 

changes to the provision of technical assistance, training, and evaluation; the evidence relied on to support these changes, including 

whether sufficient State capacity exists to implement these 

changes; the input sought or received from stakeholders, including 

State and local governments, as well as the process by which that 

input was received and considered by the agency; an analysis of the 

funding saved from this proposal and the agency’s planned use of 

these savings; and the agency’s plan to evaluate the effectiveness 

of these changes. 

AGENCY FOR HEALTHCARE RESEARCH AND QUALITY

Appropriations, 2018 ............................................................................. $334,000,000 

Budget estimate, 2019 ........................................................................... ........................... 

Committee recommendation ................................................................. 334,000,000 

The Committee provides $334,000,000 for the Agency for 

Healthcare Research and Quality [AHRQ], which is combined with 

the $99,821,000 in mandatory funding from the Patient-Centered 

Outcomes Research Trust Fund. AHRQ was established to enhance 

the quality, appropriateness, and effectiveness of health services, 

as well as access to such services. AHRQ conducts, supports, and 

disseminates scientific and policy-relevant research on topics such 

as promoting high-quality care, eliminating healthcare disparities, 

using information technology, and evaluating the effectiveness of 

clinical services. 

The Committee does not support the administration’s proposal to 

consolidate AHRQ into the NIH and instead continues to fund the 

agency as an independent operating division within the Department. 

HEALTH COSTS, QUALITY, AND OUTCOMES

The Committee provides $192,709,000 for research on health 

costs, quality, and outcomes [HCQO]. The HCQO research activity 

is focused upon improving clinical practice, improving the 

healthcare system’s capacity to deliver quality care, and tracking 

progress toward health goals through monitoring and evaluation. 

Within the total provided for HCQO, the Committee recommendation includes funding for the following activities: 

[In thousands of dollars] 

Budget activity Fiscal year 2018 

appropriation 

Committee recommendation 

Research on Health Costs, Quality, and Outcomes: 

Prevention/Care Management ................................................................................ 11,649 11,649 

Health Information Technology .............................................................................. 16,500 16,500 

Patient Safety Research ........................................................................................ 70,276 70,276 

Health Services Research, Data and Dissemination ............................................. 94,284 94,284 

Antibiotic Resistance.— The Committee notes that while AHRQ 

has been the leader in developing the tools and resources to help 

providers improve their antibiotic stewardship programs, the agency has not updated several publications related to the use of 
137 

procalcitonin [PCT] tests in sepsis and antibiotic treatment programs in more than 5 years. The Committee encourages AHRQ to 

collaborate with NIH, HRSA, BARDA, CDC, FDA and other relevant agencies to review and update their publications with the 

latest FDA approved uses for PCT tests in antibiotic stewardship. 

The Committee requests an update on these activities in the fiscal 

year 2020 CJ. 

Centers of Diagnostic Excellence.—The Committee is concerned 

about the lack of dedicated funding for research into improving 

how medical conditions are diagnosed, considering the size and impacts of patient harms resulting from diagnostic safety and quality 

challenges. The Committee encourages AHRQ to dedicate resources 

to support the creation of Centers of Diagnostic Excellence that will 

create core diagnostic research hubs for diagnostic safety and quality research; utilize strategic partnerships that capitalize on the capabilities of both academic research institutions and non-academic 

healthcare, science, and technology stakeholders; and incentivize 

high-impact research on novel solutions to improve diagnosis. 

Diabetes.—The Committee is concerned about the significant 

costs associated with providing care for individuals that suffer from 

diabetes, including those from medically underserved low health 

literacy populations. The Committee encourages AHRQ consider a 

pilot or demonstration program to support safety net clinics in increasing health literacy and preventing diabetes with the goal of 

reducing long-term costs. 

Health IT Safety.—The Committee recommendation includes 

$16,500,000 for AHRQ’s work on safe health IT practices specifically related to the design, implementation, usability, and safe use 

of health IT systems. The Committee believes this investment will 

generate new evidence regarding safe health IT practices that will 

ultimately be used by ONC, FDA, CMS, and others to inform policy 

interventions. 

Healthcare Delivery Systems.—Within the Patient Safety portfolio, the Committee includes $10,000,000 for Healthcare Delivery 

Systems grants, or ‘‘patient safety learning labs.’’ The purpose of 

these grants is to test new ways of addressing entrenched patient 

safety issues by using a systems engineering approach. 

Malnutrition.—The Committee greatly appreciates AHRQ’s work 

to better understand malnutrition in U.S. hospitals. The Committee particularly notes AHRQ’s initiative to support studies, the 

‘‘Characteristics of Hospital Stays Involving Malnutrition, 2013’’ 

and follow-up ‘‘All-Cause Readmissions Following Hospital Stays 

for Patients With Malnutrition, 2013’’ that illustrated the consequences of malnutrition in hospital patients. The Committee 

urges AHRQ to convene a technical expert panel to assess the evidence for a malnutrition-related readmissions quality measure for 

the prevention of malnutrition in hospitals. 

Nursing.—The Committee notes that AHRQ-led research often 

highlights the unique contribution of nurses, including advanced 

practice and doctorally-prepared nurses. The Committee urges 

AHRQ to continue supporting health services research that takes 

into consideration the contributions of all providers, including 

nurses. 
138 

Palliative Care.—The Committee encourages AHRQ to consult 

with appropriate professional societies, hospice and palliative care 

stakeholders, and relevant patient advocate organizations to develop and disseminate information to patients, families, and health 

professionals about palliative care as an essential part of the continuum of quality care for patients with serious or life-threatening 

illness. Such materials and resources should include specific information regarding the demonstrated benefits of patient access to 

palliative care and the interdisciplinary services provided to patients by professionals trained in hospice and palliative care. The 

Secretary is encouraged to include such information and materials 

on websites of relevant Federal agencies and departments, including the Centers for Medicare & Medicaid Services and the Administration for Community Living. 

Research Training and Career Development.—The Committee 

notes the important role that AHRQ plays in supporting research 

training and career development activities, such as ‘‘K’’ Awards and 

Mentored Clinical-Scientist Development Awards. Considering the 

current challenges facing physician-scientists and the young-investigator pipeline, AHRQ is encouraged to continue to prioritize these 

activities. 

MEDICAL EXPENDITURES PANEL SURVEYS

The Committee provides $69,991,000 for Medical Expenditure 

Panel Surveys [MEPS], which collect detailed information annually 

from households, healthcare providers, and employers regarding 

how Americans use and pay for healthcare. The data from MEPS 

are used to develop estimates of healthcare utilization, expenditures, sources of payment, and the degree of health insurance coverage of the U.S. population. 

PROGRAM SUPPORT

The Committee recommends $71,300,000 for program support. 

This activity funds the overall management of AHRQ, including 

salaries, benefits, and overhead costs such as rent. 

CENTERS FOR MEDICARE AND MEDICAID SERVICES

GRANTS TO STATES FOR MEDICAID

Appropriations, 2018 ......................................................................... $284,798,384,000 

Budget estimate, 2019 ...................................................................... 276,236,212,000 

Committee recommendation ............................................................. 276,236,212,000 

The Committee recommends $276,236,212,000 in mandatory 

funding for Grants to States for Medicaid. The fiscal year 2019 recommendation excludes $134,847,759,000 

in fiscal year 2018 advance appropriations for fiscal year 2019. As 

requested by the administration, $137,931,797,000 is provided for 

the first quarter of fiscal year 2020. 

The Medicaid program provides medical care for eligible low-income individuals and families. It is administered by each of the 50 

States, the District of Columbia, and the U.S. territories. Federal 

funds for medical assistance are made available to the States according to a formula that determines the appropriate Federal 

matching rate for State program costs. This matching rate is based 
139 

on the State’s average per capita income relative to the national 

average and cannot be less than 50 percent. 

PAYMENTS TO HEALTHCARE TRUST FUNDS

Appropriations, 2018 ......................................................................... $323,497,300,000 

Budget estimate, 2019 ...................................................................... 378,343,800,000 

Committee recommendation ............................................................. 378,343,800,000 

The Committee recommends $378,343,800,000 in mandatory 

funding for payments to healthcare trust funds. 

This entitlement account includes the general fund subsidy to 

the Federal Supplementary Medical Insurance Trust Fund for 

Medicare Part B benefits and for Medicare Part D drug benefits 

and administration, plus other reimbursements to the Federal Hospital Insurance Trust Fund for Part A benefits and related administrative costs that have not been financed by payroll taxes or premium contributions. 

The Committee provides $284,288,300,000 for the Federal payment to the Supplementary Medical Insurance Trust Fund. This 

payment provides matching funds for premiums paid by Medicare 

Part B enrollees. 

The Committee further provides $92,070,000,000 for the general 

fund share of benefits paid under Public Law 108–173, the Medicare Prescription Drug, Improvement and Modernization Act of 

2003. As in previous years, the Committee includes bill language 

requested by the administration providing indefinite authority for 

paying the general revenue portion of the Part B premium match 

and provides resources for the Part D drug benefit program in the 

event that the annual appropriation is insufficient. The Committee recommendation also includes $642,000,000 to be 

transferred to the Supplementary Insurance Trust Fund as the 

general fund share of Part D administrative expenses. The Committee recommendation includes $315,000,000 in reimbursements 

to the Health Care Fraud and Abuse Control [HCFAC] fund, which 

reflects the portion of the HCFAC spending to be reimbursed by 

the General Fund. 

PROGRAM MANAGEMENT

Appropriations, 2018 ............................................................................. $3,669,744,000 

Budget estimate, 2019 ........................................................................... 3,543,879,000 

Committee recommendation ................................................................. 3,669,744,000 

The Committee recommends $3,669,744,000 for CMS program 

management, which includes funding for research, program operations, survey and certification programs, and Federal administration. 

Research, Demonstrations and Evaluations.—The Committee recommends $20,054,000 for research, demonstrations, and evaluation 

activities. 

Program Operations 

The Committee recommends $2,519,823,000 for the Program Operations account, which covers a broad range of activities including 

claims processing and program safeguard activities performed by 

Medicare contractors. These contractors also provide information, 

guidance, and technical support to both providers and beneficiaries. 
140 

ACA Notifications.—The Committee continues bill language requiring the administration to provide detailed enrollment figures to 

the Committees on Appropriations of the House of Representatives 

and the Senate not less than two full business days before any public release of the information. 

Access to Mental Health Care.—The Committee strongly urges 

CMS to pursue initiatives that expand access to quality care and 

increase parity for mental health services. 

Alzheimer’s and Dementia Comprehensive Care and Caregiver 

Support Models.—Given the current and looming health and economic challenges posed by Alzheimer’s to the Medicare beneficiary 

population and to the Medicare program, the Committee encourages CMS to evaluate existing and potential multi-payer models 

like the Programs for All-inclusive Care for the Elderly that incorporate a comprehensive continuum of care for persons with Alzheimer’s. 

CT Colonography.—Due to the proven life and cost-savings of 

preventative screening for colorectal cancer, the Committee encourages CMS to consider covering CT Colonography as a Medicare-covered colorectal cancer screening test under section 1861(pp)(1) of 

the Social Security Act. 

Detecting Cognitive Impairment.—The Committee is concerned 

that the lack of uniform, easy-to-use and modern cognitive impairment detection tools is impeding the ability of providers to detect 

potential cognitive impairment of Medicare beneficiaries. The Committee encourages CMS to collaborate with NIA, AHRQ, and other 

relevant stakeholders to assess the current methods for detecting 

cognitive impairment to develop recommendations for health professionals and continue to monitor advancements in screening for 

cognitive impairment. 

Direct and Indirect Remuneration Fees.—The Committee is concerned about the dramatic increase of pharmacy direct and indirect 

remuneration [DIR] fees in Medicare Part D, especially the impact 

of ‘‘pharmacy DIR fees’’ on Medicare Part D beneficiaries who incur 

high drug costs. The Committee is aware that CMS has put forth 

a Request for Information included in the 2019 proposed Part D 

rule about this issue and others and encourages the agency to finalize their proposal without delay. The Committee looks forward 

to the report requested in fiscal year 2018 on how to best address 

this issue, including consideration of options to require that all DIR 

fees be accounted for a point of sale; as part of negotiated price; 

and that any incentive fees be paid separately. 

Drug Vial Size.—Within 30 days of enactment of this act, CMS 

shall enter into an agreement with the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine [the Academies] to conduct a study on the Federal healthcare 

costs, safety, and quality concerns associated with discarded drugs 

that results from weight-based dosing of medicines contained in 

singledose vials as stated in Senate report 114–274. The Committee recommendation includes $1,200,000 of the resources provided in Program Operations for this activity and CMS is directed 

to provide an update to the Committee’s on Appropriations 15 days 

after the enactment of this act and every 90 days thereafter until 
141 

the report is completed. CMS and the Academies are encouraged 

to consult with FDA. 

Graduate Medical Residencies.—As of October 2013, CMS determined that hospitals with approved residency programs cannot 

claim the time that FTE residents train at CAHs for indirect or direct GME purposes under Medicare. As a result of this determination, some hospitals have struggled to sustain efforts to train and 

retain physicians in rural communities with medical workforce 

shortages. The Committee encourages CMS to reexamine this determination and consider revisions that better support hospitals’ efforts to train more resident physicians in rural settings like CAHs. 

Health Insurance Exchange Transparency.—The Committee continues bill language that requires CMS to provide cost information 

for the following categories: Federal Payroll and Other Administrative Costs; Exchange related Information Technology [IT]; Non-IT 

Program Costs, including Health Plan Benefit and Rate Review, 

Exchange Oversight, Payment and Financial Management, Eligibility and Enrollment; Consumer Information and Outreach, including the Call Center, Navigator Grants and Consumer Education and Outreach; Exchange Quality Review; Small Business 

Health Options Program and Employer Activities; and Other Exchange Activities. Cost Information should be provided for each fiscal year since the enactment of the Patient Protection and Affordable Care Act (Public Law 111–148). CMS is also required to include the estimated costs for fiscal year 2020. 

Home Health Services.—The Committee is supportive of efforts to 

increase primary care access for low-income Medicare beneficiaries, 

in particular those living in publicly assisted housing and who have 

chronic health conditions. In approving future demonstration 

projects, CMS is encouraged to consider medical practices that coordinate with nonprofit housing providers. CMS is further encouraged to prioritize existing models of support and services at home 

that can show a reduced rate of growth in Medicare spending for 

at least the initial 500 participants as reviewed by a third party. 

Hospital-Acquired Pressure Ulcers.— The Committee is aware of 

recent data from CMS identifying that pressure ulcer discharges 

have significantly increased between the first quarter of 2016 and 

the first quarter of 2017. The Committee requests the Secretary 

and CMS Administrator provide an update and timeline in the fiscal year 2020 CJ on steps HHS and CMS are taking to reverse this 

trend. 

Initial Preventive Physical Examination/Annual Wellness Visit.— 

The Committee recognizes the importance of vaccines in preventing 

diseases, particularly among the Medicare population. The Initial 

Preventive Physical Examination [IPPE] under Medicare and Annual Wellness Visits [AWV] provide an important opportunity for 

improving immunization rates among Medicare beneficiaries. The 

National Vaccine Advisory Committee [NVAC] Standards for Adult 

Immunization Practice call on all healthcare professionals who provide care to adults to take steps to assess the immunization status 

of all patients in every clinical encounter, share a strong recommendation for vaccines that patients need, administer vaccines, 

or refer to a provider who can immunize and document administered vaccines. The goal of the standards is to reduce the number 
142 

of missed immunization opportunities by integrating these simple 

steps into clinical care. In following with the recommendations of 

NVAC, the Committee directs CMS to incorporate the Standards 

for Adult Immunization Practice in provider outreach and educational materials pertaining to the IPPE and AWV. 

Lymphatic System Failure.—The Committee encourages the Secretary to promulgate rules for covering prescribed compression garments as acknowledged by CMS’ 2001 decision memorandum 

[CAG–00016N] in the treatment of lymphatic system failure. 

Medicare Inpatient Hospital Wage Index.—There have been numerous studies, analyses, and reports on disparities in Medicare’s 

inpatient hospital wage index and ways to improve the wage index. 

Because some time has passed since these studies were conducted, 

the Committee recognizes that as part of the fiscal year 2019 Medicare Hospital Inpatient Prospective Payment System proposed rule 

[CMS–1694–P] the Secretary is currently soliciting public comments to inform future CMS regulatory action. As part of the administration’s review of public comments, the Committee encourages the Secretary to consider the extent to which population density, median annual household income, cost of living, and hospital 

closures may play a role in exacerbating wage index disparities. 

Medicare Payment for Non-Opioid Pain Management Therapies.—The Committee is concerned that some non-opioid alternatives may not be adequately reimbursed by the Medicare program which may create barriers to the appropriate use of these alternative therapies. The Committee encourages CMS to explore 

whether Medicare reimbursement should be modified for alternatives that can reduce dependence on opioid use. 

Muscular Dystrophy.—The Committee is aware of the addition of 

the new ICD–10 code for Duchenne/Becker to the fiscal year 2019 

CMS Addenda. The Committee requests a report be submitted to 

the Committees on Appropriations 180 days after enactment of the 

Act on utilization for the newly established ICD–10 code, as compared to the former broader ICD–10 code. 

National Diabetes Prevention Program.—The agreement continues to support CMS’ expansion of the Medicare Diabetes Prevention Program beginning in 2018 to improve health outcomes and 

reduce diabetes-related healthcare costs. The Committee encourages CMS to minimize the regulatory barriers impeding potential 

or existing suppliers from delivering the Diabetes Prevention Program [DPP] to Medicare beneficiaries. The Committee also encourages CMS to allow the full range of CDC recognized DPP providers 

including online, distance learning, and combination programs to 

participate as Medicare Diabetes Prevention Program suppliers. 

Out of Network Emergency Care.—The Committee recognizes the 

valuable role that emergency physicians play as the nation’s 

healthcare safety net. The Committee believes that beneficiary protections are important to reduce the financial exposure of patients 

who receive emergency care outside of their insurance network. 

The Committee is concerned that the Center for Consumer Information and Insurance Oversight [CCIIO] has not provided sufficient clarity on how to determine the, ‘‘Usual, Customary & Reasonable’’ [UCR] amount in its Final Rule for patient protections. 

Therefore, the Committee encourages CCIIO to publish guidance 
143 

clarifying what constitutes the UCR amount using a transparent 

and fair standard. 

Patient Access to Medically Necessary Foods.—The Committee 

notes the recent action taken by TRICARE to advance proper coverage for medical foods and encourages CMS to work proactively 

with the stakeholder community to identify and address barriers to 

access. 

Patient Matching.—The Committee encourages CMS, working 

with ONC, to provide technical assistance to industry to promote 

patient safety by accurately identifying patients to their health information. 

Peer Support Services.—The Committee encourages HHS to work 

with States to identify opportunities to employ certified peer support specialists in Medicaid to further address the ongoing opioid 

epidemic. 

Physician Fee Schedule.—The Committee is aware that CMS has 

recently finalized its calendar year 2018 Ambulatory Surgical Center [ASC] Payment System. Methodology utilized for ASC payment 

system is based on payments for procedures performed in a hospital office setting compared to the same procedure in an ASC operating room. Therefore, the Committee encourages CMS to submit 

a report to the Committee on the difference in cost to Medicare patients receiving Interventional Pain procedures in a hospital office 

setting compared to the same procedure in a hospital operating 

room to determine if further changes shall be made in the classification system for covered outpatient procedures in ASCs. 

Program Integrity.—The Committee is supportive of the ongoing 

work that CMS’ Center for Program Integrity [CPI] is undergoing 

to tackle unacceptable levels of waste, fraud and abuse. CPI should 

continue to work with Oak Ridge National Laboratory to leverage 

DOE’s computational facilities to bring state-of-the-art computational and data analytics capabilities to address complex issues in 

CMS to reduce waste, fraud and abuse. Within 90 days upon enactment, the Committee requests CMS CPI brief the Committees on 

Appropriations on the House of Representatives and the Senate 

with an update on its progress and funding requirements needed 

to continually address this problem. 

Program of All-Inclusive Care for the Elderly.—The Committee 

recognizes the value that the Program of All-Inclusive Care for the 

Elderly [PACE] provides for 45,000 Medicare and Medicaid beneficiaries who would otherwise require nursing home levels of care 

and are instead able to stay in their communities. The Committee 

is aware that CMS has not yet finalized their update to the regulations governing the PACE Program and encourages CMS to expeditiously publish the final rule for proposed changes for PACE [CMS– 

4168–P]. 

Relative Values Under the Medicare Physician Fee Schedule.— 

The Committee encourages CMS to increase the representation of 

primary care physicians who are board certified and actively practicing in family medicine, general internal medicine, general pediatrics, preventive medicine, obstetrics and gynecology, or psychiatry on any advisory board or work group that formulates recommendations regarding any annual updates to the physician work 

relative values. 
144 

Risk Corridor Program.—The Committee continues bill language 

to prevent the CMS Program Management appropriation account 

from being used to support risk corridor payments. The agreement 

directs CMS to provide a report starting with plan year 2014 and 

continuing through the duration of the program to the Committees 

on Appropriations of the House of Representatives and the Senate 

detailing the receipts and transfer of payments for the Risk Corridor Program. 

Robotic Stereotactic Radiosurgery.—The Committee remains concerned that inadequate payment for robotic stereotactic 

radiosurgery threatens its viability in both the hospital and freestanding center setting. The Committee encourages CMS and contractors administering the physician fee schedule in Medicare Part 

B not to make further changes to these services in the freestanding 

center as CMS complies with the Patient Access and Medicare Protection Act, Public Law 114–115. 

Rural Health Care Facilities.—The Committee encourages CMS 

to work with States and associations of rural hospitals to allow program flexibility to demonstrate sustainable service delivery model 

options for rural communities, focused on preserving access to 

emergency care services and supporting future financial viability of 

rural facilities. 

Sepsis.—The Committee is concerned that the current SEP–1 

guidelines for treating septic patients do not take into account 

evolving practices. The Committee encourages CMS to ask the 

SEP–1 measure stewards to reevaluate their SEP–1 quality measure taking into account expanded FDA approvals for biomarker 

tests like procalcitonin in conjunction with its impact on antibiotic 

stewardship. CMS is also encouraged to identify the Medicare and 

Medicaid expenditures for individuals with sepsis. The Committee 

requests an update on these activities in the fiscal year 2020 CJ. 

Sexually Transmitted Diseases [STDs].—The Committee continues to be concerned about the high rate of STDs, especially in 

pregnant women and young adults. To help curb the spread of 

these diseases and address this public health problem at every opportunity, and to reach at-risk and vulnerable populations at every 

opportunity, the Committee encourages CMS to collaborate with 

CDC’s Division of STD Prevention to develop a screening and treatment initiative under its Medicaid program. 

Survey of Surgical Procedures Involving Certified Surgical Assistants.— The Committee is aware of data showing that surgical operations which utilize Certified Surgical Assistants [CSAs] are significantly shorter in duration than the time benchmarks CMS uses 

to set reimbursement for these procedures. Peer-reviewed studies 

show that shorter operations result in fewer complications, earlier 

post-surgery discharge and fewer post-surgery readmissions. In 

order to test the beneficial implications of this data, the Committee 

encourages CMS to record, for later analysis, how CSA participation in all Medicare-funded surgical operations may impact surgery 

time. 

Telehealth.—The Committee looks forward to the report requested in Senate Report 115–150 directing the Administrator, in 

consultation with the relevant agencies and stakeholders, to submit 

a report to the Committees of Appropriations of the House of Rep-
145 

resentatives and the Senate evaluating the use of telehealth and 

remote patient monitoring under all programs and pilots under the 

Medicare and Medicaid programs. 

Telehealth and the Pediatric Population.—The Committee recognizes the potential for telehealth to help meet the needs of patients 

and families across the country, including in both rural and urban 

areas. The Committee encourages CMS to identify and share with 

States best practices regarding ways in which telehealth and remote patient monitoring can be leveraged through the Medicaid 

and CHIP programs, particularly for the pediatric population. 

Therapeutic Foster Care.—The Committee remains concerned 

about the lack of a uniform definition within the Medicaid program 

for therapeutic foster care services. A uniform definition would improve the ability for more consistent care and treatment. The Committee requests an update in the fiscal year 2020 CJ on the study 

requested in fiscal year House Report 114–699. 

Workforce Capacity for Infectious Diseases and the Opioid Epidemic.—The Committee encourages CMS to collaborate with 

SAMHSA, CDC, and HRSA to support education and training for 

medical providers on the frontlines of the opioid epidemic to help 

expand access to comprehensive, coordinated care for opioid addiction and related infections diseases. 

Use of Social Security Numbers on Medicare Beneficiaries’ 

Cards.—The Committee is pleased with CMS efforts to replace Social Security Numbers on Medicare Beneficiary’s cards and directs 

CMS to provide an update on the progress of this initiative in their 

fiscal year 2020 CJ. 

Vaccine Utilization.—The Committee is concerned about the underutilization of vaccinations, particularly pneumococcal vaccines 

and 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 those beneficiaries and their providers to adhere to the recommendations. The Committee encourages CMS to work with National Vaccine Advisory Committee to determine the vaccine adherence rate in the Medicaid and CHIP populations compared to the 

national average pediatric vaccine adherence rate. The Committee 

asks for this to be included in the Department’s CJ for fiscal year 

2020. 

State Survey and Certification 

The Committee recommends $397,334,000 for State Survey and 

Certification activities, which ensure that institutions and agencies 

providing care to Medicare and Medicaid beneficiaries meet Federal health, safety, and program standards. On-site surveys are 

conducted by State survey agencies, with a pool of Federal surveyors performing random monitoring surveys. 

Certified Nurse Aids.—The Committee is aware of concerns about 

the skilled nursing facility [SNF] and nursing facility [NF] survey 

and certification process, particularly the statutory mandatory loss 

for 2 years of the ability of SNFs and NFs to train Certified Nurse 

Aids under certain circumstances. The Committee encourages CMS 

and States to work with SNFs and NFs to improve the quality of 
146 

care provided to their residents and to educate SNFs and NFs 

about the waivers authorized under statute and appeal rights of 

disapprovals of these nurse aide training programs. 

Federal Administration 

The Committee recommends $732,533,000 for Federal Administration, which funds the majority of CMS’ staff and operating expenses for routine activities such as planning, implementing, evaluating, and ensuring accountability in the programs administered by 

CMS. 

HEALTHCARE FRAUD AND ABUSE CONTROL

Appropriations, 2018 ............................................................................. $745,000,000 

Budget estimate, 2019 ........................................................................... 770,000,000 

Committee recommendation ................................................................. 765,000,000 

The Committee recommends $765,000,000, to be transferred from 

the Medicare trust funds, for Health Care Fraud and Abuse Control [HCFAC] activities. The latest data demonstrate for every 

$1.00 spent on fraud and abuse, $2.00 is recovered by the Treasury. 

The Committee recommendation includes a base amount of 

$311,000,000 and an additional $454,000,000 through a budget cap 

adjustment authorized by section 251(b) of the Balanced Budget 

and Emergency Deficit Control Act of 1985. 

Health Care Fraud.—The Committee remains concerned by the 

upward growth and sophistication of healthcare fraud across the 

country. The Committee’s recommended funding level demonstrates 

Congress’ continued support for the HHS–DOJ’s joint efforts to 

identify healthcare fraud against the Federal government. Since 

2007, the Medicare Fraud Strike Force alone has charged over 

3,500 individuals involved in falsely billing Medicare for over 

$12,500,000,000, including the largest healthcare fraud takedown 

involving over 400 individuals who allegedly falsely billed Federal 

healthcare programs $1,300,000,000. The Committee strongly supported the Department’s efforts to curtail healthcare fraud to protect Federal healthcare programs and their beneficiaries. 

ADMINISTRATION FOR CHILDREN AND FAMILIES

PAYMENTS TO STATES FOR CHILD SUPPORT ENFORCEMENT AND

FAMILY SUPPORT PROGRAMS

Appropriations, 2018 ............................................................................. $2,995,400,000 

Budget estimate, 2019 ........................................................................... 2,922,247,000 

Committee recommendation ................................................................. 2,922,247,000 

The Committee recommendation includes $2,922,247,000 in fiscal 

year 2019 mandatory funds for Child Support Enforcement and 

Family Support programs. In addition, the Committee recommends 

$1,400,000,000 in advance funding for the first quarter of fiscal 

year 2020. 

These funds support States’ efforts to promote the self-sufficiency 

and economic security of low-income families, including administrative expenses matching funds and incentive payments to States for 

child support enforcement; grants to States to help establish and 

administer access and visitation programs between noncustodial 
147 

parents and their children; payments to territories for benefits to 

certain aged, blind, or disabled individuals; and temporary benefits 

for certain repatriated citizens. 

LOW INCOME HOME ENERGY ASSISTANCE PROGRAM

Appropriations, 2018 ............................................................................. $3,640,304,000 

Budget estimate, 2019 ........................................................................... ........................... 

Committee recommendation ................................................................. 3,690,304,000 

The Committee recommendation includes $3,690,304,000, an increase of $50,000,000 above fiscal year 2018, for LIHEAP, which 

provides home heating and cooling assistance to low-income households, generally in the form of payments to energy vendors on behalf of the recipient. Within the total, the Committee recommendation includes up to $2,988,000 for program integrity and oversight 

efforts, the same as the fiscal year 2018 level. 

REFUGEE AND ENTRANT ASSISTANCE

Appropriations, 2018 ............................................................................. $1,864,936,000 

Budget estimate, 2019 ........................................................................... 1,792,311,000 

Committee recommendation ................................................................. 1,905,201,000 

The Committee recommends $1,905,201,000 for Refugee and Entrant Assistance [REA] programs. These programs provide a variety of benefits and services to refugees, asylees, Cuban and Haitian 

entrants, immigrants arriving on Special Immigrant Visas [SIV], 

trafficking victims, and torture victims (collectively referred to 

below as ‘‘refugees’’). These programs also provide temporary care 

and services for unaccompanied children apprehended by the Department of Homeland Security or other law enforcement agencies, 

who have no lawful immigration status in the United States until 

they can be placed with a parent, guardian, or other sponsor while 

awaiting adjudication of their immigration status. 

The Committee reiterates the directive included in fiscal year 

2018 and directs the Department to provide monthly updates to the 

Committees on Appropriations of the House of Representatives and 

the Senate of arrivals each month by category, including refugees, 

asylees, Cuban and Haitian Entrants, SIVs, and unaccompanied 

alien children, to include any updates in estimated funding needs 

as a result of changes in trends in those categories. 

The U.S. refugee admission programs reflect U.S. humanitarian 

and strategic interests. The U.S. refugee resettlement program provides for the safe resettlement of some of the most vulnerable refugees and not only saves lives, but also strengthens our national security by providing support and shared responsibility for strategic 

allies and regions. The Committee notes that appropriate consultation with Congress is required by statute in advance of the President’s determination on the number of refugees to be admitted during the coming fiscal year. 

The Committee affirms the community consultation process embedded in the U.S. refugee resettlement program, which is grounded in its public-private partnerships and thrives on cooperation 

among local, State, and Federal stakeholders. In times of sudden 

reductions in refugee arrivals, the Committee encourages HHS, to 

the extent practicable, to ensure that resettlement agencies are 

able to maintain their infrastructure and capacity at a level to con-
148 

tinue to serve new refugees, previously arrived refugees, and others 

who remain statutorily eligible for integration services, and to ensure future arrivals are adequately served. 

Transitional and Medical Services 

The Committee recommendation includes $354,000,000 for Transitional and Medical Services. This program provides grants to 

States and nonprofit organizations to provide up to 8 months of 

cash and medical assistance to arriving refugees, as well as foster 

care services to unaccompanied minors. 

The recommendation is $34,000,000 more than the fiscal year 

2018 level, consistent with current HHS estimates, which indicate 

the funding level provided will allow HHS to at least sustain the 

current level and scope of services provided to eligible arrivals, including maintaining the number of months refugees are eligible for 

benefits. 

The Committee continues to support the matching grant program 

and strongly encourages HHS to increase the percentage of eligible 

arrivals served by the program. Further, the Committee strongly 

encourages HHS to give matching grant organizations flexibility in 

administering their programs, including when justified, carrying 

over unexpended funding and slots and providing exemptions to 

the 31 day enrollment period. 

Refugee Support Services 

The Committee recommendation includes $207,201,000 for Refugee Support Services. This program provides a combination of formula and competitive grants to States and nonprofit organizations 

to help refugees become self-sufficient and address barriers to employment. 

In fiscal year 2018, the Committee accepted the administration’s 

proposal to consolidate funding from Social Services, Targeted Assistance, and Preventive Health to simplify administration of refugee services at the Federal, State and local levels. The Committee 

continues to expect that activities previously funded under these 

three lines will continue at the same level as before the consolidation. Within 30 days of enactment, the Committee directs the Department to provide a list of competitive grants and set asides 

within Refugee Support Services and to include their corresponding 

funding levels in fiscal years 2016 through 2019 (estimated). 

Victims of Trafficking 

The Committee recommendation includes $26,755,000 for Victims 

of Trafficking programs. These programs support a national network of organizations that provide a variety of services—including 

case management, counseling, benefit coordination, and housing assistance—for victims of commercial sex and forced labor trafficking. 

Within the total, the Committee recommendation includes 

$19,000,000 for services for foreign national victims, and 

$7,755,000 to improve services available for U.S. citizens and legal 

permanent residents. The Committee directs HHS to use the increase in funding to help address unmet needs in both programs. 

The Committee recommendation also includes no less than the fis-
149 

cal year 2018 level for the national human trafficking resource center. 

Unaccompanied Alien Children 

The Committee recommendation includes $1,303,245,000 for the 

Unaccompanied Alien Children [UAC] program. The UAC program 

provides temporary shelter and basic services to children who have 

no lawful immigration status in the United States and who have 

been apprehended by the Department of Homeland Security [DHS] 

or other law enforcement agencies without a parent or a guardian. 

HHS takes custody of the children until they can be placed with 

a parent or a guardian living in the United States pending resolution of their immigration status, or until their immigration status 

otherwise changes. 

The Department of HHS is responsible for the temporary care of 

UACs specifically to ensure the welfare of such children, many of 

whom have experienced significant trauma in their home country 

and in travelling to the United States. Family unity is a foundation 

of child welfare principles, and child welfare and medical experts 

have expressed serious concern that separating children from their 

parents can cause additional trauma that can have lasting harmful 

effects. 

The administration’s policies related to directing that criminal 

charges pursuant to 8 U.S.C. 1325 be brought against adults apprehended at the border between ports of entry have resulted in the 

separation of family units and significantly increased the number 

of children referred to HHS custody. This combined with other administrative changes and an increase in the number of unaccompanied children crossing the border have increased the number of 

children in HHS’ care, putting a significant strain on HHS resources. The Committee is concerned about the lack of transparency and available information from the administration regarding the effect of these and other policy changes on the UAC program and estimated funding needs. The Committee is also concerned about the lack of communication regarding HHS’ plan to address the unique challenges of caring for separated children, who 

can be very young and require reunification after a parent leaves 

the criminal justice system. Accordingly, the Committee directs the 

Department to provide, at a minimum, monthly briefings to the 

Committees on Appropriations of the House of Representatives and 

the Senate on the status of balances and current expenditure rates, 

current trends in the UAC program, any planned or implemented 

policy changes that impact the UAC program, and updated cost estimates. Further the Department shall notify the Committees on 

Appropriations of the House of Representatives and the Senate 

prior to making any administrative changes to the UAC program 

including, but not limited to, policies potentially impacting the 

number of children referred to HHS; shelter operations, including 

the placement of children with sponsors; and any post-release services. 

In addition, the Committee directs HHS to include in its existing 

weekly updates additional information, including, for both all 

UACs and the children who were apprehended as part of a family 

unit, the number of children referred to HHS, the number cur-
150 

rently in their care, the age and gender distribution of children, the 

average length of stay, the number of preteen children in both shelter beds and ORR-run foster care programs, the number of children 

released to sponsors, and the category of sponsor. The weekly updates should also include historical monthly totals for all information provided, updated as it becomes available. The Committee directs HHS to make this monthly information available publicly on 

its website, and to provide weekly updates on its website of the 

number of children who have been reunited with separated family 

members. The Committee also expects that separated families will 

have the opportunity to communicate regularly by telephone with 

one another and directs HHS to provide any updates in the mechanisms for facilitating contact between children and verified family 

members with whom they arrived at the border, and the number 

of children who have been reunited with those family members. Finally, the Trafficking Victims Protection Reauthorization Act of 

2008 and the Flores agreement require that all UACs should be 

transferred from DHS to HHS within 72 hours and promptly 

placed in the least restrictive setting that is in the best interest of 

the child. The Committee directs HHS to notify the Committee immediately should children remain in DHS custody longer than 72 

hours before being transferred to HHS. 

The Committee directs HHS to provide a report, within 30 days 

of enactment, on its process for monitoring contractors and addressing allegations of abuse and neglect in UAC shelters. The 

Committee expects all cost estimates provided by the Department 

to include the resources needed to thoroughly monitor treatment of 

children in ORR’s care. The Committee also expects ORR to provide sufficient oversight over any temporary and influx care facilities and provide appropriate care for each child in its custody. The 

Department should ensure that its criteria for placing children in 

influx facilities, such as the child being at least 13 years of age and 

having no known behavioral or medical issues, are followed. 

The Committee notes that services provided by qualified and 

independent legal counsel to UACs can increase the efficiency and 

effectiveness of immigration proceedings and significantly reduce 

the failure-to-appear rate of children who are released from HHS 

custody. The Committee recommendation directs ORR to continue 

the scope and funding of these legal services at no less than fiscal 

year 2017 levels. 

Victims of Torture 

The Committee recommendation includes $14,000,000 for the 

Victims of Torture program, $3,265,000 more than the fiscal year 

2018 level, to provide increased support for non-profit organizations 

providing direct services to torture survivors and their families. 

This program provides treatment, social, and legal services to victims of torture and training to healthcare providers on treating the 

physical and psychological effects of torture. 
151 

PAYMENTS TO STATES FOR THE CHILD CARE AND DEVELOPMENT

BLOCK GRANT

Appropriations, 2018 ............................................................................. $5,226,000,000 

Budget estimate, 2019 ........................................................................... 3,006,000,000 

Committee recommendation ................................................................. 5,226,000,000 

The Committee recommends $5,226,000,000 for the Child Care 

and Development Block Grant [CCDBG], a formula grant to States 

that provides financial assistance to families to help pay for child 

care, and otherwise improve the quality of child care programs. 

The Consolidated Appropriations Act, 2018 included a 

$2,370,000,000 increase in funding for CCDBG, the largest increase 

in the history of the program. This additional funding will help 

States meet the requirements and goals of the CCDBG Act of 2014 

to improve the safety and quality of child care programs, including 

increasing provider reimbursement rates. The Committee directs 

HHS to provide a report within 120 days of enactment on how 

States are using or plan to use this increased funding, and the status of States in meeting the statutory requirements of the CCDBG 

Act. The funding will also increase access to affordable high-quality 

child care to more low-income working families. 

The CCDBG Act of 2014 requires HHS to operate a National 

Toll-Free Hotline to facilitate reports of violations of health and 

safety requirements by an eligible child care provider, including 

suspected child abuse or neglect, and provide consumer education 

information to help parents access safe and quality care. The Committee is concerned about the Department’s lack of information on 

its planned operations for this legally mandated Hotline in fiscal 

year 2019. Within 30 days of enactment, the Committee directs the 

Department to provide their plan for the Hotline after September 

30, 2018, to include an assessment of the amount of time needed 

for a contract to be renewed or re-competed. 

SOCIAL SERVICES BLOCK GRANT

Appropriations, 2018 ............................................................................. $1,700,000,000 

Budget estimate, 2019 ........................................................................... 85,000,000 

Committee recommendation ................................................................. 1,700,000,000 

The Committee recommends $1,700,000,000 in mandatory funds 

for SSBG, a flexible source of funding that allows States to provide 

a diverse array of services to low-income children and families, the 

disabled, and the elderly. The budget request does not include 

funding for SSBG but proposes $85,000,000 in discretionary funding for the Health Professions Opportunity Grants program under 

this heading, which under current law is funded with mandatory 

funding. The Committee recommendation is consistent with current 

law and does not propose to move funding for the HPOG program 

from mandatory to discretionary. 

The Committee strongly encourages ACF to provide guidance to 

States regarding the availability of SSBG funding, and other programs as appropriate, for job training and employment services for 

non-custodial parents, including best practices and evidence-based 

interventions aimed at helping get non-custodial parents with child 

support enforcement involvement into well-paying jobs. 
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CHILDREN AND FAMILIES SERVICES PROGRAMS

Appropriations, 2018 ............................................................................. $12,022,225,000 

Budget estimate, 2019 ........................................................................... 10,323,890,000 

Committee recommendation ................................................................. 12,287,225,000 

The Committee recommends $12,287,225,000 for Children and 

Families Services programs. These funds support a variety of programs for children, youth, and families; Native Americans; victims 

of child abuse, neglect, and domestic violence; and other vulnerable 

populations. 

Head Start 

The Committee recommendation includes $10,113,095,000 for 

Head Start. Head Start provides grants directly to local organizations to provide comprehensive early childhood education services 

to children and their families, from before birth to age 5. 

Within the total, the Committee recommendation includes a 

$215,000,000 cost of living adjustment for all Head Start grantees 

to help keep up with rising costs, recruit and retain highly qualified staff, and continue to provide high-quality services to children 

and families. 

The Committee recommendation also includes an increase of 

$35,000,000 for grantees to continue to expand the duration of 

services provided to children and families. The Committee continues to support efforts to expand the duration of Head Start services. Research increasingly indicates that expanding the duration of 

services, including lengthening the program day and year, plays a 

part in achieving and sustaining the benefits of early childhood 

programs. However, the Committee also understands that expanding the duration of services may not, in some communities, be the 

best way to meet the needs of the families being served. The Committee, therefore, continues to direct HHS to ensure that as part 

of the effort to expand the duration of services, grantees continue 

to have flexibility to meet the needs of their local communities, and 

to fund other quality improvement activities that may be necessary 

to improve the quality of their programs and meet program performance standards. 

Within the total, the Committee recommendation also includes 

up to $25,000,000, the same as the comparable fiscal year 2018 

level, for transition-related costs associated with the Head Start 

Designation Renewal System [DRS]. 

The Committee recommendation modifies existing bill language 

to simplify the administration of Early Head Start [EHS] Expansion and Child Care Partnerships program for grantees, but does 

not otherwise change the statutory authority regarding the use of 

such funds. Funding previously provided for EHS Expansion and 

Child Care Partnerships will continue to be used in the same 

amounts and for the same purposes and activities as in prior years. 

Of the amount available for obligation through March 31, 2020, for 

Head Start, $98,000,000 is to continue new awards under the EHS 

Expansion and Child Care Partnerships program from fiscal year 

2018 that will be made by March 31, 2019. The Committee directs 

HHS, in future budget justifications, to include actual and projected funding levels for Early Head Start-Child Care Partnerships. 
153 

The Committee notes that HHS is in the process of reviewing 

public comments on proposed changes to the DRS, which is a key 

tool in ensuring strong standards. The Committee is also aware of 

significant concerns about the use of the CLASS lowest 10 percent 

provision in appropriately identifying grantees subject to re-competition. The Committee strongly encourages HHS to complete this 

review as quickly as possible, and to maintain high standards, 

strong accountability, and transparency to grantees and the public 

while ensuring the integrity of program evaluation measures. Finally, the Committee continues to encourage HHS to continue to 

consider the unique challenges faced by Head Start grantees in remote and frontier areas when reviewing such grantees’ compliance 

with health and dental screening requirements as part of the DRS. 

The Committee strongly encourages ACF to ensure that all Head 

Start grantees are aware of any funding opportunities, or funding 

otherwise available, for making capital improvements to their facilities. Further, the Committee encourages ACF to standardize 

this process so all grantees have equal opportunity to apply and 

are aware of priorities and eligible uses of such funds. 

Individuals from low-income families are disproportionately at 

risk for obesity and other hypokinetic diseases, and early physical 

activity interventions can improve overall health, cognitive ability 

and academic success. The Committee encourages ACF to develop 

and implement strategies to improve motor skills and physical activity levels in Head Start program participants whenever possible. 

Preschool Development Grants 

The Committee recommendation includes $250,000,000 for Preschool Development Grants. This program, as authorized in the 

Every Student Succeeds Act, provides competitive grants to States 

to improve the coordination, collaboration, and quality of existing 

early childhood programs; improve the transition from early childhood programs to kindergarten; implement evidence-based practices; improve professional development for early childhood providers; and generally improve educational opportunities for children. All funding provided in fiscal year 2019 will support the second round of grants under the new authorization of the program. 

Consolidated Runaway and Homeless Youth Program 

The Committee recommendation includes $110,280,000 for the 

Consolidated Runaway and Homeless Youth program. This program supports the Basic Centers program, which provides temporary shelter, counseling, and after-care services to runaway and 

homeless youth under age 18 and their families; the Transitional 

Living Program, which provides longer-term shelter and services 

for older youth; and a national toll-free runaway and homeless 

youth crisis hotline. 

Where allowable, the Committee supports the ability of grantees 

to provide prevention services, such as counseling and case management, regardless of enrollment in residential services. 
154 

Education and Prevention Grants To Reduce Sexual Abuse of Runaway Youth 

The Committee recommendation includes $17,141,000 for Education and Prevention Grants to Reduce Sexual Abuse of Runaway 

and Homeless Youth. This program provides competitive grants for 

street-based outreach and education services for runaway and 

homeless youth who are subjected to, or are at risk of being subjected to, sexual abuse or exploitation. 

Child Abuse Prevention and Treatment State Grants 

The Committee recommendation includes $85,310,000 for the 

Child Abuse Prevention and Treatment State Grant program. This 

program provides formula grants to States to improve their child 

protective service systems. 

Infant Plans of Safe Care.—Within the total, the Committee recommendation includes $60,000,000 to help States develop and implement plans of safe care as required by section 106(b)(2)(B](iii) of 

CAPTA. The incidence of neonatal abstinence syndrome has increased as the opioid crisis has worsened, and this funding will 

help States improve their response to infants affected by a substance use disorder and their families. The Committee strongly encourages HHS to encourage States to include in their plans specialized services for parents whose children may be at risk of abuse or 

neglect in order to the reduce the need for child welfare or foster 

care system involvement. Finally, the Committee directs HHS to 

provide technical assistance to States on best-practices and evidence-based interventions in this area to help address the health, 

safety, and substance use disorder treatment needs of the child and 

family, and to evaluate State’s activities on plans of safe care. 

Child Abuse Reporting Legal Liability.—The Committee recognizes that trained professionals, including healthcare providers, 

teachers, and law enforcement, are often asked or required to participate in the identification, investigation, and reporting of suspected child maltreatment. However, individuals assisting in cases 

of suspected child maltreatment have faced potential legal liability 

for their participation in child maltreatment reporting. The Committee recognizes the intent of the Child Abuse Prevention and 

Treatment Act to provide legal immunity for persons acting in good 

faith, including both those directly reporting and those assisting 

with reports. 

Child Abuse Discretionary Activities 

The Committee recommendation includes $33,000,000 for Child 

Abuse Discretionary Activities. This program supports discretionary grants for research, demonstration, and technical assistance to increase the knowledge base of evidence-based practices 

and to disseminate information to State and local child welfare programs. 

Child Abuse Hotline.—Within the total, the Committee includes 

$1,000,000, in annual funding, to continue support for an innovation grant to develop text and online chat-based intervention and 

education services through a national child abuse hotline for child 

abuse victims and concerned adults. 
155 

Community-Based Child Abuse Prevention 

The Committee recommendation includes $39,764,000 for the 

Community-Based Child Abuse Prevention program. This program 

provides formula grants to States that then disburse funds to local, 

community-based organizations to improve local child abuse prevention and treatment efforts, including providing direct services 

and improving the coordination between State and communitybased organizations. 

Child Welfare Services 

The Committee recommendation includes $268,735,000 for Child 

Welfare Services. This formula grant program helps State and tribal public welfare agencies improve their child welfare services with 

the goal of keeping families together. These funds help States and 

tribes provide a continuum of services that prevent child neglect, 

abuse or exploitation; allow children to remain with their families, 

when appropriate; promote the safety and permanence of children 

in foster care and adoptive families; and provide training and professional development to the child welfare workforce. 

Child Welfare Research, Training, and Demonstration 

The Committee recommendation includes $17,984,000 for child 

welfare research, training, and demonstration projects. This program provides grants to public and nonprofit organizations for 

demonstration projects that encourage experimental and promising 

types of child welfare services, as well as projects that improve 

education and training programs for child welfare service providers. 

National Survey of Child and Adolescent Well-Being.—The Committee recommendation includes funding for HHS to continue the 

National Survey of Child and Adolescent Well-Being. 

Adoption Opportunities 

The Committee recommends $39,100,000 for the Adoption Opportunities program. This program funds discretionary grants to help 

facilitate the elimination of barriers to adoption and provide technical assistance to help States increase the number of children 

adopted, particularly children with special needs. 

Adoption Incentives 

The Committee recommends $75,000,000 for the Adoption Incentives program. This program provides formula-based incentive payments to States to encourage them to increase the number of adoptions of children from the foster care system, with an emphasis on 

children who are the hardest to place. 

The Committee recommendation continues the significant increase provided in fiscal year 2018 to make up a shortfall in funding owed to States. This funding level will fully fund the remaining 

amount owed to States for fiscal year 2018, and a significant 

amount of the estimated amount owed to States for fiscal year 

2019, with the goal of becoming completely current by fiscal year 

2020. The Committee directs HHS to include in future budget justifications an estimate of amounts earned by States per year, and 
156 

the total estimated amount owed to States for the budget year, including any funding owed from prior fiscal years. 

Social Services and Income Maintenance Research 

The Committee recommends $6,512,000 for Social Services and 

Income Maintenance Research. These funds support research and 

evaluation of cost-effective programs that increase the stability and 

economic independence of families and contribute to the healthy 

development of children and youth. 

Native American Programs 

The Committee recommends $54,050,000 for Native American 

programs. These funds support a variety of programs to promote 

self-sufficiency and cultural preservation activities among Native 

American, Native Hawaiian, Alaska Native, and Pacific Islander 

organizations and communities. 

Native American Language Preservation.—Within the total, the 

Committee recommendation includes $12,000,000 for Native American language preservation activities, including no less than 

$4,000,000 for Native American language nests and survival 

schools, as authorized by sections 803C(b)(7)(A]–(B] of the Native 

American Programs Act. The Committee directs HHS to give priority to programs with rigorous immersion programs. 

Community Services Block Grant 

The Committee recommendation includes $725,000,000 for the 

Community Services Block Grant [CSBG]. The CSBG is a formula 

grant to States and Indian tribes to provide a wide range of services to alleviate causes of poverty in communities and to assist lowincome individuals in becoming self-sufficient. States are required 

to pass on at least 90 percent of these funds to local communitybased organizations, the vast majority of which are community action agencies. 

Supporting Community Action Agencies’ Response to Opioid 

Abuse and Misuse.—Individuals and families in poverty face 

daunting challenges as they work toward substance use recovery 

and addressing the opioid epidemic requires a multi-pronged, community-based response. The Committee recognizes that community 

action agencies are uniquely positioned to help fight the opioid crisis and provide essential support and services for individuals and 

families who experience poverty and that these entities deliver a 

wide range of services to address immediate needs while supporting long-term goals, which make recovery sustainable. The 

Committee also recognizes that the conditions of poverty compound 

the difficulties faced by those struggling with substance use. The 

Committee recommendation includes an increase of $10,000,000 for 

CSBG to help community actions agencies continue to address 

these critical needs. 

Community Economic Development 

The Committee recommendation includes $19,883,000 for the 

Community Economic Development program, which provides 

grants to community development corporations to support employment and business opportunities for low-income individuals. Com-
157 

munity development corporations leverage on average $10 in private capital to every $1 in Federal funds, and the job creation 

standards required by the Office of Community Services are among 

the most stringent in the Federal system. 

Rural Community Facilities 

The Committee recommendation includes $8,000,000 for the 

Rural Community Facilities program, which provides grants to regional non-profit organizations to provide technical assistance to 

small, low-income rural communities, that are not served by other 

similar Federal programs, to help manage, develop, and improve 

safe drinking and waste water facilities. 

National Domestic Violence Hotline 

The Committee recommendation includes $10,250,000 for the National Domestic Violence Hotline. This national, toll-free hotline 

provides critical emergency assistance and information to victims of 

domestic violence 24 hours a day. 

Family Violence Prevention and Services 

The Committee recommendation includes $165,000,000 for Family Violence Prevention and Services programs. These funds support programs to prevent family violence and provide immediate 

shelter and related assistance for victims of domestic violence and 

their dependents. 

Chafee Education and Training Vouchers 

The Committee recommendation includes $43,257,000 for the 

Chafee Education and Training Voucher program. This program 

supports vouchers to foster care youth to help pay for expenses related to postsecondary education and vocational training. 

Disaster Human Services Case Management 

The Committee recommends $1,864,000 for Disaster Human 

Services Case Management. This program assists States in establishing the capacity to provide case management services in a timely manner in the event of a disaster. It ensures that States are able 

to meet social service needs during disasters by helping disaster 

victims prepare recovery plans, referring them to service providers 

and FEMA contacts to identify needed assistance, and providing 

ongoing support and monitoring through the recovery process. 

Program Administration 

The Committee recommendation includes $205,000,000 for the 

Federal costs of administering ACF programs. 

PROMOTING SAFE AND STABLE FAMILIES

Appropriations, 2018 ............................................................................. $444,765,000 

Budget estimate, 2019 ........................................................................... 554,765,000 

Committee recommendation ................................................................. 444,765,000 

The Committee recommends $444,765,000 for the Promoting Safe 

and Stable Families program. The Committee recommendation includes $345,000,000 in mandatory funds authorized by the Social 

Security Act and $99,765,000 in discretionary appropriations. 
158 

This program supports activities that can prevent the emergence 

of family crises that might require the temporary or permanent removal of a child from his or her home. Grants allow States to operate coordinated programs of family preservation services, time-limited family reunification services, community-based family support 

services, and adoption promotion and support services. 

Regional Partnership Grants [RPGs] and Family-Focused Residential Treatment Programs.—Within the total for discretionary 

funding, the Committee recommendation includes $20,000,000 for 

RPGs and family-focused residential treatment programs. RPGs 

promote coordination and collaboration between local child welfare 

and substance abuse treatment agencies, and other related organizations, to improve services and outcomes for children and families 

affected by substance use disorder, particularly opioid use. Familyfocused residential treatment programs are trauma-informed residential programs primarily for substance use disorder treatment 

for pregnant and postpartum women and parents and guardians 

that allow children to reside with their mothers, parents, or guardians during treatment to the extent appropriate and applicable. Organizations applying for this funding should be allowed to apply to 

operate one or both programs. This funding will help build the evidence-base of what works in anticipation of the availability of mandatory funding for similar activities under the Family First Prevention and Services Act. 

Kinship Navigator Programs.—The Committee recommendation 

includes $20,000,000, the same as the fiscal year 2018 funding 

level, for Kinship Navigator Programs to improve services for 

grandparents and other relatives taking primary responsibility for 

children, particularly children and families affected by opioid addiction and substance use disorder. The Committee encourages HHS 

to encourage States to collaborate with agencies with experience 

servicing kinship families both inside and outside foster care and 

to demonstrate how they are preparing their navigator programs to 

meet evidence-based kinship navigator standards included in the 

Family First Prevention Services Act. Similar to RPGs and familyfocused residential treatment programs, this funding helps build 

the evidence-base in anticipation of mandatory funding being available for similar activities under the Family First Prevention and 

Services Act. 

PAYMENTS FOR FOSTER CARE AND PERMANENCY

Appropriations, 2018 ............................................................................. $6,225,000,000 

Budget estimate, 2019 ........................................................................... 6,035,000,000 

Committee recommendation ................................................................. 6,035,000,000 

The Committee recommends $6,035,000,000 in mandatory funds 

for Payments for Foster Care and Permanency. In addition, the 

Committee recommends $2,800,000,000 in advance mandatory 

funding for the first quarter of fiscal year 2020. These funds support programs that assist States with the costs of maintaining eligible children in foster care, prepare children for living on their 

own, assist relatives with legal guardianship of eligible children, 

and find and support adoptive homes for children with special 

needs. 
159 

ADMINISTRATION FOR COMMUNITY LIVING

AGING AND DISABILITY SERVICES PROGRAMS

Appropriations, 2018 ............................................................................. $2,171,915,000 

Budget estimate, 2019 ........................................................................... 1,818,681,000 

Committee recommendation ................................................................. 2,177,215,000 

The Committee recommends an appropriation of $2,177,215,000 

for the Administration for Community Living [ACL], which includes $27,700,000 to be transferred to ACL from the PPH Fund. 

ACL was created with the goal of increasing access to community 

support for older Americans and people with disabilities. It is 

charged with administering programs authorized under the Older 

Americans Act [OAA] and the Developmental Disabilities Act, as 

well as promoting community living policies throughout the Federal Government for older Americans and people with disabilities. 

Home- and Community-Based Supportive Services 

The Committee recommends an appropriation of $385,074,000 for 

the Home- and Community-Based Supportive Services program. 

This program provides formula grants to States and territories to 

fund a wide range of social services that enable seniors to remain 

independent and in their homes for as long as possible. State agencies on aging award funds to designated area agencies on aging 

that, in turn, make awards to local service providers. This activity 

supports services such as transportation, adult day care, physical 

fitness programs, and in-home assistance such as personal care and 

homemaker assistance. The Committee directs ACL to work with 

States to prioritize innovative service models, like naturally occurring retirement communities [NORCs], which help older Americans 

remain independent as they age. The Committee notes that 

NORCs, and similar settings, are a more cost-effective alternative 

to long-term care that enables older Americans to be more engaged 

in their communities while living at home. 

Preventive Health Services 

The Committee recommends $24,848,000 for Preventive Health 

Services. This program funds activities such as medication management and enhanced fitness and wellness programs. These programs 

help seniors stay healthy and avoid chronic disease, thus reducing 

the need for costly medical interventions. The Committee maintains bill language that requires States to use these funds to support evidence-based models that enhance the wellness of seniors. 

Protection of Vulnerable Older Americans 

The Committee recommends $21,658,000 for grants to States for 

the Long-term Care Ombudsman program and the Prevention of 

Elder Abuse program. Both programs provide formula grants to 

States to prevent the abuse, neglect, and exploitation of older individuals. The ombudsman program focuses on the needs of residents 

of nursing homes and other long-term care facilities, while the 

elder abuse prevention program targets the elderly community at 

large. 
160 

National Family Caregiver Support Program 

The Committee recommends $180,886,000 for the National Family Caregiver Support program. Funds appropriated for this activity 

establish a multifaceted support system in each State for family 

caregivers, allowing them to care for their loved ones at home for 

as long as possible. States may use funding to provide information 

to caregivers about available services, assistance to caregivers in 

gaining access to services, caregiver counseling and training, respite care to enable caregivers to be temporarily relieved from their 

caregiving responsibilities, and limited supplemental services that 

fill remaining service gaps. 

National Family Caregiver Support Program.—The Committee 

notes that the RAISE Family Caregivers Act (Public Law 115–119) 

signed into law this year requires HHS to establish a Family 

Caregiving Advisory Council and develop a new national strategy 

to support family caregivers, including resources, best practices, 

challenges, and programs to enhance the long-term care caregiving 

workforce. The Committee includes $300,000 to establish the Council, which shall include representatives of relevant Departments 

and agencies and individuals with expertise and experience in family caregiving and long-term care supports, including caregivers. 

Native American Caregiver Support Program 

The Committee recommendation includes $9,556,000 to carry out 

the Native American Caregiver Support program. This program 

provides grants to tribes for the support of American Indian, Alaskan Native, and Native Hawaiian families caring for older relatives 

with chronic illness or disability, as well as for grandparents caring 

for grandchildren. 

Congregate and Home-Delivered Nutrition Services 

The Committee recommends $490,342,000 for congregate nutri- tion services and $246,342,000 for home-delivered meals. These 

programs address the nutritional needs of older individuals, thus 

helping them to stay healthy and reduce their risk of disability. 

Funded projects must make home-delivered and congregate meals 

available at least once a day, 5 days a week, and each meal must 

meet a minimum of one-third of daily dietary requirements. While 

States receive separate allotments of funds for congregate meals, 

home-delivered meals, and supportive services, they have flexibility 

to transfer funds between these programs. 

Nutrition Services Incentives Program.—The Committee recommendation includes $160,069,000 for the Nutrition Services Incentives Program [NSIP]. NSIP augments funding for congregate 

and home-delivered meals provided to older adults. States and 

tribes may choose to receive all or part of their funding in the form 

of commodities from the USDA. 

Aging Grants to Indian Tribes and Native Hawaiian Organizations 

The Committee recommends $33,208,000 for grants to Native 

Americans. This program provides grants to eligible tribal organizations for the delivery of nutrition and supportive services to Native Americans. 
161 

Aging Network Support Activities 

The Committee recommends $12,461,000 for Aging Network Support activities. These funds support activities that expand public 

understanding of aging and the aging process, apply social research 

and analysis to improve access to and delivery of services for older 

individuals, test innovative ideas and programs, and provide technical assistance to agencies that administer programs authorized 

by the OAA. 

The Committee also includes $5,000,000 to help provide supportive services for aging Holocaust survivors in the United States. 

Alzheimer’s Disease Program Demonstration Grants to States 

The Committee recommendation includes $23,500,000 for Alzheimer’s Disease Program which includes Demonstration Grants to 

States and the Alzheimer’s Disease Initiative consolidated in the 

Consolidated Appropriations Act, 2018. Within this funding, the 

Committee supports the continuation of the National Alzheimer’s 

Call Center, which is available in all States, 24 hours a day, 7 days 

a week, year-round, to provide expert advice, crisis counseling, care 

consultation and information referral services in at least 140 languages, for persons with Alzheimer’s disease, their family members 

and informal caregivers. 

Lifespan Respite Care 

The Committee recommends $4,110,000 for the Lifespan Respite 

Care program. The Lifespan Respite Care program provides grants 

to States to expand respite care services to family caregivers, improve the local coordination of respite care resources, and improve 

access to and quality of respite care services, thereby reducing family caregiver strain. 

Chronic Disease Self-Management Program 

The Committee recommends $8,000,000 be transferred from the 

PPH Fund to ACL for the Chronic Disease Self-Management Program [CDSMP]. This program assists those with chronic disease to 

manage their conditions and improve their health status. Topics 

covered by the program include nutrition; appropriate use of medications; fitness; and effective communications with healthcare providers. CDSMP has been shown through multiple studies to result 

in significant and measurable improvements in health and quality 

of life, as well as reductions in hospitalizations and emergency 

room visits. 

Elder Falls Prevention 

The Committee recommends that $5,000,000 be transferred from 

the PPH Fund for Elder Falls Prevention activities at ACL. Preventing falls will help seniors stay independent and in their homes 

and avoid costly hospitalizations and hip fractures, which frequently lead to nursing home placement. The Committee intends 

that these funds should be used in coordination with CDC for public education about the risk of these falls, as well as implementation and dissemination of community-based strategies that have 

been proven to reduce the incidence of falls among seniors. 
162 

Elder Rights Support Activities 

The Committee recommends $15,874,000 for Elder Rights Support activities, including $12,000,000 for the Elder Justice Initiative. These activities support programs that provide information, 

training, and technical assistance to legal and aging services organizations in order to prevent and detect elder abuse and neglect. 

Aging and Disability Resource Centers 

The Committee recommendation includes $8,119,000 for Aging 

and Disability Resource Centers [ADRCs]. These centers provide 

information, one-on-one counseling, and access for individuals to 

learn about their long-term services and support options with the 

goal of allowing seniors and individuals with disabilities to maintain their independence. The Committee urges ACL to improve coordination among ADRCs, area agencies on aging, and centers for 

independent living to ensure that there is ‘‘no wrong door’’ to access 

services. 

State Health Insurance Assistance Program 

The Committee recommendation includes $49,115,000 for State 

Health Insurance Assistance Programs, which provide accurate and 

understandable health insurance information to Medicare beneficiaries and their families. 

Paralysis Resource Center 

The Committee includes $8,700,000 for the National Paralysis 

Resource Center [PRC], an increase of $1,000,000. This program 

has long provided essential, comprehensive information, and referral services that promote independence and quality of life for the 

5,400,000 people living with paralysis and their families. The Committee directs ACL to continue support for the national PRC at not 

less than $7,700,000. 

Limb Loss 

The Committee provides $3,500,000 for the Limb Loss program, 

which supports programs and activities to improve the health of 

people with limb loss and promote their well-being, quality of life, 

prevent disease, and provide support to their families and caregivers. Maintaining these programs is critical to support independent living within the disability community across their life 

course. 

Traumatic Brain Injury 

The Committee provides $11,321,000 for the Traumatic Brain Injury program. The program supports implementation and planning 

grants to States for coordination and improvement of services to individuals and families with traumatic brain injuries. Such services 

can include: pre-hospital care, emergency department care, hospital 

care, rehabilitation, transitional services, education, employment, 

long-term support, and protection and advocacy services. 

The Committee includes not less than the fiscal year 2018 funding level for protection and advocacy services, as authorized under 

section 1305 of Public Law 106–310. 
163 

Developmental Disabilities State Councils 

The Committee includes $76,000,000 for State councils on developmental disabilities. These councils work to develop, improve, and 

expand the system of services and supports for people with developmental disabilities at the State and local level. Councils engage 

in activities such as training, educating the public, building capacity, and advocating for change in State policies with the goal of furthering the inclusion and integration of individuals with developmental disabilities in all aspects of community life. 

Developmental Disabilities Protection and Advocacy 

The Committee includes $40,734,000 for protection and advocacy 

programs for people with developmental disabilities. This formula 

grant program provides funds to States to establish and maintain 

protection and advocacy systems that protect the legal and human 

rights of persons with developmental disabilities who are receiving 

treatment, services, or rehabilitation. 

Intermediate Care Facilities.—The Department is encouraged to 

factor the needs and desires of patients, their families, caregivers, 

legal representatives, and other stakeholders, as well as the need 

to provide proper settings for care, into its enforcement of the Developmental Disabilities Act. 

Voting Access for Individuals With Disabilities 

The Committee includes $6,963,000 to improve voting access for 

individuals with disabilities. This program provides grants to protection and advocacy organizations to ensure that individuals with 

disabilities have the opportunity to participate in every step of the 

electoral process, including registering to vote, accessing polling 

places, and casting a vote. 

Developmental Disabilities Projects of National Significance 

The Committee includes $12,000,000 for projects of national significance to assist persons with developmental disabilities. This 

program funds grants and contracts that develop new technologies 

and demonstrate innovative methods to support the independence, 

productivity, and integration into the community of persons with 

developmental disabilities. 

ABLE Act.—The Achieving a Better Life Experience Act [ABLE 

Act] allows individuals and families to save for the purpose of supporting individuals with disabilities in maintaining their health, 

independence, and quality of life. The Committee strongly encourages ACL to raise awareness on the eligibility and benefits of these 

accounts. 

Specialized Housing for Individuals with Developmental Disabilities.—The Committee is aware that individuals with intellectual 

and developmental disabilities, particularly older adults, face challenges finding specialized housing with comprehensive services and 

encourages ACL to continue partnering with HUD, CMS, and other 

Federal agencies to support these critical services. 

Transportation.—The Committee includes $1,000,000 to fund 

transportation assistance activities for older adults and persons 

with disabilities. These activities should focus on the most cost-effective and sustainable strategies that can be replicated to other 
164 

communities. The Committee is pleased with the Inclusive Community Transportation program’s efforts to integrate rural transit systems for individuals with disabilities and older adults to access 

healthcare services, paratransit, multiple transportation providers, 

and other critical community based supports. These small community demonstration grants should be designed to include the perspectives of individuals with disabilities and older adults in the 

transportation system and service design. 

University Centers for Excellence in Developmental Disabilities 

The Committee includes $40,619,000 for the University Centers 

for Excellence in Developmental Disabilities [UCEDDs], a network 

of 67 centers that are interdisciplinary education, research and 

public service units of a university system or public or nonprofit 

entities associated with universities. The funding will keep the national network of Centers strong and able to assist States to initiate collaborative research, education, training, and service efforts 

that help States to implement ESSA and WIOA, thereby ensuring 

that youth with disabilities successfully complete elementary school 

and transition from school to postsecondary education and/or integrated employment. This funding also allows the University Centers to continue to address the needs of the rising numbers of individuals on the autism spectrum; demonstrate cost effective long 

term services and supports for adults with disabilities and those 

aging with disabilities; support returning veterans; and provide 

technical assistance to strengthen and support the national network of Centers as the disseminate research and best practices nationwide. 

Independent Living 

The Committee includes $113,183,000 for the Independent Living 

Program. This program helps ensure that individuals with disabilities can live a productive and independent life in society. Funding 

helps States sustain, improve, and expand independent living services and establish and support a network of centers for independent living. 

National Institute on Disability, Independent Living, and Rehabilitation Research 

The Committee includes $108,970,000 for the National Institute 

on Disability, Independent Living, and Rehabilitation Research 

[NIDILRR]. NIDILRR supports research and activities that help to 

maximize the full potential of individuals with disabilities in employment, independent living, and social activities. The Committee 

continues to support NIDILRR in ACL and does not transfer the 

program or activities to NIH. 

Assistive Technology Research.—The Committee recognizes that 

there is a significant opportunity over the next decade for the HHS 

to lower healthcare costs and improve quality of life for people with 

disabilities through technology solutions for daily living. The Committee provides NIDILRR $4,000,000 to fund competitive research 

grants that helps individuals with disabilities, with a particular 

emphasis on seniors, maintain or improve independence. 
165 

Assistive Technology 

The Committee recommendation includes $36,000,000 for Assistive Technology [AT]. AT provides States with funding to support 

individuals with disabilities of all ages to obtain devices and services that will increase, maintain, or improve their functional capabilities. 

Program Administration 

The Committee recommends $41,063,000 for program administration at ACL. These funds support salaries and related expenses 

for program management and oversight activities. 

OFFICE OF THE SECRETARY

GENERAL DEPARTMENTAL MANAGEMENT

Appropriations, 2018 ............................................................................. $535,457,000 

Budget estimate, 2019 ........................................................................... 342,990,000 

Committee recommendation ................................................................. 545,457,000 

The Committee recommends $545,457,000 for General Departmental Management [GDM]. The recommendation includes 

$64,828,000 in transfers available under section 241 of the PHS 

Act. 

This appropriation supports activities that are associated with 

the Secretary’s role as policy officer and general manager of the 

Department. It supports health activities performed by the Office 

of the Assistant Secretary for Health [ASH], including the Office of 

the Surgeon General. GDM funds also support the Department’s 

centralized services carried out by several Office of the Secretary 

staff divisions, including personnel management, administrative 

and management services, information resources management, 

intergovernmental relations, legal services, planning and evaluation, finance and accounting, and external affairs. 

Adverse Childhood Experience [ACE].—The Committee is aware 

that more than half of children, across all socioeconomic groups, experience an ACE such as physical abuse, substance misuse in the 

household, sexual abuse, and parental divorce, or separation. The 

Committee encourages the Office of the Surgeon General to develop 

a report on the connection between ACE, future substance misuse, 

and other health conditions. The Surgeon General should collaborate with CDC, NIH, SAMHSA, and ACF as they have extensive 

experience working on ACEs, their relationship to future health 

outcomes, and associated prevention efforts. 

Antibiotic Resistance.—The Department shall include in the fiscal year 2020 CJ a detailed update on the progress being made to 

implement the CARB national strategy. 

Chronic Fatigue Syndrome [ME/CFS].—The Committee is concerned that Americans afflicted with CFS also known as Myalgic 

Encephalomyelitis [ME/CFS] have very limited access to clinical 

care, that there is no diagnostic test for CFS, and that there are 

no FDA-approved treatments for them. HHS is encouraged to utilize the CFS Advisory Committee to accelerate progress on research, education, training, clinical care, and services to better address the needs of over 1,000,000 Americans suffering from CFS. 
166 

DATA Act.—The Committee notes that in a November 2017 report, independent analysis found that the Department has made 

significant progress during fiscal year 2017 in implementation of 

the Digital Accountability and Transparency Act of 2014 [DATA 

Act], which requires Federal agencies to report on financial and 

non-financial data in accordance with standards established by the 

U.S. Department of the Treasury and the Office of Management 

and Budget. The Committee directs the Department to continue to 

take action to address the deficiencies highlighted in the report in 

order to improve data quality for the benefit of the taxpayer. 

Direct-to-Consumer Advertising.—The Committee acknowledges 

Secretary Azar’s statements that the Department has the authority 

to require direct-to-consumer advertisements include the price of 

medications being advertised. The Committee is also aware that 

the Department has convened a task force on drug pricing and directs the Secretary to submit a report to the Committees on Appropriations in the House of Representatives and the Senate 60 days 

after enactment that outlines: (1) recommendations on the specific 

manner and the appropriate price that should be disclosed in direct-to-consumer advertisements; (2) the impact on consumer behavior on purchasing medications and the cost paid for such medications if the Department requires price to be disclosed; (3) how the 

Department can work with healthcare providers to improve realtime access to the potential consumer cost of a medication; (4) what 

specific existing statutory authorities HHS has to require price disclosure in direct to consumer prescription drug advertising; and (5) 

what HHS may need from Congress, if anything, to help facilitate 

price disclosure on direct to consumer advertising. 

Disparity Populations.—The Committee recognizes the importance of understanding and addressing the needs of disparity populations. To ensure underserved and disadvantaged populations continue to be best served by programs and offices within the Department and that our Federal health programs address the unique 

needs of vulnerable communities, the Committee directs the Secretary to maintain the collection of data on disparity populations, 

as defined by Healthy People 2020, on health surveys administered 

by the Department. 

Duchenne Muscular Dystrophy.—The Committee recognizes the 

potential that virally mediated gene therapy applications pose for 

Duchenne and other rare diseases. As this science moves toward 

translational and clinical evaluation, the Committee recommends 

the Secretary convene an effort across NIH, FDA, and CMS and 

other relevant entities and stakeholders, as appropriate, to develop 

a comprehensive and integrated HHS strategy to address complex, 

interrelated issues such as manufacturing practices, dosing and redosing, and reimbursement models and related data requirements 

so that patients have timely access to these innovative therapies. 

In addition, the Secretary is encouraged to promote data sharing 

across HHS and with relevant entities and stakeholders. 

Early Detection of Brain Aneurysms.—The Committee recognizes 

that although 1 in 50 Americans have a brain aneurysm, there are 

typically no warning signs or symptoms unless they have bled. 

Even when an aneurysm has bled, the symptoms are not widely 

known among healthcare professionals, such as first responders 
167 

and emergency room physicians. The Committee encourages the 

Secretary, in consultation with appropriate stakeholders, to facilitate the development of best practices on brain aneurysm detection 

and diagnosis for first responders, emergency room physicians, primary care physicians, nurses, and advanced practice providers. 

Financial Reporting.—The Committee notes that the Department 

led a pilot program under the DATA Act aimed at developing recommendations for reducing recipient reporting burden for grantees 

and contractors. The Committee recognizes the potential benefits of 

streamlined financial reporting for Federal contract spending and 

urges the Department to highlight the lessons learned from this 

pilot program. 

Global Health Research Strategy.—The Committee requests an 

update on how CDC, FDA, BARDA, and NIH jointly coordinate 

global health research activities with specific measurable metrics 

used to track progress toward agreed upon health goals. 

Health Disparities.—The Committee appreciates the Department’s efforts to address health disparities but notes a comprehensive coordinated focus would increase the probability of reducing 

these disparities. Specifically, the Committee encourages OMH, 

NIMHD, and HRSA to support a coordinated approach to factors 

that lead to health disparities including age, nutrition, medical conditions, and availability of medical support and an appropriate 

healthcare workforce in both underserved urban and rural settings. 

HIV/AIDS Prevention.—The Committee continues to be concerned with the negative impact poor adherence to chronic medications has to the health of patients and to the overall costs of 

healthcare. Adherence to pre-exposure prophylaxis therapy [PrEP] 

significantly reduces the risk of contracting HIV, but is much less 

effective when not taken consistently. The Committee encourages 

the Department to investigate the use of financial incentive structures that incorporate frequent feedback and to assess outcomes of 

these interventions to improve adherence to PrEP therapy. 

Lung Cancer.—The Committee understands that lung cancer has 

a disparate impact on women, particularly those who have never 

smoked. The Committee encourages the Secretary, in consultation 

with the Secretary of Defense and the Secretary of Veterans Affairs, to conduct an interagency study to evaluate the status of research on women and lung cancer and make recommendations for 

additional research, increased access to lung cancer preventive 

services, and strategic public awareness and education campaigns 

related to lung cancer. 

National Clinical Care Commission.—The Committee urges the 

Secretary to convene the Commission as described in Public Law 

115–80 as soon as possible. The Commission, which should be comprised of healthcare providers, patient advocates, and Federal 

agencies, is to make recommendations about developing improved 

clinical resources and tools, innovative care models, quality measures and registries, diabetes screening programs and other prevention activities. 

National Vaccine Advisory Committee [NVAC].—The Committee 

recognizes that lower childhood immunization rates have been reported in the United States among children living in poverty, 

urban children, and black and Hispanic children. The Committee 
168 

requests the NVAC, in coordination with CMS, to provide the Committee with data regarding the number of children under the age 

of 35 months that received childhood vaccinations, as well as data 

regarding disparities in immunization rates among these children. 

The NVAC should also assess the extent to which these children 

received vaccinations according to the recommendations of the CDC 

Advisory Committee on Immunization Practices. 

Nonrecurring Expenses Fund.— The Committee directs the Secretary to prioritize obligations from resources in the Nonrecurring 

Expenses Fund for CDC’s NIOSH facility in Cincinnati, Ohio and 

for CDC cybersecurity needs. 

Obligation Reports.—The Committee directs the Secretary to submit electronically to the Committee an Excel table detailing the obligations made in the most recent quarter for each office and activity funded under this appropriation not later than 30 days after the 

end of each quarter. 

Opioid Prescribing Limitations.—The Committee applauds State 

efforts to address the overprescribing of opioids by implementing 

CDC’s Guideline for Prescribing Opioids for Chronic Pain. Not later 

than 1 year after the enactment of this act, the Secretary, in conjunction with CDC, shall submit a report to the Committees on Appropriations in the House of Representatives and the Senate detailing: the impact of existing State regulations or laws to limit opioid 

prescriptions on opioid abuse and overdose rates; the impact of existing State regulations or laws to limit opioid prescriptions on legitimate access to opioids, including the impact on patient cost 

sharing (including copayments); and recommended Federal legislative or executive actions that could be taken to further reduce 

opioid abuse and overdose deaths. 

Public Health in Indian Country.—The Committee supports the 

Secretary’s current initiatives to address public health crises such 

as viral hepatitis, HIV/AIDS, Zika, the opioid crisis, and others 

that disproportionally impact Indian Country. The Committee requests that HHS provide an update on these efforts in the fiscal 

year 2020 CJ. 

Rural Communities.—The Committee encourages the Secretary 

to ensure that rural concerns and challenges are adequately represented in the Department’s policies, programs, and activities, including policies related to the opioid epidemic. The Committee requests that the Secretary include a status of these activities in the 

fiscal year 2020 CJ. 

Safety in Health Care Facilities.—The Committee directs the Department to work with the Department of Labor to provide a report 

to the Committees on Appropriations in the House of Representatives and the Senate 180 days after enactment on how they can collaborate to strengthen protections and support safe environments 

for healthcare workers, patients, families, and visitors. 

Staffing Reports.—The Committee includes a new general provision requiring the Department to submit a staffing report to the 

Committee by the 15th day of each month. The Excel table will include: the names, titles, grades, agencies, and divisions of all of the 

political appointees, special government employees, and detailees 

that were employed by or assigned to the Department during the 

previous month. 
169 

Substance Use Disorder Treatment.—The Committee directs the 

Government Accountability Office [GAO] to review inpatient and 

outpatient treatment capacity, availability, and needs. The study 

should consider, to the extent that data is available, the capacity 

of detoxification programs, transitional residential support services, 

demographic specific residential or inpatient treatment programs, 

and geographic differences in the availability of recovery options. 

The study should also identify barriers to treatment at the Federal, 

State, and local levels, and ways to overcome such barriers. The 

Committee directs GAO to complete the report and share with both 

House and Senate Appropriations Committees within 24 months of 

the enactment of this act. 

Substance Use Disorder Treatment Facilities.—The Committee is 

concerned about the lack of in-patient substance use disorder treatment facilities in the United States and the inability of State and 

local governments on the front lines who are already incurring significant additional costs related to the opioid epidemic to unilaterally provide the funding necessary to construct these much-needed 

facilities. The Committee directs the Secretary of HHS to submit 

a report to the House and Senate Committees on Appropriations 

that identifies existing sources of Federal funding that can be used 

to construct and expand in-patient substance use disorder treatment facilities along with explicit recommendations about what the 

department can and should do to promote and incentivize the creation of additional in-patient substance use disorder treatment facilities. 

Surgeon General Report on Poverty.—The Committee notes that 

too many American children still live in poverty, compromising 

their ability to be healthy, to succeed in school and to raise healthy 

families themselves. A report by the Surgeon General on improving 

the health of children could increase awareness and generate additional effort toward ameliorating this public health problem. 

Technical Assistance.—The Committee is concerned about the 

Department’s responsiveness to Technical Assistance requests and 

continues to note that it expects the Department to comply in a 

timely manner with its requests for technical assistance and information, consistent with past practice including timely answers that 

respond to any specific inquiries. 

United States/Mexico Border.—The Committee urges the Department to continue its efforts to conduct border infectious disease 

surveillance to identify and implement needed prevention and 

treatment. The Department could focus on priority surveillance, epidemiology, and preparedness activities along the borders in order 

to be able to respond to potential outbreaks and epidemics, including those caused by potential bioterrorism agents. 

Teen Pregnancy Prevention 

The Committee recommendation includes $101,000,000 for the 

Teen Pregnancy Prevention program. This program supports competitive grants to public and private entities to replicate evidencebased teen pregnancy prevention approaches. 
170 

Office of Minority Health 

The Committee recommends $56,670,000 for the Office of Minority Health. This Office focuses on strategies designed to decrease 

health disparities and to improve the health status of racial and 

ethnic minority populations in the United States. OMH establishes 

goals and coordinates all departmental activity related to improving health outcomes for disadvantaged and minority individuals. 

Lupus Initiative.—The Committee continues to support the OMH 

National Health Education Lupus Program and its efforts to develop a clinical trial education and implementation plan for lupus. 

The action plan will focus on developing public-private and community partnerships, evaluating current minority clinical trial education and participation programs, and developing a research plan 

for creating new clinical trial education models in lupus. This will 

inform the development of the broader actionable lupus clinical 

trial education plan. 

Youth Violence Prevention.—The Committee encourages OMH to 

explore innovative demonstration grants to hospitals to address the 

cyclical nature of violence in the community. These efforts should 

integrate existing community resources as well as local law enforcement to develop best practices replicable on a national scale. 

Sexual Risk Avoidance 

The Committee recommends $35,000,000 for sexual risk avoidance education. This is a competitive grant program that funds evidenced based abstinence models for adolescents. 

Funding for competitive grants for sexual risk avoidance shall 

use medically accurate information referenced to peer-reviewed 

publications by educational, scientific, governmental, or health organizations; implement an evidence-based approach; and teach the 

benefits associated with self-regulation, success sequencing for poverty prevention, healthy relationships, goal setting, and resisting 

sexual coercion, dating violence, and other youth risk behaviors. 

Office of Women’s Health 

The Committee recommends $32,140,000 for the Office of Women’s Health. This office develops, stimulates, and coordinates women’s health research, healthcare services, and public and healthcare 

professional education across the Department. It advances important crosscutting initiatives and develops public-private partnerships, providing leadership and policy direction to address the disparities in women’s health. 

The Committee recommendation includes $3,100,000 to combat 

violence against women through the State partnership initiative. 

This program provides funding to State-level public and private 

health programs to partner with domestic and sexual violence organizations to improve healthcare providers’ ability to help victims of 

violence and improve prevention programs. 

OFFICE OF MEDICARE HEARINGS AND APPEALS

Appropriations, 2018 ............................................................................. $182,381,000 

Budget estimate, 2019 ........................................................................... 112,381,000 

Committee recommendation ................................................................. 182,381,000 
171 

The Committee provides $182,381,000 for the Office of Medicare 

Hearings and Appeals [OMHA]. This Office is responsible for hearing Medicare appeals at the Administrative Law Judge [ALJ] level, 

which is the third level of Medicare claims appeals. OMHA ensures 

that Medicare beneficiaries who are dissatisfied with the initial decisions about their benefits or eligibility can appeal and exercise 

their right to a hearing in front of an ALJ. 

Appeals Backlog.—The Committee continues to be concerned over 

the nearly 500,000 cases that are still pending before ALJs at 

OMHA. OMHA shall provide an update to the Committee 180 days 

after enactment on the progress and continued challenges with reducing the caseload backlog. 

OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH INFORMATION

TECHNOLOGY

Appropriations, 2018 ............................................................................. $60,367,000 

Budget estimate, 2019 ........................................................................... 38,381,000 

Committee recommendation ................................................................. 60,367,000 

The Committee makes available $60,367,000 to the Office of the 

National Coordinator for Health Information Technology [ONC]. 

ONC is responsible for coordinating Federal health information 

systems and collaborating with the private sector to develop standards for a nationwide interoperable health information technology 

infrastructure. 

OFFICE OF INSPECTOR GENERAL

Appropriations, 2018 ............................................................................. $80,000,000 

Budget estimate, 2019 ........................................................................... 80,000,000 

Committee recommendation ................................................................. 80,000,000 

The Committee recommends $80,000,000 for the HHS Office of 

Inspector General [OIG]. In addition to discretionary funds provided in this act, the Health Insurance Portability and Accountability Act of 1996 provides a permanent appropriation of 

$334,097,000 for OIG. 

OIG conducts audits, investigations, and evaluations of the programs administered by the Department’s operating and staff divisions, including the recipients of the Department’s grant and contract funds. In doing so, OIG addresses issues of waste, fraud, and 

abuse and makes recommendations to improve the efficiency and 

effectiveness of the Department’s programs and operations. 

OFFICE FOR CIVIL RIGHTS

Appropriations, 2018 ............................................................................. $38,798,000 

Budget estimate, 2019 ........................................................................... 30,904,000 

Committee recommendation ................................................................. 38,798,000 

The Committee recommends $38,798,000 for the Office for Civil 

Rights [OCR] in budget authority. OCR is responsible for enforcing 

civil rights-related statutes in healthcare and human services programs. To enforce these statutes, OCR investigates complaints of 

discrimination, conducts program reviews to correct discriminatory 

practices, and implements programs to generate voluntary compliance among providers and constituency groups of health and 

human services. 
172 

RETIREMENT PAY AND MEDICAL BENEFITS FOR COMMISSIONED

OFFICERS

Appropriations, 2018 ............................................................................. $618,689,000 

Budget estimate, 2019 ........................................................................... 629,209,000 

Committee recommendation ................................................................. 629,209,000 

The Committee provides an estimated $629,209,000 in mandatory funds for Retirement Pay and Medical Benefits for Commissioned Officers of the U.S. Public Health Service. This account provides for retirement payments to PHS officers who are retired due 

to age, disability, or length of service; payments to survivors of deceased officers; and medical care to Active Duty and retired officers, as well as their dependents. 

PUBLIC HEALTH AND SOCIAL SERVICES EMERGENCY FUND

Appropriations, 2018 ............................................................................. $1,953,458,000 

Budget estimate, 2019 ........................................................................... 2,303,877,000 

Committee recommendation ................................................................. 2,046,458,000 

The Committee recommends $2,046,458,000 for the Public 

Health and Social Services Emergency Fund. This appropriation 

supports the activities of the Assistant Secretary for Preparedness 

and Response [ASPR] and other components within the Office of 

the Secretary to prepare for the health consequences of bioterrorism and other public health emergencies, including pandemic influenza. It also provides funding for the Department’s cybersecurity 

efforts. 

Office of the Assistant Secretary for Preparedness and Response 

The Committee recommendation includes $1,689,128,000 for activities administered by ASPR. This Office was created by the Pandemic and All-Hazards Preparedness Act to lead the Department’s 

activities regarding preventing, preparing for, and responding to 

public health emergencies, including disasters and acts of terrorism. 

National Disaster Medical System.—The Committee continues 

bill language providing coverage under the Federal Employees 

Compensation Act for National Disaster Medical System intermittent employees who are activated for training or deployment. 

Emergency Response Coordination.—The Committee recognizes 

the importance of a federally coordinated public health and medical 

preparedness response following a natural disaster or public health 

emergency. The Committee encourages ASPR to establish a process 

to facilitate the transportation and distribution of essentials in 

commerce during a presidentially declared emergency or major disaster declaration. ASPR is further encouraged to ensure this process identifies and minimizes gaps, duplication, and other inefficiencies in medical and public health preparedness response activities. 

PRISM Guidance.—The Committee is aware that ASPR is in the 

process of updating the Primary Response Incident Scene Management Guidance for Chemical Incidents [PRISM], which establishes 

standardized decontamination procedures for use by first responders. However, a 2017 field exercise revealed significant gaps in decontamination procedures for individuals with disabilities, which 

have not yet been fully evaluated or addressed in the guidance. 
173 

Therefore, the Committee encourages ASPR to develop evidencebased guidance and decontamination procedures for individuals 

with disabilities, as well as other at-risk groups. 

Strategic National Stockpile.—The Committee remains concerned 

about plans to transfer the Strategic National Stockpile from CDC 

to ASPR at the beginning of fiscal year 2019, particularly with regard to maintaining appropriate coordination and support for State 

and local public health departments. The Committee directs the 

Secretary to report to Congress within 90 days of enactment of the 

act regarding ASPR’s plans to: (1) maintain funding for State and 

local operational readiness to distribute and dispense medical countermeasures from the Stockpile; (2) continue technical assistance, 

support, and oversight for State and local health departments’ 

operational readiness to distribute and dispense medical countermeasures from the Stockpile; and (3) incorporate and access CDC 

expertise throughout the Public Health Emergency Medical Countermeasures Enterprise, including decisions related to procurement 

and deployment for the Stockpile. 

Hospital Preparedness Program 

The Committee’s recommendation includes $264,555,000 for the 

Hospital Preparedness Program [HPP]. This program provides 

grants to States to build healthcare coalitions that enhance regional and local hospital preparedness and improve overall surge 

capacity in public health emergencies. The Committee recognizes 

the vital importance of this program in helping communities respond to tragic events and for this reason includes the same funding level as fiscal year 2018. The Committee believes this funding 

should be carefully coordinated within communities to continue to 

provide our Nation’s hospitals and emergency responders the necessary tools to respond quickly and collaboratively to these and 

other public health emergencies that are inevitable in our Nation’s 

communities. 

Emergency Response.—The Committee commends CDC for 

issuing a Public Health Crisis Notice of Funding Opportunity as a 

novel approach to enable CDC to more quickly award funds in the 

event of a public health emergency. The Committee encourages 

ASPR to assess whether similar mechanisms would increase the efficiency of the disbursal of emergency funds through programs administered at ASPR, including funds distributed through the HPP 

and other mechanisms. 

Regional Disaster Health Response System [RDHRS].—The Committee encourages the Department to dedicate $6,000,000 to support ongoing activities associated with the RDHRS demonstration 

project aimed at increasing regional ability to respond to 21st Century threats, leveraging local, State, and Federal healthcare assets 

across State lines, and assuring improved communications and coordination among participating entities. The Committee encourages 

ASPR to consider innovative coalitions of academic medical centers 

in partnership with existing local healthcare coalitions and trauma 

centers that integrate their medical response capabilities with Federal facilities and local emergency medical services. Further, the 

Committee encourages ASPR to select coalition(s) from various regions, such as one with a high incidence and variety of natural dis-
174 

asters and where disaster medical response efforts are challenged 

by significant rurality. 

Biomedical Advanced Research and Development Authority 

[BARDA] 

The Committee recommendation includes $561,700,000 for advanced research and development. 

Infectious Diseases.—The Committee commends BARDA for supporting advanced development efforts to develop vaccines, 

diagnostics, drugs, and therapeutics to minimize serious threats of 

infectious diseases. BARDA is encouraged to continue to 

proactively prepare for emerging infectious disease outbreaks, including investing in rapid screening technology, and the Committee 

commends BARDA for supporting advanced development efforts of 

industry to develop vaccines, diagnostics, drugs, and therapeutics 

to minimize serious threats of infectious disease. 

Tuberculosis.—The National Strategy for CARB identified drug 

resistant TB as a serious threat level pathogen and called for new 

diagnostic, treatment and prevention tools to address this global 

health threat. The Committee encourages BARDA to support the 

development of new TB diagnostic tests, drugs and vaccines 

through the CARB initiative, and the Emerging Infectious Disease 

program. 

Zika Vaccine Development.—The Committee directs BARDA to 

use resources made available in this act to continue research into 

a Zika vaccine and provide an update on progress to the Committee 

180 days after enactment of this act. 

Project BioShield Special Reserve Fund 

The Committee recommendation includes $735,000,000 for the 

Project BioShield Special Reserve Fund. The Committee is committed to ensuring the Nation is adequately prepared against 

chemical, biological, radiological, and nuclear attacks. The Committee recognizes a public-private partnership to develop medical 

countermeasures [MCMs] is required to successfully prepare and 

defend the Nation against these threats. Where there is little or no 

commercial market, the Committee supports the goal of Government financing providing a market guarantee. 

Other Activities 

The Committee recommendation includes the following amounts 

for the following activities within ASPR: 

—Operations.—$30,938,000; 

—Preparedness and Emergency Operations.—$24,654,000; 

—National Disaster Medical System.—$57,404,000; and 

—Policy and Planning.—$14,877,000. 

Office of the Assistant Secretary for Administration 

The Committee recommends $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. 
175 

Office of the Assistant Secretary for Health/Medical Reserve Corps 

The Committee recommendation includes $6,000,000 for the 

Medical Reserve Corps [MRC] program in ASH. This program is a 

national network of local volunteers who work to strengthen the 

public health infrastructure and preparedness capabilities of their 

communities. 

The Committee maintains funding at last year’s level for the 

MRC which is composed of volunteer doctors, dentists, nurses, 

pharmacists, and other community members. The Committee notes 

that the MRC provides an important community service, assisting 

in emergency response during a natural disaster, terrorist attack, 

or disease outbreak and staffing exercises to test local capacity to 

quickly dispense medicines and vaccines in an emergency. 

Office of the Secretary 

The Committee recommendation includes $292,470,000 for activities within the Office of the Secretary. 

Pandemic Influenza Preparedness 

The Committee recommendation includes $285,000,000 for Pandemic Influenza Preparedness. Of the total, $35,000,000 is provided 

in annual funding and $250,000,000 in no-year funding. 

Pandemic Influenza Program.—The Committee recognizes the 

critical nature of preparing for and responding to the inevitability 

of pandemic influenza and directs ASPR to continue to develop, 

procure, and maintain detection, prevention, and treatment measures and countermeasures to protect the public against pandemic 

influenza. The Committee intends that ASPR use the funding provided to support innovative technologies that enhance rapid detection and response to threats relating to pandemic influenza, ensure 

readiness to respond to pandemic influenza threats, and sustain 

and replenish pandemic stockpiles of bulk antigen and adjuvant 

material and necessary ancillary supplies, including annually testing the potency and shelf-life potential of all existing pandemic 

stockpiles held by HHS. 

Office of Security and Strategic Information 

The Committee includes $7,470,000 for the Office of Security and 

Strategic Information to maintain the security of the Department’s 

personnel, systems, and critical infrastructure. 

PREVENTION AND PUBLIC HEALTH FUND

In fiscal year 2019, the level transferred from the fund after accounting for sequestration is $848,000,000. The Committee includes 

bill language in section 219 of this act that requires that funds be 

transferred within 45 days of enactment of this act to the following 

accounts, for the following activities, and in the following amounts: 

[In thousands of dollars] 

Agency Account Program Committee recommendation 

ACL ......... Aging and Disability Services Programs ......... Alzheimer’s Disease Prevention Education 

and Outreach.

14,700 

ACL ......... Aging and Disability Services Programs ......... Chronic Disease Self Management ................. 8,000 
176 

[In thousands of dollars] 

Agency Account Program Committee recommendation 

ACL ......... Aging and Disability Services Programs ......... Falls Prevention ............................................... 5,000

CDC ........ Immunization and Respiratory Diseases ......... Section 317 Immunization Grants .................. 324,350 

CDC ........ Emerging and Zoonotic Infectious Diseases ... Epidemiology and Laboratory Capacity Grants 40,000 

CDC ........ Emerging and Zoonotic Infectious Diseases ... Healthcare Associated Infections .................... 12,000 

CDC ........ Chronic Disease Prevention and Health Promotion.Office of Smoking and Health (Tobacco Prevention/Media & Quit Lines).129,600 

CDC ........ Chronic Disease Prevention and Health Promotion.Breast Feeding Grants (Hospitals Promoting 

Breastfeeding).

8,000 

CDC ........ Chronic Disease Prevention and Health Promotion.Million Hearts Program ................................... 4,000 

CDC ........ Chronic Disease Prevention and Health Promotion.Heart Disease & Stroke Prevention Program .. 57,075 

CDC ........ Chronic Disease Prevention and Health Promotion.Diabetes ........................................................... 52,275 

CDC ........ Chronic Disease Prevention and Health Promotion.Early Care Collaboratives ................................ 4,000 

CDC ........ Environmental Health ...................................... Lead Poisoning Prevention .............................. 17,000 

CDC ........ CDC-Wide Activities ......................................... Preventive Health and Health Services Block 

Grants.

160,000 

SAMHSA .. Mental Health .................................................. Suicide Prevention (Garrett Lee Smith) .......... 12,000 

GENERAL PROVISIONS

Section 201. The bill continues a provision placing a $50,000 ceiling on official representation expenses. 

Section 202. The bill continues a provision limiting the use of 

certain grant funds to pay individuals more than an annual rate 

of Executive Level II. 

Section 203. The bill continues a provision restricting the Secretary’s use of taps for program evaluation activities unless a report is submitted to the Appropriations Committees of the House 

of Representatives and the Senate on the proposed use of funds. 

Section 204. The bill modifies a provision authorizing the transfer of up to 2.6 percent of PHS Act funds for evaluation activities. 

Section 205. The bill continues a provision restricting transfers 

of appropriated funds and requires a 15-day notification to the 

Committees on Appropriations of the House of Representatives and 

the Senate. 

Section 206. The bill continues a general provision allowing National Health Service Corps contracts to be canceled up to 60 days 

after award. 

Section 207. The bill continues a provision regarding requirements for family planning applicants. 

Section 208. The bill continues language which States that no 

provider services under title X of the PHS Act may be exempt from 

State laws regarding child abuse. 

Section 209. The bill continues language which restricts the use 

of funds to carry out the Medicare Advantage Program if the Secretary denies participation to an otherwise eligible entity. 

Section 210. The bill continues a provision prohibiting the use of 

funds for lobbying activities related to gun control. 

Section 211. The bill continues a provision that limits the assignment of certain public health personnel. 

Section 212. The bill continues a provision which facilitates the 

expenditure of funds for international health activities. 
177 

Section 213. The bill continues a provision permitting the transfer of up to 3 percent of AIDS funds among ICs by the Director of 

NIH and the Director of the Office of AIDS Research at NIH. 

Section 214. The bill continues language which requires that the 

use of AIDS research funds be determined jointly by the Director 

of NIH and the Director of the Office of AIDS Research and that 

those funds be allocated directly to the Office of AIDS Research for 

distribution to the ICs consistent with the AIDS research plan. 

Section 215. The bill continues a provision authorizing the Director of NIH to enter into certain transactions to carry out research 

in support of the NIH Common Fund. 

Section 216. The bill continues a provision permitting NIH to use up to $3,500,000 per project for improvements and repairs of facilities. 

Section 217. The bill continues a provision that transfers funds 

from NIH to HRSA and AHRQ, to be used for National Research 

Service Awards. 

Section 218. The bill continues a provision that provides BARDA 

with authority to enter into a multiyear contract for up to 10 years 

and to repurpose unused termination costs to pay contract invoices. 

Section 219. The bill continues a provision requiring CJs to include certain FTE information with respect to ACA. 

Section 220. The bill continues a provision related to ACA exchange funding transparency. 

Section 221. The bill continues a provision related to notifications 

for ACA enrollment and Community Health Centers awards. 

Section 222. The bill continues a provision prohibiting funds for 

the Risk Corridor program. 

Section 223. The bill continues a requirement for HHS to conduct 

an analysis of the ACA’s impact on eligibility for certain discretionary programs. 

Section 224. The bill includes a provision requiring the Secretary 

to transfer Prevention and Public Health Fund resources within 45 

days. 

Section 225. The bill continues a provision related to breast cancer screening recommendations. 

Section 226. The bill continues a provision on NIH indirect costs. 

Section 227. The bill continues a provision for Medicare and 

Medicaid expenses. 

Section 228. The bill continues a provision requiring Congressional notification prior to NIH transfers of opioid funds internally. 

Section 229. The bill continues a provision regarding use of 

CCDBG funds. 

Section 230. The bill includes a new provision rescinding unobligated funds from the Nonrecurring Expenses Fund. 

Section 231. The bill includes a new provision on staffing reports. 

Section 232. The bill includes a new provision on HHS staff travel for medical care. 
(178) 

TITLE III 

DEPARTMENT OF EDUCATION 

EDUCATION FOR THE DISADVANTAGED

Appropriations, 2018 ............................................................................. $16,443,790,000 

Budget estimate, 2019 ........................................................................... 15,926,790,000 

Committee recommendation ................................................................. 16,568,790,000 

The Committee recommends an appropriation of $16,568,790,000 

for education for the disadvantaged. 

The programs in the Education for the Disadvantaged account 

provide a foundation of support to help ensure that all children receive a high-quality education. Funds appropriated in this account 

primarily support activities in the 2019–2020 school year. 

Grants to Local Educational Agencies 

The Committee recommends $15,884,802,000 for the title I 

grants to local educational agencies [LEAs] program. Title I grants 

to LEAs provide supplemental education funding, especially in 

high-poverty areas, for local programs that provide extra academic 

support to help raise the achievement of eligible students or, in the 

case of school-wide programs, help all students in high-poverty 

schools meet challenging State academic standards. Title I grants 

are distributed through four formulas as prescribed by this act: 

basic, concentration, targeted, and education finance incentive 

grant. 

Of the funds available for title I grants to LEAs, up to $5,000,000 

shall be available on October 1, 2018 for transfer to the Census Bureau for poverty updates; $5,038,625,000 will become available on 

July 1, 2019; and $10,841,177,000 will become available on October 

1, 2019. The funds that become available on July 1, 2019, and October 1, 2019, will remain available for obligation through September 30, 2020. 

The Committee requests that GAO initiate a review of school improvement activities being undertaken with funding available in 

this program. The Committee envisions a multi-phase process that 

would allow GAO to conduct a comprehensive examination, looking 

at, among other issues, the allocation and use of funds; selection 

and oversight of technical assistance; application of evidentiary requirements from ESSA; implementation of provisions related to resource inequities; State and local monitoring; and sustainability of 

effective practices implemented in schools. 

The Committee directs the Department to make publicly available on its website a request from a State Education Agency to 

waive the 1-percent alternate assessment cap under section 

1111(b)(2)(D)(i)(I) of the Elementary and Secondary Education Act 
179 

and its implementing regulations at 34 CFR 200.6(c) and the Department’s response to any such request. 

Comprehensive Literacy State Development Grants 

The Committee recommendation includes $190,000,000 for the 

Comprehensive Literacy State Development Grants program. This 

program provides competitive grants to State educational agencies 

[SEAs] that then subgrant at least 95 percent of such funds to eligible entities to support efforts to improve literacy instruction in 

high-need schools and early education programs in a State for each 

of several age bands ranging from birth through 12th grade. 

Innovative Approaches to Literacy 

The Committee recommendation includes $27,000,000 for the Innovative Approaches to Literacy program. This program provides 

competitive grants to national not-for-profit organizations and 

school libraries for providing books and childhood literacy activities 

to children and families living in high-need communities. 

The Committee continues to direct the Department to reserve no 

less than 50 percent of funds under this program for grants to develop and enhance effective school library programs, which may include providing professional development to school librarians, 

books, and up-to-date materials to high-need schools. Further, the 

Committee continues to direct the Department to ensure that 

grants are distributed among eligible entities that will serve geographically diverse areas, including rural areas. 

Migrant Education Program 

The Committee recommends $374,751,000 for the title I Migrant 

Education program. This funding supports grants to SEAs for programs to meet the special educational needs of the children of migratory agricultural workers or migratory fishworkers. Funding 

also supports activities to improve interstate and intrastate coordination of migrant education programs, as well as identify and improve services to the migrant student population. 

Neglected and Delinquent 

The Committee recommends $47,614,000 for the title I Neglected 

and Delinquent program. This program provides financial assistance to SEAs for education services to neglected and delinquent 

children and youth in State-run institutions and for juveniles in 

adult correctional institutions. States are authorized to set aside at 

least 15 percent, but not more than 30 percent, of their Neglected 

and Delinquent funds to help students in State-operated institutions make the transition into locally operated programs and to 

support the successful reentry of youth offenders who are age 20 

or younger and have received a secondary school diploma or its recognized equivalent. 

Special Programs for Migrant Students 

The Committee recommends $44,623,000 for Special Programs 

for Migrant Students, which consist of the High School Equivalency 

Program [HEP] and the College Assistance Migrant Program 

[CAMP]. HEP projects are 5-year grants to institutions of higher 
180 

education and other nonprofit organizations to recruit migrant students ages 16 and older and provide the academic and support 

services needed to help them obtain a high school equivalency certificate and subsequently gain employment, attain admission to a 

postsecondary institution or a job training program, or join the 

military. CAMP projects are 5-year grants to institutions of higher 

education and nonprofit organizations to provide tutoring, counseling, and financial assistance to migrant students during their 

first year of postsecondary education. 

IMPACT AID

Appropriations, 2018 ............................................................................. $1,414,112,000 

Budget estimate, 2019 ........................................................................... 1,259,790,000 

Committee recommendation ................................................................. 1,439,112,000 

The Committee recommends $1,439,112,000 for the Impact Aid 

program. Impact Aid provides financial assistance to school districts affected by the presence of Federal activities and federally 

owned land. These school districts face unique challenges because 

they must educate children living on federally owned land, such as 

military bases, while federally owned property is also exempt from 

local taxes, a primary source of revenue for local school districts. 

Basic Support Payments.—The Committee recommends 

$1,294,242,000 for the Basic Support Payments program. Under 

this statutory formula, payments are made on behalf of all categories of federally connected children, with a priority placed on 

making payments first to heavily impacted school districts and providing any remaining funds for regular basic support payments. 

Payments for Children With Disabilities.—The Committee bill includes $48,316,000 for Payments for Children With Disabilities. 

Under this program, additional payments are made for certain federally connected children eligible for services under IDEA. 

Facilities Maintenance.—The Committee recommends $4,835,000 

for Facilities Maintenance. This activity provides funding for emergency repairs and comprehensive capital improvements to certain 

school facilities owned by the Department and used by LEAs to 

serve federally connected military dependent students. Funds appropriated for this purpose are available until expended. 

Construction.—The Committee recommends $17,406,000 for eligible LEAs for school construction activities allocated competitively 

under section 7007(b) of ESEA. 

Payments for Federal Property.—The Committee recommends 

$74,313,000 for Payments for Federal Property. These payments 

compensate LEAs specifically for revenue lost due to the removal 

of Federal property from local tax rolls, regardless of whether any 

federally connected children attend schools in the district. The 

budget request proposed eliminating this program. The Committee 

recommendation again rejects this elimination and continues to 

note that this funding represents a key component of fulfilling the 

Federal Government’s commitment to school districts impacted by 

the presence of federally owned land. 

The Committee has serious concerns about the effect on school 

districts of sudden changes to decades-long practice of how the Department calculates local tax efforts for Impact Aid eligibility pur-
181 

poses. The Committee expects to work with the Department on this 

issue and requests a briefing within 30 days of enactment. 

SCHOOL IMPROVEMENT PROGRAMS

Appropriations, 2018 ............................................................................. $5,158,467,000 

Budget estimate, 2019 ........................................................................... 645,214,000 

Committee recommendation ................................................................. 5,291,967,000 

The Committee recommendation includes $5,291,967,000 for the 

School Improvement Programs account. 

Supporting Effective Instruction State Grants 

The Committee recommends $2,055,830,000 for Supporting Effective Instruction State Grants. States and LEAs may use funds for 

a range of activities related to the certification, recruitment, professional development, and support of teachers and administrators. 

Activities may include reforming teacher certification and licensure 

requirements, addressing alternative routes to State certification of 

teachers, recruiting teachers and principals, and implementing 

teacher mentoring systems, teacher testing, merit pay, and meritbased performance systems. These funds may also be used by districts to hire teachers to reduce class sizes. 

The appropriation for this program primarily supports activities 

associated with the 2019–2020 academic year. Of the funds provided, $374,389,000 will become available on July 1, 2019, and 

$1,681,441,000 will become available on October 1, 2019. These 

funds will remain available for obligation through September 30, 

2020. 

Supplemental Education Grants 

The Committee recommendation includes $16,699,000 for supplemental education grants to the Republic of Marshall Islands [RMI] 

and the Federated States of Micronesia [FSM]. This grant program 

was authorized by the Compact of Free Association Amendments 

Act of 2003. These funds will be transferred from the Department 

to the Secretary of the Interior for grants to these entities. The 

Committee bill includes language requested in the budget that allows the Secretary of Education to reserve 5 percent of these funds 

to provide FSM and RMI with technical assistance. 

21st Century Community Learning Centers 

The Committee recommends an appropriation of $1,211,673,000 

for the 21st Century Community Learning Centers program. Funds 

are allocated to States by formula, which in turn, award at least 

95 percent of their allocations to LEAs, community-based organizations, and other public and private entities. Grantees use these resources to establish or expand community learning centers that 

provide activities offering significant extended learning opportunities, such as before- and after-school programs, recreational activities, drug and violence prevention, and family literacy programs for 

students and related services to their families. Centers must target 

their services to students who attend schools that are eligible to operate a school-wide program under title I of the ESEA or serve 

high percentages of students from low-income families. 
182 

State Assessments Grants 

The Committee recommends $378,000,000 for the State Assessments Grants program. This program provides formula grants to 

States for developing and implementing standards and assessments 

required by the ESEA and helping States and LEAs carry out audits of their assessment systems to eliminate low-quality or duplicative assessments. It also provides competitive grants to States, 

including consortia of States, to improve the quality, validity, and 

reliability of academic assessments. 

Education for Homeless Children and Youth 

For carrying out education activities authorized by title VII, subtitle B of the McKinney-Vento Homeless Assistance Act, the Committee recommends $93,500,000. This program provides assistance 

to each State to support an office of the coordinator of education 

for homeless children and youth, to develop and implement State 

plans for educating homeless children, and to make subgrants to 

LEAs to support the education of those children. Grants are made 

to States based on the total that each State receives in title I 

grants to LEAs. 

Under the McKinney-Vento Homeless Children and Youth Program, SEAs must ensure that homeless children and youth have 

equal access to the same free public education, including a public 

preschool education, as is provided to other children and youth. 

Training and Advisory Services 

For Training and Advisory Services authorized by title IV of the 

Civil Rights Act, the Committee recommends $6,575,000. The funds 

provided will support awards to operate regional equity assistance 

centers [EACs]. Each EAC provides services to school districts upon 

request. Activities include disseminating information on successful 

practices and legal requirements related to nondiscrimination on 

the basis of race, color, sex, or national origin in education programs. 

Native Hawaiian Education 

The Committee recommendation includes $36,397,000 for Native 

Hawaiian Education. 

The Committee bill continues a provision that allows funding 

provided by this program to be used for construction. The Committee recommendation includes $650,000 for the Native Hawaiian 

Education Council. 

Alaska Native Education 

The Committee recommends $35,453,000 for the Alaska Native 

Education. These funds help address the unique educational needs 

of Alaska Native schoolchildren. Funds are used for the development of supplemental educational programs to benefit Alaska Natives. 

The Committee continues language that allows funding provided 

by this program to be used for construction and overriding the authorizing statute’s requirement to make noncompetitive awards to 

certain organizations. 
183 

The Committee directs the Department to make every effort to 

ensure that Alaska Native organizations and tribal representatives 

are able to fully engage in tribal consultation as part of the development of regulations intended to clarify changes made to this program by the ESSA. The Committee further directs the Department 

to consult with Congress throughout the regulatory process. Finally, the Committee continues to direct the Department to ensure 

that Alaska Native tribes, Alaska Native regional non-profits and 

Alaska Native corporations have the maximum opportunity to successfully compete for grants under this program by providing these 

entities multiple opportunities for technical assistance in developing successful applications for these funds, both in Alaska and 

via various forms of telecommunications. 

Rural Education 

The Committee recommends $180,840,000 for rural education 

programs. 

The Committee expects that rural education funding will be 

equally divided between the Small, Rural School Achievement Program, which provides funds to LEAs that serve a small number of 

students, and the Rural and Low-Income School Program, which 

provides funds to LEAs that serve concentrations of poor students, 

regardless of the number of students served. 

Comprehensive Centers 

The Committee recommends $52,000,000 for the Comprehensive 

Centers program. These funds provide support to a network of comprehensive centers that are operated by research organizations, 

agencies, institutions of higher education, or partnerships thereof, 

and provide training and technical assistance on various issues to 

States, LEAs, and schools as identified through needs assessments 

undertaken in each region. The system currently includes 15 regional centers, which are charged with providing intensive technical assistance to SEAs to increase their capacity to assist LEAs 

and schools with meeting the goals of the ESEA, and 8 content centers, which are organized by topic area. 

In selecting priorities for a new cohort of comprehensive centers 

aligned with ESSA, the Committee continues to direct the Department to recognize the unique challenges, emphasized in ESSA, affecting rural schools. The Committee strongly encourages the Department to establish at least one university-led center in a State 

with a significant percentage of students in rural schools. Such a 

center could focus on rural education and provide assistance to 

rural districts that serve high poverty and minority students. 

The Committee recommendation includes continued support for a 

comprehensive center, first funded in fiscal year 2016 and as authorized in ESSA, on students at risk of not attaining full literacy 

skills due to a disability, including dyslexia, or developmental 

delay. 

Student Support and Academic Enrichment Grants 

The Committee recommendation includes $1,225,000,000 for Student Support and Academic Enrichment [SSAE] Grants. This program provides formula grants to States, which then sub-grant to 
184 

LEAs, to help support activities to provide students with a wellrounded education, ensure safe and supportive learning environments, and use technology to improve instruction. 

The Committee notes that funds available to school districts 

within the SSAE program for promoting safe and supportive learning environments may be used for a wide range of activities, including but not limited to expanding access to or coordinating resources for school-based mental health services and supports, 

which may include trauma-informed practices and school counseling; preventing bullying and harassment; and professional development for personnel in crisis management and school-based violence prevention strategies. 

INDIAN EDUCATION

Appropriations, 2018 ............................................................................. $180,239,000 

Budget estimate, 2019 ........................................................................... 164,939,000 

Committee recommendation ................................................................. 180,239,000 

The Committee recommends $180,239,000 for Indian education 

programs. 

Grants to Local Educational Agencies 

For grants to LEAs, the Committee recommends $105,381,000. 

These funds provide financial support to elementary and secondary 

school programs that serve Indian students, including preschool 

children. Funds are awarded on a formula basis to LEAs, schools 

supported and operated by the Department of the Interior/Bureau 

of Indian Education, and in some cases directly to Indian tribes. 

Special Programs for Indian Children 

The Committee recommends $67,993,000 for special programs for 

Indian children. Funds are used for demonstration grants to improve Indian student achievement from early childhood education 

through college preparation programs, and for professional development grants for training Indians who are preparing to begin careers in teaching and school administration. 

National Activities 

The Committee recommends $6,865,000 for national activities. 

Funds are used to expand efforts to improve research, evaluation, 

and data collection on the status and effectiveness of Indian education programs, and to continue grants to tribal educational departments for education administration and planning. 

The Committee continues to note that there are significant cognitive, psychological, and academic benefits that result from Native 

American language immersion programs and that language education programs are essential for tribal self-determination. Within 

the total, the Committee recommendation includes no less than 

$2,026,000, the same as the fiscal year 2018 level and the budget 

request, for Native American language immersion programs authorized under section 6133 of ESEA. The Committee intends that 

these funds be allocated to all types of eligible entities, including 

both new and existing language immersion programs and schools, 

to support the most extensive possible geographical distribution 

and language diversity. Further, the Committee directs the Depart-
185 

ment to give the same consideration to applicants that propose to 

provide partial immersion schools and programs as to full immersion, as the local tribes, schools, and other applicants know best 

what type of program will most effectively assist their youth to succeed. 

INNOVATION AND IMPROVEMENT

Appropriations, 2018 ............................................................................. $982,256,000 

Budget estimate, 2019 ........................................................................... 1,777,647,000 

Committee recommendation ................................................................. 1,042,256,000 

The Committee recommends $1,042,256,000 for programs within 

the Innovation and Improvement account. 

Education Innovation and Research 

The Committee recommendation includes $135,000,000 for the 

Education Innovation and Research [EIR] program. This program 

supports the creation, development, implementation, replication, 

and scaling up of evidence-based, field-initiated innovations designed to improve student achievement and attainment for highneed students. EIR incorporates a tiered evidence framework that 

provides early-phase, mid-phase, and expansion and replication 

grants. This supports interventions throughout the pipeline, from 

smaller grants for early stage projects that are willing to undergo 

rigorous evaluation to test their efficacy to larger grants to scaleup proven-effective interventions that have demonstrated significant impacts through multiple rigorous evaluations. 

Science, Technology, Education and Math [STEM] Education.— 

Within the total for EIR, the Committee recommendation includes 

$65,000,000 for STEM education activities, including computer 

science education. The Committee continues to direct the Department to work with other Federal agencies that issue grants in this 

area, including the National Science Foundation, to avoid duplication and ensure that activities funded under this program build on 

existing evidence or provide a unique benefit to the field. Further, 

within this amount, the Committee directs the Department to include funding to expand access to STEM education in rural areas, 

including grants to institutions of higher education, in partnership 

with rural school districts, to utilize virtual and remote access to 

makerspace technologies, such as 3D printers, to expand opportunities for students in rural areas where such tools are often cost prohibitive. Further, the Committee notes the importance of STEM 

knowledge and skills for individuals in and outside of the STEM 

workforce, including the workforce of national laboratories, for ensuring U.S. competitiveness globally. Finally, the Committee directs the Department to provide a briefing within 60 days of enactment to the Committees on Appropriations of the House of Representatives and the Senate on the Department’s current and 

planned STEM education activities within EIR and across the Department. 

The Committee encourages the Department to include funding 

for programs authorized under EIR that address the birth to 3rd 

grade continuum and provide services for children and families 

from early childhood through early elementary school, including 
186 

two generational approaches, and that propose evidence-based 

strategies to mitigate the impacts of adverse childhood experiences. 

Charter School Program 

The Committee recommends $445,000,000 for the Charter School 

Program. This program supports the start-up, replication, and expansion of high-quality charter schools. 

Within the total, the Committee recommendation includes 

$235,000,000 for grants to State entities to support high-quality 

charter schools, including for grants directly to charter school developers in a State if no State entity receives a grant; $140,000,000 

for grants for the replication and expansion of high-quality charter 

schools; $55,000,000 for facilities financing assistance, of which not 

less than $45,000,000 shall be for the Credit Enhancement program; and $15,000,000 for national activities to provide technical 

assistance, disseminate best practices, and evaluate the impact of 

the charter school program. The Committee recommendation includes a $20,000,000 increase 

for grants to charter management organizations for the replication 

and expansion of high-quality charter schools as authorized by 

ESSA. This will continue to increase funding available for this purpose, which may include replicating and expanding very high performing charter schools that have extensive waitlists, a track 

record of high academic performance, and have demonstrated the 

ability to quickly scale while maintaining high-performance. The 

Committee recommendation also includes a $20,000,000 increase 

for State-entity grants to support State’s efforts to open and prepare for the operation of new charter schools and replicate and expand high-quality charter schools. The recommendation also includes a $4,000,000 increase for the Credit Enhancement program 

to support the financing of charter school facilities, and a 

$1,000,000 increase for national activities. 

The Committee notes that ESSA made a number of important 

changes to the Charter School Program intended to strengthen 

charter school authorizing practices, improve fiscal accountability, 

and improve overall charter school quality, including by allowing 

States to support the replication and expansion of high-quality 

charter school models. The Committee understands the Department is developing guidance for implementation of the Charter 

School Program, including these important provisions, which will 

be widely disseminated so stakeholders are aware of these critical 

changes in law. 

Charter School Authorizing.—ESSA took critical steps toward 

strengthening oversight of charter schools by requiring State entities receiving grants funds to allocate not less than 7 percent of 

funding received under the program to ‘‘improve authorizing quality, including developing capacity for, and conducting, fiscal oversight and auditing of charter schools’’. These funds, combined with 

investments through national activities including the national dissemination grant competition being administered this year, allow 

for continued improvements in authorizing quality. The Committee 

requests the Department include in its CJs, starting with its submission for fiscal year 2020, a thorough discussion of how these investments are improving authorizing quality. Additionally, the 
187 

Committee notes that the Department’s Inspector General issued 

the Nationwide Assessment of Charter and Education Management 

Organizations audit report in September 2016. The Committee requests the Department to include in its fiscal year 2020 CJ a description of actions it has taken or plans to take in response to the 

report’s findings and recommendations. 

Rural Charter School Department.—Within the total for grants to 

State entities to support high quality charter schools, the Committee recommendation includes no less than $7,500,000, the same 

as the fiscal year 2018 level, for developer grants to establish or 

expand charter schools in underserved, high-poverty, rural areas. 

This could include grants to institutions of higher education, or 

non-profit organizations in partnership with institutions of higher 

education, which are located in the region and committed to improving educational outcomes for underserved rural students. Institutions of higher education may be uniquely suited to help address 

challenges faced by charter schools in rural areas, and to give students opportunities to learn in non-traditional settings. The Committee also notes that establishing charter schools in rural, particularly underserved areas, will likely require more start-up costs 

than in some other areas, and encourages the Department to consider these factors in determining grant award levels. 

Magnet Schools Assistance 

The Committee recommends $105,000,000 for the Magnet 

Schools Assistance program. This program supports grants to LEAs 

to establish and operate magnet schools that are part of a courtordered or federally approved voluntary desegregation plan. Magnet schools are designed to attract substantial numbers of students 

from different social, economic, ethnic, and racial backgrounds. 

Grantees may use funds for planning and promotional materials; 

salaries of instructional staff; transportation, as long as such expenses are sustainable beyond the grant period and not a significant portion of the grant; and the purchase of technology, educational materials, and equipment. 

Arts in Education 

The Committee recommendation includes $29,000,000 for the 

Arts in Education program. The funding is used for competitive 

awards for national nonprofit organizations engaged in arts education, professional development activities, and model arts education programs. Funds also are used for evaluation and dissemination activities. 

The Committee recommendation includes funding for each activity within this program at no less than the fiscal year 2018 level. 

Javits Gifted and Talented Students 

The Committee recommendation includes $12,000,000 for the 

Javits Gifted and Talented Students Education program. Funds are 

used for awards to State and local educational agencies, institutions of higher education, and other public and private agencies for 

research, demonstration, and technical assistance activities designed to enhance the capability of elementary and secondary 

schools to meet the special educational needs of gifted and talented 
188 

students, including those from disadvantaged and underrepresented populations. 

American History and Civics Education 

The Committee recommendation includes $1,815,000 for Presidential and Congressional Academies for American History and 

Civics. Presidential Academies for the Teaching of American History and Civics offer residential workshops to elementary and secondary school teachers to strengthen their knowledge through instruction and interaction with primary scholars and accomplished 

teachers in these fields. The Congressional Academies for Students 

of American History and Civics provide similar workshops to students to enrich their understanding of American history and civics. 

In addition, the Committee recommendation includes $1,700,000 

for National Activities authorized under section 2233 of ESSA. 

Teacher and School Leader Incentive Grants 

The Committee recommendation includes $200,000,000 for 

Teacher and School Leader Incentive Grants. This program provides competitive grants to eligible entities to develop, implement, 

improve, or expand human capital management systems or performance-based compensation systems in schools. Funds can be 

used for a wide-range of activities, including developing or improving evaluation and support systems that are based in part on student achievement; providing principals with necessary tools to 

make school-level decisions; implementing a differentiated salary 

structure based on a variety of factors; improving the recruitment 

and retaining of effective teachers, principals, and other school 

leaders; and instituting career advancement opportunities that reward effective teachers, principals and other school leaders. 

Ready-To-Learn Television 

The Committee recommendation includes $27,741,000 for the 

Ready-to-Learn Television program. This program is designed to facilitate student academic achievement by leveraging the power and 

reach of public television to develop and distribute educational 

video programming for preschool and elementary school children 

and their parents. 

Supporting Effective Educator Development 

The Committee recommendation includes $75,000,000 for the 

Supporting Effective Educator Development [SEED] program. 

SEED provides competitive grants to improve teacher and principal 

effectiveness by supporting pathways that help teachers, principals, 

or other school leaders with non-traditional preparation and certification obtain employment in underserved LEAs; providing evidence-based professional development; and making services and 

learning opportunities freely available to LEAs. 

The Committee directs the Department to ensure that SEED 

grants are awarded to diverse set of eligible entities, including National non-profit organizations implementing evidence-based activities (as defined in section 8101(21)(A)(i) of the Elementary and Secondary Education Act) across a number of sites which can help 
189 

bring to scale evidence-based programs of National significance 

across the country. 

The Committee is aware that students in rural public schools 

and public schools serving high percentages of Native students 

have inequitable access to accomplished teachers. Therefore, the 

Committee strongly encourages the Department to establish a priority for SEED projects addressing this issue. The Committee intends for funds to be awarded to increase the number of teachers 

in such schools who have earned a nationally recognized advanced 

credential. There are a number of ways to support these teachers 

in pursuing an advanced credential, including financial support, 

training, mentorship, and access to online exemplars of accomplished teaching practice as part of a program of support; financial 

incentives for those who earn the credential and continue to teach 

in a rural or Native student classroom; and training for principals 

to encourage and support their teachers in earning such advanced 

credentials. 

Statewide Family Engagement Centers 

The Committee recommendation includes $10,000,000 for Statewide Family Engagement Centers. This program provides competitive grants to statewide organizations to promote and implement 

evidence-based family engagement activities in education programs, and provide training and technical assistance to SEAs, 

LEAs, schools, and other organizations for carrying out such activities. 

SAFE SCHOOLS AND CITIZENSHIP EDUCATION

Appropriations, 2018 ............................................................................. $185,754,000 

Budget estimate, 2019 ........................................................................... 43,000,000 

Committee recommendation ................................................................. 190,754,000 

The Committee recommends a total of $190,754,000 for activities 

to promote safe schools, healthy students, and citizenship education. 

Promise Neighborhoods 

The Committee recommendation includes $78,254,000 for the 

Promise Neighborhoods program. This program awards competitive 

grants to not-for-profit, community-based organizations for the development of comprehensive neighborhood programs designed to 

combat the effects of poverty and improve educational and life outcomes for children and youth, from birth through college. Each 

Promise Neighborhood grantee serves a high-poverty urban neighborhood or rural community. 

School Safety National Activities 

The Committee recommendation includes $95,000,000 for the 

School Safety National Activities, including up to $5,000,000 for 

Project SERV. This funding will help schools address the consequences of their students witnessing or being the victim of violence and other root causes of unhealthy school climates. 

The Committee encourages the Department, in awarding School 

Climate Transformation Grants, to prioritize funding for applicants 

that propose to promote the social and emotional learning of stu-
190 

dents. In addition, the Committee encourages the Department to 

prioritize applicants that propose projects to prevent opioid abuse 

by students, and address the mental health needs of students, families, and communities affected by opioid use disorder. 

The Committee encourages the Department to fund a demonstration program to test and evaluate innovative partnerships between 

institutions of higher education and high-needs State or local educational agencies to train school counselors, social workers, psychologists, or other mental health professionals. This could help 

demonstrate innovative ideas to foster a pipeline between graduate 

programs that train these professionals and local educational agencies, to expand access to such professionals in high-need schools 

and ultimately improve student outcomes. 

Full Service Community Schools 

The Committee recommendation includes $17,500,000 for Full 

Service Community Schools. This program provides competitive 

grants to support the implementation of a continuum of coordinated supports and services for students, families, and community 

members in elementary and secondary schools. 

ENGLISH LANGUAGE ACQUISITION

Appropriations, 2018 ............................................................................. $737,400,000 

Budget estimate, 2019 ........................................................................... 737,400,000 

Committee recommendation ................................................................. 737,400,000 

The Committee recommends an appropriation of $737,400,000 for 

the English Language Acquisition program. 

The Department makes formula grants to States based on each 

State’s share of the Nation’s limited-English-proficient and recent 

immigrant student population. The program is designed to increase 

the capacity of States and school districts to address the needs of 

these students. The authorizing statute requires that 6.5 percent of 

the appropriation be used to support national activities, which include professional development activities designed to increase the 

number of highly qualified teachers serving limited-English-proficient students; a National Clearinghouse for English Language 

Acquisition and Language Instructional Programs. National activities funds shall be available for 2 years. 

The Committee continues to encourage the Department to ensure 

States are aware of the availability of funding for English language 

learners, including emergency supplemental funding made available in response to hurricanes and other natural disasters, as well 

as current guidance in this area, to help States and school districts 

access and make the best use of available funding. 

SPECIAL EDUCATION

Appropriations, 2018 ............................................................................. $13,366,184,000 

Budget estimate, 2019 ........................................................................... 13,051,775,000 

Committee recommendation ................................................................. 13,493,684,000 

The Committee recommends an appropriation of $13,493,684,000 

for special education programs. 
191 

Grants to States 

The Committee recommendation includes $12,402,848,000 for 

IDEA Part B Grants to States. This program provides formula 

grants to assist States, outlying areas, and other entities in meeting the costs of providing special education and related services for 

children with disabilities. States pass along most of these funds to 

LEAs, but may reserve some for program monitoring, enforcement, 

technical assistance, and other activities. 

The appropriation for this program primarily supports activities 

associated with the 2019–2020 academic year. Of the funds available for this program, $3,119,465,000 will become available on July 

1, 2019, and $9,283,383,000 will become available on October 1, 

2019. These funds will remain available for obligation through September 30, 2020. 

The Committee is aware that earlier this year the Office of Special Education and Rehabilitative Services [OSERS] requested public input regarding options for the use of IDEA part B funds for 

providing technical assistance to States to which respondents overwhelmingly favored continuing to fund national technical assistance centers from funds reserved under section 616(i) of IDEA. The 

Committee believes that the approach favored by States should be 

given significant weight as OSERS reviews these investments and 

any change must be supported by evidence that would justify overruling State preferences for maintaining the current approach to 

funding national technical assistance centers that are improving 

the capacity of states to meet their IDEA data collection requirements. 

Preschool Grants 

The Committee recommends $381,120,000 for Preschool Grants. 

This program provides formula grants to States to assist them in 

making available special education and related services for children 

with disabilities aged 3 through 5. States distribute the bulk of the 

funds to LEAs. States must serve all eligible children with disabilities aged 3 through 5 and have an approved application under the 

IDEA. 

Grants for Infants and Families 

The Committee recommends $470,000,000 for the Grants for Infants and Families program under part C of the IDEA. Part C of 

the IDEA authorizes formula grants to States, outlying areas, and 

other entities to implement State-wide systems for providing early 

intervention services to all children with disabilities, ages 2 and 

younger, and their families. The IDEA also gives States the option 

of extending eligibility for part C services to children 3 and older 

if they were previously served under part C and will continue to 

be served until entrance to kindergarten. 

State Personnel Development 

The Committee recommends $38,630,000 for the State Personnel 

Development program. Ninety percent of funds must be used for 

professional development activities. The program supports grants 

to SEAs to help them reform and improve their personnel preparation and professional development related to early intervention, 
192 

educational, and transition services that improve outcomes for students with disabilities. The bill includes language proposed in the 

budget request that allows funds under the program to be used for 

program evaluation. 

Technical Assistance and Dissemination 

The Committee recommends $61,928,000 for Technical Assistance and Dissemination. This program supports awards for technical assistance, model demonstration projects, the dissemination 

of useful information, and other activities. Funding supports activities that are designed to improve the services provided under the 

IDEA. 

Special Olympics.—Within the total, the Committee recommendation includes $17,583,000, an increase of $2,500,000 above 

the fiscal year 2018 funding level, to support activities authorized 

by the Special Olympics Sport and Empowerment Act, including 

Project UNIFY. This funding supports efforts to expand Special 

Olympics programs and the design and implementation of Special 

Olympics education programs that can be integrated into classroom 

instruction and are consistent with academic content standards. 

Personnel Preparation 

The Committee recommends $83,700,000 for the Personnel Preparation program. Funds support competitive awards to help address State-identified needs for personnel who are qualified to work 

with children with disabilities, including special education teachers 

and related services personnel. The program is required to fund 

several other broad areas, including training leadership personnel 

and personnel who work with children with low-incidence disabilities, and providing enhanced support for beginning special educators. 

Parent Information Centers 

The Committee recommends $27,411,000 for Parent Information 

Centers. This program makes awards to parent organizations to 

support parent training and information centers, including community parent resource centers. These centers provide training and information to meet the needs of parents of children with disabilities 

living in the areas served by the centers, particularly underserved 

parents, and parents of children who may be inappropriately identified. 

Technology and Media Services 

The Committee recommends $28,047,000 for Technology and 

Media Services. This program makes competitive awards to support the development, demonstration, and use of technology and 

educational media activities of value to children with disabilities. 

The Committee continues to recognize the ongoing progress made 

with the tools and services provided under the Educational Technology, Media and Materials program that have allowed more than 

535,000 students with disabilities free access to more than 600,000 

books in digitally accessible formats. The Committee strongly encourages continued effort to expand this program’s reach to K–12 

students in underserved areas. 
193 

REHABILITATION SERVICES

Appropriations, 2018 ............................................................................. $3,587,130,000 

Budget estimate, 2019 ........................................................................... 3,634,977,000 

Committee recommendation ................................................................. 3,656,189,000 

Vocational Rehabilitation State Grants 

The Committee recommends $3,521,990,000 in mandatory funding for Vocational Rehabilitation [VR] State Grants. State Grants 

assist States in providing a range of services to help persons with 

physical and mental disabilities prepare for and engage in meaningful employment. 

The Rehabilitation Act requires that not less than 1 percent and 

not more than 1.5 percent of the appropriation for VR State Grants 

be set aside for Grants for American Indians. 

Client Assistance State Grants 

The Committee recommends $13,000,000 in discretionary funds 

for Client Assistance State Grants. This program funds State formula grants to help VR clients or client applicants understand the 

benefits available to them. States must operate client assistance 

programs to receive VR State Grant funds. 

Training 

The Committee recommends $29,388,000 for training rehabilitation personnel. This program supports grants to provide training to 

new VR staff, or upgrade the qualifications of existing staff. 

Demonstration and Training Programs 

The Committee recommendation includes $5,796,000 for demonstration and training programs. These programs support activities designed to increase employment opportunities for individuals 

with disabilities by expanding and improving the availability and 

provision of rehabilitation and other services. 

The Committee recommendation includes no less than the fiscal 

year 2018 level for parent information and training programs. 

Protection and Advocacy of Individual Rights 

The Committee recommends $17,650,000 for the Protection and 

Advocacy of Individual Rights program. This program provides 

grants to agencies to protect and advocate for the legal and human 

rights of persons with disabilities who are ineligible for the protection and advocacy services available through the Developmental 

Disabilities Assistance and Bill of Rights Act or the Protection and 

Advocacy for Individuals with Mental Illness Act. 

Supported Employment State Grants 

The Committee recommendation includes $22,548,000 Supported 

Employment State Grants Program. This program provides grants 

to States to provide supported employment services for individuals 

with the most significant disabilities, including youth with disabilities. 
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Independent Living Services for Older Individuals Who Are Blind 

The Committee recommends $33,317,000 for Independent Living 

State Grants. This program supports assistance to individuals over 

age 55 to help them adjust to their blindness and continue to live 

independently, including daily living skills training, counseling, 

community integration information and referral, the provision of 

low-vision and communication devices, and low-vision screening. 

Helen Keller National Center 

The Committee recommends $12,500,000 for the Helen Keller 

National Center for Deaf-Blind Youth and Adults. The Helen Keller 

National Center consists of a national headquarters in Sands 

Point, New York, with a residential training and rehabilitation facility where deaf-blind persons receive intensive specialized services; a network of 10 regional field offices that provide referral and 

counseling assistance to deaf-blind persons; and an affiliate network of agencies. 

SPECIAL INSTITUTIONS FOR PERSONS WITH DISABILITIES

AMERICAN PRINTING HOUSE FOR THE BLIND

Appropriations, 2018 ............................................................................. $27,431,000 

Budget estimate, 2019 ........................................................................... 25,431,000 

Committee recommendation ................................................................. 30,431,000 

The Committee recommends $30,431,000 to help support American Printing House for the Blind [APH]. 

APH provides educational materials to students who are legally 

blind and enrolled in programs below the college level. The Federal 

subsidy provides approximately 65 percent of APH’s total sales income. Materials are distributed free of charge to schools and States 

through per capita allotments based on the total number of students who are blind. Materials provided include textbooks and 

other educational aids in Braille, large type, recorded form, and 

computer applications. Appropriated funds may be used for staff 

salaries and expenses, as well as equipment purchases and other 

acquisitions consistent with the purpose of the Act to Promote the 

Education of the Blind. 

Within the total, the Committee recommendation includes 

$1,000,000 to establish a regional partnership with an organization 

with significant experience working with students who are blind to 

increase the availability of training for teachers and students in 

how to use education technology developed by APH. APH is continually developing new products and technologies to help ensure students who are blind and visually impaired have access to the education materials they need to succeed in school. Establishing a 

partnership with an organization to provide such training throughout a specified region could expand the ability of students and 

teachers to fully utilize available products and technologies and 

provide a model for other parts of the country. 

NATIONAL TECHNICAL INSTITUTE FOR THE DEAF

Appropriations, 2018 ............................................................................. $73,000,000 

Budget estimate, 2019 ........................................................................... 70,016,000 

Committee recommendation ................................................................. 76,500,000 
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The Committee recommends $76,500,000 for the National Technical Institute for the Deaf [NTID]. 

NTID, located on the campus of the Rochester Institute of Technology in Rochester, New York, was created by Congress in 1965 

to provide a residential facility for postsecondary technical training 

and education for persons who are deaf. NTID also provides support services for students who are deaf, trains professionals in the 

field of deafness, and conducts applied research. 

The Committee strongly supports NTID’s existing regional partnership, first established with fiscal year 2016 funds, to expand 

NTID’s geographical reach and improve access to postsecondary 

STEM education and employment for students who are deaf or 

hard of hearing in underserved areas. This has included professional development for teachers, developing relationships with 

business and industry to promote employment opportunities, and 

preparing students to be successful in STEM fields. The Committee 

recommendation includes $5,500,000, an increase of $3,500,000, to 

expand this existing partnership in fiscal year 2019. 

GALLAUDET UNIVERSITY

Appropriations, 2018 ............................................................................. $128,000,000 

Budget estimate, 2019 ........................................................................... 121,275,000 

Committee recommendation ................................................................. 133,000,000 

The Committee recommends $133,000,000 for Gallaudet University. 

Gallaudet University is a private, not-for-profit institution offering undergraduate and continuing education programs for students 

who are deaf, as well as graduate programs in fields related to 

deafness for students who are hearing and deaf. The university 

conducts basic and applied research related to hearing impairments and provides public service programs for the deaf community. 

This funding also supports the Model Secondary School for the 

Deaf, which serves as a laboratory for educational experimentation 

and development; disseminates curricula, materials, and models of 

instruction for students who are deaf; and prepares adolescents 

who are deaf for postsecondary academic or vocational education or 

the workplace. The university’s Kendall Demonstration Elementary 

School develops and provides instruction for children from infancy 

through age 15. 

Within the total the Committee recommendation includes 

$2,000,000 to establish a regional partnership focused on early language acquisition for children from birth through age three who 

are deaf or hard of hearing, with an organization with expertise in 

this area. This partnership would allow Gallaudet to expand and 

build on its current research in this area, and test and evaluate 

interventions in new and diverse geographic areas. The partnership 

should also include activities to improve early language acquisition 

training for early educators, caretakers, and other professionals. 

CAREER, TECHNICAL, AND ADULT EDUCATION

Appropriations, 2018 ............................................................................. $1,830,686,000 

Budget estimate, 2019 ........................................................................... 1,637,159,000 

Committee recommendation ................................................................. 1,855,686,000 
196 

Career and Technical Education 

The Committee recommends $1,200,019,000 for the Career and 

Technical Education [CTE] account. 

State Grants.—The Committee recommends $1,192,598,000 for 

CTE State grants. Funds provided under the State grant program 

assist States, localities, and outlying areas to expand and improve 

their CTE program and help ensure equal access to CTE for populations with special needs. Persons assisted range from secondary 

students in prevocational courses through adults who need retraining to adapt to changing technological and labor market conditions. 

Funds are distributed according to a formula based on State population and State per capita income. 

Under the Indian and Hawaiian Natives programs, competitive 

grants are awarded to federally recognized Indian Tribes or Tribal 

organizations and to organizations primarily serving and representing Hawaiian Natives for services that are additional to what 

these groups receive under other provisions of the Perkins Act. 

Of the funds available for this program, $401,598,000 will become available July 1, 2019, and $791,000,000 will become available on October 1, 2019. These funds will remain available for obligation until September 30, 2020. 

The Committee strongly encourages the Department to work 

with States, businesses, and other stakeholders to develop a report 

on the key elements of high quality CTE programs, including the 

barriers to developing or expanding high-quality CTE programs, 

how to strengthen the pipeline from CTE programs to available 

jobs, and how to raise students’ awareness of CTE opportunities. 

National Programs.—The Committee recommends $7,421,000 to 

support research, development, demonstration, dissemination, evaluation, and assessment of activities aimed at improving the quality 

and effectiveness of CTE. 

Adult Education 

The Committee recommends $655,667,000 for Adult Education 

programs. 

Adult Education State Grants.—The Committee recommendation 

includes $641,955,000 for Adult Education State Grants, an increase of $25,000,000, which will provide additional funding for 

States for programs that assist adults in becoming literate and in 

obtaining the skills necessary for employment and self-sufficiency. 

National Leadership Activities.—The Committee recommends 

$13,712,000 for adult education national leadership activities. 

STUDENT FINANCIAL ASSISTANCE

Appropriations, 2018 ............................................................................. $24,445,352,000 

Budget estimate, 2019 ........................................................................... 22,975,352,000 

Committee recommendation ................................................................. 24,445,352,000 

The Committee recommends an appropriation of $24,445,352,000 

for programs under the Student Financial Assistance account. 

Federal Pell Grant Program 

The Committee recommends $22,475,352,000 in current year discretionary funding for the Pell grant program. Pell grants provide 
197 

need-based financial assistance that helps undergraduate students 

and their families defray a portion of the costs of postsecondary 

education. Awards are determined according to a statutory needanalysis formula that takes into account a student’s family income 

and assets, household size, and the number of family members, excluding parents, attending postsecondary institutions. The Committee recommendation includes a 1.6 percent, or $100, 

increase in the discretionary maximum Pell grant award that increases the total maximum Pell grant award from $6,095 for the 

2018–2019 award year, to $6,195 for the 2019–2020 award year. 

This builds on the 3.0 percent increase last year that more than 

kept up with inflation. This is the second consecutive increase in 

the maximum award paid for with discretionary funding; the automatic increase in the maximum award paid for with mandatory 

funding expired in fiscal year 2017. 

Federal Supplemental Educational Opportunity Grant Program 

The Committee recommends $840,000,000 for the Supplemental 

Educational Opportunity Grant [SEOG] program. The SEOG program provides funds to approximately 3,700 postsecondary institutions for need-based grants to more than 1,500,000 undergraduate 

students. Institutions must contribute at least 25 percent toward 

SEOG awards. Students qualify for grants of up to $4,000 by demonstrating financial need. Priority is given to Pell grant recipients 

with exceptional need. 

Federal Work-Study Program 

The Committee bill provides $1,130,000,000 for the Federal 

Work-Study [FWS] program. This program provides grants to approximately 3,200 institutions and helps nearly 700,000 undergraduate, graduate, and professional students meet the costs of 

postsecondary education through part-time employment. Institutions must provide at least 25 percent of student earnings. 

Within the total for FWS, the Committee recommendation includes $9,625,000, the same as the fiscal year 2018 level, for the 

Work Colleges program authorized under section 448 of the HEA. 

FEDERAL DIRECT STUDENT LOAN PROGRAM ACCOUNT

Appropriations, 2018 ............................................................................. $350,000,000 

Budget estimate, 2019 ........................................................................... ........................... 

Committee recommendation ................................................................. 350,000,000 

The Committee recommendation includes $350,000,000 in discretionary funding for the Federal Direct Student Loan Program Account. This funding provides for the loan forgiveness, under authority established by the Consolidated Appropriations Act, 2018 and 

continued in this bill, for certain borrowers who are ineligible for 

the traditional Public Service Loan Forgiveness [PSLF] program 

because they were enrolled in an ineligible repayment plan, but 

who otherwise would be eligible for PSLF. 

The Committee continues to note that there has been concern 

with the level of service provided to borrowers who intend to seek 

loan forgiveness under PSLF. The Committee encourages the Department to provide borrowers more regular and current information about the status of processing their PSLF employment certifi-
198 

cation, the number of qualifying payments made, and the projected 

date of their forgiveness. Further, the Committee encourages the 

Department to expand the use of digital technology in the PSLF 

program, to allow for employment certifications and PSLF applications to be completed electronically, and with each student loan 

servicer. Finally, to ensure consistency for applicants, the Committee encourages the Department to revisit decisions to rescind 

employment certification for borrowers who were previously approved. 

The Committee notes the Department has been given the authority to administer critical student debt relief for public servants 

through the Public Service Loan Forgiveness [PSLF] program, 

which was expanded in the Consolidated Appropriations Act, 2018 

for borrowers whose payments were not made in a qualifying repayment plan, later designated by the Department as Temporary 

Expanded Public Service Loan Forgiveness [TEPSLF]. The Committee directs the Department to provide a biannual report on both 

PSLF and TEPSLF, which shall where possible provide for each 

program: the number of Employment Certification Forms approved 

and rejected, the number of Applications for Forgiveness approved 

and rejected, the most common reasons for the rejection of employment certifications and for the rejection of forgiveness applications, 

the distribution of qualifying organization types for the most recently completed employment certifications and for borrowers receiving forgiveness, the distribution of repayment plans for borrowers with any approved employment certification and for borrowers with approved applications for forgiveness, the total and average outstanding loan balances for borrowers whose employment 

certifications are approved, and the total and average outstanding 

loan balances for borrowers whose applications for forgiveness are 

approved, to the Committees on Appropriations of the House of 

Representatives and Senate and Committee on Education and the 

Workforce of the House of Representative and the Senate Committee on Health, Education, Labor and Pensions. The Committee 

directs the report to include a discussion of outreach efforts implemented and planned that will raise awareness of PSLF for all Direct Loan borrowers and improve the filing of employment certification (including the expanded authority for cancellation and outreach funding provided for TEPSLF) through improving communications and information on program requirements, benefits, and 

options; proactive contact with borrowers in ineligible repayment 

plans; regular reminders for borrowers to file employment certifications; and permitting borrowers to electronically sign and upload 

all forms regardless of the borrower’s student loan servicer and on 

a centralized website. 

STUDENT AID ADMINISTRATION

Appropriations, 2018 ............................................................................. $1,678,943,000 

Budget estimate, 2019 ........................................................................... 1,772,000,000 

Committee recommendation ................................................................. 1,678,943,000 

The Committee recommends $1,678,943,000 for the Student Aid 

Administration account. These funds are available until September 

30, 2020, and support the Department’s student aid management 

expenses. 
199 

The Committee recommendation includes $698,943,000 for administrative costs and $980,000,000 for loan servicing activities. 

The Committee directs the Department to continue to provide 

quarterly reports detailing its obligation plan by quarter for student aid administrative activities broken out by servicer and activity and detailing performance metrics, total loan volume and number of accounts, broken out by servicer and for each private collection agency. Further, any reallocation of funds between administrative costs and servicing activities within this account should be 

treated as a reprogramming of funds, and the Committee should be 

notified in advance of any such changes. 

Criminal History Questions.—The Committee recognizes that 

asking certain types of criminal history questions as part of the 

higher education admissions process can have a discriminatory effect and greatly impact who applies to and is ultimately accepted 

into higher education. The Committee encourages the Department 

to proactively distribute the ‘‘Beyond the Box: Increasing Access to 

Higher Education for Justice-Involved Individuals’’ resource guide 

to institutions of higher education, and technical assistance to institutions of higher education conducting the ‘‘College and University Self-Assessment’’ contained therein to help institutions examine whether, when, and how to use criminal justice information in 

the higher education admissions and enrollment process. The Department shall report to the Committee not later than 90 days 

after enactment of this act on the number and category of contacts 

made pursuant to this paragraph and plans for additional actions 

on this issue. 

Defaulted Student Loan Servicing.—The Committee is concerned 

with the Department’s recent management of the defaulted Federal 

student loan process and with the capacity of current private collection agencies receiving new accounts to be able to properly serve 

borrowers who have defaulted on their loans. Accordingly, the Committee encourages the Department to extend current contracts with 

private collection agencies whose award term extensions are set to 

expire in April 2019, and that are affirmatively meeting all contract requirements, serving the fiscal interest of the United States, 

and complying with applicable consumer protection laws until the 

Department is able to transition to a new collections process as 

part of the Department’s Next Generation Financial Services Environment. Furthermore, the Committee directs the Department not 

to recall accounts that are not in repayment from such private collection agencies and allow them to continue servicing their current 

portfolio to avoid disruptions for borrowers, and to comply with the 

performance reporting requirements of the explanatory statement 

accompanying the Consolidated Appropriations Act, 2018. 

Enforcement Disclosure.—The Committee directs the Secretary to 

respond to ‘‘Enforcement Disclosure’’ requests under the Statement 

of Records Notice for the Direct Loan Program (Common Services 

For Borrowers, 18–11–16) within 10 days of receipt and to publish 

and post on a publicly accessible website a detailed explanation of 

the policy that governs such a disclosure. Further, the Committee 

encourages the Secretary to make publicly available on its website 

a detailed list of all individual requests made to the Department 

under the ‘‘Enforcement Disclosure’’ provision. 
200 

Experimental Site Evaluation and Resources for Participating 

Students.—The Committee encourages the Department to work 

with an experienced third-party evaluator to conduct an external 

and objective evaluation of the Second Chance Pell Experimental 

Site Initiative [ESI]. The evaluation should study in-custody outcomes and post-release outcomes, including progress towards credential attainment, safety in prisons with postsecondary education 

programs, the size of waiting lists for in prison postsecondary education programs, the extent to which students continue their education post-release, employment and earnings outcomes, and recidivism. The evaluation should track students for 1–3 years post-release. In addition, many of the colleges participating in the Second 

Chance Pell ESI have found that students who are trying to address student loan defaults and delinquencies are having difficulty 

getting clear directions from Federal Student Aid [FSA] on how 

best to do so. Further, incarcerated students have difficulty accessing the online systems and customer service resources the Department created to streamline student loan repayment. The Committee recommends FSA designate staff who would specialize in 

working with incarcerated students and be a primary contact and 

resource to address issues with their student loans. 

FAFSA Simplification.—There have been consistent efforts in recent years to simplify the FAFSA, including eliminating questions, 

implementing skip logic to reduce duplicative or unnecessary questions based on prior answers, and implementing prior-prior-year income information to significantly increase the usefulness of the IRS 

Data Retrieval Tool. The Committee supports efforts to further 

simplify the FAFSA and verification process to reduce the burden 

on students and institutions of higher education, including implementing a mobile platform, temporarily reinstating alternative documentation options for non-tax filers, and restoring the ability of 

all servicemembers and veterans to identify their status when they 

apply for student aid separate from the dependency determination 

to assist States and institutions in supporting these populations. 

The Committee looks forward to working on these issues as part 

of changes initiated by FSA and through the Higher Education Act 

reauthorization, and appreciates collaboration with the Department 

on proposals and plans to do so. 

Federal Student Loan Servicing.—The Committee recommendation continues all requirements from the Consolidated Appropriations Act, 2018, including requiring the Department to ensure that 

any future student loan servicing contract provides for the participation of multiple student loan services that contract directly with 

the Department to manage a unique portfolio of borrower accounts 

and the full life-cycle of loans from disbursement to pay-off with 

certain limited exceptions, and allocates student loan borrower accounts to eligible student loan servicers based on performance. This 

also includes requirements for FSA to evaluate servicers based on 

their history of compliance with applicable consumer protections 

laws and hold such subcontractors accountable for meeting the requirements of the contract. The Committee continues to believe 

this will help ensure high quality service to borrowers and promote 

accountability and transparency to both borrowers and taxpayers. 

The Committee looks forward working with the Department on ef-
201 

forts to improve the student loan servicing system that maintain 

key elements that promote transparency, accountability, and competition. 

Perkins Loan Program.—Colleges and universities participating 

in the Perkins Loan Program have provided loan cancellation to eligible borrowers under 20 U.S.C. 1087ee(a). Given the wind-down of 

the program, the Secretary is set to outline the process for distributing assets from institutions’ student loan funds established under 

20 U.S.C. 1087ff later this year. The Committee encourages the 

Secretary to use any authority granted for reimbursing colleges 

and universities for cancelled loans for which no reimbursement 

has been provided and directs notification of the Committees on 

Appropriations of the House of Representatives and Senate and 

Committee on Education and the Workforce of the House of Representatives and Senate Health, Education, Labor and Pensions 

Committee not later than 10 days prior to any such reimbursement. The Committee recommendation also includes new bill language allowing funds appropriated under the Student Aid Administration account to be used for making payments to institutions of 

higher education for servicing Federal Perkins Loans. 

Return of Title IV Funds.—The Committee strongly encourages 

the Department to pursue efforts to simplify and streamline the 

Return of Title IV Funds process for institutions of higher education and students. 

Sharing FAFSA Information.—The Committee recommendation 

reaffirms language included in the Consolidated Appropriations 

Act, 2018 regarding the need to provide students with a means to 

share data from the FAFSA in order to assist an applicant in applying for and receiving financial assistance for any components of 

cost of attendance with the explicit written consent of the applicant. The Committee recommendation also further clarifies that 

such sharing is also allowed with an organization assisting the applicant in applying for and receiving Federal, State, local, or tribal 

assistance in order to fund additional components of the applicant’s 

cost of attendance. Additionally, consistent with the privacy provisions of paragraph (3)(E) of section 483(a) of the Higher Education 

Act, the Secretary may designate such entities to receive data from 

the electronic version of the FAFSA. The Committee encourages 

the Secretary to use such authority to enable the sharing of FAFSA 

data for the purpose of connecting students to State or Federal 

means-tested benefit programs for which they may be eligible and 

for which, if eligible, could reduce the applicant’s need to borrow 

or work during college. 

State-Based Servicing Organizations.—The Committee notes that 

State-based non-profit servicing organizations may be uniquely positioned to assist borrowers who reside in or attend school in the 

same State or region. The Committee encourages the Department 

to explore considering such factors in the current performancebased allocation system and in developing student loan servicing 

partnerships as part of the Next Generation Financial Services Environment. 
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HIGHER EDUCATION

Appropriations, 2018 ............................................................................. $2,246,551,000 

Budget estimate, 2019 ........................................................................... 1,485,848,000 

Committee recommendation ................................................................. 2,260,551,000 

The Committee recommends an appropriation of $2,260,551,000 

for higher education programs. 

Aid for Institutional Development 

The Committee recommends $674,502,000 in discretionary funding for Aid for Institutional Development. These totals do not include separately authorized and appropriated mandatory funding. 

Strengthening Institutions.—The Committee bill recommends 

$101,067,000 to provide competitive, 1-year planning and 5-year 

development grants for institutions with a significant percentage of 

financially needy students and low educational and general expenditures per student in comparison with similar institutions. Applicants may use these funds to develop faculty, strengthen academic programs, improve institutional management, and expand 

student services. 

Hispanic-Serving Institutions [HSIs].—The Committee recommends $125,898,000 for competitive grants to institutions at 

which Hispanic students make up at least 25 percent of enrollment. Funds may be used for acquisition, rental, or lease of scientific or laboratory equipment; renovation of instructional facilities; development of faculty; support for academic programs; institutional management; and purchase of educational materials. 

Promoting Postbaccalaureate Opportunities for Hispanic Americans.—The Committee recommends $11,296,000 for competitive, 5- 

year grants to HSIs to help Hispanic Americans gain entry into 

and succeed in graduate study. Institutions may use funding to 

support low-income students through outreach programs; academic 

support services; mentoring and financial assistance; acquisition, 

rental, or lease of scientific or laboratory equipment; construction 

and other facilities improvements; and purchase of educational materials. 

Strengthening Historically Black Colleges and Universities.—The 

Committee recommends $285,788,000 for the Strengthening 

HBCUs program. The program makes formula grants to HBCUs 

that may be used to purchase equipment; construct and renovate 

facilities; develop faculty; support academic programs; strengthen 

institutional management; enhance fundraising activities; provide 

tutoring and counseling services to students; and conduct outreach 

to elementary and secondary school students. 

Strengthening Historically Black Graduate Institutions 

[HBGIs].—The Committee recommends $73,908,000 for the 

Strengthening HBGIs program. This program provides 5-year 

grants to provide scholarships for low-income students and academic and counseling services to improve student success. Funds 

may also be used for construction, maintenance, and renovation activities; the purchase or lease of scientific and laboratory equipment; and the establishment of an endowment. 

Strengthening Predominately Black Institutions [PBIs].—The 

Committee recommends $11,611,000 for the Strengthening PBIs 
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program. This program provides 5-year grants to PBIs to plan and 

implement programs to enhance the institutions’ capacity to serve 

more low- and middle-income Black American students. Funding 

may be used for establishing or enhancing a program of teacher 

education designed to qualify students to teach in a public elementary school or secondary school in the State that shall include, as 

part of such program, preparation for teacher certification or licensure. 

Strengthening Asian American and Native American Pacific Islander-Serving Institutions [AANAPISIs].—The Committee recommends $3,910,000 for competitive grants to AANAPISIs that 

have an enrollment of undergraduate students that is at least 10 

percent Asian American or Native American Pacific Islander students. Grants may be used to improve their capacity to serve Asian 

American and Native American Pacific Islander students and lowincome individuals. 

Strengthening Alaska Native and Native Hawaiian-Serving Institutions [ANNHs].—The Committee recommends $16,120,000 for the 

Strengthening ANNHs program. 

The purpose of this program is to improve and expand the capacity of institutions serving Alaska Native and Native Hawaiian students and low-income individuals. Funds may be used to plan, develop, and implement activities that encourage faculty and curriculum development; improve administrative management; renovate educational facilities; enhance student services; purchase library and other educational materials; and, provide education or 

counseling services designed to improve the financial and economic 

literacy of students or their families. 

Strengthening Native American-Serving Non-Tribal Institutions.—The Committee recommends $3,910,000 for this program, 

which serves institutions that enroll at least 10 percent Native 

American students and at least 50 percent low-income students. 

This program helps institutions plan, develop, and implement activities that encourage faculty and curriculum development; improve administrative management; renovate educational facilities; 

enhance student services; and purchase library and other educational materials. 

Strengthening Tribally Controlled Colleges and Universities.— 

The Committee recommends $32,234,000 for this program. Tribal 

colleges and universities rely on a portion of the funds provided to 

address developmental needs, including faculty development, curriculum, and student services. 

Strengthening Masters Degree Programs at Historically Black 

Colleges and Universities.—The Committee recommends $8,760,000 

for this program, authorized by section 723 of the HEA. This program provides grants to specified colleges and universities making 

a substantial contribution to graduate education opportunities at 

the masters level in mathematics, engineering, the physical or natural sciences, computer science, information technology, nursing, 

allied health, or other scientific disciplines. 

International Education and Foreign Language Studies 

The bill includes a total of $72,164,000 for International Education and Foreign Language Studies programs. Funds are used to 
204 

increase the number of experts in foreign languages and area or 

international studies to meet national security needs through visits 

and study in foreign countries. 

Domestic Programs.—The Committee recommends $65,103,000 

for domestic program activities related to international education 

and foreign language studies under title VI of the HEA. Funds are 

used to support centers, programs, and fellowships. The Committee 

urges the Secretary to preserve the program’s longstanding focus 

on activities and institutions that address the Nation’s need for a 

strong training and research capacity in foreign languages and 

international studies, including increasing the pool of international 

experts in areas that are essential to national security and economic competitiveness. 

Overseas Programs.—The Committee recommends $7,061,000 for 

overseas programs authorized under the Mutual Educational and 

Cultural Exchange Act of 1961, popularly known as the FulbrightHays Act. Funding is provided for group, faculty, or doctoral dissertation research abroad as well as special bilateral projects. 

Grants focus on training American instructors and students to improve foreign language and area studies education in the United 

States. 

Model Comprehensive Transition and Postsecondary Programs for 

Students With Intellectual Disabilities 

The Committee recommendation includes $11,800,000 for competitive grants to postsecondary institutions to support model programs that help students with intellectual disabilities transition to 

and complete college, as authorized by section 767 of the HEA. 

Funds may be used for student support services; academic enrichment, socialization, or independent living; integrated work experiences; and partnerships with LEAs to support students with intellectual disabilities participating in the model program who are still 

eligible for special education and related services under the IDEA. 

Minority Science and Engineering Improvement 

The Committee recommends $11,268,000 for the Minority 

Science and Engineering Improvement program. Funds are used to 

provide discretionary grants to institutions with minority enrollments greater than 50 percent to purchase equipment, develop curricula, and support advanced faculty training. Grants are intended 

to improve science and engineering education programs and increase the number of minority students in the fields of science, 

mathematics, and engineering. 

Tribally Controlled Postsecondary Career and Technical Institutions 

The Committee recommends $9,678,000 for tribally controlled 

postsecondary vocational institutions. This program provides 

grants for the operation and improvement of tribally controlled 

postsecondary vocational institutions to ensure continued and expanding opportunities for Indian students. 
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Federal TRIO Programs 

The Committee recommends $1,010,000,000 for Federal TRIO 

programs, which provide a variety of services to improve postsecondary education opportunities for low-income individuals and 

first-generation college students. 

Upward Bound offers disadvantaged high school students academic services to develop the skills and motivation needed to pursue and complete a postsecondary education; Student Support 

Services provides developmental instruction, counseling, summer 

programs, and grant aid to disadvantaged college students to help 

them complete their postsecondary education; Talent Search identifies and counsels individuals between ages 11 and 27 regarding opportunities for completing high school and enrolling in postsecondary education; Educational Opportunity Centers provide information and counseling on available financial and academic assistance to low-income adults who are first-generation college students; 

and the Ronald E. McNair Postbaccalaureate Achievement Program supports research internships, seminars, tutoring, and other 

activities to encourage disadvantaged college students to enroll in 

doctoral programs. 

The Committee recommendation includes no less than the fiscal 

year 2018 level for each of the TRIO programs. 

The Committee notes there is concern about the Department’s 

planned allocation of the $60,000,000 increase provided in fiscal 

year 2018 for TRIO. The Committee directs the Department to include in its fiscal year 2020 CJ information on how these increased 

funds were allocated, including a detailed budget justification. Further, the Committee expects funding allocations like this to be included in the Department’s operating plan required under section 

516 of this act in future fiscal years. 

Income Eligibility for TRIO Programs.—The Committee is concerned with the level of burden TRIO grantees and first-generation 

students face in documenting their income to meet the definition 

of ‘‘low-income individual’’ as required under section 401A(h)(4) of 

the Higher Education Act in order to be eligible for Federal TRIO 

programs. When the Department transitioned to ‘‘prior-prior year’’ 

income on the FAFSA to benefit applicants, this created a potential 

discrepancy with section 401A(h)(4) of the Higher Education Act 

that refers to income from the preceding year. The Committee 

urges the Department to work with grantees to allow for the use 

of the student’s most recently completed FAFSA as documentation 

of a student’s income, or family’s income (as applicable), to determine eligibility for TRIO programs. 

Gaining Early Awareness and Readiness for Undergraduate Programs 

The Committee recommends $350,000,000 for GEAR UP, which 

provides grants to States and partnerships of colleges, middle and 

high schools, and community organizations to assist cohorts or students in middle and high schools serving a high percentage of lowincome students. Services provided help students prepare for and 

pursue a postsecondary education. 
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Graduate Assistance in Areas of National Need and Javits Fellowships 

The Committee recommends $23,047,000 to support the Graduate Assistance in Areas of National Need [GAANN] program. 

GAANN supports fellowships through 3-year competitive grants to 

graduate academic departments and programs in scientific and 

technical fields and other areas of national need as determined by 

the Secretary. Fellowship recipients must have excellent academic 

records and high financial need and must be pursuing doctoral degrees or the highest graduate degrees in their academic field. Each 

fellowship consists of a student stipend to cover living costs and an 

institutional payment to cover each fellow’s tuition and other expenses. Institutions of higher education must match 25 percent of 

the grant amount. 

Teacher Quality Partnership Program 

The Committee recommends $43,092,000 for the Teacher Quality 

Partnership [TQP] program. The TQP program helps improve the 

quality of teachers working in high-need schools and early childhood education programs by creating model teacher preparation 

and residency programs. 

Child Care Access Means Parents in Schools 

The Committee recommendation includes $50,000,000 for the 

Child Care Access Means Parents in Schools program. This program provides competitive grants to institutions of higher education to establish or support campus-based child care programs, to 

help support needs and participation of low-income parents in postsecondary education. 

Fund for the Improvement of Post-Secondary Education 

The Committee recommendation includes $5,000,000 for the 

Fund for the Improvement of Post-Secondary Education. The recommendation includes the full amount the Open Textbook Pilot 

first funded in the Consolidated Appropriations Act, 2018, and for 

the purposes described in the accompanying explanatory statement. 

This funding supports grants to one or a group of institutions of 

higher education for creating new open textbooks for use by students in courses, especially those with high enrollments, that are 

part of a degree granting program and expanding the use of open 

textbooks in such courses. Funds may be used for professional development for faculty and staff at institutions of higher education; 

creation or adaptation of open textbooks; development or improvement of tools and informational resources that support the use of 

open textbooks, including accessible instructional materials for students with disabilities; research evaluating the efficacy of the use 

of open textbooks for achieving savings for students and the impact 

on instruction and student learning outcomes; and partnerships 

with other entities to carry out any of these activities. In addition, 

the Committee directs the Department to require any institution of 

higher education receiving a grant through the Open Textbook 

Pilot to report to the Secretary regarding the effectiveness of the 

project in expanding the use of open textbooks and in achieving 

savings for students; the impact of the project on expanding the 
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use of open textbooks at institutions of higher education outside of 

the institution receiving the grant; open textbooks created or 

adapted under the grant, including instructions on where the public can access each open textbook; the impact of the project on instruction and student learning outcomes; and all project costs, including the value of any volunteer labor and institutional capital 

used for the project. Such reports should be made publicly available. 

HOWARD UNIVERSITY

Appropriations, 2018 ............................................................................. $232,518,000 

Budget estimate, 2019 ........................................................................... 221,821,000 

Committee recommendation ................................................................. 236,518,000 

The Committee recommends an appropriation of $236,518,000 for 

Howard University. Located in the District of Columbia, Howard 

offers undergraduate, graduate, and professional degrees through 

12 schools and colleges. The university also administers the Howard University Hospital. Federal funds from this account support 

approximately 38 percent of the university’s operating costs. The 

Committee recommends, within the funds provided, not less than 

$3,405,000 for the endowment program. 

Howard University Hospital.—Within the funds provided, the 

Committee recommends $27,325,000 for Howard University Hospital. The hospital provides inpatient and outpatient care, as well 

as training in the health professions. It also serves as a major 

acute and ambulatory care center for the District of Columbia and 

functions as a major teaching facility attached to the university. 

The Federal appropriation provides partial funding for the hospital’s operations. 

COLLEGE HOUSING AND ACADEMIC FACILITIES LOANS PROGRAM

Appropriations, 2018 ............................................................................. $435,000 

Budget estimate, 2019 ........................................................................... 448,000 

Committee recommendation ................................................................. 435,000 

Federal Administration.—The Committee bill includes $435,000 

for Federal administration of the CHAFL, College Housing Loans, 

and Higher Education Facilities Loans programs. Prior to fiscal 

year 1994, these programs provided financing for the construction, 

reconstruction, and renovation of housing, academic, and other educational facilities. While no new loans have been awarded since fiscal year 1993, costs for administering the outstanding loans will 

continue through 2030. These funds will be used to reimburse the 

Department for administrative expenses incurred in managing the 

existing loan portfolio. 

HISTORICALLY BLACK COLLEGE AND UNIVERSITY CAPITAL

FINANCING PROGRAM ACCOUNT

Appropriations, 2018 ............................................................................. $30,484,000 

Budget estimate, 2019 ........................................................................... 20,489,000 

Committee recommendation ................................................................. 30,484,000 

The Committee recommends $30,484,000 for the HBCU Capital 

Financing Program. The HBCU Capital Financing Program makes 

capital available to HBCUs for construction, renovation, and repair 
208 

of academic facilities by providing a Federal guarantee for private 

sector construction bonds. Construction loans will be made from 

the proceeds of the sale of the bonds. 

The Committee recommendation includes $20,150,000 for loan 

subsidy costs in guaranteed loan authority under this program (not 

including subsidy costs related to specific funding available for loan 

deferments described below). This will support an estimated 

$580,000,000 in new loan volume in fiscal year 2019. In addition 

to that amount, the Committee recommendation includes 

$10,000,000 specifically for loan deferments made to private 

HBCUs under this program with demonstrated financial need. Finally, the Committee recommendations includes $334,000 for administrative expenses. 

The Committee requests that the HBCU Capital Financing Advisory Board prepare an annual report to Congress that would provide an overview of the loans granted and recommendations to 

Congress, the Department of Education, and the Department’s designated bonding authority, for addressing issues related to construction financing for HBCUs. 

INSTITUTE OF EDUCATION SCIENCES

Appropriations, 2018 ............................................................................. $613,462,000 

Budget estimate, 2019 ........................................................................... 521,563,000 

Committee recommendation ................................................................. 615,462,000 

The Committee recommends $615,462,000 for the Institute of 

Education Sciences [IES]. This account supports education research, development, dissemination, and evaluation; data collection 

and analysis activities; and the assessment of student progress. 

Under the Education Sciences Reform Act of 2002, Congress established IES to provide objective and valid research-driven knowledge that was free of political influence or bias so as to better inform effective education practices at the State and local levels. The 

act required IES, in carrying out its mission, ‘‘to compile statistics, 

develop products, and conduct research, evaluations, and wide dissemination activities in areas of demonstrated national need and 

ensure that such activities conform to high standards of quality, integrity, and accuracy and are objective, secular, neutral, and nonideological and are free of partisan political influence.’’ 

The Committee directs the Director to submit an operating plan 

within 90 days of enactment to the Committees on Appropriations 

of the House of Representatives and the Senate detailing how IES 

plans to allocate funding available to the Institute for research, 

evaluation, and other activities authorized under law. 

The Committee continues to direct the Department to ensure 

that its employees, contractors, and grantees, including States that 

receive funds from Statewide Longitudinal Data System grants, adhere to the strictest and highest standards for protecting personally 

identifiable information. 

The Committee notes that in fiscal year 2019 IES plans to compete funding for a new National Research and Development Center 

for Improving Rural Education. The Committee strongly supports 

the establishment of this center which will promote research collaborations between university experts and rural school districts 
209 

that serve high poverty and minority students in order to improve 

student outcomes. 

RESEARCH, DEVELOPMENT, AND DISSEMINATION

The Committee recommends $192,695,000 for education research, 

development, and national dissemination activities. Funds are 

available for obligation for 2 fiscal years. These funds support activities that are aimed at expanding fundamental knowledge of 

education and promoting the use of research and development findings in the design of efforts to improve education. 

STATISTICS

The Committee recommends $109,500,000 for data gathering and 

statistical analysis activities at the National Center for Education 

Statistics [NCES]. 

NCES collects, analyzes, and reports statistics on education in 

the United States. Activities are carried out directly and through 

grants and contracts. The Center collects data on educational institutions at all levels, longitudinal data on student progress, and 

data relevant to public policy. NCES also provides technical assistance to SEAs, LEAs, and postsecondary institutions. 

REGIONAL EDUCATIONAL LABORATORIES

The Committee recommends $55,423,000 to continue support for 

the Regional Educational Laboratories program. Funds available in 

this bill will continue to support a network of 10 laboratories. The 

laboratories are responsible for promoting the use and development 

of knowledge and evidence in broad-based systemic strategies to increase student learning and further school improvement efforts. 

The Committee appreciates the efforts of IES to strengthen the 

connections between practitioners and the research community, so 

that federally supported research is timely, relevant, and responsive to the needs of the field. 

RESEARCH AND INNOVATION IN SPECIAL EDUCATION

The Committee recommends $56,000,000 for research and innovation in special education conducted by the National Center for 

Special Education Research [NCSER]. 

The Center addresses gaps in scientific knowledge to improve 

special education and early intervention services and outcomes for 

infants, toddlers, and children with disabilities. Funds provided to 

the Center are available for obligation for 2 fiscal years. 

The Committee strongly encourages NCSER to manage funding 

to be able to conduct research and training grant competitions annually. 

SPECIAL EDUCATION STUDIES AND EVALUATIONS

The Committee recommends $10,818,000 for special education 

studies and evaluations. 

This program supports competitive grants, contracts, and cooperative agreements to assess the implementation of IDEA. Funds are 

also used to evaluate the effectiveness of State and local efforts to 
210 

deliver special education services and early intervention programs. 

Funds are available for obligation for 2 fiscal years. 

STATEWIDE DATA SYSTEMS

The Committee recommendation includes $32,281,000 for the 

Statewide Data Systems program. 

This program supports competitive grants to SEAs to enable 

such agencies to design, develop, and implement Statewide, longitudinal data systems to manage, analyze, disaggregate, and use individual data for students of all ages. Early childhood, postsecondary, and workforce information systems may be linked to such 

systems or developed with program funds. The Committee believes 

the Department should continue its efforts to ensure every State 

has the base support necessary to develop effective systems. Funds 

are available for obligation for 2 fiscal years. 

ASSESSMENT

The Committee recommends $158,745,000 to provide support for 

the National Assessment of Educational Progress [NAEP], a congressionally mandated assessment created to measure and report 

the educational achievement of American students in a range of 

subjects and analyze trends over time. 

Within the funds appropriated, the Committee recommends 

$7,745,000 for the National Assessment Governing Board [NAGB], 

which is responsible for formulating policy for NAEP. 

The Committee recommendation includes an increase of 

$2,000,000 to help support an earlier administration of the longterm trend NAEP assessment to ensure that the United States has 

comparable data to compare student achievement over time. The 

Committee directs the NAGB to report to the Committee on Appropriations within 60 days of enactment on the resources required to 

administer a long-term trend assessment by 2020. 

The Committee continues to support assessments for students in 

United States History, Civics, and Geography. The Committee directs NAGB to continue administering assessments in these three 

areas, at least every 4 years, in accordance with the current NAEP 

schedule. The most recent assessment was in 2018, and the next 

scheduled assessment is in 2022. 

DEPARTMENTAL MANAGEMENT

PROGRAM ADMINISTRATION

Appropriations, 2018 ............................................................................. $430,000,000 

Budget estimate, 2019 ........................................................................... 459,257,000 

Committee recommendation ................................................................. 430,000,000 

The Committee recommends $430,000,000 for program administration. 

Funds support personnel compensation and benefits, travel, rent, 

communications, utilities, printing, equipment and supplies, automated data processing, and other services required to award, administer, and monitor Federal education programs. Support for 

program evaluation and studies and advisory councils is also provided under this account. 
211 

The Committee requests the Department to provide it with 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. 

College Savings Accounts.—The Committee is aware that the 

2012 GAO report on college savings accounts noted that less than 

6 percent of families with children under the age of 25 saved 

through 529 plans or Coverdell Education Savings Accounts, and 

that the families that do, had about 25 times the median financial 

assets than those without. The Committee is aware of different efforts to boost the participation of low- and middle-income families 

in such savings plans and is particularly interested in efforts that 

combine college savings accounts with counseling, mentoring, and 

other supports for students. Therefore, the Committee directs GAO 

to identify and examine the characteristics of effective local partnerships that support low-income students in preparation for a college education through the use of college savings accounts. GAO 

shall also report on the effectiveness of these accounts on low-income student college matriculation and retention. 

Competitive Grant Priorities for Rural Areas.—The Committee 

continues to encourage the Department to continue efforts to ensure that competitive grants are reaching rural areas and States 

so that support and solutions developed with Federal funding are 

relevant to and available in such areas. 

Department of Interior Schools.—The Committee commends the 

work being done by the Departments of Education and Interior to 

improve the lives of American Indian students through a quality 

education. However, the Committee remains concerned by the lack 

of progress in improving the long-documented issues facing Department of Interior schools. The Committee strongly encourages the 

Departments of Education and Interior to continue to work together to improve the quality of education opportunities offered to 

Indian youth. 

Disclosures of Foreign Gifts and Contracts.—The Committee is 

aware that concerns have been expressed about certain contracts 

held by institutions of higher education and foreign governments, 

such as Confucius Institutes, and their potential to exert influence 

on academic institutions. The Committee directs the Department to 

report to the Committees on Appropriations of the House of Representatives and the Senate within 180 days of enactment of this 

act on foreign gifts disclosure reports received pursuant to Section 

117 of the Higher Education Act of 1965 and data on the prevalence of Confucius Institutes that are identified in such reports. 

Improving Data Available for Post-Secondary Education.—The 

Committee encourages the Department to study the feasibility of 

developing data systems to help increase the information available 

to students and researchers about specific post-secondary options 

and outcomes. Specifically, the Committee encourages the Department to work with IES to evaluate the feasibility of proposals to 

aggregate datasets, including through secure multi-party computation systems that allow multiple entities to link their datasets 

through discreet calculations without transferring or otherwise revealing private data to other parties. The Committee requests a report on such evaluation within 180 days of enactment of this act. 
212 

Performance Partnerships.—The Committee recommendation 

continues authority for Performance Partnerships as included in 

prior appropriations acts. Performance Partnerships allow States 

and localities to demonstrate better ways of improving outcomes for 

disconnected youth by giving them additional flexibility in using 

discretionary funds across multiple Federal programs. The Committee also continues to encourage the administration to enhance 

its efforts working with existing and potential sites on the full 

range of flexibilities that could be employed to help better serve 

disconnected youth. Finally, the Committee is interested in expanding Performance Partnerships to other populations and programs, 

and has requested reports from GAO to help explore this possibility. 

Pooled Evaluation Authority.—The Committee requests that the 

Department provide a report to the Committee on the planned use 

of pooled evaluation funds under section 8601 of the ESEA, consistent with the required plan under such section, not later than 

15 days prior to any transfer of funds. 

Reorganization Plans.—The Committee recommendation continues all directives included in the Consolidated Appropriations 

Act, 2018 and the accompanying explanatory statement. 

Technical Assistance.—The Committee is concerned about the 

Department’s responsiveness to technical assistance requests and 

continues to note that it expects the Department to comply in a 

timely manner with its requests for technical assistance and information, consistent with past practice including timely answers that 

respond to any specific inquiries. 

OFFICE FOR CIVIL RIGHTS

Appropriations, 2018 ............................................................................. $117,000,000 

Budget estimate, 2019 ........................................................................... 107,438,000 

Committee recommendation ................................................................. 125,000,000 

The Committee recommends $125,000,000 for the Office of Civil 

Rights [OCR]. 

OCR is responsible for the enforcement of laws that prohibit discrimination on the basis of race, color, national origin, sex, disability, and age in all programs and institutions that receive financial assistance from the Department. To carry out this responsibility, OCR investigates and resolves discrimination complaints, 

monitors desegregation and equal educational opportunity plans, 

reviews possible discriminatory practices by recipients of Federal 

education funds, and provides technical assistance to recipients of 

funds to help them meet these civil rights requirements. 

The Committee directs OCR to use this appropriation to increase 

its level of full time equivalent 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 Committee is aware that OCR has made a number of 

changes related to its policies on processing complaints. To understand how OCR’s new policies are affecting its enforcement of civil 

rights laws under its jurisdiction, the Committee directs OCR to 

provide not later than 30 days after the conclusion of each quarter, 

a report to the Committees on Appropriations of the House of Rep-
213 

resentatives and Senate, the House of Representatives Committee 

on Education and the Workforce, and the Senate Committee on 

Health, Education, Labor, and Pensions on all complaints opened 

for investigation, closed, or resolved including: the institution level, 

the date each was opened or resolved, an issue code and an issue 

description, and for all complaints closed or resolved whether the 

issue was closed by dismissal, insufficient evidence, or change without an agreement. 

OFFICE OF INSPECTOR GENERAL

Appropriations, 2018 ............................................................................. $61,143,000 

Budget estimate, 2019 ........................................................................... 63,418,000 

Committee recommendation ................................................................. 61,143,000 

The Committee recommends $61,143,000 for OIG. 

OIG has the authority to investigate all departmental programs 

and administrative activities, including those under contract or 

grant, to prevent and detect fraud and abuse, and to ensure the 

quality and integrity of those programs. The Office investigates alleged misuse of Federal funds and conducts audits to determine 

compliance with laws and regulations, efficiency of operations, and 

effectiveness in achieving program goals. 

GENERAL PROVISIONS

Section 301. The bill continues a provision prohibiting the use of 

funds to prevent the implementation of programs of voluntary 

prayer and meditation in public schools. 

Section 302. The bill continues a provision giving the Secretary 

authority to transfer up to 1 percent of any discretionary funds between appropriations. 

Section 303. The bill continues a provision that allows the Republic of Palau to receive certain Federal funds. 

Section 304. The bill continues a provision making evaluation 

funds pooled under section 8601 of the ESEA available for obligation from July 1, 2019 through September 30, 2020. 

Section 305. The bill continues a general provision allowing certain institutions to continue to use endowment income for student 

scholarships. 

Section 306. The bill continues a provision extending authorization of the National Advisory Committee on Institutional Quality 

and Integrity. 

Section 307. The bill continues a provision extending authority to 

provide account maintenance fees to guarantee agencies. 

Section 308. The bill includes a general provision rescinding discretionary unobligated balances from the Pell grant program. 

Section 309. The bill modifies a provision rescinding fiscal year 

2019 mandatory funding to pay for mandatory costs of increasing 

the maximum discretionary Pell award. 

Sec. 310. The bill modifies a provision clarifying current law regarding sharing data with organizations helping students apply for 

financial aid. 
214 

Sec. 311. The bill continues a provision regarding Public Service 

Loan Forgiveness. 

Sec. 312. The bill continues a provision regarding administrative 

costs for Public Service Loan Forgiveness. 
(215) 

TITLE IV 

RELATED AGENCIES 

COMMITTEE FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR

SEVERELY DISABLED

SALARIES AND EXPENSES

Appropriations, 2018 ............................................................................. $8,250,000 

Budget estimate, 2019 ........................................................................... 8,650,000 

Committee recommendation ................................................................. 8,250,000 

The Committee recommends $8,250,000 for the Committee for 

Purchase from People Who Are Blind or Severely Disabled, of 

which no less than $1,250,000 shall be made available for the Office of Inspector General. 

The AbilityOne Commission [Commission] program provides approximately 45,000 blind or severely disabled Americans with employment opportunities each year. The primary purpose of this program is to increase the employment opportunities for people who 

are blind or have other severe disabilities and, whenever possible, 

to prepare them to engage in competitive employment. Encompassing approximately $3,300,000,000 in contracts, it is the Federal 

Government’s largest employment program for the severely disabled. The Committee is encouraged by the steps the Commission 

has taken to address concerns regarding the oversight of the central nonprofit agencies [CNA], the independent contracted organizations which administer the program. The Committee continues to 

direct the Commission to provide quarterly updates, in electronic 

format, regarding the Commission’s oversight of the CNA. 

CORPORATION FOR NATIONAL AND COMMUNITY SERVICE

The Corporation for National and Community Service [CNCS], a 

corporation owned by the Federal Government, was established to 

enhance opportunities for national and community service. CNCS 

administers programs authorized under the Domestic Volunteer 

Service Act, the National and Community Service Trust Act, and 

the SERVE America Act. Grants are awarded to States, public and 

private nonprofit organizations, and other entities to create service 

opportunities for students, out-of-school youth, adults, and seniors. 

The Committee recommendation for CNCS provides a total program level of $1,058,279,000. 

OPERATING EXPENSES

Appropriations, 2018 ............................................................................. $767,629,000 

Budget estimate, 2019 ........................................................................... 31,689,000 

Committee recommendation ................................................................. 770,629,000 
216 

The Committee recommends $770,629,000 for the operating expenses of CNCS. 

Volunteers in Service to America [VISTA] 

The Committee recommends $92,364,000 for VISTA. This program provides capacity building for small, community-based organizations with a mission of combating poverty. VISTA members 

raise resources, recruit and organize volunteers, and establish and 

expand programs in housing, employment, health, and economic 

development activities. 

National Senior Volunteer Corps 

The Committee recommends $202,117,000 for the National Senior Volunteer Corps programs, a collection of programs that connect 

Americans older than the age of 55 with opportunities to contribute 

their job skills and expertise to community projects and organizations. These programs include the Retired Senior Volunteer Program [RSVP], the Foster Grandparent Program, and the Senior 

Companion Program. 

AmeriCorps State and National Grants 

The Committee recommends $415,010,000 for AmeriCorps State 

and National Grants, which provide funds to local and national organizations and agencies to address community needs in education, 

public safety, health, and the environment. Each of these organizations and agencies, in turn, uses its AmeriCorps funding to recruit, 

place, and supervise AmeriCorps members. AmeriCorps members 

receive a modest living allowance and other benefits proportional 

to their level of time commitment. 

Commission Investment Fund [CIF].—The Committee recommendation includes no less than $8,500,000, the same as the fiscal year 2018 level for CIF, which provides funds to State commissions for training and technical assistance activities to expand the 

capacity of current and potential AmeriCorps programs, particularly in underserved areas. 

Community Development Financial Institutions.—The Committee 

notes that CNCS has developed partnerships with several Federal 

agencies to help further the agency’s goals and to support targeted 

human capital needs of their grantees, including partnerships with 

the Federal Emergency Management Agency, the Department of 

Education, the Department of Transportation, and the U.S. Forest 

Service. Given that ‘‘Economic Opportunity’’ is one of CNCS’s five 

key focus areas, the Committee encourages CNCS to engage with 

the Community Development Financial Institutions [CDFI] Fund 

to explore whether there may be potential opportunities for collaboration on initiatives to support programs under the national service 

laws that train and place individuals at certified CDFIs. 

Fixed Amount Grants.—The Committee continues to encourage 

CNCS to expand opportunities for AmeriCorps programs to utilize 

fixed amount grants, which could reduce unnecessary administrative burdens on current and potential AmeriCorps programs. The 

Committee encourages CNCS to increase the current maximum 

cost per member service year of fixed amount grants to make it 

more comparable to cost reimbursement grant levels and allow new 
217 

AmeriCorps programs to be eligible to apply for full-time fixed 

amount grants, while also ensuring that fixed amount grantees 

provide a comparable amount of matching funds and that there is 

sufficient oversight and accountability of fixed amount grantees. 

Professional Corps.—The Committee continues to direct CNCS to 

include a determination of need by the local community among the 

factors that a professional corps program may use to demonstrate 

an inadequate number of professional in a community. Further, the 

Committee strongly encourages CNCS to increase the maximum 

amount of operating funds per member service year a professional 

corps program may request as part of their grant application. The 

Committee continues to direct CNCS to provide professional corps 

programs flexibility in justifying the need for operating funds to ensure that these programs are able to provide high-quality services 

in all communities. 

National Civilian Community Corps [NCCC] 

The Committee recommendation includes $32,000,000 for NCCC, 

a full-time, team-based residential program for men and women 

ages 18 to 24. Members are assigned to one of five campuses for 

a 10-month service commitment. 

Innovation, Demonstration, and Assistance Activities 

The Committee recommendation includes $7,600,000 for innovation, demonstration, and assistance activities. 

Volunteer Generation Fund.—Within the total, the Committee 

recommendation includes $5,400,000 for the Volunteer Generation 

Fund authorized under section 198P of the SERVE America Act, 

the same as the comparable fiscal year 2018 funding level. 

National Days of Service.—The Committee recommendation includes a total of $2,200,000, the same as the fiscal year 2018 level, 

for National Days of Service to include the September 11 National 

Day of Service and Remembrance and the Martin Luther King, Jr. 

National Day of Service, to be allocated equally by CNCS to support these National Days of Service. 

Evaluation 

The Committee recommendation includes $4,000,000 for CNCS 

evaluation activities. 

State Commission Grants 

The Committee recommendation includes $17,538,000 for State 

Commission Grants. 

PAYMENT TO THE NATIONAL SERVICE TRUST

Appropriations, 2018 ............................................................................. $206,842,000 

Budget estimate, 2019 ........................................................................... ........................... 

Committee recommendation ................................................................. 198,163,000 

The Committee recommends an appropriation of $198,163,000 for 

making payments to the National Service Trust. 

The National Service Trust makes payments of Segal education 

awards, pays interest that accrues on qualified student loans for 

AmeriCorps participants during terms of service in approved na-
218 

tional service positions, and makes other payments entitled to 

members who serve in the programs of CNCS. 

The Committee recommendation reflects the estimated funding 

needed for the Trust at overall Committee recommended funding 

levels for CNCS. 

SALARIES AND EXPENSES

Appropriations, 2018 ............................................................................. $83,737,000 

Budget estimate, 2019 ........................................................................... 87,389,000 

Committee recommendation ................................................................. 83,737,000 

The Committee recommends an appropriation of $83,737,000 for 

CNCS salaries and expenses. The salaries and expenses appropriation provides funds for staff salaries, benefits, travel, training, rent, 

equipment, and other operating expenses necessary for management of CNCS programs and activities. 

OFFICE OF INSPECTOR GENERAL

Appropriations, 2018 ............................................................................. $5,750,000 

Budget estimate, 2019 ........................................................................... 3,568,000 

Committee recommendation ................................................................. 5,750,000 

The Committee recommends an appropriation of $5,750,000 for 

the CNCS OIG. The OIG’s goals are to increase organizational efficiency and effectiveness within the Corporation and to prevent 

fraud, waste, and abuse. 

ADMINISTRATIVE PROVISIONS

The Committee recommendation includes the following general 

provisions for CNCS: requiring CNCS to make any significant 

changes to program requirements or policy through rule making 

(section 401); stipulating minimum share requirements (section 

402); requiring that donations supplement and not supplant operations (section 403); aligning requirements regarding the use of 

Education Awards at GI bill-eligible institutions (section 404); allowing the required background check of certain applicants to be 

processed by States under terms of the National Child Protection 

Act (section 405); and allowing CNCS to establish a new 1,200 hour 

member service position (section 406). 

CORPORATION FOR PUBLIC BROADCASTING

Appropriations, 2020 ............................................................................. $445,000,000 

Budget estimate, 2021 ........................................................................... ........................... 

Committee recommendation, 2021 ....................................................... 445,000,000 

The Committee recommends $445,000,000 for the Corporation for 

Public Broadcasting [CPB] as an advance appropriation for fiscal 

year 2021. 

The majority of these funds go directly to local public television 

and radio stations to support their programming. CPB funds also 

support the creation of content for radio, television, and other platforms; system support activities that benefit the entire public 

broadcasting community; and CPB’s administrative costs. This 

funding supports America’s local public television and radio stations and their mission of developing and ensuring universal access 
219 

to noncommercial, high-quality programming and telecommunications services for the American public. 

Technology and distribution systems have greatly evolved since 

Congress established the practice of funding public broadcasting 

interconnection. Recognizing technology’s power in creating further 

cost efficiencies across the public media system, the Committee recommendation includes $20,000,000 for continued support of CPB in 

replacing and upgrading the public broadcasting interconnection 

system and further investing in system-wide infrastructure and 

services that benefit the American people. 

FEDERAL MEDIATION AND CONCILIATION SERVICE

SALARIES AND EXPENSES

Appropriations, 2018 ............................................................................. $46,650,000 

Budget estimate, 2019 ........................................................................... 47,200,000 

Committee recommendation ................................................................. 46,650,000 

The Committee recommends $46,650,000 for the Federal Mediation and Conciliation Service [FMCS]. FMCS provides mediation, 

conciliation, and arbitration services to labor and management organizations to prevent and minimize work stoppages and promote 

stable labor-management relationships. FMCS is also authorized to 

provide dispute resolution consultation and training to all Federal 

agencies. 

Within the total, FMCS may utilize up to $900,000 for labormanagement partnership grants. These grants support innovative 

approaches to collaborative labor-management relationships to resolve potential problems, explore ways to improve productivity, and 

avert serious work stoppages. 

FEDERAL MINE SAFETY AND HEALTH REVIEW COMMISSION

SALARIES AND EXPENSES

Appropriations, 2018 ............................................................................. $17,184,000 

Budget estimate, 2019 ........................................................................... 17,053,000 

Committee recommendation ................................................................. 17,184,000 

The Committee recommends $17,184,000 for the Federal Mine 

Safety and Health Review Commission [FMSHRC], which provides 

administrative trial and appellate review of legal disputes under 

the Federal Mine Safety and Health Act of 1977. Most cases involve civil penalties proposed by MSHA. FMSHRC’s administrative 

law judges [ALJs] decide cases at the trial level and the five-member Commission provides review of the ALJ’s decisions. The Committee directs the Federal Mine Safety and Health Review Commission to continue providing priority to reducing the excessive 

time substantive cases on appeal are awaiting a decision. 

In allocating resources and assigning staff, the Committee directs 

FMSHRC to provide priority to reducing the excessive time substantive cases on appeal are awaiting a decision. The Committee 

requests that FMSHRC describe in its fiscal year 2020 CJ the steps 

it is taking to reduce pendency of such cases. 
220 

INSTITUTE OF MUSEUM AND LIBRARY SERVICES

OFFICE OF MUSEUM AND LIBRARIES: GRANTS AND ADMINISTRATION

Appropriations, 2018 ............................................................................. $240,000,000 

Budget estimate, 2019 ........................................................................... 23,000,000 

Committee recommendation ................................................................. 242,000,000 

The Committee recommends $242,000,000, an increase of 

$2,000,000, for the Institute of Museum and Library Services. This 

agency supports programs for museums and libraries that encourage innovation, provide lifelong learning opportunities, promote 

cultural and civic engagement, and improve access to a variety of 

services and information. 

Within the total for IMLS, the Committee recommendation includes the amounts below: 

[In thousands of dollars] 

Budget activity Fiscal year 2018 

appropriation 

Committee 

recommendation 

Library Services Technology Act [LSTA]: 

Grants to States .................................................................................................... 160,803,000 160,803,000 

Native American Library Services .......................................................................... 5,063,000 5,063,000 

National Leadership: Libraries ............................................................................... 13,406,000 13,406,000 

Laura Bush 21st Century Librarian ....................................................................... 10,000,000 10,000,000 

Subtotal, LSTA ............................................................................................... 189,272,000 189,272,000 

Museum Services Act: 

Museums for America ............................................................................................ 22,899,000 22,899,000 

Native American/Hawaiian Museum Services ....................................................... 1,472,000 1,472,000 

National Leadership: Museums ............................................................................. 8,113,000 8,113,000 

Subtotal, MSA ............................................................................................... 32,484,000 32,484,000 

African American History and Culture Act ..................................................................... 2,231,000 2,231,000 

Administration ................................................................................................................. 14,000,000 15,000,000 

Research, Analysis and Data Collection ........................................................................ 2,013,000 3,013,000 

IMLS, Total .................................................................................................... 240,000,000 242,000,000 

Research, Analysis and Data Collection.—The Committee recommends an increase of $1,000,000, for additional agency staffing 

needs to continue the ongoing effort to measure the effectiveness 

of museums and libraries. Furthermore, the Committee recommends IMLS identify indicators and outcomes that enhance efficiency and efficacy as well as promote advancement and growth by 

sharing best practices and effective strategies. 

MEDICAID AND CHIP PAYMENT AND ACCESS COMMISSION

SALARIES AND EXPENSES

Appropriations, 2018 ............................................................................. $8,480,000 

Budget estimate, 2019 ........................................................................... 8,480,000 

Committee recommendation ................................................................. 8,480,000 

The Committee recommends $8,480,000 for the Medicaid and 

CHIP Payment and Access Commission [MACPAC]. This commission was established in the Children’s Health Insurance Program 

Reauthorization Act of 2009 and is tasked with reviewing State 

and Federal Medicaid and Children’s Health Insurance Program 

access and payment policies and making recommendations to Con-
221 

gress, the Secretary of HHS, and the States on a wide range of 

issues affecting those programs. The Committee recommendation 

will allow MACPAC to continue to carry out these activities. 

MEDICARE PAYMENT ADVISORY COMMISSION

SALARIES AND EXPENSES

Appropriations, 2018 ............................................................................. $12,545,000 

Budget estimate, 2019 ........................................................................... 12,545,000 

Committee recommendation ................................................................. 12,545,000 

The Committee recommends $12,545,000 for the Medicare Payment Advisory Commission [MedPAC], which provides independent 

policy and technical advice on issues affecting the Medicare program. 

NATIONAL COUNCIL ON DISABILITY

SALARIES AND EXPENSES

Appropriations, 2018 ............................................................................. $3,250,000 

Budget estimate, 2019 ........................................................................... 3,211,000 

Committee recommendation ................................................................. 3,250,000 

The Committee recommends $3,250,000 for the National Council 

on Disability [NCD]. NCD is mandated to make recommendations 

to the President, Congress, the Rehabilitation Services Administration, and the National Institute on Disability and Rehabilitation 

Research on issues of concern to individuals with disabilities. The 

Council gathers information on the implementation, effectiveness, 

and impact of the Americans with Disabilities Act and examines 

emerging policy issues as they affect persons with disabilities and 

their ability to enter or re-enter the Nation’s workforce and to live 

independently. 

NATIONAL LABOR RELATIONS BOARD

SALARIES AND EXPENSES

Appropriations, 2018 ............................................................................. $274,224,000 

Budget estimate, 2019 ........................................................................... 249,000,000 

Committee recommendation ................................................................. 274,224,000 

The Committee recommends $274,224,000 for the National Labor 

Relations Board, which administers and enforces the National 

Labor Relations Act and protects employee and employer rights 

provided under that act. 

ADMINISTRATIVE PROVISIONS

The Committee maintains language restricting the use of electronic voting (section 407). 

NATIONAL MEDIATION BOARD

SALARIES AND EXPENSES

Appropriations, 2018 ............................................................................. $13,800,000 

Budget estimate, 2019 ........................................................................... 13,205,000 

Committee recommendation ................................................................. 13,800,000 
222 

The Committee recommends $13,800,000 for the National Mediation Board [NMB], which mediates labor-management relations in 

the railroad and airline industries under the Railway Labor Act. 

The NMB mediates collective bargaining disputes, conducts elections to determine the choice of employee bargaining representatives, and administers arbitration of employee grievances. 

OCCUPATIONAL SAFETY AND HEALTH REVIEW COMMISSION

SALARIES AND EXPENSES

Appropriations, 2018 ............................................................................. $13,225,000 

Budget estimate, 2019 ........................................................................... 12,615,000 

Committee recommendation ................................................................. 13,225,000 

The Committee recommends $13,225,000 for the Occupational 

Safety and Health Review Commission [OSHRC]. OSHRC serves as 

a court to resolve disputes between OSHA and employers charged 

with violations of health and safety standards enforced by OSHA. 

RAILROAD RETIREMENT BOARD

The Railroad Retirement Board [RRB] administers the retirement/survivor and unemployment/sickness insurance benefit programs for railroad workers and their families under the Railroad 

Retirement Act and Railroad Unemployment Insurance Act. 

DUAL BENEFITS PAYMENTS ACCOUNT

Appropriations, 2018 ............................................................................. $22,000,000 

Budget estimate, 2019 ........................................................................... 19,000,000 

Committee recommendation ................................................................. 19,000,000 

The Committee recommends $19,000,000 for the Dual Benefits 

Payments Account. This amount includes an estimated $1,000,000 

derived from income taxes on vested dual benefits. This appropriation provides for vested dual benefit payments to beneficiaries covered under both the railroad retirement and Social Security systems. 

FEDERAL PAYMENTS TO THE RAILROAD RETIREMENT ACCOUNTS

Appropriations, 2018 ............................................................................. $150,000 

Budget estimate, 2019 ........................................................................... 150,000 

Committee recommendation ................................................................. 150,000 

The Committee recommends $150,000 for Federal Payments to 

the Railroad Retirement Account. These funds reimburse the railroad retirement trust funds for interest earned on non-negotiated 

checks. 

LIMITATION ON ADMINISTRATION

Appropriations, 2018 ............................................................................. $123,500,000 

Budget estimate, 2019 ........................................................................... 115,225,000 

Committee recommendation ................................................................. 123,500,000 

The Committee recommends $123,500,000 for RRB’s costs associated with the administration of railroad retirement/survivor and 

unemployment/sickness benefit programs. This account limits the 

amount of funds in the railroad retirement and railroad unemploy-
223 

ment insurance trust funds that may be used by the Board for administrative expenses. 

In fiscal year 2018, the Committee provided $10,000,000 within 

the Limitation on Administration account for the implementation 

of information technology systems modernization efforts. The Committee is again providing $10,000,000 in this fiscal year 2019 account for this purpose. The Committee looks forward to a comprehensive update on the project status, timelines to completion, 

and the total anticipated cost of development from the RRB and 

quarterly updates, beginning with the fiscal year 2018 reporting requirement, until project completion. 

The Committee maintains bill language giving RRB the authority to hire new attorneys in the excepted service. 

LIMITATION ON THE OFFICE OF THE INSPECTOR GENERAL

Appropriations, 2018 ............................................................................. $11,000,000 

Budget estimate, 2019 ........................................................................... 8,437,000 

Committee recommendation ................................................................. 11,000,000 

The Committee recommends $11,000,000 for the RRB OIG. This 

Office conducts audits and investigations to protect the integrity of 

the RRB trust funds and provides comprehensive oversight of all 

RRB operations and programs. 

SOCIAL SECURITY ADMINISTRATION

PAYMENTS TO SOCIAL SECURITY TRUST FUNDS

Appropriations, 2018 ............................................................................. $11,400,000 

Budget estimate, 2019 ........................................................................... 11,000,000 

Committee recommendation ................................................................. 11,000,000 

The Committee recommends $11,000,000 in mandatory funds for 

payments to Social Security trust funds. This account reimburses 

the Old Age and Survivors Insurance [OASI] and Disability Insurance [DI] trust funds for special payments to certain uninsured 

persons, costs incurred administering pension reform activities, and 

the value of the interest for benefit checks issued but not negotiated. This appropriation restores the trust funds to the same financial position they would have been in had they not borne these 

costs and they were properly charged to general revenues. 

SUPPLEMENTAL SECURITY INCOME PROGRAM

Appropriations, 2018 ............................................................................. $38,487,277,000 

Budget estimate, 2019 ........................................................................... 41,208,000,000 

Committee recommendation ................................................................. 41,390,721,000 

The Committee recommends $41,390,721,000 in fiscal year 2019 

mandatory funds for the SSI program. This is in addition to the 

$19,500,000,000 provided in the fiscal year 2018 appropriations act 

for the first quarter of fiscal year 2019. In addition, the Committee 

recommends $19,700,000,000 in advance funding for the first quarter of fiscal year 2020. The SSI program guarantees a minimum 

level of income to individuals who are disabled, blind, or older than 

age 65, and meet certain income and resource limitations. 
224 

Federal Benefit Payments 

The Committee recommendation includes a fiscal year 2019 program level of $55,716,000,000 for Federal benefit payments. This 

will support an average monthly benefit of approximately $577 for 

8,000,000 recipients. 

Beneficiary Services 

The Committee recommendation includes $126,000,000 in new 

mandatory budget authority for beneficiary services. 

These funds reimburse vocational rehabilitation [VR] agencies for 

successfully rehabilitating disabled SSI recipients by helping them 

achieve and sustain productive, self-supporting work activity. 

Funds also support the Ticket to Work program that provides SSI 

recipients with a ticket to offer employment networks [ENs], including VR agencies, in exchange for employment and support services. Instead of reimbursing ENs for specific services, the Ticket to 

Work program pays ENs based on recipients achieving certain 

milestones and outcomes. 

Research and Demonstration 

The Committee recommendation includes $101,000,000 in mandatory funds for research and demonstration projects conducted 

under sections 1110, 1115, and 1144 of the Social Security Act. 

These funds support a variety of research and demonstration 

projects designed to improve the disability process, promote selfsufficiency and assist individuals in returning to work, encourage 

savings and retirement planning through financial literacy, and 

generally provide analytical and data resources for use in preparing and reviewing policy proposals. 

Administrative Expenses 

The Committee recommendation includes $4,947,721,000 for SSI 

program administrative expenses. This appropriation funds the SSI 

program’s share of administrative expenses incurred through the 

Limitation on Administrative Expenses [LAE] account. 

LIMITATION ON ADMINISTRATIVE EXPENSES

Appropriations, 2018 ............................................................................. $12,868,945,000 

Budget estimate, 2019 ........................................................................... 12,387,000,000 

Committee recommendation ................................................................. 12,945,945,000 

This account provides resources for SSA to administer the OASI, 

DI, and SSI programs, and to support CMS in administering the 

Medicare program. The LAE account is funded by the Social Security and Medicare trust funds for their share of administrative expenses, the general fund for the SSI program’s share of administrative expenses, and applicable user fees. These funds support core 

administrative activities including processing retirement and disability claims, conducting hearings to review disability determination appeals, issuing Social Security numbers and cards, processing 

individuals’ annual earnings information, and ensuring the integrity of Social Security programs through continuing disability reviews [CDR] and SSI redeterminations of non-medical eligibility. 
225 

The Committee recommendation includes $1,683,000,000 for program integrity activities, including CDRs, SSI redeterminations of 

non-medical eligibility, and Cooperative Disability Investigations 

units. This includes $273,000,000 in base funding and 

$1,410,000,000 in cap adjustment funding allowed under the Budget Control Act [BCA]. The Committee recommendation is a 

$52,000,000 decrease from the fiscal year 2018 funding level, as 

specified in the BCA. Combined, these activities are estimated to 

save approximately $9,131,000,000 over 10 years for the Social Security, Medicare, and Medicaid programs by preventing waste, 

fraud, abuse, and improper payments. 

ABLE Act.—The Achieving a Better Life Experience Act [ABLE 

Act] allows individuals and families to save for the purpose of supporting individuals with disabilities in maintaining their health, 

independence, and quality of life. The Committee encourages SSA 

to continue to conduct outreach and disseminate eligibility and 

benefit information on ABLE accounts. In addition, the Committee 

supports efforts led by IRS and in coordination with SSA and other 

agencies to disseminate information on the eligibility and benefits 

of these accounts. The Committee further encourages SSA to build 

relationships with other agencies and government entities that 

support individuals living with a disability to raise awareness, understanding, and usage of ABLE accounts. 

Continuing Disability Reviews.—The Committee notes that SSA, 

as a result of directives included in the fiscal year 2017 Consolidated Appropriations Act, is in the process of reviewing and updating its CDR prioritization models. The Committee looks forward to 

an update on the results of this assessment in the next CDR Report to Congress. 

Consultative Examinations.—The Committee encourages SSA to 

evaluate the feasibility and potential administrative savings and 

program improvements from using competitively awarded multistate contracts for Consultative Exams [CEs]. Such contracts could 

standardize policies, and reduce overhead by requiring a vendor to 

manage scheduling, credentialing, recruitment and training of CEs, 

and provide certain quality assurances. The Committee encourages 

SSA to work with State Disability Determination Services to encourage them, to the extent practicable, to pilot such a contract. 

Disability Hearings Backlog.—The Committee recommendation 

includes $100,000,000, the same as the fiscal year 2018 level, in 

dedicated funding for processing the backlog of disability hearings. 

The Committee strongly encourages SSA to work with ALJs and 

other stakeholders to evaluate and implement changes, as appropriate, to streamline and improve the efficiency of the disability adjudication process while maintaining the integrity of disability programs. The Committee directs SSA to submit a report within 90 

days of enactment to the Committees on Appropriations of the 

House of Representatives and the Senate on potential administrative changes SSA has taken and could take to streamline the disability determination and adjudication process. This could include 

centralizing administrative work and reorganizing management 

structures to focus more staff on frontline workloads; reviewing the 

Hearings, Appeals, and Litigation Law Manual for changes to improve the efficiency or effectiveness of the hearing process; estab-
226 

lishing procedural rules for hearings (while preserving the non-adversarial manner of hearings and ensuring that unrepresented 

claimants are not disadvantaged); establishing a list of specialists 

and medical personnel which can be consulted by ALJs when they 

need access to medical experts; issuing Social Security Rulings that 

lists common combination of limitations for which work exists in 

the economy; and assigning law clerks or clerical employees to specific ALJs to reduce the number of clerical tasks that Judges are 

currently required to perform. 

Field Office Closures.—There remains concern about decisions to 

close field offices that may not be in accordance with law, regulations and SSA procedures. While the SSA’s Inspector General [IG] 

reviews decisions to close field offices, the Acting Commissioner is 

directed to take every action possible to maintain operations at the 

offices under review. SSA is directed to provide the Senate Appropriations Committee a response to IG field office reviews within 45 

days of the release of the IG report, addressing any recommendations and coordinating with the General Services Administration 

when appropriate. 

Medical Vocational Guidelines.—The Committee notes that SSA 

is in the process of updating its medical vocational guidelines, and 

in 2018 will complete the third year of production data collection, 

and begin collecting the first year of a planned and ongoing fiveyear refresh cycle. The Committee directs SSA to include information in future budget justifications on its ongoing efforts to improve 

its medical vocational guidelines. 

Muscular Dystrophy.—The Committee continues to note that 

SSA is included in the Muscular Dystrophy Coordinating Committee under the Muscular Dystrophy CARE Act and continues to 

expect SSA make data available on 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. 

Vocational Experts.—The Committee directs the Acting Commissioner to provide an update within 45 days of enactment on SSA’s 

plans for developing a market-based approach for acquiring vocational expert testimony, including the status of the report requested in the Explanatory Statement accompanying the Consolidated Appropriations Act, 2018. The update should address proposed scope and timeline for any planned solicitations. 

Social Security Advisory Board.—The Committee recommendation includes not less than $2,300,000 for the Social Security Advisory Board. This board advises the Commissioner of Social Security 

and makes recommendations to Congress and the President on 

policies relating to the OASI, DI, and SSI programs. 

User Fees.—Within the total for LAE, the Committee recommendation includes up to $135,000,000 for administrative activities funded from user fees. This includes up to $134,000,000 in fees 

collected from States that request SSA to administer State SSI 

supplementary payments and up to $1,000,000 from fees collected 

from non-attorney claimant representatives. 

Work Incentives Planning and Assistance [WIPA] and Protection 

and Advocacy for Beneficiaries of Social Security [PABSS].—The 

Committee recommendation includes $23,000,000 for WIPA and 
227 

$7,000,000 for PABSS, the same as the comparable fiscal year 2018 

levels, respectively. These programs provide valuable services to 

help Social Security disability beneficiaries return to work. 

OFFICE OF INSPECTOR GENERAL

Appropriations, 2018 ............................................................................. $105,500,000 

Budget estimate, 2019 ........................................................................... 105,500,000 

Committee recommendation ................................................................. 105,500,000 

The Committee recommends $105,500,000 for SSA’s OIG. This 

includes $75,500,000 funded from the OASI and DI trust funds for 

those programs’ share of OIG’s expenses and $30,000,000 funded 

from general revenues for the SSI program’s share of expenses. 
(228) 

TITLE V 

GENERAL PROVISIONS 

Section 501. The bill continues a provision authorizing transfers 

of unexpended balances. 

Section 502. The bill continues a provision limiting funding to 1- 

year availability unless otherwise specified. 

Section 503. The bill continues a provision limiting lobbying and 

related activities. 

Section 504. The bill continues a provision limiting official representation expenses. 

Section 505. The bill continues a provision clarifying Federal 

funding as a component of State and local grant funds. 

Sections 506 and 507. The bill continues provisions limiting the 

use of funds for abortion. 

Section 508. The bill continues a provision restricting human embryo research. 

Section 509. The bill continues a provision limiting the use of 

funds for promotion of legalization of controlled substances. 

Section 510. The bill continues a provision prohibiting the use of 

funds to promulgate regulations regarding the individual health 

identifier. 

Section 511. The bill continues a provision limiting the use of 

funds to enter into or review contracts with entities subject to the 

requirement in section 4212(d) of title 38, United States Code, if 

the report required by that section has not been submitted. 

Section 512. The bill continues a provision prohibiting the transfer of funds made available in this act to any department, agency, 

or instrumentality of the U.S. Government, except as otherwise 

provided by this or any other act. 

Section 513. The bill continues a provision prohibiting Federal 

funding in this act for libraries unless they are in compliance with 

the Children’s Internet Protection Act. 

Section 514. The bill continues a provision maintaining a procedure for reprogramming of funds. 

Section 515. The bill continues a provision prohibiting candidates 

for scientific advisory committees from having to disclose their political activities. 

Section 516. The bill continues a provision requiring each department and related agency to submit an operating plan. 

Section 517. The bill continues a provision requiring the Secretaries of Labor, Health and Human Services, and Education to submit a report on the number and amounts of contracts, grants, and 

cooperative agreements awarded by the Departments on a noncompetitive basis. 

Section 518. The bill continues a provision prohibiting SSA from 

processing earnings for work performed under a fraudulent social 
229 

security number if based on a conviction for a violation under section 208(a)(6) or (7) of the Social Security Act. 

Section 519. The bill continues a provision prohibiting SSA from 

establishing a totalization agreement with Mexico. 

Section 520. The bill continues a provision regarding funding for 

programs that carry out distribution of sterile needles or syringes. 

Section 521. The bill continues a provision requiring computer 

networks to block pornography. 

Section 522. The bill continues a provision prohibiting funding 

from going to the Association of Community Organizations for Reform Now [ACORN], or any of its affiliates, subsidiaries, allied organizations, or successors. 

Section 523. The bill continues a provision related to reporting 

requirements for conference spending. 

Section 524. The bill continues a provision related to advertisement costs. 

Section 525. The bill continues a provision on Performance Partnerships. 

Section 526. The bill modifies a provision regarding reporting 

status of balances of appropriations. 

Section 527. The bill modifies a provision rescinding funds from 

the Children’s Health Insurance Program State allotments. 

Section 528. The bill modifies a provision rescinding funds from 

the Children’s Health Insurance Program child enrollment contingency fund. 
(230) 

COMPLIANCE WITH PARAGRAPH 7, RULE XVI, OF THE 

STANDING RULES OF THE SENATE 

Paragraph 7 of rule XVI requires that Committee reports on general appropriations bills identify each Committee amendment to 

the House bill ‘‘which proposes an item of appropriation which is 

not made to carry out the provisions of an existing law, a treaty 

stipulation, or an act or resolution previously passed by the Senate 

during that session.’’ 

The Committee is filing an original bill, which is not covered 

under this rule, but reports this information in the spirit of full disclosure. 

The Committee recommends funding for the following programs 

and activities which currently lack authorization: Institute of Education Sciences; parts C and D of the Individuals with Disabilities 

Education Act; Nurse Education Loan Repayment; Education and 

Training Related to Geriatrics; Mental and Behavioral Health 

Training; Children’s Hospital Graduate Medical Education; Title 

XVII of the PHS Act; Ryan White CARE Act; Universal Newborn 

Hearing Screening; Organ Transplantation; Family Planning; 

Rural Health programs; Traumatic Brain Injury programs; Autism 

Collaboration, Accountability, Research, Education, and Support 

Act; Public Health Improvement Act; Healthy Start; Telehealth; 

Health Professions Education Partnership Act; Children’s Health 

Act; Women’s Health Research and Prevention Amendments of 

1998; Birth Defects Prevention, Preventive Health Amendments of 

1993; Substance Abuse and Mental Health Services programs; Low 

Income Home Energy Assistance Program; Refugee and Entrant 

Assistance programs (except for Victims of Trafficking); Head Start; 

Runaway and Homeless Youth programs; Adoption Incentives; Developmental Disabilities programs; Voting Access for Individuals 

with Disabilities; Native American Programs; Community Services 

Block Grant Act programs; National Institutes of Health; Assets for 

Independence; Alzheimer’s Disease Demonstration Grants; Office of 

Disease Prevention and Health Promotion; YouthBuild Transfer 

Act; Assistive Technology Act; Carl D. Perkins Career and Technical Education Improvement Act; Corporation for Public Broadcasting; National Council on Disability; Older Americans Act; Second Chance Act; Work Incentive Planning and Assistance; and Protection and Advocacy for Beneficiaries of Social Security. 
231 

COMPLIANCE WITH PARAGRAPH 7(C), RULE XXVI OF THE 

STANDING RULES OF THE SENATE 

Pursuant to paragraph 7(c) of rule XXVI, on June 28, 2018, the 

Committee ordered favorably reported an original bill (S. 3158) 

making appropriations for the Departments of Labor, Health and 

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

year ending September 30, 2019, and for other purposes, provided, 

that the bill be subject to amendment and that the bill be consistent with its budget allocation, and provided that the Chairman 

of the Committee or his designee be authorized to offer the substance of the original bill as a Committee amendment in the nature 

of a substitute to the House companion measure, by a recorded vote 

of 30–1, a quorum being present. The vote was as follows: 

Yeas Nays 

Chairman Shelby Mr. Lankford 

Mr. McConnell 

Mr. Alexander 

Ms. Collins 

Ms. Murkowski 

Mr. Graham 

Mr. Blunt 

Mr. Moran 

Mr. Hoeven 

Mr. Boozman 

Mrs. Capito 

Mr. Daines 

Mr. Kennedy 

Mr. Rubio 

Mrs. Hyde-Smith 

Mr. Leahy 

Mrs. Murray 

Mrs. Feinstein 

Mr. Durbin 

Mr. Reed 

Mr. Tester 

Mr. Udall 

Mrs. Shaheen 

Mr. Merkley 

Mr. Coons 

Mr. Schatz 

Ms. Baldwin 

Mr. Murphy 

Mr. Manchin 

Mr. Van Hollen 
232 

COMPLIANCE WITH PARAGRAPH 12, RULE XXVI OF THE 

STANDING RULES OF THE SENATE 

Paragraph 12 of rule XXVI requires that Committee reports on 

a bill or a joint resolution repealing or amending any statute include ‘‘(a) the text of the statute or part thereof which is proposed 

to be repealed; and (b) a comparative print of that part of the bill 

or joint resolution making the amendment and of the statute or 

part thereof proposed to be amended, showing by stricken through 

type and italics, parallel columns, or other appropriate typographical devices the omissions and insertions which would be 

made by the bill or joint resolution if enacted in the form recommended by the committee.’’ 

In compliance with this rule, changes in existing law proposed to 

be made by the bill are shown as follows: existing law to be omitted 

is enclosed in black brackets; new matter is printed in italic; and 

existing law in which no change is proposed is shown in roman. 

TITLE 20—EDUCATION 

CHAPTER 28—HIGHER EDUCATION RESOURCES AND 

STUDENT ASSISTANCE 

SUBCHAPTER I—GENERAL PROVISIONS 

PART B—ADDITIONAL GENERAL PROVISIONS

§ 1011c. National Advisory Committee on Institutional Quality and Integrity 

(a) Establishment 

* * * * * * * 

(f) Termination 

The Committee shall terminate on September 30, ø2018¿ 2019. 

* * * * * * * 

SUBCHAPTER IV—STUDENT ASSISTANCE 

PART A—GRANTS TO STUDENTS IN ATTENDANCE AT INSTITUTIONS OF

HIGHER EDUCATION

SUBPART 1—FEDERAL PELL GRANTS

§ 1070a. Federal Pell Grants: amount and determinations; 

applications 

(a) Program authority and method of distribution 

* * * * * * * 

(b) Purpose and amount of grants 

(1) * * * 

(7) ADDITIONAL FUNDS.— 

(A) IN GENERAL.—* * * 

(i) * * * 

* * * * * * * 

(iv) to carry out this section— 
233 

(I) * * * 

* * * * * * * 

(IX) ø$1,409,000,000¿ $1,370,000,000 for fiscal 

year 2019; 

* * * * * * * 

PART C—WILLIAM D. FORD FEDERAL DIRECT LOAN PROGRAM

§ 1087h. Funds for administrative expenses 

(a) Program authority and method of distribution 

(1) Mandatory funds for fiscal year 2006 

* * * * * * * 

(4) Continuing mandatory funds for account maintenance 

fees 

For each of the fiscal years 2007 through ø2018¿ 2019, 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). 

BUDGETARY IMPACT OF BILL 

PREPARED IN CONSULTATION WITH THE CONGRESSIONAL BUDGET OFFICE PURSUANT TO SEC. 

308(A), PUBLIC LAW 93–344, AS AMENDED 

[In millions of dollars] 

Budget authority Outlays 

Committee 

allocation 

Amount 

in bill 

Committee 

allocation 

Amount 

in bill 

Comparison of amounts in the bill with the subcommittee allocation for 2019: Subcommittee on Labor, HHS, Education, 

and Related Agencies: 

Mandatory ............................................................................ 783,118 783,118 782,757 1 782,757 

Discretionary ........................................................................ 179,289 181,186 184,249 1 185,822 

Security ....................................................................... .................... .................... NA NA 

Nonsecurity ................................................................. 179,289 181,186 NA NA 

Projections of outlays associated with the recommendation: 

2019 ..................................................................................... .................... .................... .................... 2 859,720 

2020 ..................................................................................... .................... .................... .................... 81,262 

2021 ..................................................................................... .................... .................... .................... 22,003 

2022 ..................................................................................... .................... .................... .................... 3,714 

2023 and future years ........................................................ .................... .................... .................... 1,272 

Financial assistance to State and local governments for 

2019 ......................................................................................... NA 482,130 NA 2 434,966 

1 Includes outlays from prior-year budget authority. 

2 Excludes outlays from prior-year budget authority. 

NA: Not applicable. 

NOTE.—Consistent with the funding recommended in the bill for continuing disability reviews and redeterminations, for healthcare fraud and abuse control, and for reemployment services and eligibility assessments and in accordance with subparagraphs (B), (C), and (E) of section 251(b)(2) of the BBEDCA of 1985, the Committee anticipates that the Budget Committee will provide, at the appropriate time, a 302(a) 

allocation for the Committee on Appropriations reflecting an upward adjustment of $1,897,000,000 in budget authority plus associated out- lays. Also, pursuant to section 1001(b)(3)(B) of the 21st Century Cures Act (Public Law 114–255), $711,000,000 in budget authority and the 

resulting outlays do not count for the purposes of estimates under the Congressional Budget and Impoundment Control Act of 1974 or the Balanced Budget and Emergency Deficit Control Act of 1985. 
234 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2018 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2019 

[In thousands of dollars] 

Item 2018 appropriation Budget estimate Committee recommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2018 appropriation Budget estimate 

TITLE I—DEPARTMENT OF LABOR 

EMPLOYMENT AND TRAINING ADMINISTRATION 

Training and Employment Services 

Grants to States: 

Adult Training, current year .............................................................................................................................. 133,556 103,556 133,556 ............................ ∂30,000 

Advance from prior year ........................................................................................................................... (712,000 ) (712,000 ) (712,000 ) ............................ ............................Fiscal year 2020 ....................................................................................................................................... 712,000 712,000 712,000 ............................ ............................

Subtotal ................................................................................................................................................ 845,556 815,556 845,556 ............................ ∂30,000 

Youth Training ................................................................................................................................................... 903,416 873,416 903,416 ............................ ∂30,000 Dislocated Worker Assistance, current year ...................................................................................................... 180,860 160,860 180,860 ............................ ∂20,000 

Advance from prior year ........................................................................................................................... (860,000 ) (860,000 ) (860,000 ) ............................ ............................Fiscal year 2020 ....................................................................................................................................... 860,000 860,000 860,000 ............................ ............................

Subtotal ................................................................................................................................................ 1,040,860 1,020,860 1,040,860 ............................ ∂20,000 

Subtotal, Grants to States ............................................................................................................................ 2,789,832 2,709,832 2,789,832 ............................ ∂80,000 

Current year ..................................................................................................................................... (1,217,832 ) (1,137,832 ) (1,217,832 ) ............................ (∂80,000 ) Fiscal year 2020 .............................................................................................................................. (1,572,000 ) (1,572,000 ) (1,572,000 ) ............................ ............................

National Programs: 

Dislocated Worker Assistance National Reserve: 

Current year .............................................................................................................................................. 20,859 20,859 20,859 ............................ ............................Advance from prior year ........................................................................................................................... (200,000 ) (200,000 ) (200,000 ) ............................ ............................Fiscal year 2020 ....................................................................................................................................... 200,000 125,000 200,000 ............................ ∂75,000 

Subtotal ................................................................................................................................................ 220,859 145,859 220,859 ............................ ∂75,000 

Subtotal, Dislocated Worker Assistance ....................................................................................................... 1,261,719 1,166,719 1,261,719 ............................ ∂95,000 
235 

Native American programs ................................................................................................................................ 54,000 ............................ 54,000 ............................ ∂54,000 Migrant and Seasonal Farmworker programs ................................................................................................... 87,896 ............................ 87,896 ............................ ∂87,896 YouthBuild activities ......................................................................................................................................... 89,534 84,534 89,534 ............................ ∂5,000 Technical assistance ......................................................................................................................................... ............................ 2,000 ............................ ............................ ¥2,000 Reintegration of Ex-Offenders ........................................................................................................................... 93,079 78,324 93,079 ............................ ∂14,755 Workforce Data Quality Initiative ...................................................................................................................... 6,000 ............................ 6,000 ............................ ∂6,000 Apprenticeship programs .................................................................................................................................. 145,000 200,000 160,000 ∂15,000 ¥40,000 

Total, National Programs .............................................................................................................................. 696,368 510,717 711,368 ∂15,000 ∂200,651 

Current year ......................................................................................................................................... (496,368 ) (385,717 ) (511,368 ) (∂15,000 ) (∂125,651 ) Fiscal year 2020 .................................................................................................................................. (200,000 ) (125,000 ) (200,000 ) ............................ (∂75,000 ) 

Total, Training and Employment Services [TES] .......................................................................................... 3,486,200 3,220,549 3,501,200 ∂15,000 ∂280,651 

Current year ......................................................................................................................................... (1,714,200 ) (1,523,549 ) (1,729,200 ) (∂15,000 ) (∂205,651 ) Fiscal year 2020 .................................................................................................................................. (1,772,000 ) (1,697,000 ) (1,772,000 ) ............................ (∂75,000 ) 

Job Corps 

Operations .................................................................................................................................................................. 1,603,325 1,189,812 1,603,325 ............................ ∂413,513 Construction, Rehabilitation and Acquisition ............................................................................................................ 83,000 75,016 83,000 ............................ ∂7,984 Administration ............................................................................................................................................................ 32,330 32,110 32,330 ............................ ∂220 

Total, Job Corps ............................................................................................................................................ 1,718,655 1,296,938 1,718,655 ............................ ∂421,717 

Current Year ......................................................................................................................................... (1,718,655 ) (1,296,938 ) (1,718,655 ) ............................ (∂421,717 ) 

Community Service Employment For Older Americans .............................................................................................. 400,000 ............................ 400,000 ............................ ∂400,000 Federal Unemployment Benefits and Allowances (indefinite) ................................................................................... 790,000 790,000 790,000 ............................ ............................

State Unemployment Insurance and Employment Service Operations 

Unemployment Compensation [UI]: 

State Operations ................................................................................................................................................ 2,510,600 2,356,816 2,356,816 ¥153,784 ............................Reemployment eligibility assessments—UI integrity ....................................................................................... 120,000 130,000 150,000 ∂30,000 ∂20,000 UI Integrity Center of Excellence ....................................................................................................................... 9,000 6,000 9,000 ............................ ∂3,000 

Subtotal, Unemployment Compensation ....................................................................................................... 2,639,600 2,492,816 2,515,816 ¥123,784 ∂23,000 

Federal–State UI National Activities ................................................................................................................. 13,897 12,000 12,000 ¥1,897 ............................
236 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2018 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2019—Continued 

[In thousands of dollars] 

Item 2018 appropriation Budget estimate Committee recommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2018 appropriation Budget estimate 

Employment Service [ES]: 

Grants to States: 

Federal Funds ........................................................................................................................................... 21,413 21,413 21,413 ............................ ............................Trust Funds .............................................................................................................................................. 645,000 650,000 645,000 ............................ ¥5,000 

Subtotal, Grants to States ................................................................................................................... 666,413 671,413 666,413 ............................ ¥5,000 

ES National Activities ........................................................................................................................................ 19,818 19,683 19,818 ............................ ∂135 

Subtotal, Employment Service ...................................................................................................................... 686,231 691,096 686,231 ............................ ¥4,865 

Federal Funds ......................................................................................................................... (21,413 ) (21,413 ) (21,413 ) ............................ ............................Trust Funds ............................................................................................................................ (664,818 ) (669,683 ) (664,818 ) ............................ (¥4,865 ) 

Foreign Labor Certifications and Related Activities: 

Federal Administration ...................................................................................................................................... 48,028 47,937 48,028 ............................ ∂91 Grants to States ................................................................................................................................................ 14,282 14,255 14,282 ............................ ∂27 

Subtotal, Foreign Labor Certification ........................................................................................................... 62,310 62,192 62,310 ............................ ∂118 

One-Stop Career Centers/Labor Market Information .................................................................................................. 62,653 67,194 62,653 ............................ ¥4,541 

Total, State UI and ES .................................................................................................................................. 3,464,691 3,325,298 3,339,010 ¥125,681 ∂13,712 

Federal Funds ...................................................................................................................................... (84,066 ) (88,607 ) (84,066 ) ............................ (¥4,541 ) Trust Funds .......................................................................................................................................... (3,380,625 ) (3,236,691 ) (3,254,944 ) (¥125,681 ) (∂18,253 ) 

Program Administration 

Training and Employment .......................................................................................................................................... 62,040 59,744 62,040 ............................ ∂2,296 

Trust Funds ....................................................................................................................................................... 8,639 8,580 8,639 ............................ ∂59 

Employment Security .................................................................................................................................................. 3,440 2,184 3,440 ............................ ∂1,256 

Trust Funds ....................................................................................................................................................... 39,264 38,997 39,264 ............................ ∂267 

Apprenticeship Services ............................................................................................................................................. 36,160 35,914 36,160 ............................ ∂246 
237 

Executive Direction ..................................................................................................................................................... 7,034 6,781 7,034 ............................ ∂253 

Trust Funds ....................................................................................................................................................... 2,079 2,065 2,079 ............................ ∂14 

Total, Program Administration ...................................................................................................................... 158,656 154,265 158,656 ............................ ∂4,391 

Federal Funds ...................................................................................................................................... (108,674 ) (104,623 ) (108,674 ) ............................ (∂4,051 ) Trust Funds .......................................................................................................................................... (49,982 ) (49,642 ) (49,982 ) ............................ (∂340 ) 

Total, Employment and Training Administration .......................................................................................... 10,018,202 8,787,050 9,907,521 ¥110,681 ∂1,120,471 

Federal Funds ...................................................................................................................................... 6,587,595 5,500,717 6,602,595 ∂15,000 ∂1,101,878 

Current year ............................................................................................................................ (4,815,595 ) (3,803,717 ) (4,830,595 ) (∂15,000 ) (∂1,026,878 ) Fiscal year 2020 ..................................................................................................................... (1,772,000 ) (1,697,000 ) (1,772,000 ) ............................ (∂75,000 ) 

Trust Funds .......................................................................................................................................... 3,430,607 3,286,333 3,304,926 ¥125,681 ∂18,593 

EMPLOYEE BENEFITS SECURITY ADMINISTRATION [EBSA] 

Salaries and Expenses 

Enforcement and Participant Assistance ................................................................................................................... 147,400 154,813 152,900 ∂5,500 ¥1,913 Policy and Compliance Assistance ............................................................................................................................ 26,901 28,033 26,901 ............................ ¥1,132 Executive Leadership, Program Oversight and Administration ................................................................................. 6,699 6,654 6,699 ............................ ∂45 

Total, EBSA ................................................................................................................................................... 181,000 189,500 186,500 ∂5,500 ¥3,000 

PENSION BENEFIT GUARANTY CORPORATION (PBGC) 

Pension Benefit Guaranty Corporation Fund 

Consolidated Administrative budget .......................................................................................................................... (424,417 ) (445,363 ) (445,363 ) (∂20,946 ) ............................WAGE AND HOUR DIVISION, Salaries and Expenses .................................................................................................. 227,500 230,068 229,000 ∂1,500 ¥1,068 OFFICE OF LABOR–MANAGEMENT STANDARDS, Salaries and Expenses .................................................................... 40,187 46,634 40,187 ............................ ¥6,447 OFFICE OF FEDERAL CONTRACT COMPLIANCE PROGRAMS, Salaries and Expenses ................................................. 103,476 91,100 103,476 ............................ ∂12,376 

OFFICE OF WORKERS’ COMPENSATION PROGRAMS 

Salaries and Expenses ............................................................................................................................................... 115,424 113,109 115,424 ............................ ∂2,315 

Trust Funds ....................................................................................................................................................... 2,177 2,173 2,177 ............................ ∂4 

Total, Salaries and Expenses ....................................................................................................................... 117,601 115,282 117,601 ............................ ∂2,319 

Federal Funds ...................................................................................................................................... (115,424 ) (113,109 ) (115,424 ) ............................ (∂2,315 ) Trust Funds .......................................................................................................................................... (2,177 ) (2,173 ) (2,177 ) ............................ (∂4 ) 
238 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2018 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2019—Continued 

[In thousands of dollars] 

Item 2018 appropriation Budget estimate Committee recommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2018 appropriation Budget estimate 

Special Benefits 

Federal Employees’ Compensation Benefits .............................................................................................................. 217,000 227,000 227,000 ∂10,000 ............................Longshore and Harbor Workers’ Benefits ................................................................................................................... 3,000 3,000 3,000 ............................ ............................

Total, Special Benefits .................................................................................................................................. 220,000 230,000 230,000 ∂10,000 ............................

Special Benefits for Disabled Coal Miners 

Benefit Payments ....................................................................................................................................................... 65,000 20,000 20,000 ¥45,000 ............................Administration ............................................................................................................................................................ 5,319 5,319 5,319 ............................ ............................

Subtotal, Fiscal year 2019 program level .................................................................................................... 70,319 25,319 25,319 ¥45,000 ............................

Less funds advanced in prior year .......................................................................................................... ¥16,000 ¥15,000 ¥15,000 ∂1,000 ............................

Total, Current Year .............................................................................................................................. 54,319 10,319 10,319 ¥44,000 ............................

New advances, 1st quarter, fiscal year 2020 ................................................................................ 15,000 14,000 14,000 ¥1,000 ............................

Total, Special Benefits for Disabled Coal Miners ........................................................................................ 69,319 24,319 24,319 ¥45,000 ............................

Administrative Expenses, Energy Employees Occupational Illness Compensation Fund 

Administrative Expenses ............................................................................................................................................ 59,846 59,098 59,098 ¥748 ............................

Black Lung Disability Trust Fund 

Benefit Payments and Interest on Advances ............................................................................................................. 345,635 257,256 257,256 ¥88,379 ............................Workers’ Compensation Programs, Salaries and Expenses ....................................................................................... 38,246 38,246 38,246 ............................ ............................Departmental Management, Salaries and Expenses ................................................................................................. 31,994 31,994 31,994 ............................ ............................Departmental Management, Inspector General ......................................................................................................... 330 330 330 ............................ ............................

Subtotal, Black Lung Disability .................................................................................................................... 416,205 327,826 327,826 ¥88,379 ............................
239 

Treasury Department Administrative Costs ............................................................................................................... 356 356 356 ............................ ............................

Total, Black Lung Disability Trust Fund ....................................................................................................... 416,561 328,182 328,182 ¥88,379 ............................Total, Workers’ Compensation Programs ...................................................................................................... 883,327 756,881 759,200 ¥124,127 ∂2,319 

Federal Funds ........................................................................................................................................... 881,150 754,708 757,023 ¥124,127 ∂2,315 

Current year ......................................................................................................................................... (866,150 ) (740,708 ) (743,023 ) (¥123,127 ) (∂2,315 ) Fiscal year 2020 .................................................................................................................................. (15,000 ) (14,000 ) (14,000 ) (¥1,000 ) ............................

Trust Funds ................................................................................................................................................... 2,177 2,173 2,177 ............................ ∂4 

OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION (OSHA) 

Salaries and Expenses 

Safety and Health Standards ..................................................................................................................................... 18,000 17,878 18,000 ............................ ∂122 Federal Enforcement ................................................................................................................................................... 208,000 212,735 210,000 ∂2,000 ¥2,735 Whistleblower enforcement ......................................................................................................................................... 17,500 17,381 17,500 ............................ ∂119 State Programs ........................................................................................................................................................... 100,850 100,165 102,850 ∂2,000 ∂2,685 Technical Support ....................................................................................................................................................... 24,469 23,766 24,469 ............................ ∂703 Compliance Assistance: 

Federal Assistance ............................................................................................................................................ 70,981 75,619 70,981 ............................ ¥4,638 State Consultation Grants ................................................................................................................................. 59,500 59,096 59,500 ............................ ∂404 Training Grants ................................................................................................................................................. 10,537 ............................ 10,537 ............................ ∂10,537 

Subtotal, Compliance Assistance ................................................................................................................. 141,018 134,715 141,018 ............................ ∂6,303 

Safety and Health Statistics ...................................................................................................................................... 32,900 32,677 32,900 ............................ ∂223 Executive Direction and Administration ..................................................................................................................... 10,050 9,716 10,050 ............................ ∂334 

Total, OSHA ................................................................................................................................................... 552,787 549,033 556,787 ∂4,000 ∂7,754 

MINE SAFETY AND HEALTH ADMINISTRATION 

Salaries and Expenses 

Coal Enforcement ....................................................................................................................................................... 160,000 156,136 160,000 ............................ ∂3,864 Metal/Non-Metal Enforcement .................................................................................................................................... 94,500 96,975 94,500 ............................ ¥2,475 Standards Development ............................................................................................................................................. 4,500 5,345 4,500 ............................ ¥845 Assessments ............................................................................................................................................................... 6,627 7,394 6,627 ............................ ¥767 Educational Policy and Development ......................................................................................................................... 39,320 38,297 39,320 ............................ ∂1,023 Technical Support ....................................................................................................................................................... 35,041 33,848 35,041 ............................ ∂1,193 Program Evaluation and Information Resources [PEIR] ............................................................................................ 17,990 21,953 17,990 ............................ ¥3,963 
240 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2018 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2019—Continued 

[In thousands of dollars] 

Item 2018 appropriation Budget estimate Committee recommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2018 appropriation Budget estimate 

Program Administration ............................................................................................................................................. 15,838 15,958 15,838 ............................ ¥120 

Total, Mine Safety and Health Administration ............................................................................................. 373,816 375,906 373,816 ............................ ¥2,090 Total, Worker Protection Agencies ................................................................................................................ 1,596,367 1,597,523 1,607,367 ∂11,000 ∂9,844 

Federal Funds ........................................................................................................................................... (1,594,190 ) (1,595,350 ) (1,605,190 ) (∂11,000 ) (∂9,840 ) Trust Funds .............................................................................................................................................. (2,177 ) (2,173 ) (2,177 ) ............................ (∂4 ) 

BUREAU OF LABOR STATISTICS 

Salaries and Expenses 

Employment and Unemployment Statistics ............................................................................................................... 209,000 209,398 212,000 ∂3,000 ∂2,602 Labor Market Information ........................................................................................................................................... 65,000 64,559 65,000 ............................ ∂441 Prices and Cost of Living .......................................................................................................................................... 209,000 207,235 209,000 ............................ ∂1,765 Compensation and Working Conditions ..................................................................................................................... 83,500 80,947 83,500 ............................ ∂2,553 Productivity and Technology ....................................................................................................................................... 10,500 10,622 10,500 ............................ ¥122 Executive Direction and Staff Services ...................................................................................................................... 35,000 36,625 35,000 ............................ ¥1,625 

Total, Bureau of Labor Statistics ................................................................................................................. 612,000 609,386 615,000 ∂3,000 ∂5,614 

Federal Funds ...................................................................................................................................... 547,000 544,827 550,000 ∂3,000 ∂5,173 Trust Funds .......................................................................................................................................... 65,000 64,559 65,000 ............................ ∂441 

OFFICE OF DISABILITY EMPLOYMENT POLICY 

Salaries and Expenses ............................................................................................................................................... 38,203 27,000 38,203 ............................ ∂11,203 

DEPARTMENTAL MANAGEMENT 

Salaries and Expenses 

Executive Direction ..................................................................................................................................................... 30,250 30,045 30,250 ............................ ∂205 Departmental Program Evaluation ............................................................................................................................. 8,040 7,985 8,040 ............................ ∂55 
241 

Legal Services ............................................................................................................................................................ 123,745 124,644 123,745 ............................ ¥899 

Trust Funds ....................................................................................................................................................... 308 306 308 ............................ ∂2 

International Labor Affairs ......................................................................................................................................... 86,125 18,500 86,125 ............................ ∂67,625 Administration and Management ............................................................................................................................... 23,534 23,808 23,534 ............................ ¥274 Adjudication ................................................................................................................................................................ 35,000 35,462 35,000 ............................ ¥462 Women’s Bureau ......................................................................................................................................................... 13,530 3,525 13,530 ............................ ∂10,005 Civil Rights Activities ................................................................................................................................................. 6,880 6,833 6,880 ............................ ∂47 Chief Financial Officer ............................................................................................................................................... 10,432 9,927 10,432 ............................ ∂505 

Total, Departmental Management Salaries and expenses ........................................................................... 337,844 261,035 337,844 ............................ ∂76,809 

Federal Funds ...................................................................................................................................... (337,536 ) (260,729 ) (337,536 ) ............................ (∂76,807 ) Trust Funds .......................................................................................................................................... (308 ) (306 ) (308 ) ............................ (∂2 ) 

Veterans Employment and Training 

State Administration, Grants ..................................................................................................................................... 180,000 173,812 180,000 ............................ ∂6,188 Transition Assistance Program .................................................................................................................................. 19,500 16,950 24,500 ∂5,000 ∂7,550 Federal Administration ............................................................................................................................................... 42,127 42,748 42,127 ............................ ¥621 National Veterans’ Employment and Training Services Institute .............................................................................. 3,414 3,391 3,414 ............................ ∂23 Homeless Veterans Programs ..................................................................................................................................... 50,000 44,694 50,000 ............................ ∂5,306 

Total, Veterans Employment and Training ................................................................................................... 295,041 281,595 300,041 ∂5,000 ∂18,446 

Federal Funds ...................................................................................................................................... 50,000 44,694 50,000 ............................ ∂5,306 Trust Funds .......................................................................................................................................... 245,041 236,901 250,041 ∂5,000 ∂13,140 

IT Modernization 

Departmental support systems .................................................................................................................................. 4,889 ............................ 4,889 ............................ ∂4,889 Infrastructure technology modernization .................................................................................................................... 15,880 ............................ 15,880 ............................ ∂15,880 

Total, IT Modernization ................................................................................................................................. 20,769 ............................ 20,769 ............................ ∂20,769 

Office of Inspector General 

Program Activities ...................................................................................................................................................... 83,487 82,061 83,487 ............................ ∂1,426 

Trust Funds ....................................................................................................................................................... 5,660 5,660 5,660 ............................ ............................

Total, Office of Inspector General ................................................................................................................ 89,147 87,721 89,147 ............................ ∂1,426 Total, Departmental Management ................................................................................................................ 742,801 630,351 747,801 ∂5,000 ∂117,450 
242 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2018 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2019—Continued 

[In thousands of dollars] 

Item 2018 appropriation Budget estimate Committee recommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2018 appropriation Budget estimate 

Federal Funds ...................................................................................................................................... 491,792 387,484 491,792 ............................ ∂104,308 

Current year ..................................................................................................................................... (491,792 ) (387,484 ) (491,792 ) ............................ (∂104,308 ) 

Trust Funds .......................................................................................................................................... 251,009 242,867 256,009 ∂5,000 ∂13,142 

Total, Workforce Investment Act Programs .................................................................................................. 5,204,855 4,517,487 5,219,855 ∂15,000 ∂702,368 

Current year ......................................................................................................................................... (3,432,855 ) (2,820,487 ) (3,447,855 ) (∂15,000 ) (∂627,368 ) Fiscal year 2020 .................................................................................................................................. (1,772,000 ) (1,697,000 ) (1,772,000 ) ............................ (∂75,000 ) 

Total, Title I, Department of Labor ............................................................................................................... 13,773,299 12,292,909 13,557,491 ¥215,808 ∂1,264,582 

Federal Funds ...................................................................................................................................... 10,024,506 8,696,977 9,929,379 ¥95,127 ∂1,232,402 

Current year ............................................................................................................................ (8,237,506 ) (6,985,977 ) (8,143,379 ) (¥94,127 ) (∂1,157,402 ) Fiscal year 2020 ..................................................................................................................... (1,787,000 ) (1,711,000 ) (1,786,000 ) (¥1,000 ) (∂75,000 ) 

Trust Funds .......................................................................................................................................... 3,748,793 3,595,932 3,628,112 ¥120,681 ∂32,180 

TITLE II—DEPARTMENT OF HEALTH AND HUMAN SERVICES 

HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) 

Primary Health Care 

Community Health Centers ........................................................................................................................................ 1,625,522 4,990,629 1,625,522 ............................ ¥3,365,107 Health CenterTort Claims ........................................................................................................................................... ............................ 99,893 ............................ ............................ ¥99,893 Free Clinics Medical Malpractice ............................................................................................................................... 1,000 1,000 1,000 ............................ ............................

Total, Primary Health Care ........................................................................................................................... 1,626,522 5,091,522 1,626,522 ............................ ¥3,465,000 

Health Workforce 

National Health Service Corps ................................................................................................................................... 105,000 310,000 105,000 ............................ ¥205,000 Training for Diversity: 

Centers of Excellence ........................................................................................................................................ 23,711 ............................ 23,711 ............................ ∂23,711 Health Careers Opportunity Program ................................................................................................................ 14,189 ............................ 14,189 ............................ ∂14,189 
243 

Faculty Loan Repayment ................................................................................................................................... 1,190 ............................ 1,190 ............................ ∂1,190 Scholarships for Disadvantaged Students ........................................................................................................ 48,970 ............................ 48,970 ............................ ∂48,970 

Total, Training for Diversity .......................................................................................................................... 88,060 ............................ 88,060 ............................ ∂88,060 

Primary Care Training and Enhancement .................................................................................................................. 48,924 ............................ 48,924 ............................ ∂48,924 Oral Health Training ................................................................................................................................................... 40,673 ............................ 40,673 ............................ ∂40,673 Interdisciplinary Community-Based Linkages: 

Area Health Education Centers ......................................................................................................................... 38,250 ............................ 40,250 ∂2,000 ∂40,250 Geriatric Programs ............................................................................................................................................ 40,737 ............................ 40,737 ............................ ∂40,737 Mental and Behavorial Health .......................................................................................................................... 36,916 ............................ 36,916 ............................ ∂36,916 Behavioral Health Workforce Education and Training ...................................................................................... 75,000 ............................ 75,000 ............................ ∂75,000 

Total, Interdisciplinary Community Linkages ............................................................................................... 190,903 ............................ 192,903 ∂2,000 ∂192,903 

Workforce Assessment ................................................................................................................................................ 5,663 4,663 5,663 ............................ ∂1,000 Public Health and Preventive Medicine programs ..................................................................................................... 17,000 ............................ 17,000 ............................ ∂17,000 Nursing Programs: 

Advanced Education Nursing ............................................................................................................................ 74,581 ............................ 74,581 ............................ ∂74,581 Nurse Education, Practice, and Retention ........................................................................................................ 41,913 ............................ 41,913 ............................ ∂41,913 Nursing Workforce Diversity .............................................................................................................................. 17,343 ............................ 17,343 ............................ ∂17,343 Nursing Corps Scholarship and Loan Repayment Program ............................................................................. 87,135 83,135 87,135 ............................ ∂4,000 Nursing Faculty Loan Program .......................................................................................................................... 28,500 ............................ 28,500 ............................ ∂28,500 

Total, Nursing programs ............................................................................................................................... 249,472 83,135 249,472 ............................ ∂166,337 

Children’s Hospitals Graduate Medical Education .................................................................................................... 315,000 ............................ 325,000 ∂10,000 ∂325,000 Teaching Health Center, Graduate Medical Education .............................................................................................. ............................ 60,000 ............................ ............................ ¥60,000 National Practitioner Data Bank ................................................................................................................................ 18,814 18,814 18,814 ............................ ............................

User Fees ........................................................................................................................................................... ¥18,814 ¥18,814 ¥18,814 ............................ ............................

Total, Health Workforce ................................................................................................................................. 1,060,695 457,798 1,072,695 ∂12,000 ∂614,897 

Maternal and Child Health 

Maternal and Child Health Block Grant .................................................................................................................... 651,700 627,700 677,700 ∂26,000 ∂50,000 Sickle Cell Anemia Demonstration Program .............................................................................................................. 4,455 ............................ 4,455 ............................ ∂4,455 Autism and Other Developmental Disabilities ........................................................................................................... 49,099 ............................ 49,099 ............................ ∂49,099 Heritable Disorders in Newborns and Children ......................................................................................................... 15,883 ............................ 15,883 ............................ ∂15,883 
244 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2018 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2019—Continued 

[In thousands of dollars] 

Item 2018 appropriation Budget estimate Committee recommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2018 appropriation Budget estimate 

Family-to-Family Health Information Centers ............................................................................................................ ............................ 5,000 ............................ ............................ ¥5,000 Maternal, Infant and Early Childhood Home Visiting Program ................................................................................. ............................ 400,000 ............................ ............................ ¥400,000 Healthy Start .............................................................................................................................................................. 110,500 103,500 122,500 ∂12,000 ∂19,000 Universal Newborn Hearing Screening ....................................................................................................................... 17,818 ............................ 17,818 ............................ ∂17,818 Emergency Medical Services for Children .................................................................................................................. 22,334 ............................ 22,334 ............................ ∂22,334 Screening and treatment for maternal depression ................................................................................................... 5,000 ............................ 5,000 ............................ ∂5,000 Pediatric Mental Health Care Access ........................................................................................................................ 10,000 ............................ 10,000 ............................ ∂10,000 

Total, Maternal and Child Health ................................................................................................................. 886,789 1,136,200 924,789 ∂38,000 ¥211,411 

Ryan White HIV/AIDS Program 

Emergency Assistance (Part A) .................................................................................................................................. 655,876 655,876 655,876 ............................ ............................Comprehensive Care Programs (Part B) .................................................................................................................... 1,315,005 1,315,005 1,315,005 ............................ ............................

AIDS Drug Assistance Program [ADAP] (NA) .................................................................................................... (900,313 ) (900,313 ) (900,313 ) ............................ ............................

Early Intervention Program (Part C) .......................................................................................................................... 201,079 201,079 201,079 ............................ ............................Children, Youth, Women, and Families (Part D) ....................................................................................................... 75,088 75,088 75,088 ............................ ............................AIDS Dental Services (Part F) .................................................................................................................................... 13,122 13,122 13,122 ............................ ............................Education and Training Centers (Part F) .................................................................................................................. 33,611 ............................ 33,611 ............................ ∂33,611 Special Projects of National Significance .................................................................................................................. 25,000 ............................ 25,000 ............................ ∂25,000 

Total, Ryan White HIV/AIDS program ............................................................................................................ 2,318,781 2,260,170 2,318,781 ............................ ∂58,611 

Health Care Systems 

Organ Transplantation ............................................................................................................................................... 25,549 23,549 25,549 ............................ ∂2,000 National Cord Blood Inventory ................................................................................................................................... 15,266 12,266 15,266 ............................ ∂3,000 C.W. Bill Young Cell Transplantation ........................................................................................................................ 24,109 22,109 24,109 ............................ ∂2,000 340B Drug Pricing program/Office of Pharmacy Affairs ........................................................................................... 10,238 26,238 10,238 ............................ ¥16,000 

User Fees ........................................................................................................................................................... ............................ ¥16,000 ............................ ............................ ∂16,000 

Poison Control Centers ............................................................................................................................................... 20,846 18,846 22,846 ∂2,000 ∂4,000 Hansen’s Disease Program ........................................................................................................................................ 13,706 11,653 13,706 ............................ ∂2,053 
245 

Hansen’s Disease Program—Buildings and Facilities .............................................................................................. 122 ............................ 122 ............................ ∂122 Payment to Hawaii, Treatment of Hansen’s .............................................................................................................. 1,857 1,857 1,857 ............................ ............................

Total, Health Care Systems .......................................................................................................................... 111,693 100,518 113,693 ∂2,000 ∂13,175 

Rural Health 

Rural Outreach Grants ............................................................................................................................................... 71,500 50,811 77,500 ∂6,000 ∂26,689 Rural Health Research/Policy Development ............................................................................................................... 9,351 5,000 9,351 ............................ ∂4,351 Rural Hospital Flexibility Grants ................................................................................................................................ 49,609 ............................ 49,609 ............................ ∂49,609 State Offices of Rural Health .................................................................................................................................... 10,000 ............................ 10,000 ............................ ∂10,000 Black Lung Clinics ..................................................................................................................................................... 10,000 7,266 10,000 ............................ ∂2,734 Radiation Exposure Screening and Education Program ............................................................................................ 1,834 1,834 1,834 ............................ ............................Telehealth ................................................................................................................................................................... 23,500 10,000 25,500 ∂2,000 ∂15,500 Rural Communities Opioid Response ......................................................................................................................... 100,000 ............................ 120,000 ∂20,000 ∂120,000 Rural Residency Program ........................................................................................................................................... 15,000 ............................ 15,000 ............................ ∂15,000 

Total, Rural Health ....................................................................................................................................... 290,794 74,911 318,794 ∂28,000 ∂243,883 

Family Planning .......................................................................................................................................................... 286,479 286,479 286,479 ............................ ............................Program Management ................................................................................................................................................ 155,000 151,993 155,000 ............................ ∂3,007 

Vaccine Injury Compensation Program Trust Fund 

Post-Fiscal Year 1988 Claims ................................................................................................................................... 268,000 308,000 308,000 ∂40,000 ............................HRSA Administrative expenses ................................................................................................................................... 9,200 9,200 9,200 ............................ ............................

Total, Vaccine Injury Compensation Trust Fund .......................................................................................... 277,200 317,200 317,200 ∂40,000 ............................Total, Health Resources and Services Administration ................................................................................. 7,013,953 9,876,791 7,133,953 ∂120,000 ¥2,742,838 

CENTERS FOR DISEASE CONTROL AND PREVENTION 

Immunization and Respiratory Diseases .................................................................................................................... 474,055 700,828 474,055 ............................ ¥226,773 

Prevention and Public Health Fund .................................................................................................................. (324,350 ) ............................ (324,350 ) ............................ (∂324,350 ) 

Subtotal ......................................................................................................................................................... (798,405 ) (700,828 ) (798,405 ) ............................ (∂97,577 ) 

HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention ......................................... 1,127,278 1,117,278 1,132,278 ∂5,000 ∂15,000 Emerging and Zoonotic Infectious Diseases .............................................................................................................. 562,572 508,328 565,572 ∂3,000 ∂57,244 

Prevention and Public Health Fund .................................................................................................................. (52,000 ) ............................ (52,000 ) ............................ (∂52,000 ) 
246 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2018 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2019—Continued 

[In thousands of dollars] 

Item 2018 appropriation Budget estimate Committee recommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2018 appropriation Budget estimate 

Subtotal ......................................................................................................................................................... 614,572 508,328 617,572 ∂3,000 ∂109,244 

Chronic Disease Prevention and Health Promotion ................................................................................................... 915,346 939,250 911,821 ¥3,525 ¥27,429 

Prevention and Public Health Fund .................................................................................................................. (247,550 ) ............................ (254,950 ) (∂7,400 ) (∂254,950 ) 

Subtotal ......................................................................................................................................................... 1,162,896 939,250 1,166,771 ∂3,875 ∂227,521 

Birth Defects, Developmental Disabilities, Disabilities and Health .......................................................................... 140,560 110,000 153,560 ∂13,000 ∂43,560 

Subtotal ......................................................................................................................................................... 140,560 110,000 153,560 ∂13,000 ∂43,560 

Public Health Scientific Services ............................................................................................................................... 490,397 332,180 492,397 ∂2,000 ∂160,217 

Evaluation Tap Funding .................................................................................................................................... ............................ (135,820 ) ............................ ............................ (¥135,820 ) 

Subtotal ......................................................................................................................................................... (490,397 ) (468,000 ) (492,397 ) (∂2,000 ) (∂24,397 ) 

Environmental Health ................................................................................................................................................. 188,750 157,000 188,750 ............................ ∂31,750 

Prevention and Public Health Fund .................................................................................................................. (17,000 ) ............................ (17,000 ) ............................ (∂17,000 ) 

Subtotal ......................................................................................................................................................... 205,750 157,000 205,750 ............................ ∂48,750 

Injury Prevention and Control .................................................................................................................................... 648,559 266,309 648,559 ............................ ∂382,250 National Institute for Occupational Safety and Health ............................................................................................. 335,200 ............................ 335,300 ∂100 ∂335,300 Energy Employees Occupational Illness Compensation Program .............................................................................. 55,358 ............................ 55,358 ............................ ∂55,358 Global Health .............................................................................................................................................................. 488,621 408,762 488,621 ............................ ∂79,859 Public Health Preparedness and Response ............................................................................................................... 1,450,000 800,000 1,470,000 ∂20,000 ∂670,000 Buildings and Facilities ............................................................................................................................................. 270,000 30,000 30,000 ¥240,000 ............................

Transfers from Nonrecurring Expenses Fund .................................................................................................... (240,000 ) ............................ ............................ (¥240,000 ) ............................

Subtotal ......................................................................................................................................................... 510,000 30,000 30,000 ¥480,000 ............................

CDC-Wide Activities and Program Support 

Prevention and Public Health Fund ........................................................................................................................... (160,000 ) ............................ (160,000 ) ............................ (∂160,000 ) 
247 

Office of the Director ................................................................................................................................................. 113,570 155,000 113,570 ............................ ¥41,430 

Subtotal, CDC-Wide Activities ...................................................................................................................... (273,570 ) (155,000 ) (273,570 ) ............................ (∂118,570 ) Total, Centers for Disease Control ............................................................................................................... 7,260,266 5,524,935 7,059,841 ¥200,425 ∂1,534,906 

Evaluation Tap Funding (NA) .............................................................................................................. ............................ (135,820 ) ............................ ............................ (¥135,820 ) Prevention and Public Health Fund ..................................................................................................... (800,900 ) ............................ (808,300 ) (∂7,400 ) (∂808,300 ) Transfers from Nonrecurring Expenses Fund ...................................................................................... (240,000 ) ............................ ............................ (¥240,000 ) ............................

Total, Centers for Disease Control Program Level ....................................................................................... (8,301,166 ) (5,660,755 ) (7,868,141 ) (¥433,025 ) (∂2,207,386 ) 

NATIONAL INSTITUTES OF HEALTH 

National Cancer Institute (NCI) ................................................................................................................................. 5,657,015 5,226,312 5,747,125 ∂90,110 ∂520,813 NIH Innovation Account, CURES Act .......................................................................................................................... 300,000 400,000 400,000 ∂100,000 ............................

Subtotal, NCI ................................................................................................................................................. 5,957,015 5,626,312 6,147,125 ∂190,110 ∂520,813 

National Heart, Lung, and Blood Institute (NHLBI) ................................................................................................... 3,382,232 3,112,032 3,490,171 ∂107,939 ∂378,139 National Institute of Dental and Craniofacial Research (NIDCR) ............................................................................. 447,735 413,196 462,024 ∂14,289 ∂48,828 National Institute of Diabetes and Digestive and Kidney Diseases [NIDDK] ............................................................ 1,968,083 1,965,434 2,030,892 ∂62,809 ∂65,458 

Juvenile Diabetes (mandatory) .......................................................................................................................... (150,000 ) (150,000 ) (150,000 ) ............................ ............................

Subtotal, NIDDK program level ..................................................................................................................... 2,118,083 2,115,434 2,180,892 ∂62,809 ∂65,458 

National Institute of Neurological Disorders and Stroke (NINDS) ............................................................................. 2,106,482 1,781,056 2,218,080 ∂111,598 ∂437,024 NIH Innovation Account, CURES Act .......................................................................................................................... 43,000 57,500 57,500 ∂14,500 ............................

Subtotal, NINDS ............................................................................................................................................ 2,149,482 1,838,556 2,275,580 ∂126,098 ∂437,024 

National Institute of Allergy and Infectious Diseases (NIAID) .................................................................................. 5,280,665 4,761,948 5,506,190 ∂225,525 ∂744,242 National Institute of General Medical Sciences (NIGMS) .......................................................................................... 1,862,529 1,831,669 1,855,971 ¥6,558 ∂24,302 

Evaluation Tap Funding .................................................................................................................................... (922,871 ) (741,000 ) (1,018,321 ) (∂95,450 ) (∂277,321 ) 

Subtotal, NIGMS program level .................................................................................................................... 2,785,400 2,572,669 2,874,292 ∂88,892 ∂301,623 

Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) .............................. 1,460,637 1,339,592 1,507,251 ∂46,614 ∂167,659 National Eye Institute (NEI) ....................................................................................................................................... 772,308 711,015 796,955 ∂24,647 ∂85,940 National Institute of Environmental Health Sciences (NIEHS) .................................................................................. 751,143 693,199 775,115 ∂23,972 ∂81,916 National Institute on Aging (NIA) .............................................................................................................................. 2,577,550 1,988,200 3,084,809 ∂507,259 ∂1,096,609 National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) ..................................................... 586,661 545,494 605,383 ∂18,722 ∂59,889 National Institute on Deafness and Other Communication Disorders (NIDCD) ........................................................ 459,974 423,992 474,653 ∂14,679 ∂50,661 National Institute of Nursing Research (NINR) ......................................................................................................... 158,033 145,842 163,076 ∂5,043 ∂17,234 
248 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2018 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2019—Continued 

[In thousands of dollars] 

Item 2018 appropriation Budget estimate Committee recommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2018 appropriation Budget estimate 

National Institute on Alcohol Abuse and Alcoholism (NIAAA) ................................................................................... 509,604 469,109 525,867 ∂16,263 ∂56,758 National Institute on Drug Abuse (NIDA) ................................................................................................................... 1,376,657 1,137,403 1,420,591 ∂43,934 ∂283,188 National Institute of Mental Health (NIMH) ............................................................................................................... 1,714,657 1,554,692 1,813,750 ∂99,093 ∂259,058 NIH Innovation Account, CURES Act .......................................................................................................................... 43,000 57,500 57,500 ∂14,500 ............................

Subtotal, NIMH .............................................................................................................................................. 1,757,657 1,612,192 1,871,250 ∂113,593 ∂259,058 

National Human Genome Research Institute (NHGRI) ............................................................................................... 558,072 512,979 575,882 ∂17,810 ∂62,903 National Institute of Biomedical Imaging and Bioengineering (NIBIB) .................................................................... 377,618 346,550 389,672 ∂12,054 ∂43,122 National Center for Complementary and Integrative Health (NCCIH) ....................................................................... 142,018 130,717 146,550 ∂4,532 ∂15,833 National Institute on Minority Health and Health Disparities (NIMHD) .................................................................... 305,108 280,545 314,845 ∂9,737 ∂34,300 John E. Fogarty International Center (FIC) ................................................................................................................ 75,733 70,084 78,150 ∂2,417 ∂8,066 National Library of Medicine (NLM) ........................................................................................................................... 428,553 395,493 442,230 ∂13,677 ∂46,737 National Center for Advancing Translational Sciences (NCATS) ............................................................................... 762,454 685,087 806,787 ∂44,333 ∂121,700 National Institute for Research on Safety and Quality (NIRSQ) ............................................................................... ............................ 255,960 ............................ ............................ ¥255,960 National Institute for Occupational Safety and Health (NIOSH) ............................................................................... ............................ 200,000 ............................ ............................ ¥200,000 National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) ................................ ............................ 95,127 ............................ ............................ ¥95,127 Energy Employees Occupational Illness Compensation Program .............................................................................. ............................ 55,358 ............................ ............................ ¥55,358 Office of the Director ................................................................................................................................................. 1,802,145 1,795,706 1,910,060 ∂107,915 ∂114,354 

Common Fund (non–add) ................................................................................................................................. (588,116 ) (586,181 ) (606,885 ) (∂18,769 ) (∂20,704 ) Gabriella Miller Kids First Research Act (Common Fund add) ........................................................................ 12,600 12,600 12,600 ............................ ............................

NIH Innovation Account, CURES Act .......................................................................................................................... 110,000 196,000 196,000 ∂86,000 ............................Buildings and Facilities ............................................................................................................................................. 128,863 200,000 200,000 ∂71,137 ............................

Total, National Institutes of Health (NIH) .................................................................................................... 36,161,129 33,847,391 38,065,679 ∂1,904,550 ∂4,218,288 

(Evaluation Tap Funding) .................................................................................................................... (922,871 ) (741,000 ) (1,018,321 ) (∂95,450 ) (∂277,321 ) 

Total, NIH Program Level .............................................................................................................................. (37,084,000 ) (34,588,391 ) (39,084,000 ) (∂2,000,000 ) (∂4,495,609 ) 

SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION (SAMHSA) 

Mental Health 

Programs of Regional and National Significance ..................................................................................................... 426,659 282,544 430,659 ∂4,000 ∂148,115 
249 

Prevention and Public Health Fund .................................................................................................................. (12,000 ) ............................ (12,000 ) ............................ (∂12,000 ) 

Subtotal ......................................................................................................................................................... 438,659 282,544 442,659 ∂4,000 ∂160,115 

Mental Health block grant ......................................................................................................................................... 701,532 541,532 726,532 ∂25,000 ∂185,000 

Evaluation Tap Funding .................................................................................................................................... (21,039 ) (21,039 ) (21,039 ) ............................ ............................

Subtotal ......................................................................................................................................................... (722,571 ) (562,571 ) (747,571 ) (∂25,000 ) (∂185,000 ) 

Certified Community Behavioral Health Clinics ........................................................................................................ 100,000 ............................ 150,000 ∂50,000 ∂150,000 National Child Traumatic Stress Initiative ................................................................................................................ ............................ ............................ ............................ ............................ ............................Children’s Mental Health ........................................................................................................................................... 125,000 119,026 125,000 ............................ ∂5,974 Grants to States for the Homeless (PATH) ................................................................................................................ 64,635 64,635 64,635 ............................ ............................Protection and Advocacy ............................................................................................................................................ 36,146 36,146 36,146 ............................ ............................

Subtotal, Mental Health ................................................................................................................................ 1,453,972 1,043,883 1,532,972 ∂79,000 ∂489,089 

(Evaluation Tap Funding) .................................................................................................................... (21,039 ) (21,039 ) (21,039 ) ............................ ............................

Subtotal, Mental Health program level ........................................................................................................ (1,487,011 ) (1,064,922 ) (1,566,011 ) (∂79,000 ) (∂501,089 ) 

Substance Abuse Treatment 

Programs of Regional and National Significance ..................................................................................................... 403,427 255,318 451,927 ∂48,500 ∂196,609 

Evaluation Tap Funding .................................................................................................................................... (2,000 ) ............................ (2,000 ) ............................ (∂2,000 ) 

Subtotal ......................................................................................................................................................... (405,427 ) (255,318 ) (453,927 ) (∂48,500 ) (∂198,609 ) 

Substance Abuse block grant .................................................................................................................................... 1,778,879 1,778,879 1,778,879 ............................ ............................

Evaluation Tap Funding .................................................................................................................................... (79,200 ) (79,200 ) (79,200 ) ............................ ............................

Subtotal, block grant .................................................................................................................................... (1,858,079 ) (1,858,079 ) (1,858,079 ) ............................ ............................

State Opioid Response grants ................................................................................................................................... 1,000,000 ............................ 1,500,000 ∂500,000 ∂1,500,000 

Subtotal, Substance Abuse Treatment ......................................................................................................... 3,182,306 2,034,197 3,730,806 ∂548,500 ∂1,696,609 

(Evaluation Tap Funding) .................................................................................................................... (81,200 ) (79,200 ) (81,200 ) ............................ (∂2,000 ) 

Subtotal, Program level ................................................................................................................................ (3,263,506 ) (2,113,397 ) (3,812,006 ) (∂548,500 ) (∂1,698,609 ) 

Substance Abuse Prevention 

Programs of Regional and National Significance ..................................................................................................... 248,219 220,885 200,219 ¥48,000 ¥20,666 

Evaluation Tap Funding (NA) ............................................................................................................................ ............................ ............................ ............................ ............................ ............................

Subtotal ......................................................................................................................................................... 248,219 220,885 200,219 ¥48,000 ¥20,666 
250 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2018 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2019—Continued 

[In thousands of dollars] 

Item 2018 appropriation Budget estimate Committee recommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2018 appropriation Budget estimate 

Total, Substance Abuse Prevention .............................................................................................................. 248,219 220,885 200,219 ¥48,000 ¥20,666 

Health Surveillance and Program Support ................................................................................................................ 128,830 126,922 128,830 ............................ ∂1,908 

Evaluation Tap Funding (NA) ............................................................................................................................ (31,428 ) (20,426 ) (31,428 ) ............................ (∂11,002 ) 

Subtotal ......................................................................................................................................................... 160,258 147,348 160,258 ............................ ∂12,910 Total, SAMHSA ............................................................................................................................................... 5,013,327 3,425,887 5,592,827 ∂579,500 ∂2,166,940 

(Evaluation Tap Funding) .................................................................................................................... (133,667 ) (120,665 ) (133,667 ) ............................ (∂13,002 ) (Prevention and Public Health Fund ) ................................................................................................. (12,000 ) ............................ (12,000 ) ............................ (∂12,000 ) 

Total, SAMHSA Program Level ...................................................................................................................... (5,158,994 ) (3,546,552 ) (5,738,494 ) (∂579,500 ) (∂2,191,942 ) 

AGENCY FOR HEALTHCARE RESEARCH AND QUALITY (AHRQ) 

Healthcare Research and Quality 

Research on Health Costs, Quality, and Outcomes: 

Federal Funds .................................................................................................................................................... 197,156 ............................ 192,709 ¥4,447 ∂192,709 

Subtotal, Health Costs, Quality, and Outcomes ........................................................................................... (197,156 ) ............................ (192,709 ) (¥4,447 ) (∂192,709 ) 

(Evaluation Tap Funding) .................................................................................................................... ............................ ............................ ............................ ............................ ............................

Medical Expenditures Panel Surveys: 

Federal Funds .................................................................................................................................................... 66,000 ............................ 69,991 ∂3,991 ∂69,991 

Program Support: 

Federal Funds .................................................................................................................................................... 70,844 ............................ 71,300 ∂456 ∂71,300 

Total, AHRQ Program Level ........................................................................................................................... (334,000 ) ............................ (334,000 ) ............................ (∂334,000 ) 

Federal funds ....................................................................................................................................... (334,000 ) ............................ (334,000 ) ............................ (∂334,000 ) 

Total, Public Health Service (PHS) appropriation ........................................................................................ 55,782,675 52,675,004 58,186,300 ∂2,403,625 ∂5,511,296 
251 

Total, Public Health Service Program Level ................................................................................................. (57,892,113 ) (53,672,489 ) (60,158,588 ) (∂2,266,475 ) (∂6,486,099 ) 

CENTERS FOR MEDICARE AND MEDICAID SERVICES 

Grants to States for Medicaid 

Medicaid Current Law Benefits .................................................................................................................................. 384,608,394 384,882,625 384,882,625 ∂274,231 ............................State and Local Administration ................................................................................................................................. 20,811,084 21,474,885 21,474,885 ∂663,801 ............................Vaccines for Children ................................................................................................................................................. 4,598,358 4,726,461 4,726,461 ∂128,103 ............................

Subtotal, Medicaid Program Level ................................................................................................................ 410,017,836 411,083,971 411,083,971 ∂1,066,135 ............................

Less funds advanced in prior year ..................................................................................................... ¥125,219,452 ¥134,847,759 ¥134,847,759 ¥9,628,307 ............................

Total, Grants to States for Medicaid ............................................................................................................ 284,798,384 276,236,212 276,236,212 ¥8,562,172 ............................

New advance, 1st quarter, fiscal year 2020 .................................................................................. 134,847,759 137,931,797 137,931,797 ∂3,084,038 ............................

Payments to Health Care Trust Funds 

Supplemental Medical Insurance ............................................................................................................................... 245,396,000 284,288,300 284,288,300 ∂38,892,300 ............................Federal Uninsured Payment ....................................................................................................................................... 132,000 127,000 127,000 ¥5,000 ............................Program Management ................................................................................................................................................ 1,104,000 898,000 898,000 ¥206,000 ............................General Revenue for Part D Benefit .......................................................................................................................... 76,133,000 92,070,000 92,070,000 ∂15,937,000 ............................General Revenue for Part D Administration .............................................................................................................. 422,000 642,000 642,000 ∂220,000 ............................HCFAC Reimbursement ............................................................................................................................................... 307,000 315,000 315,000 ∂8,000 ............................State Low-Income Determination for Part D .............................................................................................................. 3,300 3,500 3,500 ∂200 ............................

Total, Payments to Trust Funds, Program Level .......................................................................................... 323,497,300 378,343,800 378,343,800 ∂54,846,500 ............................

Program Management 

Research, Demonstration, Evaluation ........................................................................................................................ 20,054 18,054 20,054 ............................ ∂2,000 Program Operations .................................................................................................................................................... 2,519,823 2,402,089 2,519,823 ............................ ∂117,734 State Survey and Certification ................................................................................................................................... 397,334 421,135 397,334 ............................ ¥23,801 Federal Administration ............................................................................................................................................... 732,533 702,601 732,533 ............................ ∂29,932 

Total, Program management ........................................................................................................................ 3,669,744 3,543,879 3,669,744 ............................ ∂125,865 

Health Care Fraud and Abuse Control Account 

Centers for Medicare and Medicaid Services ............................................................................................................ 500,368 609,766 600,464 ∂100,096 ¥9,302 HHS Office of Inspector General ................................................................................................................................ 84,398 84,398 86,664 ∂2,266 ∂2,266 
252 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2018 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2019—Continued 

[In thousands of dollars] 

Item 2018 appropriation Budget estimate Committee recommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2018 appropriation Budget estimate 

Medicaid/CHIP ............................................................................................................................................................ 84,398 ............................ ............................ ¥84,398 ............................Department of Justice ................................................................................................................................................ 75,836 75,836 77,872 ∂2,036 ∂2,036 

Total, Health Care Fraud and Abuse Control ............................................................................................... 745,000 770,000 765,000 ∂20,000 ¥5,000 Total, Centers for Medicare and Medicaid Services .................................................................................... 747,558,187 796,825,688 796,946,553 ∂49,388,366 ∂120,865 

Federal funds ....................................................................................................................................... 743,143,443 792,511,809 792,511,809 ∂49,368,366 ............................Current year ......................................................................................................................................... (608,295,684 ) (654,580,012 ) (654,580,012 ) (∂46,284,328 ) ............................New advance, fiscal year 2020 ........................................................................................................... (134,847,759 ) (137,931,797 ) (137,931,797 ) (∂3,084,038 ) ............................

Trust Funds .............................................................................................................................................. 4,414,744 4,313,879 4,434,744 ∂20,000 ∂120,865 

ADMINISTRATION FOR CHILDREN AND FAMILIES (ACF) 

Payments to States for Child Support Enforcement and Family Support Programs 

Payments to Territories .............................................................................................................................................. 33,000 33,000 33,000 ............................ ............................Repatriation ................................................................................................................................................................ 1,000 1,000 1,000 ............................ ............................

Subtotal ......................................................................................................................................................... 34,000 34,000 34,000 ............................ ............................

Child Support Enforcement: 

State and Local Administration ........................................................................................................................ 3,763,200 3,689,574 3,689,574 ¥73,626 ............................Federal Incentive Payments .............................................................................................................................. 588,200 588,673 588,673 ∂473 ............................Access and Visitation ........................................................................................................................................ 10,000 10,000 10,000 ............................ ............................

Subtotal, Child Support Enforcement ........................................................................................................... 4,361,400 4,288,247 4,288,247 ¥73,153 ............................Total, Family Support Payments Program Level ........................................................................................... 4,395,400 4,322,247 4,322,247 ¥73,153 ............................

Less funds advanced in previous years .............................................................................................. ¥1,400,000 ¥1,400,000 ¥1,400,000 ............................ ............................

Total, Family Support Payments, current year ............................................................................................. 2,995,400 2,922,247 2,922,247 ¥73,153 ............................
253 

New advance, 1st quarter, fiscal year 2020 ...................................................................................... 1,400,000 1,400,000 1,400,000 ............................ ............................

Low Income Home Energy Assistance (LIHEAP) 

Formula Grants ........................................................................................................................................................... 3,640,304 ............................ 3,690,304 ∂50,000 ∂3,690,304 

Refugee and Entrant Assistance 

Transitional and Medical Services ............................................................................................................................. 320,000 354,000 354,000 ∂34,000 ............................Refugee Support Services .......................................................................................................................................... 207,201 160,821 207,201 ............................ ∂46,380 Victims of Trafficking ................................................................................................................................................. 23,755 18,755 26,755 ∂3,000 ∂8,000 Unaccompanied Minors .............................................................................................................................................. 1,303,245 1,048,000 1,303,245 ............................ ∂255,245 Unaccompanied Minors Contingency Fund ................................................................................................................ ............................ 200,000 ............................ ............................ ¥200,000 Victims of Torture ....................................................................................................................................................... 10,735 10,735 14,000 ∂3,265 ∂3,265 

Total, Refugee and Entrant Assistance ........................................................................................................ 1,864,936 1,792,311 1,905,201 ∂40,265 ∂112,890 

Payments to States for the Child Care and Development Block Grant .................................................................... 5,226,000 3,006,000 5,226,000 ............................ ∂2,220,000 Social Services Block Grant (Title XX) ....................................................................................................................... 1,700,000 1,700,000 1,700,000 ............................ ............................

Discretionary Funds ........................................................................................................................................... ............................ 85,000 ............................ ............................ ¥85,000 

Total, Social Services Block Grant ............................................................................................................... 1,700,000 1,785,000 1,700,000 ............................ ¥85,000 

Children and Families Services Programs 

Programs for Children, Youth and Families: 

Head Start, current funded ............................................................................................................................... 9,863,095 9,275,000 10,113,095 ∂250,000 ∂838,095 Preschool Development Grants .......................................................................................................................... 250,000 ............................ 250,000 ............................ ∂250,000 Consolidated Runaway, Homeless Youth Program ........................................................................................... 110,280 101,980 110,280 ............................ ∂8,300 Prevention Grants to Reduce Abuse of Runaway Youth ................................................................................... 17,141 17,141 17,141 ............................ ............................Child Abuse State Grants ................................................................................................................................. 85,310 25,310 85,310 ............................ ∂60,000 Child Abuse Discretionary Activities ................................................................................................................. 33,000 33,000 33,000 ............................ ............................Community Based Child Abuse Prevention ....................................................................................................... 39,764 39,764 39,764 ............................ ............................Child Welfare Services ...................................................................................................................................... 268,735 268,735 268,735 ............................ ............................Child Welfare Training, Research, or Demonstration projects ......................................................................... 17,984 17,984 17,984 ............................ ............................Adoption Opportunities ...................................................................................................................................... 39,100 39,100 39,100 ............................ ............................Adoption Incentive grants ................................................................................................................................. 75,000 37,943 75,000 ............................ ∂37,057 

Social Services and Income Maintenance Research ................................................................................................. 6,512 6,512 6,512 ............................ ............................Native American Programs ......................................................................................................................................... 54,050 52,050 54,050 ............................ ∂2,000 Community Services: 

Community Services Block Grant Act programs: 

Grants to States for Community Services ............................................................................................... 715,000 ............................ 725,000 ∂10,000 ∂725,000 
254 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2018 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2019—Continued 

[In thousands of dollars] 

Item 2018 appropriation Budget estimate Committee recommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2018 appropriation Budget estimate 

Economic Development ............................................................................................................................. 19,883 ............................ 19,883 ............................ ∂19,883 Rural Community Facilities ...................................................................................................................... 8,000 ............................ 8,000 ............................ ∂8,000 

Subtotal, Community Services ...................................................................................................................... 742,883 ............................ 752,883 ∂10,000 ∂752,883 

Domestic Violence Hotline .......................................................................................................................................... 9,250 8,250 10,250 ∂1,000 ∂2,000 Family Violence/Battered Women’s Shelters .............................................................................................................. 160,000 151,000 165,000 ∂5,000 ∂14,000 Chafee Education and Training Vouchers ................................................................................................................. 43,257 43,257 43,257 ............................ ............................Disaster Human Services Case Management ............................................................................................................ 1,864 1,864 1,864 ............................ ............................Program Direction ....................................................................................................................................................... 205,000 205,000 205,000 ............................ ............................

Total, Children and Families Services Programs ......................................................................................... 12,022,225 10,323,890 12,288,225 ∂266,000 ∂1,964,335 

Promoting Safe and Stable Families ......................................................................................................................... 345,000 325,000 345,000 ............................ ∂20,000 

Discretionary Funds ........................................................................................................................................... 99,765 209,765 99,765 ............................ ¥110,000 

Total, Promoting Safe and Stable Families ................................................................................................. 444,765 534,765 444,765 ............................ ¥90,000 

Payments for Foster Care and Permanency 

Foster Care ................................................................................................................................................................. 5,537,000 5,329,000 5,329,000 ¥208,000 ............................Adoption Assistance ................................................................................................................................................... 2,867,000 3,063,000 3,063,000 ∂196,000 ............................Guardianship .............................................................................................................................................................. 181,000 203,000 203,000 ∂22,000 ............................Independent Living ..................................................................................................................................................... 140,000 140,000 140,000 ............................ ............................

Total, Payments to States ............................................................................................................................ 8,725,000 8,735,000 8,735,000 ∂10,000 ............................

Less Advances from Prior Year ........................................................................................................... ¥2,500,000 ¥2,700,000 ¥2,700,000 ¥200,000 ............................

Total, payments, current year ......................................................................................................... 6,225,000 6,035,000 6,035,000 ¥190,000 ............................New Advance, 1st quarter, fiscal year 2020 .................................................................................. 2,700,000 2,800,000 2,800,000 ∂100,000 ............................
255 

Total, ACF ...................................................................................................................................................... 38,218,630 30,599,213 38,411,742 ∂193,112 ∂7,812,529 

Current year ......................................................................................................................................... (34,118,630 ) (26,399,213 ) (34,211,742 ) (∂93,112 ) (∂7,812,529 ) Fiscal year 2020 .................................................................................................................................. (4,100,000 ) (4,200,000 ) (4,200,000 ) (∂100,000 ) ............................

Total, ACF Program Level ................................................................................................................ 38,218,630 30,599,213 38,411,742 ∂193,112 ∂7,812,529 

ADMINISTRATION FOR COMMUNITY LIVING 

Aging and Disability Services Programs 

Grants to States: 

Home and Community-based Supportive Services ........................................................................................... 385,074 350,224 385,074 ............................ ∂34,850 Preventive Health .............................................................................................................................................. 24,848 24,848 24,848 ............................ ............................Protection of Vulnerable Older Americans–Title VII .......................................................................................... 21,658 20,628 21,658 ............................ ∂1,030 

Subtotal ......................................................................................................................................................... 431,580 395,700 431,580 ............................ ∂35,880 

Family Caregivers .............................................................................................................................................. 180,586 150,586 180,886 ∂300 ∂30,300 Native American Caregivers Support ................................................................................................................ 9,556 7,556 9,556 ............................ ∂2,000 

Subtotal, Caregivers ..................................................................................................................................... 190,142 158,142 190,442 ∂300 ∂32,300 

Nutrition: 

Congregate Meals ..................................................................................................................................... 490,342 450,342 490,342 ............................ ∂40,000 Home Delivered Meals .............................................................................................................................. 246,342 227,342 246,342 ............................ ∂19,000 Nutrition Services Incentive Program ....................................................................................................... 160,069 160,069 160,069 ............................ ............................

Subtotal ................................................................................................................................................ 896,753 837,753 896,753 ............................ ∂59,000 Subtotal, Grants to States ................................................................................................................... 1,518,475 1,391,595 1,518,775 ∂300 ∂127,180 

Grants for Native Americans ...................................................................................................................................... 33,208 31,208 33,208 ............................ ∂2,000 Aging Network Support Activities ............................................................................................................................... 12,461 8,998 12,461 ............................ ∂3,463 Alzheimer’s Disease Program ..................................................................................................................................... 8,800 19,490 8,800 ............................ ¥10,690 

Prevention and Public Health Fund .................................................................................................................. (14,700 ) ............................ (14,700 ) ............................ (∂14,700 ) 

Lifespan Respite Care ................................................................................................................................................ 4,110 3,360 4,110 ............................ ∂750 Chronic Disease Self–Management Program ............................................................................................................. ............................ ............................ ............................ ............................ ............................

Prevention and Public Health Fund .................................................................................................................. (8,000 ) ............................ (8,000 ) ............................ (∂8,000 ) 

Elder Falls Prevention ................................................................................................................................................ ............................ ............................ ............................ ............................ ............................

Prevention and Public Health Fund .................................................................................................................. (5,000 ) ............................ (5,000 ) ............................ (∂5,000 ) 

Elder Rights Support Activities .................................................................................................................................. 15,874 11,874 15,874 ............................ ∂4,000 Aging and Disability Resources ................................................................................................................................. 8,119 6,119 8,119 ............................ ∂2,000 
256 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2018 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2019—Continued 

[In thousands of dollars] 

Item 2018 appropriation Budget estimate Committee recommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2018 appropriation Budget estimate 

State Health Insurance Program ................................................................................................................................ 49,115 ............................ 49,115 ............................ ∂49,115 Paralysis Resource Center .......................................................................................................................................... 7,700 ............................ 8,700 ∂1,000 ∂8,700 Limb loss .................................................................................................................................................................... 3,500 ............................ 3,500 ............................ ∂3,500 Traumatic Brain Injury ............................................................................................................................................... 11,321 9,321 11,321 ............................ ∂2,000 Developmental Disabilities Programs: 

State Councils ................................................................................................................................................... 76,000 56,000 76,000 ............................ ∂20,000 Protection and Advocacy ................................................................................................................................... 40,734 38,734 40,734 ............................ ∂2,000 Voting Access for Individuals with Disabilities ................................................................................................ 6,963 4,963 6,963 ............................ ∂2,000 Developmental Disabilities Projects of National Significance .......................................................................... 12,000 1,050 12,000 ............................ ∂10,950 University Centers for Excellence in Developmental Disabilities ..................................................................... 40,619 32,546 40,619 ............................ ∂8,073 

Subtotal, Developmental Disabilities Programs ........................................................................................... 176,316 133,293 176,316 ............................ ∂43,023 

Workforce Innovation and Opportunity Act 

Independent Living ............................................................................................................................................ 113,183 95,997 113,183 ............................ ∂17,186 National Institute on Disability, Independent Living, and Rehabilitation Research ........................................ 104,970 ............................ 108,970 ∂4,000 ∂108,970 Assistive Technology .......................................................................................................................................... 36,000 31,939 36,000 ............................ ∂4,061 

Subtotal, Workforce Innovation and Opportunity Act ................................................................................... 254,153 127,936 258,153 ∂4,000 ∂130,217 

Aging and Disability Services Programs 

Area Agencies on Aging .................................................................................................................................... ............................ 7,500 ............................ ............................ ¥7,500 National Center for Benefits Outreach and Enrollment ................................................................................... ............................ 12,000 ............................ ............................ ¥12,000 State Health Insurance Assistance ................................................................................................................... ............................ 13,000 ............................ ............................ ¥13,000 Aging and Disability Resource Centers ............................................................................................................ ............................ 5,000 ............................ ............................ ¥5,000 

Subtotal, Aging and Disability Services Programs ...................................................................................... ............................ 37,500 ............................ ............................ ¥37,500 

Program Administration ............................................................................................................................................. 41,063 37,987 41,063 ............................ ∂3,076 

Total, Administration for Community Living (ACL) ...................................................................................... 2,144,215 1,818,681 2,149,515 ∂5,300 ∂330,834 

Federal funds ....................................................................................................................................... (2,095,100 ) (1,781,181 ) (2,100,400 ) (∂5,300 ) (∂319,219 ) 
257 

Trust Funds .......................................................................................................................................... (49,115 ) (37,500 ) (49,115 ) ............................ (∂11,615 ) (Prevention and Public Health Fund ) ................................................................................................. (27,700 ) ............................ (27,700 ) ............................ (∂27,700 ) 

Total, ACL program level .............................................................................................................................. 2,171,915 1,818,681 2,177,215 ∂5,300 ∂358,534 

OFFICE OF THE SECRETARY 

General Departmental Management 

General Departmental Management, Federal Funds ................................................................................................. 200,919 206,135 200,919 ............................ ¥5,216 Teen Pregnancy Prevention Community Grants ......................................................................................................... 101,000 ............................ 101,000 ............................ ∂101,000 

Evaluation Tap Funding .................................................................................................................................... (6,800 ) ............................ (6,800 ) ............................ (∂6,800 ) 

Subtotal, Grants ............................................................................................................................................ (107,800 ) ............................ (107,800 ) ............................ (∂107,800 ) 

Sexual Risk Avoidance ............................................................................................................................................... 25,000 ............................ 35,000 ∂10,000 ∂35,000 Office of Minority Health ............................................................................................................................................ 56,670 53,956 56,670 ............................ ∂2,714 Office on Women’s Health .......................................................................................................................................... 32,140 28,454 32,140 ............................ ∂3,686 Minority HIV/AIDS prevention and treatment ............................................................................................................. 53,900 ............................ 53,900 ............................ ∂53,900 Embryo Adoption Awareness Campaign ..................................................................................................................... 1,000 1,000 1,000 ............................ ............................Planning and Evaluation, Evaluation Tap Funding ................................................................................................... (58,028 ) (53,445 ) (58,028 ) ............................ (∂4,583 ) 

Subtotal, General Departmental Management ............................................................................................. 470,629 289,545 480,629 ∂10,000 ∂191,084 Total, General Departmental Management ................................................................................................... 470,629 289,545 480,629 ∂10,000 ∂191,084 

Federal Funds ...................................................................................................................................... (470,629 ) (289,545 ) (480,629 ) (∂10,000 ) (∂191,084 ) (Evaluation Tap Funding) .................................................................................................................... (64,828 ) (53,445 ) (64,828 ) ............................ (∂11,383 ) 

Total, General Departmental Management Program .................................................................................... 535,457 342,990 545,457 ∂10,000 ∂202,467 

Account for the State Response to the Opioid Abuse Crisis, CURES Act ................................................................. 500,000 ............................ ............................ ¥500,000 ............................Office of Medicare Hearings and Appeals ................................................................................................................. 182,381 112,381 182,381 ............................ ∂70,000 Office of Medicare Hearings and Appeals and Departmental Appeals Board Recovery Audit Contractor (RAC) 

appeals related expenses ...................................................................................................................................... ............................ 10,000 ............................ ............................ ¥10,000 

Office of the National Coordinator for Health Information Technology ..................................................................... 60,367 38,381 60,367 ............................ ∂21,986 Combatting Opioids Abuse and Misuse and Addressing Mental Illness .................................................................. ............................ 10,000,000 ............................ ............................ ¥10,000,000 

Office of Inspector General 

Inspector General Federal Funds ............................................................................................................................... 80,000 80,000 80,000 ............................ ............................

HCFAC funding (NA) .......................................................................................................................................... (334,097 ) (334,097 ) (334,097 ) ............................ ............................

Total, Inspector General Program Level ....................................................................................................... (414,097 ) (414,097 ) (414,097 ) ............................ ............................
258 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2018 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2019—Continued 

[In thousands of dollars] 

Item 2018 appropriation Budget estimate Committee recommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2018 appropriation Budget estimate 

Office for Civil Rights 

Federal Funds ............................................................................................................................................................. 38,798 30,904 38,798 ............................ ∂7,894 

Retirement Pay and Medical Benefits for Commissioned Officers 

Retirement Payments ................................................................................................................................................. 456,266 469,246 469,246 ∂12,980 ............................Survivors Benefits ...................................................................................................................................................... 31,583 31,756 31,756 ∂173 ............................Dependents’ Medical Care ......................................................................................................................................... 130,840 128,207 128,207 ¥2,633 ............................

Total, Benefits for Commissioned Officers ................................................................................................... 618,689 629,209 629,209 ∂10,520 ............................

Public Health and Social Services Emergency Fund (PHSSEF) 

Assistant Secretary for Preparedness and Response 

Operations .................................................................................................................................................................. 30,938 30,879 30,938 ............................ ∂59 Preparedness and Emergency Operations .................................................................................................................. 24,654 26,596 24,654 ............................ ¥1,942 National Disaster Medical System ............................................................................................................................. 57,404 49,809 57,404 ............................ ∂7,595 Hospital Preparedness Cooperative Agreement Grants: 

Formula Grants .................................................................................................................................................. 264,555 254,555 264,555 ............................ ∂10,000 

Biomedical Advanced Research and Development Authority (BARDA) ...................................................................... 536,700 511,700 561,700 ∂25,000 ∂50,000 Policy and Planning ................................................................................................................................................... 14,877 14,849 14,877 ............................ ∂28 Project BioShield ........................................................................................................................................................ 710,000 510,000 735,000 ∂25,000 ∂225,000 Strategic National Stockpile ....................................................................................................................................... ............................ 575,000 ............................ ............................ ¥575,000 

Subtotal, Preparedness and Response ......................................................................................................... 1,639,128 1,973,388 1,689,128 ∂50,000 ¥284,260 

Assistant Secretary for Administration 

Assistant Secretary for Administration, Cybersecurity ............................................................................................... 50,860 68,093 58,860 ∂8,000 ¥9,233 Office of Security and Strategic Information ............................................................................................................. 7,470 8,496 7,470 ............................ ¥1,026 
259 

Public Health and Science 

Medical Reserve Corps ............................................................................................................................................... 6,000 3,900 6,000 ............................ ∂2,100 Pandemic Influenza Preparedness ............................................................................................................................. 250,000 250,000 285,000 ∂35,000 ∂35,000 

Subtotal, Non-pandemic flu/BioShield/Parklawn/Other construction ........................................................... 993,458 1,543,877 1,026,458 ∂33,000 ¥517,419 Total, PHSSEF ................................................................................................................................................ 1,953,458 2,303,877 2,046,458 ∂93,000 ¥257,419 Total, Office of the Secretary ....................................................................................................................... 3,904,322 13,494,297 3,517,842 ¥386,480 ¥9,976,455 

Federal Funds ...................................................................................................................................... 3,721,941 13,381,916 3,335,461 ¥386,480 ¥10,046,455 Trust Funds .......................................................................................................................................... 182,381 112,381 182,381 ............................ ∂70,000 

(Evaluation Tap Funding) ................................................................................................................ (64,828 ) (53,445 ) (64,828 ) ............................ (∂11,383 ) 

Total, Office of the Secretary Program Level ............................................................................................... 3,969,150 13,547,742 3,582,670 ¥386,480 ¥9,965,072 Total, Title II, Health and Human Services .................................................................................................. 847,608,029 895,412,883 899,211,952 ∂51,603,923 ∂3,799,069 

Federal Funds ...................................................................................................................................... 842,952,589 890,939,923 894,536,512 ∂51,583,923 ∂3,596,589 

Current year ............................................................................................................................ (704,004,830 ) (748,808,126 ) (752,404,715 ) (∂48,399,885 ) (∂3,596,589 ) Fiscal year 2020 ..................................................................................................................... (138,947,759 ) (142,131,797 ) (142,131,797 ) (∂3,184,038 ) ............................

Trust Funds .......................................................................................................................................... 4,655,440 4,472,960 4,675,440 ∂20,000 ∂202,480 

Total, CURES Act .......................................................................................................................................... (996,000 ) (711,000 ) (711,000 ) (¥285,000 ) ............................Total, Prevention and Public Health Fund ................................................................................................... (840,600 ) ............................ (848,000 ) (∂7,400 ) (∂848,000 ) Total, Transfers from Nonrecurring Expenses Fund ..................................................................................... (240,000 ) ............................ ............................ (¥240,000 ) ............................

TITLE III—DEPARTMENT OF EDUCATION 

EDUCATION FOR THE DISADVANTAGED 

Grants to Local Educational Agencies (LEAs) 

Basic Grants: 

Advance from prior year ........................................................................................................................... (1,840,776 ) (1,540,776 ) (1,540,776 ) (¥300,000 ) ............................Forward funded ........................................................................................................................................ 4,913,625 3,777,904 5,038,625 ∂125,000 ∂1,260,721 Current funded ......................................................................................................................................... 5,000 ............................ 5,000 ............................ ∂5,000 

Subtotal, Basic grants current year approp ....................................................................................... 4,918,625 3,777,904 5,043,625 ∂125,000 ∂1,265,721 Subtotal, Basic grants total funds available ..................................................................................... (6,759,401 ) (5,318,680 ) (6,584,401 ) (¥175,000 ) (∂1,265,721 ) 

Basic Grants Fiscal Year 2020 Advance .......................................................................................................... 1,540,776 2,681,497 1,415,776 ¥125,000 ¥1,265,721 

Subtotal, Basic grants, program level ......................................................................................................... 6,459,401 6,459,401 6,459,401 ............................ ............................
260 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2018 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2019—Continued 

[In thousands of dollars] 

Item 2018 appropriation Budget estimate Committee recommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2018 appropriation Budget estimate 

Concentration Grants: 

Advance from prior year ........................................................................................................................... (1,362,301 ) (1,362,301 ) (1,362,301 ) ............................ ............................Fiscal year 2020 Advance ........................................................................................................................ 1,362,301 1,362,301 1,362,301 ............................ ............................

Subtotal ................................................................................................................................................ 1,362,301 1,362,301 1,362,301 ............................ ............................

Targeted Grants: 

Advance from prior year ........................................................................................................................... (3,819,050 ) (3,969,050 ) (3,969,050 ) (∂150,000 ) ............................Fiscal year 2020 Advance ........................................................................................................................ 3,969,050 3,819,050 4,031,550 ∂62,500 ∂212,500 

Subtotal ................................................................................................................................................ 3,969,050 3,819,050 4,031,550 ∂62,500 ∂212,500 

Education Finance Incentive Grants: 

Advance from prior year ........................................................................................................................... (3,819,050 ) (3,969,050 ) (3,969,050 ) (∂150,000 ) ............................Fiscal year 2020 Advance ........................................................................................................................ 3,969,050 3,819,050 4,031,550 ∂62,500 ∂212,500 

Subtotal ................................................................................................................................................ 3,969,050 3,819,050 4,031,550 ∂62,500 ∂212,500 

Subtotal, Grants to LEAs, program level ...................................................................................................... 15,759,802 15,459,802 15,884,802 ∂125,000 ∂425,000 

Innovative Approaches to Literacy ............................................................................................................................. 27,000 ............................ 27,000 ............................ ∂27,000 Comprehensive literacy development grants ............................................................................................................. 190,000 ............................ 190,000 ............................ ∂190,000 State Agency Programs: 

Migrant .............................................................................................................................................................. 374,751 374,751 374,751 ............................ ............................Neglected and Delinquent/High Risk Youth ...................................................................................................... 47,614 47,614 47,614 ............................ ............................

Subtotal, State Agency programs ................................................................................................................. 422,365 422,365 422,365 ............................ ............................

Special Programs for Migrant Students .................................................................................................................... 44,623 44,623 44,623 ............................ ............................

Total, Education for the disadvantaged ....................................................................................................... 16,443,790 15,926,790 16,568,790 ∂125,000 ∂642,000 

Current year ......................................................................................................................................... (5,602,613 ) (4,244,892 ) (5,727,613 ) (∂125,000 ) (∂1,482,721 ) 
261 

Fiscal year 2020 .................................................................................................................................. (10,841,177 ) (11,681,898 ) (10,841,177 ) ............................ (¥840,721 ) 

Subtotal, Forward Funded ............................................................................................................................. (5,525,990 ) (4,200,269 ) (5,650,990 ) (∂125,000 ) (∂1,450,721 ) 

IMPACT AID 

Basic Support Payments ............................................................................................................................................ 1,270,242 1,189,233 1,294,242 ∂24,000 ∂105,009 Payments for Children with Disabilities .................................................................................................................... 48,316 48,316 48,316 ............................ ............................Facilities Maintenance (Sec. 8008) ........................................................................................................................... 4,835 4,835 4,835 ............................ ............................Construction (Sec. 8007) ........................................................................................................................................... 17,406 17,406 17,406 ............................ ............................Payments for Federal Property (Sec. 8002) ............................................................................................................... 73,313 ............................ 74,313 ∂1,000 ∂74,313 

Total, Impact aid .......................................................................................................................................... 1,414,112 1,259,790 1,439,112 ∂25,000 ∂179,322 

SCHOOL IMPROVEMENT PROGRAMS 

Supporting Effective Instruction State Grants ........................................................................................................... 374,389 ............................ 374,389 ............................ ∂374,389 

Advance from prior year .................................................................................................................................... (1,681,441 ) (1,681,441 ) (1,681,441 ) ............................ ............................Fiscal year 2020 ................................................................................................................................................ 1,681,441 ............................ 1,681,441 ............................ ∂1,681,441 

Subtotal, Supporting Effective Instruction State Grants, program level ..................................................... 2,055,830 ............................ 2,055,830 ............................ ∂2,055,830 

Supplemental Education Grants ................................................................................................................................ 16,699 16,699 16,699 ............................ ............................21st Century Community Learning Centers ............................................................................................................... 1,211,673 ............................ 1,211,673 ............................ ∂1,211,673 State Assessments ..................................................................................................................................................... 378,000 369,100 378,000 ............................ ∂8,900 Education for Homeless Children and Youth ............................................................................................................. 85,000 77,000 93,500 ∂8,500 ∂16,500 Training and Advisory Services (Civil Rights) ........................................................................................................... 6,575 6,575 6,575 ............................ ............................Education for Native Hawaiians ................................................................................................................................ 36,397 ............................ 36,397 ............................ ∂36,397 Alaska Native Education Equity ................................................................................................................................. 35,453 ............................ 35,453 ............................ ∂35,453 Rural Education .......................................................................................................................................................... 180,840 175,840 180,840 ............................ ∂5,000 Comprehensive Centers .............................................................................................................................................. 52,000 ............................ 52,000 ............................ ∂52,000 Student Support and Academic Enrichment grants .................................................................................................. 1,100,000 ............................ 1,225,000 ∂125,000 ∂1,225,000 

Total, School Improvement Programs ........................................................................................................... 5,158,467 645,214 5,291,967 ∂133,500 ∂4,646,753 

Current year ......................................................................................................................................... (3,477,026 ) (645,214 ) (3,610,526 ) (∂133,500 ) (∂2,965,312 ) Fiscal year 2020 .................................................................................................................................. (1,681,441 ) ............................ (1,681,441 ) ............................ (∂1,681,441 ) 

Subtotal, Forward Funded ............................................................................................................................. (3,329,902 ) (621,940 ) (3,463,402 ) (∂133,500 ) (∂2,841,462 ) 

INDIAN EDUCATION 

Grants to Local Educational Agencies ....................................................................................................................... 105,381 100,381 105,381 ............................ ∂5,000 
262 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2018 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2019—Continued 

[In thousands of dollars] 

Item 2018 appropriation Budget estimate Committee recommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2018 appropriation Budget estimate 

Federal Programs: 

Special Programs for Indian Children .............................................................................................................. 67,993 57,993 67,993 ............................ ∂10,000 National Activities ............................................................................................................................................. 6,865 6,565 6,865 ............................ ∂300 

Subtotal, Federal Programs .......................................................................................................................... 74,858 64,558 74,858 ............................ ∂10,300 Total, Indian Education ................................................................................................................................ 180,239 164,939 180,239 ............................ ∂15,300 

INNOVATION AND IMPROVEMENT 

Opportunity Grants ..................................................................................................................................................... ............................ 1,000,000 ............................ ............................ ¥1,000,000 Education Innovation and Research .......................................................................................................................... 120,000 180,000 135,000 ∂15,000 ¥45,000 American History and Civics Academies ................................................................................................................... 1,815 ............................ 1,815 ............................ ∂1,815 American History and Civics National Activities ....................................................................................................... 1,700 ............................ 1,700 ............................ ∂1,700 Charter Schools Grants .............................................................................................................................................. 400,000 500,000 445,000 ∂45,000 ¥55,000 Magnet Schools Assistance ........................................................................................................................................ 105,000 97,647 105,000 ............................ ∂7,353 Teacher and School Leader Incentive Grants ............................................................................................................ 200,000 ............................ 200,000 ............................ ∂200,000 Ready-to-Learn Television .......................................................................................................................................... 27,741 ............................ 27,741 ............................ ∂27,741 Supporting Effective Educator Development (SEED) ................................................................................................. 75,000 ............................ 75,000 ............................ ∂75,000 Arts in Education ....................................................................................................................................................... 29,000 ............................ 29,000 ............................ ∂29,000 Javits Gifted and Talented Students ......................................................................................................................... 12,000 ............................ 12,000 ............................ ∂12,000 Statewide Family Engagement Centers ..................................................................................................................... 10,000 ............................ 10,000 ............................ ∂10,000 

Total, Innovation and Improvement .............................................................................................................. 982,256 1,777,647 1,042,256 ∂60,000 ¥735,391 

Current Year ......................................................................................................................................... (982,256 ) (1,777,647 ) (1,042,256 ) (∂60,000 ) (¥735,391 ) 

SAFE SCHOOLS AND CITIZENSHIP EDUCATION 

Promise Neighborhoods .............................................................................................................................................. 78,254 ............................ 78,254 ............................ ∂78,254 School Safety National Activities ............................................................................................................................... 90,000 43,000 95,000 ∂5,000 ∂52,000 Full-Service Community Schools ................................................................................................................................ 17,500 ............................ 17,500 ............................ ∂17,500 
263 

Total, Safe Schools and Citizenship Education ........................................................................................... 185,754 43,000 190,754 ∂5,000 ∂147,754 

ENGLISH LANGUAGE ACQUISITION 

Current funded ........................................................................................................................................................... 47,931 47,931 47,931 ............................ ............................Forward funded .......................................................................................................................................................... 689,469 689,469 689,469 ............................ ............................

Total, English Language Acquisition ............................................................................................................ 737,400 737,400 737,400 ............................ ............................

SPECIAL EDUCATION 

State Grants: 

Grants to States Part B current year ............................................................................................................... 2,994,465 1,878,745 3,119,465 ∂125,000 ∂1,240,720 

Part B advance from prior year ............................................................................................................... (9,283,383 ) (9,283,383 ) (9,283,383 ) ............................ ............................

Grants to States Part B (fiscal year 2020) ...................................................................................................... 9,283,383 10,124,103 9,283,383 ............................ ¥840,720 

Subtotal, program level ................................................................................................................................ 12,277,848 12,002,848 12,402,848 ∂125,000 ∂400,000 

Preschool Grants ............................................................................................................................................... 381,120 368,238 381,120 ............................ ∂12,882 Grants for Infants and Families ....................................................................................................................... 470,000 458,556 470,000 ............................ ∂11,444 

Subtotal, program level ................................................................................................................................ 13,128,968 12,829,642 13,253,968 ∂125,000 ∂424,326 

IDEA National Activities (current funded): 

State Personnel Development ............................................................................................................................ 38,630 38,630 38,630 ............................ ............................Technical Assistance and Dissemination (including Special Olympics Education) ......................................... 59,428 44,345 61,928 ∂2,500 ∂17,583 Personnel Preparation ....................................................................................................................................... 83,700 83,700 83,700 ............................ ............................Parent Information Centers ............................................................................................................................... 27,411 27,411 27,411 ............................ ............................

Educational Technology, Media, and Materials ......................................................................................................... 28,047 28,047 28,047 ............................ ............................

Subtotal, IDEA National Activities ................................................................................................................ 237,216 222,133 239,716 ∂2,500 ∂17,583 

Adjustment to match official bill language .............................................................................................................. ............................ 1 ............................ ............................ ¥1 

Total, Special education ............................................................................................................................... 13,366,184 13,051,776 13,493,684 ∂127,500 ∂441,908 

Current year ......................................................................................................................................... (4,082,801 ) (2,927,673 ) (4,210,301 ) (∂127,500 ) (∂1,282,628 ) Fiscal year 2020 .................................................................................................................................. (9,283,383 ) (10,124,103 ) (9,283,383 ) ............................ (¥840,720 ) 

Total, Forward Funded .................................................................................................................................. (3,845,585 ) (2,705,539 ) (3,970,585 ) (∂125,000 ) (∂1,265,046 ) 

REHABILITATION SERVICES 

Vocational Rehabilitation State Grants ..................................................................................................................... 3,452,931 3,521,990 3,521,990 ∂69,059 ............................Client Assistance State grants .................................................................................................................................. 13,000 13,000 13,000 ............................ ............................
264 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2018 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2019—Continued 

[In thousands of dollars] 

Item 2018 appropriation Budget estimate Committee recommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2018 appropriation Budget estimate 

Training ...................................................................................................................................................................... 29,388 29,388 29,388 ............................ ............................Demonstration and Training programs ...................................................................................................................... 5,796 9,296 5,796 ............................ ¥3,500 Protection and Advocacy of Individual Rights [PAIR] ............................................................................................... 17,650 17,650 17,650 ............................ ............................Supported Employment State grants ......................................................................................................................... 22,548 ............................ 22,548 ............................ ∂22,548 Independent Living: 

Services for Older Blind Individuals ................................................................................................................. 33,317 33,317 33,317 ............................ ............................

Helen Keller National Center for Deaf/Blind Youth and Adults ................................................................................ 12,500 10,336 12,500 ............................ ∂2,164 

Total, Rehabilitation services ....................................................................................................................... 3,587,130 3,634,977 3,656,189 ∂69,059 ∂21,212 

SPECIAL INSTITUTIONS FOR PERSONS WITH DISABILITIES 

American Printing House for the Blind ...................................................................................................................... 27,431 25,431 30,431 ∂3,000 ∂5,000 National Technical Institute for the Deaf [NTID]: 

Operations ......................................................................................................................................................... 73,000 70,016 76,500 ∂3,500 ∂6,484 

Gallaudet University: 

Operations ......................................................................................................................................................... 128,000 121,275 133,000 ∂5,000 ∂11,725 

Total, Gallaudet University ........................................................................................................................... 128,000 121,275 133,000 ∂5,000 ∂11,725 Total, Special Institutions for Persons with Disabilities .............................................................................. 228,431 216,722 239,931 ∂11,500 ∂23,209 

CAREER, TECHNICAL, AND ADULT EDUCATION 

Career Education: 

Basic State Grants/Secondary & Technical Education State Grants, current funded ..................................... 401,598 326,598 401,598 ............................ ∂75,000 

Advance from prior year ........................................................................................................................... (791,000 ) (791,000 ) (791,000 ) ............................ ............................Fiscal year 2020 ....................................................................................................................................... 791,000 791,000 791,000 ............................ ............................

Subtotal, Basic State Grants, program level ...................................................................................... 1,192,598 1,117,598 1,192,598 ............................ ∂75,000 
265 

National Programs ............................................................................................................................................. 7,421 20,000 7,421 ............................ ¥12,579 

Subtotal, Career Education ........................................................................................................................... 1,200,019 1,137,598 1,200,019 ............................ ∂62,421 

Adult Education: 

State Grants/Adult Basic and Literacy Education: 

State Grants, current funded ................................................................................................................... 616,955 485,849 641,955 ∂25,000 ∂156,106 

National Leadership Activities ................................................................................................................................... 13,712 13,712 13,712 ............................ ............................

Subtotal, Adult education ............................................................................................................................. 630,667 499,561 655,667 ∂25,000 ∂156,106 Total, Career, Technical, and Adult Education ............................................................................................ 1,830,686 1,637,159 1,855,686 ∂25,000 ∂218,527 

Current year ......................................................................................................................................... (1,039,686 ) (846,159 ) (1,064,686 ) (∂25,000 ) (∂218,527 ) Fiscal year 2020 .................................................................................................................................. (791,000 ) (791,000 ) (791,000 ) ............................ ............................

Total, Forward Funded .................................................................................................................................. (1,039,686 ) (846,159 ) (1,064,686 ) (∂25,000 ) (∂218,527 ) 

STUDENT FINANCIAL ASSISTANCE 

Pell Grants—maximum grant (NA) ........................................................................................................................... (5,035 ) (4,860 ) (5,135 ) (∂100 ) (∂275 ) Pell Grants .................................................................................................................................................................. 22,475,352 22,475,352 22,475,352 ............................ ............................Federal Supplemental Educational Opportunity Grants ............................................................................................. 840,000 ............................ 840,000 ............................ ∂840,000 Federal Work Study ..................................................................................................................................................... 1,130,000 500,000 1,130,000 ............................ ∂630,000 

Total, Student Financial Assistance [SFA] ................................................................................................... 24,445,352 22,975,352 24,445,352 ............................ ∂1,470,000 

FEDERAL DIRECT STUDENT LOAN PROGRAM ACCOUNT ............................................................................................. 350,000 ............................ 350,000 ............................ ∂350,000 

STUDENT AID ADMINISTRATION 

Salaries and Expenses ............................................................................................................................................... 698,943 762,000 698,943 ............................ ¥63,057 Servicing Activities ..................................................................................................................................................... 980,000 1,010,000 980,000 ............................ ¥30,000 

Total, Student Aid Administration ................................................................................................................ 1,678,943 1,772,000 1,678,943 ............................ ¥93,057 

HIGHER EDUCATION 

Aid for Institutional Development: 

Strengthening Institutions ................................................................................................................................. 98,886 ............................ 101,067 ∂2,181 ∂101,067 Hispanic Serving Institutions ............................................................................................................................ 123,183 ............................ 125,898 ∂2,715 ∂125,898 Promoting Post-Baccalaureate Opportunities for Hispanic Americans ............................................................ 11,052 ............................ 11,296 ∂244 ∂11,296 Strengthening Historically Black Colleges (HBCUs) ......................................................................................... 279,624 244,694 285,788 ∂6,164 ∂41,094 Strengthening Historically Black Graduate Institutions ................................................................................... 72,314 63,281 73,908 ∂1,594 ∂10,627 
266 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2018 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2019—Continued 

[In thousands of dollars] 

Item 2018 appropriation Budget estimate Committee recommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2018 appropriation Budget estimate 

Strengthening Predominantly Black Institutions .............................................................................................. 11,361 ............................ 11,611 ∂250 ∂11,611 Asian American Pacific Islander ....................................................................................................................... 3,826 ............................ 3,910 ∂84 ∂3,910 Strengthening Alaska Native and Native Hawaiian-Serving Institutions ......................................................... 15,772 ............................ 16,120 ∂348 ∂16,120 Strengthening Native American-Serving Nontribal Institutions ........................................................................ 3,826 ............................ 3,910 ∂84 ∂3,910 Strengthening Tribal Colleges ........................................................................................................................... 31,539 27,599 32,234 ∂695 ∂4,635 Strengthening HBCU Masters programs ........................................................................................................... 8,571 7,500 8,760 ∂189 ∂1,260 

Subtotal, Aid for Institutional development ................................................................................................. 659,954 343,074 674,502 ∂14,548 ∂331,428 

International Education and Foreign Language: 

Domestic Programs ........................................................................................................................................... 65,103 ............................ 65,103 ............................ ∂65,103 Overseas Programs ............................................................................................................................................ 7,061 ............................ 7,061 ............................ ∂7,061 

Subtotal, International Education & Foreign Lang ...................................................................................... 72,164 ............................ 72,164 ............................ ∂72,164 

Postsecondary Program for Students with Intellectual Disabilities .......................................................................... 11,800 11,800 11,800 ............................ ............................Minority Science and Engineering Improvement ........................................................................................................ 11,025 9,648 11,268 ∂243 ∂1,620 Tribally Controlled Postsec Voc/Tech Institutions ...................................................................................................... 9,469 8,286 9,678 ∂209 ∂1,392 Federal TRIO Programs ............................................................................................................................................... 1,010,000 950,000 1,010,000 ............................ ∂60,000 GEAR UP ..................................................................................................................................................................... 350,000 ............................ 350,000 ............................ ∂350,000 Graduate Assistance in Areas of National Need ....................................................................................................... 23,047 ............................ 23,047 ............................ ∂23,047 Teacher Quality Partnerships ..................................................................................................................................... 43,092 ............................ 43,092 ............................ ∂43,092 Child Care Access Means Parents in School ............................................................................................................. 50,000 15,134 50,000 ............................ ∂34,866 Fund for the Improvement of Postsecondary Ed. (FIPSE) .......................................................................................... 6,000 ............................ 5,000 ¥1,000 ∂5,000 Consolidated MSI Grant ............................................................................................................................................. ............................ 147,906 ............................ ............................ ¥147,906 

Total, Higher Education ................................................................................................................................ 2,246,551 1,485,848 2,260,551 ∂14,000 ∂774,703 

HOWARD UNIVERSITY 

Academic Program ..................................................................................................................................................... 201,788 191,091 205,788 ∂4,000 ∂14,697 Endowment Program .................................................................................................................................................. 3,405 3,405 3,405 ............................ ............................
267 

Howard University Hospital ........................................................................................................................................ 27,325 27,325 27,325 ............................ ............................

Total, Howard University ............................................................................................................................... 232,518 221,821 236,518 ∂4,000 ∂14,697 

COLLEGE HOUSING AND ACADEMIC FACILITIES LOANS PROGRAM ............................................................................ 435 448 435 ............................ ¥13 

HISTORICALLY BLACK COLLEGE AND UNIVERSITY (HBCU) CAPITAL FINANCING PROGRAM ACCOUNT 

HBCU Federal Administration ..................................................................................................................................... 334 339 334 ............................ ¥5 HBCU Loan Subsidies ................................................................................................................................................. 30,150 20,150 30,150 ............................ ∂10,000 

Total, HBCU Capital Financing Program ...................................................................................................... 30,484 20,489 30,484 ............................ ∂9,995 

INSTITUTE OF EDUCATION SCIENCES (IES) 

Research, Development and Dissemination ............................................................................................................... 192,695 187,500 192,695 ............................ ∂5,195 Statistics .................................................................................................................................................................... 109,500 112,500 109,500 ............................ ¥3,000 Regional Educational Laboratories ............................................................................................................................ 55,423 ............................ 55,423 ............................ ∂55,423 Research in Special Education .................................................................................................................................. 56,000 54,000 56,000 ............................ ∂2,000 Special Education Studies and Evaluations .............................................................................................................. 10,818 10,818 10,818 ............................ ............................Statewide Data Systems ............................................................................................................................................ 32,281 ............................ 32,281 ............................ ∂32,281 Assessment: 

National Assessment ......................................................................................................................................... 149,000 149,000 151,000 ∂2,000 ∂2,000 National Assessment Governing Board ............................................................................................................. 7,745 7,745 7,745 ............................ ............................

Subtotal, Assessment ................................................................................................................................... 156,745 156,745 158,745 ∂2,000 ∂2,000 Total, IES ....................................................................................................................................................... 613,462 521,563 615,462 ∂2,000 ∂93,899 

DEPARTMENTAL MANAGEMENT 

Program Administration: 

Salaries and Expenses ...................................................................................................................................... 430,000 432,506 430,000 ............................ ¥2,506 Building Modernization ...................................................................................................................................... ............................ 26,751 ............................ ............................ ¥26,751 

Total, Program administration ...................................................................................................................... 430,000 459,257 430,000 ............................ ¥29,257 

Office for Civil Rights ................................................................................................................................................ 117,000 107,438 125,000 ∂8,000 ∂17,562 Office of Inspector General ........................................................................................................................................ 61,143 63,418 61,143 ............................ ¥2,275 

Total, Departmental management ................................................................................................................ 608,143 630,113 616,143 ∂8,000 ¥13,970 
268 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2018 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2019—Continued 

[In thousands of dollars] 

Item 2018 appropriation Budget estimate Committee recommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2018 appropriation Budget estimate 

Total, Title III, Department of Education ...................................................................................................... 74,320,337 66,723,048 74,929,896 ∂609,559 ∂8,206,848 

Current year ......................................................................................................................................... (51,723,336 ) (44,126,047 ) (52,332,895 ) (∂609,559 ) (∂8,206,848 ) Fiscal year 2020 .................................................................................................................................. (22,597,001 ) (22,597,001 ) (22,597,001 ) ............................ ............................

TITLE IV—RELATED AGENCIES 

COMMITTEE FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR SEVERELY DISABLED ........................................... 8,250 8,650 8,250 ............................ ¥400 

CORPORATION FOR NATIONAL AND COMMUNITY SERVICE 

Operating Expenses 

Domestic Volunteer Service Programs: 

Volunteers in Service to America [VISTA] ......................................................................................................... 92,364 4,910 92,364 ............................ ∂87,454 National Senior Volunteer Corps: 

Foster Grandparents Program .................................................................................................................. 107,702 117 107,702 ............................ ∂107,585 Senior Companion Program ...................................................................................................................... 45,512 117 45,512 ............................ ∂45,395 Retired Senior Volunteer Program ............................................................................................................ 48,903 117 48,903 ............................ ∂48,786 

Subtotal, Senior Volunteers ................................................................................................................. 202,117 351 202,117 ............................ ∂201,766 Subtotal, Domestic Volunteer Service .................................................................................................. 294,481 5,261 294,481 ............................ ∂289,220 

National and Community Service Programs: 

AmeriCorps State and National Grants ............................................................................................................ 412,010 2,341 415,010 ∂3,000 ∂412,669 Innovation, Assistance, and Other Activities .................................................................................................... 7,600 ............................ 7,600 ............................ ∂7,600 Evaluation .......................................................................................................................................................... 4,000 ............................ 4,000 ............................ ∂4,000 National Civilian Community Corps (NCCC)(subtitle E) ................................................................................... 32,000 24,087 32,000 ............................ ∂7,913 State Commission Support Grants .................................................................................................................... 17,538 ............................ 17,538 ............................ ∂17,538 

Subtotal, National and Community Service ................................................................................................. 473,148 26,428 476,148 ∂3,000 ∂449,720 Total, Operating expenses ............................................................................................................................ 767,629 31,689 770,629 ∂3,000 ∂738,940 
269 

National Service Trust ................................................................................................................................................ 206,842 ............................ 198,163 ¥8,679 ∂198,163 Salaries and Expenses ............................................................................................................................................... 83,737 87,389 83,737 ............................ ¥3,652 Office of Inspector General ........................................................................................................................................ 5,750 3,568 5,750 ............................ ∂2,182 

Total, Corp. for National and Community Service ....................................................................................... 1,063,958 122,646 1,058,279 ¥5,679 ∂935,633 

CORPORATION FOR PUBLIC BROADCASTING: 

Fiscal year 2021 (current) with fiscal year 2019 comparable ........................................................................ 445,000 ............................ 445,000 ............................ ∂445,000 Fiscal year 2020 advance with fiscal year 2018 comparable (NA) ................................................................. (445,000 ) (445,000 ) (445,000 ) ............................ ............................

Rescission of fiscal year 2020 funds (NA) .............................................................................................. ............................ (¥430,000 ) ............................ ............................ (∂430,000 ) 

Subtotal, Fiscal year 2020 program level .................................................................................................... 445,000 15,000 445,000 ............................ ∂430,000 

Fiscal year 2019 advance with fiscal year 2017 comparable (NA) ................................................................. (445,000 ) (445,000 ) (445,000 ) ............................ ............................

Rescission of fiscal year 2019 funds (NA) .............................................................................................. ............................ (¥429,550 ) ............................ ............................ (∂429,550 ) 

Subtotal, Fiscal year 2019 program level .................................................................................................... 445,000 15,450 445,000 ............................ ∂429,550 

Public television interconnection system (current) ........................................................................................... 20,000 ............................ 20,000 ............................ ∂20,000 

FEDERAL MEDIATION AND CONCILIATION SERVICE .................................................................................................... 46,650 47,200 46,650 ............................ ¥550 FEDERAL MINE SAFETY AND HEALTH REVIEW COMMISSION ...................................................................................... 17,184 17,053 17,184 ............................ ∂131 INSTITUTE OF MUSEUM AND LIBRARY SERVICES ....................................................................................................... 240,000 23,000 242,000 ∂2,000 ∂219,000 MEDICAID AND CHIP PAYMENT AND ACCESS COMMISSION ....................................................................................... 8,480 8,700 8,480 ............................ ¥220 MEDICARE PAYMENT ADVISORY COMMISSION ........................................................................................................... 12,545 12,471 12,545 ............................ ∂74 NATIONAL COUNCIL ON DISABILITY ............................................................................................................................ 3,250 3,211 3,250 ............................ ∂39 NATIONAL LABOR RELATIONS BOARD ......................................................................................................................... 274,224 249,000 274,224 ............................ ∂25,224 NATIONAL MEDIATION BOARD ..................................................................................................................................... 13,800 13,205 13,800 ............................ ∂595 OCCUPATIONAL SAFETY AND HEALTH REVIEW COMMISSION ..................................................................................... 13,225 12,615 13,225 ............................ ∂610 

RAILROAD RETIREMENT BOARD 

Dual Benefits Payments Account ............................................................................................................................... 22,000 19,000 19,000 ¥3,000 ............................Less Income Tax Receipts on Dual Benefits ............................................................................................................. ¥1,000 ¥1,000 ¥1,000 ............................ ............................

Subtotal, Dual Benefits ................................................................................................................................ 21,000 18,000 18,000 ¥3,000 ............................

Federal Payments to the Railroad Retirement Accounts ........................................................................................... 150 150 150 ............................ ............................Limitation on Administration ..................................................................................................................................... 123,500 115,225 123,500 ............................ ∂8,275 Limitation on the Office of Inspector General ........................................................................................................... 11,000 8,437 11,000 ............................ ∂2,563 

SOCIAL SECURITY ADMINISTRATION 

Payments to Social Security Trust Funds .................................................................................................................. 11,400 11,000 11,000 ¥400 ............................
270 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2018 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2019—Continued 

[In thousands of dollars] 

Item 2018 appropriation Budget estimate Committee recommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2018 appropriation Budget estimate 

Supplemental Security Income Program 

Federal Benefit Payments .......................................................................................................................................... 48,236,000 55,716,000 55,716,000 ∂7,480,000 ............................Beneficiary Services ................................................................................................................................................... 159,000 126,000 126,000 ¥33,000 ............................Research and Demonstration ..................................................................................................................................... 101,000 101,000 101,000 ............................ ............................Administration ............................................................................................................................................................ 4,991,277 4,765,000 4,947,721 ¥43,556 ∂182,721 

Subtotal, SSI program level .......................................................................................................................... 53,487,277 60,708,000 60,890,721 ∂7,403,444 ∂182,721 

Less funds advanced in prior year ..................................................................................................... ¥15,000,000 ¥19,500,000 ¥19,500,000 ¥4,500,000 ............................

Subtotal, regular SSI current year ................................................................................................................ 38,487,277 41,208,000 41,390,721 ∂2,903,444 ∂182,721 

New advance, 1st quarter, fiscal year 2020 ...................................................................................... 19,500,000 19,700,000 19,700,000 ∂200,000 ............................

Total, SSI program ........................................................................................................................................ 57,987,277 60,908,000 61,090,721 ∂3,103,444 ∂182,721 

Limitation on Administrative Expenses 

OASI/DI Trust Funds ................................................................................................................................................... 5,101,321 4,895,700 5,154,585 ∂53,264 ∂258,885 HI/SMI Trust Funds ..................................................................................................................................................... 2,313,197 2,220,000 2,337,339 ∂24,142 ∂117,339 Social Security Advisory Board ................................................................................................................................... 2,300 2,300 2,300 ............................ ............................SSI .............................................................................................................................................................................. 3,602,127 3,457,000 3,639,721 ∂37,594 ∂182,721 

Subtotal, regular LAE .................................................................................................................................... 11,018,945 10,575,000 11,133,945 ∂115,000 ∂558,945 

User Fees: 

SSI User Fee activities ...................................................................................................................................... 118,000 134,000 134,000 ∂16,000 ............................

CBO adjustment ....................................................................................................................................... ¥3,000 ¥5,000 ¥5,000 ¥2,000 ............................

SSPA User Fee Activities ................................................................................................................................... 1,000 1,000 1,000 ............................ ............................

CBO adjustment ....................................................................................................................................... ¥1,000 ¥1,000 ¥1,000 ............................ ............................

Subtotal, User fees ....................................................................................................................................... 115,000 129,000 129,000 ∂14,000 ............................
271 

Subtotal, Limitation on administrative expenses ......................................................................................... 11,133,945 10,704,000 11,262,945 ∂129,000 ∂558,945 

Program Integrity: 

OASDI Trust Funds ............................................................................................................................................ 345,850 375,000 375,000 ∂29,150 ............................SSI ..................................................................................................................................................................... 1,389,150 1,308,000 1,308,000 ¥81,150 ............................

Subtotal, Program integrity funding ............................................................................................................. 1,735,000 1,683,000 1,683,000 ¥52,000 ............................Total, Limitation on Administrative Expenses .............................................................................................. 12,868,945 12,387,000 12,945,945 ∂77,000 ∂558,945 

Office of Inspector General 

Federal Funds ............................................................................................................................................................. 30,000 30,000 30,000 ............................ ............................Trust Funds ................................................................................................................................................................ 75,500 75,500 75,500 ............................ ............................

Total, Office of Inspector General ................................................................................................................ 105,500 105,500 105,500 ............................ ............................

Adjustment: Trust fund transfers from general revenues ......................................................................................... ¥4,991,277 ¥4,765,000 ¥4,947,721 ∂43,556 ¥182,721 

Total, Social Security Administration ........................................................................................................... 65,981,845 68,646,500 69,205,445 ∂3,223,600 ∂558,945 

Federal funds ....................................................................................................................................... 58,143,677 61,078,000 61,260,721 ∂3,117,044 ∂182,721 

Current year ............................................................................................................................ (38,643,677 ) (41,378,000 ) (41,560,721 ) (∂2,917,044 ) (∂182,721 ) New advances, 1st quarter, fiscal year 2020 ....................................................................... (19,500,000 ) (19,700,000 ) (19,700,000 ) (∂200,000 ) ............................

Trust funds .......................................................................................................................................... 7,838,168 7,568,500 7,944,724 ∂106,556 ∂376,224 

Total, Title IV, Related Agencies .................................................................................................................. 68,304,061 69,306,063 71,520,982 ∂3,216,921 ∂2,214,919 

Federal Funds ...................................................................................................................................... 60,318,848 61,601,430 63,429,213 ∂3,110,365 ∂1,827,783 

Current Year ........................................................................................................................... (40,373,848 ) (41,901,430 ) (43,284,213 ) (∂2,910,365 ) (∂1,382,783 ) Fiscal year 2020 Advance ...................................................................................................... (19,500,000 ) (19,700,000 ) (19,700,000 ) (∂200,000 ) ............................Fiscal year 2021 Advance ...................................................................................................... (445,000 ) ............................ (445,000 ) ............................ (∂445,000 ) 

Trust Funds .......................................................................................................................................... 7,985,213 7,704,633 8,091,769 ∂106,556 ∂387,136 

OTHER APPROPRIATIONS 

FURTHER ADDITIONAL SUPPLEMENTAL APPROPRIATIONS FOR DISASTER RELIEF REQUIREMENTS ACT, 2018 

TITLE VIII 

DEPARTMENT OF LABOR 

Employment and Training Administration 

Training and Employment Services (emergency) ....................................................................................................... 100,000 ............................ ............................ ¥100,000 ............................
272 

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2018 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL 

FOR FISCAL YEAR 2019—Continued 

[In thousands of dollars] 

Item 2018 appropriation Budget estimate Committee recommendation 

Senate Committee recommendation 

compared with (∂ or ¥) 

2018 appropriation Budget estimate 

Job Corps (emergency) ............................................................................................................................................... 30,900 ............................ ............................ ¥30,900 ............................

General Provisions—Department of Labor 

Deferment of of interest payments for U.S. Virgin Islands (Sec. 20801) (emergency) ............................................ ¥1,000 ............................ ............................ ∂1,000 ............................

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Centers for Disease Control and Prevention 

CDC-Wide Activities and Program Support (emergency) ........................................................................................... 200,000 ............................ ............................ ¥200,000 ............................

National Institutes of Health 

Office of the Director (emergency) ............................................................................................................................. 50,000 ............................ ............................ ¥50,000 ............................

Administration for Children and Families 

Children and Families Services Programs (emergency) ............................................................................................ 650,000 ............................ ............................ ¥650,000 ............................

Office of the Secretary 

Public Health and Social Services Emergency Fund (emergency) ............................................................................ 162,000 ............................ ............................ ¥162,000 ............................

DEPARTMENT OF EDUCATION 

Hurricane Education Recovery 

Hurricane Education Recovery (emergency) ............................................................................................................... 2,700,000 ............................ ............................ ¥2,700,000 ............................Hurricane Education Recovery waiver authority for HEA of 1965 (Federal Direct Student Loan Program account) 

(emergency) ............................................................................................................................................................ 5,000 ............................ ............................ ¥5,000 ............................

General Provisions—Department of Education 

HBCU Hurricane Supplemental Loan Program (loan forgiveness) (Sec. 20804) (emergency) .................................. 90,000 ............................ ............................ ¥90,000 ............................

Total, title VIII ............................................................................................................................................... 3,986,900 ............................ ............................ ¥3,986,900 ............................
273 

Total, Supplemental Appropriations for Disaster Relief Requirements (Public Law 115–123 (DivB, 

Subdivision1)) ........................................................................................................................................... 3,986,900 ............................ ............................ ¥3,986,900 ............................

Total, Other Appropriations ........................................................................................................................... 3,986,900 ............................ ............................ ¥3,986,900 ............................

RECAP 

Federal Funds (all years) ........................................................................................................................................... 991,603,180 1,027,961,378 1,042,825,000 ∂51,221,820 ∂14,863,622 Trust Funds (all years) ............................................................................................................................................... 16,389,446 15,773,525 16,395,321 ∂5,875 ∂621,796 

Grand Total ................................................................................................................................................... 1,007,992,626 1,043,734,903 1,059,220,321 ∂51,227,695 ∂15,485,418 

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