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[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4378 Enrolled Bill (ENR)]

        H.R.4378

                     One Hundred Sixteenth Congress

                                 of the

                        United States of America

                          AT THE FIRST SESSION

          Begun and held at the City of Washington on Thursday,
           the third day of January, two thousand and nineteen

                                 An Act

 
  Making continuing appropriations for fiscal year 2020, and for other 
                                purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
    This Act may be cited as the ``Continuing Appropriations Act, 2020, 
and Health Extenders Act of 2019''.
SEC. 2. TABLE OF CONTENTS.
    The table of contents of this Act is as follows:

Sec. 1. Short title.
Sec. 2. Table of Contents.
Sec. 3. References.

             DIVISION A--CONTINUING APPROPRIATIONS ACT, 2020

    DIVISION B--HEALTH AND HUMAN SERVICES EXTENDERS AND OTHER MATTERS

                    TITLE I--PUBLIC HEALTH EXTENDERS

                    TITLE II--OTHER HEALTH EXTENDERS

                      TITLE III--MEDICAID EXTENDERS

                      TITLE IV--MEDICARE EXTENDERS

                    TITLE V--HUMAN SERVICES EXTENDERS

                    TITLE VI--MISCELLANEOUS POLICIES

                      TITLE VII--BUDGETARY EFFECTS

SEC. 3. REFERENCES.
    Except as expressly provided otherwise, any reference to ``this 
Act'' contained in any division of this Act shall be treated as 
referring only to the provisions of that division.

            DIVISION A--CONTINUING APPROPRIATIONS ACT, 2020

     The following sums are hereby appropriated, out of any money in 
the Treasury not otherwise appropriated, and out of applicable 
corporate or other revenues, receipts, and funds, for the several 
departments, agencies, corporations, and other organizational units of 
Government for fiscal year 2020, and for other purposes, namely:
    Sec. 101.  Such amounts as may be necessary, at a rate for 
operations as provided in the applicable appropriations Acts for fiscal 
year 2019 and under the authority and conditions provided in such Acts, 
for continuing projects or activities (including the costs of direct 
loans and loan guarantees) that are not otherwise specifically provided 
for in this Act, that were conducted in fiscal year 2019, and for which 
appropriations, funds, or other authority were made available in the 
following appropriations Acts:
        (1) The Agriculture, Rural Development, Food and Drug 
    Administration, and Related Agencies Appropriations Act, 2019 
    (division B of Public Law 116-6), except that the language under 
    the heading ``Rural Utilities Service--Rural Water and Waste 
    Disposal Program Account'' in title III shall be applied by 
    inserting ``the cost of direct loans,'' before ``loan guarantees'' 
    at the beginning of the second sentence in the matter preceding the 
    first proviso.
        (2) The Commerce, Justice, Science, and Related Agencies 
    Appropriations Act, 2019 (division C of Public Law 116-6), except 
    section 523(b)(6).
        (3) The Department of Defense Appropriations Act, 2019 
    (division A of Public Law 115-245).
        (4) The Energy and Water Development and Related Agencies 
    Appropriations Act, 2019 (division A of Public Law 115-244), except 
    section 505.
        (5) The Financial Services and General Government 
    Appropriations Act, 2019 (division D of Public Law 116-6).
        (6) The Department of Homeland Security Appropriations Act, 
    2019 (division A of Public Law 116-6) as amended, and title I of 
    division H of Public Law 116-6.
        (7) The Department of the Interior, Environment, and Related 
    Agencies Appropriations Act, 2019 (division E of Public Law 116-6).
        (8) The Departments of Labor, Health and Human Services, and 
    Education, and Related Agencies Appropriations Act, 2019 (division 
    B of Public Law 115-245).
        (9) The Legislative Branch Appropriations Act, 2019 (division B 
    of Public Law 115-244).
        (10) The Military Construction, Veterans Affairs, and Related 
    Agencies Appropriations Act, 2019 (division C of Public Law 115-
    244).
        (11) The Department of State, Foreign Operations, and Related 
    Programs Appropriations Act, 2019 (division F of Public Law 116-6), 
    except section 7058(d).
        (12) The Transportation, Housing and Urban Development, and 
    Related Agencies Appropriations Act, 2019 (division G of Public Law 
    116-6).
    Sec. 102. (a) No appropriation or funds made available or authority 
granted pursuant to section 101 for the Department of Defense shall be 
used for:
        (1) the new production of items not funded for production in 
    fiscal year 2019 or prior years;
        (2) the increase in production rates above those sustained with 
    fiscal year 2019 funds; or
        (3) the initiation, resumption, or continuation of any project, 
    activity, operation, or organization (defined as any project, 
    subproject, activity, budget activity, program element, and 
    subprogram within a program element, and for any investment items 
    defined as a P-1 line item in a budget activity within an 
    appropriation account and an R-1 line item that includes a program 
    element and subprogram element within an appropriation account) for 
    which appropriations, funds, or other authority were not available 
    during fiscal year 2019.
    (b) No appropriation or funds made available or authority granted 
pursuant to section 101 for the Department of Defense shall be used to 
initiate multi-year procurements utilizing advance procurement funding 
for economic order quantity procurement unless specifically 
appropriated later.
    Sec. 103.  Appropriations made by section 101 shall be available to 
the extent and in the manner that would be provided by the pertinent 
appropriations Act.
    Sec. 104.  Except as otherwise provided in section 102, no 
appropriation or funds made available or authority granted pursuant to 
section 101 shall be used to initiate or resume any project or activity 
for which appropriations, funds, or other authority were not available 
during fiscal year 2019.
    Sec. 105.  Appropriations made and authority granted pursuant to 
this Act shall cover all obligations or expenditures incurred for any 
project or activity during the period for which funds or authority for 
such project or activity are available under this Act.
    Sec. 106.  Unless otherwise provided for in this Act or in the 
applicable appropriations Act for fiscal year 2020, appropriations and 
funds made available and authority granted pursuant to this Act shall 
be available until whichever of the following first occurs:
        (1) The enactment into law of an appropriation for any project 
    or activity provided for in this Act.
        (2) The enactment into law of the applicable appropriations Act 
    for fiscal year 2020 without any provision for such project or 
    activity.
        (3) November 21, 2019.
    Sec. 107.  Expenditures made pursuant to this Act shall be charged 
to the applicable appropriation, fund, or authorization whenever a bill 
in which such applicable appropriation, fund, or authorization is 
contained is enacted into law.
    Sec. 108.  Appropriations made and funds made available by or 
authority granted pursuant to this Act may be used without regard to 
the time limitations for submission and approval of apportionments set 
forth in section 1513 of title 31, United States Code, but nothing in 
this Act may be construed to waive any other provision of law governing 
the apportionment of funds.
    Sec. 109.  Notwithstanding any other provision of this Act, except 
section 106, for those programs that would otherwise have high initial 
rates of operation or complete distribution of appropriations at the 
beginning of fiscal year 2020 because of distributions of funding to 
States, foreign countries, grantees, or others, such high initial rates 
of operation or complete distribution shall not be made, and no grants 
shall be awarded for such programs funded by this Act that would 
impinge on final funding prerogatives.
    Sec. 110.  This Act shall be implemented so that only the most 
limited funding action of that permitted in the Act shall be taken in 
order to provide for continuation of projects and activities.
    Sec. 111. (a) For entitlements and other mandatory payments whose 
budget authority was provided in appropriations Acts for fiscal year 
2019, and for activities under the Food and Nutrition Act of 2008, 
activities shall be continued at the rate to maintain program levels 
under current law, under the authority and conditions provided in the 
applicable appropriations Act for fiscal year 2019, to be continued 
through the date specified in section 106(3).
    (b) Notwithstanding section 106, obligations for mandatory payments 
due on or about the first day of any month that begins after October 
2019 but not later than 30 days after the date specified in section 
106(3) may continue to be made, and funds shall be available for such 
payments.
    Sec. 112.  Amounts made available under section 101 for civilian 
personnel compensation and benefits in each department and agency may 
be apportioned up to the rate for operations necessary to avoid 
furloughs within such department or agency, consistent with the 
applicable appropriations Act for fiscal year 2019, except that such 
authority provided under this section shall not be used until after the 
department or agency has taken all necessary actions to reduce or defer 
non-personnel-related administrative expenses.
    Sec. 113.  Funds appropriated by this Act may be obligated and 
expended notwithstanding section 10 of Public Law 91-672 (22 U.S.C. 
2412), section 15 of the State Department Basic Authorities Act of 1956 
(22 U.S.C. 2680), section 313 of the Foreign Relations Authorization 
Act, Fiscal Years 1994 and 1995 (22 U.S.C. 6212), and section 504(a)(1) 
of the National Security Act of 1947 (50 U.S.C. 3094(a)(1)).
    Sec. 114. (a) Each amount incorporated by reference in this Act 
that was previously designated by the Congress for Overseas Contingency 
Operations/Global War on Terrorism or as an emergency requirement 
pursuant to section 251(b)(2)(A) of the Balanced Budget and Emergency 
Deficit Control Act of 1985 or as being for disaster relief pursuant to 
section 251(b)(2)(D) of such Act is designated by the Congress for 
Overseas Contingency Operations/Global War on Terrorism or as an 
emergency requirement pursuant to section 251(b)(2)(A) of such Act or 
as being for disaster relief pursuant to section 251(b)(2)(D) of such 
Act, respectively.
    (b) Section 5 of Public Law 116-6 shall apply to amounts designated 
in subsection (a) and section 124 of this Act for Overseas Contingency 
Operations/Global War on Terrorism.
    (c) This section shall become effective immediately upon enactment 
of this Act, and shall remain in effect through the date in section 
106(3).
    Sec. 115. (a) Rescissions or cancellations of discretionary budget 
authority that continue pursuant to section 101 in Treasury 
Appropriations Fund Symbols (TAFS)--
        (1) to which other appropriations are not provided by this Act, 
    but for which there is a current applicable TAFS that does receive 
    an appropriation in this Act; or
        (2) which are no-year TAFS and receive other appropriations in 
    this Act,
may be continued instead by reducing the rate for operations otherwise 
provided by section 101 for such current applicable TAFS, as long as 
doing so does not impinge on the final funding prerogatives of the 
Congress.
    (b) Rescissions or cancellations described in subsection (a) shall 
continue in an amount equal to the lesser of--
        (1) the amount specified for rescission or cancellation in the 
    applicable appropriations Act referenced in section 101 of this 
    Act; or
        (2) the amount of balances available, as of October 1, 2019, 
    from the funds specified for rescission or cancellation in the 
    applicable appropriations Act referenced in section 101 of this 
    Act.
    (c) No later than November 11, 2019, the Director of the Office of 
Management and Budget shall provide to the Committees on Appropriations 
of the House of Representatives and the Senate a comprehensive list of 
the rescissions or cancellations that will continue pursuant to section 
101: Provided, That the information in such comprehensive list shall be 
periodically updated to reflect any subsequent changes in the amount of 
balances available, as of October 1, 2019, from the funds specified for 
rescission or cancellation in the applicable appropriations Act 
referenced in section 101, and such updates shall be transmitted to the 
Committees on Appropriations of the House of Representatives and the 
Senate upon request.
    Sec. 116.  Title I of the Additional Supplemental Appropriations 
for Disaster Relief Act, 2019 (Public Law 116-20) is amended in the 
matter under the heading ``Department of Agriculture--Office of the 
Secretary'' by inserting ``to cooperative processors for reduced 
quantity and quality sugar beets,'' after ``planting in 2019,'': 
Provided, That amounts repurposed pursuant to this section that were 
previously designated by the Congress as an emergency requirement 
pursuant to the Balanced Budget and Emergency Deficit Control Act of 
1985 are designated by the Congress as an emergency requirement 
pursuant to section 251(b)(2)(A)(i) of the Balanced Budget and 
Emergency Deficit Control Act of 1985 and shall be available only if 
the President subsequently so designates all such amounts and transmits 
such designations to the Congress.
    Sec. 117.  The Secretary of Agriculture may waive the matching 
funds requirement under Section 412(g) of the Agricultural Research, 
Extension, and Education Reform Act of 1998 (7 U.S.C. 7632(g)).
    Sec. 118.  Amounts made available by section 101 for ``Department 
of Agriculture--Food and Nutrition Service--Child Nutrition Programs'' 
to carry out section 749(g) of the Agriculture, Rural Development, Food 
and Drug Administration, and Related Agencies Appropriations Act, 2010 
(Public Law 111-80) may be apportioned up to the rate for operations 
necessary to ensure that the program can be fully operational by May 
2020.
    Sec. 119.  Amounts provided by section 111 to the Department of 
Agriculture for ``Corporations--Commodity Credit Corporation Fund--
Reimbursement for Net Realized Losses'' may be used, prior to the 
completion of the report described in section 2 of the Act of August 
17, 1961 (15 U.S.C. 713a-11), to reimburse the Commodity Credit 
Corporation for net realized losses sustained, but not previously 
reimbursed, as of September 17, 2019: Provided, That the Secretary of 
Agriculture shall submit a report, no later than October 31, 2019, to 
the Committees on Appropriations and Agriculture of both Houses of 
Congress, including estimates for all Market Facilitation Program 
payments, in calendar year 2018 and 2019 and projected payments in 
calendar year 2020 resulting from the calendar year 2019 program that 
include State-by-State, commodity-by-commodity, including specialty 
crops, analysis of the trade damage caused by retaliatory tariffs and 
separately by non-tariff trade barriers, including dumping, on U.S. 
agricultural producers, and an accounting of any commodity purchases 
made from substantially foreign-owned companies or their subsidiaries.
    Sec. 120.  In addition to amounts provided by section 101, amounts 
are provided for ``Department of Agriculture--Agricultural Marketing 
Service--Marketing Services'' at a rate for operations of $16,496,000 
to continue the implementation of the Hemp Production Program (section 
10113 of Public Law 115-334).
    Sec. 121.  Amounts made available by section 101 for 
``International Trade Commission--Salaries and Expenses'' may be 
apportioned up to the rate for operations necessary to carry out 
responsibilities under the American Manufacturing Competitiveness Act 
of 2016 (Public Law 114-159).
    Sec. 122.  Amounts made available by section 101 to the Department 
of Commerce for ``Bureau of the Census--Periodic Censuses and 
Programs'' may be apportioned up to the rate for operations necessary 
to maintain the schedule and deliver the required data according to the 
statutory deadlines in the 2020 Decennial Census Program.
    Sec. 123.  Notwithstanding section 2208(l)(3) of title 10, United 
States Code, during the period covered by this Act, any advanced 
billing for background investigation services and related services 
purchased from activities financed using Defense Working Capital Funds 
shall be excluded from the calculation of cumulative advance billings 
under section 2208(l)(3) of such title. In the preceding sentence, the 
term ``advance billing'' has the meaning given the term in section 
2208(l)(4) of such title.
    Sec. 124. (a) The remaining unobligated balances of funds as of 
September 30, 2019, from amounts provided by section 9013 of division A 
of Public Law 115-245 are hereby rescinded: Provided, That such amounts 
that were previously designated by the Congress as being for Overseas 
Contingency Operations/Global War on Terrorism pursuant to section 
251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit Control 
Act of 1985 are designated by the Congress as being for Overseas 
Contingency Operations/Global War on Terrorism pursuant to that section 
of that Act.
    (b) In addition to the amount otherwise provided by section 101 for 
the ``Ukraine Security Assistance Initiative'', there is appropriated 
on September 30, 2019, for an additional amount for fiscal year 2019, 
an amount equal to the unobligated balances rescinded pursuant to 
subsection (a) of this section: Provided, That amounts made available 
pursuant to this subsection shall remain available until September 30, 
2020, and shall be available for the same purposes and under the same 
authorities for which they were originally provided in Public Law 115-
245: Provided further, That such amount is designated by the Congress 
as being for Overseas Contingency Operations/Global War on Terrorism 
pursuant to section 251(b)(2)(A)(ii) of the Balanced Budget and 
Emergency Deficit Control Act of 1985.
    (c) This section shall become effective immediately upon enactment 
of this Act.
    (d) If this Act is enacted after September 30, 2019, or if the 
designation in subsection 114(b) occurs after September 30, 2019, this 
section shall be applied as if it were in effect on September 30, 2019.
    Sec. 125. (a) No funds shall be transferred directly from 
``Department of Energy--Power Marketing Administration--Colorado River 
Basins Power Marketing Fund, Western Area Power Administration'' to the 
general fund of the Treasury in fiscal year 2019.
    (b) This section shall become effective immediately upon enactment 
of this Act.
    Sec. 126.  During the period covered by this Act, title I of Public 
Law 108-361, as amended (the Calfed Bay-Delta Authorization Act) (118 
Stat. 1681), shall be applied by substituting ``2020'' for ``2019'' 
each place it appears.
    Sec. 127.  Notwithstanding section 101, title I of division D of 
Public Law 116-6 shall be applied by adding the following new heading 
and appropriation language under the heading ``Department of the 
Treasury--Departmental Offices'':

      ``COMMITTEE ON FOREIGN INVESTMENT IN THE UNITED STATES FUND

    ``For necessary expenses of the Committee on Foreign Investment in 
the United States, $15,000,000, to remain available until expended: 
Provided, That the chairperson of the Committee may transfer such 
amounts to any department or agency represented on the Committee 
(including the Department of the Treasury) subject to advance 
notification to the Committees on Appropriations of the House of 
Representatives and the Senate: Provided further, That amounts so 
transferred shall remain available until expended for expenses of 
implementing section 721 of the Defense Production Act of 1950, as 
amended (50 U.S.C. 4565), and shall be available in addition to any 
other funds available to any department or agency: Provided further, 
That fees authorized by section 721(p) of such Act shall be credited to 
this appropriation as offsetting collections: Provided further, That 
the total amount appropriated pursuant to this section from the general 
fund shall be reduced as such offsetting collections are received 
during this fiscal year, so as to result in a total appropriation from 
the general fund estimated at not more than $5,000,000.''.
    Sec. 128.  Notwithstanding any other provision of this Act, except 
section 106, the District of Columbia may expend local funds made 
available under the heading ``District of Columbia--District of 
Columbia Funds'' for such programs and activities under the District of 
Columbia Appropriations Act, 2019 (title IV of division D of Public Law 
116-6) at the rate set forth in the Fiscal Year 2020 Local Budget Act 
of 2019 (D.C. Act 23-78), as modified as of the date of enactment of 
this Act.
    Sec. 129.  In addition to amounts provided by section 101, amounts 
are provided to the Office of Personnel Management for ``Salaries and 
Expenses'' at a rate for operations of $48,000,000, for an additional 
amount for administrative expenses: Provided, That of such amounts, 
$29,760,000 shall be transferred from the appropriate trust funds of 
the Office without regard to any other provision of law: Provided 
further, That such amounts may be apportioned up to the rate for 
operations necessary to maintain agency operations.
    Sec. 130.  Notwithstanding section 101, the matter preceding the 
first proviso under the heading ``Small Business Administration--
Business Loans Program Account'' in title V of division D of Public Law 
116-6 shall be applied as if the following were inserted before the 
colon: ``, and for the cost of guaranteed loans as authorized by 
section 7(a) of the Small Business Act (Public Law 83-163), 
$99,000,000, to remain available until expended'': Provided, That 
amounts made available under such heading by this Act may be 
apportioned up to the rate for operations necessary to accommodate 
increased demand for commitments for general business loans authorized 
under section 7(a) of the Small Business Act (15 U.S.C. 636(a)).
    Sec. 131.  Notwithstanding section 101, amounts are provided for 
``Small Business Administration--Disaster Loans Program Account'' at a 
rate for operations of $177,136,000: Provided, That amounts made 
available under such heading by this Act may be apportioned up to the 
rate for operations necessary to accommodate increased demand for 
commitments for disaster administrative expenses authorized under 
section 20(a) of the Small Business Act (15 U.S.C. 631): Provided 
further, That the language under such heading in title V of division D 
of Public Law 116-6 shall be applied by--
        (1) substituting ``$1,600,000'' for ``$1,000,000'';
        (2) substituting ``$8,400,000'' for ``$9,000,000''; and
        (3) inserting the following before the period: ``; and of which 
    $167,136,000 is for direct administrative expenses of loan making 
    and servicing to carry out the direct loan program, which may be 
    transferred to and merged with the appropriations for Salaries and 
    Expenses: Provided, That, of the funds provided under this heading, 
    $150,888,000 shall be for major disasters declared pursuant to the 
    Robert T. Stafford Disaster Relief and Emergency Assistance Act (42 
    U.S.C. 5122(2)): Provided further, That the amount for major 
    disasters under this heading is designated by Congress as being for 
    disaster relief pursuant to section 251(b)(2)(D) of the Balanced 
    Budget and Emergency Deficit Control Act of 1985 (Public Law 99-
    177)''.
    Sec. 132.  Amounts made available by section 101 to the Department 
of Homeland Security for ``United States Secret Service--Operations and 
Support'' may be apportioned up to the rate for operations necessary to 
support hiring and operations required for protective activities 
associated with the 2020 presidential election campaign.
    Sec. 133.  Amounts made available by section 101 to the Department 
of Homeland Security for ``Federal Emergency Management Agency--
Disaster Relief Fund'' may be apportioned up to the rate for operations 
necessary to carry out response and recovery activities under the 
Robert T. Stafford Disaster Relief and Emergency Assistance Act (42 
U.S.C. 5121 et seq.).
    Sec. 134. (a) Sections 1309(a) and 1319 of the National Flood 
Insurance Act of 1968 (42 U.S.C. 4016(a) and 4026) shall be applied by 
substituting the date specified in section 106(3) of this Act for 
``September 30, 2019''.
    (b) If this Act is enacted after September 30, 2019, this section 
shall be applied as if it were in effect on September 30, 2019.
    Sec. 135.  Amounts made available by section 101 to the Department 
of Homeland Security for ``Office of the Secretary and Executive 
Management--Operations and Support'', ``Management Directorate--
Operations and Support'', and ``Intelligence, Analysis, and Operations 
Coordination--Operations and Support'' may be apportioned up to the 
rate for operations necessary to carry out activities previously funded 
by the Working Capital Fund of the Department of Homeland Security, 
consistent with the fiscal year 2020 President's Budget.
    Sec. 136. (a) In addition to amounts provided by section 101, 
amounts are provided to the ``Department of Health and Human Services--
Indian Health Service--Indian Health Services'' at a rate for 
operations of $18,397,500, for an additional amount for costs of 
staffing and operating facilities that were opened, renovated, or 
expanded in fiscal years 2019 and 2020, and such amounts may be 
apportioned up to the rate for operations necessary to staff and 
operate such facilities.
    (b) In addition to amounts provided by section 101, amounts are 
provided for ``Department of Health and Human Services--Indian Health 
Service--Indian Health Facilities'' at a rate for operations of 
$631,000, for an additional amount for costs of staffing and operating 
facilities that were opened, renovated, or expanded in fiscal years 
2019 and 2020, and such amounts may be apportioned up to the rate for 
operations necessary to staff and operate such facilities.
    Sec. 137.  Amounts made available by section 101 to the Department 
of Health and Human Services for ``Centers for Disease Control and 
Prevention--Public Health Preparedness and Response'' and ``Office of 
the Secretary--Public Health and Social Services Emergency Fund'' may 
be obligated in the account and budget structure, and under the 
authorities and conditions, set forth in H.R. 2740, as passed by the 
U.S. House of Representatives on June 19, 2019.
    Sec. 138.  During the period covered by this Act, up to $20,000,000 
of the unobligated amounts in the Infectious Diseases Rapid Response 
Reserve Fund established by section 231 of division B of Public Law 
115-245 may be transferred to ``Department of Health and Human 
Services--Centers for Disease Control and Prevention--CDC-Wide 
Activities and Program Support'' and shall be available until expended 
for Ebola preparedness and response activities without regard to the 
limitations in the third proviso in such section 231: Provided, That 
the Director of the Centers for Disease Control and Prevention may 
transfer such amounts to any of the appropriations accounts under the 
heading ``Centers for Disease Control and Prevention'' for Ebola 
response activities: Provided further, That such transfer authority 
shall be in addition to any other transfer authority provided to the 
Department of Health and Human Services.
    Sec. 139.  Section 114(f) of the Higher Education Act of 1965 (20 
U.S.C. 1011c(f)) shall be applied by substituting the date specified in 
section 106(3) of this Act for ``September 30, 2019''.
    Sec. 140.  Amounts made available by section 101 for ``Department 
of Veterans Affairs--Veterans Benefits Administration--General 
Operating Expenses, Veterans Benefits Administration'' and ``Department 
of Veterans Affairs--Departmental Administration--Information 
Technology Systems'' may be apportioned up to the rate for operations 
necessary to support projects and activities created by the Blue Water 
Navy Vietnam Veterans Act of 2019 (Public Law 116-23).
    Sec. 141.  Section 7 of the Export-Import Bank Act of 1945 (12 
U.S.C. 635f) shall be applied by substituting the date specified in 
section 106(3) of this Act for ``September 30, 2019''.
    Sec. 142.  Section 209 of the International Religious Freedom Act 
of 1998 (22 U.S.C. 6436) shall be applied by substituting the date 
specified in section 106(3) of this Act for ``September 30, 2019''.
    Sec. 143.  Title I of division L of Public Law 115-141 and title I 
of division G of Public Law 116-6 shall be amended in the first 
provisos in each Act under the headings ``Department of 
Transportation--Federal Transit Administration--Capital Investment 
Grants'' by striking ``obligated'' and inserting ``allocated''.
    Sec. 144.  Section 9503(e)(4) of the Internal Revenue Code of 1986 
shall not apply during the period covered by this Act.
    Sec. 145.  Amounts made available by section 101 to the Department 
of Housing and Urban Development for ``Housing Programs--Housing for 
the Elderly'' may be apportioned up to the rate for operations 
necessary to maintain project rental assistance for the elderly under 
section 202(c)(2) of the Housing Act of 1959 (12 U.S.C. 1701q(c)(2)), 
including making amendments to contracts for such assistance and 
renewing expiring contracts for such assistance for up to a 1-year 
term.
     This division may be cited as the ``Continuing Appropriations Act, 
2020''.

   DIVISION B--HEALTH AND HUMAN SERVICES EXTENDERS AND OTHER MATTERS
                    TITLE I--PUBLIC HEALTH EXTENDERS

SEC. 1101. EXTENSION FOR COMMUNITY HEALTH CENTERS, THE NATIONAL HEALTH 
SERVICE CORPS, AND TEACHING HEALTH CENTERS THAT OPERATE GME PROGRAMS.
    (a) Community Health Centers.--Section 10503(b)(1)(F) of the 
Patient Protection and Affordable Care Act (42 U.S.C. 254b-2(b)(1)(F)) 
is amended by striking ``2018 and $4,000,000,000 for fiscal year 
2019.'' and inserting ``2018, $4,000,000,000 for fiscal year 2019, and 
$569,863,014 for the period beginning on October 1, 2019, and ending on 
November 21, 2019; and''.
    (b) National Health Service Corps.--Section 10503(b)(2) of the 
Patient Protection and Affordable Care Act (42 U.S.C. 254b-2(b)(2)) is 
amended--
        (1) in subparagraph (E), by striking ``; and'' and inserting a 
    semicolon;
        (2) in subparagraph (F), by striking the period at the end and 
    inserting ``; and''; and
        (3) by adding at the end the following:
            ``(G) $44,164,384 for the period beginning on October 1, 
        2019, and ending on November 21, 2019.''.
    (c) Teaching Health Centers That Operate Graduate Medical Education 
Programs.--Section 340H(g)(1) of the Public Health Service Act (42 
U.S.C. 256h(g)(1)) is amended--
        (1) by striking ``and $126,500,000'' and inserting 
    ``$126,500,000''; and
        (2) by inserting ``and $18,021,918 for the period beginning on 
    October 1, 2019, and ending on November 21, 2019,'' before ``to 
    remain available''.
    (d) Application of Provisions.--Amounts appropriated pursuant to 
this section for the period beginning on October 1, 2019, and ending on 
November 21, 2019, shall be subject to the requirements contained in 
Public Law 115-245 for funds for programs authorized under sections 330 
through 340 of the Public Health Service Act (42 U.S.C. 254 through 
256).
    (e) Conforming Amendment.--Paragraph (4) of section 3014(h) of 
title 18, United States Code, as amended by section 50901 of Public Law 
115-123, is amended by striking ``and section 50901(e) of the Advancing 
Chronic Care, Extenders, and Social Services Act'' and inserting ``, 
section 50901(e) of the Advancing Chronic Care, Extenders, and Social 
Services Act, and section 1101(d) of division B of the Continuing 
Appropriations Act, 2020, and Health Extenders Act of 2019''.
SEC. 1102. DIABETES PROGRAMS.
    (a) Type I.--Section 330B(b)(2)(D) of the Public Health Service Act 
(42 U.S.C. 254c-2(b)(2)(D)) is amended by inserting ``and $21,369,863 
for the period beginning on October 1, 2019, and ending on November 21, 
2019,'' before ``to remain available''.
    (b) Indians.--Section 330C(c)(2)(D) of the Public Health Service 
Act (42 U.S.C. 254c-3(c)(2)(D)) is amended by inserting ``and 
$21,369,863 for the period beginning on October 1, 2019, and ending on 
November 21, 2019,'' before ``to remain available''.

                    TITLE II--OTHER HEALTH EXTENDERS

SEC. 1201. EXTENSION OF SEXUAL RISK AVOIDANCE EDUCATION PROGRAM.
    Section 510 of the Social Security Act (42 U.S.C. 710) is amended--
        (1) in subsection (a)--
            (A) in paragraph (1)--
                (i) in the matter preceding subparagraph (A)--

                    (I) by inserting after ``for each of fiscal years 
                2018 and 2019'' the following: ``and for the period 
                beginning October 1, 2019, and ending November 21, 
                2019''; and
                    (II) by inserting after ``for the fiscal year'' the 
                following: ``(or, with respect to such period, for 
                fiscal year 2020)''; and

                (ii) in subparagraph (A), by striking ``for the fiscal 
            year'' each place it appears and inserting ``for the fiscal 
            year or period'' in each such place; and
            (B) in paragraph (2)--
                (i) in subparagraph (A)--

                    (I) by inserting after ``for each of fiscal years 
                2018 and 2019'' the following: ``and for the period 
                beginning October 1, 2019, and ending November 21, 
                2019''; and
                    (II) by inserting after ``for the fiscal year'' the 
                following: ``(or, with respect to such period, for 
                fiscal year 2020)''; and

                (ii) in subparagraph (B)(i), by inserting after ``for 
            the fiscal year'' the following: ``(or, with respect to 
            such period, for fiscal year 2020)''; and
        (2) in subsection (f)--
            (A) in paragraph (1), by inserting after ``for each of 
        fiscal years 2018 and 2019'' the following: ``and $10,684,931 
        for the period beginning October 1, 2019, and ending November 
        21, 2019''; and
            (B) in paragraph (2), by inserting after ``for each of 
        fiscal years 2018 and 2019'' the following: ``and for the 
        period described in paragraph (1)''.
SEC. 1202. EXTENSION OF PERSONAL RESPONSIBILITY EDUCATION PROGRAM.
    Section 513 of the Social Security Act (42 U.S.C. 713) is amended--
        (1) in subsection (a)--
            (A) in paragraph (1)--
                (i) in subparagraph (A)--

                    (I) in the matter preceding clause (i), by 
                inserting after ``for each of fiscal years 2010 through 
                2019'' the following: ``and for the period beginning 
                October 1, 2019, and ending November 21, 2019''; and
                    (II) in clause (i), by inserting after ``for the 
                fiscal year'' the following: ``or period'';

                (ii) in subparagraph (B)(i), by adding at the end the 
            following new sentence: ``The previous sentence shall not 
            apply with respect to State allotments under this paragraph 
            for the period beginning October 1, 2019, and ending 
            November 21, 2019.''; and
                (iii) in subparagraph (C)(i)--

                    (I) by inserting after ``for a fiscal year'' the 
                following: ``or the period described in subparagraph 
                (A)''; and
                    (II) by inserting after ``for the fiscal year'' the 
                following: ``or period'';

            (B) in paragraph (3)--
                (i) by inserting after ``for a fiscal year'' the 
            following: ``or the period described in paragraph (1)(A)''; 
            and
                (ii) by striking ``the end of the second succeeding 
            fiscal year'' and inserting ``the end of the second fiscal 
            year following such fiscal year or period''; and
            (C) in paragraph (4)--
                (i) in subparagraph (A)--

                    (I) by inserting after ``for each of fiscal years 
                2010 through 2019'' the following: ``and for the period 
                described in paragraph (1)(A)'';
                    (II) by inserting after ``for each of fiscal years 
                2012 through 2019'' the following: ``and for the period 
                so described''; and
                    (III) by inserting after ``for a fiscal year'' the 
                following: ``or the period so described''; and

                (ii) in subparagraph (B)(i), by striking ``continue 
            through fiscal year 2019'' and inserting ``continue through 
            the period described in paragraph (1)(A)'';
        (2) in subsection (c)--
            (A) in paragraph (1), by striking ``From the amount'' and 
        inserting ``Subject to paragraph (3), from the amount'';
            (B) in paragraph (2), by striking ``From the amount'' and 
        inserting ``Subject to paragraph (3), from the amount''; and
            (C) by adding at the end the following new paragraph:
        ``(3) Exception.--Paragraphs (1) and (2) shall not apply with 
    respect to any amount appropriated under subsection (f) for the 
    period described in subsection (a)(1)(A).''; and
        (3) in subsection (f), by inserting after ``for each of fiscal 
    years 2010 through 2019'' the following: ``and $10,684,931 for the 
    period beginning October 1, 2019, and ending November 21, 2019''.

                     TITLE III--MEDICAID EXTENDERS

SEC. 1301. EXTENSION OF COMMUNITY MENTAL HEALTH SERVICES DEMONSTRATION 
PROGRAM.
    Section 223(d)(3) of the Protecting Access to Medicare Act of 2014 
(42 U.S.C. 1396a note) is amended by striking ``September 13, 2019'' 
and inserting ``November 21, 2019''.
SEC. 1302. TEMPORARY INCREASE IN FEDERAL MEDICAL ASSISTANCE PERCENTAGE 
FOR TERRITORIES UNDER MEDICAID PROGRAM.
    Section 1905 of the Social Security Act (42 U.S.C. 1396d) is 
amended--
        (1) in subsection (b), by striking ``and (aa)'' and inserting 
    ``(aa), and (ff)''; and
        (2) by adding at the end the following new subsection:
    ``(ff) Temporary Increase in FMAP for Territories.--Notwithstanding 
subsection (b) or (z)(2), the Federal medical assistance percentage for 
Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, 
and American Samoa shall be equal to 100 percent for the period 
beginning October 1, 2019, and ending November 21, 2019.''.
SEC. 1303. DELAY OF REDUCTIONS IN MEDICAID DSH ALLOTMENTS.
    Section 1923(f)(7)(A) of the Social Security Act (42 U.S.C. 1396r-
4(f)(7)(A)) is amended--
        (1) in clause (i), in the matter preceding subclause (I), by 
    striking ``For each of fiscal years 2020 through 2025'' and 
    inserting ``For the period beginning November 22, 2019, and ending 
    September 30, 2020, and for each of fiscal years 2021 through 
    2025''; and
        (2) in clause (ii)(I), by striking ``for fiscal year 2020'' and 
    inserting ``for the period beginning November 22, 2019, and ending 
    September 30, 2020''.

                      TITLE IV--MEDICARE EXTENDERS

SEC. 1401. EXTENSION OF FUNDING FOR QUALITY MEASURE ENDORSEMENT, INPUT, 
AND SELECTION.
    Section 1890(d)(2) of the Social Security Act (42 U.S.C. 
1395aaa(d)(2)) is amended--
        (1) in the first sentence--
            (A) by striking ``and $7,500,000'' and inserting 
        ``$7,500,000''; and
            (B) by inserting before the period at the end the 
        following: ``, and $1,069,000 for the period beginning on 
        October 1, 2019, and ending on November 21, 2019''; and
        (2) in the third sentence, by inserting ``and for the period 
    beginning on October 1, 2019, and ending on November 21, 2019,'' 
    after ``2019''.
SEC. 1402. EXTENSION OF FUNDING OUTREACH AND ASSISTANCE FOR LOW-INCOME 
PROGRAMS.
    (a) Additional Funding for State Health Insurance Programs.--
Subsection (a)(1)(B) of section 119 of the Medicare Improvements for 
Patients and Providers Act of 2008 (42 U.S.C. 1395b-3 note), as amended 
by section 3306 of the Patient Protection and Affordable Care Act 
(Public Law 111-148), section 610 of the American Taxpayer Relief Act 
of 2012 (Public Law 112-240), section 1110 of the Pathway for SGR 
Reform Act of 2013 (Public Law 113-67), section 110 of the Protecting 
Access to Medicare Act of 2014 (Public Law 113-93), section 208 of the 
Medicare Access and CHIP Reauthorization Act of 2015 (Public Law 114-
10), and section 50207 of division E of the Bipartisan Budget Act of 
2018 (Public Law 115-123), is amended--
        (1) in clause (vii), by striking ``and'' at the end;
        (2) in clause (viii), by striking ``and'' at the end;
        (3) in clause (ix), by striking the period at the end and 
    inserting ``; and''; and
        (4) by inserting after clause (ix) the following new clause:
                ``(x) for the period beginning on October 1, 2019, and 
            ending on November 21, 2019, of $1,852,000.''.
    (b) Additional Funding for Area Agencies on Aging.--Subsection 
(b)(1)(B) of such section 119, as so amended, is amended--
        (1) in clause (vii), by striking ``and'' at the end;
        (2) in clause (viii), by striking ``and'' at the end;
        (3) in clause (ix), by striking the period at the end and 
    inserting ``; and''; and
        (4) by inserting after clause (ix) the following new clause:
                ``(x) for the period beginning on October 1, 2019, and 
            ending on November 21, 2019, of $1,069,000.''.
    (c) Additional Funding for Aging and Disability Resource Centers.--
Subsection (c)(1)(B) of such section 119, as so amended, is amended--
        (1) in clause (vii), by striking ``and'' at the end;
        (2) in clause (viii), by striking ``and'' at the end;
        (3) in clause (ix), by striking the period at the end and 
    inserting ``; and''; and
        (4) by inserting after clause (ix) the following new clause:
                ``(x) for the period beginning on October 1, 2019, and 
            ending on November 21, 2019, of $712,000.''.
    (d) Additional Funding for Contract With the National Center for 
Benefits and Outreach Enrollment.--Subsection (d)(2) of such section 
119, as so amended, is amended--
        (1) in clause (vii), by striking ``and'' at the end;
        (2) in clause (viii), by striking ``and'' at the end;
        (3) in clause (ix), by striking the period at the end and 
    inserting ``; and''; and
        (4) by inserting after clause (ix) the following new clause:
                ``(x) for the period beginning on October 1, 2019, and 
            ending on November 21, 2019, of $1,710,000.''.
SEC. 1403. EXTENSION OF TERMINATION DATE OF PATIENT-CENTERED OUTCOMES 
RESEARCH TRUST FUND.
    Section 9511(f) of the Internal Revenue Code of 1986 is amended by 
striking ``September 30'' and inserting ``November 21''.

                   TITLE V--HUMAN SERVICES EXTENDERS

SEC. 1501. EXTENSION OF DEMONSTRATION PROJECTS TO ADDRESS HEALTH 
PROFESSIONS WORKFORCE NEEDS.
    Activities authorized by section 2008 of the Social Security Act 
shall continue through November 21, 2019, in the manner authorized for 
fiscal year 2019, and out of any money in the Treasury of the United 
States not otherwise appropriated, there are hereby appropriated such 
sums as may be necessary for such purpose. Grants and payments may be 
made pursuant to this authority through the date so specified at the 
pro rata portion of the total amount authorized for such activities in 
fiscal year 2019.
SEC. 1502. EXTENSION OF THE TEMPORARY ASSISTANCE FOR NEEDY FAMILIES 
PROGRAM AND RELATED PROGRAMS.
    Activities authorized by part A of title IV and section 1108(b) of 
the Social Security Act shall continue through November 21, 2019, in 
the manner authorized for fiscal year 2019, and out of any money in the 
Treasury of the United States not otherwise appropriated, there are 
hereby appropriated such sums as may be necessary for such purpose.

                    TITLE VI--MISCELLANEOUS POLICIES

SEC. 1601. ALASKA NATIVE REGIONAL HEALTH ENTITIES.
    Section 424(a) of the Consolidated Appropriations Act, 2014 (Public 
Law 113-76), as amended by section 428 of the Consolidated 
Appropriations Act, 2018 (Public Law 115-141), shall be applied by 
substituting ``November 21, 2019'' for ``October 1, 2019''.
SEC. 1602. INCREASING NUMERICAL LIMITATIONS OF THE WORLD TRADE CENTER 
HEALTH PROGRAM.
    (a) World Trade Center Responders.--Section 3311(a)(4)(A) of the 
Public Health Service Act (42 U.S.C. 300mm-21(a)(4)(A)) is amended by 
striking ``25,000'' and inserting ``75,000''.
    (b) World Trade Center Survivors.--Section 3321(a)(3)(A) of the 
Public Health Service Act (42 U.S.C. 300mm-31(a)(3)(A)) is amended by 
striking ``25,000'' and inserting ``75,000''.
    (c) Rule of Construction Regarding Annual Funding Limitations.--
Nothing in this section, or the amendments made by this section, shall 
alter the annual limitations on amounts appropriated to the World Trade 
Center Health Program Fund under section 3351(a)(2) of the Public 
Health Service Act (42 U.S.C. 300mm-61(a)(2)).
SEC. 1603. EXCLUDING AUTHORIZED GENERIC DRUGS FROM CALCULATION OF 
AVERAGE MANUFACTURER PRICE FOR PURPOSES OF THE MEDICAID DRUG REBATE 
PROGRAM; EXCLUDING MANUFACTURERS FROM DEFINITION OF WHOLESALER.
    (a) In General.--Subparagraph (C) of section 1927(k)(1) of the 
Social Security Act (42 U.S.C. 1396r-8(k)(1)) is amended--
        (1) in the subparagraph heading, by striking ``INCLUSION'' and 
    inserting ``EXCLUSION'';
        (2) by striking ``a new drug application'' and inserting ``the 
    manufacturer's new drug application''; and
        (3) by striking ``inclusive'' and inserting ``exclusive''.
    (b) Excluding Manufacturers From Definition of Wholesaler.--Section 
1927(k)(11) of the Social Security Act (42 U.S.C. 1396r-8(k)(11)) is 
amended--
        (1) by striking ``manufacturers,''; and
        (2) by striking ``manufacturer's and''.
    (c) Effective Date.--The amendments made by this section shall take 
effect on the first day of the first fiscal quarter that begins after 
the date of enactment of this Act.
SEC. 1604. MEDICAID IMPROVEMENT FUND.
    Section 1941(b) of the Social Security Act (42 U.S.C. 1396w-1(b)), 
as amended by section 2 of Public Law 116-29, is amended--
        (1) in paragraph (1), by striking ``$1,000,000'' and inserting 
    ``$0''; and
        (2) in paragraph (3)--
            (A) by striking ``2023'' each place it appears and 
        inserting ``2025''; and
            (B) in subparagraph (A), by striking ``$0'' and inserting 
        ``$2,387,000,000''.

                      TITLE VII--BUDGETARY EFFECTS

SEC. 1701. BUDGETARY EFFECTS.
    (a) Statutory PAYGO Scorecards.--The budgetary effects of this 
division shall not be entered on either PAYGO scorecard maintained 
pursuant to section 4(d) of the Statutory Pay-As-You-Go Act of 2010.
    (b) Senate PAYGO Scorecards.--The budgetary effects of this 
division shall not be entered on any PAYGO scorecard maintained for 
purposes of section 4106 of H. Con. Res. 71 (115th Congress).
    (c) Classification of Budgetary Effects.--Notwithstanding Rule 3 of 
the Budget Scorekeeping Guidelines set forth in the joint explanatory 
statement of the committee of conference accompanying Conference Report 
105-217 and section 250(c)(8) of the Balanced Budget and Emergency 
Deficit Control Act of 1985, the budgetary effects of this division 
shall not be estimated--
        (1) for purposes of section 251 of such Act; and
        (2) for purposes of paragraph (4)(C) of section 3 of the 
    Statutory Pay-As-You-Go Act of 2010 as being included in an 
    appropriation Act.

                               Speaker of the House of Representatives.

                            Vice President of the United States and    
                                               President of the Senate.
```