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 
H. R. 4378—2 

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. 
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(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). 
H. R. 4378—4 

(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. 
H. R. 4378—5 

(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 nontariff 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 
H. R. 4378—6 

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. 
H. R. 4378—7 

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 
H. R. 4378—8 

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 
H. R. 4378—9 

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 
H. R. 4378—10 

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 MED- ICAL 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). 
H. R. 4378—11 

(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 
H. R. 4378—12 

(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: 
H. R. 4378—13 

‘‘(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 
H. R. 4378—14 

(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.’’. 
H. R. 4378—15 

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)). 
H. R. 4378—16 

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-YouGo 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 
H. R. 4378—17 

(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.