116TH CONGRESS 

1ST SESSION H. R. 4378 

AN ACT 

Making continuing appropriations for fiscal year 2020, and 

for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 
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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Continuing Appropria3 tions Act, 2020, and Health Extenders Act of 2019’’. 

4 SEC. 2. TABLE OF CONTENTS. 

5 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 

6 SEC. 3. REFERENCES. 

7 Except as expressly provided otherwise, any reference 

8 to ‘‘this Act’’ contained in any division of this Act shall 

9 be treated as referring only to the provisions of that divi10 sion. 

11 DIVISION A—CONTINUING 

12 APPROPRIATIONS ACT, 2020 

13 The following sums are hereby appropriated, out of 

14 any money in the Treasury not otherwise appropriated, 

15 and out of applicable corporate or other revenues, receipts, 

16 and funds, for the several departments, agencies, corpora-
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1 tions, and other organizational units of Government for 

2 fiscal year 2020, and for other purposes, namely: 

3 SEC. 101. Such amounts as may be necessary, at a 

4 rate for operations as provided in the applicable appro5 priations Acts for fiscal year 2019 and under the authority 

6 and conditions provided in such Acts, for continuing 

7 projects or activities (including the costs of direct loans 

8 and loan guarantees) that are not otherwise specifically 

9 provided for in this Act, that were conducted in fiscal year 

10 2019, and for which appropriations, funds, or other au11 thority were made available in the following appropriations 

12 Acts: 

13 (1) The Agriculture, Rural Development, Food 

14 and Drug Administration, and Related Agencies Ap15 propriations Act, 2019 (division B of Public Law 

16 116–6), except that the language under the heading 

17 ‘‘Rural Utilities Service—Rural Water and Waste 

18 Disposal Program Account’’ in title III shall be ap19 plied by inserting ‘‘the cost of direct loans,’’ before 

20 ‘‘loan guarantees’’ at the beginning of the second 

21 sentence in the matter preceding the first proviso. 

22 (2) The Commerce, Justice, Science, and Re23 lated Agencies Appropriations Act, 2019 (division C 

24 of Public Law 116–6), except section 523(b)(6). 
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1 (3) The Department of Defense Appropriations 

2 Act, 2019 (division A of Public Law 115–245). 

3 (4) The Energy and Water Development and 

4 Related Agencies Appropriations Act, 2019 (division 

5 A of Public Law 115–244), except section 505. 

6 (5) The Financial Services and General Govern7 ment Appropriations Act, 2019 (division D of Public 

8 Law 116–6). 

9 (6) The Department of Homeland Security Ap10 propriations Act, 2019 (division A of Public Law 

11 116–6) as amended, and title I of division H of Pub12 lic Law 116–6. 

13 (7) The Department of the Interior, Environ14 ment, and Related Agencies Appropriations Act, 

15 2019 (division E of Public Law 116–6). 

16 (8) The Departments of Labor, Health and 

17 Human Services, and Education, and Related Agen18 cies Appropriations Act, 2019 (division B of Public 

19 Law 115–245). 

20 (9) The Legislative Branch Appropriations Act, 

21 2019 (division B of Public Law 115–244). 

22 (10) The Military Construction, Veterans Af23 fairs, and Related Agencies Appropriations Act, 

24 2019 (division C of Public Law 115–244). 
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1 (11) The Department of State, Foreign Oper2 ations, and Related Programs Appropriations Act, 

3 2019 (division F of Public Law 116–6), except sec4 tion 7058(d). 

5 (12) The Transportation, Housing and Urban 

6 Development, and Related Agencies Appropriations 

7 Act, 2019 (division G of Public Law 116–6). 

8 SEC. 102. (a) No appropriation or funds made avail9 able or authority granted pursuant to section 101 for the 

10 Department of Defense shall be used for: 

11 (1) the new production of items not funded for 

12 production in fiscal year 2019 or prior years; 

13 (2) the increase in production rates above those 

14 sustained with fiscal year 2019 funds; or 

15 (3) the initiation, resumption, or continuation 

16 of any project, activity, operation, or organization 

17 (defined as any project, subproject, activity, budget 

18 activity, program element, and subprogram within a 

19 program element, and for any investment items de20 fined as a P–1 line item in a budget activity within 

21 an appropriation account and an R–1 line item that 

22 includes a program element and subprogram element 

23 within an appropriation account) for which appro24 priations, funds, or other authority were not avail25 able during fiscal year 2019. 
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1 (b) No appropriation or funds made available or au2 thority granted pursuant to section 101 for the Depart3 ment of Defense shall be used to initiate multi-year pro4 curements utilizing advance procurement funding for eco5 nomic order quantity procurement unless specifically ap6 propriated later. 

7 SEC. 103. Appropriations made by section 101 shall 

8 be available to the extent and in the manner that would 

9 be provided by the pertinent appropriations Act. 

10 SEC. 104. Except as otherwise provided in section 

11 102, no appropriation or funds made available or author12 ity granted pursuant to section 101 shall be used to ini13 tiate or resume any project or activity for which appro14 priations, funds, or other authority were not available dur15 ing fiscal year 2019. 

16 SEC. 105. Appropriations made and authority grant17 ed pursuant to this Act shall cover all obligations or ex18 penditures incurred for any project or activity during the 

19 period for which funds or authority for such project or 

20 activity are available under this Act. 

21 SEC. 106. Unless otherwise provided for in this Act 

22 or in the applicable appropriations Act for fiscal year 

23 2020, appropriations and funds made available and au24 thority granted pursuant to this Act shall be available 

25 until whichever of the following first occurs: 
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1 (1) The enactment into law of an appropriation 

2 for any project or activity provided for in this Act. 

3 (2) The enactment into law of the applicable 

4 appropriations Act for fiscal year 2020 without any 

5 provision for such project or activity. 

6 (3) November 21, 2019. 

7 SEC. 107. Expenditures made pursuant to this Act 

8 shall be charged to the applicable appropriation, fund, or 

9 authorization whenever a bill in which such applicable ap10 propriation, fund, or authorization is contained is enacted 

11 into law. 

12 SEC. 108. Appropriations made and funds made 

13 available by or authority granted pursuant to this Act may 

14 be used without regard to the time limitations for submis15 sion and approval of apportionments set forth in section 

16 1513 of title 31, United States Code, but nothing in this 

17 Act may be construed to waive any other provision of law 

18 governing the apportionment of funds. 

19 SEC. 109. Notwithstanding any other provision of 

20 this Act, except section 106, for those programs that 

21 would otherwise have high initial rates of operation or 

22 complete distribution of appropriations at the beginning 

23 of fiscal year 2020 because of distributions of funding to 

24 States, foreign countries, grantees, or others, such high 

25 initial rates of operation or complete distribution shall not 
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1 be made, and no grants shall be awarded for such pro2 grams funded by this Act that would impinge on final 

3 funding prerogatives. 

4 SEC. 110. This Act shall be implemented so that only 

5 the most limited funding action of that permitted in the 

6 Act shall be taken in order to provide for continuation of 

7 projects and activities. 

8 SEC. 111. (a) For entitlements and other mandatory 

9 payments whose budget authority was provided in appro10 priations Acts for fiscal year 2019, and for activities under 

11 the Food and Nutrition Act of 2008, activities shall be 

12 continued at the rate to maintain program levels under 

13 current law, under the authority and conditions provided 

14 in the applicable appropriations Act for fiscal year 2019, 

15 to be continued through the date specified in section 

16 106(3). 

17 (b) Notwithstanding section 106, obligations for man18 datory payments due on or about the first day of any 

19 month that begins after October 2019 but not later than 

20 30 days after the date specified in section 106(3) may con21 tinue to be made, and funds shall be available for such 

22 payments. 

23 SEC. 112. Amounts made available under section 101 

24 for civilian personnel compensation and benefits in each 

25 department and agency may be apportioned up to the rate 
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1 for operations necessary to avoid furloughs within such de2 partment or agency, consistent with the applicable appro3 priations Act for fiscal year 2019, except that such author4 ity provided under this section shall not be used until after 

5 the department or agency has taken all necessary actions 

6 to reduce or defer non-personnel-related administrative ex7 penses. 

8 SEC. 113. Funds appropriated by this Act may be 

9 obligated and expended notwithstanding section 10 of 

10 Public Law 91–672 (22 U.S.C. 2412), section 15 of the 

11 State Department Basic Authorities Act of 1956 (22 

12 U.S.C. 2680), section 313 of the Foreign Relations Au13 thorization Act, Fiscal Years 1994 and 1995 (22 U.S.C. 

14 6212), and section 504(a)(1) of the National Security Act 

15 of 1947 (50 U.S.C. 3094(a)(1)). 

16 SEC. 114. (a) Each amount incorporated by reference 

17 in this Act that was previously designated by the Congress 

18 for Overseas Contingency Operations/Global War on Ter19 rorism or as an emergency requirement pursuant to sec20 tion 251(b)(2)(A) of the Balanced Budget and Emergency 

21 Deficit Control Act of 1985 or as being for disaster relief 

22 pursuant to section 251(b)(2)(D) of such Act is des23 ignated by the Congress for Overseas Contingency Oper24 ations/Global War on Terrorism or as an emergency re25 quirement pursuant to section 251(b)(2)(A) of such Act 
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1 or as being for disaster relief pursuant to section 

2 251(b)(2)(D) of such Act, respectively. 

3 (b) Section 5 of Public Law 116–6 shall apply to 

4 amounts designated in subsection (a) and section 124 of 

5 this Act for Overseas Contingency Operations/Global War 

6 on Terrorism. 

7 (c) This section shall become effective immediately 

8 upon enactment of this Act, and shall remain in effect 

9 through the date in section 106(3). 

10 SEC. 115. (a) Rescissions or cancellations of discre11 tionary budget authority that continue pursuant to section 

12 101 in Treasury Appropriations Fund Symbols (TAFS)— 

13 (1) to which other appropriations are not pro14 vided by this Act, but for which there is a current 

15 applicable TAFS that does receive an appropriation 

16 in this Act; or 

17 (2) which are no-year TAFS and receive other 

18 appropriations in this Act, 

19 may be continued instead by reducing the rate for oper20 ations otherwise provided by section 101 for such current 

21 applicable TAFS, as long as doing so does not impinge 

22 on the final funding prerogatives of the Congress. 

23 (b) Rescissions or cancellations described in sub24 section (a) shall continue in an amount equal to the lesser 

25 of— 
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1 (1) the amount specified for rescission or can2 cellation in the applicable appropriations Act ref3 erenced in section 101 of this Act; or 

4 (2) the amount of balances available, as of Oc5 tober 1, 2019, from the funds specified for rescission 

6 or cancellation in the applicable appropriations Act 

7 referenced in section 101 of this Act. 

8 (c) No later than November 11, 2019, the Director 

9 of the Office of Management and Budget shall provide to 

10 the Committees on Appropriations of the House of Rep11 resentatives and the Senate a comprehensive list of the 

12 rescissions or cancellations that will continue pursuant to 

13 section 101: Provided, That the information in such com14 prehensive list shall be periodically updated to reflect any 

15 subsequent changes in the amount of balances available, 

16 as of October 1, 2019, from the funds specified for rescis17 sion or cancellation in the applicable appropriations Act 

18 referenced in section 101, and such updates shall be trans19 mitted to the Committees on Appropriations of the House 

20 of Representatives and the Senate upon request. 

21 SEC. 116. Title I of the Additional Supplemental Ap22 propriations for Disaster Relief Act, 2019 (Public Law 

23 116–20) is amended in the matter under the heading ‘‘De24 partment of Agriculture—Office of the Secretary’’ by in25 serting ‘‘to cooperative processors for reduced quantity 
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1 and quality sugar beets,’’ after ‘‘planting in 2019,’’: Pro2 vided, That amounts repurposed pursuant to this section 

3 that were previously designated by the Congress as an 

4 emergency requirement pursuant to the Balanced Budget 

5 and Emergency Deficit Control Act of 1985 are des6 ignated by the Congress as an emergency requirement 

7 pursuant to section 251(b)(2)(A)(i) of the Balanced Budg8 et and Emergency Deficit Control Act of 1985 and shall 

9 be available only if the President subsequently so des10 ignates all such amounts and transmits such designations 

11 to the Congress. 

12 SEC. 117. The Secretary of Agriculture may waive 

13 the matching funds requirement under Section 412(g) of 

14 the Agricultural Research, Extension, and Education Re15 form Act of 1998 (7 U.S.C. 7632(g)). 

16 SEC. 118. Amounts made available by section 101 for 

17 ‘‘Department of Agriculture—Food and Nutrition Serv18 ice—Child Nutrition Programs’’ to carry out section 

19 749(g) of the Agriculture, Rural Development, Food and 

20 Drug Administration, and Related Agencies Appropria21 tions Act, 2010 (Public Law 111–80) may be apportioned 

22 up to the rate for operations necessary to ensure that the 

23 program can be fully operational by May 2020. 

24 SEC. 119. Amounts provided by section 111 to the 

25 Department of Agriculture for ‘‘Corporations—Com-
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1 modity Credit Corporation Fund—Reimbursement for Net 

2 Realized Losses’’ may be used, prior to the completion of 

3 the report described in section 2 of the Act of August 17, 

4 1961 (15 U.S.C. 713a–11), to reimburse the Commodity 

5 Credit Corporation for net realized losses sustained, but 

6 not previously reimbursed, as of September 17, 2019: Pro7 vided, That the Secretary of Agriculture shall submit a 

8 report, no later than October 31, 2019, to the Committees 

9 on Appropriations and Agriculture of both Houses of Con10 gress, including estimates for all Market Facilitation Pro11 gram payments, in calendar year 2018 and 2019 and pro12 jected payments in calendar year 2020 resulting from the 

13 calendar year 2019 program that include State-by-State, 

14 commodity-by-commodity, including specialty crops, anal15 ysis of the trade damage caused by retaliatory tariffs and 

16 separately by non-tariff trade barriers, including dumping, 

17 on U.S. agricultural producers, and an accounting of any 

18 commodity purchases made from substantially foreign19 owned companies or their subsidiaries. 

20 SEC. 120. In addition to amounts provided by section 

21 101, amounts are provided for ‘‘Department of Agri22 culture—Agricultural Marketing Service—Marketing 

23 Services’’ at a rate for operations of $16,496,000 to con24 tinue the implementation of the Hemp Production Pro25 gram (section 10113 of Public Law 115–334). 
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1 SEC. 121. Amounts made available by section 101 for 

2 ‘‘International Trade Commission—Salaries and Ex3 penses’’ may be apportioned up to the rate for operations 

4 necessary to carry out responsibilities under the American 

5 Manufacturing Competitiveness Act of 2016 (Public Law 

6 114–159). 

7 SEC. 122. Amounts made available by section 101 to 

8 the Department of Commerce for ‘‘Bureau of the Cen9 sus—Periodic Censuses and Programs’’ may be appor10 tioned up to the rate for operations necessary to maintain 

11 the schedule and deliver the required data according to 

12 the statutory deadlines in the 2020 Decennial Census Pro13 gram. 

14 SEC. 123. Notwithstanding section 2208(l)(3) of title 

15 10, United States Code, during the period covered by this 

16 Act, any advanced billing for background investigation 

17 services and related services purchased from activities fi18 nanced using Defense Working Capital Funds shall be ex19 cluded from the calculation of cumulative advance billings 

20 under section 2208(l)(3) of such title. In the preceding 

21 sentence, the term ‘‘advance billing’’ has the meaning 

22 given the term in section 2208(l)(4) of such title. 

23 SEC. 124. (a) The remaining unobligated balances of 

24 funds as of September 30, 2019, from amounts provided 

25 by section 9013 of division A of Public Law 115–245 are 
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1 hereby rescinded: Provided, That such amounts that were 

2 previously designated by the Congress as being for Over3 seas Contingency Operations/Global War on Terrorism 

4 pursuant to section 251(b)(2)(A)(ii) of the Balanced 

5 Budget and Emergency Deficit Control Act of 1985 are 

6 designated by the Congress as being for Overseas Contin7 gency Operations/Global War on Terrorism pursuant to 

8 that section of that Act. 

9 (b) In addition to the amount otherwise provided by 

10 section 101 for the ‘‘Ukraine Security Assistance Initia11 tive’’, there is appropriated on September 30, 2019, for 

12 an additional amount for fiscal year 2019, an amount 

13 equal to the unobligated balances rescinded pursuant to 

14 subsection (a) of this section: Provided, That amounts 

15 made available pursuant to this subsection shall remain 

16 available until September 30, 2020, and shall be available 

17 for the same purposes and under the same authorities for 

18 which they were originally provided in Public Law 115– 

19 245: Provided further, That such amount is designated by 

20 the Congress as being for Overseas Contingency Oper21 ations/Global War on Terrorism pursuant to section 

22 251(b)(2)(A)(ii) of the Balanced Budget and Emergency 

23 Deficit Control Act of 1985. 

24 (c) This section shall become effective immediately 

25 upon enactment of this Act. 
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1 (d) If this Act is enacted after September 30, 2019, 

2 or if the designation in subsection 114(b) occurs after Sep3 tember 30, 2019, this section shall be applied as if it were 

4 in effect on September 30, 2019. 

5 SEC. 125. (a) No funds shall be transferred directly 

6 from ‘‘Department of Energy—Power Marketing Admin7 istration—Colorado River Basins Power Marketing Fund, 

8 Western Area Power Administration’’ to the general fund 

9 of the Treasury in fiscal year 2019. 

10 (b) This section shall become effective immediately 

11 upon enactment of this Act. 

12 SEC. 126. During the period covered by this Act, title 

13 I of Public Law 108–361, as amended (the Calfed Bay14 Delta Authorization Act) (118 Stat. 1681), shall be ap15 plied by substituting ‘‘2020’’ for ‘‘2019’’ each place it ap16 pears. 

17 SEC. 127. Notwithstanding section 101, title I of divi18 sion D of Public Law 116–6 shall be applied by adding 

19 the following new heading and appropriation language 

20 under the heading ‘‘Department of the Treasury—Depart21 mental Offices’’: 

22 ‘‘COMMITTEE ON FOREIGN INVESTMENT IN 

23 THE UNITED STATES FUND 

24 ‘‘For necessary expenses of the Committee on For25 eign Investment in the United States, $15,000,000, to re-
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1 main available until expended: Provided, That the chair2 person of the Committee may transfer such amounts to 

3 any department or agency represented on the Committee 

4 (including the Department of the Treasury) subject to ad5 vance notification to the Committees on Appropriations of 

6 the House of Representatives and the Senate: Provided 

7 further, That amounts so transferred shall remain avail8 able until expended for expenses of implementing section 

9 721 of the Defense Production Act of 1950, as amended 

10 (50 U.S.C. 4565), and shall be available in addition to 

11 any other funds available to any department or agency: 

12 Provided further, That fees authorized by section 721(p) 

13 of such Act shall be credited to this appropriation as off14 setting collections: Provided further, That the total amount 

15 appropriated pursuant to this section from the general 

16 fund shall be reduced as such offsetting collections are re17 ceived during this fiscal year, so as to result in a total 

18 appropriation from the general fund estimated at not more 

19 than $5,000,000.’’. 

20 SEC. 128. Notwithstanding any other provision of 

21 this Act, except section 106, the District of Columbia may 

22 expend local funds made available under the heading ‘‘Dis23 trict of Columbia—District of Columbia Funds’’ for such 

24 programs and activities under the District of Columbia 

25 Appropriations Act, 2019 (title IV of division D of Public 
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1 Law 116–6) at the rate set forth in the Fiscal Year 2020 

2 Local Budget Act of 2019 (D.C. Act 23–78), as modified 

3 as of the date of enactment of this Act. 

4 SEC. 129. In addition to amounts provided by section 

5 101, amounts are provided to the Office of Personnel 

6 Management for ‘‘Salaries and Expenses’’ at a rate for 

7 operations of $48,000,000, for an additional amount for 

8 administrative expenses: Provided, That of such amounts, 

9 $29,760,000 shall be transferred from the appropriate 

10 trust funds of the Office without regard to any other pro11 vision of law: Provided further, That such amounts may 

12 be apportioned up to the rate for operations necessary to 

13 maintain agency operations. 

14 SEC. 130. Notwithstanding section 101, the matter 

15 preceding the first proviso under the heading ‘‘Small Busi16 ness Administration—Business Loans Program Account’’ 

17 in title V of division D of Public Law 116–6 shall be ap18 plied as if the following were inserted before the colon: 

19 ‘‘, and for the cost of guaranteed loans as authorized by 

20 section 7(a) of the Small Business Act (Public Law 83– 

21 163), $99,000,000, to remain available until expended’’: 

22 Provided, That amounts made available under such head23 ing by this Act may be apportioned up to the rate for oper24 ations necessary to accommodate increased demand for 
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1 commitments for general business loans authorized under 

2 section 7(a) of the Small Business Act (15 U.S.C. 636(a)). 

3 SEC. 131. Notwithstanding section 101, amounts are 

4 provided for ‘‘Small Business Administration—Disaster 

5 Loans Program Account’’ at a rate for operations of 

6 $177,136,000: Provided, That amounts made available 

7 under such heading by this Act may be apportioned up 

8 to the rate for operations necessary to accommodate in9 creased demand for commitments for disaster administra10 tive expenses authorized under section 20(a) of the Small 

11 Business Act (15 U.S.C. 631): Provided further, That the 

12 language under such heading in title V of division D of 

13 Public Law 116–6 shall be applied by— 

14 (1) substituting ‘‘$1,600,000’’ for 

15 ‘‘$1,000,000’’; 

16 (2) substituting ‘‘$8,400,000’’ for 

17 ‘‘$9,000,000’’; and 

18 (3) inserting the following before the period: ‘‘; 

19 and of which $167,136,000 is for direct administra20 tive expenses of loan making and servicing to carry 

21 out the direct loan program, which may be trans22 ferred to and merged with the appropriations for 

23 Salaries and Expenses: Provided, That, of the funds 

24 provided under this heading, $150,888,000 shall be 

25 for major disasters declared pursuant to the Robert 
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1 T. Stafford Disaster Relief and Emergency Assist2 ance Act (42 U.S.C. 5122(2)): Provided further, 

3 That the amount for major disasters under this 

4 heading is designated by Congress as being for dis5 aster relief pursuant to section 251(b)(2)(D) of the 

6 Balanced Budget and Emergency Deficit Control 

7 Act of 1985 (Public Law 99–177)’’. 

8 SEC. 132. Amounts made available by section 101 to 

9 the Department of Homeland Security for ‘‘United States 

10 Secret Service—Operations and Support’’ may be appor11 tioned up to the rate for operations necessary to support 

12 hiring and operations required for protective activities as13 sociated with the 2020 presidential election campaign. 

14 SEC. 133. Amounts made available by section 101 to 

15 the Department of Homeland Security for ‘‘Federal Emer16 gency Management Agency—Disaster Relief Fund’’ may 

17 be apportioned up to the rate for operations necessary to 

18 carry out response and recovery activities under the Rob19 ert T. Stafford Disaster Relief and Emergency Assistance 

20 Act (42 U.S.C. 5121 et seq.). 

21 SEC. 134. (a) Sections 1309(a) and 1319 of the Na22 tional Flood Insurance Act of 1968 (42 U.S.C. 4016(a) 

23 and 4026) shall be applied by substituting the date speci24 fied in section 106(3) of this Act for ‘‘September 30, 

25 2019’’. 
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1 (b) If this Act is enacted after September 30, 2019, 

2 this section shall be applied as if it were in effect on Sep3 tember 30, 2019. 

4 SEC. 135. Amounts made available by section 101 to 

5 the Department of Homeland Security for ‘‘Office of the 

6 Secretary and Executive Management—Operations and 

7 Support’’, ‘‘Management Directorate—Operations and 

8 Support’’, and ‘‘Intelligence, Analysis, and Operations Co9 ordination—Operations and Support’’ may be apportioned 

10 up to the rate for operations necessary to carry out activi11 ties previously funded by the Working Capital Fund of 

12 the Department of Homeland Security, consistent with the 

13 fiscal year 2020 President’s Budget. 

14 SEC. 136. (a) In addition to amounts provided by sec15 tion 101, amounts are provided to the ‘‘Department of 

16 Health and Human Services—Indian Health Service—In17 dian Health Services’’ at a rate for operations of 

18 $18,397,500, for an additional amount for costs of staff19 ing and operating facilities that were opened, renovated, 

20 or expanded in fiscal years 2019 and 2020, and such 

21 amounts may be apportioned up to the rate for operations 

22 necessary to staff and operate such facilities. 

23 (b) In addition to amounts provided by section 101, 

24 amounts are provided for ‘‘Department of Health and 

25 Human Services—Indian Health Service—Indian Health 
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1 Facilities’’ at a rate for operations of $631,000, for an 

2 additional amount for costs of staffing and operating fa3 cilities that were opened, renovated, or expanded in fiscal 

4 years 2019 and 2020, and such amounts may be appor5 tioned up to the rate for operations necessary to staff and 

6 operate such facilities. 

7 SEC. 137. Amounts made available by section 101 to 

8 the Department of Health and Human Services for ‘‘Cen9 ters for Disease Control and Prevention—Public Health 

10 Preparedness and Response’’ and ‘‘Office of the Sec11 retary—Public Health and Social Services Emergency 

12 Fund’’ may be obligated in the account and budget struc13 ture, and under the authorities and conditions, set forth 

14 in H.R. 2740, as passed by the U.S. House of Representa15 tives on June 19, 2019. 

16 SEC. 138. During the period covered by this Act, up 

17 to $20,000,000 of the unobligated amounts in the Infec18 tious Diseases Rapid Response Reserve Fund established 

19 by section 231 of division B of Public Law 115–245 may 

20 be transferred to ‘‘Department of Health and Human 

21 Services—Centers for Disease Control and Prevention— 

22 CDC–Wide Activities and Program Support’’ and shall be 

23 available until expended for Ebola preparedness and re24 sponse activities without regard to the limitations in the 

25 third proviso in such section 231: Provided, That the Di-
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1 rector of the Centers for Disease Control and Prevention 

2 may transfer such amounts to any of the appropriations 

3 accounts under the heading ‘‘Centers for Disease Control 

4 and Prevention’’ for Ebola response activities: Provided 

5 further, That such transfer authority shall be in addition 

6 to any other transfer authority provided to the Depart7 ment of Health and Human Services. 

8 SEC. 139. Section 114(f) of the Higher Education 

9 Act of 1965 (20 U.S.C. 1011c(f)) shall be applied by sub10 stituting the date specified in section 106(3) of this Act 

11 for ‘‘September 30, 2019’’. 

12 SEC. 140. Amounts made available by section 101 for 

13 ‘‘Department of Veterans Affairs—Veterans Benefits Ad14 ministration—General Operating Expenses, Veterans 

15 Benefits Administration’’ and ‘‘Department of Veterans 

16 Affairs—Departmental Administration—Information 

17 Technology Systems’’ may be apportioned up to the rate 

18 for operations necessary to support projects and activities 

19 created by the Blue Water Navy Vietnam Veterans Act 

20 of 2019 (Public Law 116–23). 

21 SEC. 141. Section 7 of the Export-Import Bank Act 

22 of 1945 (12 U.S.C. 635f) shall be applied by substituting 

23 the date specified in section 106(3) of this Act for ‘‘Sep24 tember 30, 2019’’. 
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1 SEC. 142. Section 209 of the International Religious 

2 Freedom Act of 1998 (22 U.S.C. 6436) shall be applied 

3 by substituting the date specified in section 106(3) of this 

4 Act for ‘‘September 30, 2019’’. 

5 SEC. 143. Title I of division L of Public Law 115– 

6 141 and title I of division G of Public Law 116–6 shall 

7 be amended in the first provisos in each Act under the 

8 headings ‘‘Department of Transportation—Federal Tran9 sit Administration—Capital Investment Grants’’ by strik10 ing ‘‘obligated’’ and inserting ‘‘allocated’’. 

11 SEC. 144. Section 9503(e)(4) of the Internal Revenue 

12 Code of 1986 shall not apply during the period covered 

13 by this Act. 

14 SEC. 145. Amounts made available by section 101 to 

15 the Department of Housing and Urban Development for 

16 ‘‘Housing Programs—Housing for the Elderly’’ may be 

17 apportioned up to the rate for operations necessary to 

18 maintain project rental assistance for the elderly under 

19 section 202(c)(2) of the Housing Act of 1959 (12 U.S.C. 

20 1701q(c)(2)), including making amendments to contracts 

21 for such assistance and renewing expiring contracts for 

22 such assistance for up to a 1-year term. 

23 This division may be cited as the ‘‘Continuing Appro24 priations Act, 2020’’. 
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1 DIVISION B—HEALTH AND 

2 HUMAN SERVICES EXTEND3 ERS AND OTHER MATTERS 

4 TITLE I—PUBLIC HEALTH 

5 EXTENDERS 

6 SEC. 1101. EXTENSION FOR COMMUNITY HEALTH CENTERS, 

7 THE NATIONAL HEALTH SERVICE CORPS, 

8 AND TEACHING HEALTH CENTERS THAT OP9 ERATE GME PROGRAMS. 

10 (a) COMMUNITY HEALTH CENTERS.—Section 

11 10503(b)(1)(F) of the Patient Protection and Affordable 

12 Care Act (42 U.S.C. 254b–2(b)(1)(F)) is amended by 

13 striking ‘‘2018 and $4,000,000,000 for fiscal year 2019.’’ 

14 and inserting ‘‘2018, $4,000,000,000 for fiscal year 2019, 

15 and $569,863,014 for the period beginning on October 1, 

16 2019, and ending on November 21, 2019; and’’. 

17 (b) NATIONAL HEALTH SERVICE CORPS.—Section 

18 10503(b)(2) of the Patient Protection and Affordable 

19 Care Act (42 U.S.C. 254b–2(b)(2)) is amended— 

20 (1) in subparagraph (E), by striking ‘‘; and’’ 

21 and inserting a semicolon; 

22 (2) in subparagraph (F), by striking the period 

23 at the end and inserting ‘‘; and’’; and 

24 (3) by adding at the end the following: 
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1 ‘‘(G) $44,164,384 for the period beginning 

2 on October 1, 2019, and ending on November 

3 21, 2019.’’. 

4 (c) TEACHING HEALTH CENTERS THAT OPERATE

5 GRADUATE MEDICAL EDUCATION PROGRAMS.—Section 

6 340H(g)(1) of the Public Health Service Act (42 U.S.C. 

7 256h(g)(1)) is amended— 

8 (1) by striking ‘‘and $126,500,000’’ and insert9 ing ‘‘$126,500,000’’; and 

10 (2) by inserting ‘‘and $18,021,918 for the pe11 riod beginning on October 1, 2019, and ending on 

12 November 21, 2019,’’ before ‘‘to remain available’’. 

13 (d) APPLICATION OF PROVISIONS.—Amounts appro14 priated pursuant to this section for the period beginning 

15 on October 1, 2019, and ending on November 21, 2019, 

16 shall be subject to the requirements contained in Public 

17 Law 115–245 for funds for programs authorized under 

18 sections 330 through 340 of the Public Health Service Act 

19 (42 U.S.C. 254 through 256). 

20 (e) CONFORMING AMENDMENT.—Paragraph (4) of 

21 section 3014(h) of title 18, United States Code, as amend22 ed by section 50901 of Public Law 115–123, is amended 

23 by striking ‘‘and section 50901(e) of the Advancing 

24 Chronic Care, Extenders, and Social Services Act’’ and in25 serting ‘‘, section 50901(e) of the Advancing Chronic 
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1 Care, Extenders, and Social Services Act, and section 

2 1101(d) of division B of the Continuing Appropriations 

3 Act, 2020, and Health Extenders Act of 2019’’. 

4 SEC. 1102. DIABETES PROGRAMS. 

5 (a) TYPE I.—Section 330B(b)(2)(D) of the Public 

6 Health Service Act (42 U.S.C. 254c–2(b)(2)(D)) is 

7 amended by inserting ‘‘and $21,369,863 for the period be8 ginning on October 1, 2019, and ending on November 21, 

9 2019,’’ before ‘‘to remain available’’. 

10 (b) INDIANS.—Section 330C(c)(2)(D) of the Public 

11 Health Service Act (42 U.S.C. 254c–3(c)(2)(D)) is 

12 amended by inserting ‘‘and $21,369,863 for the period be13 ginning on October 1, 2019, and ending on November 21, 

14 2019,’’ before ‘‘to remain available’’. 

15 TITLE II—OTHER HEALTH 

16 EXTENDERS 

17 SEC. 1201. EXTENSION OF SEXUAL RISK AVOIDANCE EDU18 CATION PROGRAM. 

19 Section 510 of the Social Security Act (42 U.S.C. 

20 710) is amended— 

21 (1) in subsection (a)— 

22 (A) in paragraph (1)— 

23 (i) in the matter preceding subpara24 graph (A)— 
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1 (I) by inserting after ‘‘for each of 

2 fiscal years 2018 and 2019’’ the fol3 lowing: ‘‘and for the period beginning 

4 October 1, 2019, and ending Novem5 ber 21, 2019’’; and 

6 (II) by inserting after ‘‘for the 

7 fiscal year’’ the following: ‘‘(or, with 

8 respect to such period, for fiscal year 

9 2020)’’; and 

10 (ii) in subparagraph (A), by striking 

11 ‘‘for the fiscal year’’ each place it appears 

12 and inserting ‘‘for the fiscal year or pe13 riod’’ in each such place; and 

14 (B) in paragraph (2)— 

15 (i) in subparagraph (A)— 

16 (I) by inserting after ‘‘for each of 

17 fiscal years 2018 and 2019’’ the fol18 lowing: ‘‘and for the period beginning 

19 October 1, 2019, and ending Novem20 ber 21, 2019’’; and 

21 (II) by inserting after ‘‘for the 

22 fiscal year’’ the following: ‘‘(or, with 

23 respect to such period, for fiscal year 

24 2020)’’; and 
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1 (ii) in subparagraph (B)(i), by insert2 ing after ‘‘for the fiscal year’’ the fol3 lowing: ‘‘(or, with respect to such period, 

4 for fiscal year 2020)’’; and 

5 (2) in subsection (f)— 

6 (A) in paragraph (1), by inserting after 

7 ‘‘for each of fiscal years 2018 and 2019’’ the 

8 following: ‘‘and $10,684,931 for the period be9 ginning October 1, 2019, and ending November 

10 21, 2019’’; and 

11 (B) in paragraph (2), by inserting after 

12 ‘‘for each of fiscal years 2018 and 2019’’ the 

13 following: ‘‘and for the period described in para14 graph (1)’’. 

15 SEC. 1202. EXTENSION OF PERSONAL RESPONSIBILITY 

16 EDUCATION PROGRAM. 

17 Section 513 of the Social Security Act (42 U.S.C. 

18 713) is amended— 

19 (1) in subsection (a)— 

20 (A) in paragraph (1)— 

21 (i) in subparagraph (A)— 

22 (I) in the matter preceding clause 

23 (i), by inserting after ‘‘for each of fis24 cal years 2010 through 2019’’ the fol25 lowing: ‘‘and for the period beginning 
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1 October 1, 2019, and ending Novem2 ber 21, 2019’’; and 

3 (II) in clause (i), by inserting 

4 after ‘‘for the fiscal year’’ the fol5 lowing: ‘‘or period’’; 

6 (ii) in subparagraph (B)(i), by adding 

7 at the end the following new sentence: 

8 ‘‘The previous sentence shall not apply 

9 with respect to State allotments under this 

10 paragraph for the period beginning Octo11 ber 1, 2019, and ending November 21, 

12 2019.’’; and 

13 (iii) in subparagraph (C)(i)— 

14 (I) by inserting after ‘‘for a fiscal 

15 year’’ the following: ‘‘or the period de16 scribed in subparagraph (A)’’; and 

17 (II) by inserting after ‘‘for the 

18 fiscal year’’ the following: ‘‘or period’’; 

19 (B) in paragraph (3)— 

20 (i) by inserting after ‘‘for a fiscal 

21 year’’ the following: ‘‘or the period de22 scribed in paragraph (1)(A)’’; and 

23 (ii) by striking ‘‘the end of the second 

24 succeeding fiscal year’’ and inserting ‘‘the 
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1 end of the second fiscal year following such 

2 fiscal year or period’’; and 

3 (C) in paragraph (4)— 

4 (i) in subparagraph (A)— 

5 (I) by inserting after ‘‘for each of 

6 fiscal years 2010 through 2019’’ the 

7 following: ‘‘and for the period de8 scribed in paragraph (1)(A)’’; 

9 (II) by inserting after ‘‘for each 

10 of fiscal years 2012 through 2019’’ 

11 the following: ‘‘and for the period so 

12 described’’; and 

13 (III) by inserting after ‘‘for a fis14 cal year’’ the following: ‘‘or the period 

15 so described’’; and 

16 (ii) in subparagraph (B)(i), by strik17 ing ‘‘continue through fiscal year 2019’’ 

18 and inserting ‘‘continue through the period 

19 described in paragraph (1)(A)’’; 

20 (2) in subsection (c)— 

21 (A) in paragraph (1), by striking ‘‘From 

22 the amount’’ and inserting ‘‘Subject to para23 graph (3), from the amount’’; 
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1 (B) in paragraph (2), by striking ‘‘From 

2 the amount’’ and inserting ‘‘Subject to para3 graph (3), from the amount’’; and 

4 (C) by adding at the end the following new 

5 paragraph: 

6 ‘‘(3) EXCEPTION.—Paragraphs (1) and (2) 

7 shall not apply with respect to any amount appro8 priated under subsection (f) for the period described 

9 in subsection (a)(1)(A).’’; and 

10 (3) in subsection (f), by inserting after ‘‘for 

11 each of fiscal years 2010 through 2019’’ the fol12 lowing: ‘‘and $10,684,931 for the period beginning 

13 October 1, 2019, and ending November 21, 2019’’. 

14 TITLE III—MEDICAID 

15 EXTENDERS 

16 SEC. 1301. EXTENSION OF COMMUNITY MENTAL HEALTH 

17 SERVICES DEMONSTRATION PROGRAM. 

18 Section 223(d)(3) of the Protecting Access to Medi19 care Act of 2014 (42 U.S.C. 1396a note) is amended by 

20 striking ‘‘September 13, 2019’’ and inserting ‘‘November 

21 21, 2019’’. 
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1 SEC. 1302. TEMPORARY INCREASE IN FEDERAL MEDICAL 

2 ASSISTANCE PERCENTAGE FOR TERRITORIES 

3 UNDER MEDICAID PROGRAM. 

4 Section 1905 of the Social Security Act (42 U.S.C. 

5 1396d) is amended— 

6 (1) in subsection (b), by striking ‘‘and (aa)’’ 

7 and inserting ‘‘(aa), and (ff)’’; and 

8 (2) by adding at the end the following new sub9 section: 

10 ‘‘(ff) TEMPORARY INCREASE IN FMAP FOR TERRI11 TORIES.—Notwithstanding subsection (b) or (z)(2), the 

12 Federal medical assistance percentage for Puerto Rico, the 

13 Virgin Islands, Guam, the Northern Mariana Islands, and 

14 American Samoa shall be equal to 100 percent for the pe15 riod beginning October 1, 2019, and ending November 21, 

16 2019.’’. 

17 SEC. 1303. DELAY OF REDUCTIONS IN MEDICAID DSH AL18 LOTMENTS. 

19 Section 1923(f)(7)(A) of the Social Security Act (42 

20 U.S.C. 1396r–4(f)(7)(A)) is amended— 

21 (1) in clause (i), in the matter preceding sub22 clause (I), by striking ‘‘For each of fiscal years 2020 

23 through 2025’’ and inserting ‘‘For the period begin24 ning November 22, 2019, and ending September 30, 

25 2020, and for each of fiscal years 2021 through 

26 2025’’; and 
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1 (2) in clause (ii)(I), by striking ‘‘for fiscal year 

2 2020’’ and inserting ‘‘for the period beginning No3 vember 22, 2019, and ending September 30, 2020’’. 

4 TITLE IV—MEDICARE 

5 EXTENDERS 

6 SEC. 1401. EXTENSION OF FUNDING FOR QUALITY MEAS7 URE ENDORSEMENT, INPUT, AND SELECTION. 

8 Section 1890(d)(2) of the Social Security Act (42 

9 U.S.C. 1395aaa(d)(2)) is amended— 

10 (1) in the first sentence— 

11 (A) by striking ‘‘and $7,500,000’’ and in12 serting ‘‘$7,500,000’’; and 

13 (B) by inserting before the period at the 

14 end the following: ‘‘, and $1,069,000 for the pe15 riod beginning on October 1, 2019, and ending 

16 on November 21, 2019’’; and 

17 (2) in the third sentence, by inserting ‘‘and for 

18 the period beginning on October 1, 2019, and ending 

19 on November 21, 2019,’’ after ‘‘2019’’. 

20 SEC. 1402. EXTENSION OF FUNDING OUTREACH AND AS21 SISTANCE FOR LOW-INCOME PROGRAMS. 

22 (a) ADDITIONAL FUNDING FOR STATE HEALTH IN23 SURANCE PROGRAMS.—Subsection (a)(1)(B) of section 

24 119 of the Medicare Improvements for Patients and Pro25 viders Act of 2008 (42 U.S.C. 1395b–3 note), as amended 
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1 by section 3306 of the Patient Protection and Affordable 

2 Care Act (Public Law 111–148), section 610 of the Amer3 ican Taxpayer Relief Act of 2012 (Public Law 112–240), 

4 section 1110 of the Pathway for SGR Reform Act of 2013 

5 (Public Law 113–67), section 110 of the Protecting Ac6 cess to Medicare Act of 2014 (Public Law 113–93), sec7 tion 208 of the Medicare Access and CHIP Reauthoriza8 tion Act of 2015 (Public Law 114–10), and section 50207 

9 of division E of the Bipartisan Budget Act of 2018 (Public 

10 Law 115–123), is amended— 

11 (1) in clause (vii), by striking ‘‘and’’ at the end; 

12 (2) in clause (viii), by striking ‘‘and’’ at the 

13 end; 

14 (3) in clause (ix), by striking the period at the 

15 end and inserting ‘‘; and’’; and 

16 (4) by inserting after clause (ix) the following 

17 new clause: 

18 ‘‘(x) for the period beginning on Octo19 ber 1, 2019, and ending on November 21, 

20 2019, of $1,852,000.’’. 

21 (b) ADDITIONAL FUNDING FOR AREA AGENCIES ON

22 AGING.—Subsection (b)(1)(B) of such section 119, as so 

23 amended, is amended— 

24 (1) in clause (vii), by striking ‘‘and’’ at the end; 
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1 (2) in clause (viii), by striking ‘‘and’’ at the 

2 end; 

3 (3) in clause (ix), by striking the period at the 

4 end and inserting ‘‘; and’’; and 

5 (4) by inserting after clause (ix) the following 

6 new clause: 

7 ‘‘(x) for the period beginning on Octo8 ber 1, 2019, and ending on November 21, 

9 2019, of $1,069,000.’’. 

10 (c) ADDITIONAL FUNDING FOR AGING AND DIS11 ABILITY RESOURCE CENTERS.—Subsection (c)(1)(B) of 

12 such section 119, as so amended, is amended— 

13 (1) in clause (vii), by striking ‘‘and’’ at the end; 

14 (2) in clause (viii), by striking ‘‘and’’ at the 

15 end; 

16 (3) in clause (ix), by striking the period at the 

17 end and inserting ‘‘; and’’; and 

18 (4) by inserting after clause (ix) the following 

19 new clause: 

20 ‘‘(x) for the period beginning on Octo21 ber 1, 2019, and ending on November 21, 

22 2019, of $712,000.’’. 

23 (d) ADDITIONAL FUNDING FOR CONTRACT WITH

24 THE NATIONAL CENTER FOR BENEFITS AND OUTREACH
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1 ENROLLMENT.—Subsection (d)(2) of such section 119, as 

2 so amended, is amended— 

3 (1) in clause (vii), by striking ‘‘and’’ at the end; 

4 (2) in clause (viii), by striking ‘‘and’’ at the 

5 end; 

6 (3) in clause (ix), by striking the period at the 

7 end and inserting ‘‘; and’’; and 

8 (4) by inserting after clause (ix) the following 

9 new clause: 

10 ‘‘(x) for the period beginning on Octo11 ber 1, 2019, and ending on November 21, 

12 2019, of $1,710,000.’’. 

13 SEC. 1403. EXTENSION OF TERMINATION DATE OF PATIENT14 CENTERED OUTCOMES RESEARCH TRUST 

15 FUND. 

16 Section 9511(f) of the Internal Revenue Code of 

17 1986 is amended by striking ‘‘September 30’’ and insert18 ing ‘‘November 21’’. 

19 TITLE V—HUMAN SERVICES 

20 EXTENDERS 

21 SEC. 1501. EXTENSION OF DEMONSTRATION PROJECTS TO 

22 ADDRESS HEALTH PROFESSIONS WORK23 FORCE NEEDS. 

24 Activities authorized by section 2008 of the Social Se25 curity Act shall continue through November 21, 2019, in 
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1 the manner authorized for fiscal year 2019, and out of 

2 any money in the Treasury of the United States not other3 wise appropriated, there are hereby appropriated such 

4 sums as may be necessary for such purpose. Grants and 

5 payments may be made pursuant to this authority through 

6 the date so specified at the pro rata portion of the total 

7 amount authorized for such activities in fiscal year 2019. 

8 SEC. 1502. EXTENSION OF THE TEMPORARY ASSISTANCE 

9 FOR NEEDY FAMILIES PROGRAM AND RE10 LATED PROGRAMS. 

11 Activities authorized by part A of title IV and section 

12 1108(b) of the Social Security Act shall continue through 

13 November 21, 2019, in the manner authorized for fiscal 

14 year 2019, and out of any money in the Treasury of the 

15 United States not otherwise appropriated, there are here16 by appropriated such sums as may be necessary for such 

17 purpose. 

18 TITLE VI—MISCELLANEOUS 

19 POLICIES 

20 SEC. 1601. ALASKA NATIVE REGIONAL HEALTH ENTITIES. 

21 Section 424(a) of the Consolidated Appropriations 

22 Act, 2014 (Public Law 113–76), as amended by section 

23 428 of the Consolidated Appropriations Act, 2018 (Public 

24 Law 115–141), shall be applied by substituting ‘‘Novem25 ber 21, 2019’’ for ‘‘October 1, 2019’’. 
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1 SEC. 1602. INCREASING NUMERICAL LIMITATIONS OF THE 

2 WORLD TRADE CENTER HEALTH PROGRAM. 

3 (a) WORLD TRADE CENTER RESPONDERS.—Section 

4 3311(a)(4)(A) of the Public Health Service Act (42 U.S.C. 

5 300mm–21(a)(4)(A)) is amended by striking ‘‘25,000’’ 

6 and inserting ‘‘75,000’’. 

7 (b) WORLD TRADE CENTER SURVIVORS.—Section 

8 3321(a)(3)(A) of the Public Health Service Act (42 U.S.C. 

9 300mm–31(a)(3)(A)) is amended by striking ‘‘25,000’’ 

10 and inserting ‘‘75,000’’. 

11 (c) RULE OF CONSTRUCTION REGARDING ANNUAL

12 FUNDING LIMITATIONS.—Nothing in this section, or the 

13 amendments made by this section, shall alter the annual 

14 limitations on amounts appropriated to the World Trade 

15 Center Health Program Fund under section 3351(a)(2) 

16 of the Public Health Service Act (42 U.S.C. 300mm– 

17 61(a)(2)). 

18 SEC. 1603. EXCLUDING AUTHORIZED GENERIC DRUGS 

19 FROM CALCULATION OF AVERAGE MANUFAC20 TURER PRICE FOR PURPOSES OF THE MED21 ICAID DRUG REBATE PROGRAM; EXCLUDING 

22 MANUFACTURERS FROM DEFINITION OF 

23 WHOLESALER. 

24 (a) IN GENERAL.—Subparagraph (C) of section 

25 1927(k)(1) of the Social Security Act (42 U.S.C. 1396r– 

26 8(k)(1)) is amended— 
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1 (1) in the subparagraph heading, by striking 

2 ‘‘INCLUSION’’ and inserting ‘‘EXCLUSION’’; 

3 (2) by striking ‘‘a new drug application’’ and 

4 inserting ‘‘the manufacturer’s new drug applica5 tion’’; and 

6 (3) by striking ‘‘inclusive’’ and inserting ‘‘exclu7 sive’’. 

8 (b) EXCLUDING MANUFACTURERS FROM DEFINI9 TION OF WHOLESALER.—Section 1927(k)(11) of the So10 cial Security Act (42 U.S.C. 1396r–8(k)(11)) is amend11 ed— 

12 (1) by striking ‘‘manufacturers,’’; and 

13 (2) by striking ‘‘manufacturer’s and’’. 

14 (c) EFFECTIVE DATE.—The amendments made by 

15 this section shall take effect on the first day of the first 

16 fiscal quarter that begins after the date of enactment of 

17 this Act. 

18 SEC. 1604. MEDICAID IMPROVEMENT FUND. 

19 Section 1941(b) of the Social Security Act (42 U.S.C. 

20 1396w–1(b)), as amended by section 2 of Public Law 

21 116–29, is amended— 

22 (1) in paragraph (1), by striking ‘‘$1,000,000’’ 

23 and inserting ‘‘$0’’; and 

24 (2) in paragraph (3)— 
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1 (A) by striking ‘‘2023’’ each place it ap2 pears and inserting ‘‘2025’’; and 

3 (B) in subparagraph (A), by striking ‘‘$0’’ 

4 and inserting ‘‘$2,387,000,000’’. 

5 TITLE VII—BUDGETARY 

6 EFFECTS 

7 SEC. 1701. BUDGETARY EFFECTS. 

8 (a) STATUTORY PAYGO SCORECARDS.—The budg9 etary effects of this division shall not be entered on either 

10 PAYGO scorecard maintained pursuant to section 4(d) of 

11 the Statutory Pay-As-You-Go Act of 2010. 

12 (b) SENATE PAYGO SCORECARDS.—The budgetary 

13 effects of this division shall not be entered on any PAYGO 

14 scorecard maintained for purposes of section 4106 of H. 

15 Con. Res. 71 (115th Congress). 

16 (c) CLASSIFICATION OF BUDGETARY EFFECTS.— 

17 Notwithstanding Rule 3 of the Budget Scorekeeping 

18 Guidelines set forth in the joint explanatory statement of 

19 the committee of conference accompanying Conference Re20 port 105–217 and section 250(c)(8) of the Balanced 

21 Budget and Emergency Deficit Control Act of 1985, the 

22 budgetary effects of this division shall not be estimated— 

23 (1) for purposes of section 251 of such Act; and 
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1 (2) for purposes of paragraph (4)(C) of section 

2 3 of the Statutory Pay-As-You-Go Act of 2010 as 

3 being included in an appropriation Act. 

Passed the House of Representatives September 19, 

2019. 

Attest: 

Clerk. 

116TH CONGRESS 

1ST SESSION H. R. 4378 

AN ACT 

Making continuing appropriations for fiscal year 

2020, and for other purposes.