H. R. 6157—100 
program support funding provided under the headings ‘‘Mental 
Health’’, ‘‘Substance Abuse Treatment’’, and ‘‘Substance Abuse 
Prevention’’. 
AGENCY FOR HEALTHCARE RESEARCH AND QUALITY 
HEALTHCARE RESEARCH AND QUALITY 
For carrying out titles III and IX of the PHS Act, part A 
of title XI of the Social Security Act, and section 1013 of the 
Medicare Prescription Drug, Improvement, and Modernization Act 
of 2003, $338,000,000: Provided, That section 947(c) of the PHS 
Act shall not apply in fiscal year 2019: Provided further, That 
in addition, amounts received from Freedom of Information Act 
fees, reimbursable and interagency agreements, and the sale of 
data shall be credited to this appropriation and shall remain avail-
able until September 30, 2020. 
CENTERS FOR MEDICARE & MEDICAID SERVICES 
GRANTS TO STATES FOR MEDICAID 
For carrying out, except as otherwise provided, titles XI and 
XIX of the Social Security Act, $276,236,212,000, to remain avail-
able until expended. 
For making, after May 31, 2019, payments to States under 
title XIX or in the case of section 1928 on behalf of States under 
title XIX of the Social Security Act for the last quarter of fiscal 
year 2019 for unanticipated costs incurred for the current fiscal 
year, such sums as may be necessary. 
For making payments to States or in the case of section 1928 
on behalf of States under title XIX of the Social Security Act 
for the first quarter of fiscal year 2020, $137,931,797,000, to remain 
available until expended. 
Payment under such title XIX may be made for any quarter 
with respect to a State plan or plan amendment in effect during 
such quarter, if submitted in or prior to such quarter and approved 
in that or any subsequent quarter. 
PAYMENTS TO THE HEALTH CARE TRUST FUNDS 
For payment to the Federal Hospital Insurance Trust Fund 
and the Federal Supplementary Medical Insurance Trust Fund, 
as provided under sections 217(g), 1844, and 1860D–16 of the Social 
Security Act, sections 103(c) and 111(d) of the Social Security 
Amendments of 1965, section 278(d)(3) of Public Law 97–248, and 
for administrative expenses incurred pursuant to section 201(g) 
of the Social Security Act, $378,343,800,000. 
In addition, for making matching payments under section 1844 
and benefit payments under section 1860D–16 of the Social Security 
Act that were not anticipated in budget estimates, such sums as 
may be necessary. 
PROGRAM MANAGEMENT 
For carrying out, except as otherwise provided, titles XI, XVIII, 
XIX, and XXI of the Social Security Act, titles XIII and XXVII 
of the PHS Act, the Clinical Laboratory Improvement Amendments
H. R. 6157—101 
of 1988, and other responsibilities of the Centers for Medicare 
& Medicaid Services, not to exceed $3,669,744,000, to be transferred 
from the Federal Hospital Insurance Trust Fund and the Federal 
Supplementary Medical Insurance Trust Fund, as authorized by 
section 201(g) of the Social Security Act; together with all funds 
collected in accordance with section 353 of the PHS Act and section 
1857(e)(2) of the Social Security Act, funds retained by the Secretary 
pursuant to section 1893(h) of the Social Security Act, and such 
sums as may be collected from authorized user fees and the sale 
of data, which shall be credited to this account and remain available 
until expended: Provided, That all funds derived in accordance 
with 31 U.S.C. 9701 from organizations established under title 
XIII of the PHS Act shall be credited to and available for carrying 
out the purposes of this appropriation: Provided further, That the 
Secretary is directed to collect fees in fiscal year 2019 from Medicare 
Advantage organizations pursuant to section 1857(e)(2) of the Social 
Security Act and from eligible organizations with risk-sharing con-
tracts under section 1876 of that Act pursuant to section 
1876(k)(4)(D) of that Act. 
HEALTH CARE FRAUD AND ABUSE CONTROL ACCOUNT 
In addition to amounts otherwise available for program integ-
rity and program management, $765,000,000, to remain available 
through September 30, 2020, to be transferred from the Federal 
Hospital Insurance Trust Fund and the Federal Supplementary 
Medical Insurance Trust Fund, as authorized by section 201(g) 
of the Social Security Act, of which $599,389,000 shall be for the 
Centers for Medicare & Medicaid Services program integrity activi-
ties, of which $87,230,000 shall be for the Department of Health 
and Human Services Office of Inspector General to carry out fraud 
and abuse activities authorized by section 1817(k)(3) of such Act, 
and of which $78,381,000 shall be for the Department of Justice 
to carry out fraud and abuse activities authorized by section 
1817(k)(3) of such Act: Provided, That the report required by section 
1817(k)(5) of the Social Security Act for fiscal year 2019 shall 
include measures of the operational efficiency and impact on fraud, 
waste, and abuse in the Medicare, Medicaid, and CHIP programs 
for the funds provided by this appropriation: Provided further, 
That of the amount provided under this heading, $311,000,000 
is provided to meet the terms of section 251(b)(2)(C)(ii) of the 
Balanced Budget and Emergency Deficit Control Act of 1985, as 
amended, and $454,000,000 is additional new budget authority 
specified for purposes of section 251(b)(2)(C) of such Act: Provided 
further, That the Secretary shall provide not less than $17,621,000 
for the Senior Medicare Patrol program to combat health care 
fraud and abuse from the funds provided to this account. 
ADMINISTRATION FOR CHILDREN AND FAMILIES 
PAYMENTS TO STATES FOR CHILD SUPPORT ENFORCEMENT AND 
FAMILY SUPPORT PROGRAMS 
For carrying out, except as otherwise provided, titles I, IV– 
D, X, XI, XIV, and XVI of the Social Security Act and the Act 
of July 5, 1960, $2,922,247,000, to remain available until expended; 
and for such purposes for the first quarter of fiscal year 2020, 
$1,400,000,000, to remain available until expended.
H. R. 6157—102 
For carrying out, after May 31 of the current fiscal year, except 
as otherwise provided, titles I, IV–D, X, XI, XIV, and XVI of the 
Social Security Act and the Act of July 5, 1960, for the last 3 
months of the current fiscal year for unanticipated costs, incurred 
for the current fiscal year, such sums as may be necessary. 
LOW INCOME HOME ENERGY ASSISTANCE 
For making payments under subsections (b) and (d) of section 
2602 of the Low Income Home Energy Assistance Act of 1981, 
$3,690,304,000: Provided, That all but $716,000,000 of this amount 
shall be allocated as though the total appropriation for such pay-
ments for fiscal year 2019 was less than $1,975,000,000: Provided 
further, That notwithstanding section 2609A(a), of the amounts 
appropriated under section 2602(b), not more than $2,988,000 of 
such amounts may be reserved by the Secretary for technical assist-
ance, training, and monitoring of program activities for compliance 
with internal controls, policies and procedures and may, in addition 
to the authorities provided in section 2609A(a)(1), use such funds 
through contracts with private entities that do not qualify as non-
profit organizations. 
REFUGEE AND ENTRANT ASSISTANCE 
(INCLUDING TRANSFER OF FUNDS) 
For necessary expenses for refugee and entrant assistance 
activities authorized by section 414 of the Immigration and Nation-
ality Act and section 501 of the Refugee Education Assistance 
Act of 1980, and for carrying out section 462 of the Homeland 
Security Act of 2002, section 235 of the William Wilberforce Traf-
ficking Victims Protection Reauthorization Act of 2008, the Traf-
ficking Victims Protection Act of 2000 (‘‘TVPA’’), and the Torture 
Victims Relief Act of 1998, $1,905,201,000, of which $1,864,446,000 
shall remain available through September 30, 2021 for carrying 
out such sections 414, 501, 462, and 235: Provided, That amounts 
available under this heading to carry out the TVPA shall also 
be available for research and evaluation with respect to activities 
under such Act: Provided further, That the limitation in section 
205 of this Act regarding transfers increasing any appropriation 
shall apply to transfers to appropriations under this heading by 
substituting ‘‘15 percent’’ for ‘‘3 percent’’. 
PAYMENTS TO STATES FOR THE CHILD CARE AND DEVELOPMENT 
BLOCK GRANT 
For carrying out the Child Care and Development Block Grant 
Act of 1990 (‘‘CCDBG Act’’), $5,276,000,000 shall be used to supple-
ment, not supplant State general revenue funds for child care 
assistance for low-income families: Provided, That technical assist-
ance under section 658I(a)(3) of such Act may be provided directly, 
or through the use of contracts, grants, cooperative agreements, 
or interagency agreements: Provided further, That all funds made 
available to carry out section 418 of the Social Security Act (42 
U.S.C. 618), including funds appropriated for that purpose in such 
section 418 or any other provision of law, shall be subject to the 
reservation of funds authority in paragraphs (4) and (5) of section 
658O(a) of the CCDBG Act: Provided further, That in addition
H. R. 6157—103 
to the amounts required to be reserved by the Secretary under 
section 658O(a)(2)(A) of such Act, $156,780,000 shall be for Indian 
tribes and tribal organizations. 
SOCIAL SERVICES BLOCK GRANT 
For making grants to States pursuant to section 2002 of the 
Social Security Act, $1,700,000,000: Provided, That notwithstanding 
subparagraph (B) of section 404(d)(2) of such Act, the applicable 
percent specified under such subparagraph for a State to carry 
out State programs pursuant to title XX–A of such Act shall be 
10 percent. 
CHILDREN AND FAMILIES SERVICES PROGRAMS 
For carrying out, except as otherwise provided, the Runaway 
and Homeless Youth Act, the Head Start Act, the Every Student 
Succeeds Act, the Child Abuse Prevention and Treatment Act, sec-
tions 303 and 313 of the Family Violence Prevention and Services 
Act, the Native American Programs Act of 1974, title II of the 
Child Abuse Prevention and Treatment and Adoption Reform Act 
of 1978 (adoption opportunities), part B–1 of title IV and sections 
429, 473A, 477(i), 1110, 1114A, and 1115 of the Social Security 
Act, and the Community Services Block Grant Act (‘‘CSBG Act’’); 
and for necessary administrative expenses to carry out titles I, 
IV, V, X, XI, XIV, XVI, and XX–A of the Social Security Act, 
the Act of July 5, 1960, the Low-Income Home Energy Assistance 
Act of 1981, the Child Care and Development Block Grant Act 
of 1990, the Assets for Independence Act, title IV of the Immigration 
and Nationality Act, and section 501 of the Refugee Education 
Assistance Act of 1980, $12,239,225,000, of which $75,000,000, to 
remain available through September 30, 2020, shall be for grants 
to States for adoption and legal guardianship incentive payments, 
as defined by section 473A of the Social Security Act and may 
be made for adoptions and legal guardianships completed before 
September 30, 2019: Provided, That $10,063,095,000 shall be for 
making payments under the Head Start Act, of which, notwith-
standing section 640 of such Act: 
(1) $150,000,000 shall be available for a cost of living 
adjustment, and with respect to any continuing appropriations 
act, funding available for a cost of living adjustment shall 
not be construed as an authority or condition under this Act; 
(2) $25,000,000 shall be available for allocation by the 
Secretary to supplement activities described in paragraphs 
(7)(B) and (9) of section 641(c) of the Head Start Act under 
the Designation Renewal System, established under the 
authority of sections 641(c)(7), 645A(b)(12), and 645A(d) of such 
Act, and such funds shall not be included in the calculation 
of ‘‘base grant’’ in subsequent fiscal years, as such term is 
used in section 640(a)(7)(A) of such Act; and 
(3) $805,000,000, in addition to funds otherwise available 
under such section 640 for such purposes, shall be available 
through March 31, 2020, for Early Head Start programs as 
described in section 645A of such Act, for conversion of Head 
Start services to Early Head Start services as described in 
section 645(a)(5)(A) of such Act, for discretionary grants for 
high quality infant and toddler care through Early Head Start- 
Child Care Partnerships, to entities defined as eligible under