II 
Calendar No. 213 
116TH CONGRESS 
1ST SESSION H. R. 4378 
IN THE SENATE OF THE UNITED STATES 
SEPTEMBER 19, 2019 
Received; read the first time 
SEPTEMBER 23, 2019 
Read the second time and placed on the calendar 
AN ACT 
Making continuing appropriations for fiscal year 2020, and 
for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Continuing Appropria-
tions 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 
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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 divi-
sion. 
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, corpora-
tions, 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 appro-
priations 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 
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and loan guarantees) that are not otherwise specifically 
provided for in this Act, that were conducted in fiscal year 
2019, and for which appropriations, funds, or other au-
thority were made available in the following appropriations 
Acts: 
(1) The Agriculture, Rural Development, Food 
and Drug Administration, and Related Agencies Ap-
propriations 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 ap-
plied 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 Re-
lated 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 Govern-
ment Appropriations Act, 2019 (division D of Public 
Law 116–6). 
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(6) The Department of Homeland Security Ap-
propriations Act, 2019 (division A of Public Law 
116–6) as amended, and title I of division H of Pub-
lic Law 116–6. 
(7) The Department of the Interior, Environ-
ment, 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 Agen-
cies 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 Af-
fairs, and Related Agencies Appropriations Act, 
2019 (division C of Public Law 115–244). 
(11) The Department of State, Foreign Oper-
ations, and Related Programs Appropriations Act, 
2019 (division F of Public Law 116–6), except sec-
tion 7058(d). 
(12) The Transportation, Housing and Urban 
Development, and Related Agencies Appropriations 
Act, 2019 (division G of Public Law 116–6). 
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SEC. 102. (a) No appropriation or funds made avail-
able 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 de-
fined 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 appro-
priations, funds, or other authority were not avail-
able during fiscal year 2019. 
(b) No appropriation or funds made available or au-
thority granted pursuant to section 101 for the Depart-
ment of Defense shall be used to initiate multi-year pro-
curements utilizing advance procurement funding for eco-
nomic order quantity procurement unless specifically ap-
propriated later. 
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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 author-
ity granted pursuant to section 101 shall be used to ini-
tiate or resume any project or activity for which appro-
priations, funds, or other authority were not available dur-
ing fiscal year 2019. 
SEC. 105. Appropriations made and authority grant-
ed pursuant to this Act shall cover all obligations or ex-
penditures 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 au-
thority 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. 
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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 ap-
propriation, 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 submis-
sion 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 pro-
grams 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 
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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 appro-
priations Acts for fiscal year 2019, and for activities under 
the Food and Nutrition Act of 2008, activities shall be 
continued at the rate to maintain program levels under 
current law, under the authority and conditions provided 
in the applicable appropriations Act for fiscal year 2019, 
to be continued through the date specified in section 
106(3). 
(b) Notwithstanding section 106, obligations for man-
datory 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 con-
tinue 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 de-
partment or agency, consistent with the applicable appro-
priations Act for fiscal year 2019, except that such author-
ity provided under this section shall not be used until after 
the department or agency has taken all necessary actions 
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to reduce or defer non-personnel-related administrative ex-
penses. 
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 Au-
thorization 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 Ter-
rorism or as an emergency requirement pursuant to sec-
tion 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 des-
ignated by the Congress for Overseas Contingency Oper-
ations/Global War on Terrorism or as an emergency re-
quirement 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 
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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 discre-
tionary budget authority that continue pursuant to section 
101 in Treasury Appropriations Fund Symbols (TAFS)— 
(1) to which other appropriations are not pro-
vided 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 oper-
ations 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 sub-
section (a) shall continue in an amount equal to the lesser 
of— 
(1) the amount specified for rescission or can-
cellation in the applicable appropriations Act ref-
erenced in section 101 of this Act; or 
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(2) the amount of balances available, as of Oc-
tober 1, 2019, from the funds specified for rescission 
or cancellation in the applicable appropriations Act 
referenced in section 101 of this Act. 
(c) No later than November 11, 2019, the Director 
of the Office of Management and Budget shall provide to 
the Committees on Appropriations of the House of Rep-
resentatives and the Senate a comprehensive list of the 
rescissions or cancellations that will continue pursuant to 
section 101: Provided, That the information in such com-
prehensive 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 rescis-
sion or cancellation in the applicable appropriations Act 
referenced in section 101, and such updates shall be trans-
mitted to the Committees on Appropriations of the House 
of Representatives and the Senate upon request. 
SEC. 116. Title I of the Additional Supplemental Ap-
propriations for Disaster Relief Act, 2019 (Public Law 
116–20) is amended in the matter under the heading ‘‘De-
partment of Agriculture—Office of the Secretary’’ by in-
serting ‘‘to cooperative processors for reduced quantity 
and quality sugar beets,’’ after ‘‘planting in 2019,’’: Pro-
vided, That amounts repurposed pursuant to this section 
that were previously designated by the Congress as an 
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emergency requirement pursuant to the Balanced Budget 
and Emergency Deficit Control Act of 1985 are des-
ignated by the Congress as an emergency requirement 
pursuant to section 251(b)(2)(A)(i) of the Balanced Budg-
et and Emergency Deficit Control Act of 1985 and shall 
be available only if the President subsequently so des-
ignates 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 Re-
form Act of 1998 (7 U.S.C. 7632(g)). 
SEC. 118. Amounts made available by section 101 for 
‘‘Department of Agriculture—Food and Nutrition Serv-
ice—Child Nutrition Programs’’ to carry out section 
749(g) of the Agriculture, Rural Development, Food and 
Drug Administration, and Related Agencies Appropria-
tions 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—Com-
modity 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, 
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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: Pro-
vided, 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 Con-
gress, including estimates for all Market Facilitation Pro-
gram payments, in calendar year 2018 and 2019 and pro-
jected payments in calendar year 2020 resulting from the 
calendar year 2019 program that include State-by-State, 
commodity-by-commodity, including specialty crops, anal-
ysis of the trade damage caused by retaliatory tariffs and 
separately by non-tariff trade barriers, including dumping, 
on U.S. agricultural producers, and an accounting of any 
commodity purchases made from substantially foreign- 
owned companies or their subsidiaries. 
SEC. 120. In addition to amounts provided by section 
101, amounts are provided for ‘‘Department of Agri-
culture—Agricultural 
Marketing 
Service—Marketing 
Services’’ at a rate for operations of $16,496,000 to con-
tinue the implementation of the Hemp Production Pro-
gram (section 10113 of Public Law 115–334). 
SEC. 121. Amounts made available by section 101 for 
‘‘International Trade Commission—Salaries and Ex-
penses’’ may be apportioned up to the rate for operations 
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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 Cen-
sus—Periodic Censuses and Programs’’ may be appor-
tioned 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 Pro-
gram. 
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 fi-
nanced using Defense Working Capital Funds shall be ex-
cluded 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 Over-
seas Contingency Operations/Global War on Terrorism 
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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 Contin-
gency 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 Initia-
tive’’, 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 Oper-
ations/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 Sep-
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tember 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 Admin-
istration—Colorado River Basins Power Marketing Fund, 
Western Area Power Administration’’ to the general fund 
of the Treasury in fiscal year 2019. 
(b) This section shall become effective immediately 
upon enactment of this Act. 
SEC. 126. During the period covered by this Act, title 
I of Public Law 108–361, as amended (the Calfed Bay- 
Delta Authorization Act) (118 Stat. 1681), shall be ap-
plied by substituting ‘‘2020’’ for ‘‘2019’’ each place it ap-
pears. 
SEC. 127. Notwithstanding section 101, title I of divi-
sion 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—Depart-
mental Offices’’: 
‘‘COMMITTEE ON FOREIGN INVESTMENT IN 
THE UNITED STATES FUND 
‘‘For necessary expenses of the Committee on For-
eign Investment in the United States, $15,000,000, to re-
main available until expended: Provided, That the chair-
person of the Committee may transfer such amounts to 
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any department or agency represented on the Committee 
(including the Department of the Treasury) subject to ad-
vance notification to the Committees on Appropriations of 
the House of Representatives and the Senate: Provided 
further, That amounts so transferred shall remain avail-
able 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 off-
setting collections: Provided further, That the total amount 
appropriated pursuant to this section from the general 
fund shall be reduced as such offsetting collections are re-
ceived 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 ‘‘Dis-
trict 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 
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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 pro-
vision 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 Busi-
ness Administration—Business Loans Program Account’’ 
in title V of division D of Public Law 116–6 shall be ap-
plied 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 head-
ing by this Act may be apportioned up to the rate for oper-
ations necessary to accommodate increased demand for 
commitments for general business loans authorized under 
section 7(a) of the Small Business Act (15 U.S.C. 636(a)). 
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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 in-
creased demand for commitments for disaster administra-
tive 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 administra-
tive expenses of loan making and servicing to carry 
out the direct loan program, which may be trans-
ferred 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 Assist-
ance Act (42 U.S.C. 5122(2)): Provided further, 
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That the amount for major disasters under this 
heading is designated by Congress as being for dis-
aster 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 appor-
tioned up to the rate for operations necessary to support 
hiring and operations required for protective activities as-
sociated with the 2020 presidential election campaign. 
SEC. 133. Amounts made available by section 101 to 
the Department of Homeland Security for ‘‘Federal Emer-
gency Management Agency—Disaster Relief Fund’’ may 
be apportioned up to the rate for operations necessary to 
carry out response and recovery activities under the Rob-
ert 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 Na-
tional Flood Insurance Act of 1968 (42 U.S.C. 4016(a) 
and 4026) shall be applied by substituting the date speci-
fied in section 106(3) of this Act for ‘‘September 30, 
2019’’. 
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(b) If this Act is enacted after September 30, 2019, 
this section shall be applied as if it were in effect on Sep-
tember 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 Co-
ordination—Operations and Support’’ may be apportioned 
up to the rate for operations necessary to carry out activi-
ties 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 sec-
tion 101, amounts are provided to the ‘‘Department of 
Health and Human Services—Indian Health Service—In-
dian Health Services’’ at a rate for operations of 
$18,397,500, for an additional amount for costs of staff-
ing 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 
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Facilities’’ at a rate for operations of $631,000, for an 
additional amount for costs of staffing and operating fa-
cilities that were opened, renovated, or expanded in fiscal 
years 2019 and 2020, and such amounts may be appor-
tioned 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 ‘‘Cen-
ters for Disease Control and Prevention—Public Health 
Preparedness and Response’’ and ‘‘Office of the Sec-
retary—Public Health and Social Services Emergency 
Fund’’ may be obligated in the account and budget struc-
ture, and under the authorities and conditions, set forth 
in H.R. 2740, as passed by the U.S. House of Representa-
tives on June 19, 2019. 
SEC. 138. During the period covered by this Act, up 
to $20,000,000 of the unobligated amounts in the Infec-
tious 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 re-
sponse activities without regard to the limitations in the 
third proviso in such section 231: Provided, That the Di-
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rector 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 Depart-
ment 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 sub-
stituting 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 Ad-
ministration—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 ‘‘Sep-
tember 30, 2019’’. 
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SEC. 142. Section 209 of the International Religious 
Freedom Act of 1998 (22 U.S.C. 6436) shall be applied 
by substituting the date specified in section 106(3) of this 
Act for ‘‘September 30, 2019’’. 
SEC. 143. Title I of division L of Public Law 115– 
141 and title I of division G of Public Law 116–6 shall 
be amended in the first provisos in each Act under the 
headings ‘‘Department of Transportation—Federal Tran-
sit Administration—Capital Investment Grants’’ by strik-
ing ‘‘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 Appro-
priations Act, 2020’’. 
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DIVISION 
B—HEALTH 
AND 
HUMAN 
SERVICES 
EXTEND-
ERS 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 OP-
ERATE 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: 
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‘‘(G) $44,164,384 for the period beginning 
on October 1, 2019, and ending on November 
21, 2019.’’. 
(c) TEACHING HEALTH CENTERS THAT OPERATE 
GRADUATE MEDICAL EDUCATION PROGRAMS.—Section 
340H(g)(1) of the Public Health Service Act (42 U.S.C. 
256h(g)(1)) is amended— 
(1) by striking ‘‘and $126,500,000’’ and insert-
ing ‘‘$126,500,000’’; and 
(2) by inserting ‘‘and $18,021,918 for the pe-
riod beginning on October 1, 2019, and ending on 
November 21, 2019,’’ before ‘‘to remain available’’. 
(d) APPLICATION OF PROVISIONS.—Amounts appro-
priated pursuant to this section for the period beginning 
on October 1, 2019, and ending on November 21, 2019, 
shall be subject to the requirements contained in Public 
Law 115–245 for funds for programs authorized under 
sections 330 through 340 of the Public Health Service Act 
(42 U.S.C. 254 through 256). 
(e) CONFORMING AMENDMENT.—Paragraph (4) of 
section 3014(h) of title 18, United States Code, as amend-
ed 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 in-
serting ‘‘, section 50901(e) of the Advancing Chronic 
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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 be-
ginning 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 be-
ginning 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 EDU-
CATION 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 subpara-
graph (A)— 
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(I) by inserting after ‘‘for each of 
fiscal years 2018 and 2019’’ the fol-
lowing: ‘‘and for the period beginning 
October 1, 2019, and ending Novem-
ber 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 pe-
riod’’ 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 fol-
lowing: ‘‘and for the period beginning 
October 1, 2019, and ending Novem-
ber 21, 2019’’; and 
(II) by inserting after ‘‘for the 
fiscal year’’ the following: ‘‘(or, with 
respect to such period, for fiscal year 
2020)’’; and 
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(ii) in subparagraph (B)(i), by insert-
ing after ‘‘for the fiscal year’’ the fol-
lowing: ‘‘(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 be-
ginning October 1, 2019, and ending November 
21, 2019’’; and 
(B) in paragraph (2), by inserting after 
‘‘for each of fiscal years 2018 and 2019’’ the 
following: ‘‘and for the period described in para-
graph (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 fis-
cal years 2010 through 2019’’ the fol-
lowing: ‘‘and for the period beginning 
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October 1, 2019, and ending Novem-
ber 21, 2019’’; and 
(II) in clause (i), by inserting 
after ‘‘for the fiscal year’’ the fol-
lowing: ‘‘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 Octo-
ber 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 de-
scribed 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 de-
scribed in paragraph (1)(A)’’; and 
(ii) by striking ‘‘the end of the second 
succeeding fiscal year’’ and inserting ‘‘the 
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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 de-
scribed 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 fis-
cal year’’ the following: ‘‘or the period 
so described’’; and 
(ii) in subparagraph (B)(i), by strik-
ing ‘‘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 para-
graph (3), from the amount’’; 
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(B) in paragraph (2), by striking ‘‘From 
the amount’’ and inserting ‘‘Subject to para-
graph (3), from the amount’’; and 
(C) by adding at the end the following new 
paragraph: 
‘‘(3) EXCEPTION.—Paragraphs (1) and (2) 
shall not apply with respect to any amount appro-
priated 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 fol-
lowing: ‘‘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 Medi-
care Act of 2014 (42 U.S.C. 1396a note) is amended by 
striking ‘‘September 13, 2019’’ and inserting ‘‘November 
21, 2019’’. 
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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 sub-
section: 
‘‘(ff) TEMPORARY INCREASE IN FMAP FOR TERRI-
TORIES.—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 pe-
riod beginning October 1, 2019, and ending November 21, 
2019.’’. 
SEC. 1303. DELAY OF REDUCTIONS IN MEDICAID DSH AL-
LOTMENTS. 
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 sub-
clause (I), by striking ‘‘For each of fiscal years 2020 
through 2025’’ and inserting ‘‘For the period begin-
ning November 22, 2019, and ending September 30, 
2020, and for each of fiscal years 2021 through 
2025’’; and 
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(2) in clause (ii)(I), by striking ‘‘for fiscal year 
2020’’ and inserting ‘‘for the period beginning No-
vember 22, 2019, and ending September 30, 2020’’. 
TITLE IV—MEDICARE 
EXTENDERS 
SEC. 1401. EXTENSION OF FUNDING FOR QUALITY MEAS-
URE 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 in-
serting ‘‘$7,500,000’’; and 
(B) by inserting before the period at the 
end the following: ‘‘, and $1,069,000 for the pe-
riod beginning on October 1, 2019, and ending 
on November 21, 2019’’; and 
(2) in the third sentence, by inserting ‘‘and for 
the period beginning on October 1, 2019, and ending 
on November 21, 2019,’’ after ‘‘2019’’. 
SEC. 1402. EXTENSION OF FUNDING OUTREACH AND AS-
SISTANCE FOR LOW-INCOME PROGRAMS. 
(a) ADDITIONAL FUNDING FOR STATE HEALTH IN-
SURANCE PROGRAMS.—Subsection (a)(1)(B) of section 
119 of the Medicare Improvements for Patients and Pro-
viders Act of 2008 (42 U.S.C. 1395b–3 note), as amended 
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by section 3306 of the Patient Protection and Affordable 
Care Act (Public Law 111–148), section 610 of the Amer-
ican 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 Ac-
cess to Medicare Act of 2014 (Public Law 113–93), sec-
tion 208 of the Medicare Access and CHIP Reauthoriza-
tion 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 Octo-
ber 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; 
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(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 Octo-
ber 1, 2019, and ending on November 21, 
2019, of $1,069,000.’’. 
(c) ADDITIONAL FUNDING
FOR AGING
AND DIS-
ABILITY 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 Octo-
ber 1, 2019, and ending on November 21, 
2019, of $712,000.’’. 
(d) ADDITIONAL FUNDING
FOR CONTRACT WITH 
THE NATIONAL CENTER FOR BENEFITS AND OUTREACH 
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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 Octo-
ber 1, 2019, and ending on November 21, 
2019, of $1,710,000.’’. 
SEC. 1403. EXTENSION OF TERMINATION DATE OF PATIENT- 
CENTERED 
OUTCOMES 
RESEARCH 
TRUST 
FUND. 
Section 9511(f) of the Internal Revenue Code of 
1986 is amended by striking ‘‘September 30’’ and insert-
ing ‘‘November 21’’. 
TITLE V—HUMAN SERVICES 
EXTENDERS 
SEC. 1501. EXTENSION OF DEMONSTRATION PROJECTS TO 
ADDRESS 
HEALTH 
PROFESSIONS 
WORK-
FORCE NEEDS. 
Activities authorized by section 2008 of the Social Se-
curity Act shall continue through November 21, 2019, in 
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the manner authorized for fiscal year 2019, and out of 
any money in the Treasury of the United States not other-
wise 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 RE-
LATED 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 here-
by 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 ‘‘Novem-
ber 21, 2019’’ for ‘‘October 1, 2019’’. 
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SEC. 1602. INCREASING NUMERICAL LIMITATIONS OF THE 
WORLD TRADE CENTER HEALTH PROGRAM. 
(a) WORLD TRADE CENTER RESPONDERS.—Section 
3311(a)(4)(A) of the Public Health Service Act (42 U.S.C. 
300mm–21(a)(4)(A)) is amended by striking ‘‘25,000’’ 
and inserting ‘‘75,000’’. 
(b) WORLD TRADE CENTER SURVIVORS.—Section 
3321(a)(3)(A) of the Public Health Service Act (42 U.S.C. 
300mm–31(a)(3)(A)) is amended by striking ‘‘25,000’’ 
and inserting ‘‘75,000’’. 
(c) RULE OF CONSTRUCTION REGARDING ANNUAL 
FUNDING LIMITATIONS.—Nothing in this section, or the 
amendments made by this section, shall alter the annual 
limitations on amounts appropriated to the World Trade 
Center Health Program Fund under section 3351(a)(2) 
of the Public Health Service Act (42 U.S.C. 300mm– 
61(a)(2)). 
SEC. 1603. EXCLUDING AUTHORIZED GENERIC DRUGS 
FROM CALCULATION OF AVERAGE MANUFAC-
TURER PRICE FOR PURPOSES OF THE MED-
ICAID 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— 
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(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 applica-
tion’’; and 
(3) by striking ‘‘inclusive’’ and inserting ‘‘exclu-
sive’’. 
(b) EXCLUDING MANUFACTURERS FROM DEFINI-
TION OF WHOLESALER.—Section 1927(k)(11) of the So-
cial Security Act (42 U.S.C. 1396r–8(k)(11)) is amend-
ed— 
(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)— 
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(A) by striking ‘‘2023’’ each place it ap-
pears 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 budg-
etary effects of this division shall not be entered on either 
PAYGO scorecard maintained pursuant to section 4(d) of 
the Statutory Pay-As-You-Go Act of 2010. 
(b) SENATE PAYGO SCORECARDS.—The budgetary 
effects of this division shall not be entered on any PAYGO 
scorecard maintained for purposes of section 4106 of H. 
Con. Res. 71 (115th Congress). 
(c) CLASSIFICATION
OF BUDGETARY EFFECTS.— 
Notwithstanding Rule 3 of the Budget Scorekeeping 
Guidelines set forth in the joint explanatory statement of 
the committee of conference accompanying Conference Re-
port 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 
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(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. 
Passed the House of Representatives September 19, 
2019. 
Attest: 
CHERYL L. JOHNSON, 
Clerk. 
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Calendar No. 213 
116TH CONGRESS 
1ST SESSION 
H. R. 4378 
AN ACT 
Making continuing appropriations for fiscal year 
2020, and for other purposes. 
SEPTEMBER 23, 2019 
Read the second time and placed on the calendar 
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