H. R. 4378 
One Hundred Sixteenth Congress 
of the 
United States of America 
AT THE FIRST SESSION 
Begun and held at the City of Washington on Thursday, 
the third day of January, two thousand and nineteen 
An Act 
Making continuing appropriations for fiscal year 2020, and for other purposes. 
Be it enacted by the Senate and House of Representatives of 
the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Continuing Appropriations Act, 
2020, and Health Extenders Act of 2019’’. 
SEC. 2. TABLE OF CONTENTS. 
The table of contents of this Act is as follows: 
Sec. 1. Short title. 
Sec. 2. Table of Contents. 
Sec. 3. References. 
DIVISION A—CONTINUING APPROPRIATIONS ACT, 2020 
DIVISION B—HEALTH AND HUMAN SERVICES EXTENDERS AND OTHER 
MATTERS 
TITLE I—PUBLIC HEALTH EXTENDERS 
TITLE II—OTHER HEALTH EXTENDERS 
TITLE III—MEDICAID EXTENDERS 
TITLE IV—MEDICARE EXTENDERS 
TITLE V—HUMAN SERVICES EXTENDERS 
TITLE VI—MISCELLANEOUS POLICIES 
TITLE VII—BUDGETARY EFFECTS 
SEC. 3. REFERENCES. 
Except as expressly provided otherwise, any reference to ‘‘this 
Act’’ contained in any division of this Act shall be treated as 
referring only to the provisions of that division. 
DIVISION A—CONTINUING APPROPRIATIONS ACT, 2020 
The following sums are hereby appropriated, out of any money 
in the Treasury not otherwise appropriated, and out of applicable 
corporate or other revenues, receipts, and funds, for the several 
departments, agencies, corporations, and other organizational units 
of Government for fiscal year 2020, and for other purposes, namely: 
SEC. 101. Such amounts as may be necessary, at a rate for 
operations as provided in the applicable appropriations Acts for 
fiscal year 2019 and under the authority and conditions provided 
in such Acts, for continuing projects or activities (including the 
costs of direct loans and loan guarantees) that are not otherwise
H. R. 4378—2 
specifically provided for in this Act, that were conducted in fiscal 
year 2019, and for which appropriations, funds, or other authority 
were made available in the following appropriations Acts: 
(1) The Agriculture, Rural Development, Food and Drug 
Administration, and Related Agencies Appropriations Act, 2019 
(division B of Public Law 116–6), except that the language 
under the heading ‘‘Rural Utilities Service—Rural Water and 
Waste Disposal Program Account’’ in title III shall be applied 
by inserting ‘‘the cost of direct loans,’’ before ‘‘loan guarantees’’ 
at the beginning of the second sentence in the matter preceding 
the first proviso. 
(2) The Commerce, Justice, Science, and Related Agencies 
Appropriations Act, 2019 (division C of Public Law 116–6), 
except section 523(b)(6). 
(3) The Department of Defense Appropriations Act, 2019 
(division A of Public Law 115–245). 
(4) The Energy and Water Development and Related Agen-
cies Appropriations Act, 2019 (division A of Public Law 115– 
244), except section 505. 
(5) The Financial Services and General Government Appro-
priations Act, 2019 (division D of Public Law 116–6). 
(6) The Department of Homeland Security Appropriations 
Act, 2019 (division A of Public Law 116–6) as amended, and 
title I of division H of Public Law 116–6. 
(7) The Department of the Interior, Environment, and 
Related Agencies Appropriations Act, 2019 (division E of Public 
Law 116–6). 
(8) The Departments of Labor, Health and Human Services, 
and Education, and Related Agencies Appropriations Act, 2019 
(division B of Public Law 115–245). 
(9) The Legislative Branch Appropriations Act, 2019 (divi-
sion B of Public Law 115–244). 
(10) The Military Construction, Veterans Affairs, and 
Related Agencies Appropriations Act, 2019 (division C of Public 
Law 115–244). 
(11) The Department of State, Foreign Operations, and 
Related Programs Appropriations Act, 2019 (division F of Public 
Law 116–6), except section 7058(d). 
(12) The Transportation, Housing and Urban Development, 
and Related Agencies Appropriations Act, 2019 (division G of 
Public Law 116–6). 
SEC. 102. (a) No appropriation or funds made available or 
authority granted pursuant to section 101 for the Department of 
Defense shall be used for: 
(1) the new production of items not funded for production 
in fiscal year 2019 or prior years; 
(2) the increase in production rates above those sustained 
with fiscal year 2019 funds; or 
(3) the initiation, resumption, or continuation of any 
project, activity, operation, or organization (defined as any 
project, subproject, activity, budget activity, program element, 
and subprogram within a program element, and for any invest-
ment items defined as a P–1 line item in a budget activity 
within an appropriation account and an R–1 line item that 
includes a program element and subprogram element within 
an appropriation account) for which appropriations, funds, or 
other authority were not available during fiscal year 2019.
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(b) No appropriation or funds made available or authority 
granted pursuant to section 101 for the Department of Defense 
shall be used to initiate multi-year procurements utilizing advance 
procurement funding for economic order quantity procurement 
unless specifically appropriated later. 
SEC. 103. Appropriations made by section 101 shall be available 
to the extent and in the manner that would be provided by the 
pertinent appropriations Act. 
SEC. 104. Except as otherwise provided in section 102, no 
appropriation or funds made available or authority granted pursu-
ant to section 101 shall be used to initiate or resume any project 
or activity for which appropriations, funds, or other authority were 
not available during fiscal year 2019. 
SEC. 105. Appropriations made and authority granted pursuant 
to this Act shall cover all obligations or expenditures incurred 
for any project or activity during the period for which funds or 
authority for such project or activity are available under this Act. 
SEC. 106. Unless otherwise provided for in this Act or in the 
applicable appropriations Act for fiscal year 2020, appropriations 
and funds made available and authority granted pursuant to this 
Act shall be available until whichever of the following first occurs: 
(1) The enactment into law of an appropriation for any 
project or activity provided for in this Act. 
(2) The enactment into law of the applicable appropriations 
Act for fiscal year 2020 without any provision for such project 
or activity. 
(3) November 21, 2019. 
SEC. 107. Expenditures made pursuant to this Act shall be 
charged to the applicable appropriation, fund, or authorization 
whenever a bill in which such applicable appropriation, fund, or 
authorization is contained is enacted into law. 
SEC. 108. Appropriations made and funds made available by 
or authority granted pursuant to this Act may be used without 
regard to the time limitations for submission and approval of appor-
tionments 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 appropria-
tions at the beginning of fiscal year 2020 because of distributions 
of funding to States, foreign countries, grantees, or others, such 
high initial rates of operation or complete distribution shall not 
be made, and no grants shall be awarded for such programs funded 
by this Act that would impinge on final funding prerogatives. 
SEC. 110. This Act shall be implemented so that only the 
most limited funding action of that permitted in the Act shall 
be taken in order to provide for continuation of projects and activi-
ties. 
SEC. 111. (a) For entitlements and other mandatory payments 
whose budget authority was provided in appropriations Acts for 
fiscal year 2019, and for activities under the Food and Nutrition 
Act of 2008, activities shall be continued at the rate to maintain 
program levels under current law, under the authority and condi-
tions provided in the applicable appropriations Act for fiscal year 
2019, to be continued through the date specified in section 106(3).
H. R. 4378—4 
(b) Notwithstanding section 106, obligations for mandatory pay-
ments due on or about the first day of any month that begins 
after October 2019 but not later than 30 days after the date specified 
in section 106(3) may continue to be made, and funds shall be 
available for such payments. 
SEC. 112. Amounts made available under section 101 for civilian 
personnel compensation and benefits in each department and 
agency may be apportioned up to the rate for operations necessary 
to avoid furloughs within such department or agency, consistent 
with the applicable appropriations Act for fiscal year 2019, except 
that such authority provided under this section shall not be used 
until after the department or agency has taken all necessary actions 
to reduce or defer non-personnel-related administrative expenses. 
SEC. 113. Funds appropriated by this Act may be obligated 
and expended notwithstanding section 10 of Public Law 91–672 
(22 U.S.C. 2412), section 15 of the State Department Basic Authori-
ties Act of 1956 (22 U.S.C. 2680), section 313 of the Foreign Rela-
tions Authorization Act, Fiscal Years 1994 and 1995 (22 U.S.C. 
6212), and section 504(a)(1) of the National Security Act of 1947 
(50 U.S.C. 3094(a)(1)). 
SEC. 114. (a) Each amount incorporated by reference in this 
Act that was previously designated by the Congress for Overseas 
Contingency Operations/Global War on Terrorism or as an emer-
gency requirement pursuant to section 251(b)(2)(A) of the Balanced 
Budget and Emergency Deficit Control Act of 1985 or as being 
for disaster relief pursuant to section 251(b)(2)(D) of such Act is 
designated by the Congress for Overseas Contingency Operations/ 
Global War on Terrorism or as an emergency requirement pursuant 
to section 251(b)(2)(A) of such Act or as being for disaster relief 
pursuant to section 251(b)(2)(D) of such Act, respectively. 
(b) Section 5 of Public Law 116–6 shall apply to amounts 
designated in subsection (a) and section 124 of this Act for Overseas 
Contingency Operations/Global War on Terrorism. 
(c) This section shall become effective immediately upon enact-
ment of this Act, and shall remain in effect through the date 
in section 106(3). 
SEC. 115. (a) Rescissions or cancellations of discretionary budget 
authority that continue pursuant to section 101 in Treasury Appro-
priations Fund Symbols (TAFS)— 
(1) to which other appropriations are not provided by this 
Act, but for which there is a current applicable TAFS that 
does receive an appropriation in this Act; or 
(2) which are no-year TAFS and receive other appropria-
tions in this Act, 
may be continued instead by reducing the rate for operations other-
wise provided by section 101 for such current applicable TAFS, 
as long as doing so does not impinge on the final funding preroga-
tives of the Congress. 
(b) Rescissions or cancellations described in subsection (a) shall 
continue in an amount equal to the lesser of— 
(1) the amount specified for rescission or cancellation in 
the applicable appropriations Act referenced in section 101 
of this Act; or 
(2) the amount of balances available, as of October 1, 
2019, from the funds specified for rescission or cancellation 
in the applicable appropriations Act referenced in section 101 
of this Act.
H. R. 4378—5 
(c) No later than November 11, 2019, the Director of the Office 
of Management and Budget shall provide to the Committees on 
Appropriations of the House of Representatives and the Senate 
a comprehensive list of the rescissions or cancellations that will 
continue pursuant to section 101: Provided, That the information 
in such comprehensive list shall be periodically updated to reflect 
any subsequent changes in the amount of balances available, as 
of October 1, 2019, from the funds specified for rescission or can-
cellation in the applicable appropriations Act referenced in section 
101, and such updates shall be transmitted to the Committees 
on Appropriations of the House of Representatives and the Senate 
upon request. 
SEC. 116. Title I of the Additional Supplemental Appropriations 
for Disaster Relief Act, 2019 (Public Law 116–20) is amended in 
the matter under the heading ‘‘Department of Agriculture—Office 
of the Secretary’’ by inserting ‘‘to cooperative processors for reduced 
quantity and quality sugar beets,’’ after ‘‘planting in 2019,’’: Pro-
vided, That amounts repurposed pursuant to this section that were 
previously designated by the Congress as an emergency requirement 
pursuant to the Balanced Budget and Emergency Deficit Control 
Act of 1985 are designated by the Congress as an emergency 
requirement pursuant to section 251(b)(2)(A)(i) of the Balanced 
Budget and Emergency Deficit Control Act of 1985 and shall be 
available only if the President subsequently so designates all such 
amounts and transmits such designations to the Congress. 
SEC. 117. The Secretary of Agriculture may waive the matching 
funds requirement under Section 412(g) of the Agricultural 
Research, Extension, and Education Reform Act of 1998 (7 U.S.C. 
7632(g)). 
SEC. 118. Amounts made available by section 101 for ‘‘Depart-
ment of Agriculture—Food and Nutrition Service—Child Nutrition 
Programs’’ to carry out section 749(g) of the Agriculture, Rural 
Development, Food and Drug Administration, and Related Agencies 
Appropriations Act, 2010 (Public Law 111–80) may be apportioned 
up to the rate for operations necessary to ensure that the program 
can be fully operational by May 2020. 
SEC. 119. Amounts provided by section 111 to the Department 
of Agriculture for ‘‘Corporations—Commodity Credit Corporation 
Fund—Reimbursement for Net Realized Losses’’ may be used, prior 
to the completion of the report described in section 2 of the Act 
of August 17, 1961 (15 U.S.C. 713a–11), to reimburse the Com-
modity Credit Corporation for net realized losses sustained, but 
not previously reimbursed, as of September 17, 2019: Provided, 
That the Secretary of Agriculture shall submit a report, no later 
than October 31, 2019, to the Committees on Appropriations and 
Agriculture of both Houses of Congress, including estimates for 
all Market Facilitation Program payments, in calendar year 2018 
and 2019 and projected payments in calendar year 2020 resulting 
from the calendar year 2019 program that include State-by-State, 
commodity-by-commodity, including specialty crops, analysis of the 
trade damage caused by retaliatory tariffs and separately by non- 
tariff trade barriers, including dumping, on U.S. agricultural pro-
ducers, and an accounting of any commodity purchases made from 
substantially foreign-owned companies or their subsidiaries. 
SEC. 120. In addition to amounts provided by section 101, 
amounts are provided for ‘‘Department of Agriculture—Agricultural 
Marketing Service—Marketing Services’’ at a rate for operations
H. R. 4378—6 
of $16,496,000 to continue the implementation of the Hemp Produc-
tion Program (section 10113 of Public Law 115–334). 
SEC. 121. Amounts made available by section 101 for ‘‘Inter-
national Trade Commission—Salaries and Expenses’’ may be appor-
tioned up to the rate for operations necessary to carry out respon-
sibilities under the American Manufacturing Competitiveness Act 
of 2016 (Public Law 114–159). 
SEC. 122. Amounts made available by section 101 to the Depart-
ment of Commerce for ‘‘Bureau of the Census—Periodic Censuses 
and Programs’’ may be apportioned up to the rate for operations 
necessary to maintain the schedule and deliver the required data 
according to the statutory deadlines in the 2020 Decennial Census 
Program. 
SEC. 123. Notwithstanding section 2208(l)(3) of title 10, United 
States Code, during the period covered by this Act, any advanced 
billing for background investigation services and related services 
purchased from activities financed using Defense Working Capital 
Funds shall be excluded from the calculation of cumulative advance 
billings under section 2208(l)(3) of such title. In the preceding 
sentence, the term ‘‘advance billing’’ has the meaning given the 
term in section 2208(l)(4) of such title. 
SEC. 124. (a) The remaining unobligated balances of funds 
as of September 30, 2019, from amounts provided by section 9013 
of division A of Public Law 115–245 are hereby rescinded: Provided, 
That such amounts that were previously designated by the Congress 
as being for Overseas Contingency Operations/Global War on Ter-
rorism pursuant to section 251(b)(2)(A)(ii) of the Balanced Budget 
and Emergency Deficit Control Act of 1985 are designated by the 
Congress as being for Overseas Contingency Operations/Global War 
on Terrorism pursuant to that section of that Act. 
(b) In addition to the amount otherwise provided by section 
101 for the ‘‘Ukraine Security Assistance Initiative’’, there is appro-
priated on September 30, 2019, for an additional amount for fiscal 
year 2019, an amount equal to the unobligated balances rescinded 
pursuant to subsection (a) of this section: Provided, That amounts 
made available pursuant to this subsection shall remain available 
until September 30, 2020, and shall be available for the same 
purposes and under the same authorities for which they were 
originally provided in Public Law 115–245: Provided further, That 
such amount is designated by the Congress as being for Overseas 
Contingency Operations/Global War on Terrorism pursuant to sec-
tion 251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit 
Control Act of 1985. 
(c) This section shall become effective immediately upon enact-
ment of this Act. 
(d) If this Act is enacted after September 30, 2019, or if the 
designation in subsection 114(b) occurs after September 30, 2019, 
this section shall be applied as if it were in effect on September 
30, 2019. 
SEC. 125. (a) No funds shall be transferred directly from 
‘‘Department of Energy—Power Marketing Administration—Colo-
rado 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 enact-
ment of this Act.
H. R. 4378—7 
SEC. 126. During the period covered by this Act, title I of 
Public Law 108–361, as amended (the Calfed Bay-Delta Authoriza-
tion Act) (118 Stat. 1681), shall be applied by substituting ‘‘2020’’ 
for ‘‘2019’’ each place it appears. 
SEC. 127. Notwithstanding section 101, title I of division D 
of Public Law 116–6 shall be applied by adding the following 
new heading and appropriation language under the heading 
‘‘Department of the Treasury—Departmental Offices’’: 
‘‘COMMITTEE ON FOREIGN INVESTMENT IN THE UNITED 
STATES FUND 
‘‘For necessary expenses of the Committee on Foreign Invest-
ment in the United States, $15,000,000, to remain available until 
expended: Provided, That the chairperson of the Committee may 
transfer such amounts to any department or agency represented 
on the Committee (including the Department of the Treasury) sub-
ject to advance notification to the Committees on Appropriations 
of the House of Representatives and the Senate: Provided further, 
That amounts so transferred shall remain available until expended 
for expenses of implementing section 721 of the Defense Production 
Act of 1950, as amended (50 U.S.C. 4565), and shall be available 
in addition to any other funds available to any department or 
agency: Provided further, That fees authorized by section 721(p) 
of such Act shall be credited to this appropriation as offsetting 
collections: Provided further, That the total amount appropriated 
pursuant to this section from the general fund shall be reduced 
as such offsetting collections are received during this fiscal year, 
so as to result in a total appropriation from the general fund 
estimated at not more than $5,000,000.’’. 
SEC. 128. Notwithstanding any other provision of this Act, 
except section 106, the District of Columbia may expend local funds 
made available under the heading ‘‘District of Columbia—District 
of Columbia Funds’’ for such programs and activities under the 
District of Columbia Appropriations Act, 2019 (title IV of division 
D of Public Law 116–6) at the rate set forth in the Fiscal Year 
2020 Local Budget Act of 2019 (D.C. Act 23–78), as modified as 
of the date of enactment of this Act. 
SEC. 129. In addition to amounts provided by section 101, 
amounts are provided to the Office of Personnel Management for 
‘‘Salaries and Expenses’’ at a rate for operations of $48,000,000, 
for an additional amount for administrative expenses: Provided, 
That of such amounts, $29,760,000 shall be transferred from the 
appropriate trust funds of the Office without regard to any other 
provision of law: Provided further, That such amounts may be 
apportioned up to the rate for operations necessary to maintain 
agency operations. 
SEC. 130. Notwithstanding section 101, the matter preceding 
the first proviso under the heading ‘‘Small Business Administra-
tion—Business Loans Program Account’’ in title V of division D 
of Public Law 116–6 shall be applied as if the following were 
inserted before the colon: ‘‘, and for the cost of guaranteed loans 
as authorized by section 7(a) of the Small Business Act (Public 
Law 83–163), $99,000,000, to remain available until expended’’: 
Provided, That amounts made available under such heading by 
this Act may be apportioned up to the rate for operations necessary 
to accommodate increased demand for commitments for general
H. R. 4378—8 
business loans authorized under section 7(a) of the Small Business 
Act (15 U.S.C. 636(a)). 
SEC. 131. Notwithstanding section 101, amounts are provided 
for ‘‘Small Business Administration—Disaster Loans Program 
Account’’ at a rate for operations of $177,136,000: Provided, That 
amounts made available under such heading by this Act may be 
apportioned up to the rate for operations necessary to accommodate 
increased demand for commitments for disaster administrative 
expenses authorized under section 20(a) of the Small Business 
Act (15 U.S.C. 631): Provided further, That the language under 
such heading in title V of division D of Public Law 116–6 shall 
be applied by— 
(1) substituting ‘‘$1,600,000’’ for ‘‘$1,000,000’’; 
(2) substituting ‘‘$8,400,000’’ for ‘‘$9,000,000’’; and 
(3) inserting the following before the period: ‘‘; and of 
which $167,136,000 is for direct administrative expenses of 
loan making and servicing to carry out the direct loan program, 
which may be transferred to and merged with the appropria-
tions for Salaries and Expenses: Provided, That, of the funds 
provided under this heading, $150,888,000 shall be for major 
disasters declared pursuant to the Robert T. Stafford Disaster 
Relief and Emergency Assistance Act (42 U.S.C. 5122(2)): Pro-
vided further, That the amount for major disasters under this 
heading is designated by Congress as being for disaster relief 
pursuant to section 251(b)(2)(D) of the Balanced Budget and 
Emergency Deficit Control Act of 1985 (Public Law 99–177)’’. 
SEC. 132. Amounts made available by section 101 to the Depart-
ment of Homeland Security for ‘‘United States Secret Service— 
Operations and Support’’ may be apportioned up to the rate for 
operations necessary to support hiring and operations required 
for protective activities associated with the 2020 presidential elec-
tion campaign. 
SEC. 133. Amounts made available by section 101 to the Depart-
ment of Homeland Security for ‘‘Federal Emergency Management 
Agency—Disaster Relief Fund’’ may be apportioned up to the rate 
for operations necessary to carry out response and recovery activi-
ties under the Robert T. Stafford Disaster Relief and Emergency 
Assistance Act (42 U.S.C. 5121 et seq.). 
SEC. 134. (a) Sections 1309(a) and 1319 of the National Flood 
Insurance Act of 1968 (42 U.S.C. 4016(a) and 4026) shall be applied 
by substituting the date specified in section 106(3) of this Act 
for ‘‘September 30, 2019’’. 
(b) If this Act is enacted after September 30, 2019, this section 
shall be applied as if it were in effect on September 30, 2019. 
SEC. 135. Amounts made available by section 101 to the Depart-
ment of Homeland Security for ‘‘Office of the Secretary and Execu-
tive Management—Operations and Support’’, ‘‘Management Direc-
torate—Operations and Support’’, and ‘‘Intelligence, Analysis, and 
Operations Coordination—Operations and Support’’ may be appor-
tioned up to the rate for operations necessary to carry out activities 
previously funded by the Working Capital Fund of the Department 
of Homeland Security, consistent with the fiscal year 2020 Presi-
dent’s Budget. 
SEC. 136. (a) In addition to amounts provided by section 101, 
amounts are provided to the ‘‘Department of Health and Human 
Services—Indian Health Service—Indian Health Services’’ at a rate 
for operations of $18,397,500, for an additional amount for costs
H. R. 4378—9 
of staffing and operating facilities that were opened, renovated, 
or expanded in fiscal years 2019 and 2020, and such amounts 
may be apportioned up to the rate for operations necessary to 
staff and operate such facilities. 
(b) In addition to amounts provided by section 101, amounts 
are provided for ‘‘Department of Health and Human Services— 
Indian Health Service—Indian Health Facilities’’ at a rate for oper-
ations of $631,000, for an additional amount for costs of staffing 
and operating facilities that were opened, renovated, or expanded 
in fiscal years 2019 and 2020, and such amounts may be apportioned 
up to the rate for operations necessary to staff and operate such 
facilities. 
SEC. 137. Amounts made available by section 101 to the Depart-
ment of Health and Human Services for ‘‘Centers for Disease Con-
trol and Prevention—Public Health Preparedness and Response’’ 
and ‘‘Office of the Secretary—Public Health and Social Services 
Emergency Fund’’ may be obligated in the account and budget 
structure, and under the authorities and conditions, set forth in 
H.R. 2740, as passed by the U.S. House of Representatives on 
June 19, 2019. 
SEC. 138. During the period covered by this Act, up to 
$20,000,000 of the unobligated amounts in the Infectious Diseases 
Rapid Response Reserve Fund established by section 231 of division 
B of Public Law 115–245 may be transferred to ‘‘Department of 
Health and Human Services—Centers for Disease Control and 
Prevention—CDC–Wide Activities and Program Support’’ and shall 
be available until expended for Ebola preparedness and response 
activities without regard to the limitations in the third proviso 
in such section 231: Provided, That the Director of the Centers 
for Disease Control and Prevention may transfer such amounts 
to any of the appropriations accounts under the heading ‘‘Centers 
for Disease Control and Prevention’’ for Ebola response activities: 
Provided further, That such transfer authority shall be in addition 
to any other transfer authority provided to the Department of 
Health and Human Services. 
SEC. 139. Section 114(f) of the Higher Education Act of 1965 
(20 U.S.C. 1011c(f)) shall be applied by substituting the date speci-
fied in section 106(3) of this Act for ‘‘September 30, 2019’’. 
SEC. 140. Amounts made available by section 101 for ‘‘Depart-
ment of Veterans Affairs—Veterans Benefits Administration—Gen-
eral Operating Expenses, Veterans Benefits Administration’’ and 
‘‘Department of Veterans Affairs—Departmental Administration— 
Information Technology Systems’’ may be apportioned up to the 
rate for operations necessary to support projects and activities 
created by the Blue Water Navy Vietnam Veterans Act of 2019 
(Public Law 116–23). 
SEC. 141. Section 7 of the Export-Import Bank Act of 1945 
(12 U.S.C. 635f) shall be applied by substituting the date specified 
in section 106(3) of this Act for ‘‘September 30, 2019’’. 
SEC. 142. Section 209 of the International Religious Freedom 
Act of 1998 (22 U.S.C. 6436) shall be applied by substituting the 
date specified in section 106(3) of this Act for ‘‘September 30, 
2019’’. 
SEC. 143. Title I of division L of Public Law 115–141 and 
title I of division G of Public Law 116–6 shall be amended in 
the first provisos in each Act under the headings ‘‘Department
H. R. 4378—10 
of Transportation—Federal Transit Administration—Capital Invest-
ment Grants’’ by striking ‘‘obligated’’ and inserting ‘‘allocated’’. 
SEC. 144. Section 9503(e)(4) of the Internal Revenue Code of 
1986 shall not apply during the period covered by this Act. 
SEC. 145. Amounts made available by section 101 to the Depart-
ment of Housing and Urban Development for ‘‘Housing Programs— 
Housing for the Elderly’’ may be apportioned up to the rate for 
operations necessary to maintain project rental assistance for the 
elderly under section 202(c)(2) of the Housing Act of 1959 (12 
U.S.C. 1701q(c)(2)), including making amendments to contracts for 
such assistance and renewing expiring contracts for such assistance 
for up to a 1-year term. 
This division may be cited as the ‘‘Continuing Appropriations 
Act, 2020’’. 
DIVISION 
B—HEALTH 
AND 
HUMAN 
SERVICES EXTENDERS AND OTHER 
MATTERS 
TITLE I—PUBLIC HEALTH EXTENDERS 
SEC. 1101. EXTENSION FOR COMMUNITY HEALTH CENTERS, THE 
NATIONAL HEALTH SERVICE CORPS, AND TEACHING 
HEALTH CENTERS THAT OPERATE GME PROGRAMS. 
(a) COMMUNITY HEALTH CENTERS.—Section 10503(b)(1)(F) of 
the Patient Protection and Affordable Care Act (42 U.S.C. 254b– 
2(b)(1)(F)) is amended by striking ‘‘2018 and $4,000,000,000 for 
fiscal year 2019.’’ and inserting ‘‘2018, $4,000,000,000 for fiscal 
year 2019, and $569,863,014 for the period beginning on October 
1, 2019, and ending on November 21, 2019; and’’. 
(b) NATIONAL HEALTH SERVICE CORPS.—Section 10503(b)(2) of 
the Patient Protection and Affordable Care Act (42 U.S.C. 254b– 
2(b)(2)) is amended— 
(1) in subparagraph (E), by striking ‘‘; and’’ and inserting 
a semicolon; 
(2) in subparagraph (F), by striking the period at the end 
and inserting ‘‘; and’’; and 
(3) by adding at the end the following: 
‘‘(G) $44,164,384 for the period beginning on October 
1, 2019, and ending on November 21, 2019.’’. 
(c) TEACHING HEALTH CENTERS THAT OPERATE GRADUATE MED-
ICAL EDUCATION PROGRAMS.—Section 340H(g)(1) of the Public 
Health Service Act (42 U.S.C. 256h(g)(1)) is amended— 
(1) 
by 
striking 
‘‘and 
$126,500,000’’ 
and 
inserting 
‘‘$126,500,000’’; and 
(2) by inserting ‘‘and $18,021,918 for the period beginning 
on October 1, 2019, and ending on November 21, 2019,’’ before 
‘‘to remain available’’. 
(d) APPLICATION OF PROVISIONS.—Amounts appropriated pursu-
ant to this section for the period beginning on October 1, 2019, 
and ending on November 21, 2019, shall be subject to the require-
ments contained in Public Law 115–245 for funds for programs 
authorized under sections 330 through 340 of the Public Health 
Service Act (42 U.S.C. 254 through 256).
H. R. 4378—11 
(e) CONFORMING AMENDMENT.—Paragraph (4) of section 3014(h) 
of title 18, United States Code, as amended by section 50901 of 
Public Law 115–123, is amended by striking ‘‘and section 50901(e) 
of the Advancing Chronic Care, Extenders, and Social Services 
Act’’ and inserting ‘‘, section 50901(e) of the Advancing Chronic 
Care, Extenders, and Social Services Act, and section 1101(d) of 
division B of the Continuing Appropriations Act, 2020, and Health 
Extenders Act of 2019’’. 
SEC. 1102. DIABETES PROGRAMS. 
(a) TYPE I.—Section 330B(b)(2)(D) of the Public Health Service 
Act (42 U.S.C. 254c–2(b)(2)(D)) is amended by inserting ‘‘and 
$21,369,863 for the period beginning on October 1, 2019, and ending 
on November 21, 2019,’’ before ‘‘to remain available’’. 
(b) INDIANS.—Section 330C(c)(2)(D) of the Public Health Service 
Act (42 U.S.C. 254c–3(c)(2)(D)) is amended by inserting ‘‘and 
$21,369,863 for the period beginning on October 1, 2019, and ending 
on November 21, 2019,’’ before ‘‘to remain available’’. 
TITLE II—OTHER HEALTH EXTENDERS 
SEC. 1201. EXTENSION OF SEXUAL RISK AVOIDANCE EDUCATION PRO-
GRAM. 
Section 510 of the Social Security Act (42 U.S.C. 710) is 
amended— 
(1) in subsection (a)— 
(A) in paragraph (1)— 
(i) in the matter preceding subparagraph (A)— 
(I) by inserting after ‘‘for each of fiscal years 
2018 and 2019’’ the following: ‘‘and for the period 
beginning October 1, 2019, and ending November 
21, 2019’’; and 
(II) by inserting after ‘‘for the fiscal year’’ the 
following: ‘‘(or, with respect to such period, for 
fiscal year 2020)’’; and 
(ii) in subparagraph (A), by striking ‘‘for the fiscal 
year’’ each place it appears and inserting ‘‘for the fiscal 
year or period’’ in each such place; and 
(B) in paragraph (2)— 
(i) in subparagraph (A)— 
(I) by inserting after ‘‘for each of fiscal years 
2018 and 2019’’ the following: ‘‘and for the period 
beginning October 1, 2019, and ending November 
21, 2019’’; and 
(II) by inserting after ‘‘for the fiscal year’’ the 
following: ‘‘(or, with respect to such period, for 
fiscal year 2020)’’; and 
(ii) in subparagraph (B)(i), by inserting after ‘‘for 
the fiscal year’’ the following: ‘‘(or, with respect to 
such period, for fiscal year 2020)’’; and 
(2) in subsection (f)— 
(A) in paragraph (1), by inserting after ‘‘for each of 
fiscal years 2018 and 2019’’ the following: ‘‘and $10,684,931 
for the period beginning October 1, 2019, and ending 
November 21, 2019’’; and
H. R. 4378—12 
(B) in paragraph (2), by inserting after ‘‘for each of 
fiscal years 2018 and 2019’’ the following: ‘‘and for the 
period described in paragraph (1)’’. 
SEC. 1202. EXTENSION OF PERSONAL RESPONSIBILITY EDUCATION 
PROGRAM. 
Section 513 of the Social Security Act (42 U.S.C. 713) is 
amended— 
(1) in subsection (a)— 
(A) in paragraph (1)— 
(i) in subparagraph (A)— 
(I) in the matter preceding clause (i), by 
inserting after ‘‘for each of fiscal years 2010 
through 2019’’ the following: ‘‘and for the period 
beginning October 1, 2019, and ending November 
21, 2019’’; and 
(II) in clause (i), by inserting after ‘‘for the 
fiscal year’’ the following: ‘‘or period’’; 
(ii) in subparagraph (B)(i), by adding at the end 
the following new sentence: ‘‘The previous sentence 
shall not apply with respect to State allotments under 
this paragraph for the period beginning October 1, 
2019, and ending November 21, 2019.’’; and 
(iii) in subparagraph (C)(i)— 
(I) by inserting after ‘‘for a fiscal year’’ the 
following: ‘‘or the period described in subparagraph 
(A)’’; and 
(II) by inserting after ‘‘for the fiscal year’’ the 
following: ‘‘or period’’; 
(B) in paragraph (3)— 
(i) by inserting after ‘‘for a fiscal year’’ the fol-
lowing: ‘‘or the period described in paragraph (1)(A)’’; 
and 
(ii) by striking ‘‘the end of the second succeeding 
fiscal year’’ and inserting ‘‘the end of the second fiscal 
year following such fiscal year or period’’; and 
(C) in paragraph (4)— 
(i) in subparagraph (A)— 
(I) by inserting after ‘‘for each of fiscal years 
2010 through 2019’’ the following: ‘‘and for the 
period described in paragraph (1)(A)’’; 
(II) by inserting after ‘‘for each of fiscal years 
2012 through 2019’’ the following: ‘‘and for the 
period so described’’; and 
(III) by inserting after ‘‘for a fiscal year’’ the 
following: ‘‘or the period so described’’; and 
(ii) in subparagraph (B)(i), by striking ‘‘continue 
through fiscal year 2019’’ and inserting ‘‘continue 
through the period described in paragraph (1)(A)’’; 
(2) in subsection (c)— 
(A) in paragraph (1), by striking ‘‘From the amount’’ 
and inserting ‘‘Subject to paragraph (3), from the amount’’; 
(B) in paragraph (2), by striking ‘‘From the amount’’ 
and inserting ‘‘Subject to paragraph (3), from the amount’’; 
and 
(C) by adding at the end the following new paragraph:
H. R. 4378—13 
‘‘(3) EXCEPTION.—Paragraphs (1) and (2) shall not apply 
with respect to any amount appropriated under subsection (f) 
for the period described in subsection (a)(1)(A).’’; and 
(3) in subsection (f), by inserting after ‘‘for each of fiscal 
years 2010 through 2019’’ the following: ‘‘and $10,684,931 for 
the period beginning October 1, 2019, and ending November 
21, 2019’’. 
TITLE III—MEDICAID EXTENDERS 
SEC. 1301. EXTENSION OF COMMUNITY MENTAL HEALTH SERVICES 
DEMONSTRATION PROGRAM. 
Section 223(d)(3) of the Protecting Access to Medicare Act of 
2014 (42 U.S.C. 1396a note) is amended by striking ‘‘September 
13, 2019’’ and inserting ‘‘November 21, 2019’’. 
SEC. 1302. TEMPORARY INCREASE IN FEDERAL MEDICAL ASSISTANCE 
PERCENTAGE FOR TERRITORIES UNDER MEDICAID PRO-
GRAM. 
Section 1905 of the Social Security Act (42 U.S.C. 1396d) is 
amended— 
(1) in subsection (b), by striking ‘‘and (aa)’’ and inserting 
‘‘(aa), and (ff)’’; and 
(2) by adding at the end the following new subsection: 
‘‘(ff) TEMPORARY INCREASE IN FMAP FOR TERRITORIES.—Not-
withstanding subsection (b) or (z)(2), the Federal medical assistance 
percentage for Puerto Rico, the Virgin Islands, Guam, the Northern 
Mariana Islands, and American Samoa shall be equal to 100 percent 
for the period beginning October 1, 2019, and ending November 
21, 2019.’’. 
SEC. 1303. DELAY OF REDUCTIONS IN MEDICAID DSH ALLOTMENTS. 
Section 1923(f)(7)(A) of the Social Security Act (42 U.S.C. 
1396r–4(f)(7)(A)) is amended— 
(1) in clause (i), in the matter preceding subclause (I), 
by striking ‘‘For each of fiscal years 2020 through 2025’’ and 
inserting ‘‘For the period beginning November 22, 2019, and 
ending September 30, 2020, and for each of fiscal years 2021 
through 2025’’; and 
(2) in clause (ii)(I), by striking ‘‘for fiscal year 2020’’ and 
inserting ‘‘for the period beginning November 22, 2019, and 
ending September 30, 2020’’. 
TITLE IV—MEDICARE EXTENDERS 
SEC. 1401. EXTENSION OF FUNDING FOR QUALITY MEASURE ENDORSE-
MENT, INPUT, AND SELECTION. 
Section 1890(d)(2) of the Social Security Act (42 U.S.C. 
1395aaa(d)(2)) is amended— 
(1) in the first sentence— 
(A) by striking ‘‘and $7,500,000’’ and inserting 
‘‘$7,500,000’’; and 
(B) by inserting before the period at the end the fol-
lowing: ‘‘, and $1,069,000 for the period beginning on 
October 1, 2019, and ending on November 21, 2019’’; and
H. R. 4378—14 
(2) in the third sentence, by inserting ‘‘and for the period 
beginning on October 1, 2019, and ending on November 21, 
2019,’’ after ‘‘2019’’. 
SEC. 1402. EXTENSION OF FUNDING OUTREACH AND ASSISTANCE FOR 
LOW-INCOME PROGRAMS. 
(a) ADDITIONAL FUNDING FOR STATE HEALTH INSURANCE PRO-
GRAMS.—Subsection (a)(1)(B) of section 119 of the Medicare 
Improvements for Patients and Providers Act of 2008 (42 U.S.C. 
1395b–3 note), as amended by section 3306 of the Patient Protection 
and Affordable Care Act (Public Law 111–148), section 610 of the 
American Taxpayer Relief Act of 2012 (Public Law 112–240), section 
1110 of the Pathway for SGR Reform Act of 2013 (Public Law 
113–67), section 110 of the Protecting Access to Medicare Act of 
2014 (Public Law 113–93), section 208 of the Medicare Access 
and CHIP Reauthorization Act of 2015 (Public Law 114–10), and 
section 50207 of division E of the Bipartisan Budget Act of 2018 
(Public Law 115–123), is amended— 
(1) in clause (vii), by striking ‘‘and’’ at the end; 
(2) in clause (viii), by striking ‘‘and’’ at the end; 
(3) in clause (ix), by striking the period at the end and 
inserting ‘‘; and’’; and 
(4) by inserting after clause (ix) the following new clause: 
‘‘(x) for the period beginning on October 1, 2019, 
and ending on November 21, 2019, of $1,852,000.’’. 
(b) ADDITIONAL FUNDING
FOR AREA AGENCIES
ON AGING.— 
Subsection (b)(1)(B) of such section 119, as so amended, is 
amended— 
(1) in clause (vii), by striking ‘‘and’’ at the end; 
(2) in clause (viii), by striking ‘‘and’’ at the end; 
(3) in clause (ix), by striking the period at the end and 
inserting ‘‘; and’’; and 
(4) by inserting after clause (ix) the following new clause: 
‘‘(x) for the period beginning on October 1, 2019, 
and ending on November 21, 2019, of $1,069,000.’’. 
(c) ADDITIONAL FUNDING FOR AGING AND DISABILITY RESOURCE 
CENTERS.—Subsection (c)(1)(B) of such section 119, as so amended, 
is amended— 
(1) in clause (vii), by striking ‘‘and’’ at the end; 
(2) in clause (viii), by striking ‘‘and’’ at the end; 
(3) in clause (ix), by striking the period at the end and 
inserting ‘‘; and’’; and 
(4) by inserting after clause (ix) the following new clause: 
‘‘(x) for the period beginning on October 1, 2019, 
and ending on November 21, 2019, of $712,000.’’. 
(d) ADDITIONAL FUNDING FOR CONTRACT WITH THE NATIONAL 
CENTER FOR BENEFITS AND OUTREACH ENROLLMENT.—Subsection 
(d)(2) of such section 119, as so amended, is amended— 
(1) in clause (vii), by striking ‘‘and’’ at the end; 
(2) in clause (viii), by striking ‘‘and’’ at the end; 
(3) in clause (ix), by striking the period at the end and 
inserting ‘‘; and’’; and 
(4) by inserting after clause (ix) the following new clause: 
‘‘(x) for the period beginning on October 1, 2019, 
and ending on November 21, 2019, of $1,710,000.’’.