506 
the preceding proviso shall be subject to section 241 of the 
PHS Act or section 205 of this Act. 
ADMINISTRATION FOR STRATEGIC PREPAREDNESS AND 
RESPONSE 
RESEARCH, DEVELOPMENT, AND PROCUREMENT 
For carrying out title III and subtitles A and B of 
title XXVIII of the PHS Act, with respect to the research, 
development, storage, production, and procurement of med-
ical countermeasures to counter potential chemical, biologi-
cal, radiological, and nuclear threats to civilian popu-
lations, $3,135,000,000: Provided, That of such amount: 
(1) $1,015,000,000, to remain available through 
September 30, 2025, shall be for expenses necessary to 
support advanced research and development pursuant 
to section 319L of the PHS Act and other adminis-
trative expenses of the Biomedical Advanced Research 
and Development Authority; 
(2) $825,000,000, to remain available until ex-
pended, shall be for expenses necessary for procuring 
security countermeasures (as defined in section 319F– 
2(c)(1)(B) of the PHS Act); 
(3) $980,000,000, to remain available until ex-
pended, shall be for expenses necessary to carry out 
section 319F–2(a) of the PHS Act; and
507 
(4) $315,000,000 shall be for expenses necessary 
to prepare for or respond to an influenza pandemic, 
of which $280,000,000 shall remain available until 
expended for activities including the development and 
purchase of vaccines, antivirals, necessary medical 
supplies, diagnostics, and surveillance tools: Provided, 
That notwithstanding section 496(b) of the PHS Act, 
funds allocated under this paragraph may be used for 
the construction or renovation of privately owned fa-
cilities for the production of pandemic influenza vac-
cines and other biologics, if the Secretary finds such 
construction or renovation necessary to secure suffi-
cient supplies of such vaccines or biologics: 
Provided further, That funds provided under this heading 
for purposes of acquisition of security countermeasures shall 
be in addition to any other funds made available for such 
purposes: Provided further, That products purchased with 
funds made available under this heading may, at the discre-
tion of the Secretary, be deposited in the Strategic National 
Stockpile pursuant to section 319F–2 of the PHS Act. 
OPERATIONS, PREPAREDNESS, AND EMERGENCY RESPONSE 
For carrying out titles III, XII, and subtitles A and 
B of title XXVIII of the PHS Act, operations and emer-
gency response activities related to countering potential 
chemical, biological, radiological, and nuclear threats and
508 
other public health emergencies, $499,606,000: Provided, 
That of the amounts made available under this heading, 
$5,000,000 shall remain available through September 30, 
2026, to support emergency operations: Provided further, 
That of the amounts made available under this heading, 
$15,000,000 shall remain available through September 30, 
2025, to support coordination of the development, produc-
tion, and distribution of vaccines, therapeutics, and other 
medical countermeasures: Provided further, That of the 
amounts made available under this heading, $10,000,000 
shall remain available until September 30, 2025, for ad-
vanced research and development, manufacturing, produc-
tion, procurement, distribution, and the acquisition, con-
struction, alteration, or renovation of non-federally owned 
facilities for the production and purchase of medical coun-
termeasures, which may include the development, trans-
lation, and demonstration at scale of innovations in manu-
facturing platform. 
OFFICE OF THE SECRETARY 
GENERAL DEPARTMENTAL MANAGEMENT 
For necessary expenses, not otherwise provided, for 
general departmental management, including hire of six 
passenger motor vehicles, and for carrying out titles III, 
XVII, XXI, and section 229 of the PHS Act, the United 
States-Mexico Border Health Commission Act, and research
509 
studies under section 1110 of the Social Security Act, 
$537,144,000, together with $64,828,000 from the amounts 
available under section 241 of the PHS Act to carry out 
national health or human services research and evaluation 
activities: Provided, That of this amount, $60,000,000 shall 
be for minority AIDS prevention and treatment activities: 
Provided further, That of the funds made available under 
this heading, $101,000,000 shall be for making competitive 
contracts and grants to public and private entities to fund 
medically accurate and age appropriate programs that re-
duce teen pregnancy and for the Federal costs associated 
with administering and evaluating such contracts and 
grants, of which not more than 10 percent of the available 
funds shall be for training and technical assistance, evalua-
tion, outreach, and additional program support activities, 
and of the remaining amount 75 percent shall be for repli-
cating programs that have been proven effective through rig-
orous evaluation to reduce teenage pregnancy, behavioral 
risk factors underlying teenage pregnancy, or other associ-
ated risk factors, and 25 percent shall be available for re-
search and demonstration grants to develop, replicate, re-
fine, and test additional models and innovative strategies 
for preventing teenage pregnancy: Provided further, That 
of the amounts provided under this heading from amounts 
available under section 241 of the PHS Act, $6,800,000
510 
shall be available to carry out evaluations (including longi-
tudinal evaluations) of teenage pregnancy prevention ap-
proaches: Provided further, That of the funds made avail-
able under this heading, $35,000,000 shall be for making 
competitive grants which exclusively implement education 
in sexual risk avoidance (defined as voluntarily refraining 
from non-marital sexual activity): Provided further, That 
funding for such competitive grants for sexual risk avoid-
ance shall use medically accurate information referenced to 
peer-reviewed publications by educational, scientific, gov-
ernmental, or health organizations; implement an evidence- 
based approach integrating research findings with practical 
implementation that aligns with the needs and desired out-
comes for the intended audience; and teach the benefits asso-
ciated with self-regulation, success sequencing for poverty 
prevention, healthy relationships, goal setting, and resisting 
sexual coercion, dating violence, and other youth risk behav-
iors such as underage drinking or illicit drug use without 
normalizing teen sexual activity: Provided further, That no 
more than 10 percent of the funding for such competitive 
grants for sexual risk avoidance shall be available for tech-
nical assistance and administrative costs of such programs: 
Provided further, That funds provided in this Act for em-
bryo adoption activities may be used to provide to individ-
uals adopting embryos, through grants and other mecha-
511 
nisms, medical and administrative services deemed nec-
essary for such adoptions: Provided further, That such serv-
ices shall be provided consistent with 42 CFR 59.5(a)(4): 
Provided further, That of the funds made available under 
this heading, $5,000,000 shall be for carrying out prize 
competitions sponsored by the Office of the Secretary to ac-
celerate innovation in the prevention, diagnosis, and treat-
ment of kidney diseases (as authorized by section 24 of the 
Stevenson-Wydler Technology Innovation Act of 1980 (15 
U.S.C. 3719)). 
In addition, for expenses necessary to carry out title 
II of the PHS Act to support, except as otherwise provided, 
activities related to safeguarding classified national secu-
rity information and providing intelligence and national 
security support across the Department and to counter cy-
bersecurity threats to civilian populations, $108,983,000. 
MEDICARE HEARINGS AND APPEALS 
For expenses necessary for Medicare hearings and ap-
peals in the Office of the Secretary, $196,000,000 shall re-
main available until September 30, 2025, to be transferred 
in appropriate part from the Federal Hospital Insurance 
Trust Fund and the Federal Supplementary Medical Insur-
ance Trust Fund.
512 
OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH 
INFORMATION TECHNOLOGY 
For expenses necessary for the Office of the National 
Coordinator for Health Information Technology, including 
grants, contracts, and cooperative agreements for the devel-
opment and advancement of interoperable health informa-
tion technology, $69,238,000 shall be from amounts made 
available under section 241 of the PHS Act. 
OFFICE OF INSPECTOR GENERAL 
For expenses necessary for the Office of Inspector Gen-
eral, including the hire of passenger motor vehicles for in-
vestigations, in carrying out the provisions of the Inspector 
General Act of 1978, $87,000,000: Provided, That of such 
amount, necessary sums shall be available for providing 
protective services to the Secretary and investigating non- 
payment of child support cases for which non-payment is 
a Federal offense under 18 U.S.C. 228: Provided further, 
That of the amount appropriated under this heading, nec-
essary sums shall be available for carrying out activities 
authorized under section 3022 of the PHS Act (42 U.S.C. 
300jj–52). 
OFFICE FOR CIVIL RIGHTS 
For expenses necessary for the Office for Civil Rights, 
$39,798,000.
513 
RETIREMENT PAY AND MEDICAL BENEFITS FOR 
COMMISSIONED OFFICERS 
For retirement pay and medical benefits of Public 
Health Service Commissioned Officers as authorized by law, 
for payments under the Retired Serviceman’s Family Pro-
tection Plan and Survivor Benefit Plan, and for medical 
care of dependents and retired personnel under the Depend-
ents’ Medical Care Act, such amounts as may be required 
during the current fiscal year. 
GENERAL PROVISIONS 
SEC. 201. Funds appropriated in this title shall be 
available for not to exceed $50,000 for official reception and 
representation expenses when specifically approved by the 
Secretary. 
SEC. 202. None of the funds appropriated in this title 
shall be used to pay the salary of an individual, through 
a grant or other extramural mechanism, at a rate in excess 
of Executive Level II: Provided, That none of the funds ap-
propriated in this title shall be used to prevent the NIH 
from paying up to 100 percent of the salary of an indi-
vidual at this rate. 
SEC. 203. None of the funds appropriated in this Act 
may be expended pursuant to section 241 of the PHS Act, 
except for funds specifically provided for in this Act, or for 
other taps and assessments made by any office located in
514 
HHS, prior to the preparation and submission of a report 
by the Secretary to the Committees on Appropriations of 
the House of Representatives and the Senate detailing the 
planned uses of such funds. 
SEC. 204. Notwithstanding section 241(a) of the PHS 
Act, such portion as the Secretary shall determine, but not 
more than 2.5 percent, of any amounts appropriated for 
programs authorized under such Act shall be made available 
for the evaluation (directly, or by grants or contracts) and 
the implementation and effectiveness of programs funded in 
this title. 
(TRANSFER OF FUNDS) 
SEC. 205. Not to exceed 1 percent of any discretionary 
funds (pursuant to the Balanced Budget and Emergency 
Deficit Control Act of 1985) which are appropriated for the 
current fiscal year for HHS in this Act may be transferred 
between appropriations, but no such appropriation shall be 
increased by more than 3 percent by any such transfer: Pro-
vided, That the transfer authority granted by this section 
shall not be used to create any new program or to fund 
any project or activity for which no funds are provided in 
this Act: Provided further, That the Committees on Appro-
priations of the House of Representatives and the Senate 
are notified at least 15 days in advance of any transfer.
515 
SEC. 206. In lieu of the timeframe specified in section 
338E(c)(2) of the PHS Act, terminations described in such 
section may occur up to 60 days after the effective date of 
a contract awarded in fiscal year 2024 under section 338B 
of such Act, or at any time if the individual who has been 
awarded such contract has not received funds due under the 
contract. 
SEC. 207. None of the funds appropriated in this Act 
may be made available to any entity under title X of the 
PHS Act unless the applicant for the award certifies to the 
Secretary that it encourages family participation in the de-
cision of minors to seek family planning services and that 
it provides counseling to minors on how to resist attempts 
to coerce minors into engaging in sexual activities. 
SEC. 208. Notwithstanding any other provision of law, 
no provider of services under title X of the PHS Act shall 
be exempt from any State law requiring notification or the 
reporting of child abuse, child molestation, sexual abuse, 
rape, or incest. 
SEC. 209. None of the funds appropriated by this Act 
(including funds appropriated to any trust fund) may be 
used to carry out the Medicare Advantage program if the 
Secretary denies participation in such program to an other-
wise eligible entity (including a Provider Sponsored Orga-
nization) because the entity informs the Secretary that it
516 
will not provide, pay for, provide coverage of, or provide 
referrals for abortions: Provided, That the Secretary shall 
make appropriate prospective adjustments to the capitation 
payment to such an entity (based on an actuarially sound 
estimate of the expected costs of providing the service to such 
entity’s enrollees): Provided further, That nothing in this 
section shall be construed to change the Medicare program’s 
coverage for such services and a Medicare Advantage orga-
nization described in this section shall be responsible for 
informing enrollees where to obtain information about all 
Medicare covered services. 
SEC. 210. None of the funds made available in this 
title may be used, in whole or in part, to advocate or pro-
mote gun control. 
SEC. 211. The Secretary shall make available through 
assignment not more than 60 employees of the Public 
Health Service to assist in child survival activities and to 
work in AIDS programs through and with funds provided 
by the Agency for International Development, the United 
Nations International Children’s Emergency Fund or the 
World Health Organization. 
SEC. 212. In order for HHS to carry out international 
health activities, including HIV/AIDS and other infectious 
disease, chronic and environmental disease, and other 
health activities abroad during fiscal year 2024:
517 
(1) The Secretary may exercise authority equiva-
lent to that available to the Secretary of State in sec-
tion 2(c) of the State Department Basic Authorities 
Act of 1956. The Secretary shall consult with the Sec-
retary of State and relevant Chief of Mission to en-
sure that the authority provided in this section is ex-
ercised in a manner consistent with section 207 of the 
Foreign Service Act of 1980 and other applicable stat-
utes administered by the Department of State. 
(2) The Secretary is authorized to provide such 
funds by advance or reimbursement to the Secretary 
of State as may be necessary to pay the costs of ac-
quisition, lease, alteration, renovation, and manage-
ment of facilities outside of the United States for the 
use of HHS. The Department of State shall cooperate 
fully with the Secretary to ensure that HHS has se-
cure, safe, functional facilities that comply with ap-
plicable regulation governing location, setback, and 
other facilities requirements and serve the purposes 
established by this Act. The Secretary is authorized, 
in consultation with the Secretary of State, through 
grant or cooperative agreement, to make available to 
public or nonprofit private institutions or agencies in 
participating foreign countries, funds to acquire, 
lease, alter, or renovate facilities in those countries as
518 
necessary to conduct programs of assistance for inter-
national health activities, including activities relating 
to HIV/AIDS and other infectious diseases, chronic 
and environmental diseases, and other health activi-
ties abroad. 
(3) The Secretary is authorized to provide to 
personnel appointed or assigned by the Secretary to 
serve abroad, allowances and benefits similar to those 
provided under chapter 9 of title I of the Foreign 
Service Act of 1980, and 22 U.S.C. 4081 through 
4086 and subject to such regulations prescribed by the 
Secretary. The Secretary is further authorized to pro-
vide locality-based comparability payments (stated as 
a percentage) up to the amount of the locality-based 
comparability payment (stated as a percentage) that 
would be payable to such personnel under section 
5304 of title 5, United States Code if such personnel’s 
official duty station were in the District of Columbia. 
Leaves of absence for personnel under this subsection 
shall be on the same basis as that provided under sub-
chapter I of chapter 63 of title 5, United States Code, 
or section 903 of the Foreign Service Act of 1980, to 
individuals serving in the Foreign Service.
519 
(TRANSFER OF FUNDS) 
SEC. 213. The Director of the NIH, jointly with the 
Director of the Office of AIDS Research, may transfer up 
to 3 percent among institutes and centers from the total 
amounts identified by these two Directors as funding for 
research pertaining to the human immunodeficiency virus: 
Provided, That the Committees on Appropriations of the 
House of Representatives and the Senate are notified at 
least 15 days in advance of any transfer. 
(TRANSFER OF FUNDS) 
SEC. 214. Of the amounts made available in this Act 
for NIH, the amount for research related to the human im-
munodeficiency virus, as jointly determined by the Director 
of NIH and the Director of the Office of AIDS Research, 
shall be made available to the ‘‘Office of AIDS Research’’ 
account. The Director of the Office of AIDS Research shall 
transfer from such account amounts necessary to carry out 
section 2353(d)(3) of the PHS Act. 
SEC. 215. (a) AUTHORITY.—Notwithstanding any 
other provision of law, the Director of NIH (‘‘Director’’) 
may use funds authorized under section 402(b)(12) of the 
PHS Act to enter into transactions (other than contracts, 
cooperative agreements, or grants) to carry out research 
identified pursuant to or research and activities described 
in such section 402(b)(12).
520 
(b) PEER REVIEW.—In entering into transactions 
under subsection (a), the Director may utilize such peer re-
view procedures (including consultation with appropriate 
scientific experts) as the Director determines to be appro-
priate to obtain assessments of scientific and technical 
merit. Such procedures shall apply to such transactions in 
lieu of the peer review and advisory council review proce-
dures that would otherwise be required under sections 
301(a)(3), 405(b)(1)(B), 405(b)(2), 406(a)(3)(A), 492, and 
494 of the PHS Act. 
SEC. 216. Not to exceed $100,000,000 of funds appro-
priated by this Act to the institutes and centers of the Na-
tional Institutes of Health may be used for alteration, re-
pair, or improvement of facilities, as necessary for the prop-
er and efficient conduct of the activities authorized herein, 
at not to exceed $5,000,000 per project. 
(TRANSFER OF FUNDS) 
SEC. 217. Of the amounts made available for NIH, 1 
percent of the amount made available for National Research 
Service Awards (‘‘NRSA’’) shall be made available to the 
Administrator of the Health Resources and Services Admin-
istration to make NRSA awards for research in primary 
medical care to individuals affiliated with entities who have 
received grants or contracts under sections 736, 739, or 747 
of the PHS Act, and 1 percent of the amount made avail-
521 
able for NRSA shall be made available to the Director of 
the Agency for Healthcare Research and Quality to make 
NRSA awards for health service research. 
SEC. 218. (a) The Biomedical Advanced Research and 
Development Authority (‘‘BARDA’’) may enter into a con-
tract, for more than one but no more than 10 program 
years, for purchase of research services or of security coun-
termeasures, as that term is defined in section 319F– 
2(c)(1)(B) of the PHS Act (42 U.S.C. 247d–6b(c)(1)(B)), 
if— 
(1) funds are available and obligated— 
(A) for the full period of the contract or for 
the first fiscal year in which the contract is in 
effect; and 
(B) for the estimated costs associated with 
a necessary termination of the contract; and 
(2) the Secretary determines that a multi-year 
contract will serve the best interests of the Federal 
Government by encouraging full and open competi-
tion or promoting economy in administration, per-
formance, and operation of BARDA’s programs. 
(b) A contract entered into under this section— 
(1) shall include a termination clause as de-
scribed by subsection (c) of section 3903 of title 41, 
United States Code; and
522 
(2) shall be subject to the congressional notice re-
quirement stated in subsection (d) of such section. 
SEC. 219. (a) The Secretary shall publish in the fiscal 
year 2025 budget justification and on Departmental Web 
sites information concerning the employment of full-time 
equivalent Federal employees or contractors for the purposes 
of implementing, administering, enforcing, or otherwise 
carrying out the provisions of the ACA, and the amend-
ments made by that Act, in the proposed fiscal year and 
each fiscal year since the enactment of the ACA. 
(b) With respect to employees or contractors supported 
by all funds appropriated for purposes of carrying out the 
ACA (and the amendments made by that Act), the Secretary 
shall include, at a minimum, the following information: 
(1) For each such fiscal year, the section of such 
Act under which such funds were appropriated, a 
statement indicating the program, project, or activity 
receiving such funds, the Federal operating division 
or office that administers such program, and the 
amount of funding received in discretionary or man-
datory appropriations. 
(2) For each such fiscal year, the number of full- 
time equivalent employees or contracted employees as-
signed to each authorized and funded provision de-
tailed in accordance with paragraph (1).
523 
(c) In carrying out this section, the Secretary may ex-
clude from the report employees or contractors who— 
(1) are supported through appropriations en-
acted in laws other than the ACA and work on pro-
grams that existed prior to the passage of the ACA; 
(2) spend less than 50 percent of their time on 
activities funded by or newly authorized in the ACA; 
or 
(3) work on contracts for which FTE reporting 
is not a requirement of their contract, such as fixed- 
price contracts. 
SEC. 220. The Secretary shall publish, as part of the 
fiscal year 2025 budget of the President submitted under 
section 1105(a) of title 31, United States Code, information 
that details the uses of all funds used by the Centers for 
Medicare & Medicaid Services specifically for Health Insur-
ance Exchanges for each fiscal year since the enactment of 
the ACA and the proposed uses for such funds for fiscal year 
2025. Such information shall include, for each such fiscal 
year, the amount of funds used for each activity specified 
under the heading ‘‘Health Insurance Exchange Trans-
parency’’ in the explanatory statement described in section 
4 (in the matter preceding division A of this consolidated 
Act).
524 
SEC. 221. None of the funds made available by this 
Act from the Federal Hospital Insurance Trust Fund or 
the Federal Supplemental Medical Insurance Trust Fund, 
or transferred from other accounts funded by this Act to 
the ‘‘Centers for Medicare & Medicaid Services—Program 
Management’’ account, may be used for payments under 
section 1342(b)(1) of Public Law 111–148 (relating to risk 
corridors). 
(TRANSFER OF FUNDS) 
SEC. 222. (a) Within 45 days of enactment of this Act, 
the Secretary shall transfer funds appropriated under sec-
tion 4002 of the ACA to the accounts specified, in the 
amounts specified, and for the activities specified under the 
heading ‘‘Prevention and Public Health Fund’’ in the ex-
planatory statement described in section 4 (in the matter 
preceding division A of this consolidated Act). 
(b) Notwithstanding section 4002(c) of the ACA, the 
Secretary may not further transfer these amounts. 
(c) Funds transferred for activities authorized under 
section 2821 of the PHS Act shall be made available with-
out reference to section 2821(b) of such Act. 
SEC. 223. Effective during the period beginning on No-
vember 1, 2015 and ending January 1, 2026, any provision 
of law that refers (including through cross-reference to an-
other provision of law) to the current recommendations of
525 
the United States Preventive Services Task Force with re-
spect to breast cancer screening, mammography, and pre-
vention shall be administered by the Secretary involved as 
if— 
(1) such reference to such current recommenda-
tions were a reference to the recommendations of such 
Task Force with respect to breast cancer screening, 
mammography, and prevention last issued before 
2009; and 
(2) such recommendations last issued before 2009 
applied to any screening mammography modality 
under section 1861(jj) of the Social Security Act (42 
U.S.C. 1395x(jj)). 
SEC. 224. In making Federal financial assistance, the 
provisions relating to indirect costs in part 75 of title 45, 
Code of Federal Regulations, including with respect to the 
approval of deviations from negotiated rates, shall continue 
to apply to the National Institutes of Health to the same 
extent and in the same manner as such provisions were ap-
plied in the third quarter of fiscal year 2017. None of the 
funds appropriated in this or prior Acts or otherwise made 
available to the Department of Health and Human Services 
or to any department or agency may be used to develop 
or implement a modified approach to such provisions, or 
to intentionally or substantially expand the fiscal effect of
526 
the approval of such deviations from negotiated rates be-
yond the proportional effect of such approvals in such quar-
ter. 
(TRANSFER OF FUNDS) 
SEC. 225. The NIH Director may transfer funds for 
opioid addiction, opioid alternatives, stimulant misuse and 
addiction, pain management, and addiction treatment to 
other Institutes and Centers of the NIH to be used for the 
same purpose 15 days after notifying the Committees on 
Appropriations of the House of Representatives and the 
Senate: Provided, That the transfer authority provided in 
the previous proviso is in addition to any other transfer 
authority provided by law. 
SEC. 226. (a) The Secretary shall provide to the Com-
mittees on Appropriations of the House of Representatives 
and the Senate: 
(1) Detailed monthly enrollment figures from the 
Exchanges established under the Patient Protection 
and Affordable Care Act of 2010 pertaining to enroll-
ments during the open enrollment period; and 
(2) Notification of any new or competitive grant 
awards, including supplements, authorized under sec-
tion 330 of the Public Health Service Act. 
(b) The Committees on Appropriations of the House 
and Senate must be notified at least 2 business days in
527 
advance of any public release of enrollment information or 
the award of such grants. 
SEC. 227. In addition to the amounts otherwise avail-
able for ‘‘Centers for Medicare & Medicaid Services, Pro-
gram Management’’, the Secretary of Health and Human 
Services may transfer up to $455,000,000 to such account 
from the Federal Hospital Insurance Trust Fund and the 
Federal Supplementary Medical Insurance Trust Fund to 
support program management activity related to the Medi-
care Program: Provided, That except for the foregoing pur-
pose, such funds may not be used to support any provision 
of Public Law 111–148 or Public Law 111–152 (or any 
amendment made by either such Public Law) or to supplant 
any other amounts within such account. 
SEC. 228. The Department of Health and Human 
Services shall provide the Committees on Appropriations of 
the House of Representatives and Senate a biannual report 
30 days after enactment of this Act on staffing described 
in the explanatory statement described in section 4 (in the 
matter preceding division A of this consolidated Act). 
SEC. 229. Funds appropriated in this Act that are 
available for salaries and expenses of employees of the De-
partment of Health and Human Services shall also be 
available to pay travel and related expenses of such an em-
ployee or of a member of his or her family, when such em-
528 
ployee is assigned to duty, in the United States or in a 
U.S. territory, during a period and in a location that are 
the subject of a determination of a public health emergency 
under section 319 of the Public Health Service Act and such 
travel is necessary to obtain medical care for an illness, 
injury, or medical condition that cannot be adequately ad-
dressed in that location at that time. For purposes of this 
section, the term ‘‘U.S. territory’’ means Guam, the Com-
monwealth of Puerto Rico, the Northern Mariana Islands, 
the Virgin Islands, American Samoa, or the Trust Territory 
of the Pacific Islands. 
SEC. 230. The Department of Health and Human 
Services may accept donations from the private sector, non-
governmental organizations, and other groups independent 
of the Federal Government for the care of unaccompanied 
alien children (as defined in section 462(g)(2) of the Home-
land Security Act of 2002 (6 U.S.C. 279(g)(2))) in the care 
of the Office of Refugee Resettlement of the Administration 
for Children and Families, including medical goods and 
services, which may include early childhood developmental 
screenings, school supplies, toys, clothing, and any other 
items intended to promote the wellbeing of such children. 
SEC. 231. None of the funds made available in this 
Act under the heading ‘‘Department of Health and Human 
Services—Administration for Children and Families—Ref-
529 
ugee and Entrant Assistance’’ may be obligated to a grantee 
or contractor to house unaccompanied alien children (as 
such term is defined in section 462(g)(2) of the Homeland 
Security Act of 2002 (6 U.S.C. 279(g)(2))) in any facility 
that is not State-licensed for the care of unaccompanied 
alien children, except in the case that the Secretary deter-
mines that housing unaccompanied alien children in such 
a facility is necessary on a temporary basis due to an influx 
of such children or an emergency, provided that— 
(1) the terms of the grant or contract for the op-
erations of any such facility that remains in oper-
ation for more than six consecutive months shall re-
quire compliance with— 
(A) the same requirements as licensed place-
ments, as listed in Exhibit 1 of the Flores Settle-
ment Agreement that the Secretary determines 
are applicable to non-State licensed facilities; 
and 
(B) staffing ratios of one (1) on-duty Youth 
Care Worker for every eight (8) children or youth 
during waking hours, one (1) on-duty Youth 
Care Worker for every sixteen (16) children or 
youth during sleeping hours, and clinician ratios 
to children (including mental health providers) 
as required in grantee cooperative agreements;
530 
(2) the Secretary may grant a 60-day waiver for 
a contractor’s or grantee’s non-compliance with para-
graph (1) if the Secretary certifies and provides a re-
port to Congress on the contractor’s or grantee’s good- 
faith efforts and progress towards compliance; 
(3) not more than four consecutive waivers under 
paragraph (2) may be granted to a contractor or 
grantee with respect to a specific facility; 
(4) ORR shall ensure full adherence to the moni-
toring requirements set forth in section 5.5 of its Poli-
cies and Procedures Guide as of May 15, 2019; 
(5) for any such unlicensed facility in operation 
for more than three consecutive months, ORR shall 
conduct a minimum of one comprehensive monitoring 
visit during the first three months of operation, with 
quarterly monitoring visits thereafter; and 
(6) not later than 60 days after the date of en-
actment of this Act, ORR shall brief the Committees 
on Appropriations of the House of Representatives 
and the Senate outlining the requirements of ORR for 
influx facilities including any requirement listed in 
paragraph (1)(A) that the Secretary has determined 
are not applicable to non-State licensed facilities. 
SEC. 232. In addition to the existing Congressional no-
tification for formal site assessments of potential influx fa-
531 
cilities, the Secretary shall notify the Committees on Appro-
priations of the House of Representatives and the Senate 
at least 15 days before operationalizing an unlicensed facil-
ity, and shall (1) specify whether the facility is hard-sided 
or soft-sided, and (2) provide analysis that indicates that, 
in the absence of the influx facility, the likely outcome is 
that unaccompanied alien children will remain in the cus-
tody of the Department of Homeland Security for longer 
than 72 hours or that unaccompanied alien children will 
be otherwise placed in danger. Within 60 days of bringing 
such a facility online, and monthly thereafter, the Secretary 
shall provide to the Committees on Appropriations of the 
House of Representatives and the Senate a report detailing 
the total number of children in care at the facility, the aver-
age length of stay and average length of care of children 
at the facility, and, for any child that has been at the facil-
ity for more than 60 days, their length of stay and reason 
for delay in release. 
SEC. 233. None of the funds made available in this 
Act may be used to prevent a United States Senator or 
Member of the House of Representatives from entering, for 
the purpose of conducting oversight, any facility in the 
United States used for the purpose of maintaining custody 
of, or otherwise housing, unaccompanied alien children (as 
defined in section 462(g)(2) of the Homeland Security Act
532 
of 2002 (6 U.S.C. 279(g)(2))), provided that such Senator 
or Member has coordinated the oversight visit with the Of-
fice of Refugee Resettlement not less than two business days 
in advance to ensure that such visit would not interfere 
with the operations (including child welfare and child safe-
ty operations) of such facility. 
SEC. 234. Not later than 14 days after the date of en-
actment of this Act, and monthly thereafter, the Secretary 
shall submit to the Committees on Appropriations of the 
House of Representatives and the Senate, and make pub-
licly available online, a report with respect to children who 
were separated from their parents or legal guardians by the 
Department of Homeland Security (DHS) (regardless of 
whether or not such separation was pursuant to an option 
selected by the children, parents, or guardians), subse-
quently classified as unaccompanied alien children, and 
transferred to the care and custody of ORR during the pre-
vious month. Each report shall contain the following infor-
mation: 
(1) the number and ages of children so separated 
subsequent to apprehension at or between ports of 
entry, to be reported by sector where separation oc-
curred; and 
(2) the documented cause of separation, as re-
ported by DHS when each child was referred.
533 
SEC. 235. Funds appropriated in this Act that are 
available for salaries and expenses of employees of the Cen-
ters for Disease Control and Prevention shall also be avail-
able for the primary and secondary schooling of eligible de-
pendents of personnel stationed in a U.S. territory as de-
fined in section 229 of this Act at costs not in excess of 
those paid for or reimbursed by the Department of Defense. 
SEC. 236. Section 231 of division B of the Department 
of Defense and Labor, Health and Human Services, and 
Education Appropriations Act, 2019 and Continuing Ap-
propriations Act, 2019 (42 U.S.C. 247d–4a) is amended by 
striking the fifth, sixth, and seventh provisos and inserting 
the following: ‘‘Provided further, That the Director shall 
provide to the Committees on Appropriations of the House 
of Representatives and the Senate, at least 7 days in ad-
vance of any transfer or obligation of funds made under 
the authority provided in this section, both a notification 
on the anticipated uses of funds by program, project, or ac-
tivity; and a detailed spend plan of anticipated uses of 
funds, including estimated personnel and administrative 
costs, disaggregated by program, project, or activity: Pro-
vided further, That such spend plans shall be updated to 
include all applicable obligations to date and unobligated 
amounts and submitted quarterly to such Committees on 
Appropriations until such funds are fully expended:’’.
534 
SEC. 237. Title VIII of division B of the CARES Act 
(Public Law 116–136) is amended, under the heading ‘‘De-
partment of Health and Human Services—Centers for Dis-
ease Control and Prevention—CDC-Wide Activities and 
Program Support’’ by striking the ninth proviso. 
SEC. 238. In this fiscal year and each fiscal year there-
after, notwithstanding the income eligibility requirements 
of subsections (a) and paragraphs (1) and (2) of subsection 
(d) of section 645 of the Head Start Act and income eligi-
bility criteria and allowances prescribed in regulations, an 
Indian tribe that operates a Head Start program may, at 
its discretion, establish selection criteria, including criteria 
to prioritize children in families for which a child, a family 
member, or a member of the same household, is a member 
of an Indian tribe, to enroll children who would benefit 
from the Head Start program. 
SEC. 239. In this fiscal year and each fiscal year there-
after, notwithstanding the income eligibility requirements 
of subsection (a) of section 645 of the Head Start Act and 
income eligibility criteria and allowances prescribed in reg-
ulations, an agency that operates a migrant or seasonal 
Head Start program may, at its discretion, establish selec-
tion criteria to enroll children who would benefit from the 
Head Start program, giving priority to children of migrant 
farmworker families: Provided, That such selection criteria
535 
shall limit that enrollment to children who have at least 
one family member whose income comes primarily from ag-
ricultural employment as defined in section 3 of the Mi-
grant and Seasonal Agricultural Worker Protection Act (29 
U.S.C. 1802). 
(RESCISSION) 
SEC. 240. Of the unobligated balances in the ‘‘Non-
recurring Expenses Fund’’ established in section 223 of di-
vision G of Public Law 110–161, $1,250,000,000 are hereby 
rescinded not later than September 30, 2024. 
(RESCISSION) 
SEC. 241. Of the unobligated balances from amounts 
made available under the heading ‘‘Department of Health 
and Human Services—Administration for Children and 
Families—Children and Families Services Programs’’ in 
division H of the Consolidated Appropriations Act, 2023 
(Public Law 117–328) for grants to States for incentive 
payments, as defined by section 473A of the Social Security 
Act, $70,000,000 are hereby rescinded. 
This title may be cited as the ‘‘Department of Health 
and Human Services Appropriations Act, 2024’’.
536 
TITLE III 
DEPARTMENT OF EDUCATION 
EDUCATION FOR THE DISADVANTAGED 
For carrying out title I and subpart 2 of part B of 
title II of the Elementary and Secondary Education Act 
of 1965 (referred to in this Act as ‘‘ESEA’’) and section 
418A of the Higher Education Act of 1965 (referred to in 
this 
Act 
as 
‘‘HEA’’), 
$19,107,790,000, 
of 
which 
$8,179,490,000 shall become available on July 1, 2024, and 
shall remain available through September 30, 2025, and of 
which $10,841,177,000 shall become available on October 1, 
2024, and shall remain available through September 30, 
2025, for academic year 2024–2025: Provided, That 
$6,459,401,000 shall be for basic grants under section 1124 
of the ESEA: Provided further, That up to $5,000,000 of 
these funds shall be available to the Secretary of Education 
(referred to in this title as ‘‘Secretary’’) on October 1, 2023, 
to obtain annually updated local educational agency-level 
census poverty data from the Bureau of the Census: Pro-
vided further, That $1,362,301,000 shall be for concentra-
tion grants under section 1124A of the ESEA: Provided fur-
ther, That $5,292,550,000 shall be for targeted grants under 
section 1125 of the ESEA: Provided further, That 
$5,292,550,000 shall be for education finance incentive 
grants under section 1125A of the ESEA: Provided further,
537 
That $224,000,000 shall be for carrying out subpart 2 of 
part B of title II: Provided further, That $52,123,000 shall 
be for carrying out section 418A of the HEA. 
IMPACT AID 
For carrying out programs of financial assistance to 
federally affected schools authorized by title VII of the 
ESEA, $1,625,151,000, of which $1,474,000,000 shall be for 
basic support payments under section 7003(b), $48,316,000 
shall be for payments for children with disabilities under 
section 7003(d), $19,000,000 shall be for construction under 
section 7007(a), $79,000,000 shall be for Federal property 
payments under section 7002, and $4,835,000, to remain 
available until expended, shall be for facilities maintenance 
under section 7008: Provided, That for purposes of com-
puting the amount of a payment for an eligible local edu-
cational agency under section 7003(a) for school year 2023– 
2024, children enrolled in a school of such agency that 
would otherwise be eligible for payment under section 
7003(a)(1)(B) of such Act, but due to the deployment of both 
parents or legal guardians, or a parent or legal guardian 
having sole custody of such children, or due to the death 
of a military parent or legal guardian while on active duty 
(so long as such children reside on Federal property as de-
scribed in section 7003(a)(1)(B)), are no longer eligible 
under such section, shall be considered as eligible students