NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS 
AND STROKE 
For carrying out section 301 and title IV of the PHS 
Act with respect to neurological disorders and stroke, 
$2,171,280,000. 
NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS 
DISEASES 
For carrying out section 301 and title IV of the PHS 
Act with respect to allergy and infectious diseases, 
$5,368,029,000. 
NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES 
For carrying out section 301 and title IV of the PHS 
Act 
with 
respect 
to 
general 
medical 
sciences, 
$2,818,667,000, of which $922,871,000 shall be from 
funds available under section 241 of the PHS Act: Pro-
vided, That not less than $365,575,000 is provided for 
the Institutional Development Awards program. 
EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF 
CHILD HEALTH AND HUMAN DEVELOPMENT 
For carrying out section 301 and title IV of the PHS 
Act with respect to child health and human development, 
$1,469,346,000. 
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NATIONAL EYE INSTITUTE 
For carrying out section 301 and title IV of the PHS 
Act with respect to eye diseases and visual disorders, 
$781,540,000. 
NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH 
SCIENCES 
For carrying out section 301 and title IV of the PHS 
Act with respect to environmental health sciences, 
$760,113,000. 
NATIONAL INSTITUTE ON AGING 
For carrying out section 301 and title IV of the PHS 
Act with respect to aging, $3,005,831,000. 
NATIONAL INSTITUTE OF ARTHRITIS AND 
MUSCULOSKELETAL AND SKIN DISEASES 
For carrying out section 301 and title IV of the PHS 
Act with respect to arthritis and musculoskeletal and skin 
diseases, $593,663,000. 
NATIONAL INSTITUTE ON DEAFNESS AND OTHER 
COMMUNICATION DISORDERS 
For carrying out section 301 and title IV of the PHS 
Act with respect to deafness and other communication dis-
orders, $465,467,000. 
NATIONAL INSTITUTE OF NURSING RESEARCH 
For carrying out section 301 and title IV of the PHS 
Act with respect to nursing research, $159,920,000. 
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NATIONAL INSTITUTE ON ALCOHOL ABUSE AND 
ALCOHOLISM 
For carrying out section 301 and title IV of the PHS 
Act with respect to alcohol abuse and alcoholism, 
$515,658,000. 
NATIONAL INSTITUTE ON DRUG ABUSE 
For carrying out section 301 and title IV of the PHS 
Act with respect to drug abuse, $1,400,126,000. 
NATIONAL INSTITUTE OF MENTAL HEALTH 
For carrying out section 301 and title IV of the PHS 
Act with respect to mental health, $1,732,731,000. 
NATIONAL HUMAN GENOME RESEARCH INSTITUTE 
For carrying out section 301 and title IV of the PHS 
Act 
with 
respect 
to 
human 
genome 
research, 
$563,531,000. 
NATIONAL INSTITUTE OF BIOMEDICAL IMAGING AND 
BIOENGINEERING 
For carrying out section 301 and title IV of the PHS 
Act with respect to biomedical imaging and bioengineering 
research, $382,384,000. 
NATIONAL CENTER FOR COMPLEMENTARY AND 
INTEGRATIVE HEALTH 
For carrying out section 301 and title IV of the PHS 
Act with respect to complementary and integrative health, 
$143,882,000. 
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NATIONAL INSTITUTE ON MINORITY HEALTH AND 
HEALTH DISPARITIES 
For carrying out section 301 and title IV of the PHS 
Act with respect to minority health and health disparities 
research, $306,821,000. 
JOHN E. FOGARTY INTERNATIONAL CENTER 
For carrying out the activities of the John E. Fogarty 
International Center (described in subpart 2 of part E of 
title IV of the PHS Act), $76,637,000. 
NATIONAL LIBRARY OF MEDICINE 
For carrying out section 301 and title IV of the PHS 
Act with respect to health information communications, 
$433,671,000: Provided, That of the amounts available for 
improvement of information systems, $4,000,000 shall be 
available until September 30, 2020: Provided further, That 
in fiscal year 2019, the National Library of Medicine may 
enter into personal services contracts for the provision of 
services in facilities owned, operated, or constructed under 
the jurisdiction of the National Institutes of Health (re-
ferred to in this title as ‘‘NIH’’). 
NATIONAL CENTER FOR ADVANCING TRANSLATIONAL 
SCIENCES 
For carrying out section 301 and title IV of the PHS 
Act with respect to translational sciences, $751,219,000: 
Provided, That up to $30,000,000 shall be available to im-
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plement section 480 of the PHS Act, relating to the Cures 
Acceleration Network: Provided further, That at least 
$542,771,000 is provided to the Clinical and Translational 
Sciences Awards program. 
OFFICE OF THE DIRECTOR 
For carrying out the responsibilities of the Office of 
the Director, NIH, $1,902,828,000: Provided, That fund-
ing shall be available for the purchase of not to exceed 
29 passenger motor vehicles for replacement only: Pro-
vided further, That all funds credited to the NIH Manage-
ment Fund shall remain available for one fiscal year after 
the fiscal year in which they are deposited: Provided fur-
ther, That $165,000,000 shall be for the Environmental 
Influences on Child Health Outcomes Study Follow-on: 
Provided further, That $595,139,000 shall be available for 
the Common Fund established under section 402A(c)(1) 
of the PHS Act: Provided further, That of the funds pro-
vided, $10,000 shall be for official reception and represen-
tation expenses when specifically approved by the Director 
of the NIH: Provided further, That the Office of AIDS 
Research within the Office of the Director of the NIH may 
spend up to $8,000,000 to make grants for construction 
or renovation of facilities as provided for in section 
2354(a)(5)(B) of the PHS Act. 
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In addition to other funds appropriated for the Com-
mon Fund established under section 402A(c) of the PHS 
Act, $12,600,000 is appropriated to the Common Fund 
from the 10-Year Pediatric Research Initiative Fund de-
scribed in section 9008 of the Internal Revenue Code of 
1986, 
for 
the 
purpose 
of 
carrying 
out 
section 
402(b)(7)(B)(ii) of the PHS Act (relating to pediatric re-
search), as authorized in the Gabriella Miller Kids First 
Research Act. 
BUILDINGS AND FACILITIES 
For the study of, construction or demolition of, ren-
ovation of, and acquisition of equipment for, facilities of 
or used by NIH, including the acquisition of real property, 
$200,000,000, to remain available through September 30, 
2023. 
NIH INNOVATION ACCOUNT 
(INCLUDING TRANSFER OF FUNDS) 
For necessary expenses to carry out the purposes de-
scribed in section 1001(b)(4) of the 21st Century Cures 
Act, in addition to amounts available for such purposes 
in the appropriations provided to the NIH in this Act, 
$711,000,000, to remain available until expended: Pro-
vided, That such amounts are appropriated pursuant to 
section 1001(b)(3) of such Act, and are to be derived from 
amounts transferred under section 1001(b)(2)(A) of such 
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520A(f)(2) of the PHS Act, no funds appropriated for car-
rying out section 520A shall be available for carrying out 
section 1971 of the PHS Act: Provided further, That in 
addition to amounts provided herein, $21,039,000 shall be 
available under section 241 of the PHS Act to carry out 
subpart I of part B of title XIX of the PHS Act to fund 
section 1920(b) technical assistance, national data, data 
collection and evaluation activities, and further that the 
total available under this Act for section 1920(b) activities 
shall not exceed 5 percent of the amounts appropriated 
for subpart I of part B of title XIX: Provided further, That 
up to 10 percent of the amounts made available to carry 
out the Children’s Mental Health Services program may 
be used to carry out demonstration grants or contracts 
for early interventions with persons not more than 25 
years of age at clinical high risk of developing a first epi-
sode of psychosis: Provided further, That section 
520E(b)(2) of the PHS Act shall not apply to funds ap-
propriated in this Act for fiscal year 2019: Provided fur-
ther, That States shall expend at least 10 percent of the 
amount each receives for carrying out section 1911 of the 
PHS Act to support evidence-based programs that address 
the needs of individuals with early serious mental illness, 
including psychotic disorders, regardless of the age of the 
individual at onset: Provided further, That none of the 
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funds provided for section 1911 of the PHS Act shall be 
subject to section 241 of such Act: Provided further, That 
of the funds made available under this heading, 
$15,000,000 shall be to carry out section 224 of the Pro-
tecting Access to Medicare Act of 2014 (Public Law 113– 
93; 42 U.S.C. 290aa 22 note): Provided further, That of 
the funds made available under this heading, $63,887,000 
shall be for the National Child Traumatic Stress Initia-
tive, of which $10,000,000 shall be available for grants 
to partners in the National Child Traumatic Stress Net-
work for behavioral health services and counseling for mi-
nors who were separated from their parents or family 
units and subsequently classified as unaccompanied alien 
children and transferred to the custody of the Department 
of Health and Human Services’ Office of Refugee Reset-
tlement: Provided further, That pursuant to the preceding 
proviso, the Department of Health and Human Services 
shall not share with any other Federal agency any person-
ally identifiable information or data relating to such mi-
nors receiving such services and counseling from partners 
receiving such grants: Provided further, That the Depart-
ment of Health and Human Services may agree to a 
memorandum of understanding with the Department of 
Homeland Security to allow grantees to provide behavioral 
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health services and counseling to families in the custody 
of the Department of Homeland Security. 
SUBSTANCE ABUSE TREATMENT 
For carrying out titles III and V of the PHS Act 
with respect to substance abuse treatment and title XIX 
of such Act with respect to substance abuse treatment and 
prevention, 
$3,772,306,000: 
Provided, 
That 
$1,000,000,000 shall be for State Opioid Response Grants 
for carrying out activities pertaining to opioids undertaken 
by the State agency responsible for administering the sub-
stance abuse prevention and treatment block grant under 
subpart II of part B of title XIX of the PHS Act (42 
U.S.C. 300x–21 et seq.): Provided further, That of such 
amount $50,000,000 shall be made available to Indian 
Tribes or tribal organizations: Provided further, That 15 
percent of the remaining amount shall be for the States 
with the highest mortality rate related to opioid use dis-
orders: Provided further, That of the amounts provided for 
State Opioid Response Grants not more than 2 percent 
shall be available for Federal administrative expenses, 
training, technical assistance, and evaluation: Provided 
further, That of the amount not reserved by the previous 
three provisos, the Secretary shall make allocations to 
States, territories, and the District of Columbia according 
to a formula using national survey results that the Sec-
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retary determines are the most objective and reliable 
measure of drug use and drug-related deaths: Provided 
further, That the Secretary shall submit the formula meth-
odology to the Committees on Appropriations of the House 
of Representatives and the Senate not less than 30 days 
prior to publishing a Funding Opportunity Announce-
ment: Provided further, That prevention and treatment ac-
tivities funded through such grants may include education, 
treatment (including the provision of medication), behav-
ioral health services for individuals in treatment programs, 
referral to treatment services, recovery support, and med-
ical screening associated with such treatment: Provided 
further, That each State, as well as the District of Colum-
bia, shall receive not less than $4,000,000: Provided fur-
ther, That in addition to amounts provided herein, the fol-
lowing amounts shall be available under section 241 of the 
PHS Act: (1) $79,200,000 to carry out subpart II of part 
B of title XIX of the PHS Act to fund section 1935(b) 
technical assistance, national data, data collection and 
evaluation activities, and further that the total available 
under this Act for section 1935(b) activities shall not ex-
ceed 5 percent of the amounts appropriated for subpart 
II of part B of title XIX; and (2) $2,000,000 to evaluate 
substance abuse treatment programs: Provided further, 
That none of the funds provided for section 1921 of the 
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PHS Act or State Opioid Response Grants shall be subject 
to section 241 of such Act. 
SUBSTANCE ABUSE PREVENTION 
For carrying out titles III and V of the PHS Act 
with respect to substance abuse prevention, $19,954,000: 
Provided, That in addition to amounts provided herein, 
$228,765,000 shall be available under section 241 of the 
PHS Act to supplement funds otherwise available for sub-
stance abuse prevention activities. 
HEALTH SURVEILLANCE AND PROGRAM SUPPORT 
For program support and cross-cutting activities that 
supplement activities funded under the headings ‘‘Mental 
Health’’,‘‘Substance Abuse Treatment’’, and ‘‘Substance 
Abuse Prevention’’ in carrying out titles III, V, and XIX 
of the PHS Act and the Protection and Advocacy for Indi-
viduals with Mental Illness Act in the Substance Abuse 
and 
Mental 
Health 
Services 
Administration, 
$133,830,000: Provided, That in addition to amounts pro-
vided herein, $31,428,000 shall be available under section 
241 of the PHS Act to supplement funds available to 
carry out national surveys on drug abuse and mental 
health, to collect and analyze program data, and to con-
duct public awareness and technical assistance activities: 
Provided further, That, in addition, fees may be collected 
for the costs of publications, data, data tabulations, and 
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data analysis completed under title V of the PHS Act and 
provided to a public or private entity upon request, which 
shall be credited to this appropriation and shall remain 
available until expended for such purposes: Provided fur-
ther, That amounts made available in this Act for carrying 
out section 501(o) of the PHS Act shall remain available 
through September 30, 2020: Provided further, That 
funds made available under this heading may be used to 
supplement program support funding provided under the 
headings ‘‘Mental Health’’, ‘‘Substance Abuse Treat-
ment’’, and ‘‘Substance Abuse Prevention’’. 
AGENCY FOR HEALTHCARE RESEARCH AND QUALITY 
HEALTHCARE RESEARCH AND QUALITY 
For carrying out titles III and IX of the PHS Act, 
part A of title XI of the Social Security Act, and section 
1013 of the Medicare Prescription Drug, Improvement, 
and Modernization Act of 2003, $334,000,000: Provided, 
That section 947(c) of the PHS Act shall not apply in 
fiscal year 2018: Provided further, That in addition, 
amounts received from Freedom of Information Act fees, 
reimbursable and interagency agreements, and the sale of 
data shall be credited to this appropriation and shall re-
main available until September 30, 2020. 
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CENTERS FOR MEDICARE & MEDICAID SERVICES 
GRANTS TO STATES FOR MEDICAID 
For carrying out, except as otherwise provided, titles 
XI and XIX of the Social Security Act, $276,236,212,000, 
to remain available until expended. 
For making, after May 31, 2019, payments to States 
under title XIX or in the case of section 1928 on behalf 
of States under title XIX of the Social Security Act for 
the last quarter of fiscal year 2019 for unanticipated costs 
incurred for the current fiscal year, such sums as may be 
necessary. 
For making payments to States or in the case of sec-
tion 1928 on behalf of States under title XIX of the Social 
Security Act for the first quarter of fiscal year 2020, 
$137,931,797,000, to remain available until expended. 
Payment under such title XIX may be made for any 
quarter with respect to a State plan or plan amendment 
in effect during such quarter, if submitted in or prior to 
such quarter and approved in that or any subsequent 
quarter. 
PAYMENTS TO THE HEALTH CARE TRUST FUNDS 
For payment to the Federal Hospital Insurance 
Trust Fund and the Federal Supplementary Medical In-
surance Trust Fund, as provided under sections 217(g), 
1844, and 1860D–16 of the Social Security Act, sections 
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103(c) and 111(d) of the Social Security Amendments of 
1965, section 278(d)(3) of Public Law 97–248, and for 
administrative expenses incurred pursuant to section 
201(g) of the Social Security Act, $378,343,800,000. 
In addition, for making matching payments under 
section 1844 and benefit payments under section 1860D– 
16 of the Social Security Act that were not anticipated 
in budget estimates, such sums as may be necessary. 
PROGRAM MANAGEMENT 
For carrying out, except as otherwise provided, titles 
XI, XVIII, XIX, and XXI of the Social Security Act, titles 
XIII and XXVII of the PHS Act, the and Clinical Labora-
tory Improvement Amendments of 1988, not to exceed 
$3,502,024,000, to be transferred from the Federal Hos-
pital Insurance Trust Fund and the Federal Supple-
mentary Medical Insurance Trust Fund, as authorized by 
section 201(g) of the Social Security Act; together with 
all funds collected in accordance with section 353 of the 
PHS Act and section 1857(e)(2) of the Social Security 
Act, funds retained by the Secretary pursuant to section 
1893(h) of the Social Security Act, and such sums as may 
be collected from authorized user fees and the sale of data, 
which shall be credited to this account and remain avail-
able until expended: Provided further, That no funds shall 
be derived from offsetting collections through fees col-
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lected from qualified heath plans offered through an Ex-
change established under Public Law 111-148 to operate 
such an Exchange: Provided further, That all funds de-
rived in accordance with 31 U.S.C. 9701 from organiza-
tions established under title XIII of the PHS Act shall 
be credited to and available for carrying out the purposes 
of this appropriation: Provided further, That the Secretary 
is directed to collect fees in fiscal year 2019 from Medicare 
Advantage organizations pursuant to section 1857(e)(2) 
of the Social Security Act and from eligible organizations 
with risk-sharing contracts under section 1876 of that Act 
pursuant to section 1876(k)(4)(D) of that Act. 
HEALTH CARE FRAUD AND ABUSE CONTROL ACCOUNT 
In addition to amounts otherwise available for pro-
gram integrity and program management, $765,000,000, 
to remain available through September 30, 2020, to be 
transferred from the Federal Hospital Insurance Trust 
Fund and the Federal Supplementary Medical Insurance 
Trust Fund, as authorized by section 201(g) of the Social 
Security Act, of which $599,389,000 shall be for the Cen-
ters for Medicare & Medicaid Services program integrity 
activities, of which $87,230,000 shall be for the Depart-
ment of Health and Human Services Office of Inspector 
General to carry out fraud and abuse activities authorized 
by section 1817(k)(3) of such Act, and of which 
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$78,381,000 shall be for the Department of Justice to 
carry out fraud and abuse activities authorized by section 
1817(k)(3) of such Act: Provided, That the report re-
quired by section 1817(k)(5) of the Social Security Act 
for fiscal year 2019 shall include measures of the oper-
ational efficiency and impact on fraud, waste, and abuse 
in the Medicare, Medicaid, and CHIP programs for the 
funds provided by this appropriation: Provided further, 
That of the amount provided under this heading, 
$311,000,000 is provided to meet the terms of section 
251(b)(2)(C)(ii) of the Balanced Budget and Emergency 
Deficit Control Act of 1985, as amended, and 
$454,000,000 is additional new budget authority specified 
for purposes of section 251(b)(2)(C) of such Act: Provided 
further, That the Secretary shall provide not less than 
$17,621,000 for the Senior Medicare Patrol program to 
combat health care fraud and abuse from the funds pro-
vided to this account. 
ADMINISTRATION FOR CHILDREN AND FAMILIES 
PAYMENTS TO STATES FOR CHILD SUPPORT 
ENFORCEMENT AND FAMILY SUPPORT PROGRAMS 
For carrying out, except as otherwise provided, titles 
I, IV–D, X, XI, XIV, and XVI of the Social Security Act 
and the Act of July 5, 1960, $2,922,247,000, to remain 
available until expended; and for such purposes for the 
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first quarter of fiscal year 2020, $1,400,000,000, to re-
main available until expended. 
For carrying out, after May 31 of the current fiscal 
year, except as otherwise provided, titles I, IV–D, X, XI, 
XIV, and XVI of the Social Security Act and the Act of 
July 5, 1960, for the last 3 months of the current fiscal 
year for unanticipated costs, incurred for the current fiscal 
year, such sums as may be necessary. 
LOW INCOME HOME ENERGY ASSISTANCE 
For making payments under subsections (b) and (d) 
of section 2602 of the Low Income Home Energy Assist-
ance Act of 1981, $3,640,304,000: Provided, That all but 
$678,500,000 of this amount shall be allocated as though 
the total appropriation for such payments for fiscal year 
2019 was less than $1,975,000,000: Provided further, 
That notwithstanding section 2609A(a), of the amounts 
appropriated under section 2602(b), not more than 
$2,988,000 of such amounts may be reserved by the Sec-
retary for technical assistance, training, and monitoring 
of program activities for compliance with internal controls, 
policies and procedures and may, in addition to the au-
thorities provided in section 2609A(a)(1), use such funds 
through contracts with private entities that do not qualify 
as nonprofit organizations. 
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REFUGEE AND ENTRANT ASSISTANCE 
(INCLUDING TRANSFER OF FUNDS) 
For necessary expenses for refugee and entrant as-
sistance activities authorized by section 414 of the Immi-
gration and Nationality Act and section 501 of the Ref-
ugee Education Assistance Act of 1980, and for carrying 
out section 462 of the Homeland Security Act of 2002, 
section 235 of the William Wilberforce Trafficking Victims 
Protection Reauthorization Act of 2008, the Trafficking 
Victims Protection Act of 2000 (‘‘TVPA’’), and the Tor-
ture Victims Relief Act of 1998, $1,864,936,000, of which 
$1,830,446,000 shall remain available through September 
30, 2021, for carrying out such sections 414, 501, 462, 
and 235: Provided, That amounts available under this 
heading to carry out the TVPA shall also be available for 
research and evaluation with respect to activities under 
such Act: Provided further, That the limitation in section 
205 of this Act regarding transfers increasing any appro-
priation shall apply to transfers to appropriations under 
this heading by substituting ‘‘10 percent’’ for ‘‘3 percent’’. 
PAYMENTS TO STATES FOR THE CHILD CARE AND 
DEVELOPMENT BLOCK GRANT 
For carrying out the Child Care and Development 
Block 
Grant 
Act 
of 
1990 
(‘‘CCDBG 
Act’’), 
$5,226,000,000 shall be used to supplement, not supplant 
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State general revenue funds for child care assistance for 
low-income families: Provided, That technical assistance 
under section 658I(a)(3) of such Act may be provided di-
rectly, or through the use of contracts, grants, cooperative 
agreements, or interagency agreements: Provided further, 
That all funds made available to carry out section 418 
of the Social Security Act (42 U.S.C. 618), including 
funds appropriated for that purpose in such section 418 
or any other provision of law, shall be subject to the res-
ervation of funds authority in paragraphs (4) and (5) of 
section 658O(a) of the CCDBG Act: Provided further, 
That in addition to the amounts required to be reserved 
by the Secretary under section 658O(a)(2)(A) of such Act, 
$156,780,000 shall be for Indian tribes and tribal organi-
zations: Provided further, That, in addition to the amounts 
reserved under section 658O(a)(5) of the CCDBG Act, 
$100,000,000 shall be for carrying out a program of com-
petitive grants to States, territories, tribes, local govern-
ments, and public entities, to develop, implement, and 
evaluate models of providing care for working families in 
rural communities, families needing child care on an emer-
gency basis, or families with non-traditional work hours. 
SOCIAL SERVICES BLOCK GRANT 
For making grants to States pursuant to section 
2002 of the Social Security Act, $1,700,000,000: Pro-
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vided, That notwithstanding subparagraph (B) of section 
404(d)(2) of such Act, the applicable percent specified 
under such subparagraph for a State to carry out State 
programs pursuant to title XX–A of such Act shall be 10 
percent. 
CHILDREN AND FAMILIES SERVICES PROGRAMS 
For carrying out, except as otherwise provided, the 
Runaway and Homeless Youth Act, the Head Start Act, 
the Every Student Succeeds Act, the Child Abuse Preven-
tion and Treatment Act, sections 303 and 313 of the 
Family Violence Prevention and Services Act, the Native 
American Programs Act of 1974, title II of the Child 
Abuse Prevention and Treatment and Adoption Reform 
Act of 1978 (adoption opportunities), part B–1 of title IV 
and sections 429, 473A, 477(i), 1110, 1114A, and 1115 
of the Social Security Act, and the Community Services 
Block Grant Act (‘‘CSBG Act’’); and for necessary admin-
istrative expenses to carry out titles I, IV, V, X, XI, XIV, 
XVI, and XX–A of the Social Security Act, the Act of 
July 5, 1960, the Low-Income Home Energy Assistance 
Act of 1981, the Child Care and Development Block Grant 
Act of 1990, the Assets for Independence Act, title IV of 
the Immigration and Nationality Act, and section 501 of 
the 
Refugee 
Education 
Assistance 
Act 
of 
1980, 
$12,122,225,000, of which $80,000,000, to remain avail-
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able through September 30, 2020, shall be for grants to 
States for adoption and legal guardianship incentive pay-
ments, as defined by section 473A of the Social Security 
Act and may be made for adoptions and legal 
guardianships completed before September 30, 2019: Pro-
vided, That $9,913,095,000 shall be for making payments 
under the Head Start Act: Provided further, That of the 
amount in the previous proviso, $9,108,095,000 shall be 
available for payments under section 640 of the Head 
Start Act, of which $25,000,000 shall be available for a 
cost 
of 
living 
adjustment 
notwithstanding 
section 
640(a)(3)(A) of such Act: Provided further, That of the 
amount provided for making payments under the Head 
Start Act, $25,000,000 shall be available for allocation by 
the Secretary to supplement activities described in para-
graphs (7)(B) and (9) of section 641(c) of such Act under 
the Designation Renewal System, established under the 
authority of sections 641(c)(7), 645A(b)(12) and 645A(d) 
of such Act: Provided further, That notwithstanding such 
section 640, of the amount provided for making payments 
under the Head Start Act, and in addition to funds other-
wise available under such section 640 for such purposes, 
$780,000,000 shall be available through March 31, 2020, 
for Early Head Start programs as described in section 
645A of such Act, for conversion of Head Start services 
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to Early Head Start services as described in section 
645(a)(5)(A) of such Act, for discretionary grants for high 
quality infant and toddler care through Early Head Start- 
Child Care Partnerships, to entities defined as eligible 
under section 645A(d) of such Act, for training and tech-
nical assistance for such activities, and for up to 
$16,000,000 in Federal costs of administration and eval-
uation, and, notwithstanding section 645A(c)(2) of such 
Act, these funds are available to serve children under age 
4: Provided further, That funds described in the preceding 
two provisos shall not be included in the calculation of 
‘‘base grant’’ in subsequent fiscal years, as such term is 
used in section 640(a)(7)(A) of such Act: Provided further, 
That $250,000,000 shall be for carrying out sections 9212 
and 9213 of the Every Student Succeeds Act: Provided 
further, That up to 3 percent of the funds in the preceding 
proviso shall be available for technical assistance and eval-
uation related to grants awarded under such section 9212: 
Provided further, That $779,883,000 shall be for making 
payments under the CSBG Act: Provided further, That 
$30,233,000 shall be for sections 680 and 678E(b)(2) of 
the CSBG Act, of which not less than $19,883,000 shall 
be for section 680(a)(2) and not less than $10,000,000 
shall be for section 680(a)(3)(B) of such Act: Provided 
further, That, notwithstanding section 675C(a)(3) of such 
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Act, to the extent Community Services Block Grant funds 
are distributed as grant funds by a State to an eligible 
entity as provided under such Act, and have not been ex-
pended by such entity, they shall remain with such entity 
for carryover into the next fiscal year for expenditure by 
such entity consistent with program purposes: Provided 
further, That the Secretary shall establish procedures re-
garding the disposition of intangible assets and program 
income that permit such assets acquired with, and pro-
gram income derived from, grant funds authorized under 
section 680 of the CSBG Act to become the sole property 
of such grantees after a period of not more than 12 years 
after the end of the grant period for any activity consistent 
with section 680(a)(2)(A) of the CSBG Act: Provided fur-
ther, That intangible assets in the form of loans, equity 
investments and other debt instruments, and program in-
come may be used by grantees for any eligible purpose 
consistent with section 680(a)(2)(A) of the CSBG Act: 
Provided further, That these procedures shall apply to 
such grant funds made available after November 29, 1999: 
Provided further, That funds appropriated for section 
680(a)(2) of the CSBG Act shall be available for financing 
construction and rehabilitation and loans or investments 
in private business enterprises owned by community devel-
opment 
corporations: 
Provided 
further, 
That 
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$160,000,000 shall be for carrying out section 303(a) of 
the Family Violence Prevention and Services Act, of which 
$5,000,000 shall be allocated notwithstanding section 
303(a)(2) of such Act for carrying out section 309 of such 
Act: Provided further, That the percentages specified in 
section 112(a)(2) of the Child Abuse Prevention and 
Treatment Act shall not apply to funds appropriated 
under this heading: Provided further That $1,864,000 
shall be for a human services case management system 
for federally declared disasters, to include a comprehensive 
national case management contract and Federal costs of 
administering the system: Provided further, That up to 
$2,000,000 shall be for improving the Public Assistance 
Reporting Information System, including grants to States 
to support data collection for a study of the system’s effec-
tiveness. 
PROMOTING SAFE AND STABLE FAMILIES 
For carrying out, except as otherwise provided, sec-
tion 436 of the Social Security Act, $345,000,000 and, 
for carrying out, except as otherwise provided, section 437 
of such Act, $59,765,000. 
PAYMENTS FOR FOSTER CARE AND PERMANENCY 
For carrying out, except as otherwise provided, title 
IV–E of the Social Security Act, $6,035,000,000. 
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For carrying out, except as otherwise provided, title 
IV–E of the Social Security Act, for the first quarter of 
fiscal year 2020, $2,800,000,000. 
For carrying out, after May 31 of the current fiscal 
year, except as otherwise provided, section 474 of title IV– 
E of the Social Security Act, for the last 3 months of the 
current fiscal year for unanticipated costs, incurred for the 
current fiscal year, such sums as may be necessary. 
ADMINISTRATION FOR COMMUNITY LIVING 
AGING AND DISABILITY SERVICES PROGRAMS 
(INCLUDING TRANSFER OF FUNDS) 
For carrying out, to the extent not otherwise pro-
vided, the Older Americans Act of 1965 (‘‘OAA’’), titles 
III and XXIX of the PHS Act, sections 1252 and 1253 
of the PHS Act, section 119 of the Medicare Improve-
ments for Patients and Providers Act of 2008, title XX– 
B of the Social Security Act, the Developmental Disabil-
ities Assistance and Bill of Rights Act, parts 2 and 5 of 
subtitle D of title II of the Help America Vote Act of 
2002, the Assistive Technology Act of 1998, titles II and 
VII (and section 14 with respect to such titles) of the Re-
habilitation Act of 1973, and for Department-wide coordi-
nation of policy and program activities that assist individ-
uals with disabilities, $2,137,617,000, together with 
$49,115,000 to be transferred from the Federal Hospital 
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Insurance Trust Fund and the Federal Supplementary 
Medical Insurance Trust Fund to carry out section 4360 
of the Omnibus Budget Reconciliation Act of 1990: Pro-
vided, That amounts appropriated under this heading may 
be used for grants to States under section 361 of the OAA 
only for disease prevention and health promotion pro-
grams and activities which have been demonstrated 
through rigorous evaluation to be evidence-based and ef-
fective: Provided further, That of amounts made available 
under this heading to carry out sections 311, 331, and 
336 of the OAA, up to one percent of such amounts shall 
be available for developing and implementing evidence- 
based practices for enhancing senior nutrition: Provided 
further, That notwithstanding any other provision of this 
Act, funds made available under this heading to carry out 
section 311 of the OAA may be transferred to the Sec-
retary of Agriculture in accordance with such section: Pro-
vided further, That $2,000,000 shall be for competitive 
grants to support alternative financing programs that pro-
vide for the purchase of assistive technology devices, such 
as a low-interest loan fund; an interest buy-down program; 
a revolving loan fund; a loan guarantee; or an insurance 
program: Provided further, That applicants shall provide 
an assurance that, and information describing the manner 
in which, the alternative financing program will expand 
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and emphasize consumer choice and control: Provided fur-
ther, That State agencies and community-based disability 
organizations that are directed by and operated for indi-
viduals with disabilities shall be eligible to compete: Pro-
vided further, That none of the funds made available under 
this heading may be used by an eligible system (as defined 
in section 102 of the Protection and Advocacy for Individ-
uals with Mental Illness Act (42 U.S.C. 10802)) to con-
tinue to pursue any legal action in a Federal or State 
court on behalf of an individual or group of individuals 
with a developmental disability (as defined in section 
102(8)(A) of the Developmental Disabilities and Assist-
ance and Bill of Rights Act of 2000 (20 U.S.C. 
15002(8)(A)) that is attributable to a mental impairment 
(or a combination of mental and physical impairments), 
that has as the requested remedy the closure of State op-
erated intermediate care facilities for people with intellec-
tual or developmental disabilities, unless reasonable public 
notice of the action has been provided to such individuals 
(or, in the case of mental incapacitation, the legal guard-
ians who have been specifically awarded authority by the 
courts to make healthcare and residential decisions on be-
half of such individuals) who are affected by such action, 
within 90 days of instituting such legal action, which in-
forms such individuals (or such legal guardians) of their 
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legal rights and how to exercise such rights consistent with 
current Federal Rules of Civil Procedure: Provided further, 
That the limitations in the immediately preceding proviso 
shall not apply in the case of an individual who is neither 
competent to consent nor has a legal guardian, nor shall 
the proviso apply in the case of individuals who are a ward 
of the State or subject to public guardianship. 
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 re-
search studies under section 1110 of the Social Security 
Act, $379,845,000, together with $53,445,000 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, 
$53,900,000 shall be for minority AIDS prevention and 
treatment activities: Provided further , That of the funds 
made available under this heading, $30,000,000 shall be 
for making competitive grants which exclusively imple-
ment education in sexual risk avoidance (defined as volun-
tarily refraining from non-marital sexual activity): Pro-
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vided further, That funding for such competitive grants 
for sexual risk avoidance shall use medically accurate in-
formation referenced to peer-reviewed publications by edu-
cational, scientific, governmental, or health organizations; 
implement an evidence-based approach integrating re-
search findings with practical implementation that aligns 
with the needs and desired outcomes for the intended au-
dience; and teach the benefits associated with self-regula-
tion, success sequencing for poverty prevention, healthy 
relationships, goal setting, and resisting sexual coercion, 
dating violence, and other youth risk behaviors 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 technical assist-
ance and administrative costs of such programs: Provided 
further, That funds provided in this Act for embryo adop-
tion activities may be used to provide to individuals adopt-
ing embryos, through grants and other mechanisms, med-
ical and administrative services deemed necessary for such 
adoptions: Provided further, That such services shall be 
provided consistent with 42 CFR 59.5(a)(4). 
OFFICE OF MEDICARE HEARINGS AND APPEALS 
For expenses necessary for the Office of Medicare 
Hearings and Appeals, $172,381,000 shall remain avail-
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able until September 30, 2020, to be transferred in appro-
priate part from the Federal Hospital Insurance Trust 
Fund and the Federal Supplementary Medical Insurance 
Trust Fund. 
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 de-
velopment and advancement of interoperable health infor-
mation technology, $42,705,000. 
OFFICE OF INSPECTOR GENERAL 
For expenses necessary for the Office of Inspector 
General, including the hire of passenger motor vehicles for 
investigations, in carrying out the provisions of the Inspec-
tor General Act of 1978, $80,000,000: Provided, That of 
such amount, necessary sums shall be available for pro-
viding protective services to the Secretary and inves-
tigating non-payment of child support cases for which non- 
payment is a Federal offense under 18 U.S.C. 228. 
OFFICE FOR CIVIL RIGHTS 
For expenses necessary for the Office for Civil 
Rights, $38,798,000. 
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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 
Protection Plan and Survivor Benefit Plan, and for med-
ical care of dependents and retired personnel under the 
Dependents’ Medical Care Act, such amounts as may be 
required during the current fiscal year. 
PUBLIC HEALTH AND SOCIAL SERVICES EMERGENCY 
FUND 
For expenses necessary to support activities related 
to countering potential biological, nuclear, radiological, 
chemical, and cybersecurity threats to civilian populations, 
and for other public health emergencies, $1,783,128,000, 
of which $586,700,000 shall remain available through 
September 30, 2020, for expenses necessary to support 
advanced research and development pursuant to section 
319L of the PHS Act and other administrative expenses 
of the Biomedical Advanced Research and Development 
Authority and $710,000,000 shall remain available until 
expended for the Strategic National Stockpile: Provided, 
That funds provided under this heading for the purpose 
of acquisition of security countermeasures shall be in addi-
tion to any other funds available for such purpose: Pro-
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vided further, That products purchased with funds pro-
vided under this heading may, at the discretion of the Sec-
retary, be deposited in the Strategic National Stockpile 
pursuant to section 319F–2 of the PHS Act: Provided fur-
ther, That $5,000,000 of the amounts made available to 
support emergency operations shall remain available 
through September 30, 2021. 
For expenses necessary for procuring security coun-
termeasures (as defined in section 319F–2(c)(1)(B) of the 
PHS Act), $780,000,000, to remain available until ex-
pended. 
For an additional amount for expenses necessary to 
prepare for or respond to an influenza pandemic, 
$250,000,000; of which $215,000,000 shall be available 
until expended, for activities including the development 
and purchase of vaccine, antivirals, necessary medical sup-
plies, diagnostics, and other surveillance tools: Provided, 
That notwithstanding section 496(b) of the PHS Act, 
funds may be used for the construction or renovation of 
privately owned facilities for the production of pandemic 
influenza vaccines and other biologics, if the Secretary 
finds such construction or renovation necessary to secure 
sufficient supplies of such vaccines or biologics. 
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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. 
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 HHS, prior to the preparation and submission of a re-
port by the Secretary to the Committees on Appropria-
tions of the House of Representatives and the Senate de-
tailing 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 appro-
priated 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. 
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(TRANSFER OF FUNDS) 
SEC. 205. Not to exceed 1 percent of any discre-
tionary funds (pursuant to the Balanced Budget and 
Emergency Deficit Control Act of 1985) which are appro-
priated 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: Provided, That the transfer author-
ity 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 Appropriations of the House of Rep-
resentatives and the Senate are notified at least 15 days 
in advance of any transfer. 
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 execution 
of a contract awarded in fiscal year 2019 under section 
338B of such Act. 
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 decision of minors to seek family planning services and 
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that it provides counseling to minors on how to resist at-
tempts 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 oth-
erwise eligible entity (including a Provider Sponsored Or-
ganization) because the entity informs the Secretary that 
it will not provide, pay for, provide coverage of, or provide 
referrals for abortions: Provided, That the Secretary shall 
make appropriate prospective adjustments to the capita-
tion payment to such an entity (based on an actuarially 
sound estimate of the expected costs of providing the serv-
ice to such entity’s enrollees): Provided further, That noth-
ing in this section shall be construed to change the Medi-
care program’s coverage for such services and a Medicare 
Advantage organization described in this section shall be 
responsible for informing enrollees where to obtain infor-
mation about all Medicare covered services. 
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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 inter-
national health activities, including HIV/AIDS and other 
infectious disease, chronic and environmental disease, and 
other health activities abroad during fiscal year 2019: 
(1) The Secretary may exercise authority equiv-
alent to that available to the Secretary of State in 
section 2(c) of the State Department Basic Authori-
ties Act of 1956. The Secretary shall consult with 
the Secretary of State and relevant Chief of Mission 
to ensure that the authority provided in this section 
is exercised in a manner consistent with section 207 
of the Foreign Service Act of 1980 and other appli-
cable statutes administered by the Department of 
State. 
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(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 co-
operate fully with the Secretary to ensure that HHS 
has secure, safe, functional facilities that comply 
with applicable regulation governing location, set-
back, 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 institu-
tions or agencies in participating foreign countries, 
funds to acquire, lease, alter, or renovate facilities in 
those countries as necessary to conduct programs of 
assistance for international health activities, includ-
ing activities relating to HIV/AIDS and other infec-
tious diseases, chronic and environmental diseases, 
and other health activities 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 For-
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100 
eign Service Act of 1980, and 22 U.S.C. 4081 
through 4086 and subject to such regulations pre-
scribed by the Secretary. The Secretary is further 
authorized to provide 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 per-
sonnel 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 per-
sonnel under this subsection shall be on the same 
basis as that provided under subchapter I of chapter 
63 of title 5, United States Code, or section 903 of 
the Foreign Service Act of 1980, to individuals serv-
ing in the Foreign Service. 
(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. 
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101 
(TRANSFER OF FUNDS) 
SEC. 214. Of the amounts made available in this Act 
for NIH, the amount for research related to the human 
immunodeficiency virus, as jointly determined by the Di-
rector of NIH and the Director of the Office of AIDS Re-
search, 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 nec-
essary 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)(7) or 
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 such section 
402(b)(7) (pertaining to the Common Fund) or research 
and activities described in such section 402(b)(12). 
(b) PEER REVIEW.—In entering into transactions 
under subsection (a), the Director may utilize such peer 
review 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 pro-
cedures that would otherwise be required under sections 
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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 $45,000,000 of funds appro-
priated by this Act to the institutes and centers of the 
National Institutes of Health may be used for alteration, 
repair, or improvement of facilities, as necessary for the 
proper and efficient conduct of the activities authorized 
herein, at not to exceed $3,500,000 per project. 
(TRANSFER OF FUNDS) 
SEC. 217. Of the amounts made available for NIH, 
1 percent of the amount made available for National Re-
search Service Awards (‘‘NRSA’’) shall be made available 
to the Administrator of the Health Resources and Services 
Administration to make NRSA awards for research in pri-
mary 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 available for NRSA shall be made available to the 
Director of the Agency for Healthcare Research and Qual-
ity to make NRSA awards for health service research. 
SEC. 218. (a) The Biomedical Advanced Research 
and Development Authority (‘‘BARDA’’) may enter into 
a contract, for more than one but no more than 10 pro-
gram years, for purchase of research services or of security 
countermeasures, as that term is defined in section 319F– 
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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 
(2) shall be subject to the congressional notice 
requirement stated in subsection (d) of such section. 
SEC. 219. (a) The Secretary shall publish in the fiscal 
year 2020 budget justification and on Departmental Web 
sites information concerning the employment of full-time 
equivalent Federal employees or contractors for the pur-
poses of implementing, administering, enforcing, or other-
wise carrying out the provisions of the ACA, and the 
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amendments 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 sup-
ported 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 ac-
tivity receiving such funds, the Federal operating di-
vision or office that administers such program, and 
the amount of funding received in discretionary or 
mandatory appropriations. 
(2) For each such fiscal year, the number of 
full-time equivalent employees or contracted employ-
ees assigned to each authorized and funded provision 
detailed in accordance with paragraph (1). 
(c) In carrying out this section, the Secretary may 
exclude 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; 
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(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 2020 budget of the President submitted under 
section 1105(a) of title 31, United States Code, informa-
tion that details the uses of all funds used by the Centers 
for Medicare and Medicaid Services specifically for Health 
Insurance Exchanges for each fiscal year since the enact-
ment of the ACA and the proposed uses for such funds 
for fiscal year 2020. Such information shall include, for 
each such fiscal year, the amount of funds used for each 
activity specified under the heading ‘‘Health Insurance 
Exchange Transparency’’ in the committee report accom-
panying the Act. 
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 
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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 
section 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 
committee report accompanying the 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 
November 1, 2015 and ending January 1, 2021, any pro-
vision of law that refers (including through cross-reference 
to another provision of law) to the current recommenda-
tions of the United States Preventive Services Task Force 
with respect to breast cancer screening, mammography, 
and prevention shall be administered by the Secretary in-
volved 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 
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screening, mammography, and prevention last issued 
before 2009; and 
(2) such recommendations last issued before 
2009 applied to any screening mammography modal-
ity 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 con-
tinue to apply to the National Institutes of Health to the 
same extent and in the same manner as such provisions 
were applied 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 provi-
sions, or to intentionally or substantially expand the fiscal 
effect of the approval of such deviations from negotiated 
rates beyond the proportional effect of such approvals in 
such quarter. 
(TRANSFER OF FUNDS) 
SEC. 225. The NIH Director may transfer funds spe-
cifically appropriated for opioid addiction, opioid alter-
natives, pain management, and addiction treatment to 
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other Institutes and Centers of the NIH to be used for 
the same purpose 15 days after notifying the Committees 
on Appropriations: Provided, That the transfer authority 
provided in the previous proviso is in addition to any other 
transfer authority provided by law. 
(TRANSFER OF FUNDS) 
SEC. 226. (a) The Secretary may reserve not more 
than 0.25 percent from each appropriation made available 
in this Act identified in subsection (b) in order to carry 
out evaluations of any of the programs or activities that 
are funded under such accounts. Any such funds reserved 
under this section may be transferred to ‘‘Children and 
Families Services Programs’’ for use by the Assistant Sec-
retary for the Administration for Children and Families 
to remain available until expended: Provided, That such 
funds shall only be available if such Assistant Secretary 
submits a plan to the Committees on Appropriations of 
the House of Representatives and the Senate describing 
the evaluations to be carried out 15 days in advance of 
any such transfer. 
(b) The accounts referred to in subsection (a) are: 
‘‘Low Income Home Energy Assistance’’, ‘‘Refugee and 
Entrant Assistance’’, ‘‘Payments to States for the Child 
Care and Development Block Grant’’, and ‘‘Children and 
Families Services Programs’’. 
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SEC. 227. None of the funds appropriated in this Act 
may be used to carry out title X of the PHS Act. 
(INCLUDING TRANSFER OF FUNDS) 
SEC. 228. There is established in the Treasury a re-
serve fund to be known as the ‘‘Infectious Diseases Rapid 
Response Reserve Fund’’ (the ‘‘Reserve Fund’’): Provided, 
That of the funds provided under the heading ‘‘CDC-Wide 
Activities and Program Support’’, $325,000,000, to re-
main available until expended, shall be available to the Di-
rector of the CDC for deposit in the Reserve Fund: Pro-
vided further, That amounts in the Reserve Fund shall be 
for carrying out titles II, III, and XVII of the PHS Act 
to prevent, prepare for, or respond to an infectious disease 
emergency, including, in connection with such activities, 
to purchase or lease and provide for the insurance of pas-
senger motor vehicles for official use in foreign countries: 
Provided further, That amounts in the Reserve Fund may 
only be provided for an infectious disease emergency if the 
infectious disease emergency (1) is declared by the Sec-
retary of Health and Human Services under section 319 
of the PHS Act to be a public health emergency; or (2) 
as determined by the Secretary, has significant potential 
to imminently occur and potential, on occurrence, to affect 
national security or the health and security of United 
States citizens, domestically or internationally: Provided 
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further, That amounts in the Reserve Fund may be trans-
ferred by the Director of the CDC to other accounts of 
the CDC, to accounts of the NIH, or to the Public Health 
and Social Services Emergency Fund, to be merged with 
such accounts or Fund for the purposes provided in this 
section: Provided further, That the Committees on Appro-
priations of the House of Representatives and the Senate 
shall be notified at least 15 days prior to any transfer or 
obligation made under the authority provided in this sec-
tion, including notification on the anticipated uses of such 
funds by program, project, or activity: Provided further, 
That the Committees on Appropriations of the House of 
Representatives and the Senate shall receive a report not 
later than 30 days after the end of each quarter in a fiscal 
year on the unobligated balances in the Reserve Fund and 
all actual obligations incurred for that fiscal year, includ-
ing obligations by program, project, or activity: Provided 
further, That amounts in the Reserve Fund shall be in 
addition to amounts otherwise available to the Department 
of Health and Human Services for the purposes provided 
in this section: Provided further, That the transfer au-
thorities in this section are in addition to any transfer au-
thority otherwise available to the Department of Health 
and Human Services: Provided further, That products pur-
chased using amounts in the Reserve Fund may, at the 
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111 
discretion of the Secretary of Health and Human Services, 
be deposited in the Strategic National Stockpile under sec-
tion 319F–2 of the PHS Act: Provided further, That this 
section shall be in effect as of the date of the enactment 
of this Act through each fiscal year hereafter. 
SEC. 229. None of the funds made available by this 
Act may be used to support the Monograph Programme 
of the International Agency for Research on Cancer (re-
ferred to in this title as ‘‘IARC’’) unless, within 90 days 
of enactment of this Act, the NIH provides to the Com-
mittee on Appropriations and the Committee on Science, 
Space, and Technology of the House of Representatives 
a report describing that grants, contracts, or cooperative 
agreement awards to IARC will require: 1) a transparent 
review process for Monograph Programme assessments in 
which drafts and revisions are publicly available online; 2) 
a process to address conflicts of interest in the selection 
of individuals involved with Monograph Programme as-
sessments; 3) use of the best available science in devel-
oping Monograph Programme assessment conclusions; 
and 4) summaries of relevant and significant studies and 
reports that do not support assessments conclusions. 
SEC. 230. Effective during the period beginning on 
the date of the enactment of this Act and ending Decem-
ber 31, 2022, for the purposes of any provision of law, 
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the recommendations of the United States Preventive 
Service Task Force regarding cervical cancer screening 
with a combination of cytology and human papillomavirus 
testing for women age 30 to 65 (issued in March 2012) 
shall be considered the most current recommendations of 
the United States Preventive Service Task Force for such 
cervical cancer screening. Any final recommendation re-
garding cervical cancer screening described in the pre-
ceding sentence issued by the United States Preventive 
Service Task Force that is based on the draft rec-
ommendation for such screening issued by the United 
States Preventive Service Task Force in 2017 shall have 
no force or effect under any provision of law. 
SEC. 231. Section 9(jj)(7) of the Small Business Act 
(15 U.S.C. 638(jj)(7)) is amended by striking ‘‘fiscal year 
2017’’ and inserting ‘‘fiscal year 2019’’. 
SEC. 232. The Department of Health and Human 
Services may accept donations from the private sector, 
nongovernmental organizations, and other groups inde-
pendent of the Federal Government for the care of unac-
companied alien children (as defined in section 462(g)(2) 
of the Homeland Security Act of 2002 (6 U.S.C. 
279(g)(2))) in the care of the Office of Refugee Resettle-
ment of the Administration for Children and Families, in-
cluding medical goods and services, school supplies, toys, 
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clothing, and any other items intended to promote the 
wellbeing of such children. 
SEC. 233. Not later than 30 days after the last day 
of each calendar quarter (beginning with the first calendar 
quarter beginning on or after the date of the enactment 
of this Act), the Secretary shall submit to Congress a re-
port on, with respect to children who were separated from 
their parents or legal guardians by the Department of 
Homeland Security and subsequently classified as unac-
companied alien children and transferred to the custody 
of the HHS’ Office of Refugee Resettlement— 
(1) the number of children so separated; 
(2) the length of any such separation; 
(3) the status of any efforts undertaken by the 
Secretary to reunify such children with a parent or 
legal guardian; and 
(4) the number of any such reunifications. 
SEC. 234. The Secretary shall submit to the Congress 
a plan to promptly facilitate the reunification of all chil-
dren separated from their parents or family units and 
placed in the custody of the Office of Refugee Resettle-
ment: Provided, That the funds made available in this title 
under the heading ‘‘OFFICE OF THE SECRETARY—GEN-
ERAL DEPARTMENTAL MANAGEMENT’’ shall be reduced by 
$100,000 for each day after August 1, 2018, that such 
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reunification plan has not been submitted to the Congress 
and such funds shall be rescinded in the amount of each 
such reduction: Provided further, That no portion of the 
reduction required by the preceding proviso shall be taken 
from any of the specific line items listed below the ‘‘Gen-
eral Departmental Management, Federal Funds’’ line in 
the table at the end of the committee report accompanying 
this Act. 
SEC. 235. To the extent practicable, and so long as 
it is appropriate and in the best interest of the child, in 
cases where the Office of Refugee Resettlement of the De-
partment of Health and Human Services is responsible for 
the care of siblings who are unaccompanied alien children 
(as defined in section 462(g)(2) of the Homeland Security 
Act of 2002 (6 U.S.C. 279(g)(2)), the Director of the Of-
fice shall place the siblings— 
(1) in the same facility; or 
(2) with the same sponsor. 
SEC. 236. Beginning with April 2018, the Secretary 
shall submit to Congress a monthly report on, with respect 
to children who were separated from their parents or legal 
guardians by the Department of Homeland Security and 
subsequently classified as unaccompanied alien children 
and transferred to the custody of the HHS’ Office of Ref-
ugee Resettlement— 
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(1) the number and ages of children so sepa-
rated at or between ports of entry; 
(2) the length of any such separation; 
(3) the status of any efforts undertaken by the 
Secretary to reunify such children with a parent or 
legal guardian; and 
(4) the number of any such reunifications, and 
whether the reunified families were placed in family 
detention. 
This title may be cited as the ‘‘Department of Health 
and Human Services Appropriations Act, 2019’’. 
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’’), $16,443,790,000, of which 
$5,525,990,000 shall become available on July 1, 2019, 
and shall remain available through September 30, 2020, 
and of which $10,841,177,000 shall become available on 
October 1, 2019, and shall remain available through Sep-
tember 30, 2020, for academic year 2019–2020: Provided, 
That $6,459,401,000 shall be for basic grants under sec-
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tion 1124 of the ESEA: Provided further, That up to 
$5,000,000 of these funds shall be available to the Sec-
retary of Education (referred to in this title as ‘‘Sec-
retary’’) on October 1, 2018, to obtain annually updated 
local educational agency-level census poverty data from 
the Bureau of the Census: Provided further, That 
$1,362,301,000 shall be for concentration grants under 
section 1124A of the ESEA: Provided further, That 
$3,969,050,000 shall be for targeted grants under section 
1125 
of 
the 
ESEA: 
Provided 
further, 
That 
$3,969,050,000 shall be for education finance incentive 
grants under section 1125A of the ESEA: Provided fur-
ther, That $217,000,000 shall be for carrying out subpart 
2 of part B of title II: Provided further, That $44,623,000 
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, $1,466,112,000, of which $1,320,242,000 shall be 
for basic support payments under section 7003(b), 
$48,316,000 shall be for payments for children with dis-
abilities under section 7003(d), $17,406,000 shall be for 
construction under section 7007(a), $75,313,000 shall be 
for Federal property payments under section 7002, and 
$4,835,000, to remain available until expended, shall be 
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for facilities maintenance under section 7008: Provided, 
That for purposes of computing the amount of a payment 
for an eligible local educational agency under section 
7003(a) for school year 2018–2019, 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 described in section 
7003(a)(1)(B)), are no longer eligible under such section, 
shall be considered as eligible students under such section, 
provided such students remain in average daily attendance 
at a school in the same local educational agency they at-
tended prior to their change in eligibility status. 
SCHOOL IMPROVEMENT PROGRAMS 
For carrying out school improvement activities au-
thorized by part B of title I, part A of title II, subpart 
1 of part A of title IV, part B of title IV, part B of title 
V, and parts B and C of title VI of the ESEA; the McKin-
ney-Vento Homeless Assistance Act; section 203 of the 
Educational Technical Assistance Act of 2002; the Com-
pact of Free Association Amendments Act of 2003; and 
the Civil Rights Act of 1964, $5,258,467,000, of which 
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$3,429,902,000 shall become available on July 1, 2019, 
and remain available through September 30, 2020, and 
of which $1,681,441,000 shall become available on Octo-
ber 1, 2019, and shall remain available through September 
30, 2020, for academic year 2019–2020: Provided, That 
$378,000,000 shall be for part B of title I: Provided fur-
ther, That $1,211,673,000 shall be for part B of title IV: 
Provided further, That $36,397,000 shall be for part B 
of title VI and may be used for construction, renovation, 
and modernization of any elementary school, secondary 
school, or structure related to an elementary school or sec-
ondary school, run by the Department of Education of the 
State of Hawaii, that serves a predominantly Native Ha-
waiian student body: Provided further, That $35,453,000 
shall be for part C of title VI and shall be awarded on 
a competitive basis, and also may be used for construction: 
Provided further, That $52,000,000 shall be available to 
carry out section 203 of the Educational Technical Assist-
ance Act of 2002 and the Secretary shall make such ar-
rangements as determined to be necessary to ensure that 
the Bureau of Indian Education has access to services pro-
vided under this section: Provided 
further, That 
$16,699,000 shall be available to carry out the Supple-
mental Education Grants program for the Federated 
States of Micronesia and the Republic of the Marshall Is-
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119 
lands: Provided further, That the Secretary may reserve 
up to 5 percent of the amount referred to in the previous 
proviso to provide technical assistance in the implementa-
tion of these grants: Provided further, That $180,840,000 
shall be for part B of title V: Provided further, That 
$1,200,000,000 shall be available for grants under sub-
part 1 of part A of title IV. 
INDIAN EDUCATION 
For expenses necessary to carry out, to the extent 
not otherwise provided, title VI, part A of the ESEA, 
$180,239,000, of which $67,993,000 shall be for subpart 
2 of part A of title VI and $6,865,000 shall be for subpart 
3 of part A of title VI. 
INNOVATION AND IMPROVEMENT 
For carrying out activities authorized by subparts 1, 
3 and 4 of part B of title II, and parts C, D, and E and 
subparts 1 and 4 of part F of title IV of the ESEA, 
$1,058,441,000. 
SAFE SCHOOLS AND CITIZENSHIP EDUCATION 
For carrying out activities authorized by subparts 2 
and 3 of part F of title IV of the ESEA, $185,754,000: 
Provided, That $90,000,000 shall be available for section 
4631, of which up to $5,000,000, to remain available until 
expended, shall be for the Project School Emergency Re-
sponse to Violence (Project SERV) program: Provided fur-
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ther, That $17,500,000 shall be available for section 4625: 
Provided further, That $78,254,000 shall be available 
through December 31, 2019, for section 4624: Provided 
further, That section 4623(b) of the ESEA shall apply to 
funds appropriated for Promise Neighborhoods under this 
heading in prior appropriations acts. 
ENGLISH LANGUAGE ACQUISITION 
For carrying out part A of title III of the ESEA, 
$737,400,000, which shall become available on July 1, 
2019, and shall remain available through September 30, 
2020, except that 6.5 percent of such amount shall be 
available on October 1, 2018, and shall remain available 
through September 30, 2020, to carry out activities under 
section 3111(c)(1)(C). 
SPECIAL EDUCATION 
For carrying out the Individuals with Disabilities 
Education Act (IDEA), $13,422,651,000, of which 
$3,709,465,000 shall become available on July 1, 2019, 
and shall remain available through September 30, 2020, 
and of which $9,483,383,000 shall become available on 
October 1, 2019, and shall remain available through Sep-
tember 30, 2020, for academic year 2019–2020: Provided, 
That the amount for section 611(b)(2) of the IDEA shall 
be equal to the lesser of the amount available for that ac-
tivity during fiscal year 2018, increased by the amount 
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of inflation as specified in section 619(d)(2)(B) of the 
IDEA, or the percent change in the funds appropriated 
under section 611(i) of the IDEA, but not less than the 
amount for that activity during fiscal year 2018: Provided 
further, That the Secretary shall, without regard to section 
611(d) of the IDEA, distribute to all other States (as that 
term is defined in section 611(g)(2)), subject to the third 
proviso, any amount by which a State’s allocation under 
section 611, from funds appropriated under this heading, 
is reduced under section 612(a)(18)(B), according to the 
following: 85 percent on the basis of the States’ relative 
populations of children aged 3 through 21 who are of the 
same age as children with disabilities for whom the State 
ensures the availability of a free appropriate public edu-
cation under this part, and 15 percent to States on the 
basis of the States’ relative populations of those children 
who are living in poverty: Provided further, That the Sec-
retary may not distribute any funds under the previous 
proviso to any State whose reduction in allocation from 
funds appropriated under this heading made funds avail-
able for such a distribution: Provided further, That the 
States shall allocate such funds distributed under the sec-
ond proviso to local educational agencies in accordance 
with section 611(f): Provided further, That the amount by 
which a State’s allocation under section 611(d) of the 
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122 
IDEA is reduced under section 612(a)(18)(B) and the 
amounts distributed to States under the previous provisos 
in fiscal year 2012 or any subsequent year shall not be 
considered in calculating the awards under section 611(d) 
for fiscal year 2013 or for any subsequent fiscal years: 
Provided further, That, notwithstanding the provision in 
section 612(a)(18)(B) regarding the fiscal year in which 
a State’s allocation under section 611(d) is reduced for 
failure to comply with the requirement of section 
612(a)(18)(A), the Secretary may apply the reduction 
specified in section 612(a)(18)(B) over a period of con-
secutive fiscal years, not to exceed five, until the entire 
reduction is applied: Provided further, That the Secretary 
may, in any fiscal year in which a State’s allocation under 
section 611 is reduced in accordance with section 
612(a)(18)(B), reduce the amount a State may reserve 
under section 611(e)(1) by an amount that bears the same 
relation to the maximum amount described in that para-
graph as the reduction under section 612(a)(18)(B) bears 
to the total allocation the State would have received in 
that fiscal year under section 611(d) in the absence of the 
reduction: Provided further, That the Secretary shall ei-
ther reduce the allocation of funds under section 611 for 
any fiscal year following the fiscal year for which the State 
fails to comply with the requirement of section 
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123 
612(a)(18)(A) as authorized by section 612(a)(18)(B), or 
seek to recover funds under section 452 of the General 
Education Provisions Act (20 U.S.C. 1234a): Provided 
further, That the funds reserved under 611(c) of the 
IDEA may be used to provide technical assistance to 
States to improve the capacity of the States to meet the 
data collection requirements of sections 616 and 618 and 
to administer and carry out other services and activities 
to improve data collection, coordination, quality, and use 
under parts B and C of the IDEA: Provided further, That 
the Secretary may use funds made available for the State 
Personnel Development Grants program under part D, 
subpart 1 of IDEA to evaluate program performance 
under such subpart. 
REHABILITATION SERVICES 
For carrying out, to the extent not otherwise pro-
vided, the Rehabilitation Act of 1973 and the Helen Keller 
National 
Center 
Act, 
$3,657,689,000, 
of 
which 
$3,521,990,000 shall be for grants for vocational rehabili-
tation services under title I of the Rehabilitation Act: Pro-
vided, That the Secretary may use amounts provided in 
this Act that remain available subsequent to the reallot-
ment of funds to States pursuant to section 110(b) of the 
Rehabilitation Act for innovative activities aimed at im-
proving the outcomes of individuals with disabilities as de-
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124 
fined in section 7(20)(B) of the Rehabilitation Act, includ-
ing activities aimed at improving the education and post- 
school outcomes of children receiving Supplemental Secu-
rity Income (‘‘SSI’’) and their families that may result 
in long-term improvement in the SSI child recipient’s eco-
nomic status and self-sufficiency: Provided further, That 
States may award subgrants for a portion of the funds 
to other public and private, nonprofit entities: Provided 
further, That any funds made available subsequent to real-
lotment for innovative activities aimed at improving the 
outcomes of individuals with disabilities shall remain avail-
able until September 30, 2020. 
SPECIAL INSTITUTIONS FOR PERSONS WITH 
DISABILITIES 
AMERICAN PRINTING HOUSE FOR THE BLIND 
For carrying out the Act to promote the Education 
of the Blind of March 3, 1879, $28,431,000. 
NATIONAL TECHNICAL INSTITUTE FOR THE DEAF 
For the National Technical Institute for the Deaf 
under titles I and II of the Education of the Deaf Act 
of 1986, $75,000,000: Provided, That from the total 
amount available, the Institute may at its discretion use 
funds for the endowment program as authorized under 
section 207 of such Act. 
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125 
GALLAUDET UNIVERSITY 
For the Kendall Demonstration Elementary School, 
the Model Secondary School for the Deaf, and the partial 
support of Gallaudet University under titles I and II of 
the Education of the Deaf Act of 1986, $134,361,000: 
Provided, That from the total amount available, the Uni-
versity may at its discretion use funds for the endowment 
program as authorized under section 207 of such Act. 
CAREER, TECHNICAL, AND ADULT EDUCATION 
For carrying out, to the extent not otherwise pro-
vided, the Carl D. Perkins Career and Technical Edu-
cation Act of 2006 and the Adult Education and Family 
Literacy Act (‘‘AEFLA’’), $1,945,265,000, of which 
$1,154,265,000 shall become available on July 1, 2019, 
and shall remain available through September 30, 2020, 
and of which $791,000,000 shall become available on Oc-
tober 1, 2019, and shall remain available through Sep-
tember 30, 2020: Provided, That of the amounts made 
available for AEFLA, $13,712,000 shall be for national 
leadership activities under section 242. 
STUDENT FINANCIAL ASSISTANCE 
For carrying out subparts 1, 3, and 10 of part A, 
and part C of title IV of the HEA, $24,445,352,000, 
which shall remain available through September 30, 2020. 
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126 
The maximum Pell Grant for which a student shall 
be eligible during award year 2019–2020 shall be $5,035. 
STUDENT AID ADMINISTRATION 
For Federal administrative expenses to carry out part 
D of title I, and subparts 1, 3, 9, and 10 of part A, and 
parts B, C, D, and E of title IV of the HEA, and subpart 
1 of part A of title VII of the Public Health Service Act, 
$1,678,943,000, to remain available through September 
30, 2020. 
HIGHER EDUCATION 
For carrying out, to the extent not otherwise pro-
vided, titles II, III, IV, V, VI, and VII of the HEA, the 
Mutual Educational and Cultural Exchange Act of 1961, 
and section 117 of the Carl D. Perkins Career and Tech-
nical Education Act of 2006, $2,300,551,000: Provided, 
That notwithstanding any other provision of law, funds 
made available in this Act to carry out title VI of the HEA 
and section 102(b)(6) of the Mutual Educational and Cul-
tural Exchange Act of 1961 may be used to support visits 
and study in foreign countries by individuals who are par-
ticipating in advanced foreign language training and inter-
national studies in areas that are vital to United States 
national security and who plan to apply their language 
skills and knowledge of these countries in the fields of gov-
ernment, the professions, or international development: 
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127 
Provided further, That of the funds referred to in the pre-
ceding proviso up to 1 percent may be used for program 
evaluation, national outreach, and information dissemina-
tion activities: Provided further, That up to 1.5 percent 
of the funds made available under chapter 2 of subpart 
2 of part A of title IV of the HEA may be used for evalua-
tion. 
HOWARD UNIVERSITY 
For 
partial 
support 
of 
Howard 
University, 
$232,518,000, of which not less than $3,405,000 shall be 
for a matching endowment grant pursuant to the Howard 
University Endowment Act and shall remain available 
until expended. 
COLLEGE HOUSING AND ACADEMIC FACILITIES LOANS 
PROGRAM 
For Federal administrative expenses to carry out ac-
tivities related to existing facility loans pursuant to section 
121 of the HEA, $448,000. 
HISTORICALLY BLACK COLLEGE AND UNIVERSITY 
CAPITAL FINANCING PROGRAM ACCOUNT 
For the cost of guaranteed loans, $20,150,000, as au-
thorized pursuant to part D of title III of the HEA, which 
shall remain available through September 30, 2020: Pro-
vided, That such costs, including the cost of modifying 
such loans, shall be as defined in section 502 of the Con-
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128 
gressional Budget Act of 1974: Provided further, That 
these funds are available to subsidize total loan principal, 
any part of which is to be guaranteed, not to exceed 
$580,000,000: Provided further, That these funds may be 
used to support loans to public and private Historically 
Black Colleges and Universities without regard to the limi-
tations within section 344(a) of the HEA. 
In addition, $10,000,000 shall be made available to 
provide for the deferment of loans made under part D of 
title III of the HEA to eligible institutions that are private 
Historically Black Colleges and Universities, which apply 
for the deferment of such a loan and demonstrate financial 
need for such deferment by having a score of 2.6 or less 
on the Department of Education’s financial responsibility 
test: Provided, That during the period of deferment of 
such a loan, interest on the loan will not accrue or be cap-
italized, and the period of deferment shall be for at least 
a period of 3-fiscal years and not more than 6-fiscal years: 
Provided further, That when determining priority for such 
institutions to receive such a deferment, the Secretary 
shall give priority to institutions that operated in a finan-
cial deficit for at least one of the previous 5 years accord-
ing to the audits provided to the Department, or were 
sanctioned for financial reasons by the agency or associa-
tion that accredited such institutions. 
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129 
In addition, for administrative expenses to carry out 
the Historically Black College and University Capital Fi-
nancing Program entered into pursuant to part D of title 
III of the HEA, $339,000. 
INSTITUTE OF EDUCATION SCIENCES 
For carrying out activities authorized by the Edu-
cation Sciences Reform Act of 2002, the National Assess-
ment of Educational Progress Authorization Act, section 
208 of the Educational Technical Assistance Act of 2002, 
and section 664 of the Individuals with Disabilities Edu-
cation Act, $613,462,000, which shall remain available 
through September 30, 2020: Provided, That funds avail-
able to carry out section 208 of the Educational Technical 
Assistance Act may be used to link Statewide elementary 
and secondary data systems with early childhood, postsec-
ondary, and workforce data systems, or to further develop 
such systems: Provided further, That up to $6,000,000 of 
the funds available to carry out section 208 of the Edu-
cational Technical Assistance Act may be used for awards 
to public or private organizations or agencies to support 
activities to improve data coordination, quality, and use 
at the local, State, and national levels. 
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130 
DEPARTMENTAL MANAGEMENT 
PROGRAM ADMINISTRATION 
For carrying out, to the extent not otherwise pro-
vided, the Department of Education Organization Act, in-
cluding rental of conference rooms in the District of Co-
lumbia and hire of three passenger motor vehicles, 
$432,506,000: Provided, That, notwithstanding any other 
provision of law, none of the funds provided by this Act 
or provided by previous Appropriations Acts to the De-
partment of Education available for obligation or expendi-
ture in the current fiscal year may be used for any activity 
relating to implementing a reorganization that decentral-
izes, reduces the staffing level, or alters the responsibil-
ities, structure, authority, or functionality of the Budget 
Service of the Department of Education, relative to the 
organization and operation of the Budget Service as in 
effect on January 1, 2018. 
OFFICE FOR CIVIL RIGHTS 
For expenses necessary for the Office for Civil 
Rights, as authorized by section 203 of the Department 
of Education Organization Act, $117,000,000. 
OFFICE OF INSPECTOR GENERAL 
For expenses necessary for the Office of Inspector 
General, as authorized by section 212 of the Department 
of Education Organization Act, $61,143,000. 
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131 
GENERAL PROVISIONS 
SEC. 301. No funds appropriated in this Act may be 
used to prevent the implementation of programs of vol-
untary prayer and meditation in the public schools. 
(TRANSFER OF FUNDS) 
SEC. 302. Not to exceed 1 percent of any discre-
tionary funds (pursuant to the Balanced Budget and 
Emergency Deficit Control Act of 1985) which are appro-
priated for the Department of Education in this Act may 
be transferred between appropriations, but no such appro-
priation shall be increased by more than 3 percent by any 
such transfer: Provided, 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 Appropriations of the House of Rep-
resentatives and the Senate are notified at least 15 days 
in advance of any transfer. 
SEC. 303. Section 105(f)(1)(B)(ix) of the Compact 
of Free Association Amendments Act of 2003 (48 U.S.C. 
1921d(f)(1)(B)(ix)) shall be applied by substituting 
‘‘2019’’ for ‘‘2018’’. 
SEC. 304. Funds appropriated in this Act and con-
solidated for evaluation purposes under section 8601(c) of 
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132 
the ESEA shall be available from July 1, 2019, through 
September 30, 2020. 
SEC. 305. (a) An institution of higher education that 
maintains an endowment fund supported with funds ap-
propriated for title III or V of the HEA for fiscal year 
2019 may use the income from that fund to award schol-
arships to students, subject to the limitation in section 
331(c)(3)(B)(i) of the HEA. The use of such income for 
such purposes, prior to the enactment of this Act, shall 
be considered to have been an allowable use of that in-
come, subject to that limitation. 
(b) Subsection (a) shall be in effect until titles III 
and V of the HEA are reauthorized. 
SEC. 306. Section 114(f) of the HEA (20 U.S.C. 
1011c(f)) is amended by striking ‘‘2018’’ and inserting 
‘‘2019’’. 
SEC. 307. Section 458(a) of the HEA (20 U.S.C. 
1087h(a)) is amended in paragraph (4) by striking 
‘‘2018’’ and inserting ‘‘2019’’. 
SEC. 308. From amounts appropriated for the serv-
icing of Federal student loans, the Secretary of Education 
may make payments for student loan servicing to an insti-
tution of higher education that services outstanding Fed-
eral Perkins Loans. 
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133 
SEC. 309. (a) Section 455(f) of the Higher Education 
Act of 1965 (20 U.S.C. 1087e(f)) is amended— 
(1) by redesignating paragraphs (3) and (4) as 
paragraphs (4) and (5), respectively; and 
(2) by inserting after paragraph (2) the fol-
lowing: 
‘‘(3) DEFERMENT FOR BORROWERS RECEIVING 
CANCER TREATMENT.— 
‘‘(A) EFFECT ON PRINCIPAL AND INTER-
EST.—A borrower of a loan made under this 
part who meets the requirements of subpara-
graph (B) shall be eligible for a deferment, dur-
ing which periodic installments of principal 
need not be paid, and interest shall not accrue. 
‘‘(B) ELIGIBILITY.—A borrower of a loan 
made under this part shall be eligible for a 
deferment during— 
‘‘(i) any period in which such bor-
rower is receiving treatment for cancer; 
and 
‘‘(ii) the 6 months after such period. 
‘‘(C) 
APPLICABILITY.—This 
paragraph 
shall apply with respect to loans— 
‘‘(i) made on or after the date of the 
enactment of this paragraph; or 
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134 
‘‘(ii) in repayment on the date of the 
enactment of this paragraph.’’. 
(b) Section 427(a)(2)(C) of the Higher Education 
Act of 1965 (20 U.S.C. 1077(a)(2)(C)) is amended— 
(1) in clause (ii), by striking ‘‘; or’’ and insert-
ing a semicolon; 
(2) in clause (iii), by inserting ‘‘or’’ after the 
semicolon; and 
(3) by inserting after clause (iii) the following: 
‘‘(iv) in which the borrower is receiv-
ing treatment for cancer and the 6 months 
after such period.’’. 
(c) Section 428(b)(1)(M) of the Higher Education 
Act of 1965 (20 U.S.C. 1078(b)(1)(M)) is amended— 
(1) in clause (iii), by striking ‘‘or (II); or’’ and 
inserting a ‘‘or (II);’’; 
(2) in clause (iv), by inserting ‘‘or’’ after the 
semicolon; and 
(3) by adding at the end the following: 
‘‘(v) during which the borrower is re-
ceiving treatment for cancer and the 6 
months after such period;’’. 
(d) Section 464(c)(2) of the Higher Education Act 
of 1965 (20 U.S.C. 1087dd(c)(2)) is amended— 
(1) in subparagraph (A)— 
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135 
(A) in clause (iv), by striking ‘‘; or’’ and 
inserting a semicolon; 
(B) in clause (v), by inserting ‘‘or’’ after 
the semicolon; and 
(C) by inserting after clause (v) the fol-
lowing: 
‘‘(vi) during which the borrower is receiv-
ing treatment for cancer and the 6 months 
after such period;’’. 
(e) Section 428H(e)(2) of the Higher Education Act 
of 1965 (20 U.S.C. 1078–8(e)(2)) is amended— 
(1) in subparagraph (A), by striking ‘‘Interest’’ 
and inserting, ‘‘Except as provided in subparagraph 
(C), interest’’; and 
(2) by adding at the end the following: 
‘‘(C) Interest shall not accrue on a loan de-
ferred 
under 
section 
428(b)(1)(M)(v) 
or 
427(a)(2)(C)(iv).’’. 
(f) The amendments made by this Act shall apply 
with respect to loans— 
(1) made on or after the date of the enactment 
of this Act; or 
(2) in repayment on the date of the enactment 
of this Act. 
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136 
SEC. 310. (a) No performance bonus shall be paid 
to an employee of the Office of Federal Student Aid of 
the Department of Education unless the employee meets 
the performance targets established by the Secretary of 
Education under subsection (b). 
(b) The Secretary of Education shall establish per-
formance targets for employees of the Office of Federal 
Student Aid of the Department of Education. The per-
formance targets shall be based on the following factors: 
(1) Customer service, contractor compliance 
with applicable Federal consumer protection laws, 
minimizing improper payments, portfolio resolution, 
collection rates, and overall current repayment sta-
tus of the portfolio of Federal student loans; and 
(2) the optimal use of qualified large and small 
business contractors to help the Office achieve, at 
minimum, the average portfolio resolution percent-
age achieved by the Office for the period of fiscal 
years 2015 through 2018. 
(c) Not later than 60 days after the date of the enact-
ment of this Act, the Secretary of Education shall submit 
to the appropriate congressional committees a report that 
includes— 
(1) the performance targets established by the 
Secretary under subsection (b); 
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137 
(2) the rationale for such targets; and 
(3) the Office of Federal Student Aid’s histor-
ical performance in meeting such targets, if known. 
(d) Not later than 180 days after the date of the en-
actment of this Act, the Secretary of Education shall sub-
mit to the appropriate congressional committees a report 
that assesses the performance of the Office of Federal 
Student Aid in meeting the performance targets estab-
lished by the Secretary under subsection (b). 
(e) In this section: 
(1) The term ‘‘appropriate congressional com-
mittees’’ means— 
(A) the Committees on Appropriations of 
the House of Representatives and the Senate; 
and 
(B) each committee of the House of Rep-
resentatives or the Senate with jurisdiction over 
the Office of Federal Student Aid of the De-
partment of Education. 
(2) The term ‘‘Federal student loan’’ means a 
loan made under part D of title IV of the Higher 
Education Act of 1965 (20 U.S.C. 1087a et seq.). 
(3) The term ‘‘portfolio resolution’’ means the 
proportion of the total value of recoveries from de-
faulted Federal student loans, not including consoli-
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138 
dations, compared with the total value of newly de-
faulted Federal student loans for each fiscal quarter. 
This title may be cited as the ‘‘Department of Edu-
cation Appropriations Act, 2019’’. 
TITLE IV 
RELATED AGENCIES 
COMMITTEE FOR PURCHASE FROM PEOPLE WHO ARE 
BLIND OR SEVERELY DISABLED 
SALARIES AND EXPENSES 
For expenses necessary for the Committee for Pur-
chase From People Who Are Blind or Severely Disabled 
established under section 8502 of title 41, United States 
Code, $8,250,000: Provided, That in order to authorize 
any central nonprofit agency designated pursuant to sec-
tion 8503(c) of title 41, United States Code, to perform 
requirements of the Committee as prescribed under sec-
tion 51–3.2 of title 41, Code of Federal Regulations, the 
Committee shall enter into a written agreement with any 
such central nonprofit agency: Provided further, That such 
agreement shall contain such auditing, oversight, and re-
porting provisions as necessary to implement chapter 85 
of title 41, United States Code: Provided further, That 
such agreement shall include the elements listed under the 
heading ″Committee For Purchase From People Who Are 
Blind 
or 
Severely 
Disabled—Written 
Agreement 
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160 
ments describing projects or programs funded in whole or 
in part with Federal money, all grantees receiving Federal 
funds included in this Act, including but not limited to 
State and local governments and recipients of Federal re-
search grants, shall clearly state— 
(1) the percentage of the total costs of the pro-
gram or project which will be financed with Federal 
money; 
(2) the dollar amount of Federal funds for the 
project or program; and 
(3) percentage and dollar amount of the total 
costs of the project or program that will be financed 
by non-governmental sources. 
SEC. 506. (a) None of the funds appropriated in this 
Act, and none of the funds in any trust fund to which 
funds are appropriated in this Act, shall be expended for 
any abortion. 
(b) None of the funds appropriated in this Act, and 
none of the funds in any trust fund to which funds are 
appropriated in this Act, shall be expended for health ben-
efits coverage that includes coverage of abortion. 
(c) The term ‘‘health benefits coverage’’ means the 
package of services covered by a managed care provider 
or organization pursuant to a contract or other arrange-
ment. 
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