H. R. 2471—422 
(1) are supported through appropriations enacted in laws 
other than the ACA and work on programs that existed prior 
to the passage of the ACA; 
(2) spend less than 50 percent of their time on activities 
funded by or newly authorized in the ACA; or 
(3) work on contracts for which FTE reporting is not a 
requirement of their contract, such as fixed-price contracts. 
SEC. 220. The Secretary shall publish, as part of the fiscal 
year 2023 budget of the President submitted under section 1105(a) 
of title 31, United States Code, information that details the uses 
of all funds used by the Centers for Medicare & Medicaid Services 
specifically for Health Insurance Exchanges for each fiscal year 
since the enactment of the ACA and the proposed uses for such 
funds for fiscal year 2023. 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 explanatory statement described in section 4 (in the matter 
preceding division A of this consolidated Act). 
SEC. 221. None of the funds made available by this Act from 
the Federal Hospital Insurance Trust Fund or the Federal Supple-
mental 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 pay-
ments under section 1342(b)(1) of Public Law 111–148 (relating 
to risk corridors). 
(TRANSFER OF FUNDS) 
SEC. 222. (a) Within 45 days of enactment of this Act, the 
Secretary shall transfer funds appropriated under 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 explanatory statement described in 
section 4 (in the matter preceding division A of this consolidated 
Act). 
(b) Notwithstanding section 4002(c) of the ACA, the Secretary 
may not further transfer these amounts. 
(c) Funds transferred for activities authorized under section 
2821 of the PHS Act shall be made available without reference 
to section 2821(b) of such Act. 
SEC. 223. Effective during the period beginning on November 
1, 2015 and ending January 1, 2024, any provision of law that 
refers (including through cross-reference to another provision of 
law) to the current recommendations of the United States Preven-
tive Services Task Force with respect to breast cancer screening, 
mammography, and prevention shall be administered by the Sec-
retary involved as if— 
(1) such reference to such current recommendations were 
a reference to the recommendations of such Task Force with 
respect to breast cancer screening, mammography, and preven-
tion last issued before 2009; and 
(2) such recommendations last issued before 2009 applied 
to any screening mammography modality under section 1861(jj) 
of the Social Security Act (42 U.S.C. 1395x(jj)). 
SEC. 224. In making Federal financial assistance, the provisions 
relating to indirect costs in part 75 of title 45, Code of Federal 
Regulations, including with respect to the approval of deviations
H. R. 2471—423 
from negotiated rates, shall continue to apply to the National 
Institutes of Health to the same extent and in the same manner 
as such provisions were 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 provisions, or to inten-
tionally 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 for opioid 
addiction, opioid alternatives, stimulant misuse and addiction, pain 
management, and addiction treatment to other Institutes and Cen-
ters of the NIH to be used for the same purpose 15 days after 
notifying the Committees on Appropriations of the House of Rep-
resentatives and the Senate: Provided, That the transfer authority 
provided in the previous proviso is in addition to any other transfer 
authority provided by law. 
SEC. 226. (a) The Secretary shall provide to the Committees 
on Appropriations of the House of Representatives and the Senate: 
(1) 
Detailed 
monthly 
enrollment 
figures 
from 
the 
Exchanges established under the Patient Protection and Afford-
able Care Act of 2010 pertaining to enrollments during the 
open enrollment period; and 
(2) Notification of any new or competitive grant awards, 
including supplements, authorized under section 330 of the 
Public Health Service Act. 
(b) The Committees on Appropriations of the House and Senate 
must be notified at least 2 business days in advance of any public 
release of enrollment information or the award of such grants. 
SEC. 227. In addition to the amounts otherwise available for 
‘‘Centers for Medicare & Medicaid Services, Program Management’’, 
the Secretary of Health and Human Services may transfer up 
to $355,000,000 to such account from the Federal Hospital Insur-
ance Trust Fund and the Federal Supplementary Medical Insurance 
Trust Fund to support program management activity related to 
the Medicare Program: Provided, That except for the foregoing 
purpose, such funds may not be used to support any provision 
of Public Law 111–148 or Public Law 111–152 (or any amendment 
made by either such Public Law) or to supplant any other amounts 
within such account. 
SEC. 228. The Department of Health and Human Services 
shall provide the Committees on Appropriations of the House of 
Representatives and Senate a biannual report 30 days after enact-
ment of this Act on staffing described in the explanatory statement 
described in section 4 (in the matter preceding division A of this 
consolidated Act). 
SEC. 229. Funds appropriated in this Act that are available 
for salaries and expenses of employees of the Department of Health 
and Human Services shall also be available to pay travel and 
related expenses of such an employee or of a member of his or 
her family, when such employee is assigned to duty, in the United 
States or in a U.S. territory, during a period and in a location 
that are the subject of a determination of a public health emergency
H. R. 2471—424 
under section 319 of the Public Health Service Act and such travel 
is necessary to obtain medical care for an illness, injury, or medical 
condition that cannot be adequately addressed in that location 
at that time. For purposes of this section, the term ‘‘U.S. territory’’ 
means Guam, the Commonwealth of Puerto Rico, the Northern 
Mariana Islands, the Virgin Islands, American Samoa, or the Trust 
Territory of the Pacific Islands. 
SEC. 230. The Department of Health and Human Services 
may accept donations from the private sector, nongovernmental 
organizations, and other groups independent of the Federal Govern-
ment for the care of unaccompanied 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 Resettlement of 
the Administration for Children and Families, including medical 
goods and services, which may include early childhood develop-
mental screenings, school supplies, toys, clothing, and any other 
items intended to promote the wellbeing of such children. 
SEC. 231. None of the funds made available in this Act under 
the heading ‘‘Department of Health and Human Services—Adminis-
tration for Children and Families—Refugee and Entrant Assistance’’ 
may be obligated to a grantee or contractor to house unaccompanied 
alien children (as such term is defined in section 462(g)(2) of the 
Homeland Security Act of 2002 (6 U.S.C. 279(g)(2))) in any facility 
that is not State-licensed for the care of unaccompanied alien chil-
dren, except in the case that the Secretary determines that housing 
unaccompanied alien children in such a facility is necessary on 
a temporary basis due to an influx of such children or an emergency, 
provided that— 
(1) the terms of the grant or contract for the operations 
of any such facility that remains in operation for more than 
six consecutive months shall require compliance with— 
(A) the same requirements as licensed placements, as 
listed in Exhibit 1 of the Flores Settlement Agreement 
that the Secretary determines are applicable to non-State 
licensed facilities; and 
(B) staffing ratios of one (1) on-duty Youth Care Worker 
for every eight (8) children or youth during waking hours, 
one (1) on-duty Youth Care Worker for every sixteen (16) 
children or youth during sleeping hours, and clinician ratios 
to children (including mental health providers) as required 
in grantee cooperative agreements; 
(2) the Secretary may grant a 60-day waiver for a contrac-
tor’s or grantee’s non-compliance with paragraph (1) if the 
Secretary certifies and provides a report to Congress on the 
contractor’s or grantee’s good-faith efforts and progress towards 
compliance; 
(3) not more than four consecutive waivers under paragraph 
(2) may be granted to a contractor or grantee with respect 
to a specific facility; 
(4) ORR shall ensure full adherence to the monitoring 
requirements set forth in section 5.5 of its Policies and Proce-
dures Guide as of May 15, 2019; 
(5) for any such unlicensed facility in operation for more 
than three consecutive months, ORR shall conduct a minimum 
of one comprehensive monitoring visit during the first three 
months of operation, with quarterly monitoring visits there-
after; and
H. R. 2471—425 
(6) not later than 60 days after the date of enactment 
of this Act, ORR shall brief the Committees on Appropriations 
of the House of Representatives and the Senate outlining the 
requirements of ORR for influx facilities including any require-
ment listed in paragraph (1)(A) that the Secretary has deter-
mined are not applicable to non-State licensed facilities. 
SEC. 232. In addition to the existing Congressional notification 
for formal site assessments of potential influx facilities, the Sec-
retary shall notify the Committees on Appropriations of the House 
of Representatives and the Senate at least 15 days before 
operationalizing an unlicensed facility, and shall (1) specify whether 
the facility is hard-sided or soft-sided, and (2) provide analysis 
that indicates that, in the absence of the influx facility, the likely 
outcome is that unaccompanied alien children will remain in the 
custody of the Department of Homeland Security for longer than 
72 hours or that unaccompanied alien children will be otherwise 
placed in danger. Within 60 days of bringing such a facility online, 
and monthly thereafter, the Secretary shall provide to the Commit-
tees on Appropriations of the House of Representatives and the 
Senate a report detailing the total number of children in care 
at the facility, the average length of stay and average length of 
care of children at the facility, and, for any child that has been 
at the facility for more than 60 days, their length of stay and 
reason for delay in release. 
SEC. 233. None of the funds made available in this Act may 
be used to prevent a United States Senator or Member of the 
House of Representatives from entering, for the purpose of con-
ducting oversight, any facility in the United States used for the 
purpose of maintaining custody of, or otherwise housing, unaccom-
panied alien children (as defined in section 462(g)(2) of the Home-
land Security Act of 2002 (6 U.S.C. 279(g)(2))), provided that such 
Senator or Member has coordinated the oversight visit with the 
Office of Refugee Resettlement not less than two business days 
in advance to ensure that such visit would not interfere with 
the operations (including child welfare and child safety operations) 
of such facility. 
SEC. 234. Not later than 14 days after the date of enactment 
of this Act, and monthly thereafter, the Secretary shall submit 
to the Committees on Appropriations of the House of Representa-
tives and the Senate, and make publicly available online, a report 
with respect to children who were separated from their parents 
or legal guardians by the Department of Homeland Security (DHS) 
(regardless of whether or not such separation was pursuant to 
an option selected by the children, parents, or guardians), subse-
quently classified as unaccompanied alien children, and transferred 
to the care and custody of ORR during the previous month. Each 
report shall contain the following information: 
(1) the number and ages of children so separated subse-
quent to apprehension at or between ports of entry, to be 
reported by sector where separation occurred; and 
(2) the documented cause of separation, as reported by 
DHS when each child was referred. 
SEC. 235. Funds appropriated in this Act that are available 
for salaries and expenses of employees of the Centers for Disease 
Control and Prevention shall also be available for the primary 
and secondary schooling of eligible dependents of personnel sta-
tioned in a U.S. territory as defined in section 229 of this Act