accordance with 31 U.S.C. 9701 from organizations estab-
lished under title XIII of the PHS Act shall be credited 
to and available for carrying out the purposes of this ap-
propriation: Provided further, That the Secretary is di-
rected to collect fees in fiscal year 2020 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: Provided 
further, That amounts available under this heading for 
quality improvement organizations (as defined in section 
1152 of the Social Security Act) may not exceed the 
amount provided under this heading in division H of the 
Consolidated Appropriations Act, 2018 (Public Law 115- 
141) for such organizations. 
In addition, the Secretary shall obligate not less than 
$100,000,000 in fiscal year 2020 out of amounts collected 
through the user fees on participating health insurance 
issuers pursuant to section 156.50 of title 45, Code of 
Federal Regulations (or any successor regulations) to 
carry out the navigator program (as described in section 
1311(i) of the Patient Protection and Affordable Care Act 
(42 U.S.C. 18031(i)), and to carry out outreach and edu-
cational activities, for purposes of informing potential en-
rollees in qualified health plans (as defined in section 
VerDate Sep 11 2014 
01:41 May 16, 2019
Jkt 089200
PO 00000
Frm 00072
Fmt 6652
Sfmt 6201
E:\BILLS\H2740.RH
H2740
pbinns on DSK79D2C42PROD with BILLS
1301(a) of such Act (42 U.S.C. 18021(a)) offered through 
an Exchange established or operated by the Secretary 
within a State, of the availability of coverage under such 
plans and financial assistance for coverage under such 
plans: Provided, That awards under such program shall 
be based solely on an entity’s demonstrated capacity to 
carry out each of the duties specified in section 1311(i)(3) 
of such Act: Provided further, That not less than 
$15,000,000 shall be obligated for national television and 
not less than $15,000,000 shall be obligated for internet 
search advertising for purposes of carrying out such out-
reach and educational activities: Provider further, That not 
less than $30,000,000 of the funds made available in this 
paragraph shall be obligated for advertising during the 
final two weeks of the open enrollment period specified by 
the Secretary pursuant to section 1311(c)(6)(B) of such 
Act occurring during 2019: Provided further, That no 
amounts collected through such user fees shall be available 
for expenditures for promoting health insurance coverage 
or a group health plan (as such terms are defined in sec-
tion 2791 of the PHS Act (42 U.S.C. 300gg-91)) that 
is not a qualified health plan. 
HEALTH CARE FRAUD AND ABUSE CONTROL ACCOUNT 
In addition to amounts otherwise available for pro-
gram integrity and program management, $786,000,000, 
VerDate Sep 11 2014 
01:41 May 16, 2019
Jkt 089200
PO 00000
Frm 00073
Fmt 6652
Sfmt 6201
E:\BILLS\H2740.RH
H2740
pbinns on DSK79D2C42PROD with BILLS
to remain available through September 30, 2021, 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 $610,000,000 shall be for the Cen-
ters for Medicare & Medicaid Services program integrity 
activities, of which $93,000,000 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 
$83,000,000 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 2020 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 
$475,000,000 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 
VerDate Sep 11 2014 
01:41 May 16, 2019
Jkt 089200
PO 00000
Frm 00074
Fmt 6652
Sfmt 6201
E:\BILLS\H2740.RH
H2740
pbinns on DSK79D2C42PROD with BILLS
$18,000,000 from amounts made available under this 
heading and amounts made available for fiscal year 2020 
under section 1817(k)(3)(A) of the Social Security Act for 
the Senior Medicare Patrol program to combat health care 
fraud and abuse. 
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, $2,890,000,000, to remain 
available until expended; and for such purposes for the 
first quarter of fiscal year 2021, $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 
(42 
U.S.C. 
8621 
et 
seq.), 
$3,840,304,000: Provided, That notwithstanding section 
VerDate Sep 11 2014 
01:41 May 16, 2019
Jkt 089200
PO 00000
Frm 00075
Fmt 6652
Sfmt 6201
E:\BILLS\H2740.RH
H2740
pbinns on DSK79D2C42PROD with BILLS
2609A(a) of such Act, not more than $2,988,000 may be 
reserved by the Secretary of Health and Human Services 
for technical assistance, training, and monitoring of pro-
gram activities for compliance with internal controls, poli-
cies and procedures and the Secretary may, in addition 
to the authorities provided in section 2609A(a)(1), use 
such funds through contracts with private entities that do 
not qualify as nonprofit organizations: Provided further, 
That $3,637,316,000 of the amount appropriated under 
this heading shall be allocated to each State and territory 
in amounts equal to the amount each State and territory 
was allocated in fiscal year 2018 pursuant to allocations 
made from amounts appropriated under this heading in 
the Consolidated Appropriations Act, 2018 (Public Law 
115-141): Provided further, that $37,280,000 of the 
amount appropriated under this heading shall be allocated 
as though the total appropriation for such payments for 
fiscal year 2020 was less than $1,975,000,000. 
REFUGEE AND ENTRANT ASSISTANCE 
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 
VerDate Sep 11 2014 
01:41 May 16, 2019
Jkt 089200
PO 00000
Frm 00076
Fmt 6652
Sfmt 6201
E:\BILLS\H2740.RH
H2740
pbinns on DSK79D2C42PROD with BILLS
Protection Reauthorization Act of 2008, the Trafficking 
Victims Protection Act of 2000 (‘‘TVPA’’), and the Tor-
ture Victims Relief Act of 1998, $2,411,701,000, of which 
$2,364,446,000 shall remain available through September 
30, 2022 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 not less than 
$190,000,000 shall be used for legal services, child advo-
cates, and post-release services: Provided further, That 
none of the funds made available by this Act may be used 
to implement or enforce the Memorandum of Agreement 
Among the Office of Refugee Resettlement of the Depart-
ment of Health and Human Services and U.S. Immigra-
tion and Customs Enforcement and U.S. Customs and 
Border Protection of the Department of Homeland Secu-
rity Regarding Consultation and Information Sharing in 
Unaccompanied Alien Children Matters, dated April 13, 
2018: Provided further, That not later than 30 days after 
the date of enactment of this Act, the Secretary of Health 
and Human Services shall submit to the Committees on 
Appropriations of the House of Representatives and the 
Senate a detailed spend plan of anticipated uses of funds 
made available in this account, including the following: 
VerDate Sep 11 2014 
01:41 May 16, 2019
Jkt 089200
PO 00000
Frm 00077
Fmt 6652
Sfmt 6201
E:\BILLS\H2740.RH
H2740
pbinns on DSK79D2C42PROD with BILLS
costs, capacity, and timelines for existing grants and con-
tracts; costs for expanding capacity through use of com-
munity-based residential care placements (including long- 
term and transitional foster care and small group homes) 
through new or modified grants and contracts; costs and 
services to be provided for legal services, child advocates, 
and post-release services; program administration; and the 
average number of weekly referrals and discharge rate as-
sumed in the spend plan: Provided further, That such plan 
shall be updated to reflect changes and expenditures and 
submitted to the Committees every 60 days thereafter. 
None of the funds made available in this Act may 
be used in contravention of the Homeland Security Act 
of 2002, the William Wilberforce Trafficking Victims Pro-
tection Reauthorization Act of 2008, or the Adoption and 
Safe Families Act of 1997 (as those law are in effect on 
the date of the enactment of this Act, and including provi-
sions of other statutes amended or added by those laws, 
as so in effect), or the Stipulated Settlement Agreement 
in Flores v. Reno (U.S. District Court, Central District 
of California, 1997). 
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’’), 
VerDate Sep 11 2014 
01:41 May 16, 2019
Jkt 089200
PO 00000
Frm 00078
Fmt 6652
Sfmt 6201
E:\BILLS\H2740.RH
H2740
pbinns on DSK79D2C42PROD with BILLS
$7,676,000,000 shall be used to supplement, not supplant 
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. 
SOCIAL SERVICES BLOCK GRANT 
For making grants to States pursuant to section 
2002 of the Social Security Act, $1,700,000,000: Pro-
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. 
VerDate Sep 11 2014 
01:41 May 16, 2019
Jkt 089200
PO 00000
Frm 00079
Fmt 6652
Sfmt 6201
E:\BILLS\H2740.RH
H2740
pbinns on DSK79D2C42PROD with BILLS
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, 
$13,967,468,000, of which $75,000,000, to remain avail-
able through September 30, 2021, 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, 2020: Pro-
VerDate Sep 11 2014 
01:41 May 16, 2019
Jkt 089200
PO 00000
Frm 00080
Fmt 6652
Sfmt 6201
E:\BILLS\H2740.RH
H2740
pbinns on DSK79D2C42PROD with BILLS
vided, That $11,563,095,000 shall be for making pay-
ments under the Head Start Act, of which, notwith-
standing section 640 of such Act: 
(1) $217,000,000 shall be available for a cost 
of living adjustment, and with respect to any con-
tinuing appropriations act, funding available for a 
cost of living adjustment shall not be construed as 
an authority or condition under this Act; 
(2) $25,000,000 shall be available for allocation 
by the Secretary to supplement activities described 
in paragraphs (7)(B) and (9) of section 641(c) of 
the Head Start Act under the Designation Renewal 
System, established under the authority of sections 
641(c)(7), 645A(b)(12), and 645A(d) of such Act, 
and such funds shall not be included in the calcula-
tion of ‘‘base grant’’ in subsequent fiscal years, as 
such term is used in section 640(a)(7)(A) of such 
Act; 
(3) $1,330,000,000, in addition to funds other-
wise available under such section 640 for such pur-
poses, shall be available through March 31, 2021, 
for Early Head Start programs as described in sec-
tion 645A of such Act, for conversion of Head Start 
services to Early Head Start services as described in 
section 645(a)(5)(A) of such Act, for discretionary 
VerDate Sep 11 2014 
01:41 May 16, 2019
Jkt 089200
PO 00000
Frm 00081
Fmt 6652
Sfmt 6201
E:\BILLS\H2740.RH
H2740
pbinns on DSK79D2C42PROD with BILLS
further, That $36,000,000 shall be for sections 680 and 
678E(b)(2) of the CSBG Act, of which not less than 
$25,000,000 shall be for section 680(a)(2) and not less 
than $11,000,000 shall be for section 680(a)(3)(B) of 
such Act: Provided further, That, notwithstanding section 
675C(a)(3) of such 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 expended by such entity, they shall remain 
with such entity for carryover into the next fiscal year for 
expenditure by such entity consistent with program pur-
poses: Provided further, That the Secretary shall establish 
procedures regarding the disposition of intangible assets 
and program income that permit such assets acquired 
with, and program income derived from, grant funds au-
thorized 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 further, That intangible assets in the 
form of loans, equity investments and other debt instru-
ments, and program income 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 No-
VerDate Sep 11 2014 
01:41 May 16, 2019
Jkt 089200
PO 00000
Frm 00083
Fmt 6652
Sfmt 6201
E:\BILLS\H2740.RH
H2740
pbinns on DSK79D2C42PROD with BILLS
vember 29, 1999: Provided further, That funds appro-
priated 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 development corporations: Provided further, 
That $175,000,000 shall be for carrying out section 
303(a) of the Family Violence Prevention and Services 
Act, of which $5,000,000 shall be allocated notwith-
standing section 303(a)(2) of such Act for carrying out 
section 309 of such Act: Provided further, That the per-
centages 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 manage-
ment system for federally declared disasters, to include a 
comprehensive national case management contract and 
Federal costs of administering the system: Provided fur-
ther, That up to $2,000,000 shall be for improving the 
Public Assistance Reporting Information System, includ-
ing grants to States to support data collection for a study 
of the system’s effectiveness. 
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 
VerDate Sep 11 2014 
01:41 May 16, 2019
Jkt 089200
PO 00000
Frm 00084
Fmt 6652
Sfmt 6201
E:\BILLS\H2740.RH
H2740
pbinns on DSK79D2C42PROD with BILLS
of such Act, $79,765,000: Provided, That of the funds 
available to carry out section 437, $59,765,000 shall be 
allocated consistent with subsections (b) through (d) of 
such section: Provided further, That of the funds available 
to carry out section 437, to assist in meeting the require-
ments described in section 471(e)(4)(C), $20,000,000 
shall be for grants to each State, territory, and Indian 
tribe operating title IV–E plans for developing, enhancing, 
or evaluating kinship navigator programs, as described in 
section 427(a)(1) of such Act: Provided further, That sec-
tion 437(b)(1) shall be applied to amounts in the previous 
proviso by substituting ‘‘5 percent’’ for ‘‘3.3 percent’’, and 
notwithstanding section 436(b)(1), such reserved amounts 
may be used for identifying, establishing, and dissemi-
nating practices to meet the criteria specified in section 
471(e)(4)(C): Provided further, That the reservation in 
section 437(b)(2) and the limitations in section 437(d) 
shall not apply to funds specified in the second proviso: 
Provided further, That the minimum grant award for kin-
ship navigator programs in the case of States and terri-
tories shall be $200,000, and, in the case of tribes, shall 
be $25,000: Provided further, That section 437(b)(4) of 
such Act shall be applied by substituting ‘‘fiscal year 
2020’’ for ‘‘fiscal year 2018’’. 
VerDate Sep 11 2014 
01:41 May 16, 2019
Jkt 089200
PO 00000
Frm 00085
Fmt 6652
Sfmt 6201
E:\BILLS\H2740.RH
H2740
pbinns on DSK79D2C42PROD with BILLS
PAYMENTS FOR FOSTER CARE AND PERMANENCY 
For carrying out, except as otherwise provided, title 
IV–E of the Social Security Act, $5,744,000,000. 
For carrying out, except as otherwise provided, title 
IV–E of the Social Security Act, for the first quarter of 
fiscal year 2021, $3,000,000,000. 
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’’), the 
RAISE Family Caregivers Act, the Supporting Grand-
parents Raising Grandchildren Act, titles III and XXIX 
of the PHS Act, sections 1252 and 1253 of the PHS Act, 
section 119 of the Medicare Improvements for Patients 
and Providers Act of 2008, title XX–B of the Social Secu-
rity Act, the Developmental Disabilities 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 
VerDate Sep 11 2014 
01:41 May 16, 2019
Jkt 089200
PO 00000
Frm 00086
Fmt 6652
Sfmt 6201
E:\BILLS\H2740.RH
H2740
pbinns on DSK79D2C42PROD with BILLS
14 with respect to such titles) of the Rehabilitation Act 
of 1973, and for Department-wide coordination of policy 
and program activities that assist individuals with disabil-
ities, $2,294,343,000, together with $55,000,000 to be 
transferred from the Federal Hospital Insurance Trust 
Fund and the Federal Supplementary Medical Insurance 
Trust Fund to carry out section 4360 of the Omnibus 
Budget Reconciliation Act of 1990: Provided, 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 programs and ac-
tivities which have been demonstrated through rigorous 
evaluation to be evidence-based and effective: Provided 
further, That of amounts made available under this head-
ing 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 not-
withstanding 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 Secretary of Agri-
culture in accordance with such section: Provided further, 
That $2,000,000 shall be for competitive grants to sup-
port alternative financing programs that provide for the 
purchase of assistive technology devices, such as a low- 
VerDate Sep 11 2014 
01:41 May 16, 2019
Jkt 089200
PO 00000
Frm 00087
Fmt 6652
Sfmt 6201
E:\BILLS\H2740.RH
H2740
pbinns on DSK79D2C42PROD with BILLS
interest loan fund; an interest buy-down program; a re-
volving loan fund; a loan guarantee; or an insurance pro-
gram: Provided further, That applicants shall provide an 
assurance that, and information describing the manner in 
which, the alternative financing program will expand and 
emphasize consumer choice and control: Provided further, 
That State agencies and community-based disability orga-
nizations that are directed by and operated for individuals 
with disabilities shall be eligible to compete: Provided fur-
ther, 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 Individuals 
with Mental Illness Act (42 U.S.C. 10802)) to continue 
to pursue any legal action in a Federal or State court on 
behalf of an individual or group of individuals with a de-
velopmental disability (as defined in section 102(8)(A) of 
the Developmental Disabilities and Assistance and Bill of 
Rights Act of 2000 (20 U.S.C. 15002(8)(A)) that is at-
tributable to a mental impairment (or a combination of 
mental and physical impairments), that has as the re-
quested remedy the closure of State operated intermediate 
care facilities for people with intellectual 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 guardians who have been 
VerDate Sep 11 2014 
01:41 May 16, 2019
Jkt 089200
PO 00000
Frm 00088
Fmt 6652
Sfmt 6201
E:\BILLS\H2740.RH
H2740
pbinns on DSK79D2C42PROD with BILLS
specifically awarded authority by the courts to make 
healthcare and residential decisions on behalf of such indi-
viduals) who are affected by such action, within 90 days 
of instituting such legal action, which informs such indi-
viduals (or such legal guardians) of their legal rights and 
how to exercise such rights consistent with current Fed-
eral 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. 
DEPARTMENTAL MANAGEMENT 
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, functions 
of the Departmental Appeals Board authorized in title 
XVIII of the Social Security Act, the United States-Mex-
ico Border Health Commission Act, and research studies 
under section 1110 of the Social Security Act, 
$474,169,000, together with $64,828,000 from the 
amounts available under section 241 of the PHS Act to 
carry out national health or human services research and 
VerDate Sep 11 2014 
01:41 May 16, 2019
Jkt 089200
PO 00000
Frm 00089
Fmt 6652
Sfmt 6201
E:\BILLS\H2740.RH
H2740
pbinns on DSK79D2C42PROD with BILLS
evaluation activities: Provided, That of the funds made 
available under this heading, $60,000,000 shall be for mi-
nority AIDS prevention and treatment activities: Provided 
further, That of the funds made available under this head-
ing, $20,000,000 shall be for the Departmental Appeals 
Board: Provided further, That of the funds made available 
under this heading, $110,000,000 shall be for making 
competitive grants to public and private entities, as well 
as continuing to fund through fiscal year 2020 grants 
awarded for fiscal years 2015 through 2019, to fund medi-
cally accurate and age appropriate programs that reduce 
teen pregnancy and for the Federal costs associated with 
administering and evaluating such grants, of which not 
more than 10 percent of the available funds shall be for 
training and technical assistance, outreach, and additional 
program support activities, and of the remaining amount 
75 percent shall be for replicating programs that have 
been proven effective through rigorous evaluation to re-
duce teenage pregnancy, behavioral risk factors underlying 
teenage pregnancy, or other associated risk factors, and 
25 percent shall be available for research and demonstra-
tion grants to develop, replicate, refine, and test additional 
models and innovative strategies for preventing teenage 
pregnancy: Provided further, That amounts made available 
under this heading for programs to reduce teen pregnancy 
VerDate Sep 11 2014 
01:41 May 16, 2019
Jkt 089200
PO 00000
Frm 00090
Fmt 6652
Sfmt 6201
E:\BILLS\H2740.RH
H2740
pbinns on DSK79D2C42PROD with BILLS
shall not be made available by interagency agreement or 
otherwise to any agency within the Department of Health 
and Human Services other than the Office of the Sec-
retary to carry out or support such programs: Provided 
further, That of the amounts provided under this heading 
from amounts available under section 241 of the PHS Act, 
$6,800,000 shall be available to carry out evaluations (in-
cluding longitudinal evaluations) of teenage pregnancy 
prevention approaches: Provided further, That funds pro-
vided in this Act for embryo adoption activities may be 
used to provide to individuals adopting embryos, through 
grants and other mechanisms, medical and administrative 
services deemed necessary for such adoptions: Provided 
further, That such services shall be provided consistent 
with 42 CFR 59.5(a)(4). 
For an additional amount for prize competitions (as 
authorized by section 24 of the Stevenson-Wydler Tech-
nology Innovation Act of 1980 (15 U.S.C. 3719)), 
$10,000,000. 
OFFICE OF MEDICARE HEARINGS AND APPEALS 
For expenses necessary for the Office of Medicare 
Hearings and Appeals, $182,381,000 shall remain avail-
able until September 30, 2021, to be transferred in appro-
priate part from the Federal Hospital Insurance Trust 
VerDate Sep 11 2014 
01:41 May 16, 2019
Jkt 089200
PO 00000
Frm 00091
Fmt 6652
Sfmt 6201
E:\BILLS\H2740.RH
H2740
pbinns on DSK79D2C42PROD with BILLS
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, $60,367,000 shall be available from 
amounts available under section 241 of the PHS Act. 
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, $85,000,000: 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. 
VerDate Sep 11 2014 
01:41 May 16, 2019
Jkt 089200
PO 00000
Frm 00092
Fmt 6652
Sfmt 6201
E:\BILLS\H2740.RH
H2740
pbinns on DSK79D2C42PROD with BILLS
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, $1,083,458,000, 
of which $566,700,000 shall remain available through 
September 30, 2021, 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: Provided, That funds provided under this head-
ing for the purpose of acquisition of security counter-
measures shall be in addition to any other funds available 
for such purpose: Provided further, That products pur-
chased with funds provided under this heading may, at 
VerDate Sep 11 2014 
01:41 May 16, 2019
Jkt 089200
PO 00000
Frm 00093
Fmt 6652
Sfmt 6201
E:\BILLS\H2740.RH
H2740
pbinns on DSK79D2C42PROD with BILLS
the discretion of the Secretary, be deposited in the Stra-
tegic National Stockpile pursuant to section 319F–2 of 
the PHS Act: Provided further, That $5,000,000 of the 
amounts made available to support emergency operations 
shall remain available through September 30, 2022. 
For expenses necessary for procuring security coun-
termeasures (as defined in section 319F–2(c)(1)(B) of the 
PHS Act), $735,000,000, to remain available until ex-
pended. 
For expenses necessary to carry out section 319F- 
2(a) of the PHS Act, $920,000,000, to remain available 
until expended. 
For an additional amount for expenses necessary to 
prepare for or respond to an influenza pandemic, 
$270,000,000, of which $225,000,000 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. 
VerDate Sep 11 2014 
01:41 May 16, 2019
Jkt 089200
PO 00000
Frm 00094
Fmt 6652
Sfmt 6201
E:\BILLS\H2740.RH
H2740
pbinns on DSK79D2C42PROD with BILLS
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. 
VerDate Sep 11 2014 
01:41 May 16, 2019
Jkt 089200
PO 00000
Frm 00095
Fmt 6652
Sfmt 6201
E:\BILLS\H2740.RH
H2740
pbinns on DSK79D2C42PROD with BILLS
(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 be available only to meet 
emergency needs and 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 Represent-
atives and the Senate are notified at least 15 days in ad-
vance 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 effective 
date of a contract awarded in fiscal year 2020 under sec-
tion 338B of such Act, or at any time if the individual 
who has been awarded such contract has not received 
funds due under the contract. 
SEC. 207. None of the funds appropriated in this Act 
may be made available to any entity under title X of the 
PHS Act unless the applicant for the award certifies to 
VerDate Sep 11 2014 
01:41 May 16, 2019
Jkt 089200
PO 00000
Frm 00096
Fmt 6652
Sfmt 6201
E:\BILLS\H2740.RH
H2740
pbinns on DSK79D2C42PROD with BILLS
the Secretary that it encourages family participation in 
the decision of minors to seek family planning services and 
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 
VerDate Sep 11 2014 
01:41 May 16, 2019
Jkt 089200
PO 00000
Frm 00097
Fmt 6652
Sfmt 6201
E:\BILLS\H2740.RH
H2740
pbinns on DSK79D2C42PROD with BILLS
responsible for informing enrollees where to obtain infor-
mation about all Medicare covered services. 
SEC. 210. None of the funds made available in this 
title may be used, in whole or in part, to advocate or pro-
mote gun control. 
SEC. 211. The Secretary shall make available through 
assignment not more than 60 employees of the Public 
Health Service to assist in child survival activities and to 
work in AIDS programs through and with funds provided 
by the Agency for International Development, the United 
Nations International Children’s Emergency Fund or the 
World Health Organization. 
SEC. 212. In order for HHS to carry out inter-
national health activities, including HIV/AIDS and other 
infectious disease, chronic and environmental disease, and 
other health activities abroad during fiscal year 2020: 
(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-
VerDate Sep 11 2014 
01:41 May 16, 2019
Jkt 089200
PO 00000
Frm 00098
Fmt 6652
Sfmt 6201
E:\BILLS\H2740.RH
H2740
pbinns on DSK79D2C42PROD with BILLS
cable statutes administered by the Department of 
State. 
(2) The Secretary is authorized to provide such 
funds by advance or reimbursement to the Secretary 
of State as may be necessary to pay the costs of ac-
quisition, lease, alteration, renovation, and manage-
ment of facilities outside of the United States for 
the use of HHS. The Department of State shall 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 
VerDate Sep 11 2014 
01:41 May 16, 2019
Jkt 089200
PO 00000
Frm 00099
Fmt 6652
Sfmt 6201
E:\BILLS\H2740.RH
H2740
pbinns on DSK79D2C42PROD with BILLS
100 
serve abroad, allowances and benefits similar to 
those provided under chapter 9 of title I of the For-
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. 
VerDate Sep 11 2014 
01:41 May 16, 2019
Jkt 089200
PO 00000
Frm 00100
Fmt 6652
Sfmt 6201
E:\BILLS\H2740.RH
H2740
pbinns on DSK79D2C42PROD with BILLS
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)(12) of the 
PHS Act to enter into transactions (other than contracts, 
cooperative agreements, or grants) to carry out research 
identified pursuant to or research and activities described 
in such section 402(b)(12). 
(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 
VerDate Sep 11 2014 
01:41 May 16, 2019
Jkt 089200
PO 00000
Frm 00101
Fmt 6652
Sfmt 6201
E:\BILLS\H2740.RH
H2740
pbinns on DSK79D2C42PROD with BILLS
102 
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– 
VerDate Sep 11 2014 
01:41 May 16, 2019
Jkt 089200
PO 00000
Frm 00102
Fmt 6652
Sfmt 6201
E:\BILLS\H2740.RH
H2740
pbinns on DSK79D2C42PROD with BILLS
103 
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 2021 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 
VerDate Sep 11 2014 
01:41 May 16, 2019
Jkt 089200
PO 00000
Frm 00103
Fmt 6652
Sfmt 6201
E:\BILLS\H2740.RH
H2740
pbinns on DSK79D2C42PROD with BILLS
104 
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; 
VerDate Sep 11 2014 
01:41 May 16, 2019
Jkt 089200
PO 00000
Frm 00104
Fmt 6652
Sfmt 6201
E:\BILLS\H2740.RH
H2740
pbinns on DSK79D2C42PROD with BILLS
105 
(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 2021 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 & 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 2021. 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 this 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 
VerDate Sep 11 2014 
01:41 May 16, 2019
Jkt 089200
PO 00000
Frm 00105
Fmt 6652
Sfmt 6201
E:\BILLS\H2740.RH
H2740
pbinns on DSK79D2C42PROD with BILLS
106 
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 this 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, 2022, 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 
VerDate Sep 11 2014 
01:41 May 16, 2019
Jkt 089200
PO 00000
Frm 00106
Fmt 6652
Sfmt 6201
E:\BILLS\H2740.RH
H2740
pbinns on DSK79D2C42PROD with BILLS
107 
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 
other Institutes and Centers of the NIH to be used for 
VerDate Sep 11 2014 
01:41 May 16, 2019
Jkt 089200
PO 00000
Frm 00107
Fmt 6652
Sfmt 6201
E:\BILLS\H2740.RH
H2740
pbinns on DSK79D2C42PROD with BILLS
108 
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. 
SEC. 226. (a) The Secretary shall provide to the 
Committees on Appropriations of the House of Represent-
atives and the Senate: 
(1) Detailed monthly enrollment figures from 
the Exchanges established under the Patient Protec-
tion and Affordable 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. Not later than the 15th day of each month, 
the Department of Health and Human Services shall pro-
vide the Committees on Appropriations of the House of 
Representatives and Senate a report on staffing described 
in the committee report accompanying this Act. 
SEC. 228. Funds appropriated in this Act that are 
available for salaries and expenses of employees of the De-
VerDate Sep 11 2014 
01:41 May 16, 2019
Jkt 089200
PO 00000
Frm 00108
Fmt 6652
Sfmt 6201
E:\BILLS\H2740.RH
H2740
pbinns on DSK79D2C42PROD with BILLS
109 
partment 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 emer-
gency 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 ade-
quately addressed in that location at that time. For pur-
poses 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. 229. 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, 
clothing, and any other items intended to promote the 
wellbeing of such children. 
VerDate Sep 11 2014 
01:41 May 16, 2019
Jkt 089200
PO 00000
Frm 00109
Fmt 6652
Sfmt 6201
E:\BILLS\H2740.RH
H2740
pbinns on DSK79D2C42PROD with BILLS
110 
(RESCISSION) 
SEC. 230. Of the unobligated balances made available 
by 
section 
301(b)(3) 
of 
Public 
Law 
114-10, 
$4,300,000,000 are hereby permanently rescinded. 
SEC. 231. None of the funds made available by this 
Act may be used to prevent a United States Senator or 
Member of the House of Representatives from entering, 
for the purpose of conducting oversight, any facility in the 
United States used for the purpose of maintaining custody 
of, or otherwise housing, unaccompanied alien children (as 
defined in section 462(g)(2) of the Homeland Security Act 
of 2002 (6 U.S.C. 279(g)(2))). Nothing in this section 
shall be construed to require such a Senator or Member 
to provide prior notice of the intent to enter such a facility 
for such purpose. 
SEC. 232. 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. 
VerDate Sep 11 2014 
01:41 May 16, 2019
Jkt 089200
PO 00000
Frm 00110
Fmt 6652
Sfmt 6201
E:\BILLS\H2740.RH
H2740
pbinns on DSK79D2C42PROD with BILLS
111 
SEC. 233. (a) None of the funds provided by this Act 
or provided by any accounts in the Treasury of the United 
States derived by the collection of fees available to the Sec-
retary of Health and Human Services, or to any other offi-
cial of a Federal agency funded by this Act may be used 
to facilitate the Secretary of Homeland Security placing 
in detention, removing, referring for a decision whether 
to initiate removal proceedings, or initiating removal pro-
ceedings against a sponsor, potential sponsor, or member 
of a household of a sponsor or potential sponsor of an un-
accompanied alien child (as defined in section 462(g) of 
the Homeland Security Act of 2002 (6 U.S.C. 279(g))) 
based on information shared by the Secretary of Health 
and Human Services, or information shared by an unac-
companied alien child himself or herself with the Depart-
ment of Homeland Security or the Department of Health 
and Human Services. 
(b) Subsection (a) shall not apply if a background 
check of a sponsor, potential sponsor, or member of a 
household of a sponsor or potential sponsor reveals— 
(1) a felony conviction or pending felony charge 
that relates to— 
(A) an aggravated felony (as defined in 
section 101(a)(43) of the Immigration and Na-
tionality Act (8 U.S.C. 1101(a)(43))); 
VerDate Sep 11 2014 
01:41 May 16, 2019
Jkt 089200
PO 00000
Frm 00111
Fmt 6652
Sfmt 6201
E:\BILLS\H2740.RH
H2740
pbinns on DSK79D2C42PROD with BILLS
112 
(B) child abuse; 
(C) sexual violence or abuse; or 
(D) child pornography; 
(2) an association with any business that em-
ploys a minor who— 
(A) is unrelated to the sponsor, potential 
sponsor, or member of a household of a sponsor 
or potential sponsor; and 
(B) is— 
(i) not paid a legal wage; or 
(ii) unable to attend school due to em-
ployment; or 
(3) an association with the organization or im-
plementation of prostitution. 
SEC. 234. None of the funds made available in this 
Act may be used to house unaccompanied alien children 
(as such term is defined in section 462(g) of the Home-
land Security Act of 2002 (6 U.S.C. 279(g))) in— 
(a) soft-sided dormitories; or 
(b) an influx facility that is not State-licensed for the 
care of dependent minors, except in the case that the Sec-
retary of Health and Human Services 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— 
VerDate Sep 11 2014 
01:41 May 16, 2019
Jkt 089200
PO 00000
Frm 00112
Fmt 6652
Sfmt 6201
E:\BILLS\H2740.RH
H2740
pbinns on DSK79D2C42PROD with BILLS
113 
(1) any such influx facility that remains in op-
eration for more than three consecutive months shall 
fully comply with the requirements listed in Exhibit 
1 of the Flores Settlement Agreement, regardless of 
the status of the underlying settlement agreement, 
as well as the standard staffing ratio requirements 
for youth care workers, mental health providers, and 
clinicians to children that permanent facilities are 
required to meet, including those in section 4.4.1 of 
the Office of Refugee Resettlement’s (ORR) Policies 
and Procedures Guide for ‘‘Children Entering the 
United States Unaccompanied’’; 
(2) the Secretary of Health and Human Serv-
ices may grant a one-month waiver for an influx fa-
cility’s non-compliance with paragraph (1) if the 
Secretary certifies and provides a report to Congress 
on the facility’s good-faith efforts and progress to-
wards compliance; 
(3) not more than three consecutive waivers 
under paragraph (2) may be granted to any one fa-
cility; 
(4) ORR shall ensure full adherence to the 
monitoring requirements set forth in section 5.5 of 
its Policies and Procedures Guide; and 
VerDate Sep 11 2014 
01:41 May 16, 2019
Jkt 089200
PO 00000
Frm 00113
Fmt 6652
Sfmt 6201
E:\BILLS\H2740.RH
H2740
pbinns on DSK79D2C42PROD with BILLS