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‘‘(B) the term ‘employee employed to adjust or 
evaluate claims resulting from or relating to such 
major disaster’ means an individual who timely se-
cured or secures a license required by applicable law 
to engage in and perform the activities described in 
clauses (i) through (v) of paragraph (1)(C) relating 
to a major disaster, and is employed by an employer 
that maintains worker compensation insurance cov-
erage or protection for its employees, if required by 
applicable law, and withholds applicable Federal, 
State, and local income and payroll taxes from the 
wages, salaries and any benefits of such employees; 
and 
‘‘(C) the term ‘affiliate’ means a company that, 
by reason of ownership or control of 25 percent or 
more of the outstanding shares of any class of voting 
securities of one or more companies, directly or indi-
rectly, controls, is controlled by, or is under common 
control with, another company.’’. 
(b) This section shall be effective on the date of en-
actment of this Act. 
(RESCISSION) 
SEC. 110. Of the funds made available under the 
heading ‘‘Employment and Training Administration– 
Training and Employment Services’’ in division H of Pub-
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lic Law 115–31, $200,000,000 is rescinded, to be derived 
from the amount made available in paragraph (2)(A) 
under such heading for the period October 1, 2017, 
through September 30, 2018. 
SEC. 111. (a) FLEXIBILITY WITH RESPECT TO THE 
CROSSING OF H–2B NONIMMIGRANTS WORKING IN THE 
SEAFOOD INDUSTRY.— 
(1) IN GENERAL.—Subject to paragraph (2), if 
a petition for H–2B nonimmigrants filed by an em-
ployer in the seafood industry is granted, the em-
ployer may bring the nonimmigrants described in 
the petition into the United States at any time dur-
ing the 120-day period beginning on the start date 
for which the employer is seeking the services of the 
nonimmigrants without filing another petition. 
(2) REQUIREMENTS
FOR
CROSSINGS
AFTER 
90TH
DAY.—An employer in the seafood industry 
may not bring H–2B nonimmigrants into the United 
States after the date that is 90 days after the start 
date for which the employer is seeking the services 
of the nonimmigrants unless the employer— 
(A) completes a new assessment of the 
local labor market by— 
(i) listing job orders in local news-
papers on 2 separate Sundays; and 
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(ii) posting the job opportunity on the 
appropriate Department of Labor Elec-
tronic Job Registry and at the employer’s 
place of employment; and 
(B) offers the job to an equally or better 
qualified United States worker who— 
(i) applies for the job; and 
(ii) will be available at the time and 
place of need. 
(3) EXEMPTION FROM RULES WITH RESPECT 
TO STAGGERING.—The Secretary of Labor shall not 
consider an employer in the seafood industry who 
brings H–2B nonimmigrants into the United States 
during the 120-day period specified in paragraph (1) 
to be staggering the date of need in violation of sec-
tion 655.20(d) of title 20, Code of Federal Regula-
tions, or any other applicable provision of law. 
(b) H–2B NONIMMIGRANTS DEFINED.—In this sec-
tion, the term ‘‘H–2B nonimmigrants’’ means aliens ad-
mitted to the United States pursuant to section 
101(a)(15)(H)(ii)(B) of the Immigration and Nationality 
Act (8 U.S.C. 1101(a)(15)(H)(ii)(B)). 
SEC. 112. The determination of prevailing wage for 
the purposes of the H–2B program shall be the greater 
of—(1) the actual wage level paid by the employer to other 
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employees with similar experience and qualifications for 
such position in the same location; or (2) the prevailing 
wage level for the occupational classification of the posi-
tion in the geographic area in which the H–2B non-
immigrant will be employed, based on the best information 
available at the time of filing the petition. In the deter-
mination of prevailing wage for the purposes of the H– 
2B program, the Secretary shall accept private wage sur-
veys even in instances where Occupational Employment 
Statistics survey data are available unless the Secretary 
determines that the methodology and data in the provided 
survey are not statistically supported. 
SEC. 113. None of the funds in this Act shall be used 
to enforce the definition of corresponding employment 
found in 20 CFR 655.5 or the three-fourths guarantee 
rule definition found in 20 CFR 655.20, or any references 
thereto. Further, for the purpose of regulating admission 
of temporary workers under the H–2B program, the defi-
nition of temporary need shall be that provided in 8 CFR 
214.2(h)(6)(ii)(B). 
SEC. 114. Notwithstanding any other provision of 
law, the final rule issued by the Department of Labor enti-
tled ‘‘Definition of the Term ‘‘Fiduciary’’; Conflict of In-
terest Rule-Retirement Investment Advice’’ and published 
by the Department of Labor in the Federal Register on 
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April 8, 2016 (81 Fed. Reg. 20946 et seq.), shall have 
no force or effect. 
This title may be cited as the ‘‘Department of Labor 
Appropriations Act, 2018’’. 
TITLE II 
DEPARTMENT OF HEALTH AND HUMAN 
SERVICES 
HEALTH RESOURCES AND SERVICES ADMINISTRATION 
PRIMARY HEALTH CARE 
For carrying out titles II and III of the Public Health 
Service Act (referred to in this Act as the ‘‘PHS Act’’) 
with respect to primary health care and the Native Hawai-
ian Health Care Act of 1988, $1,491,522,000: Provided, 
That no more than $100,000 shall be available until ex-
pended for carrying out the provisions of section 224(o) 
of the PHS Act: Provided further, That no more than 
$99,893,000 shall be available until expended for carrying 
out the provisions of sections 224(g)–(n) and (q) of the 
PHS Act, and for expenses incurred by the Department 
of Health and Human Services (referred to in this Act 
as ‘‘HHS’’) pertaining to administrative claims made 
under such law. 
HEALTH WORKFORCE 
For carrying out titles III, VII, and VIII of the PHS 
Act with respect to the health workforce, sections 1128E 
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and 1921 of the Social Security Act, and the Health Care 
Quality Improvement Act of 1986, $748,236,000 (reduced 
by $18,270,000) (increased by $18,270,000): Provided, 
That sections 736(h)(1), 747(c)(2), 751(j)(2), 762(k), and 
the proportional funding amounts in paragraphs (1) 
through (4) of section 756(f) of the PHS Act shall not 
apply to funds made available under this heading: Pro-
vided further, That for any program operating under sec-
tion 751 of the PHS Act on or before January 1, 2009, 
the Secretary of Health and Human Services (referred to 
in this title as the ‘‘Secretary’’) may hereafter waive any 
of the requirements contained in sections 751(d)(2)(A) 
and 751(d)(2)(B) of such Act for the full project period 
of a grant under such section: Provided further, That no 
funds shall be available for section 340G–1 of the PHS 
Act: Provided further, That fees collected for the disclosure 
of information under section 427(b) of the Health Care 
Quality 
Improvement 
Act 
of 
1986 
and 
sections 
1128E(d)(2) and 1921 of the Social Security Act shall be 
sufficient to recover the full costs of operating the pro-
grams authorized by such sections and shall remain avail-
able until expended for the National Practitioner Data 
Bank: Provided further, That funds transferred to this ac-
count to carry out section 846 and subpart 3 of part D 
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of title III of the PHS Act may be used to make prior 
year adjustments to awards made under such sections. 
MATERNAL AND CHILD HEALTH 
For carrying out titles III, XI, XII, and XIX of the 
PHS Act with respect to maternal and child health, title 
V of the Social Security Act, and section 712 of the Amer-
ican Jobs Creation Act of 2004, $848,617,000 (increased 
by $1,000,000) (increased by $24,800,000): Provided, 
That notwithstanding sections 502(a)(1) and 502(b)(1) of 
the Social Security Act, not more than $80,593,000 shall 
be available for carrying out special projects of regional 
and national significance pursuant to section 501(a)(2) of 
such Act and $10,276,000 shall be available for projects 
described in subparagraphs (A) through (F) of section 
501(a)(3) of such Act. 
RYAN WHITE HIV/AIDS PROGRAM 
For carrying out title XXVI of the PHS Act with 
respect to the Ryan White HIV/AIDS program, 
$2,318,781,000, of which $1,970,881,000 shall remain 
available to the Secretary through September 30, 2020, 
for parts A and B of title XXVI of the PHS Act, and 
of which not less than $900,313,000 shall be for State 
AIDS Drug Assistance Programs under the authority of 
section 2616 or 311(c) of such Act. 
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HEALTH CARE SYSTEMS 
For carrying out titles III and XII of the PHS Act 
with respect to health care systems, and the Stem Cell 
Therapeutic and Research Act of 2005, $100,518,000. 
RURAL HEALTH 
For carrying out titles III and IV of the PHS Act 
with respect to rural health, section 427(a) of the Federal 
Coal Mine Health and Safety Act of 1969, and sections 
711 and 1820 of the Social Security Act, $156,060,000, 
of which $43,609,000 from general revenues, notwith-
standing section 1820(j) of the Social Security Act, shall 
be available for carrying out the Medicare rural hospital 
flexibility grants program: Provided, That of the funds 
made available under this heading for Medicare rural hos-
pital flexibility grants, $14,942,000 shall be available for 
the Small Rural Hospital Improvement Grant Program 
for quality improvement and adoption of health informa-
tion technology and up to $1,000,000 shall be to carry 
out section 1820(g)(6) of the Social Security Act, with 
funds provided for grants under section 1820(g)(6) avail-
able for the purchase and implementation of telehealth 
services, including pilots and demonstrations on the use 
of electronic health records to coordinate rural veterans 
care between rural providers and the Department of Vet-
erans Affairs electronic health record system: Provided 
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further, That notwithstanding section 338J(k) of the PHS 
Act, $10,000,000 shall be available for State Offices of 
Rural Health. 
PROGRAM MANAGEMENT 
For program support in the Health Resources and 
Services Administration, $151,993,000: Provided, That 
funds made available under this heading may be used to 
supplement program support funding provided under the 
headings ‘‘Primary Health Care’’, ‘‘Health Workforce’’, 
‘‘Maternal and Child Health’’, ‘‘Ryan White HIV/AIDS 
Program’’, ‘‘Health Care Systems’’, and ‘‘Rural Health’’. 
VACCINE INJURY COMPENSATION PROGRAM TRUST FUND 
For payments from the Vaccine Injury Compensation 
Program Trust Fund (the ‘‘Trust Fund’’), such sums as 
may be necessary for claims associated with vaccine-re-
lated injury or death with respect to vaccines administered 
after September 30, 1988, pursuant to subtitle 2 of title 
XXI of the PHS Act, to remain available until expended: 
Provided, That for necessary administrative expenses, not 
to exceed $8,250,000 shall be available from the Trust 
Fund to the Secretary. 
CENTERS FOR DISEASE CONTROL AND PREVENTION 
IMMUNIZATION AND RESPIRATORY DISEASES 
For carrying out titles II, III, XVII, and XXI, and 
section 2821 of the PHS Act, titles II and IV of the Immi-
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gration and Nationality Act, and section 501 of the Ref-
ugee Education Assistance Act, with respect to immuniza-
tion and respiratory diseases, $470,700,000. 
HIV/AIDS, VIRAL HEPATITIS, SEXUALLY TRANSMITTED 
DISEASES, AND TUBERCULOSIS PREVENTION 
For carrying out titles II, III, XVII, and XXIII of 
the PHS Act with respect to HIV/AIDS, viral hepatitis, 
sexually transmitted diseases, and tuberculosis prevention, 
$1,117,278,000. 
EMERGING AND ZOONOTIC INFECTIOUS DISEASES 
For carrying out titles II, III, and XVII, and section 
2821 of the PHS Act, titles II and IV of the Immigration 
and Nationality Act, and section 501 of the Refugee Edu-
cation Assistance Act, with respect to emerging and 
zoonotic infectious diseases, $499,522,000 (increased by 
$300,000) (increased by $1,000,000). 
CHRONIC DISEASE PREVENTION AND HEALTH 
PROMOTION 
For carrying out titles II, III, XI, XV, XVII, and 
XIX of the PHS Act with respect to chronic disease pre-
vention and health promotion, $703,696,000: Provided, 
That funds appropriated under this account may be avail-
able for making grants under section 1509 of the PHS 
Act for not less than 21 States, tribes, or tribal organiza-
tions: Provided further, That of the funds available under 
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this heading, $10,000,000 shall be available to continue 
and expand community specific extension and outreach 
programs to combat obesity in counties with the highest 
levels of obesity: Provided further, That the proportional 
funding requirements under section 1503(a) of the PHS 
Act shall not apply to funds made available under this 
heading. 
BIRTH DEFECTS, DEVELOPMENTAL DISABILITIES, 
DISABILITIES AND HEALTH 
For carrying out titles II, III, XI, and XVII of the 
PHS Act with respect to birth defects, developmental dis-
abilities, disabilities and health, $137,560,000. 
PUBLIC HEALTH SCIENTIFIC SERVICES 
For carrying out titles II, III, and XVII of the PHS 
Act with respect to health statistics, surveillance, health 
informatics, and workforce development, $328,697,000: 
Provided, That in addition to amounts provided herein, 
$150,700,000 shall be available from amounts available 
under section 241 of the PHS Act to carry out Public 
Health Scientific Services. 
ENVIRONMENTAL HEALTH 
For carrying out titles II, III, and XVII of the PHS 
Act with respect to environmental health, $142,750,000 
(increased by $1,000,000) (increased by $400,000). 
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INJURY PREVENTION AND CONTROL 
For carrying out titles II, III, and XVII of the PHS 
Act with respect to injury prevention and control, 
$286,059,000 (increased by $1,000,000): Provided, That 
of the funds provided under this heading, $112,000,000 
shall be available for an evidence-based opioid drug over-
dose prevention program. 
NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND 
HEALTH 
For carrying out titles II, III, and XVII of the PHS 
Act, sections 101, 102, 103, 201, 202, 203, 301, and 501 
of the Federal Mine Safety and Health Act, section 13 
of the Mine Improvement and New Emergency Response 
Act, and sections 20, 21, and 22 of the Occupational Safe-
ty and Health Act, with respect to occupational safety and 
health, $325,200,000. 
ENERGY EMPLOYEES OCCUPATIONAL ILLNESS 
COMPENSATION PROGRAM 
For necessary expenses to administer the Energy 
Employees Occupational Illness Compensation Program 
Act, $55,358,000, to remain available until expended: Pro-
vided, That this amount shall be available consistent with 
the provision regarding administrative expenses in section 
151(b) of division B, title I of Public Law 106–554. 
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GLOBAL HEALTH 
For carrying out titles II, III, and XVII of the PHS 
Act with respect to global health, $435,121,000, of which 
$128,421,000 for international HIV/AIDS shall remain 
available through September 30, 2019: Provided, That 
funds may be used for purchase and insurance of official 
motor vehicles in foreign countries. 
PUBLIC HEALTH PREPAREDNESS AND RESPONSE 
For carrying out titles II, III, and XVII of the PHS 
Act with respect to public health preparedness and re-
sponse, and for expenses necessary to support activities 
related to countering potential biological, nuclear, radio-
logical, and chemical threats to civilian populations, 
$1,450,000,000 
(reduced 
by 
$400,000), 
of 
which 
$600,000,000 shall remain available until expended for 
the Strategic National Stockpile: Provided, That in the 
event the Director of the Centers for Disease Control and 
Prevention (referred to in this title as ‘‘CDC’’) activates 
the Emergency Operations Center, the Director of the 
CDC may detail CDC staff without reimbursement for up 
to 90 days to support the work of the CDC Emergency 
Operations Center, so long as the Director provides a no-
tice to the Committees on Appropriations of the House 
of Representatives and the Senate within 15 days of the 
use of this authority and a full report within 30 days after 
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use of this authority which includes the number of staff 
and funding level broken down by the originating center 
and number of days detailed: Provided further, That funds 
appropriated under this heading may be used to support 
a contract for the operation and maintenance of an air-
craft in direct support of activities throughout CDC to en-
sure the agency is prepared to address public health pre-
paredness emergencies. 
BUILDINGS AND FACILITIES 
(INCLUDING TRANSFER OF FUNDS) 
For acquisition of real property, equipment, construc-
tion, demolition, and renovation of facilities, $10,000,000, 
to remain available until September 30, 2022: Provided, 
That funds previously set-aside by CDC for repair and up-
grade of the Lake Lynn Experimental Mine and Labora-
tory shall be used to acquire a replacement mine safety 
research facility: Provided further, That in addition, the 
prior year unobligated balance of any amounts assigned 
to former employees in accounts of CDC made available 
for Individual Learning Accounts shall be credited to and 
merged with the amounts made available under this head-
ing to support the replacement of the mine safety research 
facility. 
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CDC-WIDE ACTIVITIES AND PROGRAM SUPPORT 
For carrying out titles II, III, XVII and XIX, and 
section 2821 of the PHS Act and for cross-cutting activi-
ties and program support for activities funded in other 
appropriations included in this Act for the Centers for 
Disease Control and Prevention, $103,570,000: Provided, 
That paragraphs (1) through (3) of subsection (b) of sec-
tion 2821 of the PHS Act shall not apply to funds appro-
priated under this heading and in all other accounts of 
the CDC: Provided further, That employees of CDC or the 
Public Health Service, both civilian and commissioned of-
ficers, detailed to States, municipalities, or other organiza-
tions under authority of section 214 of the PHS Act, or 
in overseas assignments, shall be treated as non-Federal 
employees for reporting purposes only and shall not be in-
cluded within any personnel ceiling applicable to the Agen-
cy, Service, or HHS during the period of detail or assign-
ment: Provided further, That CDC may use up to $10,000 
from amounts appropriated to CDC in this Act for official 
reception and representation expenses when specifically 
approved by the Director of CDC: Provided further, That 
in addition, such sums as may be derived from authorized 
user fees, which shall be credited to the appropriation 
charged with the cost thereof: Provided further, That with 
respect to the previous proviso, authorized user fees from 
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the Vessel Sanitation Program and the Respirator Certifi-
cation Program shall be available through September 30, 
2019. 
NATIONAL INSTITUTES OF HEALTH 
NATIONAL CANCER INSTITUTE 
For carrying out section 301 and title IV of the PHS 
Act with respect to cancer, $5,471,181,000 (increased by 
$1,000,000) (increased by $3,819,000), of which up to 
$10,000,000 may be used for facilities repairs and im-
provements at the National Cancer Institute—Frederick 
Federally Funded Research and Development Center in 
Frederick, Maryland. 
NATIONAL HEART, LUNG, AND BLOOD INSTITUTE 
For carrying out section 301 and title IV of the PHS 
Act with respect to cardiovascular, lung, and blood dis-
eases, and blood and blood products, $3,256,521,000. 
NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL 
RESEARCH 
For carrying out section 301 and title IV of the PHS 
Act with respect to dental and craniofacial diseases, 
$432,363,000. 
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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, 
$1,401,727,000. 
NATIONAL EYE INSTITUTE 
For carrying out section 301 and title IV of the PHS 
Act with respect to eye diseases and visual disorders, 
$743,881,000. 
NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH 
SCIENCES 
For carrying out section 301 and title IV of the PHS 
Act with respect to environmental health sciences, 
$725,387,000. 
NATIONAL INSTITUTE ON AGING 
For carrying out section 301 and title IV of the PHS 
Act with respect to aging, $2,458,733,000. 
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, $566,515,000. 
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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, $443,624,000. 
NATIONAL INSTITUTE OF NURSING RESEARCH 
For carrying out section 301 and title IV of the PHS 
Act with respect to nursing research, $152,599,000. 
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, 
$490,796,000. 
NATIONAL INSTITUTE ON DRUG ABUSE 
For carrying out section 301 and title IV of the PHS 
Act with respect to drug abuse, $1,107,497,000. 
NATIONAL INSTITUTE OF MENTAL HEALTH 
For carrying out section 301 and title IV of the PHS 
Act with respect to mental health, $1,625,461,000. 
NATIONAL HUMAN GENOME RESEARCH INSTITUTE 
For carrying out section 301 and title IV of the PHS 
Act 
with 
respect 
to 
human 
genome 
research, 
$536,774,000. 
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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, $362,506,000. 
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, 
$136,741,000. 
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, $293,583,000. 
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), $73,353,000. 
NATIONAL LIBRARY OF MEDICINE 
For carrying out section 301 and title IV of the PHS 
Act with respect to health information communications, 
$413,848,000: Provided, That of the amounts available for 
improvement of information systems, $4,000,000 shall be 
available until September 30, 2019: Provided further, That 
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in fiscal year 2018, 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, $718,867,000: 
Provided, That up to $25,835,000 shall be available to im-
plement section 480 of the PHS Act, relating to the Cures 
Acceleration Network: Provided further, That at least 
$526,120,000 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, $1,705,248,000: 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 National Chil-
dren’s 
Study 
Follow-on: 
Provided 
further, 
That 
$682,980,000 shall be available for the Common Fund es-
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tablished under section 402A(c)(1) of the PHS Act: Pro-
vided further, That of the funds provided, $10,000 shall 
be for official reception and representation expenses when 
specifically approved by the Director of the NIH: Provided 
further, That the Office of AIDS Research within the Of-
fice 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. 
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 title 26, United States Code, 
for the purpose of carrying out section 402(b)(7)(B)(ii) 
of the PHS Act (relating to pediatric research), as author-
ized 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, 
$128,863,000, to remain available through September 30, 
2022. 
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NIH INNOVATION ACCOUNT 
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, 
$496,000,000, 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 
Act: Provided further, That of the amount appropriated 
under this heading, $300,000,000 shall be transferred to 
the ‘‘National Cancer Institute’’ account for the purposes 
described 
in 
section 
1001(b)(4)(C) 
of 
such 
Act, 
$43,000,000 shall be transferred to the ‘‘National Insti-
tute of Neurological Disorders and Stroke’’ account for 
the purposes described in section 1001(b)(4)(B) of such 
Act, and $43,000,000 shall be transferred to the ‘‘Na-
tional Institute of Mental Health’’ account for the pur-
poses described in section 1001(b)(4)(B) of such Act: Pro-
vided further, That remaining amounts may be transferred 
by the Director of the NIH to any accounts of the NIH: 
Provided further, That upon a determination by the Direc-
tor that funds transferred pursuant to any of the previous 
provisos are not necessary for the purposes provided, such 
amounts may be transferred back to this account: Pro-
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vided further, That the transfer authority provided under 
this heading is in addition to any other transfer authority 
provided by law. 
SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES 
ADMINISTRATION 
MENTAL HEALTH 
For carrying out titles III, V, and XIX of the PHS 
Act with respect to mental health, and the Protection and 
Advocacy for Individuals with Mental Illness Act, 
$928,668,000 (reduced by $12,500,000) (increased by 
$12,500,000) (increased by $231,330,000): Provided, 
That notwithstanding section 520A(f)(2) of the PHS Act, 
no funds appropriated for carrying 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 per-
cent of the amounts appropriated for subpart I of part 
B of title XIX: Provided further, That States shall expend 
at least 10 percent of the amount each receives for car-
rying out section 1911 of the PHS Act to support evi-
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dence-based programs that address the needs of individ-
uals with early serious mental illness, including psychotic 
disorders, regardless of the age of the individual at onset: 
Provided further, That none of the funds provided for sec-
tion 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 Protecting Access to Medicare 
Act of 2014 (Public Law 113–93; 42 U.S.C. 290aa 22 
note). 
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, $2,130,306,000: Provided, That in addition to 
amounts provided herein, $81,200,000 shall be available 
under section 241 of the PHS Act to supplement funds 
otherwise available for substance abuse treatment activi-
ties and to carry out subpart II of part B of title XIX 
of the PHS Act to fund section 1935(b) technical assist-
ance, national data, data collection and evaluation activi-
ties, and further that the total available under this Act 
for section 1935(b) activities shall not exceed 5 percent 
of the amounts appropriated for subpart II of part B of 
title XIX: Provided further, That none of the funds pro-
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vided for section 1921 of the PHS Act 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, $165,373,000. 
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, 
$108,922,000: Provided, That in addition to amounts pro-
vided herein, $23,426,000 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 
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-
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ther, That amounts made available in this Act for carrying 
out section 501(o) of the PHS Act shall remain available 
through September 30, 2019: Provided further, That funds 
made available under this heading may be used to supple-
ment program support funding provided under the head-
ings ‘‘Mental Health’’, ‘‘Substance Abuse Treatment’’, 
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, $300,000,000: 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, 2019. 
CENTERS FOR MEDICARE AND MEDICAID SERVICES 
GRANTS TO STATES FOR MEDICAID 
For carrying out, except as otherwise provided, titles 
XI and XIX of the Social Security Act, $284,798,384,000, 
to remain available until expended. 
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For making, after May 31, 2018, 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 2018 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 2019, 
$134,847,759,000, 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 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 
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, $323,497,300,000. 
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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, and the Clinical Labora-
tory Improvement Amendments of 1988, not to exceed 
$3,451,141,000, 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, That no funds shall be de-
rived from offsetting collections through fees collected 
from qualified health plans offered through an Exchange 
established under Public Law 111–148 to operate such an 
Exchange: Provided further, That all funds derived in ac-
cordance with 31 U.S.C. 9701 from organizations estab-
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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 2018 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, $745,000,000, 
to remain available through September 30, 2019, 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 $486,936,000 shall be for the Medi-
care Integrity Program at the Centers for Medicare and 
Medicaid Services, including administrative costs, to con-
duct oversight activities for Medicare Advantage under 
Part C and the Medicare Prescription Drug Program 
under Part D of the Social Security Act and for activities 
described in section 1893(b) of such Act, of which 
$82,132,000 shall be for the Department of Health and 
Human Services Office of Inspector General to carry out 
fraud and abuse activities authorized by section 
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1817(k)(3) of such Act, of which $82,132,000 shall be for 
the Medicaid and Children’s Health Insurance Program 
(‘‘CHIP’’) program integrity activities, and of which 
$93,800,000 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 2018 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 
$434,000,000 is additional new budget authority specified 
for purposes of section 251(b)(2)(C) of such Act: Provided 
further, That the Secretary shall support the Senior Medi-
care Patrol program to combat health care fraud and 
abuse from the funds provided 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 
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and the Act of July 5, 1960, $2,995,400,000, to remain 
available until expended; and for such purposes for the 
first quarter of fiscal year 2019, $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, $3,390,304,000: Provided, That all but 
$491,000,000 of this amount shall be allocated as though 
the total appropriation for such payments for fiscal year 
2018 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 
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through contracts with private entities that do not qualify 
as nonprofit organizations. 
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, $1,022,811,000, of which 
$993,321,000 shall remain available through September 
30, 2020 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’’. 
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PAYMENTS TO STATES FOR THE CHILD CARE AND 
DEVELOPMENT BLOCK GRANT 
For carrying out the Child Care and Development 
Block 
Grant 
Act 
of 
2014 
(‘‘CCDBG 
Act’’), 
$2,860,000,000 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. 
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. 
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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’’); for necessary administra-
tive 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 2014, the Assets for Independence Act, title IV of the 
Immigration and Nationality Act, and section 501 of the 
Refugee 
Education 
Assistance 
Act 
of 
1980, 
$11,181,500,000 (reduced by $1,000,000) (increased by 
$1,000,000) (reduced by $5,000,000) (increased by 
$5,000,000), of which $37,943,000, to remain available 
through September 30, 2019, shall be for grants to States 
for adoption and legal guardianship incentive payments, 
as defined by section 473A of the Social Security Act and 
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may be made for adoptions and legal guardianships com-
pleted before September 30, 2018: Provided, That 
$9,275,000,000 shall be for making payments under the 
Head Start Act: Provided further, That of the amount in 
the previous proviso, $8,610,000,000 shall be available for 
payments under section 640 of the Head Start Act, of 
which $21,905,000 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 supple-
ment activities described in paragraphs (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: Pro-
vided further, That notwithstanding such section 640, of 
the amount provided for making payments under the 
Head Start Act, and in addition to funds otherwise avail-
able under such section 640 for such purposes, 
$640,000,000 shall be available through March 31, 2019 
for Early Head Start programs as described in section 
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 grants for high 
quality infant and toddler care through Early Head Start- 
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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 
$14,000,000 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 available until December 31, 
2018 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 evaluation related 
to grants awarded under such section 9212: Provided fur-
ther, That $617,500,000 shall be for making payments 
under the CSBG Act: Provided further, That $17,850,000 
shall be for sections 680 and 678E(b)(2) of the CSBG 
Act, of which not less than $10,000,000 shall be for sec-
tion 680(a)(2) and not less than $7,500,000 shall be for 
section 680(a)(3)(B) of such Act: Provided further, That, 
notwithstanding section 675C(a)(3) of such Act, to the ex-
tent Community Services Block Grant funds are distrib-
uted as grant funds by a State to an eligible entity as 
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provided under such Act, and have not been expended by 
such entity, they shall remain with such entity for carry-
over into the next fiscal year for expenditure by such enti-
ty consistent with program purposes: 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 in-
come 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 further, 
That intangible assets in the form of loans, equity invest-
ments and other debt instruments, and program income 
may be used by grantees for any eligible purpose con-
sistent with section 680(a)(2)(A) of the CSBG Act: Pro-
vided further, That these procedures shall apply to such 
grant funds made available after November 29, 1999: Pro-
vided 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 $1,864,000 
shall be for a human services case management system 
for federally declared disasters, to include a comprehensive 
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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, $325,000,000 and, 
for carrying out, except as otherwise provided, section 437 
of such Act, $59,765,000: Provided, That notwithstanding 
sections 438(c)(3)(A) and 436(b)(2) of such Act, 
$10,000,000 shall be available for such section 436(b)(2), 
of which no funds shall be available for carrying out sec-
tions 438(c)(3)(A)(ii) and (iii) of such Act. 
PAYMENTS FOR FOSTER CARE AND PERMANENCY 
For carrying out, except as otherwise provided, title 
IV–E of the Social Security Act, $6,225,000,000. 
For carrying out, except as otherwise provided, title 
IV–E of the Social Security Act, for the first quarter of 
fiscal year 2019, $2,700,000,000. 
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 
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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, $2,237,224,000 (increased by 
$14,232,847): 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 activities which have been 
demonstrated through rigorous evaluation to be evidence- 
based and effective: Provided further, That of the amounts 
provided under this heading, $300,000,000 shall be avail-
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able for carrying out title V of the OAA: Provided further, 
That with respect to the previous proviso, such funds shall 
be available through June 30, 2019, and may be recap-
tured and reobligated in accordance with section 517(c) 
of the OAA: 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 imple-
menting evidence-based practices for enhancing senior nu-
trition: 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 trans-
ferred to the Secretary of Agriculture in accordance with 
such section: Provided further, That $2,000,000 shall be 
for competitive grants to support alternative financing 
programs that provide for the purchase of assistive tech-
nology devices, such as a low-interest loan fund; an inter-
est buy-down program; a revolving loan fund; a loan guar-
antee; or an insurance program: Provided further, That 
applicants shall provide an assurance that, and informa-
tion describing the manner in which, the alternative fi-
nancing program will expand and emphasize consumer 
choice and control: Provided further, That State agencies 
and community-based disability organizations that are di-
rected by and operated for individuals with disabilities 
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shall be eligible to compete: Provided 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 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 developmental 
disability (as defined in section 102(8)(A) of the Develop-
mental Disabilities and Assistance 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 operated intermediate care facilities 
for people with intellectual or developmental disabilities, 
unless reasonable public notice of the action has been pro-
vided to such individuals (or, in the case of mental inca-
pacitation, the legal guardians who have been specifically 
awarded authority by the courts to make healthcare and 
residential decisions on behalf of such individuals) who are 
affected by such action, within 90 days of instituting such 
legal action, which informs such individuals (or such legal 
guardians) of their legal rights and how to exercise such 
rights consistent with current Federal Rules of Civil Pro-
cedure: Provided further, That the limitations in the imme-
diately preceding proviso shall not apply in the case of an 
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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 pub-
lic 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, $292,881,000 (reduced by $3,000,000) (reduced by 
$300,000) 
(reduced 
by 
$1,000,000) 
(reduced 
by 
$1,000,000) (reduced by $3,819,000) (reduced by 
$24,800,000) (reduced by $219,620,000) (reduced by 
$2,000,000) (increased by $2,000,000), together with 
$57,465,000 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 the funds made available under this heading, 
$20,000,000 shall be for making competitive grants which 
exclusively implement education in sexual risk avoidance 
(defined as voluntarily refraining from non-marital sexual 
activity): Provided further, That funding for such competi-
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tive grants for sexual risk avoidance shall use medically 
accurate information referenced to peer-reviewed publica-
tions by educational, scientific, governmental, or health or-
ganizations; implement an evidence-based approach inte-
grating research findings with practical implementation 
that aligns with the needs and desired outcomes for the 
intended audience; and teach the benefits associated with 
self-regulation, success sequencing for poverty prevention, 
healthy relationships, goal setting, and resisting sexual co-
ercion, dating violence, and other youth risk behaviors 
such as underage drinking or illicit drug use without nor-
malizing teen sexual activity: Provided further, That no 
more than 10 percent of the funding for such competitive 
grants for sexual risk avoidance shall be available for tech-
nical assistance and administrative costs of such pro-
grams: Provided further, That funds provided 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). 
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STATE RESPONSE TO THE OPIOID ABUSE CRISIS 
ACCOUNT, CURES ACT 
For necessary expenses to carry out the purposes de-
scribed under section 1003(c) of the 21st Century Cures 
Act, $500,000,000, to remain available until expended: 
Provided, That such amounts are appropriated pursuant 
to section 1003(b)(3) of the 21st Century Cures Act, are 
to be derived from amounts transferred under section 
1003(b)(2)(A) of such Act, and may be transferred by the 
Secretary of Health and Human Services to other ac-
counts of the Department solely for the purposes provided 
in such Act: Provided further, That such transfer authority 
is in addition to any other transfer authority provided by 
law. 
OFFICE OF MEDICARE HEARINGS AND APPEALS 
For expenses necessary for the Office of Medicare 
Hearings and Appeals, $112,381,000, to be transferred in 
appropriate part from the Federal Hospital Insurance 
Trust Fund and the Federal Supplementary Medical In-
surance Trust Fund: Provided, That of amounts the Sec-
retary retains for adjudications related to Recovery Audit 
Contractor (RAC) appeals under section 1893(h)(1)(c) of 
the Social Security Act, $5,000,000 shall be used as addi-
tional funds for the necessary expenses of the Office of 
Medicare Hearings and Appeals and the Departmental 
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Appeals Board to process RAC-related appeals, and to es-
tablish a process to provide educational feedback from 
such Office and Board to the Centers for Medicare and 
Medicaid Services to reduce the claims overturn rate from 
the claims that are reviewed by such Office or Board. 
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, $38,381,000. 
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 
(INCLUDING TRANSFER OF FUNDS) 
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, $959,258,000, of 
which $520,000,000 shall remain available through Sep-
tember 30, 2019, for expenses necessary to support ad-
vanced 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-
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chased with funds provided under this heading may, at 
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, 2020. 
For expenses necessary for procuring security coun-
termeasures (as defined in section 319F–2(c)(1)(B) of the 
PHS Act), $530,000,000, 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 $210,000,000 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: Provided 
further, That the limitation in section 205 of this Act re-
garding transfers increasing any appropriation shall apply 
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to transfers to appropriations under this heading by sub-
stituting ‘‘10 percent’’ for ‘‘3 percent’’. 
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 2.4 percent, of any amounts appro-
priated for programs authorized under such Act shall be 
made available for the evaluation (directly, or by grants 
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or contracts) and the implementation and effectiveness of 
programs funded in this title. 
(TRANSFER OF FUNDS) 
SEC. 205. Not to exceed 1 percent of any 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 2018 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 
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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 
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 2018: 
(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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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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(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 
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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 establish a publicly 
accessible Web site to provide information regarding the 
uses of funds made available under section 4002 of the 
Patient Protection and Affordable Care Act of 2010 
(‘‘ACA’’). 
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(b) With respect to funds provided under section 
4002 of the ACA, the Secretary shall include on the Web 
site established under subsection (a) at a minimum the 
following information: 
(1) In the case of each transfer of funds under 
section 4002(c), a statement indicating the program 
or activity receiving funds, the operating division or 
office that will administer the funds, and the 
planned uses of the funds, to be posted not later 
than the day after the transfer is made. 
(2) Identification (along with a link to the full 
text) of each funding opportunity announcement, re-
quest for proposals, or other announcement or solici-
tation of proposals for grants, cooperative agree-
ments, or contracts intended to be awarded using 
such funds, to be posted not later than the day after 
the announcement or solicitation is issued. 
(3) Identification of each grant, cooperative 
agreement, or contract with a value of $25,000 or 
more awarded using such funds, including the pur-
pose of the award and the identity of the recipient, 
to be posted not later than 5 days after the award 
is made. 
(4) A report detailing the uses of all funds 
transferred under section 4002(c) during the fiscal 
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year, to be posted not later than 90 days after the 
end of the fiscal year. 
(c) With respect to awards made in fiscal years 2013 
through 2018, the Secretary shall also include on the Web 
site established under subsection (a), semi-annual reports 
from each entity awarded a grant, cooperative agreement, 
or contract from such funds with a value of $25,000 or 
more, summarizing the activities undertaken and identi-
fying any sub-grants or sub-contracts awarded (including 
the purpose of the award and the identity of the recipient), 
to be posted not later than 30 days after the end of each 
6-month period. 
(d) In carrying out this section, the Secretary shall— 
(1) present the information required in sub-
section (b)(1) on a single webpage or on a single 
database; 
(2) ensure that all information required in this 
section is directly accessible from the single webpage 
or database; and 
(3) ensure that all information required in this 
section is able to be organized by program or State. 
SEC. 220. (a) The Secretary shall publish in the fiscal 
year 2019 budget justification and on Departmental Web 
sites information concerning the employment of full-time 
equivalent Federal employees or contractors for the pur-
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poses of implementing, administering, enforcing, or other-
wise carrying out the provisions of the ACA, and the 
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. 221. The Secretary shall publish, as part of the 
fiscal year 2019 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 2019. 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. 222. (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 
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(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. 223. 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 and Medicaid Services—Pro-
gram Management’’ account, may be used for payments 
under section 1342(b)(1) of Public Law 111–148 (relating 
to risk corridors). 
SEC. 224. The Secretary shall include in the fiscal 
year 2019 budget justification an analysis of how section 
2713 of the PHS Act will impact eligibility for discre-
tionary HHS programs. 
(TRANSFER OF FUNDS) 
SEC. 225. (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 
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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. 226. None of the funds appropriated in this Act 
may be used to carry out title X of the PHS Act. 
SEC. 227. Effective during the period beginning on 
November 1, 2015 and ending January 1, 2020, 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 
screening, mammography, and prevention last issued 
before 2009; and 
(2) such recommendations last issued before 
2009 applied to any screening mammography modal-
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ity under section 1861(jj) of the Social Security Act 
(42 U.S.C. 1395x(jj)). 
SEC. 228. In making Federal financial assistance, the 
NIH shall continue to apply the provisions relating to indi-
rect costs in part 75 of title 45, Code of Federal Regula-
tions, including with respect to the approval of deviations 
from negotiated rates, to the same extent and in the same 
manner as the NIH applied such provisions in the third 
quarter of fiscal year 2017. None of the funds appro-
priated by this Act may be used by the NIH to develop 
or implement a modified approach to such provisions, or 
to intentionally or substantially expand the fiscal effect of 
the approval of such deviations from negotiated rates be-
yond the proportional effect of such approvals in such 
quarter. 
SEC. 229. None of the funds appropriated in this Act 
may be used to implement, further, enforce, or advance 
the Navigators program as provided under section 1311(i) 
of Public Law 111–148 and title I and subtitle B of title 
II of Public Law 111–152. 
This title may be cited as the ‘‘Department of Health 
and Human Services Appropriations Act, 2018’’. 
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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’’), $15,953,790,000, of which 
$5,035,990,000 shall become available on July 1, 2018, 
and shall remain available through September 30, 2019, 
and of which $10,841,177,000 shall become available on 
October 1, 2018, and shall remain available through Sep-
tember 30, 2019, for academic year 2018–2019: Provided, 
That $6,459,401,000 shall be for basic grants under sec-
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, 2017, 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 
$3,819,050,000 shall be for targeted grants under section 
1125 
of 
the 
ESEA: 
Provided 
further, 
That 
$3,819,050,000 shall be for education finance incentive 
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