This title may be cited as the ‘‘Department of Labor 
Appropriations Act, 2020’’. 
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, $1,676,522,000 (increased 
by $5,000,000): Provided, That no more than $1,000,000 
shall be available until expended for carrying out the pro-
visions of section 224(o) of the PHS Act: Provided further, 
That no more than $120,000,000 shall be available until 
expended for carrying out subsections (g) through (n) and 
(q) of section 224 of the PHS Act, and for expenses in-
curred by the Department of Health and Human Services 
(referred to in this Act as ‘‘HHS’’) pertaining to adminis-
trative 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 
and 1921 of the Social Security Act, and the Health Care 
Quality Improvement Act of 1986, $1,244,942,000 (re-
duced by $1) (increased by $1) (increased by $5,000,000): 
Provided, That sections 751(j)(2) and 762(k) of the PHS 
Act 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 
of title III of the PHS Act may be used to make prior 
year adjustments to awards made under such section and 
subpart: Provided further, That $120,000,000 shall re-
main available until expended for the purposes of pro-
viding primary health services, assigning National Health 
Service Corps (‘‘NHSC’’) members to expand the delivery 
of substance use disorder treatment services, notwith-
standing the assignment priorities and limitations under 
sections 333(a)(1)(D), 333(b), and 333A(a)(1)(B)(ii) of 
the PHS Act, and making payments under the NHSC 
Loan Repayment Program under section 338B of such 
Act: Provided further, That, within the amount made 
available in the previous proviso, $15,000,000 shall re-
main available until expended for the purposes of making 
payments under the NHSC Loan Repayment Program 
under section 338B of the PHS Act to individuals partici-
pating in such program who provide primary health serv-
ices in Indian Health Service facilities, Tribally-Operated 
638 Health Programs, and Urban Indian Health Pro-
grams (as those terms are defined by the Secretary), not-
withstanding the assignment priorities and limitations 
under section 333(b) of such Act: Provided further, That 
for purposes of the previous two provisos, section 
331(a)(3)(D) of the PHS Act shall be applied as if the 
term ‘‘primary health services’’ includes clinical substance 
use disorder treatment services, including those provided 
by masters level, licensed substance use disorder treat-
ment counselors: Provided further, That of the funds made
available under this heading, $20,000,000 shall be avail-
able to make grants to establish or expand optional com-
munity-based nurse practitioner fellowship programs that 
are accredited or in the accreditation process, with a pref-
erence for those in Federally Qualified Health Centers, for 
practicing postgraduate nurse practitioners in primary 
care or behavioral health. 
Of the funds made available under this heading, 
$40,000,000 shall remain available until expended for 
grants to public institutions of higher education to expand 
or support graduate education for physicians provided by 
such institutions: Provided, That, in awarding such 
grants, the Secretary shall give priority to public institu-
tions of higher education located in States with a projected 
primary care provider shortage in 2025, as determined by 
the Secretary: Provided further, That grants so awarded 
are limited to such public institutions of higher education 
in States in the top quintile of States with a projected 
primary care provider shortage in 2025, as determined by 
the Secretary: Provided further, That the minimum 
amount of a grant so awarded to such an institution shall 
be not less than $1,000,000 per year: Provided further, 
That such a grant may be awarded for a period not to 
exceed 5 years: Provided further, That such a grant award-
ed with respect to a year to such an institution shall be
subject to a matching requirement of non-Federal funds 
in an amount that is not less than 10 percent of the total 
amount of Federal funds provided in the grant to such 
institution with respect to such year. 
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, $972,751,000 (increased by 
$7,000,000): Provided, That notwithstanding sections 
502(a)(1) and 502(b)(1) of the Social Security Act, not 
more than $119,593,000 (increased by $7,000,000) 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, 
$2,435,157,000, of which $2,009,200,000 shall remain 
available to the Secretary through September 30, 2022, 
for parts A and B of title XXVI of the PHS Act, and 
of which not less than $912,017,000 shall be for State 
AIDS Drug Assistance Programs under the authority of 
section 2616 or 311(c) of such Act: Provided, That of the
funds made available under this heading, $175,000,000 
shall be for the Minority AIDS Initiative under section 
2693 of such Act, of which $56,664,000 shall be allocated 
under 
subsection 
(b)(2)(A) 
of 
such 
section 
and 
$74,376,000 shall be allocated under subsection (b)(2)(C) 
of such section: Provided further, That of the funds made 
available under this heading, $70,000,000, to remain 
available until expended, shall be available to the Secretary 
for carrying out a program of grants and contracts under 
title XXVI or section 311(c) of such Act focused on ending 
the nationwide HIV/AIDS epidemic, with any grants 
issued under such section 311(c) administered in conjunc-
tion with title XXVI of the PHS Act, including the limita-
tion on administrative expenses. 
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, $123,693,000, of 
which $122,000 shall be available until expended for facili-
ties renovations at the Gillis W. Long Hansen’s Disease 
Center. 
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, $317,794,000 
(increased by $1,000,000), of which $59,000,000 from 
general revenues, notwithstanding section 1820(j) of the 
Social Security Act, shall be available for carrying out the 
Medicare rural hospital flexibility grants program: Pro-
vided, That of the funds made available under this heading 
for Medicare rural hospital flexibility grants, $19,942,000 
shall be available for the Small Rural Hospital Improve-
ment Grant Program for quality improvement and adop-
tion of health information 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) available for the purchase and imple-
mentation of telehealth services, including pilots and dem-
onstrations on the use of electronic health records to co-
ordinate rural veterans care between rural providers and 
the Department of Veterans Affairs electronic health 
record system: Provided further, That notwithstanding 
section 338J(k) of the PHS Act, $12,500,000 shall be 
available for State Offices of Rural Health: Provided fur-
ther, That $10,000,000 shall remain available through 
September 30, 2022, to support the Rural Residency De-
velopment Program.
FAMILY PLANNING 
For carrying out the program under title X of the 
PHS Act to provide for voluntary family planning 
projects, $400,000,000: Provided, That the Secretary shall 
carry out section 1001 of the PHS Act solely in accord-
ance with any regulations or other conditions or instruc-
tions established by the Secretary pursuant to the author-
ity under section 1006 of the PHS Act that applied as 
of January 18, 2017, to grants and contracts awarded 
under section 1001 of the PHS Act: Provided further, 
That amounts provided to said projects under such title 
shall not be expended for abortions, that all pregnancy 
counseling shall be nondirective, and that such amounts 
shall not be expended for any activity (including the publi-
cation or distribution of literature) that in any way tends 
to promote public support or opposition to any legislative 
proposal or candidate for public office. 
PROGRAM MANAGEMENT 
For program support in the Health Resources and 
Services Administration, $155,250,000 (reduced by 
$7,000,000) (reduced by $1,000,000) (increased by 
$1,000,000) (increased by $1,000,000): 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 $11,200,000 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-
gration and Nationality Act, and section 501 of the Ref-
ugee Education Assistance Act, with respect to immuniza-
tion and respiratory diseases, $499,758,000. 
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, 
$1,335,197,000 (increased by $15,000,000).
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, $592,622,000 (increased by 
$1,000,000) (increased by $1,000,000): Provided, That of 
the funds made available under this heading to pay for 
the transportation, medical care, treatment, and other re-
lated costs of persons quarantined or isolated under Fed-
eral or State quarantine law, up to $1,000,000 shall re-
main available until expended. 
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, $1,080,121,000 (increased 
by $500,000) (increased by $3,000,000): Provided, That 
funds made available under this heading may be available 
for making grants under section 1509 of the PHS Act 
for not less than 21 States, tribes, or tribal organizations: 
Provided further, That of the funds made available under 
this heading, $15,000,000 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, $161,560,000 (increased 
by $2,000,000) (increased by $2,000,000). 
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, $603,897,000. 
ENVIRONMENTAL HEALTH 
For carrying out titles II, III, and XVII of the PHS 
Act with respect to environmental health, $226,350,000. 
INJURY PREVENTION AND CONTROL 
For carrying out titles II, III, and XVII of the PHS 
Act with respect to injury prevention and control, 
$697,559,000 (increased by $4,500,000) (increased by 
$5,570,000) (reduced by $5,000,000) (increased by 
$5,000,000) 
(increased 
by 
$2,000,000), 
of 
which 
$25,000,000 is provided for firearm injury and mortality 
prevention research.
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, $346,300,000 (increased by $900,000). 
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. 
GLOBAL HEALTH 
For carrying out titles II, III, and XVII of the PHS 
Act with respect to global health, $523,621,000, of which: 
(1) $128,421,000 shall remain available through Sep-
tember 30, 2021, for international HIV/AIDS; and (2) 
$99,762,000 shall be available for global public health pro-
tection: Provided, That funds may be used for purchase
and insurance of official motor vehicles in foreign coun-
tries. 
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, 
$880,200,000: Provided, That the Director of the Centers 
for Disease Control and Prevention (referred to in this 
title as ‘‘CDC’’) or the Administrator of the Agency for 
Toxic Substances and Disease Registry may detail staff 
without reimbursement for up to 180 days to support an 
activation of the CDC Emergency Operations Center, so 
long as the Director or Administrator, as applicable, pro-
vides a notice 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 use of this authority which includes the number 
of staff and funding level broken down by the originating 
center and number of days detailed. 
BUILDINGS AND FACILITIES 
(INCLUDING TRANSFER OF FUNDS) 
For acquisition of real property, equipment, construc-
tion, installation, demolition, and renovation of facilities,
$30,000,000, which shall remain available until September 
30, 2024: Provided, That in addition to the amount pro-
vided, for a new CDC research support building and all 
related material handling, utility, transportation, and per-
sonnel support infrastructure at the Chamblee campus, in-
cluding necessary acquisition of real property, equipment, 
construction, demolition, installation, activation, renova-
tion, and improvements, $225,000,000, which shall be de-
rived by transfer from the Fund established by Public Law 
110–161, division G, title II, section 223 and shall remain 
available until September 30, 2024: Provided further, That 
funds previously set aside by CDC for repair and upgrade 
of the Lake Lynn Experimental Mine and Laboratory 
shall be used to acquire a replacement mine safety re-
search 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. 
CDC-WIDE ACTIVITIES AND PROGRAM SUPPORT 
(INCLUDING TRANSFER OF FUNDS) 
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, $163,570,000 (reduced 
by $500,000), of which up to $10,000,000 (reduced by 
$500,000) may be transferred to the reserve of the Work-
ing Capital Fund authorized under this heading in division 
F of Public Law 112–74: Provided, That paragraphs (1) 
through (3) of subsection (b) of section 2821 of the PHS 
Act shall not apply to funds appropriated under this head-
ing and in all other accounts of the CDC: Provided further, 
That of the amounts made available under this heading, 
$50,000,000 shall be transferred to and merged with the 
Infectious Diseases Rapid Response Reserve Fund estab-
lished by section 231 of division B of Public Law 115– 
245: Provided further, That any funds made available by 
this Act to the Centers for Disease Control and Prevention 
may be used to support the purchase, hire, maintenance, 
and operation of an aircraft for use and support of the 
activities of CDC: Provided further, That employees of 
CDC or the Public Health Service, both civilian and com-
missioned officers, detailed to States, municipalities, or 
other organizations 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 included within any personnel ceiling applica-
ble to the Agency, Service, or HHS during the period of 
detail or assignment: 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: Pro-
vided further, That in addition, such sums as may be de-
rived from authorized user fees, which shall be credited 
to the appropriation charged with the cost thereof: Pro-
vided further, That with respect to the previous proviso, 
authorized user fees from the Vessel Sanitation Program 
and the Respirator Certification Program shall be avail-
able through September 30, 2021. 
NATIONAL INSTITUTES OF HEALTH 
NATIONAL CANCER INSTITUTE 
For carrying out section 301 and title IV of the PHS 
Act with respect to cancer, $6,249,165,000 (reduced by 
$1,000,000) (increased by $1,000,000), of which up to 
$30,000,000 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, $3,658,822,000.
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, 
$484,350,000. 
NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND 
KIDNEY DISEASES 
For carrying out section 301 and title IV of the PHS 
Act with respect to diabetes and digestive and kidney dis-
ease, $2,129,027,000 (reduced by $10,000,000) (in-
creased by $10,000,000). 
NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS 
AND STROKE 
For carrying out section 301 and title IV of the PHS 
Act with respect to neurological disorders and stroke, 
$2,315,571,000. 
NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS 
DISEASES 
For carrying out section 301 and title IV of the PHS 
Act with respect to allergy and infectious diseases, 
$5,808,268,000 (increased by $3,000,000). 
NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES 
For carrying out section 301 and title IV of the PHS 
Act 
with 
respect 
to 
general 
medical 
sciences, 
$3,033,183,000, of which $1,146,821,000 shall be from
funds available under section 241 of the PHS Act: Pro-
vided, That not less than $381,573,000 is provided for 
the Institutional Development Awards program. 
EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF 
CHILD HEALTH AND HUMAN DEVELOPMENT 
For carrying out section 301 and title IV of the PHS 
Act with respect to child health and human development, 
$1,580,084,000. 
NATIONAL EYE INSTITUTE 
For carrying out section 301 and title IV of the PHS 
Act with respect to eye diseases and visual disorders, 
$835,465,000. 
NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH 
SCIENCES 
For carrying out section 301 and title IV of the PHS 
Act with respect to environmental health sciences, 
$812,570,000 (reduced by $6,250,000) (increased by 
$6,250,000). 
NATIONAL INSTITUTE ON AGING 
For carrying out section 301 and title IV of the PHS 
Act with respect to aging, $3,286,107,000 (increased by 
$70,000,000).
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, $634,637,000. 
NATIONAL INSTITUTE ON DEAFNESS AND OTHER 
COMMUNICATION DISORDERS 
For carrying out section 301 and title IV of the PHS 
Act with respect to deafness and other communication dis-
orders, $497,590,000. 
NATIONAL INSTITUTE OF NURSING RESEARCH 
For carrying out section 301 and title IV of the PHS 
Act with respect to nursing research, $170,958,000. 
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, 
$551,278,000. 
NATIONAL INSTITUTE ON DRUG ABUSE 
For carrying out section 301 and title IV of the PHS 
Act with respect to drug abuse, $1,489,237,000. 
NATIONAL INSTITUTE OF MENTAL HEALTH 
For carrying out section 301 and title IV of the PHS 
Act with respect to mental health, $1,891,704,000.
NATIONAL HUMAN GENOME RESEARCH INSTITUTE 
For carrying out section 301 and title IV of the PHS 
Act 
with 
respect 
to 
human 
genome 
research, 
$603,710,000. 
NATIONAL INSTITUTE OF BIOMEDICAL IMAGING AND 
BIOENGINEERING 
For carrying out section 301 and title IV of the PHS 
Act with respect to biomedical imaging and bioengineering 
research, $408,498,000. 
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, 
$153,632,000. 
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, $341,244,000. 
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), $84,926,000.
NATIONAL LIBRARY OF MEDICINE 
For carrying out section 301 and title IV of the PHS 
Act with respect to health information communications, 
$463,599,000: Provided, That of the amounts available for 
improvement of information systems, $4,000,000 shall be 
available until September 30, 2021: Provided further, That 
in fiscal year 2020, 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, $845,783,000: 
Provided, That up to $80,000,000 shall be available to im-
plement section 480 of the PHS Act, relating to the Cures 
Acceleration Network. 
OFFICE OF THE DIRECTOR 
For carrying out the responsibilities of the Office of 
the 
Director, 
NIH, 
$2,049,992,000 
(reduced 
by 
$3,000,000): Provided, That funding shall be available for 
the purchase of not to exceed 29 passenger motor vehicles 
for replacement only: Provided further, That all funds 
credited to the NIH Management Fund shall remain avail-
able for 1 fiscal year after the fiscal year in which they 
are deposited: Provided further, That $165,000,000 shall 
be for the Environmental Influences on Child Health Out-
comes study: Provided further, That $617,761,000 shall 
be available for the Common Fund established under sec-
tion 402A(c)(1) of the PHS Act: Provided further, That 
of the funds provided, $10,000 shall be for official recep-
tion and representation expenses when specifically ap-
proved by the Director of the NIH: Provided further, That 
the Office of AIDS Research within the Office of the Di-
rector of the NIH may spend up to $8,000,000 to make 
grants for construction or renovation of facilities as pro-
vided for in section 2354(a)(5)(B) of the PHS Act: Pro-
vided further, That $25,000,000 shall be used to carry out 
section 404I of the PHS Act (42 U.S.C. 283K), relating 
to biomedical and behavioral research facilities. 
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 of, demolition of, ren-
ovation of, and acquisition of equipment for, facilities of 
or used by NIH, including the acquisition of real property, 
$200,000,000, to remain available through September 30, 
2024. 
NIH INNOVATION ACCOUNT, CURES ACT 
(INCLUDING TRANSFER OF FUNDS) 
For necessary expenses to carry out the purposes de-
scribed in section 1001(b)(4) of the 21st Century Cures 
Act, in addition to amounts available for such purposes 
in the appropriations provided to the NIH in this Act, 
$492,000,000, to remain available until expended: Pro-
vided, That such amounts are appropriated pursuant to 
section 1001(b)(3) of such Act, are to be derived from 
amounts transferred under section 1001(b)(2)(A) of such 
Act, and may be transferred by the Director of the Na-
tional Institutes of Health to other accounts of the Na-
tional Institutes of Health solely for the purposes provided 
in such Act: Provided further, That upon a determination 
by the Director that funds transferred pursuant to the 
previous proviso are not necessary for the purposes pro-
vided, such amounts may be transferred back to the Ac-
count: Provided further, That the transfer authority pro-
vided under this heading is in addition to any other trans-
fer 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, the Protection and Ad-
vocacy for Individuals with Mental Illness Act, and section 
224 of the Protecting Access to Medicare Act of 2014, 
$1,622,974,000 (increased by $5,000,000) (reduced by 
$5,000,000) (increased by $6,500,000) (reduced by $1) 
(increased by $1) (reduced by $500,000) (increased by 
$500,000) (increased by $2,000,000): Provided, That of 
the funds made available under this heading, $70,887,000 
shall be for the National Child Traumatic Stress Initia-
tive: Provided further, That notwithstanding section 
520A(f)(2) of the PHS Act, no funds appropriated for car-
rying out section 520A shall be available for carrying out 
section 1971 of the PHS Act: Provided further, That in 
addition to amounts provided herein, $21,039,000 shall be 
available under section 241 of the PHS Act to supplement 
funds otherwise available for mental health activities and 
to carry out subpart I of part B of title XIX of the PHS 
Act to fund section 1920(b) technical assistance, national 
data, data collection and evaluation activities, and further
that the total available under this Act for section 1920(b) 
activities shall not exceed 5 percent of the amounts appro-
priated for subpart I of part B of title XIX: Provided fur-
ther, That up to 10 percent of the amounts made available 
to carry out the Children’s Mental Health Services pro-
gram may be used to carry out demonstration grants or 
contracts for early interventions with persons not more 
than 25 years of age at clinical high risk of developing 
a first episode of psychosis: Provided further, That section 
520E(b)(2) of the PHS Act shall not apply to funds ap-
propriated in this Act for fiscal year 2020: Provided fur-
ther, That of the total amount each State receives for car-
rying out section 1911 of the PHS Act, the State shall 
expend at least 10 percent of such total amount to support 
evidence-based programs that address the needs of individ-
uals with early serious mental illness, including psychotic 
disorders, regardless of the age at onset, and shall expend 
at least 5 percent of such total amount for evidence-based 
crisis care programs addressing the needs of individuals 
with serious mental illnesses and children with serious 
mental and emotional disturbances: Provided further, That 
$150,000,000 shall be available until September 30, 2022, 
for grants to communities and community organizations 
who meet criteria for Certified Community Behavioral 
Health Clinics pursuant to section 223(a) of Public Law
113–93: Provided further, That none of the funds provided 
for section 1911 of the PHS Act shall be subject to section 
241 of such Act. 
SUBSTANCE ABUSE TREATMENT 
For carrying out titles III and V of the PHS Act 
with respect to substance abuse treatment, title XIX of 
such Act with respect to substance abuse treatment and 
prevention, and section 3203 of the Support for Patients 
and Communities Act, $3,761,056,000 (increased by $1) 
(reduced by $1) (increased by $10,000,000) (increased by 
$1,000,000) (increased by $20,000,000): Provided, That 
$1,500,000,000 shall be for State Opioid Response Grants 
for carrying out activities pertaining to opioids undertaken 
by the State agency responsible for administering the sub-
stance abuse prevention and treatment block grant under 
subpart II of part B of title XIX of the PHS Act (42 
U.S.C. 300x–21 et seq.): Provided further, That of such 
amount $50,000,000 shall be made available to Indian 
Tribes or tribal organizations: Provided further, That 15 
percent of the remaining amount shall be for the States 
with the highest mortality rate related to opioid use dis-
orders: Provided further, That of the amounts provided for 
State Opioid Response Grants not more than 2 percent 
shall be available for Federal administrative expenses, 
training, technical assistance, and evaluation: Provided
further, That of the amount not reserved by the previous 
three provisos, the Secretary shall make allocations to 
States, territories, and the District of Columbia according 
to a formula using national survey results that the Sec-
retary determines are the most objective and reliable 
measure of drug use and drug-related deaths: Provided 
further, That the Secretary shall submit the formula meth-
odology to the Committees on Appropriations of the House 
of Representatives and the Senate not less than 15 days 
prior to publishing a Funding Opportunity Announce-
ment: Provided further, That prevention and treatment ac-
tivities funded through such grants may include education, 
treatment (including the provision of medication), behav-
ioral health services for individuals in treatment programs, 
referral to treatment services, recovery support, and med-
ical screening associated with such treatment: Provided 
further, That each State, as well as the District of Colum-
bia, shall receive not less than $4,000,000: Provided fur-
ther, That in addition to amounts provided herein, the fol-
lowing amounts shall be available under section 241 of the 
PHS Act: (1) $79,200,000 to carry out subpart II of part 
B of title XIX of the PHS Act to fund section 1935(b) 
technical assistance, national data, data collection and 
evaluation activities, and further that the total available 
under this Act for section 1935(b) activities shall not ex-
ceed 5 percent of the amounts appropriated for subpart 
II of part B of title XIX; and (2) $2,000,000 to evaluate 
substance abuse treatment programs: Provided further, 
That none of the funds provided for section 1921 of the 
PHS Act or State Opioid Response Grants shall be subject 
to section 241 of such Act: Provided further, That of the 
amount made available under this heading and not re-
served by the preceding provisos, $10,000,000 shall be 
made available to carry out section 7091 of the SUP-
PORT for Patients and Communities Act (Public Law 
115–271). 
SUBSTANCE ABUSE PREVENTION 
For carrying out titles III and V of the PHS Act 
with respect to substance abuse prevention, $212,469,000 
(increased by $2,000,000). 
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, 
$128,830,000 (reduced by $10,000,000) (reduced by 
$1,000,000) (reduced by $6,500,000) (reduced by
$2,000,000) (increased by $19,500,000): Provided, That 
in addition to amounts provided herein, $31,428,000 shall 
be available under section 241 of the PHS Act to supple-
ment funds available to carry out national surveys on drug 
abuse and mental health, to collect and analyze program 
data, and to conduct public awareness and technical as-
sistance 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 pur-
poses: Provided further, That amounts made available in 
this Act for carrying out section 501(o) of the PHS Act 
shall remain available through September 30, 2021: Pro-
vided further, That funds made available under this head-
ing may be used to supplement program support funding 
provided under the headings ‘‘Mental Health’’, ‘‘Sub-
stance Abuse Treatment’’, and ‘‘Substance Abuse Preven-
tion’’. 
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, $339,809,000: Provided, 
That in addition to amounts provided herein, $18,408,000 
shall be available from amounts available under section 
241 of the PHS Act: Provided further, That section 947(c) 
of the PHS Act shall not apply in fiscal year 2020: Pro-
vided further, That in addition, amounts received from 
Freedom of Information Act fees, reimbursable and inter-
agency agreements, and the sale of data shall be credited 
to this appropriation and shall remain available until Sep-
tember 30, 2021. 
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, $273,188,478,000, 
to remain available until expended. 
In addition, for carrying out such titles after May 31, 
2020, for the last quarter of fiscal year 2020 for unantici-
pated costs incurred for the current fiscal year, such sums 
as may be necessary, to remain available until expended. 
In addition, for carrying out such titles for the first 
quarter of fiscal year 2021, $139,903,075,000, to remain 
available until expended. 
Payment under such title XIX may be made for any 
quarter with respect to a State plan or plan amendment 
in effect during such quarter, if submitted in or prior to
such quarter and approved in that or any subsequent 
quarter. 
PAYMENTS TO THE HEALTH CARE TRUST FUNDS 
For payment to the Federal Hospital Insurance 
Trust Fund and the Federal Supplementary Medical In-
surance Trust Fund, as provided under sections 217(g), 
1844, and 1860D–16 of the Social Security Act, sections 
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, $410,796,100,000. 
In addition, for making matching payments under 
section 1844 and benefit payments under section 1860D– 
16 of the Social Security Act that were not anticipated 
in budget estimates, such sums as may be necessary. 
PROGRAM MANAGEMENT 
For carrying out, except as otherwise provided, titles 
XI, XVIII, XIX, and XXI of the Social Security Act, titles 
XIII and XXVII of the PHS Act, the Clinical Laboratory 
Improvement Amendments of 1988, and other responsibil-
ities of the Centers for Medicare & Medicaid Services, not 
to exceed $3,984,744,000 (reduced by $4,500,000) (re-
duced by $5,000,000), to be transferred from the Federal 
Hospital 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 all funds derived in 
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 
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 2 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, 
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 
$18,000,000 (increased by $2,000,000) 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 
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 
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 (reduced 
by $500,000) (increased by $500,000) (increased by 
$100,000,000), of which $2,364,446,000 (increased by 
$100,000,000) 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 (increased by $10,000,000) shall be used 
for legal services, child advocates, and post-release serv-
ices: Provided further, That none of the funds made avail-
able by this Act may be used to implement or enforce the 
Memorandum of Agreement Among the Office of Refugee
Resettlement of the Department of Health and Human 
Services and U.S. Immigration and Customs Enforcement 
and U.S. Customs and Border Protection of the Depart-
ment of Homeland Security 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 Rep-
resentatives and the Senate a detailed spend plan of an-
ticipated uses of funds made available in this account, in-
cluding the following: costs, capacity, and timelines for ex-
isting grants and contracts; costs for expanding capacity 
through use of community-based residential care place-
ments (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; pro-
gram administration; and the average number of weekly 
referrals and discharge rate assumed in the spend plan: 
Provided further, That such plan shall be updated to re-
flect changes and expenditures and submitted to the Com-
mittees 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’’), 
$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. 
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 (increased by $2,000,000) (increased by 
$3,000,000), of which $75,000,000, to remain available 
through September 30, 2021, shall be for grants to States 
for adoption and legal guardianship incentive payments, 
as defined by section 473A of the Social Security Act and 
may be made for adoptions and legal guardianships com-
pleted before September 30, 2020: Provided, That 
$11,563,095,000 shall be for making payments under the 
Head Start Act, of which, notwithstanding 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 
grants for high quality infant and toddler care 
through Early Head Start-Child Care Partnerships, 
to entities defined as eligible under section 645A(d) 
of such Act, for training and technical assistance for 
such activities, and for up to $26,000,000 in Federal 
costs of administration and evaluation; 
(4) $750,000,000 shall be available for quality 
improvement consistent with section 640(a)(5) of 
such Act; and 
(5) $8,000,000 shall be available for the pur-
poses of re-establishing the Tribal Colleges and Uni-
versities Head Start Partnership Program consistent 
with section 648(g) of such Act:
Provided further, That the Secretary may reduce the res-
ervation of funds under section 640(a)(2)(C) of such Act 
in lieu of reducing the reservation of funds under sections 
640(a)(2)(B), 640(a)(2)(D), and 640(a)(2)(E) of such 
Act: Provided further, That $350,000,000 shall be avail-
able until December 31, 2020 for carrying out sections 
9212 and 9213 of the Every Student Succeeds Act: Pro-
vided further, That up to 3 percent of the funds in the 
preceding proviso shall be available for technical assist-
ance and evaluation related to grants awarded under such 
section 9212: Provided further, That $796,000,000 shall 
be for making payments under the CSBG Act: Provided 
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-
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 
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’’. 
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 
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 (increased by $4,500,000) (in-
creased by $2,000,000), 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 1 percent of such amounts shall be available for de-
veloping and implementing evidence-based practices for 
enhancing senior nutrition, including medically-tailored 
meals: 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 
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 
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. 
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 (reduced by $1,000,000) (reduced by 
$900,000) 
(reduced 
by 
$2,000,000) 
(reduced 
by 
$5,000,000) (reduced by $1,000,000) (increased by 
$5,000,000) (reduced by $5,000,000) (reduced by 
$2,000,000) (reduced by $2,000,000) (reduced by 
$2,000,000) (reduced by $5,570,000) (reduced by 
$2,000,000) (reduced by $3,000,000) (reduced by 
$15,000,000) (reduced by $2,000,000) (reduced by 
$1,000,000) (reduced by $1,000,000) (reduced by 
$3,000,000) (reduced by $1,000,000), together with 
$64,828,000 from the amounts available under section 
241 of the PHS Act to carry out national health or human
services research and evaluation activities: Provided, That 
of the funds made available under this heading, 
$60,000,000 (increased by $5,000,000) shall be for minor-
ity 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 
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
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.
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 
(increased by $1,000,000), of which $566,700,000 shall 
remain available through September 30, 2021, for ex-
penses necessary to support advanced research and devel-
opment 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 heading for the purpose of ac-
quisition of security countermeasures shall be in addition 
to any other funds available for such purpose: Provided 
further, That products purchased with funds provided
under this heading may, at the discretion of the Secretary, 
be deposited in the Strategic 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 Sep-
tember 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.
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.
(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
100 
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
101 
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-
102 
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
103 
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.
104 
(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
105 
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–
106 
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
107 
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;
108 
(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
109 
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
110 
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
111 
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, in-
cluding State enrollment figures disaggregated by 
race, ethnicity, preferred language, age, and sex. 
(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.
112 
SEC. 228. Funds appropriated in this Act that are 
available for salaries and expenses of employees of the De-
partment of Health and Human Services shall also be 
available to pay travel and related expenses of such an 
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, which may include
113 
early childhood developmental screenings, school supplies, 
toys, clothing, and any other items intended to promote 
the wellbeing of such children. 
(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—
114 
(1) in the same facility; or 
(2) with the same sponsor. 
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—
115 
(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))); 
(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
116 
housing unaccompanied alien children in such a facility 
is necessary on a temporary basis due to an influx of such 
children or an emergency, provided that— 
(1) any such influx facility that remains in op-
eration for more than 3 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 1-month waiver for an influx facili-
ty’s non-compliance with paragraph (1) if the Sec-
retary certifies and provides a report to Congress on 
the facility’s good-faith efforts and progress towards 
compliance; 
(3) not more than three consecutive waivers 
under paragraph (2) may be granted to any one fa-
cility;
117 
(4) ORR shall ensure full adherence to the 
monitoring requirements set forth in sections 5.5 
and 3.3.16 of its Policies and Procedures Guide; and 
(5) for any such influx facility in operation for 
more than 3 consecutive months, ORR shall conduct 
a minimum of one comprehensive monitoring visit 
during the first 3 months of operation, with quar-
terly monitoring visits thereafter. 
SEC. 235. Not later than 14 days after the date of 
enactment of this Act, and weekly thereafter, the Sec-
retary of Health and Human Services shall submit to the 
Committees on Appropriations of the House of Represent-
atives and the Senate, and make publicly available online, 
a report with respect to children who were separated from 
their parents or legal guardians by the Department of 
Homeland Security (DHS) (regardless of whether or not 
such separation was pursuant to an option selected by the 
children, parents, or guardians), subsequently classified as 
unaccompanied alien children, and transferred to the care 
and custody of the Office of Refugee Resettlement of the 
Department of Health and Human Services (ORR) during 
the previous week. Each report shall contain the following 
information:
118 
(1) The number and ages of children so sepa-
rated at or between ports of entry, to be reported by 
sector where separation occurred. 
(2) The documented cause of separation, as re-
ported by DHS when each child was referred. 
(3) The custody status of the parents or legal 
guardians from whom the child was separated. 
SEC. 236. (a) None of the funds made available by 
this Act may be awarded to any organization, including 
under the Federal Foster Care program under part E of 
title IV of the Social Security Act, that does not comply 
with subsections (c) and (d) of section 75.300 of title 45, 
Code of Federal Regulations (prohibiting discrimination 
on the basis of age, disability, sex, race, color, national 
origin, religion, gender identity, or sexual orientation). 
(b) None of the funds made available by this Act may 
be used by the Department of Health and Human Services 
to grant an exception from either such subsection for any 
Federal grantee. 
SEC. 237. Funds appropriated under this Act, any 
previous appropriations Act, or the Patient Protection and 
Affordable Care Act that are available for salaries and ex-
penses of employees of the Department of Health and 
Human Services shall also remain available for obligation 
for the primary and secondary schooling of eligible de-
119 
pendents of HHS personnel stationed in the Common-
wealth of Puerto Rico, the Commonwealth of the Northern 
Mariana Islands, and other territories or possessions of 
the United States at costs not in excess of those paid for 
or reimbursed by the Department of Defense. 
SEC. 238. None of the funds made available by this 
Act may be used to implement, enforce, or otherwise give 
effect to the revision to section 447.10 of title 42, Code 
of Federal Regulations, contained in the proposed rule en-
titled ‘‘Medicaid Program; Reassignment of Medicaid Pro-
vider Claims’’ (83 Fed. Reg. 32252 (July 12, 2018)). 
SEC. 239. None of the funds appropriated in this bill 
or otherwise made available to the Department of Health 
and Human Services shall be used to publish the proposed 
regulation in the Fall 2018 Unified Agenda of Regulatory 
and Deregulatory Actions relating to the Medicaid Non-
emergency Medical Transportation benefit for Medicaid 
beneficiaries expected to be published for comment in May 
2019 and promulgated in Fall 2019 (RIN: 0938–AT81). 
SEC. 240. None of the funds made available by this 
Act may be used to finalize, implement, or enforce the rule 
entitled ‘‘Protecting Statutory Conscience Rights in 
Health Care; Delegations of Authority’’ issued by the De-
partment of Health and Human Services (RIN 0945– 
AA10).
120 
This title may be cited as the ‘‘Department of Health 
and Human Services Appropriations Act, 2020’’. 
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’’), $17,563,802,000 (increased by 
$1,000,000) 
(reduced 
by 
$1,000,000), 
of 
which 
$6,638,625,000 shall become available on July 1, 2020, 
and shall remain available through September 30, 2021, 
and of which $10,841,177,000 shall become available on 
October 1, 2020, and shall remain available through Sep-
tember 30, 2021, for academic year 2020–2021: 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, 2019, 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
121 
$4,519,050,000 shall be for targeted grants under section 
1125 
of 
the 
ESEA: 
Provided 
further, 
That 
$4,519,050,000 shall be for education finance incentive 
grants under section 1125A of the ESEA: Provided fur-
ther, That $224,000,000 shall be for carrying out subpart 
2 of part B of title II: Provided further, That $50,000,000 
shall be for carrying out section 418A of the HEA. 
IMPACT AID 
For carrying out programs of financial assistance to 
federally affected schools authorized by title VII of the 
ESEA, $1,498,112,000, of which $1,351,242,000 shall be 
for basic support payments under section 7003(b), 
$48,316,000 shall be for payments for children with dis-
abilities under section 7003(d), $17,406,000, shall be for 
construction under section 7007(a), $76,313,000 shall be 
for Federal property payments under section 7002, and 
$4,835,000, to remain available until expended, shall be 
for facilities maintenance under section 7008: Provided, 
That for purposes of computing the amount of a payment 
for an eligible local educational agency under section 
7003(a) for school year 2019–2020, children enrolled in 
a school of such agency that would otherwise be eligible 
for payment under section 7003(a)(1)(B) of such Act, but 
due to the deployment of both parents or legal guardians, 
or a parent or legal guardian having sole custody of such
122 
children, or due to the death of a military parent or legal 
guardian while on active duty (so long as such children 
reside on Federal property as described in section 
7003(a)(1)(B)), are no longer eligible under such section, 
shall be considered as eligible students under such section, 
provided such students remain in average daily attendance 
at a school in the same local educational agency they at-
tended prior to their change in eligibility status. 
SCHOOL IMPROVEMENT PROGRAMS 
For carrying out school improvement activities au-
thorized by part B of title I, part A of title II, subpart 
1 of part A of title IV, part B of title IV, part B of title 
V, and parts B and C of title VI of the ESEA; the McKin-
ney-Vento Homeless Assistance Act; section 203 of the 
Educational Technical Assistance Act of 2002; the Com-
pact of Free Association Amendments Act of 2003; and 
the Civil Rights Act of 1964, $6,016,470,000, of which 
$4,174,902,000 shall become available on July 1, 2020, 
and remain available through September 30, 2021, and 
of which $1,681,441,000 shall become available on Octo-
ber 1, 2020, and shall remain available through September 
30, 2021, for academic year 2020–2021: Provided, That 
$378,000,000 shall be for part B of title I: Provided fur-
ther, That $1,321,673,000 shall be for part B of title IV: 
Provided further, That $40,000,000 shall be for part B
149 
overall minimum share requirement of 24 percent for the 
first 3 years that they receive AmeriCorps funding, and 
thereafter shall meet the overall minimum share require-
ment as provided in section 2521.60 of title 45, Code of 
Federal Regulations, without regard to the operating costs 
match requirement in section 121(e) or the member sup-
port Federal share limitations in section 140 of the 1990 
Act, and subject to partial waiver consistent with section 
2521.70 of title 45, Code of Federal Regulations. 
SEC. 403. Donations made to CNCS under section 
196 of the 1990 Act for the purposes of financing pro-
grams and operations under titles I and II of the 1973 
Act or subtitle B, C, D, or E of title I of the 1990 Act 
shall be used to supplement and not supplant current pro-
grams and operations. 
SEC. 404. In addition to the requirements in section 
146(a) of the 1990 Act, use of an educational award for 
the purpose described in section 148(a)(4) shall be limited 
to individuals who are veterans as defined under section 
101 of the Act. 
SEC. 405. For the purpose of carrying out section 
189D of the 1990 Act— 
(1) entities described in paragraph (a) of such 
section shall be considered ‘‘qualified entities’’ under
205 
PROCUREMENT OF AMMUNITION, ARMY 
For construction, procurement, production, and 
modification of ammunition, and accessories therefor; spe-
cialized equipment and training devices; expansion of pub-
lic and private plants, including ammunition facilities, au-
thorized by section 2854 of title 10, United States Code, 
and the land necessary therefor, for the foregoing pur-
poses, and such lands and interests therein, may be ac-
quired, and construction prosecuted thereon prior to ap-
proval of title; and procurement and installation of equip-
ment, appliances, and machine tools in public and private 
plants; reserve plant and Government and contractor- 
owned equipment layaway; and other expenses necessary 
for the foregoing purposes, $2,583,895,000, to remain 
available for obligation until September 30, 2022. 
OTHER PROCUREMENT, ARMY 
For construction, procurement, production, and 
modification of vehicles, including tactical, support, and 
non-tracked combat vehicles; the purchase of passenger 
motor vehicles for replacement only; communications and 
electronic equipment; other support equipment; spare 
parts, ordnance, and accessories therefor; specialized 
equipment and training devices; expansion of public and 
private plants, including the land necessary therefor, for 
the foregoing purposes, and such lands and interests
206 
therein, may be acquired, and construction prosecuted 
thereon prior to approval of title; and procurement and 
installation of equipment, appliances, and machine tools 
in public and private plants; reserve plant and Govern-
ment and contractor-owned equipment layaway; and other 
expenses 
necessary 
for 
the 
foregoing 
purposes, 
$7,583,678,000, to remain available for obligation until 
September 30, 2022. 
AIRCRAFT PROCUREMENT, NAVY 
For construction, procurement, production, modifica-
tion, and modernization of aircraft, equipment, including 
ordnance, spare parts, and accessories therefor; specialized 
equipment; expansion of public and private plants, includ-
ing the land necessary therefor, and such lands and inter-
ests therein, may be acquired, and construction prosecuted 
thereon prior to approval of title; and procurement and 
installation of equipment, appliances, and machine tools 
in public and private plants; reserve plant and Govern-
ment 
and 
contractor-owned 
equipment 
layaway, 
$18,971,913,000, to remain available for obligation until 
September 30, 2022. 
WEAPONS PROCUREMENT, NAVY 
For construction, procurement, production, modifica-
tion, and modernization of missiles, torpedoes, other weap-
ons, and related support equipment including spare parts,