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improving quality of care or expanded service grants under 
section 330 of the PHS Act to support and enhance behav-
ioral health, mental health, or substance use disorder serv-
ices. 
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 Qual-
ity Improvement Act of 1986, $1,072,695,000, of which 
$111,916,000 shall be available to carry out sections 755 
and 756 of the PHS Act: Provided, That sections 747(c)(2), 
751(j)(2), 762(k), and the proportional funding amounts in 
paragraphs (1) through (4) of section 756(f) of the PHS 
Act shall not apply to funds made available under this 
heading: Provided further, That for any program operating 
under section 751 of the PHS Act on or before January 
1, 2009, the Secretary of Health and Human Services (re-
ferred 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 fur-
ther, 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
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1128E(d)(2) and 1921 of the Social Security Act shall be 
sufficient to recover the full costs of operating the programs 
authorized by such sections and shall remain available until 
expended for the National Practitioner Data Bank: Pro-
vided further, That funds transferred to this account 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 sections: Provided further, That 
$105,000,000 shall remain available until expended for the 
purposes of providing primary health services, be used to 
assign National Health Service Corps (‘‘NHSC’’) members 
to expand the delivery of substance use disorder treatment 
services, notwithstanding the assignment priorities and 
limitations in or under sections 333(a)(1)(D), 333(b), and 
333A(a)(1)(B)(ii) of the PHS Act, and to make NHSC 
Loan Repayment Program awards under section 338B of 
such Act: Provided further, That for purposes of the pre-
vious proviso, 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 dis-
order treatment counselors. 
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
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V of the Social Security Act, and section 712 of the Amer-
ican Jobs Creation Act of 2004, $924,789,000, of which 
$10,000,000 shall be available for carrying out section 
330M of the PHS Act: Provided, That notwithstanding sec-
tions 502(a)(1) and 502(b)(1) of the Social Security Act, 
not more than $109,593,000 shall be available for carrying 
out special projects of regional and national significance 
pursuant to section 501(a)(2) of such Act and $10,276,000 
shall be available for projects described in subparagraphs 
(A) through (F) of section 501(a)(3) of such Act. 
RYAN WHITE HIV/AIDS PROGRAM 
For carrying out title XXVI of the PHS Act with re-
spect 
to 
the 
Ryan 
White 
HIV/AIDS 
program, 
$2,318,781,000, of which $1,970,881,000 shall remain 
available to the Secretary through September 30, 2021, for 
parts A and B of title XXVI of the PHS Act, and of which 
not less than $900,313,000 shall be for State AIDS Drug 
Assistance Programs under the authority of section 2616 
or 311(c) of such Act. 
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, $113,693,000, of 
which $122,000 shall be available until expended for facili-
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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, $318,794,000, of which 
$49,609,000 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: Provided, That of the funds made available under 
this heading for Medicare rural hospital flexibility grants, 
$15,942,000 shall be available for the Small Rural Hospital 
Improvement Grant Program for quality improvement and 
adoption 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 coordi-
nate rural veterans care between rural providers and the 
Department of Veterans Affairs electronic health record sys-
tem: Provided further, That notwithstanding section 
338J(k) of the PHS Act, $10,000,000 shall be available for 
State Offices of Rural Health: Provided further, That
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$15,000,000 shall remain available through September 30, 
2021 to support the Rural Residency Development Pro-
gram: Provided further, That $120,000,000 shall be for the 
Rural Communities Opioids Response Program: Provided 
further, that of the funds made available under this head-
ing, $1,000,000 shall be available through the Telehealth 
Network grant to fund awards that use evidence-based prac-
tices that promote school safety and individual health, men-
tal health, and well-being by providing assessment and re-
ferrals for health, mental health, or substance use disorder 
services to students who may be struggling with behavioral 
or mental health issues and providing training and support 
to teachers, school counselors, administrative staff, school re-
source officers, and other relevant staff to identify, refer, 
and intervene to help students experiencing mental health 
needs or who are considering harming themselves or others. 
FAMILY PLANNING 
For carrying out the program under title X of the PHS 
Act to provide for voluntary family planning projects, 
$286,479,000: Provided, 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 publication or distribution of literature) that
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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, $155,000,000: 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-related 
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 
$9,200,000 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 Refugee
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Education Assistance Act, with respect to immunization 
and respiratory diseases, $474,055,000. 
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, sexu-
ally transmitted diseases, and tuberculosis prevention, 
$1,132,278,000. 
EMERGING AND ZOONOTIC INFECTIOUS DISEASES 
For carrying out titles II, III, and XVII, and section 
2821 of the PHS Act, titles II and IV of the Immigration 
and Nationality Act, and section 501 of the Refugee Edu-
cation Assistance Act, with respect to emerging and zoonotic 
infectious diseases, $565,572,000: Provided, that of the 
funds made available under this heading, $1,000,000 shall 
be available to enhance harmful algal bloom exposure ac-
tivities, including surveillance, mitigation, and event re-
sponse efforts, with a priority given to geographic locations 
subject to a state of emergency designation related to toxic 
algae blooms within the past 12 months. 
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 prevention 
and health promotion, $911,821,000: Provided, That funds 
appropriated under this account may be available for mak-
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† HR 6157 EAS 
ing grants under section 1509 of the PHS Act for not less 
than 21 States, tribes, or tribal organizations: Provided fur-
ther, That of the funds made available under this heading, 
$15,000,000 shall be available to continue and expand com-
munity specific extension and outreach programs to combat 
obesity in counties with the highest levels of obesity: Pro-
vided 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, $153,560,000. 
PUBLIC HEALTH SCIENTIFIC SERVICES 
For carrying out titles II, III, and XVII of the PHS 
Act with respect to health statistics, surveillance, health 
informatics, and workforce development, $492,397,000. 
ENVIRONMENTAL HEALTH 
For carrying out titles II, III, and XVII of the PHS 
Act with respect to environmental health, $188,750,000. 
INJURY PREVENTION AND CONTROL 
For carrying out titles II, III, and XVII of the PHS 
Act with respect to injury prevention and control, 
$648,559,000, of which $475,579,000 shall remain available
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until September 30, 2020 for an evidence-based opioid drug 
overdose prevention program. 
NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND 
HEALTH 
For carrying out titles II, III, and XVII of the PHS 
Act, sections 101, 102, 103, 201, 202, 203, 301, and 501 
of the Federal Mine Safety and Health Act, section 13 of 
the Mine Improvement and New Emergency Response Act, 
and sections 20, 21, and 22 of the Occupational Safety and 
Health Act, with respect to occupational safety and health, 
$335,300,000. 
ENERGY EMPLOYEES OCCUPATIONAL ILLNESS 
COMPENSATION PROGRAM 
For necessary expenses to administer the Energy Em-
ployees Occupational Illness Compensation Program Act, 
$55,358,000, to remain available until expended: Provided, 
That this amount shall be available consistent with the pro-
vision 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, $488,621,000, of which: 
(1) $128,421,000 shall remain available through September 
30, 2020 for international HIV/AIDS; and (2) $50,000,000 
shall remain available through September 30, 2021 for
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† HR 6157 EAS 
Global Disease Detection and Emergency Response: Pro-
vided, That funds may be used for purchase and insurance 
of official motor vehicles in foreign countries. 
PUBLIC HEALTH PREPAREDNESS AND RESPONSE 
For carrying out titles II, III, and XVII of the PHS 
Act with respect to public health preparedness and response, 
and for expenses necessary to support activities related to 
countering potential biological, nuclear, radiological, and 
chemical threats to civilian populations, $1,470,000,000, of 
which $610,000,000 shall remain available until expended 
for the Strategic National Stockpile: Provided, That in the 
event the Director of the Centers for Disease Control and 
Prevention (referred to in this title as ‘‘CDC’’) activates the 
Emergency Operations Center, the Director of the CDC may 
detail CDC staff without reimbursement for up to 90 days 
to support the work of the CDC Emergency Operations Cen-
ter, so long as the Director provides a notice to the Commit-
tees 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 de-
tailed: Provided further, That funds appropriated under 
this heading may be used to support a contract for the oper-
ation and maintenance of an aircraft in direct support of
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activities throughout CDC to ensure the agency is prepared 
to address public health preparedness emergencies. 
BUILDINGS AND FACILITIES 
(INCLUDING TRANSFER OF FUNDS) 
For acquisition of real property, equipment, construc-
tion, demolition, and renovation of facilities, $30,000,000, 
which shall remain available until September 30, 2023: 
Provided, That funds previously set-aside by CDC for re-
pair and upgrade of the Lake Lynn Experimental Mine 
and Laboratory shall be used to acquire a replacement mine 
safety research facility: Provided further, That in addition, 
the prior year unobligated balance of any amounts assigned 
to former employees in accounts of CDC made available for 
Individual Learning Accounts shall be credited to and 
merged with the amounts made available under this head-
ing to support the replacement of the mine safety research 
facility. 
CDC-WIDE ACTIVITIES AND PROGRAM SUPPORT 
For carrying out titles II, III, XVII and XIX, and 
section 2821 of the PHS Act and for cross-cutting activities 
and program support for activities funded in other appro-
priations included in this Act for the Centers for Disease 
Control and Prevention, $113,570,000: Provided, That 
paragraphs (1) through (3) of subsection (b) of section 2821 
of the PHS Act shall not apply to funds appropriated under
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† HR 6157 EAS 
this heading and in all other accounts of the CDC: Provided 
further, That employees of CDC or the Public Health Serv-
ice, both civilian and commissioned officers, detailed to 
States, municipalities, or other organizations under author-
ity of section 214 of the PHS Act, or in overseas assign-
ments, shall be treated as non-Federal employees for report-
ing purposes only and shall not be included within any 
personnel ceiling applicable 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 appro-
priated to CDC in this Act for official reception and rep-
resentation expenses when specifically approved by the Di-
rector of CDC: Provided further, That in addition, such 
sums as may be derived from authorized user fees, which 
shall be credited to the appropriation charged with the cost 
thereof: Provided further, That with respect to the previous 
proviso, authorized user fees from the Vessel Sanitation Pro-
gram and the Respirator Certification Program shall be 
available through September 30, 2020. 
NATIONAL INSTITUTES OF HEALTH 
NATIONAL CANCER INSTITUTE 
For carrying out section 301 and title IV of the PHS 
Act with respect to cancer, $5,747,125,000, of which up to 
$30,000,000 may be used for facilities repairs and improve-
ments at the National Cancer Institute—Frederick Feder-
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NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH 
SCIENCES 
For carrying out section 301 and title IV of the PHS 
Act with respect to environmental health sciences, 
$775,115,000. 
NATIONAL INSTITUTE ON AGING 
For carrying out section 301 and title IV of the PHS 
Act with respect to aging, $3,084,809,000. 
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, $605,383,000. 
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, $474,653,000. 
NATIONAL INSTITUTE OF NURSING RESEARCH 
For carrying out section 301 and title IV of the PHS 
Act with respect to nursing research, $163,076,000.
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NATIONAL INSTITUTE ON ALCOHOL ABUSE AND 
ALCOHOLISM 
For carrying out section 301 and title IV of the PHS 
Act with respect to alcohol abuse and alcoholism, 
$525,867,000. 
NATIONAL INSTITUTE ON DRUG ABUSE 
For carrying out section 301 and title IV of the PHS 
Act with respect to drug abuse, $1,420,591,000: Provided, 
That $250,000,000 shall be for research related to opioid 
addiction, development of opioid alternatives, pain man-
agement, and addiction treatment: Provided further, That 
each for-profit recipient of funds provided in the previous 
proviso shall be subject to a matching requirement of funds 
or documented in-kind contributions of not less than 50 per-
cent of the total funds awarded to such entity. 
NATIONAL INSTITUTE OF MENTAL HEALTH 
For carrying out section 301 and title IV of the PHS 
Act with respect to mental health, $1,813,750,000. 
NATIONAL HUMAN GENOME RESEARCH INSTITUTE 
For carrying out section 301 and title IV of the PHS 
Act with respect to human genome research, $575,882,000.
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NATIONAL INSTITUTE OF BIOMEDICAL IMAGING AND 
BIOENGINEERING 
For carrying out section 301 and title IV of the PHS 
Act with respect to biomedical imaging and bioengineering 
research, $389,672,000. 
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, 
$146,550,000. 
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, $314,845,000. 
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), $78,150,000. 
NATIONAL LIBRARY OF MEDICINE 
For carrying out section 301 and title IV of the PHS 
Act with respect to health information communications, 
$442,230,000: Provided, That of the amounts available for 
improvement of information systems, $4,000,000 shall be 
available until September 30, 2020: Provided further, That
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† HR 6157 EAS 
in fiscal year 2019, the National Library of Medicine may 
enter into personal services contracts for the provision of 
services in facilities owned, operated, or constructed under 
the jurisdiction of the National Institutes of Health (re-
ferred to in this title as ‘‘NIH’’). 
NATIONAL CENTER FOR ADVANCING TRANSLATIONAL 
SCIENCES 
For carrying out section 301 and title IV of the PHS 
Act with respect to translational sciences, $806,787,000: 
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: Provided further, That at least 
$560,031,000 is provided to the Clinical and Translational 
Sciences Awards program. 
OFFICE OF THE DIRECTOR 
For carrying out the responsibilities of the Office of 
the Director, NIH, $1,910,060,000: Provided, That funding 
shall be available for the purchase of not to exceed 29 pas-
senger motor vehicles for replacement only: Provided fur-
ther, That all funds credited to the NIH Management Fund 
shall remain available for one fiscal year after the fiscal 
year in which they are deposited: Provided further, That 
$606,885,000 shall be available for the Common Fund es-
tablished under section 402A(c)(1) of the PHS Act: Pro-
vided further, That of the funds provided, $10,000 shall be
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† HR 6157 EAS 
for official reception and representation expenses when spe-
cifically approved by the Director of the NIH: Provided fur-
ther, That the Office of AIDS Research within the Office 
of the Director of the NIH may spend up to $8,000,000 
to make grants for construction or renovation of facilities 
as provided for in section 2354(a)(5)(B) of the PHS Act: 
Provided further, That $50,000,000 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 authorized in 
the Gabriella Miller Kids First Research Act. 
BUILDINGS AND FACILITIES 
For the study of, construction of, demolition of, renova-
tion of, and acquisition of equipment for, facilities of or 
used by NIH, including the acquisition of real property, 
$200,000,000, to remain available through September 30, 
2023.
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NIH INNOVATION ACCOUNT, CURES ACT 
For necessary expenses to carry out the purposes de-
scribed in section 1001(b)(4) of the 21st Century Cures Act, 
in addition to amounts available for such purposes in the 
appropriations provided to the NIH in this Act, 
$711,000,000, to remain available until expended: Pro-
vided, That such amounts are appropriated pursuant to 
section 1001(b)(3) of such Act, 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 National 
Institutes of Health to other accounts of the National Insti-
tutes of Health solely for the purposes provided in such Act: 
Provided further, That upon a determination by the Direc-
tor that funds transferred pursuant to the previous proviso 
are not necessary for the purposes provided, such amounts 
may be transferred back to the Account: Provided further, 
That the transfer authority provided under this heading is 
in addition to any other transfer authority provided by 
law. 
SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES 
ADMINISTRATION 
MENTAL HEALTH 
For carrying out titles III, V, and XIX of the PHS 
Act with respect to mental health, and the Protection and 
Advocacy for Individuals with Mental Illness Act,
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† HR 6157 EAS 
$1,532,972,000: Provided, 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 ad-
dition to amounts provided herein, $21,039,000 shall be 
available under section 241 of the PHS Act to carry out 
subpart I of part B of title XIX of the PHS Act to fund 
section 1920(b) technical assistance, national data, data 
collection and evaluation activities, and further that the 
total available under this Act for section 1920(b) activities 
shall not exceed 5 percent of the amounts appropriated for 
subpart I of part B of title XIX: Provided further, That 
up to 10 percent of the amounts made available to carry 
out the Children’s Mental Health Services program may be 
used to carry out demonstration grants or contracts for 
early interventions with persons not more than 25 years 
of age at clinical high risk of developing a first episode of 
psychosis: Provided further, That section 520E(b)(2) of the 
PHS Act shall not apply to funds appropriated in this Act 
for fiscal year 2019: Provided further, That States shall ex-
pend at least 10 percent of the amount each receives for 
carrying out section 1911 of the PHS Act to support evi-
dence-based programs that address the needs of individuals 
with early serious mental illness, including psychotic dis-
orders, regardless of the age of the individual at onset: Pro-
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† HR 6157 EAS 
vided further, That $150,000,000 shall be available until 
September 30, 2021 for grants to communities and commu-
nity organizations who meet criteria for Certified Commu-
nity 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: Provided further, That 
of the funds made available under this heading, $15,000,000 
shall be to carry out section 224 of the Protecting Access 
to Medicare Act of 2014 (Public Law 113–93; 42 U.S.C. 
290aa 22 note). 
SUBSTANCE ABUSE TREATMENT 
For carrying out titles III and V of the PHS Act with 
respect to substance abuse treatment and title XIX of such 
Act with respect to substance abuse treatment and preven-
tion, $3,730,806,000: Provided, That $1,500,000,000 shall 
be for State Opioid Response Grants for carrying out ac-
tivities pertaining to opioids undertaken by the State agen-
cy responsible for administering the substance abuse preven-
tion 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
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† HR 6157 EAS 
to opioid use disorders: Provided further, That of the 
amounts provided for State Opioid Response Grants not 
more than 2 percent shall be available for Federal adminis-
trative expenses, training, technical assistance, and evalua-
tion: Provided further, That of the amount not reserved by 
the previous three provisos, the Secretary shall make alloca-
tions to States, territories, and the District of Columbia ac-
cording to a formula using national survey results that the 
Secretary determines are the most objective and reliable 
measure of drug use and drug-related deaths: Provided fur-
ther, That the Secretary shall submit the formula method-
ology to the Committees on Appropriations of the House 
of Representatives and the Senate not less than 15 days 
prior to publishing a Funding Opportunity Announcement: 
Provided further, That prevention and treatment activities 
funded through such grants may include education, treat-
ment (including the provision of medication), behavioral 
health services for individuals in treatment programs, refer-
ral to treatment services, recovery support, and medical 
screening associated with such treatment: Provided further, 
That each State, as well as the District of Columbia, shall 
receive not less than $4,000,000: Provided further, That in 
addition to amounts provided herein, the following 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
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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 sec-
tion 1935(b) activities shall not exceed 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 pro-
vided for section 1921 of the PHS Act or State Opioid Re-
sponse Grants shall be subject to section 241 of such Act. 
SUBSTANCE ABUSE PREVENTION 
For carrying out titles III and V of the PHS Act with 
respect to substance abuse prevention, $200,219,000. 
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: Pro-
vided, That in addition to amounts provided herein, 
$31,428,000 shall be available under section 241 of the PHS 
Act to supplement funds available to carry out national 
surveys on drug abuse and mental health, to collect and 
analyze program data, and to conduct public awareness
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† HR 6157 EAS 
and technical assistance activities: Provided further, That, 
in addition, fees may be collected for the costs of publica-
tions, data, data tabulations, and data analysis completed 
under title V of the PHS Act and provided to a public or 
private entity upon request, which shall be credited to this 
appropriation and shall remain available until expended 
for such purposes: Provided further, That amounts made 
available in this Act for carrying out section 501(m) of the 
PHS Act shall remain available through September 30, 
2020: Provided further, That funds made available under 
this heading may be used to supplement program support 
funding provided under the headings ‘‘Mental Health’’, 
‘‘Substance Abuse Treatment’’, and ‘‘Substance Abuse Pre-
vention’’. 
AGENCY FOR HEALTHCARE RESEARCH AND QUALITY 
HEALTHCARE RESEARCH AND QUALITY 
For carrying out titles III and IX of the PHS Act, 
part A of title XI of the Social Security Act, and section 
1013 of the Medicare Prescription Drug, Improvement, and 
Modernization Act of 2003, $334,000,000: Provided, That 
section 947(c) of the PHS Act shall not apply in fiscal year 
2019: Provided further, That in addition, amounts received 
from Freedom of Information Act fees, reimbursable and 
interagency agreements, and the sale of data shall be cred-
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ited to this appropriation and shall remain available until 
September 30, 2020. 
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, $276,236,212,000, 
to remain available until expended. 
For making, after May 31, 2019, payments to States 
under title XIX or in the case of section 1928 on behalf 
of States under title XIX of the Social Security Act for the 
last quarter of fiscal year 2019 for unanticipated costs in-
curred for the current fiscal year, such sums as may be nec-
essary. 
For making payments to States or in the case of sec-
tion 1928 on behalf of States under title XIX of the Social 
Security Act for the first quarter of fiscal year 2020, 
$137,931,797,000, to remain available until expended. 
Payment under such title XIX may be made for any 
quarter with respect to a State plan or plan amendment 
in effect during such quarter, if submitted in or prior to 
such quarter and approved in that or any subsequent quar-
ter. 
PAYMENTS TO THE HEALTH CARE TRUST FUNDS 
For payment to the Federal Hospital Insurance Trust 
Fund and the Federal Supplementary Medical Insurance
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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, $378,343,800,000. 
In addition, for making matching payments under sec-
tion 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 and Medicaid Services, not 
to exceed $3,669,744,000, 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
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be credited to this account and remain available until ex-
pended: Provided, That all funds derived in accordance 
with 31 U.S.C. 9701 from organizations established under 
title XIII of the PHS Act shall be credited to and available 
for carrying out the purposes of this appropriation: Pro-
vided further, That the Secretary is directed to collect fees 
in fiscal year 2019 from Medicare Advantage organizations 
pursuant to section 1857(e)(2) of the Social Security Act 
and from eligible organizations with risk-sharing contracts 
under section 1876 of that Act pursuant to section 
1876(k)(4)(D) of that Act. 
HEALTH CARE FRAUD AND ABUSE CONTROL ACCOUNT 
In addition to amounts otherwise available for pro-
gram integrity and program management, $765,000,000, to 
remain available through September 30, 2020, to be trans-
ferred 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 $600,464,000 shall be for the Centers for Medicare 
and Medicaid Services Program integrity activities, of 
which $86,664,000 shall be for the Department of Health 
and Human Services Office of Inspector General to carry 
out fraud and abuse activities authorized by section 
1817(k)(3) of such Act, and of which $77,872,000 shall be 
for the Department of Justice to carry out fraud and abuse
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activities authorized by section 1817(k)(3) of such Act: Pro-
vided, That the report required by section 1817(k)(5) of the 
Social Security Act for fiscal year 2019 shall include meas-
ures of the operational 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 sec-
tion 251(b)(2)(C)(ii) of the Balanced Budget and Emer-
gency Deficit Control Act of 1985, as amended, and 
$454,000,000 is additional new budget authority specified 
for purposes of section 251(b)(2)(C) of such Act: Provided 
further, That the Secretary shall provide not less than 
$17,621,000 for the Senior Medicare Patrol program to 
combat health care fraud and abuse from the funds provided 
to this account. 
ADMINISTRATION FOR CHILDREN AND FAMILIES 
PAYMENTS TO STATES FOR CHILD SUPPORT ENFORCEMENT 
AND FAMILY SUPPORT PROGRAMS 
For carrying out, except as otherwise provided, titles 
I, IV–D, X, XI, XIV, and XVI of the Social Security Act 
and the Act of July 5, 1960, $2,922,247,000, to remain 
available until expended; and for such purposes for the first 
quarter of fiscal year 2020, $1,400,000,000, to remain 
available until expended.
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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 Assistance 
Act of 1981, $3,690,304,000: Provided, That all but 
$716,000,000 of this amount shall be allocated as though 
the total appropriation for such payments for fiscal year 
2019 was less than $1,975,000,000: Provided further, That 
notwithstanding section 2609A(a), of the amounts appro-
priated under section 2602(b), not more than $2,988,000 
of such amounts may be reserved by the Secretary for tech-
nical assistance, training, and monitoring of program ac-
tivities for compliance with internal controls, policies and 
procedures and 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 orga-
nizations.
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REFUGEE AND ENTRANT ASSISTANCE 
(INCLUDING TRANSFER OF FUNDS) 
For necessary expenses for refugee and entrant assist-
ance activities authorized by section 414 of the Immigration 
and Nationality Act and section 501 of the Refugee Edu-
cation 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 Re-
authorization Act of 2008, the Trafficking Victims Protec-
tion Act of 2000 (‘‘TVPA’’), and the Torture Victims Relief 
Act of 1998, $1,905,201,000, of which $1,864,446,000 shall 
remain available through September 30, 2021 for carrying 
out such sections 414, 501, 462, and 235: Provided, That 
amounts available under this heading to carry out the 
TVPA shall also be available for research and evaluation 
with respect to activities under such Act: Provided further, 
That the limitation in section 205 of this Act regarding 
transfers increasing any appropriation shall apply to 
transfers to appropriations under this heading by sub-
stituting ‘‘15 percent’’ for ‘‘3 percent’’. 
PAYMENTS TO STATES FOR THE CHILD CARE AND 
DEVELOPMENT BLOCK GRANT 
For carrying out the Child Care and Development 
Block Grant Act of 1990 (‘‘CCDBG Act’’), $5,226,000,000 
shall be used to supplement, not supplant State general rev-
237 
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enue funds for child care assistance for low-income families: 
Provided, 
That 
technical 
assistance 
under 
section 
658I(a)(3) of such Act may be provided directly, 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 Secu-
rity 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 reservation of funds authority 
in paragraphs (4) and (5) of section 658O(a) of the CCDBG 
Act: Provided further, That in addition to the amounts re-
quired 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 organizations. 
SOCIAL SERVICES BLOCK GRANT 
For making grants to States pursuant to section 2002 
of the Social Security Act, $1,700,000,000: Provided, That 
notwithstanding subparagraph (B) of section 404(d)(2) of 
such Act, the applicable percent specified under such sub-
paragraph for a State to carry out State programs pursu-
ant 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 Prevention
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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 administrative 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 Inde-
pendence Act, title IV of the Immigration and Nationality 
Act, and section 501 of the Refugee Education Assistance 
Act of 1980, $12,288,225,000, of which $75,000,000, to re-
main available through September 30, 2020, shall be for 
grants to States for adoption and legal guardianship incen-
tive payments, as defined by section 473A of the Social Se-
curity Act and may be made for adoptions and legal 
guardianships completed before September 30, 2019: Pro-
vided, That $10,113,095,000, of which $132,000,000 shall 
be available through March 31, 2020, shall be for making 
payments under the Head Start Act, of which: 
(1) $215,000,000 shall be available for a cost of 
living 
adjustment 
notwithstanding 
section
239 
† HR 6157 EAS 
640(a)(3)(A) of such Act, and with respect to any 
continuing appropriations act, funding available for 
a cost of living adjustment shall not be construed as 
an authority or condition under this Act; 
(2) $16,000,000 shall be available to supplement 
funding otherwise available for research, evaluation, 
and Federal administrative costs; 
(3) $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 Sys-
tem, 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 calculation of 
‘‘base grant’’ in subsequent fiscal years, as such term 
is used in section 640(a)(7)(A) of such Act; and 
(4) $35,000,000 of the amount available through 
March 31, 2020 shall be available for award by the 
Secretary to grantees that apply for supplemental 
funding to increase their hours of program operations 
and for training and technical assistance for such ac-
tivities (of which up to one percent may be reserved 
for research and evaluation in addition to amounts 
described in paragraph (2)):
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Provided further, That notwithstanding the sixth proviso 
under this heading in division H of Public Law 115–141, 
any amount issued through a grant for the purposes de-
scribed in the following proviso shall be included in any 
calculation of ‘‘base grant’’, as such term is used in section 
640(a)(7)(A) of the Head Start Act, that affects the alloca-
tion of funds appropriated in this Act: Provided further, 
That the previous proviso applies to funds granted for 
Early Head Start programs as described in section 645A 
of the Head Start Act, for conversion of Head Start services 
to Early Head Start services as described in section 
645(a)(5)(A) of such Act, and 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: Provided further, That 
the Secretary may reduce the reservation of funds under 
section 640(a)(2)(C) of such Act in lieu of reducing the res-
ervation 
of 
funds 
under 
sections 
640(a)(2)(B), 
640(a)(2)(D), and 640(a)(2)(E) of such Act: Provided fur-
ther, That $250,000,000 shall be available until December 
31, 2019 for carrying out sections 9212 and 9213 of the 
Every Student Succeeds Act: Provided further, That up to 
3 percent of the funds in the preceding proviso shall be 
available for technical assistance and evaluation related to 
grants awarded under such section 9212: Provided further,
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That $752,883,000 shall be for making payments under the 
CSBG Act: Provided further, That $28,233,000 shall be for 
sections 680 and 678E(b)(2) of the CSBG Act, of which not 
less than $19,883,000 shall be for section 680(a)(2) and not 
less than $8,000,000 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 ex-
penditure by such entity consistent with program purposes: 
Provided further, That the Secretary shall establish proce-
dures regarding the disposition of intangible assets and pro-
gram income that permit such assets acquired with, and 
program income derived from, grant funds authorized 
under section 680 of the CSBG Act to become the sole prop-
erty of such grantees after a period of not more than 12 
years after the end of the grant period for any activity con-
sistent 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 instruments, and program in-
come may be used by grantees for any eligible purpose con-
sistent with section 680(a)(2)(A) of the CSBG Act: Provided 
further, That these procedures shall apply to such grant
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funds made available after November 29, 1999: Provided 
further, That funds appropriated for section 680(a)(2) of 
the CSBG Act shall be available for financing construction 
and rehabilitation and loans or investments in private 
business enterprises owned by community development cor-
porations: Provided further, That $165,000,000 shall be for 
carrying out section 303(a) of the Family Violence Preven-
tion and Services Act, of which $5,000,000 shall be allocated 
notwithstanding section 303(a)(2) of such Act for carrying 
out section 309 of such Act: Provided further, That the per-
centages specified in section 112(a)(2) of the Child Abuse 
Prevention and Treatment Act shall not apply to funds ap-
propriated under this heading: Provided further That 
$1,864,000 shall be for a human services case management 
system for federally declared disasters, to include a com-
prehensive national case management contract and Federal 
costs of administering the system: Provided further, That 
up to $2,000,000 shall be for improving the Public Assist-
ance Reporting Information System, including 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, section 
436 of the Social Security Act, $345,000,000 and, for car-
rying out, except as otherwise provided, section 437 of such
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† HR 6157 EAS 
Act, $99,765,000: Provided, That of the funds available to 
carry out section 437, $59,765,000 shall be allocated con-
sistent with subsections (b) through (d) of such section: Pro-
vided further, That of the funds available to carry out sec-
tion 437, to assist in meeting the requirements 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, and $20,000,000, in addition to funds otherwise 
appropriated in section 436 for such purposes, shall be for 
competitive grants to regional partnerships as described in 
section 437(f) and for developing enhancing, or evaluating 
family-focused residential treatment programs: Provided 
further, That section 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 re-
served amounts may be used for identifying, establishing, 
and disseminating practices to meet the criteria specified 
in section 471(e)(4)(C): Provided further, That the reserva-
tion in section 437(b)(2) and the limitations in section 
437(d) shall not apply to funds specified in the second pro-
viso: Provided further, That the minimum grant award for 
kinship navigator programs in the case of States and terri-