H. R. 1105—248 
available to establish State-administered controlled substance moni-
toring systems as authorized by Public Law 109–60: Provided fur-
ther, That $772,000 shall be for reimbursing the General Services 
Administration for environmental testing and remediation on the 
federally owned facilities at St. Elizabeths Hospital, including but 
not limited to testing and remediation conducted prior to fiscal 
year 2009: 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 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 exceed 5 percent of the amounts appro-
priated for subpart II of part B of title XIX; (2) $21,039,000 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 collec-
tion 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; (3) $22,750,000 to carry out national surveys on drug 
abuse and mental health; and (4) $8,596,000 to collect and analyze 
data and evaluate substance abuse treatment programs: Provided 
further, That section 520E(b)(2) of the PHS Act shall not apply 
to funds appropriated under this Act for fiscal year 2009. 
AGENCY FOR HEALTHCARE RESEARCH AND QUALITY 
HEALTHCARE RESEARCH AND QUALITY 
For carrying out titles III and IX of the Public Health Service 
Act (‘‘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, amounts received from Freedom 
of Information Act fees, reimbursable and interagency agreements, 
and the sale of data shall be credited to this appropriation and 
shall remain available until expended: Provided, That the amount 
made available pursuant to section 937(c) of the PHS Act shall 
not exceed $372,053,000. 
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, $149,335,031,000, to remain avail-
able until expended. 
For making, after May 31, 2009, payments to States under 
title XIX of the Social Security Act for the last quarter of fiscal 
year 2009 for unanticipated costs, incurred for the current fiscal 
year, such sums as may be necessary. 
For making payments to States or in the case of section 1928 
on behalf of States under title XIX of the Social Security Act 
for the first quarter of fiscal year 2010, $71,700,038,000, to remain 
available until expended. 
Payment under 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.
H. R. 1105—249 
PAYMENTS TO HEALTH CARE TRUST FUNDS 
For payment to the Federal Hospital Insurance Trust Fund 
and the Federal Supplementary Medical Insurance 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) of Public Law 97–248, and 
for administrative expenses incurred pursuant to section 201(g) 
of the Social Security Act, $195,383,000,000. 
In addition, for making matching payments under section 1844, 
and benefit payments under section 1860D–16 of the Social Security 
Act, 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 Public Health Service Act (‘‘PHS Act’’), and the Clinical 
Laboratory Improvement Amendments of 1988, not to exceed 
$3,305,386,000, to be transferred from the Federal Hospital Insur-
ance Trust Fund and the Federal Supplementary 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 of Health and Human Services 
pursuant to section 302 of the Tax Relief and Health Care Act 
of 2006; 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 available 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 appropriation: Pro-
vided further, That $35,700,000, to remain available through Sep-
tember 30, 2010, shall be for contract costs for the Healthcare 
Integrated General Ledger Accounting System: Provided further, 
That $108,900,000, to remain available through September 30, 2010, 
shall be for the Centers for Medicare and Medicaid Services (‘‘CMS’’) 
Medicare contracting reform activities: Provided further, That funds 
appropriated under this heading shall be available for the Healthy 
Start, Grow Smart program under which the CMS may, directly 
or through grants, contracts, or cooperative agreements, produce 
and distribute informational materials including, but not limited 
to, pamphlets and brochures on infant and toddler health care 
to expectant parents enrolled in the Medicaid program and to 
parents and guardians enrolled in such program with infants and 
children: Provided further, That the Secretary is directed to collect 
fees in fiscal year 2009 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 $4,542,000 shall be used for the projects, and in 
the amounts, specified under the heading ‘‘Program Management’’ 
in the explanatory statement described in section 4 (in the matter 
preceding division A of this consolidated Act): Provided further, 
That $75,000,000 is available for the State high risk health insur-
ance pool program as authorized by the State High Risk Pool 
Funding Extension Act of 2006.
H. R. 1105—250 
HEALTH CARE FRAUD AND ABUSE CONTROL ACCOUNT 
In addition to amounts otherwise available for program integ-
rity and program management, $198,000,000, 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 $147,038,000 
shall be for the Medicare Integrity Program at the Centers for 
Medicare and Medicaid Services to conduct oversight of activities 
for Medicare Advantage and the Medicare Prescription Drug Pro-
gram authorized in title XVIII of the Social Security Act, including 
activities listed in section 1893(b) of such Act; of which $18,967,000 
shall be for the Department of Health and Human Services Office 
of Inspector General; of which $13,028,000 shall be for the Medicaid 
and State Children’s Health Insurance Program (‘‘SCHIP’’) program 
integrity activities; and of which $18,967,000 shall be for the 
Department of Justice: Provided, That the report required by section 
1817(k)(5) of the Social Security Act for fiscal year 2009 shall 
include measures of the operational efficiency and impact on fraud, 
waste, and abuse in the Medicare, Medicaid, and SCHIP programs 
for the funds provided by this appropriation. 
ADMINISTRATION FOR CHILDREN AND FAMILIES 
PAYMENTS TO STATES FOR CHILD SUPPORT ENFORCEMENT AND 
FAMILY SUPPORT PROGRAMS 
For making payments to States or other non-Federal entities 
under titles I, IV–D, X, XI, XIV, and XVI of the Social Security 
Act and the Act of July 5, 1960, $2,759,078,000, to remain available 
until expended; and for such purposes for the first quarter of 
fiscal year 2010, $1,000,000,000, to remain available until expended. 
For making payments to each State for carrying out the pro-
gram of Aid to Families with Dependent Children under title IV– 
A of the Social Security Act before the effective date of the program 
of Temporary Assistance for Needy Families with respect to such 
State, such sums as may be necessary: Provided, That the sum 
of the amounts available to a State with respect to expenditures 
under such title IV–A in fiscal year 1997 under this appropriation 
and under such title IV–A as amended by the Personal Responsi-
bility and Work Opportunity Reconciliation Act of 1996 shall not 
exceed the limitations under section 116(b) of such Act. 
For making, after May 31 of the current fiscal year, payments 
to States or other non-Federal entities under 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 unantici-
pated costs, incurred for the current fiscal year, such sums as 
may be necessary. 
REFUGEE AND ENTRANT ASSISTANCE 
For necessary expenses for refugee and entrant assistance 
activities authorized by section 414 of the Immigration and Nation-
ality Act and section 501 of the Refugee Education Assistance 
Act of 1980, for carrying out section 462 of the Homeland Security 
Act of 2002, for costs associated with the care and placement 
of unaccompanied alien children, and for carrying out the Torture 
Victims Relief Act of 1998, $633,442,000, of which up to $9,814,000