Continuing Appropriations Act, 2020, and Health Extenders Act of 2019
PL 116-59 (H.R.4378), enacted 09/27/2019

[116th Congress Public Law 59]
[From the U.S. Government Publishing Office]



[[Page 133 STAT. 1093]]

Public Law 116-59
116th Congress

                                 An Act


 
  Making continuing appropriations for fiscal year 2020, and for other 
           purposes. <<NOTE: Sept. 27, 2019 -  [H.R. 4378]>> 

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled, <<NOTE: Continuing 
Appropriations Act, 2020, and Health Extenders Act of 2019.>> 
SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Continuing Appropriations Act, 2020, 
and Health Extenders Act of 2019''.
SEC. 2. TABLE OF CONTENTS.

    The table of contents of this Act is as follows:

Sec. 1. Short title.
Sec. 2. Table of Contents.
Sec. 3. References.

             DIVISION A--CONTINUING APPROPRIATIONS ACT, 2020

    DIVISION B--HEALTH AND HUMAN SERVICES EXTENDERS AND OTHER MATTERS

                    TITLE I--PUBLIC HEALTH EXTENDERS

                    TITLE II--OTHER HEALTH EXTENDERS

                      TITLE III--MEDICAID EXTENDERS

                      TITLE IV--MEDICARE EXTENDERS

                    TITLE V--HUMAN SERVICES EXTENDERS

                    TITLE VI--MISCELLANEOUS POLICIES

                      TITLE VII--BUDGETARY EFFECTS

SEC. 3. REFERENCES.

    Except as expressly provided otherwise, any reference to ``this 
Act'' contained in any division of this Act shall be treated as 
referring only to the provisions of that division.

 DIVISION A--CONTINUING <<NOTE: Continuing Appropriations Act, 2020.>>  
APPROPRIATIONS ACT, 2020

     The following sums are hereby appropriated, out of any money in the 
Treasury not otherwise appropriated, and out of applicable corporate or 
other revenues, receipts, and funds, for the several departments, 
agencies, corporations, and other organizational units of Government for 
fiscal year 2020, and for other purposes, namely:
    Sec. 101.  Such amounts as may be necessary, at a rate for 
operations as provided in the applicable appropriations Acts for fiscal 
year 2019 and under the authority and conditions provided in such Acts, 
for continuing projects or activities (including the costs of direct 
loans and loan guarantees) that are not otherwise

[[Page 133 STAT. 1094]]

specifically provided for in this Act, that were conducted in fiscal 
year 2019, and for which appropriations, funds, or other authority were 
made available in the following appropriations Acts:
            (1) <<NOTE: Applicability.>>  The Agriculture, Rural 
        Development, Food and Drug Administration, and Related Agencies 
        Appropriations Act, 2019 (division B of Public Law 116-6), 
        except that the language under the heading ``Rural Utilities 
        Service--Rural Water and Waste Disposal Program Account'' in 
        title III shall be applied by inserting ``the cost of direct 
        loans,'' before ``loan guarantees'' at the beginning of the 
        second sentence <<NOTE: Ante, p. 64.>>  in the matter preceding 
        the first proviso.
            (2) The Commerce, Justice, Science, and Related Agencies 
        Appropriations Act, 2019 (division C of Public Law 116-6), 
        except section 523(b)(6).
            (3) The Department of Defense Appropriations Act, 2019 
        (division A of Public Law 115-245).
            (4) The Energy and Water Development and Related Agencies 
        Appropriations Act, 2019 (division A of Public Law 115-244), 
        except section 505.
            (5) The Financial Services and General Government 
        Appropriations Act, 2019 (division D of Public Law 116-6).
            (6) The Department of Homeland Security Appropriations Act, 
        2019 (division A of Public Law 116-6) as amended, and title I of 
        division H of Public Law 116-6.
            (7) The Department of the Interior, Environment, and Related 
        Agencies Appropriations Act, 2019 (division E of Public Law 116-
        6).
            (8) The Departments of Labor, Health and Human Services, and 
        Education, and Related Agencies Appropriations Act, 2019 
        (division B of Public Law 115-245).
            (9) The Legislative Branch Appropriations Act, 2019 
        (division B of Public Law 115-244).
            (10) The Military Construction, Veterans Affairs, and 
        Related Agencies Appropriations Act, 2019 (division C of Public 
        Law 115-244).
            (11) The Department of State, Foreign Operations, and 
        Related Programs Appropriations Act, 2019 (division F of Public 
        Law 116-6), except section 7058(d).
            (12) The Transportation, Housing and Urban Development, and 
        Related Agencies Appropriations Act, 2019 (division G of Public 
        Law 116-6).

    Sec. 102. (a) No appropriation or funds made available or authority 
granted pursuant to section 101 for the Department of Defense shall be 
used for:
            (1) the new production of items not funded for production in 
        fiscal year 2019 or prior years;
            (2) the increase in production rates above those sustained 
        with fiscal year 2019 funds; or
            (3) the initiation, resumption, or continuation of any 
        project, activity, operation, or organization (defined as any 
        project, subproject, activity, budget activity, program element, 
        and subprogram within a program element, and for any investment 
        items defined as a P-1 line item in a budget activity within an 
        appropriation account and an R-1 line item that includes a 
        program element and subprogram element within an appropriation 
        account) for which appropriations, funds, or other authority 
        were not available during fiscal year 2019.

[[Page 133 STAT. 1095]]

    (b) <<NOTE: Contracts.>> No appropriation or funds made available or 
authority granted pursuant to section 101 for the Department of Defense 
shall be used to initiate multi-year procurements utilizing advance 
procurement funding for economic order quantity procurement unless 
specifically appropriated later.

    Sec. 103.  Appropriations made by section 101 shall be available to 
the extent and in the manner that would be provided by the pertinent 
appropriations Act.
    Sec. 104.  Except as otherwise provided in section 102, no 
appropriation or funds made available or authority granted pursuant to 
section 101 shall be used to initiate or resume any project or activity 
for which appropriations, funds, or other authority were not available 
during fiscal year 2019.
    Sec. 105.  Appropriations made and authority granted pursuant to 
this Act shall cover all obligations or expenditures incurred for any 
project or activity during the period for which funds or authority for 
such project or activity are available under this Act.
    Sec. 106.  Unless otherwise provided for in this Act or in the 
applicable appropriations Act for fiscal year 2020, appropriations and 
funds made available and authority granted pursuant to this Act shall be 
available until whichever of the following first occurs:
            (1) The enactment into law of an appropriation for any 
        project or activity provided for in this Act.
            (2) The enactment into law of the applicable appropriations 
        Act for fiscal year 2020 without any provision for such project 
        or activity.
            (3) <<NOTE: Expiration date.>>  November 21, 2019.

    Sec. 107.  Expenditures made pursuant to this Act shall be charged 
to the applicable appropriation, fund, or authorization whenever a bill 
in which such applicable appropriation, fund, or authorization is 
contained is enacted into law.
    Sec. 108.  Appropriations made and funds made available by or 
authority granted pursuant to this Act may be used without regard to the 
time limitations for submission and approval of apportionments set forth 
in section 1513 of title 31, United States Code, but nothing in this Act 
may be construed to waive any other provision of law governing the 
apportionment of funds.
    Sec. 109.  Notwithstanding any other provision of this Act, except 
section 106, for those programs that would otherwise have high initial 
rates of operation or complete distribution of appropriations at the 
beginning of fiscal year 2020 because of distributions of funding to 
States, foreign countries, grantees, or others, such high initial rates 
of operation or complete distribution shall not be made, and no grants 
shall be awarded for such programs funded by this Act that would impinge 
on final funding prerogatives.
    Sec. 110.  This Act shall be implemented so that only the most 
limited funding action of that permitted in the Act shall be taken in 
order to provide for continuation of projects and activities.
    Sec. 111. <<NOTE: Continuation.>>  (a) For entitlements and other 
mandatory payments whose budget authority was provided in appropriations 
Acts for fiscal year 2019, and for activities under the Food and 
Nutrition Act of 2008, activities shall be continued at the rate to 
maintain program levels under current law, under the authority and 
conditions provided in the applicable appropriations Act for fiscal year 
2019, to be continued through the date specified in section 106(3).

[[Page 133 STAT. 1096]]

    (b) <<NOTE: Time period.>>  Notwithstanding section 106, obligations 
for mandatory payments due on or about the first day of any month that 
begins after October 2019 but not later than 30 days after the date 
specified in section 106(3) may continue to be made, and funds shall be 
available for such payments.

    Sec. 112.  Amounts made available under section 101 for civilian 
personnel compensation and benefits in each department and agency may be 
apportioned up to the rate for operations necessary to avoid furloughs 
within such department or agency, consistent with the applicable 
appropriations Act for fiscal year 2019, except that such authority 
provided under this section shall not be used until after the department 
or agency has taken all necessary actions to reduce or defer non-
personnel-related administrative expenses.
    Sec. 113.  Funds appropriated by this Act may be obligated and 
expended notwithstanding section 10 of Public Law 91-672 (22 U.S.C. 
2412), section 15 of the State Department Basic Authorities Act of 1956 
(22 U.S.C. 2680), section 313 of the Foreign Relations Authorization 
Act, Fiscal Years 1994 and 1995 (22 U.S.C. 6212), and section 504(a)(1) 
of the National Security Act of 1947 (50 U.S.C. 3094(a)(1)).
    Sec. 114. (a) Each amount incorporated by reference in this Act that 
was previously designated by the Congress for Overseas Contingency 
Operations/Global War on Terrorism or as an emergency requirement 
pursuant to section 251(b)(2)(A) of the Balanced Budget and Emergency 
Deficit Control Act of 1985 or as being for disaster relief pursuant to 
section 251(b)(2)(D) of such Act is designated by the Congress for 
Overseas Contingency Operations/Global War on Terrorism or as an 
emergency requirement pursuant to section 251(b)(2)(A) of such Act or as 
being for disaster relief pursuant to section 251(b)(2)(D) of such Act, 
respectively.
    (b) <<NOTE: Applicability.>>  Section 5 of Public Law 116-6 shall 
apply to amounts designated in subsection (a) and section 124 of this 
Act for Overseas Contingency Operations/Global War on Terrorism.

    (c) <<NOTE: Effective date.>>  This section shall become effective 
immediately upon enactment of this Act, and shall remain in effect 
through the date in section 106(3).

    Sec. 115. (a) Rescissions or cancellations of discretionary budget 
authority that continue pursuant to section 101 in Treasury 
Appropriations Fund Symbols (TAFS)--
            (1) to which other appropriations are not provided by this 
        Act, but for which there is a current applicable TAFS that does 
        receive an appropriation in this Act; or
            (2) which are no-year TAFS and receive other appropriations 
        in this Act,

may be continued instead by reducing the rate for operations otherwise 
provided by section 101 for such current applicable TAFS, as long as 
doing so does not impinge on the final funding prerogatives of the 
Congress.
    (b) <<NOTE: Continuation.>>  Rescissions or cancellations described 
in subsection (a) shall continue in an amount equal to the lesser of--
            (1) the amount specified for rescission or cancellation in 
        the applicable appropriations Act referenced in section 101 of 
        this Act; or
            (2) the amount of balances available, as of October 1, 2019, 
        from the funds specified for rescission or cancellation in the 
        applicable appropriations Act referenced in section 101 of this 
        Act.

[[Page 133 STAT. 1097]]

    (c) <<NOTE: Deadline. Lists.>>  No later than November 11, 2019, the 
Director of the Office of Management and Budget shall provide to the 
Committees on Appropriations of the House of Representatives and the 
Senate a comprehensive list of the rescissions or cancellations that 
will continue pursuant to section 101: Provided, <<NOTE: Effective 
date.>> That the information in such comprehensive list shall be 
periodically updated to reflect any subsequent changes in the amount of 
balances available, as of October 1, 2019, from the funds specified for 
rescission or cancellation in the applicable appropriations Act 
referenced in section 101, and such updates shall be transmitted to the 
Committees on Appropriations of the House of Representatives and the 
Senate upon request.

    Sec. 116.  Title I of the Additional Supplemental Appropriations for 
Disaster Relief Act, 2019 (Public Law 116-20) <<NOTE: Ante, p. 871.>>  
is amended in the matter under the heading ``Department of Agriculture--
Office of the Secretary'' by inserting ``to cooperative processors for 
reduced quantity and quality sugar beets,'' after ``planting in 2019,'': 
Provided, That amounts repurposed pursuant to this section that were 
previously designated by the Congress as an emergency requirement 
pursuant to the Balanced Budget and Emergency Deficit Control Act of 
1985 are designated by the Congress as an emergency requirement pursuant 
to section 251(b)(2)(A)(i) of the Balanced Budget and Emergency Deficit 
Control Act of 1985 and shall be available only if the President 
subsequently so designates all such amounts and transmits such 
designations to the Congress.

    Sec. 117.  The <<NOTE: Waiver authority.>>  Secretary of Agriculture 
may waive the matching funds requirement under Section 412(g) of the 
Agricultural Research, Extension, and Education Reform Act of 1998 (7 
U.S.C. 7632(g)).

    Sec. 118.  Amounts made available by section 101 for ``Department of 
Agriculture--Food and Nutrition Service--Child Nutrition Programs'' to 
carry out section 749(g) of the Agriculture, Rural Development, Food and 
Drug Administration, and Related Agencies Appropriations Act, 2010 
(Public Law 111-80) may be apportioned up to the rate for operations 
necessary to ensure that the program can be fully operational by May 
2020.
    Sec. 119.  Amounts provided by section 111 to the Department of 
Agriculture for ``Corporations--Commodity Credit Corporation Fund--
Reimbursement for Net Realized Losses'' may be used, prior to the 
completion of the report described in section 2 of the Act of August 17, 
1961 (15 U.S.C. 713a-11), to reimburse the Commodity Credit Corporation 
for net realized losses sustained, but not previously reimbursed, as of 
September 17, 2019: Provided, That the 
Secretary <<NOTE: Reports. Deadline. Estimates. Analysis.>>  of 
Agriculture shall submit a report, no later than October 31, 2019, to 
the Committees on Appropriations and Agriculture of both Houses of 
Congress, including estimates for all Market Facilitation Program 
payments, in calendar year 2018 and 2019 and projected payments in 
calendar year 2020 resulting from the calendar year 2019 program that 
include State-by-State, commodity-by-commodity, including specialty 
crops, analysis of the trade damage caused by retaliatory tariffs and 
separately by non-tariff trade barriers, including dumping, on U.S. 
agricultural producers, and an accounting of any commodity purchases 
made from substantially foreign-owned companies or their subsidiaries.

    Sec. 120.  In addition to amounts provided by section 101, amounts 
are provided for ``Department of Agriculture--Agricultural Marketing 
Service--Marketing Services'' at a rate for operations

[[Page 133 STAT. 1098]]

of $16,496,000 to continue the implementation of the Hemp Production 
Program (section 10113 of Public Law 115-334).
    Sec. 121.  Amounts made available by section 101 for ``International 
Trade Commission--Salaries and Expenses'' may be apportioned up to the 
rate for operations necessary to carry out responsibilities under the 
American Manufacturing Competitiveness Act of 2016 (Public Law 114-159).
    Sec. 122.  Amounts made available by section 101 to the Department 
of Commerce for ``Bureau of the Census--Periodic Censuses and Programs'' 
may be apportioned up to the rate for operations necessary to maintain 
the schedule and deliver the required data according to the statutory 
deadlines in the 2020 Decennial Census Program.
    Sec. 123.  Notwithstanding section 2208(l)(3) of title 10, United 
States Code, during the period covered by this Act, any advanced billing 
for background investigation services and related services purchased 
from activities financed using Defense Working Capital Funds shall be 
excluded from the calculation of cumulative advance billings under 
section 2208(l)(3) of such title. <<NOTE: Definition.>> In the preceding 
sentence, the term ``advance billing'' has the meaning given the term in 
section 2208(l)(4) of such title.

    Sec. 124. (a) <<NOTE: Rescissions.>>  The remaining unobligated 
balances of funds as of September 30, 2019, from amounts provided by 
section 9013 of division A of Public Law 115-245 are hereby rescinded: 
Provided, That such amounts that were previously designated by the 
Congress as being for Overseas Contingency Operations/Global War on 
Terrorism pursuant to section 251(b)(2)(A)(ii) of the Balanced Budget 
and Emergency Deficit Control Act of 1985 are designated by the Congress 
as being for Overseas Contingency Operations/Global War on Terrorism 
pursuant to that section of that Act.

    (b) In addition to the amount otherwise provided by section 101 for 
the ``Ukraine Security Assistance Initiative'', there is appropriated on 
September 30, 2019, for an additional amount for fiscal year 2019, an 
amount equal to the unobligated balances rescinded pursuant to 
subsection (a) of this section: <<NOTE: Expiration date.>>  Provided, 
That amounts made available pursuant to this subsection shall remain 
available until September 30, 2020, and shall be available for the same 
purposes and under the same authorities for which they were originally 
provided in Public Law 115-245: Provided further, That such amount is 
designated by the Congress as being for Overseas Contingency Operations/
Global War on Terrorism pursuant to section 251(b)(2)(A)(ii) of the 
Balanced Budget and Emergency Deficit Control Act of 1985.

    (c) <<NOTE: Effective date.>>  This section shall become effective 
immediately upon enactment of this Act.

    (d) <<NOTE: Applicability.>>  If this Act is enacted after September 
30, 2019, or if the designation in subsection 114(b) occurs after 
September 30, 2019, this section shall be applied as if it were in 
effect on September 30, 2019.

    Sec. 125. (a) No funds shall be transferred directly from 
``Department of Energy--Power Marketing Administration--Colorado River 
Basins Power Marketing Fund, Western Area Power Administration'' to the 
general fund of the Treasury in fiscal year 2019.
    (b) <<NOTE: Effective date.>>  This section shall become effective 
immediately upon enactment of this Act.

[[Page 133 STAT. 1099]]

    Sec. 126.  During <<NOTE: Applicability.>>  the period covered by 
this Act, title I of Public Law 108-361, as amended (the Calfed Bay-
Delta Authorization Act) (118 Stat. 1681), shall be applied by 
substituting ``2020'' for ``2019'' each place it appears.

    Sec. 127.  Notwithstanding <<NOTE: Applicability.>>  section 101, 
title I of division D of Public Law 116-6 shall <<NOTE: Ante, p. 139.>>  
be applied by adding the following new heading and appropriation 
language under the heading ``Department of the Treasury--Departmental 
Offices'':

       ``COMMITTEE ON FOREIGN INVESTMENT IN THE UNITED STATES FUND

    ``For necessary expenses of the Committee on Foreign Investment in 
the United States, $15,000,000, to remain available until expended: 
Provided, That <<NOTE: Transfer authority. Notification.>>  the 
chairperson of the Committee may transfer such amounts to any department 
or agency represented on the Committee (including the Department of the 
Treasury) subject to advance notification to the Committees on 
Appropriations of the House of Representatives and the Senate: Provided 
further, That amounts so transferred shall remain available until 
expended for expenses of implementing section 721 of the Defense 
Production Act of 1950, as amended (50 U.S.C. 4565), and shall be 
available in addition to any other funds available to any department or 
agency: Provided further, That fees authorized by section 721(p) of such 
Act shall be credited to this appropriation as offsetting collections: 
Provided further, That the total amount appropriated pursuant to this 
section from the general fund shall be reduced as such offsetting 
collections are received during this fiscal year, so as to result in a 
total appropriation from the general fund estimated at not more than 
$5,000,000.''.

    Sec. 128.  Notwithstanding any other provision of this Act, except 
section 106, the District of Columbia may expend local funds made 
available under the heading ``District of Columbia--District of Columbia 
Funds'' for such programs and activities under the District of Columbia 
Appropriations Act, 2019 (title IV of division D of Public Law 116-6) at 
the rate set forth in the Fiscal Year 2020 Local Budget Act of 2019 
(D.C. Act 23-78), as modified as of the date of enactment of this Act.
    Sec. 129.  In addition to amounts provided by section 101, amounts 
are provided to the Office of Personnel Management for ``Salaries and 
Expenses'' at a rate for operations of $48,000,000, for an additional 
amount for administrative expenses: Provided, That of 
such <<NOTE: Transfer authority.>>  amounts, $29,760,000 shall be 
transferred from the appropriate trust funds of the Office without 
regard to any other provision of law: Provided further, That such 
amounts may be apportioned up to the rate for operations necessary to 
maintain agency operations.

    Sec. 130.  Notwithstanding <<NOTE: Applicability.>>  section 101, 
the matter preceding the first proviso under the heading ``Small 
Business Administration--Business Loans Program Account'' in title V of 
division D of Public Law 116-6 shall <<NOTE: Ante, p. 179.>>  be applied 
as if the following were inserted before the colon: ``, and for the cost 
of guaranteed loans as authorized by section 7(a) of the Small Business 
Act (Public Law 83-163), $99,000,000, to remain available until 
expended'': Provided, That amounts made available under such heading by 
this Act may be apportioned up to the rate for operations necessary to 
accommodate increased demand for commitments for general

[[Page 133 STAT. 1100]]

business loans authorized under section 7(a) of the Small Business Act 
(15 U.S.C. 636(a)).

    Sec. 131.  Notwithstanding section 101, amounts are provided for 
``Small Business Administration--Disaster Loans Program Account'' at a 
rate for operations of $177,136,000: Provided, That amounts made 
available under such heading by this Act may be apportioned up to the 
rate for operations necessary to accommodate increased demand for 
commitments for disaster administrative expenses authorized under 
section 20(a) of the Small Business Act (15 U.S.C. 631): Provided 
further, That <<NOTE: Applicability.>>  the language under such heading 
in title V of division D of Public Law 116-6 <<NOTE: Ante, p. 179.>>  
shall be applied by--
            (1) substituting ``$1,600,000'' for ``$1,000,000'';
            (2) substituting ``$8,400,000'' for ``$9,000,000''; and
            (3) inserting the following before the period: ``; and of 
        which $167,136,000 is for direct administrative expenses of loan 
        making and servicing to carry out the direct loan program, which 
        may be transferred to and merged with the appropriations for 
        Salaries and Expenses: Provided, That, of the funds provided 
        under this heading, $150,888,000 shall be for major disasters 
        declared pursuant to the Robert T. Stafford Disaster Relief and 
        Emergency Assistance Act (42 U.S.C. 5122(2)): Provided further, 
        That the amount for major disasters under this heading is 
        designated by Congress as being for disaster relief pursuant to 
        section 251(b)(2)(D) of the Balanced Budget and Emergency 
        Deficit Control Act of 1985 (Public Law 99-177)''.

    Sec. 132.  Amounts made available by section 101 to the Department 
of Homeland Security for ``United States Secret Service--Operations and 
Support'' may be apportioned up to the rate for operations necessary to 
support hiring and operations required for protective activities 
associated with the 2020 presidential election campaign.
    Sec. 133.  Amounts made available by section 101 to the Department 
of Homeland Security for ``Federal Emergency Management Agency--Disaster 
Relief Fund'' may be apportioned up to the rate for operations necessary 
to carry out response and recovery activities under the Robert T. 
Stafford Disaster Relief and Emergency Assistance Act (42 U.S.C. 5121 et 
seq.).
    Sec. 134. (a) <<NOTE: Applicability.>>  Sections 1309(a) and 1319 of 
the National Flood Insurance Act of 1968 (42 U.S.C. 4016(a) and 4026) 
shall be applied by substituting the date specified in section 106(3) of 
this Act for ``September 30, 2019''.

    (b) If this Act is enacted after September 30, 2019, this section 
shall be applied as if it were in effect on September 30, 2019.
    Sec. 135.  Amounts made available by section 101 to the Department 
of Homeland Security for ``Office of the Secretary and Executive 
Management--Operations and Support'', ``Management Directorate--
Operations and Support'', and ``Intelligence, Analysis, and Operations 
Coordination--Operations and Support'' may be apportioned up to the rate 
for operations necessary to carry out activities previously funded by 
the Working Capital Fund of the Department of Homeland Security, 
consistent with the fiscal year 2020 President's Budget.
    Sec. 136. (a) In addition to amounts provided by section 101, 
amounts are provided to the ``Department of Health and Human Services--
Indian Health Service--Indian Health Services'' at a rate for operations 
of $18,397,500, for an additional amount for costs

[[Page 133 STAT. 1101]]

of staffing and operating facilities that were opened, renovated, or 
expanded in fiscal years 2019 and 2020, and such amounts may be 
apportioned up to the rate for operations necessary to staff and operate 
such facilities.
    (b) In addition to amounts provided by section 101, amounts are 
provided for ``Department of Health and Human Services--Indian Health 
Service--Indian Health Facilities'' at a rate for operations of 
$631,000, for an additional amount for costs of staffing and operating 
facilities that were opened, renovated, or expanded in fiscal years 2019 
and 2020, and such amounts may be apportioned up to the rate for 
operations necessary to staff and operate such facilities.
    Sec. 137.  Amounts made available by section 101 to the Department 
of Health and Human Services for ``Centers for Disease Control and 
Prevention--Public Health Preparedness and Response'' and ``Office of 
the Secretary--Public Health and Social Services Emergency Fund'' may be 
obligated in the account and budget structure, and under the authorities 
and conditions, set forth in H.R. 2740, as passed by the U.S. House of 
Representatives on June 19, 2019.
    Sec. 138.  During <<NOTE: Transfer authority.>>  the period covered 
by this Act, up to $20,000,000 of the unobligated amounts in the 
Infectious Diseases Rapid Response Reserve Fund established by section 
231 of division B of Public Law 115-245 may be transferred to 
``Department of Health and Human Services--Centers for Disease Control 
and Prevention--CDC-Wide Activities and Program Support'' and shall be 
available until expended for Ebola preparedness and response activities 
without regard to the limitations in the third proviso in such section 
231: Provided, That the Director of the Centers for Disease Control and 
Prevention may transfer such amounts to any of the appropriations 
accounts under the heading ``Centers for Disease Control and 
Prevention'' for Ebola response activities: Provided further, That such 
transfer authority shall be in addition to any other transfer authority 
provided to the Department of Health and Human Services.

    Sec. 139.  Section <<NOTE: Applicability.>>  114(f) of the Higher 
Education Act of 1965 (20 U.S.C. 1011c(f)) shall be applied by 
substituting the date specified in section 106(3) of this Act for 
``September 30, 2019''.

    Sec. 140.  Amounts made available by section 101 for ``Department of 
Veterans Affairs--Veterans Benefits Administration--General Operating 
Expenses, Veterans Benefits Administration'' and ``Department of 
Veterans Affairs--Departmental Administration--Information Technology 
Systems'' may be apportioned up to the rate for operations necessary to 
support projects and activities created by the Blue Water Navy Vietnam 
Veterans Act of 2019 (Public Law 116-23).
    Sec. 141.  Section <<NOTE: Applicability.>>  7 of the Export-Import 
Bank Act of 1945 (12 U.S.C. 635f) shall be applied by substituting the 
date specified in section 106(3) of this Act for ``September 30, 2019''.

    Sec. 142.  Section <<NOTE: Applicability.>>  209 of the 
International Religious Freedom Act of 1998 (22 U.S.C. 6436) shall be 
applied by substituting the date specified in section 106(3) of this Act 
for ``September 30, 2019''.

    Sec. 143.  Title I of division L of Public Law 115-141 and title I 
of division G of Public Law 116-6 shall be amended in the first provisos 
in each Act under the headings ``Department

[[Page 133 STAT. 1102]]

of Transportation--Federal Transit Administration--Capital Investment 
Grants'' <<NOTE: 132 Stat. 997;3Ante, p. 422.>> by striking 
``obligated'' and inserting ``allocated''.

    Sec. 144.  Section 9503(e)(4) of the Internal Revenue Code of 1986 
shall not apply during the period covered by this Act.
    Sec. 145.  <<NOTE: Contracts. Time period.>> Amounts made available 
by section 101 to the Department of Housing and Urban Development for 
``Housing Programs--Housing for the Elderly'' may be apportioned up to 
the rate for operations necessary to maintain project rental assistance 
for the elderly under section 202(c)(2) of the Housing Act of 1959 (12 
U.S.C. 1701q(c)(2)), including making amendments to contracts for such 
assistance and renewing expiring contracts for such assistance for up to 
a 1-year term.

     This division may be cited as the ``Continuing Appropriations Act, 
2020''.

    DIVISION B--HEALTH AND HUMAN SERVICES EXTENDERS AND OTHER MATTERS

                    TITLE I--PUBLIC HEALTH EXTENDERS

SEC. 1101. EXTENSION FOR COMMUNITY HEALTH CENTERS, THE NATIONAL 
                          HEALTH SERVICE CORPS, AND TEACHING 
                          HEALTH CENTERS THAT OPERATE GME 
                          PROGRAMS.

    (a) Community Health Centers.--Section 10503(b)(1)(F) of the Patient 
Protection and Affordable Care Act (42 U.S.C. 254b-2(b)(1)(F)) is 
amended by striking ``2018 and $4,000,000,000 for fiscal year 2019.'' 
and inserting ``2018, $4,000,000,000 for fiscal year 2019, and 
$569,863,014 for the period beginning on October 1, 2019, and ending on 
November 21, 2019; and''.
    (b) National Health Service Corps.--Section 10503(b)(2) of the 
Patient Protection and Affordable Care Act (42 U.S.C. 254b-2(b)(2)) is 
amended--
            (1) in subparagraph (E), by striking ``; and'' and inserting 
        a semicolon;
            (2) in subparagraph (F), by striking the period at the end 
        and inserting ``; and''; and
            (3) by adding at the end the following:
                    ``(G) $44,164,384 for the period beginning on 
                October 1, 2019, and ending on November 21, 2019.''.

    (c) Teaching Health Centers That Operate Graduate Medical Education 
Programs.--Section 340H(g)(1) of the Public Health Service Act (42 
U.S.C. 256h(g)(1)) is amended--
            (1) by striking ``and $126,500,000'' and inserting 
        ``$126,500,000''; and
            (2) by inserting ``and $18,021,918 for the period beginning 
        on October 1, 2019, and ending on November 21, 2019,'' before 
        ``to remain available''.

    (d) <<NOTE: Time period.>>  Application of Provisions.--Amounts 
appropriated pursuant to this section for the period beginning on 
October 1, 2019, and ending on November 21, 2019, shall be subject to 
the requirements contained in Public Law 115-245 for funds for programs 
authorized under sections 330 through 340 of the Public Health Service 
Act (42 U.S.C. 254 through 256).

[[Page 133 STAT. 1103]]

    (e) Conforming Amendment.--Paragraph (4) of section 3014(h) of title 
18, United States Code, as amended by section 50901 of Public Law 115-
123, is amended by striking ``and section 50901(e) of the Advancing 
Chronic Care, Extenders, and Social Services Act'' and inserting ``, 
section 50901(e) of the Advancing Chronic Care, Extenders, and Social 
Services Act, and section 1101(d) of division B of the Continuing 
Appropriations Act, 2020, and Health Extenders Act of 2019''.
SEC. 1102. DIABETES PROGRAMS.

    (a) Type I.--Section 330B(b)(2)(D) of the Public Health Service Act 
(42 U.S.C. 254c-2(b)(2)(D)) is amended by inserting ``and $21,369,863 
for the period beginning on October 1, 2019, and ending on November 21, 
2019,'' before ``to remain available''.
    (b) Indians.--Section 330C(c)(2)(D) of the Public Health Service Act 
(42 U.S.C. 254c-3(c)(2)(D)) is amended by inserting ``and $21,369,863 
for the period beginning on October 1, 2019, and ending on November 21, 
2019,'' before ``to remain available''.

                    TITLE II--OTHER HEALTH EXTENDERS

SEC. 1201. EXTENSION OF SEXUAL RISK AVOIDANCE EDUCATION PROGRAM.

    Section 510 of the Social Security Act (42 U.S.C. 710) is amended--
            (1) in subsection (a)--
                    (A) in paragraph (1)--
                          (i) in the matter preceding subparagraph (A)--
                                    (I) by inserting after ``for each of 
                                fiscal years 2018 and 2019'' the 
                                following: ``and for the period 
                                beginning October 1, 2019, and ending 
                                November 21, 2019''; and
                                    (II) by inserting after ``for the 
                                fiscal year'' the following: ``(or, with 
                                respect to such period, for fiscal year 
                                2020)''; and
                          (ii) in subparagraph (A), by striking ``for 
                      the fiscal year'' each place it appears and 
                      inserting ``for the fiscal year or period'' in 
                      each such place; and
                    (B) in paragraph (2)--
                          (i) in subparagraph (A)--
                                    (I) by inserting after ``for each of 
                                fiscal years 2018 and 2019'' the 
                                following: ``and for the period 
                                beginning October 1, 2019, and ending 
                                November 21, 2019''; and
                                    (II) by inserting after ``for the 
                                fiscal year'' the following: ``(or, with 
                                respect to such period, for fiscal year 
                                2020)''; and
                          (ii) in subparagraph (B)(i), by inserting 
                      after ``for the fiscal year'' the following: 
                      ``(or, with respect to such period, for fiscal 
                      year 2020)''; and
            (2) in subsection (f)--
                    (A) in paragraph (1), by inserting after ``for each 
                of fiscal years 2018 and 2019'' the following: ``and 
                $10,684,931 for the period beginning October 1, 2019, 
                and ending November 21, 2019''; and

[[Page 133 STAT. 1104]]

                    (B) in paragraph (2), by inserting after ``for each 
                of fiscal years 2018 and 2019'' the following: ``and for 
                the period described in paragraph (1)''.
SEC. 1202. EXTENSION OF PERSONAL RESPONSIBILITY EDUCATION PROGRAM.

    Section 513 of the Social Security Act (42 U.S.C. 713) is amended--
            (1) in subsection (a)--
                    (A) in paragraph (1)--
                          (i) in subparagraph (A)--
                                    (I) in the matter preceding clause 
                                (i), by inserting after ``for each of 
                                fiscal years 2010 through 2019'' the 
                                following: ``and for the period 
                                beginning October 1, 2019, and ending 
                                November 21, 2019''; and
                                    (II) in clause (i), by inserting 
                                after ``for the fiscal year'' the 
                                following: ``or period'';
                          (ii) in subparagraph (B)(i), by adding at the 
                      end the following new sentence: ``The previous 
                      sentence shall not apply with respect to State 
                      allotments under this paragraph for the period 
                      beginning October 1, 2019, and ending November 21, 
                      2019.''; and
                          (iii) in subparagraph (C)(i)--
                                    (I) by inserting after ``for a 
                                fiscal year'' the following: ``or the 
                                period described in subparagraph (A)''; 
                                and
                                    (II) by inserting after ``for the 
                                fiscal year'' the following: ``or 
                                period'';
                    (B) in paragraph (3)--
                          (i) by inserting after ``for a fiscal year'' 
                      the following: ``or the period described in 
                      paragraph (1)(A)''; and
                          (ii) by striking ``the end of the second 
                      succeeding fiscal year'' and inserting ``the end 
                      of the second fiscal year following such fiscal 
                      year or period''; and
                    (C) in paragraph (4)--
                          (i) in subparagraph (A)--
                                    (I) by inserting after ``for each of 
                                fiscal years 2010 through 2019'' the 
                                following: ``and for the period 
                                described in paragraph (1)(A)'';
                                    (II) by inserting after ``for each 
                                of fiscal years 2012 through 2019'' the 
                                following: ``and for the period so 
                                described''; and
                                    (III) by inserting after ``for a 
                                fiscal year'' the following: ``or the 
                                period so described''; and
                          (ii) in subparagraph (B)(i), by striking 
                      ``continue through fiscal year 2019'' and 
                      inserting ``continue through the period described 
                      in paragraph (1)(A)'';
            (2) in subsection (c)--
                    (A) in paragraph (1), by striking ``From the 
                amount'' and inserting ``Subject to paragraph (3), from 
                the amount'';
                    (B) in paragraph (2), by striking ``From the 
                amount'' and inserting ``Subject to paragraph (3), from 
                the amount''; and
                    (C) by adding at the end the following new 
                paragraph:

[[Page 133 STAT. 1105]]

            ``(3) Exception.--Paragraphs (1) and (2) shall not apply 
        with respect to any amount appropriated under subsection (f) for 
        the period described in subsection (a)(1)(A).''; and
            (3) in subsection (f), by inserting after ``for each of 
        fiscal years 2010 through 2019'' the following: ``and 
        $10,684,931 for the period beginning October 1, 2019, and ending 
        November 21, 2019''.

                      TITLE III--MEDICAID EXTENDERS

SEC. 1301. EXTENSION OF COMMUNITY MENTAL HEALTH SERVICES 
                          DEMONSTRATION PROGRAM.

    Section 223(d)(3) of the Protecting Access to Medicare Act of 2014 
(42 U.S.C. 1396a note) is amended by striking ``September 13, 2019'' and 
inserting ``November 21, 2019''.
SEC. 1302. TEMPORARY INCREASE IN FEDERAL MEDICAL ASSISTANCE 
                          PERCENTAGE FOR TERRITORIES UNDER 
                          MEDICAID PROGRAM.

    Section 1905 of the Social Security Act (42 U.S.C. 1396d) is 
amended--
            (1) in subsection (b), by striking ``and (aa)'' and 
        inserting ``(aa), and (ff)''; and
            (2) by adding at the end the following new subsection:

    ``(ff) <<NOTE: Time period.>>  Temporary Increase in FMAP for 
Territories.--Notwithstanding subsection (b) or (z)(2), the Federal 
medical assistance percentage for Puerto Rico, the Virgin Islands, Guam, 
the Northern Mariana Islands, and American Samoa shall be equal to 100 
percent for the period beginning October 1, 2019, and ending November 
21, 2019.''.
SEC. 1303. DELAY OF REDUCTIONS IN MEDICAID DSH ALLOTMENTS.

    Section 1923(f)(7)(A) of the Social Security Act (42 U.S.C. 1396r-
4(f)(7)(A)) is amended--
            (1) in clause (i), in the matter preceding subclause (I), by 
        striking ``For each of fiscal years 2020 through 2025'' and 
        inserting ``For the period beginning November 22, 2019, and 
        ending September 30, 2020, and for each of fiscal years 2021 
        through 2025''; and
            (2) in clause (ii)(I), by striking ``for fiscal year 2020'' 
        and inserting ``for the period beginning November 22, 2019, and 
        ending September 30, 2020''.

                      TITLE IV--MEDICARE EXTENDERS

SEC. 1401. EXTENSION OF FUNDING FOR QUALITY MEASURE ENDORSEMENT, 
                          INPUT, AND SELECTION.

    Section 1890(d)(2) of the Social Security Act (42 U.S.C. 
1395aaa(d)(2)) is amended--
            (1) in the first sentence--
                    (A) by striking ``and $7,500,000'' and inserting 
                ``$7,500,000''; and
                    (B) by inserting before the period at the end the 
                following: ``, and $1,069,000 for the period beginning 
                on October 1, 2019, and ending on November 21, 2019''; 
                and

[[Page 133 STAT. 1106]]

            (2) in the third sentence, by inserting ``and for the period 
        beginning on October 1, 2019, and ending on November 21, 2019,'' 
        after ``2019''.
SEC. 1402. EXTENSION OF FUNDING OUTREACH AND ASSISTANCE FOR LOW-
                          INCOME PROGRAMS.

    (a) Additional Funding for State Health Insurance Programs.--
Subsection (a)(1)(B) of section 119 of the Medicare Improvements for 
Patients and Providers Act of 2008 (42 U.S.C. 1395b-3 note), as amended 
by section 3306 of the Patient Protection and Affordable Care Act 
(Public Law 111-148), section 610 of the American Taxpayer Relief Act of 
2012 (Public Law 112-240), section 1110 of the Pathway for SGR Reform 
Act of 2013 (Public Law 113-67), section 110 of the Protecting Access to 
Medicare Act of 2014 (Public Law 113-93), section 208 of the Medicare 
Access and CHIP Reauthorization Act of 2015 (Public Law 114-10), and 
section 50207 of division E of the Bipartisan Budget Act of 2018 (Public 
Law 115-123), is amended--
            (1) in clause (vii), by striking ``and'' at the end;
            (2) in clause (viii), by striking ``and'' at the end;
            (3) in clause (ix), by striking the period at the end and 
        inserting ``; and''; and
            (4) by inserting after clause (ix) the following new clause:
                          ``(x) for the period beginning on October 1, 
                      2019, and ending on November 21, 2019, of 
                      $1,852,000.''.

    (b) Additional Funding for Area Agencies on Aging.--Subsection 
(b)(1)(B) of such section 119, as so amended, is amended--
            (1) in clause (vii), by striking ``and'' at the end;
            (2) in clause (viii), by striking ``and'' at the end;
            (3) in clause (ix), by striking the period at the end and 
        inserting ``; and''; and
            (4) by inserting after clause (ix) the following new clause:
                          ``(x) for the period beginning on October 1, 
                      2019, and ending on November 21, 2019, of 
                      $1,069,000.''.

    (c) Additional Funding for Aging and Disability Resource Centers.--
Subsection (c)(1)(B) of such section 119, as so amended, is amended--
            (1) in clause (vii), by striking ``and'' at the end;
            (2) in clause (viii), by striking ``and'' at the end;
            (3) in clause (ix), by striking the period at the end and 
        inserting ``; and''; and
            (4) by inserting after clause (ix) the following new clause:
                          ``(x) for the period beginning on October 1, 
                      2019, and ending on November 21, 2019, of 
                      $712,000.''.

    (d) Additional Funding for Contract With the National Center for 
Benefits and Outreach Enrollment.--Subsection (d)(2) of such section 
119, as so amended, is amended--
            (1) in clause (vii), by striking ``and'' at the end;
            (2) in clause (viii), by striking ``and'' at the end;
            (3) in clause (ix), by striking the period at the end and 
        inserting ``; and''; and
            (4) by inserting after clause (ix) the following new clause:
                          ``(x) for the period beginning on October 1, 
                      2019, and ending on November 21, 2019, of 
                      $1,710,000.''.

[[Page 133 STAT. 1107]]

SEC. 1403. EXTENSION OF TERMINATION DATE OF PATIENT-CENTERED 
                          OUTCOMES RESEARCH TRUST FUND.

    Section 9511(f) of the Internal Revenue Code of 1986 <<NOTE: 26 USC 
9511.>>  is amended by striking ``September 30'' and inserting 
``November 21''.

                    TITLE V--HUMAN SERVICES EXTENDERS

SEC. 1501. EXTENSION OF DEMONSTRATION PROJECTS TO ADDRESS HEALTH 
                          PROFESSIONS WORKFORCE NEEDS.

    Activities authorized by section 2008 of the Social Security Act 
shall continue through November 21, 2019, in the manner authorized for 
fiscal year 2019, and out of any money in the Treasury of the United 
States not otherwise appropriated, there are hereby appropriated such 
sums as may be necessary for such purpose. Grants and payments may be 
made pursuant to this authority through the date so specified at the pro 
rata portion of the total amount authorized for such activities in 
fiscal year 2019.
SEC. 1502. EXTENSION OF THE TEMPORARY ASSISTANCE FOR NEEDY 
                          FAMILIES PROGRAM AND RELATED PROGRAMS.

    Activities authorized by part A of title IV and section 1108(b) of 
the Social Security Act shall continue through November 21, 2019, in the 
manner authorized for fiscal year 2019, and out of any money in the 
Treasury of the United States not otherwise appropriated, there are 
hereby appropriated such sums as may be necessary for such purpose.

                    TITLE VI--MISCELLANEOUS POLICIES

SEC. 1601. ALASKA NATIVE REGIONAL HEALTH ENTITIES.

    Section <<NOTE: Applicability.>>  424(a) of the Consolidated 
Appropriations Act, 2014 (Public Law 113-76), as amended by section 428 
of the Consolidated Appropriations Act, 2018 (Public Law 115-
141), <<NOTE: 128 Stat. 343.>>  shall be applied by substituting 
``November 21, 2019'' for ``October 1, 2019''.
SEC. 1602. INCREASING NUMERICAL LIMITATIONS OF THE WORLD TRADE 
                          CENTER HEALTH PROGRAM.

    (a) World Trade Center Responders.--Section 3311(a)(4)(A) of the 
Public Health Service Act (42 U.S.C. 300mm-21(a)(4)(A)) is amended by 
striking ``25,000'' and inserting ``75,000''.
    (b) World Trade Center Survivors.--Section 3321(a)(3)(A) of the 
Public Health Service Act (42 U.S.C. 300mm-31(a)(3)(A)) is amended by 
striking ``25,000'' and inserting ``75,000''.
    (c) <<NOTE: 42 USC 300mm-21 note.>>  Rule of Construction Regarding 
Annual Funding Limitations.--Nothing in this section, or the amendments 
made by this section, shall alter the annual limitations on amounts 
appropriated to the World Trade Center Health Program Fund under section 
3351(a)(2) of the Public Health Service Act (42 U.S.C. 300mm-61(a)(2)).

[[Page 133 STAT. 1108]]

SEC. 1603. EXCLUDING AUTHORIZED GENERIC DRUGS FROM CALCULATION OF 
                          AVERAGE MANUFACTURER PRICE FOR PURPOSES 
                          OF THE MEDICAID DRUG REBATE PROGRAM; 
                          EXCLUDING MANUFACTURERS FROM DEFINITION 
                          OF WHOLESALER.

    (a) In General.--Subparagraph (C) of section 1927(k)(1) of the 
Social Security Act (42 U.S.C. 1396r-8(k)(1)) is amended--
            (1) in the subparagraph heading, by striking ``INCLUSION'' 
        and inserting ``EXCLUSION'';
            (2) by striking ``a new drug application'' and inserting 
        ``the manufacturer's new drug application''; and
            (3) by striking ``inclusive'' and inserting ``exclusive''.

    (b) Excluding Manufacturers From Definition of Wholesaler.--Section 
1927(k)(11) of the Social Security Act (42 U.S.C. 1396r-8(k)(11)) is 
amended--
            (1) by striking ``manufacturers,''; and
            (2) by striking ``manufacturer's and''.

    (c) <<NOTE: 42 USC 1396r-8 note.>>  Effective Date.--The amendments 
made by this section shall take effect on the first day of the first 
fiscal quarter that begins after the date of enactment of this Act.
SEC. 1604. MEDICAID IMPROVEMENT FUND.

    Section 1941(b) of the Social Security Act (42 U.S.C. 1396w-1(b)), 
as amended by section 2 of Public Law 116-29, is amended--
            (1) in paragraph (1), by striking ``$1,000,000'' and 
        inserting ``$0''; and
            (2) in paragraph (3)--
                    (A) by striking ``2023'' each place it appears and 
                inserting ``2025''; and
                    (B) in subparagraph (A), by striking ``$0'' and 
                inserting ``$2,387,000,000''.

                      TITLE VII--BUDGETARY EFFECTS

SEC. 1701. BUDGETARY EFFECTS.

    (a) Statutory PAYGO Scorecards.--The budgetary effects of this 
division shall not be entered on either PAYGO scorecard maintained 
pursuant to section 4(d) of the Statutory Pay-As-You-Go Act of 2010.
    (b) Senate PAYGO Scorecards.--The budgetary effects of this division 
shall not be entered on any PAYGO scorecard maintained for purposes of 
section 4106 of H. Con. Res. 71 (115th Congress).
    (c) Classification of Budgetary Effects.--Notwithstanding Rule 3 of 
the Budget Scorekeeping Guidelines set forth in the joint explanatory 
statement of the committee of conference accompanying Conference Report 
105-217 and section 250(c)(8) of the Balanced Budget and Emergency 
Deficit Control Act of 1985, the budgetary effects of this division 
shall not be estimated--
            (1) for purposes of section 251 of such Act; and

[[Page 133 STAT. 1109]]

            (2) for purposes of paragraph (4)(C) of section 3 of the 
        Statutory Pay-As-You-Go Act of 2010 as being included in an 
        appropriation Act.

    Approved September 27, 2019.

LEGISLATIVE HISTORY--H.R. 4378:
---------------------------------------------------------------------------

CONGRESSIONAL RECORD, Vol. 165 (2019):
            Sept. 19, considered and passed House.
            Sept. 26, considered and passed Senate.

                                  <all>