Senate Report 115-289 - DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND RELATED AGENCIES APPROPRIATION BILL, 2019

[Senate Report 115-289]
[From the U.S. Government Publishing Office]

Calendar No. 497
115th Congress } { Report
SENATE
2d Session } { 115-289

======================================================================

DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND
RELATED AGENCIES APPROPRIATION BILL, 2019
_______

June 28, 2018.--Ordered to be printed

_______

Mr. Blunt, from the Committee on Appropriations,
submitted the following

REPORT

[To accompany S. 3158]

The Committee on Appropriations reports the bill (S. 3158)
making appropriations for Departments of Labor, Health and
Human Services, and Education, and related agencies for the
fiscal year ending September 30, 2019, and for other purposes,
reports favorably thereon without amendment and recommends that
the bill do pass.

Amounts to new budget authority

Total of bill as reported to the Senate...............$1,059,220,321,000
Amount of 2018
appropriations............................ 1,007,992,626,000
Amount of 2019 budget estimate.........................1,043,734,903,000
Bill as recommended to Senate compared to:
2018
appropriations.......................................
....... +51,227,695,000
2019 budget
estimate............................................ +15,485,418,000

CONTENTS

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Page

List of Abbreviations............................................ 4
Summary of Budget Estimates and Committee Recommendations........ 8
Overview..................................................... 8
National Institutes of Health................................ 8
Combating Opioid Abuse....................................... 9
Promoting College Affordability and Completion............... 10
Strengthening the Workforce for a Stronger Economy........... 11
Increasing Access to High-Quality Early Childhood Care and
Education.................................................. 12
Rural America................................................ 13
Alzeimer's Disease........................................... 14
Investing in Public Health Preparedness...................... 15
Improving Fiscal Accountability.............................. 16
Increasing the Efficiency and Cost Effectiveness of
Government................................................. 16
Bill-Wide Directives......................................... 18
Other Highlights of the Bill................................. 18
Title I: Department of Labor:
Employment and Training Administration....................... 21
Employee Benefits Security Administration.................... 30
Pension Benefit Guaranty Corporation......................... 31
Wage and Hour Division....................................... 32
Office of Labor-Management Standards......................... 32
Office of Federal Contract Compliance Programs............... 32
Office of Workers' Compensation Programs..................... 33
Occupational Safety and Health Administration................ 35
Mine Safety and Health Administration........................ 36
Bureau of Labor Statistics................................... 37
Office of Disability Employment Policy....................... 38
Departmental Management...................................... 38
General Provisions........................................... 42
Title II: Department of Health and Human Services:
Health Resources and Services Administration................. 44
Centers for Disease Control and Prevention................... 61
National Institutes of Health................................ 85
Substance Abuse and Mental Health Services Administration.... 126
Agency for Healthcare Research and Quality................... 136
Centers for Medicare and Medicaid Services................... 138
Administration for Children and Families..................... 146
Administration for Community Living.......................... 159
Office of the Secretary...................................... 165
General Provisions........................................... 176
Title III: Department of Education:
Education for the Disadvantaged.............................. 178
Impact Aid................................................... 180
School Improvement Programs.................................. 181
Indian Education............................................. 184
Innovation and Improvement................................... 185
Safe Schools and Citizenship Education....................... 189
English Language Acquisition................................. 190
Special Education............................................ 190
Rehabilitation Services...................................... 193
Special Institutions for Persons With Disabilities:
American Printing House for the Blind.................... 194
National Technical Institute for the Deaf................ 194
Gallaudet University..................................... 195
Career, Technical, and Adult Education....................... 195
Student Financial Assistance................................. 196
Federal Direct Student Loan Program Account.................. 197
Student Aid Administration................................... 198
Higher Education............................................. 202
Howard University............................................ 207
College Housing and Academic Facilities Loans Program........ 207
Historically Black College and University Capital Financing
Program Account............................................ 207
Institute of Education Sciences.............................. 208
Departmental Management:
Program Administration................................... 210
Office for Civil Rights.................................. 212
Office of the Inspector General.......................... 213
General Provisions........................................... 213
Title IV: Related Agencies:
Committee for Purchase From People Who Are Blind or Severely
Disabled................................................... 215
Corporation for National and Community Service............... 215
Corporation for Public Broadcasting.......................... 218
Federal Mediation and Conciliation Service................... 219
Federal Mine Safety and Health Review Commission............. 219
Institute of Museum and Library Services..................... 220
Medicaid and CHIP Payment and Access Commission.............. 220
Medicare Payment Advisory Commission......................... 221
National Council on Disability............................... 221
National Labor Relations Board............................... 221
National Mediation Board..................................... 221
Occupational Safety and Health Review Commission............. 222
Railroad Retirement Board.................................... 222
Social Security Administration............................... 223
Title V: General Provisions...................................... 228
Compliance With Paragraph 7, Rule XVI of the Standing Rules of
the Sen- ate................................................... 230
Compliance With Paragraph 7(c), Rule XXVI of the Standing Rules
of the Senate.................................................. 231
Compliance With Paragraph 12, Rule XXVI of the Standing Rules of
the Senate..................................................... 232
Budgetary Impact of Bill......................................... 233
Comparative Statement of New Budget Authority.................... 234

LIST OF ABBREVIATIONS

ACA--Patient Protection and Affordable Care Act
ACL--Administration for Community Living
ADAP--AIDS Drug Assistance Program
AHEC--Area Health Education Center
AHRQ--Agency for Healthcare Research and Quality
AP--Advanced Placement
APH--American Printing House for the Blind
ASH--Assistant Secretary for Health
ASPR--Assistant Secretary for Preparedness and Response
BARDA--Biomedical Advanced Research and Development
Authority
BCA--Budget Control Act of 2011
BLS--Bureau of Labor Statistics
CAN--Cures Acceleration Network
CCAMPIS--Child Care Access Means Parents in School
CCDBG--Child Care and Development Block Grant
CDC--Centers for Disease Control and Prevention
CHAFL--College Housing and Academic Facilities Loans
CHC--Community Health Center
CHGME--Children's Hospitals Graduate Medical Education
CJ--Congressional Justification of Estimates for
Appropriations Committees
CMS--Centers for Medicare and Medicaid Services
CNCS--Corporation for National and Community Service
CPB--Corporation for Public Broadcasting
CSAP--Center for Substance Abuse Prevention
CSAT--Center for Substance Abuse Treatment
CSBG--Community Services Block Grant
CSEOA--Community Service Employment for Older Americans
DOD--Department of Defense
DOL--Department of Labor
DRA--Delta Regional Authority
EBSA--Employee Benefits Security Administration
EEOICPA--Energy Employees Occupational Illness Compensation
Program Act
ERISA--Employee Retirement Income Security Act of 1974
ESEA--Elementary and Secondary Education Act
ETA--Employment and Training Administration
FDA--Food and Drug Administration
FEMA--Federal Emergency Management Agency
FIC--Fogarty International Center
FIE--Fund for the Improvement of Education
FIPSE--Fund for the Improvement of Postsecondary Education
FMCS--Federal Mediation and Coalition Service
FMSHRC--Federal Mine Safety and Health Review Commission
FTE--full-time equivalent
FWS--Federal Work Study
GAANN--Graduate Assistance in Areas of National Need
GAO--Government Accountability Office
GEAR UP--Gaining Early Awareness and Readiness for
Undergraduate Programs
HBCUs--Historically Black Colleges and Universities
HCFAC--Health Care Fraud and Abuse Control
HEA--Higher Education Act
HELP--Health, Education, Labor, and Pensions
HHS--Health and Human Services
HRSA--Health Resources and Services Administration
IC--Institute and Center
IDeA--Institutional Development Award
IDEA--Individuals with Disabilities Education Act
IES--Institute of Education Sciences
IMLS--Institute of Museum and Library Services
IOM--Institute of Medicine
LEA--local educational agency
LIHEAP--Low Income Home Energy Assistance Program
MACPAC--Medicaid and CHIP Payment and Access Commission
MCH--Maternal and Child Health
MedPAC--Medicare Payment Advisory Commission
MSHA--Mine Safety and Health Administration
NAEP--National Assessment of Educational Progress
NAGB--National Assessment Governing Board
NCATS--National Center for Advancing Translational Sciences
NCBDDD--National Center on Birth Defects and Developmental
Disabilities
NCES--National Center for Education Statistics
NCHS--National Center for Health Statistics
NCI--National Cancer Institute
NEI--National Eye Institute
NHGRI--National Human Genome Research Institute
NHLBI--National Heart, Lung, and Blood Institute
NIA--National Institute on Aging
NIAAA--National Institute on Alcohol Abuse and Alcoholism
NIAID--National Institute of Allergy and Infectious Disease
NIAMS--National Institute of Arthritis and Musculoskeletal
and Skin Diseases
NIBIB--National Institute of Biomedical Imaging and
Bioengineering
NICHD--Eunice Kennedy Shriver National Institute of Child
Health and Human Development
NIDA--National Institute on Drug Abuse
NIDCD--National Institute on Deafness and Other
Communication Disorders
NIDCR--National Institute of Dental and Craniofacial
Research
NIDDK--National Institute of Diabetes and Digestive and
Kidney Disease
NIDRR--National Institute on Disability and Rehabilitation
Research
NIEHS--National Institute of Environmental Health Sciences
NIGMS--National Institute of General Medical Sciences
NIH--National Institutes of Health
NIMH--National Institute of Mental Health
NIMHD--National Institute on Minority Health and Health
Disparities
NINDS--National Institute of Neurological Disorders and
Stroke
NINR--National Institute of Nursing Research
NLM--National Library of Medicine
NLRB--National Labor Relations Board
NSF--National Science Foundation
NSIP--Nutrition Services Incentives Program
NTID--National Technical Institute for the Deaf
NFP--Not-for-Profit
OAR--Office of AIDS Research
OCR--Office for Civil Rights
ODEP--Office of Disability Employment Policy
OFCCP--Office of Federal Contract Compliance Programs
OIG--Office of the Inspector General
OLMS--Office of Labor-Management Standards
OMB--Office of Management and Budget
OMH--Office of Minority Health
OMHA--Office of Medicare Hearings and Appeals
ONC--Office of the National Coordinator for Health
Information Technology
ORR--Office of Refugee Resettlement
ORWH--Office of Research on Women's Health
OSEP--Office of Special Education Programs
OSHA--Occupational Safety and Health Administration
OWCP--Office of Workers' Compensation Programs
OWH--Office of Women's Health
PAIMI--protection and advocacy for individuals with mental
illness
PATH--Projects for Assistance in Transition From
Homelessness
PBGC--Pension Benefit Guaranty Corporation
PHS--Public Health Service
PPH Fund--Prevention and Public Health Fund
PRNS--Programs of Regional and National Significance
PROMISE--Promoting School Readiness of Minors in SSI
RSA--Rehabilitation Services Administration
SAMHSA--Substance Abuse and Mental Health Services
Administration
SAPT--Substance Abuse Prevention and Treatment
SEA--State educational agency
SEOG--Supplemental Educational Opportunity Grant
SIG--School Improvement Grants
SPRANS--Special Projects of Regional and National
Significance
SSA--Social Security Administration
SSBG--Social Services Block Grant
SSI--Supplemental Security Income
STEM--science, technology, engineering, and mathematics
TB--tuberculosis
TBI--traumatic brain injury
TIF--Teacher Incentive Fund
TIVAS--Title IV Additional Servicers
UAC--unaccompanied alien children
UCEDD--University Center for Excellence in Developmental
Disabilities
UI--unemployment insurance
USAID--U.S. Agency for International Development
VETS--Veterans' Employment and Training Services
VISTA--Volunteers in Service to America
VR--Vocational Rehabilitation
WANTO--Women in Apprenticeship and Non-Traditional
Occupations
WHD--Wage and Hour Division
WIA--Workforce Investment Act
WIOA--Workforce Innovation and Opportunity Act
WIF--Workforce Innovation Fund
WISEWOMAN--Well-Integrated Screening and Evaluation for
Women Across the Nation

SUMMARY OF BUDGET ESTIMATES AND COMMITTEE RECOMMENDATIONS

For fiscal year 2019, the Committee recommends total budget
authority of $1,059,220,321,000 for the Departments of Labor,
Health and Human Services, and Education, and Related Agencies.
This amount includes $179,289,000,000 in current year
discretionary funding subject to discretionary spending caps
and $1,897,000,000 in cap adjustments for healthcare fraud and
abuse control, Unemployment Insurance Trust Fund program
integrity, and for program integrity at the Social Security
Administration, in accordance with the allocation for this
bill.
Fiscal year 2018 levels cited in this report reflect the
enacted amounts in Public Law 115-141, the Consolidated
Appropriations Act, 2018, adjusted for comparability where
noted.

OVERVIEW

The Labor, Health and Human Services, and Education, and
Related Agencies [Labor-HHS-Education] appropriations bill
constitutes the largest share of non-defense discretionary
spending, 30 percent of the total in fiscal year 2019. Total
spending in this bill subject to discretionary spending caps is
$2,189,000,000 above the comparable fiscal year 2018 level. In
addition, the bill includes $6,743,000,000 in spending offset
by savings from changes in mandatory programs, $28,613,000 less
than the fiscal year 2018 level. This funding level has
required the Committee to make difficult funding decisions and
consider the appropriate role and jurisdiction of Federal
programs. The priorities and considerations of the Committee in
developing this bill are summarized in the section below:

NATIONAL INSTITUTES OF HEALTH

The Committee recommendation includes $39,084,000,000 for
the NIH, an increase of $2,000,000,000 or 5.4 percent. The
Committee continues to prioritize funding for medical research
because it has provided millions of Americans and their
families with hope. NIH-funded research has raised life
expectancy and improved the quality of life for all Americans.
In addition, it has lowered healthcare costs and spurred
economic growth by supporting jobs in research and generating
biomedical innovations.
Over the past 4 years, funding for NIH has increased
$9,000,000,000 or 30 percent. This investment has nearly
quadrupled funding for Alzheimer's research, started the All of
Us precision medicine initiative, and targeted resources to
such revolutionary projects as the BRAIN Initiative, a
universal flu vaccine, and efforts to combat antibiotic
resistance. The National Academy of Sciences published a report
this year that showed that NIH funding contributed to every one
of the 210 new drugs approved by the Food and Drug
Administration [FDA] from 2010-2016. The Committee's commitment
to an increased investment in medical research has allowed the
best researchers in the country to have their research funded
to discover the next breakthrough.
Finally, in addition to supporting specific research
priorities, the Committee continues to place a high value on
support for all Institutes and Centers and allowing NIH to
maintain flexibility to pursue unplanned scientific
opportunities and address unforeseen public health needs. The
Committee recommendation is estimated to support over 11,400
new and competing grants in fiscal year 2019.

COMBATING OPIOID ABUSE

Opioid abuse and misuse continues to be a nationwide
epidemic. More than 11.0 million Americans abused prescription
opioids in 2016, the latest year recorded, and more than 42,000
individuals died that same year of an opioid overdose, more
than any year on record. Even more troubling, prescription
opioid abuse is a risk factor for heroin use, another form of
opioids. The Department of Health and Human Services reported
that nearly 80 percent of heroin users reported abusing
prescription opioids prior to heroin. To stop the spread of
further opioid abuse, the bill provides $3,722,000,000, an
increase of $3,452,000,000, or 1,275 percent, over the past 4
years, in discretionary funding to fight both prescription
opioid and heroin abuse:
State Opioid Response Grants.--The Committee provides
$1,500,000,000 for flexible grants dedicated to State responses
to opioid abuse, for a total of $3,000,000,000 over the past
two fiscal years. The bill continues the 15 percent set-aside
for States with the highest age-adjusted mortality rate related
to opioid use disorders as well as the $50,000,000 for grants
to Indian tribes or tribal organizations.
Centers for Disease Control and Prevention.--The Committee
includes $475,579,000 for improved prevention and surveillance
efforts in all 50 states. In addition, the Committee includes
$5,000,000 for a new initiative to address the alarming trend
of increased infectious diseases associated with the opioid
epidemic.
National Institutes of Health.--The Committee includes
$500,000,000 for research related to opioid addiction,
development of opioid alternatives, pain management, and
addiction treatment.
Community Health Centers.--The Committee provides
$200,000,000 for grants to expand services for the treatment,
prevention, and awareness of opioid abuse. This funding will
help health centers support 220,000 patients with accessing
substance abuse services.
Rural Opioid Workforce Initiative.--The Committee includes
$5,000,000 of the funds available for career and workforce
training services for the Appalachian Regional Commission [ARC]
and Delta Regional Authority [DRA] regions to assist
individuals affected by an opioid abuse disorder.
Certified Community Behavioral Health Clinics.--The bill
includes $150,000,000, an increase of $50,000,000, to provide
grants to clinics certified by their State to provide treatment
for those with mental health illness. The Committee expects
SAMHSA will continue to provide competitive grants to those
areas also impacted by the opioid crisis.
Plans of Infant Safe Care.--The Committee includes
$60,000,000 to States under the Child Abuse Prevention and
Treatment Act to help States develop and implement plans of
safe care and improve services for infants affected by
substance use disorder, and their families.
Preventive Services for Children At-Risk of Entering Foster
Care.--The Committee provides $20,000,000 in continued funding
for Kinship Navigator Programs. This program improves services
available to grandparents and other relatives taking primary
responsibility for children because the child's parent is
struggling with opioid addition or substance use disorder. The
recommendation also includes $20,000,000 for Regional
Partnership Grants and family-focused residential treatment
programs, to improve the coordination of services for children
and families affected by opioid and other substance use
disorders and help families remain together during treatment.
Funding for both of these programs will help build the
evidence-base of what works for children and families to
prevent children from entering the foster care system,
consistent with changes made in the Family First Prevention
Services Act.
In addition, States have access to the Substance Abuse
Prevention and Treatment Block Grant, funded at $1,858,079,000
in fiscal year 2019.

PROMOTING COLLEGE AFFORDABILITY AND COMPLETION

The Committee continues and builds on the significant
investments included last year to promote college affordability
and completion. These investments help students of all
backgrounds enter and complete college, further their post-
secondary education, develop the skills needed for the in-
demand jobs of today and the future, and graduate with less
debt.
Pell Grants.--The Committee increases the maximum Pell
grant award to $6,195 for the 2019-20 school year, an increase
of 1.6 percent, or $100. This is the second consecutive
increase in the discretionary maximum award, building on the 3
percent, $175, increase provided in fiscal year 2018. The
Committee recommendation also includes more than sufficient
funding to continue Year Round Pell, which will help
approximately one million students annually stay continuously
enrolled, complete their program faster, graduate with less
debt, and enter or re-enter the workforce sooner.
Campus-Based Student Aid Programs.--The Committee maintains
the significant increases in fiscal year 2018 by including
$1,130,000,000 for Federal Work Study and $840,000,000 for
Supplemental Educational Opportunity Grants. These programs
allow individual colleges and universities to allocate need-
based financial aid to students and design financial aid
packages that work best for them.
Federal TRIO Program.--The Committee includes
$1,010,000,000 for TRIO, which helps low-income and first-
generation students prepare for and complete college. This
maintains the significant investments in TRIO in recent years,
which has been increased by more than 20 percent since fiscal
year 2015.
Child Care Access Means Parents in School.--The Committee
recommendation includes $50,000,000 to help colleges and
universities meet the child care needs of students. This
maintains the almost tripling of funding for the program in
fiscal year 2018.
Public Service Loan Forgiveness [PSLF].--The Committee
recommendation includes $350,000,000, continuing the level of
funding and authority from fiscal year 2018, to address
eligibility issues in the PSLF program related to students
being enrolled in ineligible repayment plans. The additional
funding provided this year will ensure that even more students
can qualify for loan forgiveness under this program and reduces
concerns that funding availability would limit eligibility in
the immediate future.

STRENGTHENING THE WORKFORCE FOR A STRONGER ECONOMY

The U.S. economy continues to grow following the recession.
The national unemployment rate fell below 4 percent in April
2018 for the first time in 18 years, and the number of
underemployed and long-term unemployed workers has also
decreased. For its part, the Committee has recognized the
changing needs of employers and the evolving nature of the
workforce. In particular, the disparity between the skills job
seekers have and the skills employers need to fill available
positions, also known as the ``skills gap,'' can hinder
employers from expanding, innovating, and improving
productivity and limit workers' ability to obtain well-paying
jobs in in-demand industries. The Committee has provided
critical funding for workforce training and employment services
and has encouraged the Department of Labor to reduce
occupational barriers and prepare workers for in-demand
occupations.
Apprenticeship Grants.--The Committee recommendation
includes $160,000,000 for continued support for the
apprenticeship program created in fiscal year 2016. The
Committee continues to support the funding and development of
industry or sector partnerships as a means of closing the
skills gap and expanding apprenticeships in in-demand
industries.
WIOA State Grants.--The bill includes $2,789,832,000 for
employment training grants distributed by formula to States
under the Workforce Innovation and Opportunity Act. These
grants, which provide flexibility to State and local
governments to meet their own unique job training needs, form
the bedrock of the Federal workforce development effort.
Veterans Employment and Training Service.--The Committee
recommendation includes $300,041,000, for programs targeted
towards employment needs of recently separating service members
and veterans. Within this amount, the Committee includes
$50,000,000 to support the Homeless Veteran's Reintegration
Program [HVRP]. HVRP provides an array of specialized services
to help homeless veterans, such as job training, social
services, clothing, substance abuse treatment, transportation,
and housing referrals.
Occupational Licensing.--The Committee started an
initiative in 2016 to reduce barriers created by a lack of
interstate reciprocity for occupational licenses, for which the
Department of Labor is encouraged to continue to work with the
consortia of States, with technical and other types of
assistance, to evaluate and pursue cooperative approaches to
enhance reciprocity or portability of occupational licenses
across State lines. Such agreements would significantly ease
barriers to opportunity and reemployment for thousands of
Americans, especially for military spouses, dislocated workers
from various industries, and transitioning service members.
Governor's Statewide Reserve.--The bill continues to allow
the full 15 percent State training grant funding reserve for
governors to address a variety of statewide or regional
training needs, projects, expanded partnerships, emergency
response, and other services as needed throughout their State.
Targeted Youth Training.--The Committee maintains funding
from fiscal year 2018 for both the Job Corps and Youthbuild
programs to provide at-risk youth with the opportunity to gain
educational and occupational skills.
Career and Technical Education [CTE].--The Committee
recommendation includes $1,200,019,000 for CTE, the same as the
fiscal year 2018 level. This maintains the $75,000,000 increase
for CTE in fiscal year 2018 to help States develop, expand, and
improve their career and technical education programs in high
school and post-secondary settings, and create pathways
beginning in high-school to in-demand jobs and careers.
STEM Education.--The Committee recommendation includes
$65,000,000, an increase of $15,000,000, in dedicated funding
for STEM education, including computer science education,
through the Education Innovation and Research program. This
funding will expand access to high-quality STEM education for
students, including students in rural schools, and build on the
evidence-base of what works to improve student outcomes. In
addition to this dedicated funding, several other programs,
including formula grants to school districts through the
Student Support and Academic Enrichment program, which is
increased by $125,000,000, can also be used for STEM education
activities.

INCREASING ACCESS TO HIGH-QUALITY EARLY CHILDHOOD CARE AND EDUCATION

The Committee recommendation continues and expands record
increases in funding included in fiscal year 2018 to increase
access to high-quality early childhood care and education, and
help provide safe, affordable, stable, and quality child care
options for working families.
Child Care and Development Block Grant [CCDBG].--The fiscal
year 2018 Consolidated Appropriations Act included a
$2,370,000,000 increase for CCDBG, the largest 1 year increase
in the history of the program. The Committee recommendation
continues this funding in fiscal year 2019 which will help
States meet the requirements and goals of the CCDBG Act to
improve the health, safety, and quality of child care programs,
including increasing provider reimbursement rates, and expand
working families' access to child care.
Head Start.--The Committee recommendation includes an
increase of $250,000,000 including $215,000,000 to help all
Head Start programs keep up with rising costs, recruit and
retain high-qualified staff, and otherwise ensure the quality
of their programs, and $35,000,000 in additional funding to
extend the duration of Head Start services by increasing the
number of full day/full-year slots. This builds off of the
$610,000,000 increase provided for Head Start in fiscal year
2018, which also included funding to expand Early Head Start,
including through Early Head Start-Child Care Partnerships
which will be awarded early in calendar year 2019. Overall
since fiscal year 2015 funding for Head Start has increased
$1,515,000,000 or 18 percent.

RURAL AMERICA

Approximately 60.0 million people, or one in five
Americans, live in rural America. Rural communities face
obstacles, including access to healthcare and job
opportunities, unique and often significantly different than
those faced by urban and suburban communities. The Committee
continues its investments in programs throughout the bill that
target funding towards rural America and their specific needs.
Rural Health.--The Committee recommendation continues its
commitment to funding HRSA's rural health programs and includes
$318,794,000 for Rural Health programs, an increase of
$28,000,000 above fiscal year 2018. Included in that amount is
$20,000,000 to support underserved rural communities in the DRA
region identify and better address their healthcare needs and
to help small rural hospitals improve their financial and
operational performance.
Rural Communities Opioid Response.--While the opioid
epidemic has affected both urban and rural counties, the burden
in rural areas is significantly higher. Rural communities face
a number of challenges in gaining access to healthcare in
general, and substance abuse treatment in particular. CDC has
found that drug-related deaths are 45 percent higher in rural
communities, and that rural states are more likely to have
higher rates of overdose deaths. The Committee provides
$120,000,000 to address substance abuse, including opioid
abuse, and the overdose crisis in rural communities. Within the
funding provided, the Committee includes $20,000,000 for the
establishment of 3 rural centers of excellence on substance use
disorders to support the dissemination of best practices
related to the treatment for and prevention of substance use
disorders within rural communities. The centers will focus on
the current opioid crisis and developing methods to address
future substance use disorder epidemics. This funding, in
addition to the $100,000,000 provided last year, will continue
efforts to allow communities to develop plans to address local
needs. In addition, the Committee recommendation allows the
Department of Labor to use a portion of career and training
funding focused on the ARC and DRA regions to assist
individuals who are returning, entering, or seeking to maintain
participation in the workforce after being affected by an
opioid abuse disorder.
Telehealth.--The Committee continues to prioritize funding
for telehealth and the impact it has on access to care for
medically underserved and rural populations. The Committee
provides $25,500,000, an increase of $2,000,000, for the Office
for the Advancement of Telehealth [OAT]. Telehealth has become
an increasingly important program for patients in rural
communities to access specialty care.
Training Assistance to Appalachian Regional Commission
[ARC] and Delta Regional Authority [DRA] Regions.--The
Committee continues support for an initiative within the
Dislocated Worker National Reserve for reemployment and
training assistance to workers dislocated in rural areas of the
country hardest hit by the recession. The bill devotes
$30,000,000 to assist unemployed workers from any industry
within the ARC and DRA regions to adapt existing skills and
learn new ones demanded by growing industries.
Rural Education.--The Committee recommendation includes a
combined $250,000,000 increase for Title I Grants to LEAs and
Student Support and Academic Enrichment Grants, flexible
formula grants that allow school districts, including rural
districts, to decide how to best use limited resources to meet
the needs of their students. Further, the Committee
recommendation includes $180,840,000, the same as the fiscal
year 2018 level for the Rural Education program to specifically
address the need of small rural school districts and schools.
Finally, the Committee recommendation continues language
requiring the Department to prioritize rural communities as
part of all competitive grant programs, including funding for
STEM education and charter schools.
Rural Community Development Technical Assistance.--The
Committee recommendation includes $8,000,000, level with fiscal
year 2018, for training and technical assistance in developing
and maintaining safe drinking and waste water facilities to
very small rural communities that otherwise would not have
access to such assistance.

ALZHEIMER'S DISEASE

In 2018, Medicare and Medicaid will spend an estimated
$186,000,000,000 caring for those with Alzheimer's and other
dementias, 67 percent of total costs. It is the most expensive
disease in America. Without a medical breakthrough to prevent,
slow, or stop the disease, by 2050 the combined Medicare and
Medicaid spending on people with Alzheimer's disease will more
than quadruple.
Alzheimer's Research.--The Committee recommendation
includes an increase of $425,000,000 for Alzheimer's disease
research, bringing the total available in fiscal year 2019 to
approximately $2,340,000,000, a 22 percent increase above
fiscal year 2018. Over the last 4 years, funding for
Alzheimer's disease has increased $1,709,000,000, a 271 percent
increase.
Brain Research through Advancing Innovative
Neurotechnologies [BRAIN].--The Committee continues to strongly
support the BRAIN Initiative and provides $429,389,000 in
fiscal year 2019. This is an increase of $29,000,000 above
fiscal year 2018. The BRAIN Initiative is developing a more
complete understanding of brain function and has the
possibility of helping millions of people who suffer from a
wide variety of neurological and psychiatric disorders such as
Parkinson's disease, schizophrenia, Alzheimer's disease and
dementia, depression, and traumatic brain injury.
Alzheimer's Disease Program.--The Committee continues to
provide $23,500,000 in the Administration for Community Living
for the Alzheimer's Disease Program and maintains a streamlined
flexible program that will allow States, communities,
nonprofits, and Indian tribes greater access to funding
opportunities authorized under Title IV of the Older Americans
Act.
Alzheimer's and Healthy Aging.--The Committee provides a
$1,000,000 increase to continue supporting CDC activities
through the Healthy Brain road map for State and national
partnerships to monitor, evaluate, educate, and empower those
fighting Alzheimer's.
Caregivers.--At any given time, more than 15.0 million
Americans are providing informal care to an older relative with
dementia. However, dementia caregivers experience considerable
stress and depression; impaired subjective well-being, self-
efficacy, and physical health, and perhaps even increased
mortality. Studies have shown that coordinated support services
can reduce caregiver depression, anxiety, and stress, and
enable them to provide care longer, which avoids or delays the
need for costly institutional care. This bill provides funding
to a variety of programs to support caregivers, including
research at the National Institute on Aging, the Lifespan
Respite Care program, the National Family Caregiver Support
program, and new funding to begin the Family Caregiver Council
at the Administration for Community Living.

INVESTING IN PUBLIC HEALTH PREPAREDNESS

The Committee continues to invest in HHS programs that help
America's communities prepare for, respond to, and recover from
public health and medical disasters and emergencies. These
events include natural disasters, pandemic diseases, and man
made threats. Americans just experienced one of the deadliest
flu seasons on record, and with outbreaks in Ebola, Zika, and
recent natural disasters, the Committee believes it critical to
continue investments in this area. The Committee provides
$3,516,458,000 for HHS preparedness activities, a nearly 20
percent increase over the past 2 years. In fiscal year 2019,
the Committee provides:
Biomedical Advanced Research and Development Authority
[BARDA].--The Committee provides $561,700,000, an increase of
$25,000,000, to continue investments in developing late stage
medical countermeasures and leading efforts to develop
strategies to combat antibiotic resistant bacteria.
Project BioShield.--The Committee includes $735,000,000 for
Project BioShield, an increase of $25,000,000, to purchase
critical medical countermeasures, such as vaccines,
therapeutics, and diagnostics.
Public Health Emergency and Hospital Preparedness.--The
Committee provides $680,000,000 for CDC's Public Health
Emergency Preparedness program, an increase of $10,000,000, to
continue preparing communities and hospitals to respond to
public health emergencies.
Pandemic Influenza.--The Committee provides $285,000,000
for Pandemic Influenza within the Office of the Secretary, an
increase of $35,000,000, to improve the effectiveness of the
flu vaccine and better respond to late changes to flu strains.

IMPROVING FISCAL ACCOUNTABILITY

The Committee has an obligation to promote fiscal
accountability and the effective use of U.S. taxpayer funds.
The annual appropriations process affords Congress the
opportunity to continuously improve and refine how Government
works. Appropriations bills provide oversight of every
discretionary program, every year, which gives these bills the
unique ability to react to changing needs and unintended
consequences in the intervening years of an authorization bill.
Taxpayer Transparency.--U.S. taxpayers have a right to know
how the Federal Government is spending their hard-earned
taxpayer dollars--especially when that money is being spent on
advertising Federal programs. The Committee recommendation
continues a provision to promote Government transparency and
accountability by requiring Federal agencies funded in this act
to include disclaimers when advertising materials are paid for
with Federal funds. The Committee expects each agency to
include in their fiscal year 2020 CJ information detailing how
much funding was spent on advertising in fiscal year 2019.
Open Access to Federal Research.--The Committee has
received reports from the Office of Science and Technology
Policy [OSTP] on the progress of all Federal agencies in
developing and implementing policies to increase public access
to federally funded scientific research. The Committee commends
the agencies funded in this bill who have issued plans in
response to OSTP's policy directive issued in 2013. The
Committee urges the continued efforts towards full
implementation of the plan, and directs agencies to provide an
update on progress made in the fiscal year 2020 CJ. This will
ensure that the Committee remains apprised of the remaining
progress needed to make federally funded research accessible to
the public as expeditiously as possible.
Public Health Services Act [PHS] Evaluation Transfer.--The
Committee recommendation continues to ensure that in fiscal
year 2019, no funds will leave NIH via the transfer required by
section 241 of the PHS Act.

INCREASING THE EFFICIENCY AND COST EFFECTIVENESS OF GOVERNMENT

The Committee provides funding for a variety of activities
aimed at reducing fraud, waste, and abuse of taxpayer dollars.
These program integrity initiatives have proven to be a wise
Federal investment, resulting in billions of dollars of savings
each year. In addition, the Committee recommendation provides
direction to the Departments on opportunities to take action
where Federal programs are fragmented or duplicative. The bill
advocates that longstanding priority by reforming and
transforming government in many small ways, and several
initiatives to increase the efficiency and cost effectiveness
of Government, including:
Fighting Healthcare Fraud and Abuse.--The Committee
includes $765,000,000 for the Health Care Fraud and Abuse
Control program at CMS. The Committee notes that the latest
data demonstrates for every new $1.00 spent on fraud and abuse,
$2.00 is recovered by the U.S. Treasury.
Inspectors General.--The Committee recommendation provides
$440,284,000 for the Inspectors General funded in this act to
conduct additional audits and investigations of possible waste
and fraud in Government programs. The Committee appreciates the
strong working relationships between the Inspectors General and
the agencies they work with under this Committee's
jurisdiction. The Committee reiterates the strong expectation
that Inspectors General have timely and independent access to
all records, reports, audits, reviews, documents, papers,
recommendations, data and data systems, or other materials
related to their responsibilities under this act and under the
Inspector General Act of 1978. Further, the Committee also
expects that all agencies funded by this act treat electronic
data, records, and systems no differently than paper-based
records and files with respect to access by OIGs unless
particular electronic systems are clearly and explicitly
protected from Inspectors General access by statute.
Preventing Improper Social Security Payments.--The
Committee recommendation includes $1,683,000,000 for the Social
Security Administration to conduct continuing disability
reviews and SSI program redeterminations of non-medical
eligibility, and other program integrity efforts. Combined,
these activities are estimated to save over $9,000,000,000 over
10 years in taxpayer dollars by reducing waste, fraud, abuse,
and improper payments in the Social Security, Medicare, and
Medicaid programs.
Taxpayer Accountability.--Given the current fiscal
environment, it is imperative for Government agencies to
increase efficiencies, while fulfilling statutory requirements,
to maximize the effectiveness of agency programs. Since 2011,
GAO has published reports showing as many as 272 areas of
potential duplication and overlap. GAO has identified 792
actions to reduce, eliminate, or better manage fragmentation,
overlap, or duplication; achieve costs savings; or enhance
revenue. While GAO has noted that the Nation has achieved
$178,000,000,000 in savings based on these reports, many more
efficiencies may be realized. The Committee directed each
agency funded in the fiscal year 2018 bill to report to the
Committee, within 1 year of enactment, on all efforts made to
address the duplication identified by the annual GAO reports
along with identifying substantive challenges and legal
barriers to implementing GAO's recommendations, as well as
suggested legislative recommendations that could help the
agency to further reduce duplication. The Committee looks
forward to receiving the reports.
Tribal Coordination.--The Committee directs all Departments
with American Indian and Alaskan Native specific programs or
grants to coordinate with the Department of the Interior when
possible to ensure there is no overlap or duplication of
funding or services and to enhance the programs' effectiveness.
Unemployment Insurance Trust Fund Integrity.--The Committee
provides $150,000,000 for Reemployment Services and Eligibility
Assessments [RESEA] for fiscal year 2019. The RESEA program
provides for intensive, in-person attention from specialists in
the One-Stop career center system for individuals most likely
to exhaust unemployment compensation benefits, those with
particular barriers to reemployment, and others who have been
difficult to place. RESEA has significantly reduced the time
participating individuals must rely on unemployment
compensation payments and reduced the total amount of benefits
paid from the Unemployment Insurance Trust Fund. The program
has also shown the benefit of reducing improper payments to
ineligible claimants, thus helping protect the fiscal solvency
of the trust fund. The RESEA program is based on a service-
delivery model that has demonstrated a return of $2.60 in
savings for every $1.00 spent on the program.

BILL-WIDE DIRECTIVES

Children Exposed to Trauma.--The Committee notes that
childhood exposure to trauma, such as witnessing violence or
substance abuse, can result in negative health, education, and
employment outcomes, for which agencies funded in this bill
seek to address. The Committee encourages the Departments and
agencies funded in this bill to enhance coordination on
activities that address child trauma, and to disseminate and
promote through grant awards best practices for identifying,
referring, and supporting children exposed to trauma.
Congressional Budget Justifications.--Congressional
justifications are the primary tool used for the Committee to
evaluate budget requests, agency performance, and resource
requirements. The Committee expects the fiscal year 2020
congressional justifications to include sufficient detail to
justify all programs, projects, and activities contained in
each department, agency, board, corporation, or commission's
budget request. The justifications shall include a sufficient
level of detailed data, exhibits, and explanatory statements to
support the appropriations requests, including tables that
outline each agency's programs, projects, and activities for
fiscal years 2019 and 2020. Specifically, every bill and report
number included in either the House of Representatives or
Senate Appropriations bill or report or the final
appropriations bill or explanatory statement of the fiscal year
should be reflected within these justifications.
The Committee directs the chief financial officer of each
department, agency, board, corporation, or commission funded in
this Act's jurisdiction to ensure that adequate justification
is given to support each increase, decrease, and staffing
change proposed in the fiscal year 2020 budget. When requesting
additional resources, reduced funding, or eliminations of
programs, changes should be outlined with an adequate
justification. Should the final fiscal year 2019 appropriations
bill be enacted within a timeframe that does not allow it to be
reflected within the congressional justifications for fiscal
year 2020, the Committee directs each department, agency,
board, corporation, or commission funded in this act to submit
within 30 days of enactment updated information to the
Committee on funding comparisons to fiscal year 2019.

OTHER HIGHLIGHTS OF THE BILL

Children's Hospitals Graduate Medical Education [CHGME].--
The Committee recommendation includes $325,000,000 for CHGME,
an increase of $10,000,000 above fiscal year 2018. This funding
supports 58 freestanding children's teaching hospitals to
provide Graduate Medical Education for physicians.
Community Health Centers [CHC].--The Committee
recommendation includes $1,625,222,000 for CHC's, level with
fiscal year 2018. The Committee's recommendation is projected
to support 26.0 million patients and continues quality
improvement activities for more than 1,400 health centers
operating over 11,000 primary sites.
Corporation for National and Community Service.--The
Committee recommendation includes $415,010,000 for AmeriCorps
State and National Grants, an increase of $3,000,000, and
$32,000,000 for NCCC, $92,,364,000 for VISTA, and $202,117,000
for Senior Corps, all the same as the fiscal year 2018 funding
levels.
Corporation for Public Broadcasting.--The bill continues
advance funding in the amount of $445,000,000 for the
Corporation for Public Broadcasting and an additional
$20,000,000 to continue investments in system-wide
infrastructure and services, including the interconnection
project.
Domestic Violence Programs.--The Committee recommendation
includes $165,000,000, an increase of $5,000,000 for Family
Violence Prevention and Services programs, and $10,250,000, an
increase of $1,000,000, for the National Domestic Violence
Hotline.
Institute for Museum and Library Services [IMLS].--The
Committee recommendation includes $242,000,000 for IMLS, an
increase of $2,000,000 above fiscal year 2018. This funding
supports 123,000 libraries and 35,000 museums, ensuring that
all Americans have access to essential museum, library, and
information services.
Low Income Home Energy Assistance Program [LIHEAP].--The
Committee recommendation includes $3,690,304,000, an increase
of $50,000,000.
Medicare Appeals Backlog.--The Committee continues to be
concerned that the Office of Medicare Hearing and Appeals has a
current case backlog of approximately 500,000 cases. The bill
continues the investment provided in fiscal year 2018 and
expects that the Department will make significant progress in
addressing the backlog in the next few years.
Social Security Administration.--The Committee
recommendation includes $12,945,945,000 for SSAs administrative
expenses, an increase of $77,000,000. Accounting for one-time
funding provided for IT modernization efforts in fiscal year
2018, this increase will help SSA continue to improve service
to the public and work down backlogs in critical workloads.
Supporting Local Control and Investments in Elementary and
Secondary Education.--The Committee continues to prioritize
funding for elementary and secondary education programs that
provide the most flexibility for states, school districts,
schools, and parents to make education decisions impacting
students and families.
--$15,884,802,000, an increase of $125,000,000 for title I
grants to LEAs
--$1,225,000,000, an increase of $125,000,000 for title IV
Student Support and Academic Enrichment Grants
--$12,402,848,000, an increase of $125,000,000 for IDEA
Grants to States (Part B, Section 611)
--$1,439,112,000, an increase of $25,000,000 for Impact Aid
--$445,000,000, an increase of $45,000,000 for the Charter
Schools Program

TITLE I

DEPARTMENT OF LABOR

Any references in this title of the report to the
``Secretary'' or the ``Department'' shall be interpreted to
mean the Secretary of Labor or the Department of Labor,
respectively, unless otherwise noted.

Employment and Training Administration

TRAINING AND EMPLOYMENT SERVICES

Appropriations, 2018.................................... $3,486,200,000
Budget estimate, 2019................................... 3,220,549,000
Committee recommendation................................ 3,501,200,000

The Training and Employment Services account provides
funding primarily for activities under the Workforce Innovation
and Opportunity Act, and is a decentralized, integrated system
of skill training and related services designed to enhance the
employment and earnings of economically disadvantaged and
dislocated workers. Funds provided for many training programs
for fiscal year 2019 will support the program from July 1,
2019, through June 30, 2020. A portion of this account's
funding, $1,772,000,000, is available on October 1, 2019, for
the 2019 program year.
The Committee strongly encourages the Department to
continue to work with other Federal agencies to align and
streamline employment and training services. In cases where
legislation would be required to achieve these goals, the
President's budget request should include recommendations and
specific proposals for consolidation of programs.
Building a skilled workforce pipeline is critical to the
success of the American economy in the 21st Century. The
Committee encourages DOL to identify and invest in national
workforce development partnerships that target youth and teens
for soft-skills development, career exploration and exposure,
and on-the-job work experiences including internships, first
jobs, and pre-apprenticeships, to prepare youth for the jobs of
today and tomorrow. In building these partnerships, the
Committee encourages the Department to support organizations
with a national reach that serve both youth and teens, to
provide the maximum number of young people the opportunity to
build the skills necessary to be prepared for their future and
to be full participants in our economy. The Committee also
encourages DOL to support partnerships between workforce
investment boards and youth-serving organizations to further
address the skills gap.
The Committee encourages the Employment and Training
Administration to expand its collaborative work with the
Institute of Museum and Library Services to assist in the
implementation of WIOA to help States and local boards
integrate the education, employment, and training services
provided by public libraries into the workforce investment
system. The Committee also encourages ETA to continue to invest
in building and strengthening partnerships between the one-stop
system and public libraries by encouraging applicants for
competitive grant opportunities to collaborate with public
libraries.

Grants to States

The Committee recommends $2,789,832,000 for Training and
Employment Services Grants to States.
Under WIOA, a local board is given up to 100 percent
transfer authority between Adult and Dislocated Worker
activities upon approval of the Governor.
The Committee recommendation is consistent with the WIOA
authorization regarding the amount of WIOA State grant funding
that may be reserved by Governors.
Although the national unemployment rate hit an 18-year low
in May 2018, the Committee is concerned that unemployment
remains high in some States and regions around the Nation. WIOA
State grant funding continues to serve critical functions,
including to assist States that continue to experience high
unemployment and to address the disparity between the skills
job seekers have and the skills employers need to fill
available positions.
Adult Employment and Training.--For adult employment and
training activities, the Committee recommends $845,556,000.
Formula funding is provided to States and further
distributed to local workforce investment areas through one-
stop centers. The program provides employment and training
services to disadvantaged, low-skilled, unemployed, and
underemployed adults, including veterans.
Funds are made available in this bill for adult employment
and training activities in program year 2019, which occurs from
July 1, 2019, through June 30, 2020. The bill provides that
$133,556,000 is available for obligation on July 1, 2019, and
that $712,000,000 is available on October 1, 2019. Both
categories of funding are available for obligation through June
30, 2020.
Youth Training.--For youth training activities, the
Committee recommends $903,416,000. The purpose of this program
is to provide low-income youth facing barriers to employment
with services that prepare them to succeed in the knowledge-
based economy. Funds are made available for youth training
activities in program year 2019, which occurs from April 1,
2019, through June 30, 2020.
The Committee recognizes that employment between ages 14
and 24 can significantly improve adult employment outcomes,
including higher earnings, lower poverty rates, and better
overall health. Youth workforce development programs can also
decrease violent crime arrests among youth living in areas with
high rates of community violence. The Committee supports the
dedicated funding stream for these activities as authorized
under WIOA to ensure Federal job training support for out-of-
school and low-income, in-school youth.
Dislocated Worker Assistance.--For dislocated worker
assistance, the Committee recommends $1,040,860,000. This
program is a State-operated effort that provides training
services and support to help permanently separated workers
return to productive unsubsidized employment. In addition,
States must use State-wide reserve funds for rapid response
assistance to help workers affected by mass layoffs and plant
closures. States must also use these funds to carry out
additional State-wide employment and training activities such
as providing technical assistance to certain low-performing
local areas, evaluating State programs, and assisting with the
operation of one-stop delivery systems. States may also use
funds for implementing innovative training programs.
Funds made available in this bill support activities in
program year 2019, which occurs from July 1, 2019, through June
30, 2020. The bill provides that $180,860,000 is available for
obligation on July 1, 2019, and that $860,000,000 is available
on October 1, 2019. Both categories of funding are available
for obligation through June 30, 2020.
The Committee is aware of allegations that federally-funded
local workforce development boards in Florida were improperly
reporting inflated job placement numbers. The Committee
understands the Department is investigating the allegations and
requests a briefing upon conclusion of the investigation. The
Committee also encourages the Department to take action to
ensure that there are sufficient practices in place to deter
fraud and abuse in workforce development boards receiving
Federal funding through WIOA.

Federally Administered Programs

Dislocated Worker Assistance National Reserve.--The
Committee recommends $220,859,000 for the Dislocated Worker
Assistance National Reserve, which is available to the
Secretary for activities such as responding to mass layoffs,
plant and/or military base closings, and natural disasters that
cannot be otherwise anticipated, as well as for technical
assistance, training, and demonstration projects.
Funds made available for the National Reserve in this bill
support activities in program year 2019. The bill provides that
$20,859,000 is available for obligation on July 1, 2019, and
that $200,000,000 is available on October 1, 2019. Both
categories of funding are available for obligation through
September 30, 2020.
The Committee bill makes $30,000,000 available for
obligation on October 1, 2018, through September 30, 2020, to
provide enhanced dislocated worker training to promote economic
recovery in the Appalachian and Delta regions. The initiative
will include projects for dislocated workers within the Delta
Regional Authority [DRA] and Appalachian Regional Commission
[ARC] areas. These regions have been particularly hard hit by
industrial downsizing and closures, and funding is provided to
target these underserved areas. The Department is strongly
urged to engage proactively with Workforce Development Boards
and other appropriate entities at the State and local levels,
including those typically involved in applying for and
administering National Dislocated Worker Grants or Dislocated
Worker demonstration projects to ensure that they are aware of
the availability of the targeted funds so they will be sought
and utilized promptly and effectively to assist workers in
areas hardest hit by job loss. The Department, DRA, and ARC are
directed to jointly continue to update the Committee quarterly
on the community engagement and progress made on this program
until all funds are expended.
In addition, the Committee directs the Department to use at
least $5,000,000 of the funds made available for the DRA and
ARC areas for projects to provide career and training services
to assist individuals who have been affected by an opioid or
other substance use disorder and who are returning, entering,
or seeking to maintain participation in the workforce. The
career and training services supported by these funds should be
reflective of allowable services described in the Training and
Employment Guidance Letter No. 19-16. In awarding the funds,
the Committee encourages the Department to give priority to
States with the highest age-adjusted mortality rate related to
opioid overdose deaths.
The Committee encourages the Department to use funds
provided to carry out sections 168(b) and 169(c) of WIOA, which
may be used for technical assistance and demonstration
projects, to support demonstration programs that allow at-risk
youth who are out-of-school and have limited work experience to
participate in the workforce.
Advances in automation and artificial intelligence have the
potential to alter the workplace. These changes in the nature
of work will require new approaches to job training. The
Committee encourages DOL to support demonstration projects on
workforce development activities that will assist workers in
sectors, particularly in transportation, most at risk of job
dislocation due to automation and artificial intelligence. The
Committee requests a briefing not later than 120 days after
enactment of this act regarding how DOL is assessing and
addressing the needs of the workforce most at risk of
dislocation.
Indian and Native American Programs.--The Committee
recommends $54,000,000 for Indian and Native American Programs.
These programs are designed to improve the academic,
occupational, and literacy skills of Native Americans, Alaskan
Natives, and Native Hawaiians to aid the participants in
securing permanent, unsubsidized employment. Allowable training
services include adult basic education, GED attainment,
literacy training, English language training, as well as the
establishment of linkages with remedial education.
The Committee directs the Department to obligate funding at
the authorized levels for activities pursuant to section 166(k)
of subtitle D of title I of the WIOA.
Migrant and Seasonal Farmworker Programs.--The Committee
recommends $87,896,000 for migrant and seasonal farmworkers
programs, which serve members of economically disadvantaged
families whose principal livelihood is derived from migratory
and other forms of seasonal farm work, fishing, or logging
activities. Enrollees and their families are provided with
employment, training, and related services intended to prepare
them for stable, year-round employment within and outside of
the agriculture industry.
The Committee recommendation provides that $81,447,000 be
used for State service area grants. The Committee
recommendation also includes bill language directing that
$5,922,000 be used for migrant and seasonal farmworker housing
grants, of which not less than 70 percent shall be for
permanent housing. The principal purpose of these funds is to
continue the network of local farmworker housing organizations
working on permanent housing solutions for migrant and seasonal
farmworkers. The Committee recommendation also includes
$527,000 to be used for section 167 training, technical
assistance, and related activities, including funds for migrant
rest center activities.
YouthBuild.--The Committee supports the YouthBuild program
and recommends $89,534,000 to support its work to target at-
risk high school dropouts and prepare them with the skills and
knowledge they need to succeed in a knowledge-based economy.
The Committee is aware of the OIG findings (Report 04-18-
002-03-001) that YouthBuild grantees did not adequately comply
with standards set by the Department when reporting program
outcomes. Given the enactment of WIOA, the Committee encourages
the Department to clarify the program criteria for YouthBuild
grantees.

National Activities

Reintegration of Ex-Offenders.--The Committee recommends
$93,079,000 for the Reintegration of Ex-Offenders program. The
Reintegration of Ex-Offenders program helps prepare and assist
adult ex-offenders return to their communities through pre-
release services, mentoring, and case management. The program
also provides support, opportunities, education, and training
to youth who are involved in court and on probation, in
aftercare, on parole, or who would benefit from alternatives to
incarceration or diversion from formal judicial proceedings.
Programs are carried out directly through State and local
governmental entities and community based organizations, as
well as indirectly through intermediary organizations. States
are encouraged to continue to support reintegration efforts for
ex-offenders with resources available through the comprehensive
workforce development investment system. The Committee directs
the Department to use funding to support efforts in high-crime,
high-poverty areas and, in particular, communities that are
seeking to address relevant impacts and root causes of civil
unrest and high levels of community violence.
Evaluation.--The bill continues to use a set-aside funding
mechanism to support the evaluation of employment and training
programs. Instead of directly providing funds for evaluation,
the Committee recommendation supports evaluation activities
through a 0.75 percent set-aside on all training and employment
programs, including the WIOA formula programs, Job Corps,
Community Service Employment for Older Americans, the
Employment Service, and others. The set-aside approach ensures
that sufficient funding is available to carry out comprehensive
evaluation and applied research activities.
ETA will continue to conduct evaluation and applied
research activities in consultation with the Department's chief
evaluation officer, who oversees the evaluation program.
Results will inform policy, advance the Department's mission,
and improve its performance-based management initiatives.
Workforce Data Quality Initiative.--The Committee
recommends $6,000,000 for the Workforce Data Quality
Initiative. Funds are used to assist States with incorporating
comprehensive workforce information into longitudinal data
systems being developed in part with the support of funding
provided by the Department of Education. The initiative is also
intended to help improve the quality and accessibility of
performance data being produced by training providers.
Apprenticeship Grants.--The recommendation includes
$160,000,000, an increase of $15,000,000, for continued support
for the apprenticeship program that the Committee created in
fiscal year 2016. This funding shall be for making competitive
contracts and to continue funding grants to States and industry
partnerships. The Department is directed to ensure approval of
apprenticeship opportunities that engage, recruit, and serve
women and other under-represented populations and local
communities that have high rates of unemployment and high
levels of community violence. The Committee also directs the
Department to use funding to support economic development
strategies that generate new or leverage existing employer
demand for apprenticeships. The Committee also directs the
Department to collaborate with the DRA to develop a targeted
apprenticeship and job training program to meet the unique
needs of underserved rural communities in this region. The
Committee recognizes the role that sector partnerships play in
organizing key stakeholders in an industry cluster to address
the shared goals and human resources needs of the industry
cluster. The Committee supports the funding and development of
industry or sector partnerships as a means of closing the
skills gap and expanding apprenticeships in in-demand
industries. The Committee is aware that Apprenticeship State
Expansion grants have been used to positive effect in States
with high unemployment. The Department is encouraged to
prioritize the provision of grants to States with high
unemployment and long-standing and effective partnerships
between job training programs and employers who seek well-
qualified employees in the healthcare, maritime, construction,
and oil & gas industries. The Committee directs the Office of
Apprenticeship to work with Congress to take steps to broaden
the availability of apprenticeship opportunities by including
non-traditional programs, such as craft-training programs and
programs certified by the National Center for Construction
Education and Research.

JOB CORPS

Appropriations, 2018.................................... $1,718,655,000
Budget estimate, 2019................................... 1,296,938,000
Committee recommendation................................ 1,718,655,000

The recommendation for operations of Job Corps centers is
$1,603,325,000.
The Committee remains concerned about the issue of student
safety on Job Corps campuses across the country and recognizes
the Department has taken important steps toward addressing
these issues. The Committee strongly urges the Department to
continue corrective actions to ensure the safety of students
and staff.
Job Corps Enrollment.--The Committee recognizes Job Corps
plays a critical role in providing tens of thousands of
underserved youth the skills they need to secure employment in
high-growth industries. The Committee understands that in
recent years student enrollments in Job Corps have decreased
resulting in unused capacity. This decrease has occurred even
while it is estimated that nearly 5,000,000 young Americans are
neither employed nor enrolled in school and likely eligible for
Job Corps. The Committee directs the Department to provide
quarterly accountability reports regarding the number of calls
to Job Corps' national enrollment hotline, the on-board
strength of each Job Corps center, and the investments and
steps Job Corps has made to improve both enrollment and on-
board strength.
The Committee recommendation for administrative costs is
$32,330,000.
The Committee also recommends a total of $83,000,000 in
construction, renovation, and acquisition [CRA] funds. This
amount is available from July 1, 2019, to June 30, 2020. The
Committee continues bill language allowing the Secretary to
transfer up to 15 percent of CRA funds, if necessary, to meet
the operational needs of Job Corps centers or to achieve
administrative efficiencies. The bill continues to require the
Secretary to notify the Committees on Appropriations of the
House of Representatives and the Senate at least 15 days in
advance of any transfer. The Committee expects any notification
to include a justification.
The Committee reminds the Department of the directive
included in the Joint Explanatory Statement accompanying the
Consolidated Appropriations Act, 2018, to support and
incentivize center operators to build and enhance partnerships
between centers and other training sites to enhance opportunity
and work experiences for students in underserved rural or
remote communities as well as urban settings, with a priority
for communities that have experienced Job Corps center
closures.
Gulfport Job Corps Center.--The Committee continues to be
encouraged by the progress made toward rebuilding the Gulfport
Job Corps Center, including the completion of the ``Scope of
Work'' for the design phase of the project and the issuance of
a Request for Proposal for architecture and engineering
services. The Committee expects this proposal will be
expeditiously awarded. The Committee expects the Department to
remain diligently committed to ensuring that the Center is
fully rebuilt and able to return to serving the number of young
people that it once served while, in the meantime, reserving
sufficient funds for the restoration of the facility consistent
with the expectations of the Committee. The Committee continues
to direct the Department to prioritize the Gulfport Job Corps
Center among pending construction cases in the CRA Account. The
Committee requests to be updated every 30 days regarding
progress on this project.

COMMUNITY SERVICE EMPLOYMENT FOR OLDER AMERICANS

Appropriations, 2018.................................... $400,000,000
Budget estimate, 2019...................................................
Committee recommendation................................ 400,000,000

Community Service Employment for Older Americans [CSEOA]
provides part-time employment in community service activities
for unemployed, low-income persons aged 55 and older. The
Committee recommendation includes $400,000,000 for CSEOA.

FEDERAL UNEMPLOYMENT BENEFITS AND ALLOWANCES

Appropriations, 2018.................................... $790,000,000
Budget estimate, 2019................................... 790,000,000
Committee recommendation................................ 790,000,000

The Committee recommendation includes mandatory funds for
the Federal unemployment benefits and allowances program that
assists trade-impacted workers with benefits and services to
upgrade skills and retrain in new careers. These benefits and
services are designed to help participants find a path back
into middle-class jobs, improve earnings, and increase
credential and education rates. The Committee recommendation
provides for the full operation of the Trade Adjustment Act
program in fiscal year 2019 consistent with current law.
The Trade Adjustment Assistance [TAA] program provides
assistance to workers who have been adversely affected by
international trade. TAA provides benefits and services to
those who qualify, to include: job training, job search and
relocation allowances, and wage supplements for workers age 50
and older.

STATE UNEMPLOYMENT INSURANCE AND EMPLOYMENT SERVICE OPERATIONS

Appropriations, 2018.................................... $3,464,691,000
Budget estimate, 2019................................... 3,325,298,000
Committee recommendation................................ 3,339,010,000

The Committee recommendation includes $3,254,944,000
authorized to be drawn from the Employment Security
Administration account of the Unemployment Trust Fund and
$84,066,000 to be provided from the general fund of the
Treasury.
The funds in this account are used to provide
administrative grants and assistance to State agencies that
administer Federal and State unemployment compensation laws and
operate the public employment service. The account is workload
based, and due to the improving economy, fewer unemployment
applications are being processed. Therefore less funding is
required for this purpose as reflected in the bill.
The Committee recommends a total of $2,527,816,000 for UI
activities. For UI State operations, the Committee recommends
$2,515,816,000. Of these funds, the Committee includes
$150,000,000 to expand intensive, individualized reemployment
assistance and to help address and prevent long-term
unemployment and reduce improper payments through the
Reemployment Services and Eligibility Assessments [RESEA]
initiative. This includes $117,000,000 in base funding and
$33,000,000 in cap adjustment funding allowed under the
Bipartisan Budget Act of 2018.
As State consortia continue work to modernize their UI
information technology systems, the Committee expects the
Department will continue to closely support and oversee the
consortia's efforts and to keep the Committee informed on how
funds are utilized and progress on system development.
The Committee recommendation includes $9,000,000 for the UI
Integrity Center of Excellence, including supporting an
integrated data hub, training modules, and data analytics
capacity to help States reduce fraud.
The Committee recommendation provides for a contingency
reserve amount should the unemployment workload exceed an
average weekly insured claims volume of 2,030,000.
The Committee recommends $12,000,000 for UI national
activities, which will support activities that benefit the
entire Federal-State UI system, including supporting the
continuation of IT upgrades and technical assistance.
For the Employment Service allotments to States, the
Committee recommends $666,413,000. This amount includes
$21,413,000 in general funds together with an authorization to
spend $645,000,000 from the Employment Security Administration
account of the Unemployment Trust Fund.
The Committee also recommends $19,818,000 for Employment
Service national activities. The administration of the work
opportunity tax credit program accounts for $18,485,000 of the
recommended amount; the remainder is for technical assistance
and training to States.
For carrying out the Department's responsibilities related
to foreign labor certification activities, the Committee
recommends $48,028,000. In addition, 5 percent of the revenue
from H-1B fees is available to the Department for costs
associated with processing H-1B alien labor certification
applications, and $14,282,000, the same as the fiscal year 2018
enacted level, is available for related State grants.
The Committee remains concerned about efficient, effective
management of the H-2B and H-2A programs. Processing delays in
the past 2 years have degraded the effectiveness of the
programs for those who depend on them for meeting short-term,
seasonal surges in demand. Authority was included in fiscal
year 2018 to utilize H-1B fee receipts through fiscal year 2019
to augment processing capacity. This short-term authority was
intended to prevent excessive labor certification and wage
determination delays while the Department develops improved
administrative procedures for the longer term. The Committee
expects the Department to provide timely updates about the use
of the fee authority and Department's longer-term plans to
improve the efficiency of these programs.
In fiscal year 2017, the Committee urged the Department to
engage with all stakeholders to assess the impacts of the H-2B
mobile housing policy in industries requiring a mobile
workforce found in the 2015 Interim Final Rule [IFR]. The
Committee is aware that the Department has not fully assessed
the impacts of the housing policy outlined in the IFR in
industries requiring a mobile workforce. The Department is
directed to provide the Committee with a detailed report within
120 days of enactment with an assessment of the impacts of the
housing policy in industries requiring a mobile workforce, a
justification for the housing policy, and details regarding any
consultation with industries requiring a mobile workforce.
In the determination of prevailing wage for the purposes of
the H-2B program, the Secretary shall accept private wage
surveys even in instances where Occupational Employment
Statistics [OES] survey data are available unless the Secretary
determines that the methodology and data in the provided survey
are not statistically supported. The bill continues general
provisions related to enforcement of H-2B regulations.
For one-stop career centers and labor market information,
the Committee recommends $62,653,000.
Occupational Licensing.--The Committee has provided
$17,500,000 since fiscal year 2016 to establish occupational
licensing grants for State consortia to identify, explore, and
address areas where licensing requirements create an
unnecessary barrier to labor market entry or labor mobility
across State lines. The Committee appreciates the Secretary's
support of pursuing cooperative approaches to reduce barriers
to employment for thousands of Americans, especially for
military spouses, dislocated workers, and transitioning service
members. The Committee appreciates the Department's recent
report and looks forward to additional updates on the progress
and outcomes of the occupational licensing initiative.

ADVANCES TO THE UNEMPLOYMENT TRUST FUND AND OTHER FUNDS

The Committee bill continues language providing such sums
as necessary in mandatory funds for this account. The
appropriation is available to provide advances to several
accounts for purposes authorized under various Federal and
State unemployment compensation laws and the Black Lung
Disability Trust Fund, whenever balances in such accounts prove
insufficient.

PROGRAM ADMINISTRATION

Appropriations, 2018.................................... $158,656,000
Budget estimate, 2019................................... 154,265,000
Committee recommendation................................ 158,656,000

The Committee recommendation of $158,656,000 for program
administration includes $108,674,000 in general funds and
$49,982,000 from the Employment Security Administration account
of the Unemployment Trust Fund.
General funds in this account pay for the Federal staff
needed to administer employment and training programs under
WIOA, Older Americans Act [OAA], the Trade Act of 1974, and the
National Apprenticeship Act. Trust funds provide for the
Federal administration of employment security, training and
employment, and executive direction functions.

Employee Benefits Security Administration

SALARIES AND EXPENSES

Appropriations, 2018.................................... $181,000,000
Budget estimate, 2019................................... 189,500,000
Committee recommendation................................ 186,500,000

The Committee recommends $186,500,000 for the Employee
Benefits Security Administration. EBSA is responsible for the
enforcement of title I of ERISA in both civil and criminal
areas and for enforcement of sections 8477 and 8478 of the
Federal Employees' Retirement Security Act of 1986. EBSA
administers an integrated program of regulation, compliance
assistance and education, civil and criminal enforcement, and
research and analysis. Bill language continues to allow EBSA to
obligate up to $3,000,000 for two fiscal years, as proposed in
the budget. The authority will be useful in situations where
services may be needed for cases extending beyond the end of
the fiscal year.
The Committee understands there has been an increase in
enforcement actions taken by the Department against employee
stock ownership plan [ESOP] companies. Congress has encouraged
the creation and operation of ESOPs since 1973, including a
section of the Tax Reform Act of 1976, which declared ESOPs
strengthen the free enterprise system The Committee requests a
report on the reasons for the increased enforcement actions in
the fiscal year 2020 CJ.
The Committee recommendation includes an increase of
$5,500,000 for the update and replacement components of the
ERISA Filing Acceptance System, EFAST, as requested by the
Department.

Pension Benefit Guaranty Corporation

The Pension Benefit Guaranty Corporation's estimated
obligations for fiscal year 2019 include single-employer
benefit payments of $7,212,000,000, multi-employer financial
assistance of $204,000,000, and consolidated administrative
expenses of $445,363,000. Administrative expenses are comprised
of three activities: pension insurance activities, pension plan
termination expenses, and operational support. These
expenditures are financed by permanent authority. Previously,
the Committee accepted the PBGC's proposal to reform the
previous administrative apportionment classifications from
three budget activities to one budget activity to make
operations more efficient and improve stewardship of resources.
That consolidated approach for the three activities is
continued, but PBGC is directed to continue providing detail
every year on the three activities in its annual CJ.
The PBGC is a wholly owned Government corporation
established by ERISA. The law places it within DOL and makes
the Secretary the chair of its board of directors. The
Corporation receives its income primarily from insurance
premiums collected from covered pension plans, assets of
terminated pension plans, collection of employer liabilities
imposed by the act, and investment earnings. The primary
purpose of the PBGC is to guarantee the payment of pension plan
benefits to participants if covered defined benefit plans fail
or go out of existence.
The bill continues authority for a contingency fund for the
PBGC that provides additional administrative resources when the
number of participants in terminated plans exceeds 100,000.
When the trigger is reached, an additional $9,200,000 becomes
available through September 30, 2020, for every 20,000
additional participants in terminated plans. The Committee bill
also continues authority allowing the PBGC additional
obligation authority for unforeseen and extraordinary pre-
termination expenses, after approval by OMB and notification of
the Committees on Appropriations of the House of
Representatives and the Senate.

Wage and Hour Division

SALARIES AND EXPENSES

Appropriations, 2018.................................... $227,500,000
Budget estimate, 2019................................... 230,068,000
Committee recommendation................................ 229,000,000

The Committee recommends $229,000,000 for the Wage and Hour
Division.
WHD is responsible for administering and enforcing laws
that provide minimum standards for wages and working conditions
in the United States. The Fair Labor Standards Act, employment
rights under the Family and Medical Leave Act, and the Migrant
and Seasonal Agricultural Worker Protection Act are several of
the important laws that WHD is charged with administering and/
or enforcing.
The Committee directs WHD to submit a report to the
Committee no later than 12 months after the date of this act
detailing the outcomes of the Payroll Audit Independent
Determination pilot program. The report shall include, at
minimum, the number of employers that voluntarily participated
in the program, the number of and reason employers were denied
participation, and the amount of back wages paid back to
employees.

Office of Labor-Management Standards

SALARIES AND EXPENSES

Appropriations, 2018.................................... $40,187,000
Budget estimate, 2019................................... 46,634,000
Committee recommendation................................ 40,187,000

The Committee recommends $40,187,000 for the Office of
Labor-Management Standards.
OLMS administers the Labor-Management Reporting and
Disclosure Act of 1959 and related laws. These laws establish
safeguards for union democracy and financial integrity. They
also require public disclosure by unions, union officers,
employers, and others. In addition, the Office administers
employee protections under federally sponsored transportation
programs.

Office of Federal Contract Compliance Programs

SALARIES AND EXPENSES

Appropriations, 2018.................................... $103,476,000
Budget estimate, 2019................................... 91,100,000
Committee recommendation................................ 103,476,000

The Committee recommends $103,476,000 for the Office of
Federal Contract Compliance Programs.
This Office protects workers and potential employees of
Federal contractors from employment discrimination prohibited
under Executive Order 11246, section 503 of the Rehabilitation
Act of 1973, and the Vietnam Era Veterans' Readjustment
Assistance Act of 1974.

Office of Workers' Compensation Programs

SALARIES AND EXPENSES

Appropriations, 2018.................................... $117,601,000
Budget estimate, 2019................................... 115,282,000
Committee recommendation................................ 117,601,000

The Committee recommends $117,601,000 for the Office of
Workers' Compensation. The bill provides authority to expend
$2,177,000 from the special fund established by the Longshore
and Harbor Workers' Compensation Act.
OWCP administers four distinct compensation programs: the
Federal Employees' Compensation Act [FECA], the Longshore and
Harbor Workers' Compensation Act, the Black Lung Benefits
programs, and the Energy Employees Occupational Illness
Compensation Program. In addition, OWCP houses the Division of
Information Technology Management and Services.
Special Benefits for Disabled Coal Miners and Black Lung
Disability Trust Fund.--The Committee notes that the decline in
appropriations for the Special Benefits for Disabled Coal
Miners [SBDCM] is a result of the significantly increased use
of unobligated balances to meet its obligations to
beneficiaries. The Committee believes OWCP should take no
action that could potentially disrupt the ability of the
program to ensure all beneficiaries receive promised benefits.
The Committee directs the Secretary to include in annual CJs
the number of beneficiaries, total benefit payments and
budgetary resources and expenditures within the SBDCM program
dating back at least 5 years. The Committee also notes that the
decline in appropriations for the Black Lung Disability Trust
Fund [BLDTF] corresponds with an estimated decline in the
Fund's Payment toward Bond Interest, slightly offset by an
increase in the Payment of Interest on Advances. The Committee
directs the Secretary to include in its annual CJ a detailed
explanation of changes in interest costs and the impact on the
BLDTF.

SPECIAL BENEFITS

Appropriations, 2018.................................... $220,000,000
Budget estimate, 2019................................... 230,000,000
Committee recommendation................................ 230,000,000

The Committee recommends $230,000,000 for this account.
This mandatory appropriation, which is administered by OWCP,
primarily provides benefits under FECA.
The Committee continues to provide authority to require
disclosure of Social Security numbers by individuals filing
claims under FECA or the Longshore and Harbor Workers'
Compensation Act and its extensions.
The Committee continues language that provides authority to
use FECA funds to reimburse a new employer for a portion of the
salary of a newly reemployed injured Federal worker. FECA funds
will be used to reimburse new employers during the first 3
years of employment, not to exceed 75 percent of salary in the
worker's first year, and declining thereafter.
The Committee continues language that allows carryover of
unobligated balances to be used in the following year and that
provides authority to draw such sums as are needed after August
15 to pay current beneficiaries. Such funds are charged to the
subsequent year appropriation.
The Committee continues language to provide authority to
deposit into the special benefits account of the employees'
compensation fund those funds that the Postal Service, the
Tennessee Valley Authority, and other entities are required to
pay to cover their fair share of the costs of administering the
claims filed by their employees under FECA.
Finally, the Committee maintains language consistent with
long-standing interpretations and implementation of this
appropriation stating that, along with the other compensation
statutes already specifically enumerated, the appropriation is
used to pay obligations that arise under the War Hazards
Compensation Act, and the appropriation is deposited in the
Employees' Compensation Fund and assumes its attributes, namely
availability without time limit as provided by 5 U.S.C. section
8147.

SPECIAL BENEFITS FOR DISABLED COAL MINERS

Appropriations, 2018.................................... $54,319,000
Budget estimate, 2019................................... 10,319,000
Committee recommendation................................ 10,319,000

The Committee recommends a mandatory appropriation of
$10,319,000 in fiscal year 2019 for special benefits for
disabled coal miners. This is in addition to the $15,000,000
appropriated last year as an advance for the first quarter of
fiscal year 2019, for a total program level of $25,319,000 in
fiscal year 2019. The decrease in this account below the fiscal
year 2018 level reflects a declining beneficiary population.
These mandatory funds are used to provide monthly benefits
to coal miners disabled by black lung disease and their widows
and certain other dependents, as well as to pay related
administrative costs.
The Committee also recommends an advance appropriation of
$14,000,000 for the first quarter of fiscal year 2020. These
funds will ensure uninterrupted benefit payments to coal
miners, their widows, and dependents.

DIVISION OF ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION

SALARIES AND EXPENSES

Appropriations, 2018.................................... $59,846,000
Budget estimate, 2019................................... 59,098,000
Committee recommendation................................ 59,098,000

The Committee recommends $59,098,000 for the Division of
Energy Employees Occupational Illness Compensation. This is a
mandatory appropriation.
The Division administers the Energy Employees Occupational
Illness Compensation Program Act, which provides benefits to
eligible employees and former employees of the Department of
Energy [DOE], its contractors and subcontractors, or to certain
survivors of such individuals. The mission also includes
delivering benefits to certain beneficiaries of the Radiation
Exposure Compensation Act. The Division is part of OWCP.
In fiscal year 2019, the volume of incoming claims under
part B of EEOICPA is estimated at about 5,207 from DOE
employees or survivors and private companies under contract
with DOE, who suffer from a radiation-related cancer,
beryllium-related disease, or chronic silicosis as a result of
their work in producing or testing nuclear weapons.
Under part E, approximately 4,738 new claims will be
received during fiscal year 2019. Under this authority, the
Department provides benefits to eligible DOE contractor
employees who were found to have work-related occupational
illnesses due to exposure to a toxic substance at a DOE
facility, or to the employees' survivors.
The Committee is concerned that positions remain vacant on
the Advisory Board on Toxic Substances and Worker Health. The
Committee directs the Department to ensure the Board has
sufficient funding and staffing to meet its obligations as
defined by the EEOICPA.

BLACK LUNG DISABILITY TRUST FUND

Appropriations, 2018.................................... $416,561,000
Budget estimate, 2019................................... 328,182,000
Committee recommendation................................ 328,182,000

The Committee bill provides an estimated $328,182,000 as
requested for this mandatory appropriations account. This
estimate is comprised of $70,926,000 for administrative
expenses and an estimated $257,256,000 for benefit payment and
interest costs.
The Committee bill continues to provide indefinite
authority for the Black Lung Disability Trust Fund to provide
for benefit payments. In addition, the bill provides for
transfers from the trust fund for administrative expenses for
the following Department agencies as requested: up to
$38,246,000 for the part C costs of the Division of Coal Mine
Workers' Compensation Programs; up to $31,994,000 for
Departmental Management, Salaries and Expenses; and up to
$330,000 for Departmental Management, Inspector General. The
bill also allows a transfer of up to $356,000 for the
Department of the Treasury.
The Trust Fund pays all black lung compensation/medical and
survivor benefit expenses when no responsible mine operation
can be assigned liability for such benefits or when coal mine
employment ceased prior to 1970, as well as all administrative
costs that are incurred in administering the benefits program
and operating the trust fund.

Occupational Safety and Health Administration

SALARIES AND EXPENSES

Appropriations, 2018.................................... $552,787,000
Budget estimate, 2019................................... 549,033,000
Committee recommendation................................ 556,787,000

The Committee recommends $556,787,000 for the Occupational
Safety and Health Administration, which is responsible for
enforcing the Occupational Safety and Health Act of 1970 in the
Nation's workplaces.
The Committee continues bill language to allow OSHA to
retain course tuition and fees for training institute courses
used for occupational safety and health training and education
activities in the private sector. The cap established by the
bill is $499,000, the same as current law.
The Committee continues bill language to exempt farms
employing 10 or fewer people from the provisions of the act
with the exception of those farms having a temporary labor
camp. The Committee also continues language exempting small
firms in industry classifications having a lost workday injury
rate less than the national average from general schedule
safety inspections.
The exemption of small farming operations from OSHA
regulation has been in place since 1976. OSHA clarified the
limits of its authority to conduct enforcement on small farms
in July 2014, particularly regarding post-harvest activities of
a farming operation. The continued exemption for small farms
and recognition of limits of the OSHA regulatory authority are
critical for family farms. It is also important the Department
of Agriculture be consulted in any future attempts by OSHA to
redefine or modify any aspect of the small farm exemption.
The Committee recommends $102,850,000 for grants to States
under section 23(g) of the Occupational Safety and Health Act.
These funds primarily are provided to States that have taken
responsibility for administering their own occupational safety
and health programs for the private sector and/or the public
sector. State plans must be at least as effective as the
Federal program and are monitored by OSHA. The Committee bill
continues language that allows OSHA to provide grants of up to
50 percent for the costs of State plans approved by the agency.
The Committee recommendation provides $10,537,000 for the
OSHA Susan Harwood Training Grant Program, including not less
than $4,500,000 to continue the set aside for capacity building
development grants required by this act. The Committee also
directs OSHA to dedicate no less than $3,500,000 per year for
the purpose of administering the Voluntary Protection Program
[VPP] in its Federal Compliance Assistance budget. OSHA shall
not reduce funding levels or the number of employees
administering the VPP, the Safety and Health Achievement
Recognition Program, or Federal Compliance Assistance, and
shall not collect any monies from participants for the purpose
of administering these programs.
The Committee recognizes the importance of disclosing
workplace injury, illness, and fatality data to the public.
Accordingly, the Committee instructs OSHA to resume timely and
public reporting on its website of fatalities that occur at
workplaces, regardless if a citation is issued. Making this
information and data publicly available furthers OSHA's mission
by ensuring businesses, workers, and the public know about and
have access to timely and complete information on workplace
safety, including enforcement actions, injuries, illnesses, and
deaths.

Mine Safety and Health Administration

SALARIES AND EXPENSES

Appropriations, 2018.................................... $373,816,000
Budget estimate, 2019................................... 375,906,000
Committee recommendation................................ 373,816,000

The Committee recommendation includes $373,816,000 for the
Mine Safety and Health Administration.
MSHA enforces the Federal Mine Safety and Health Act by
conducting inspections and special investigations of mine
operations, promulgating mandatory safety and health standards,
cooperating with the States in developing effective State
programs, and improving training in conjunction with States and
the mining industry.
The Committee continues language authorizing MSHA to use up
to $2,000,000 for mine rescue and recovery activities. It also
retains the provision allowing the Secretary to use any funds
available to the Department to provide for the costs of mine
rescue and survival operations in the event of a major
disaster. To prepare properly for an actual emergency, the
Committee also directs MSHA to continue to devote sufficient
resources toward a competitive grant activity for effective
emergency response and recovery training in various types of
mine conditions.
In addition, bill language is included to allow the
National Mine Health and Safety Academy to collect not more
than $750,000 for room, board, tuition, and the sale of
training materials to be available for mine safety and health
education and training activities. Bill language also allows
MSHA to retain up to $2,499,000 from fees collected for the
approval and certification of equipment, materials, and
explosives for use in mines, and to utilize such sums for these
activities.
The Committee supports the significant advances MSHA has
achieved in mine rescue and communications capabilities. To
prepare properly for a mine rescue emergency, the Committee
directs MSHA to continue to devote sufficient resources towards
mine rescue technology by fully equipping and maintaining the
existing MSHA mine rescue stations. In addition, the Committee
directs MSHA to continue to provide all necessary technical
assistance regarding mine rescue communications to State and
private mine rescue teams and to ensure that all relevant MSHA
grant programs prioritize mine rescue communications
technology.

Bureau of Labor Statistics

SALARIES AND EXPENSES

Appropriations, 2018.................................... $612,000,000
Budget estimate, 2019................................... 609,386,000
Committee recommendation................................ 615,000,000

The Committee recommends $615,000,000 for the Bureau of
Labor Statistics, an increase of $3,000,000, to support the
improvement of the quality and accuracy of labor force
statistics. This amount includes $65,000,000 from the
Employment Security Administration account of the Unemployment
Trust Fund and $550,000,000 in Federal funds.
BLS is the principal fact finding agency in the Federal
Government in the broad field of labor economics. The Committee
recognizes that the Nation requires current, accurate, detailed
workforce statistics for Federal and non-Federal data users as
provided by BLS. The Committee is concerned by inaccurate,
preliminary data released in December 2017 that showed the
largest over-the-year percentage decrease in employment
occurred in Cape Girardeau, Missouri. Inaccurate economic data
can have damaging effects on local employers and communities,
such as Cape Girardeau. The Department and BLS are directed to
review the practice of releasing preliminary economic data;
take steps to improve the reliability, accuracy, and timeliness
of economic statistical data; and provide an update on the
actions taken in the fiscal year 2020 CJ.
The Committee is pleased BLS is reporting on the contingent
workforce during the current fiscal year. The Committee directs
BLS to continue capturing data on contingent work and
alternative work arrangements by conducting the Contingent
Worker Supplement to the Current Population Survey on a
biennial basis.
The Committee is concerned that there continues to be
insufficient data on the impact technology is having on the
American workforce. The Committee encourages BLS to develop a
strategy to better understand how automation, digitization, and
artificial intelligence are changing the employment landscape.
BLS is directed to submit a report to the Committees on
Appropriations of the House of Representatives and the Senate
no later than 90 days after enactment of this act detailing the
steps taken to develop the data strategy as directed.
The Committee believes that the Current Population Survey
lacks critical occupational data on career and technical
occupations that would be beneficial to Congress as it develops
policies related to workforce and higher education. The
Committee requests BLS prepare a report on improvements to the
Current Population Survey that would allow greater reporting on
career and technical occupations. This report should be
submitted to the Committees on Appropriations of the House of
Representatives and Senate and the Committees on Education and
the Workforce and Health, Education, Labor and Pensions of the
House of Representatives and Senate not later than 90 days of
enactment of this act.

Office of Disability Employment Policy

Appropriations, 2018.................................... $38,203,000
Budget estimate, 2019................................... 27,000,000
Committee recommendation................................ 38,203,000

The Committee recommends $38,203,000, the same as fiscal
year 2018, for the Office of Disability Employment Policy to
provide leadership, develop policy and initiatives, and award
grants furthering the objective of eliminating physical and
programmatic barriers to the training and employment of people
with disabilities and to design and implement research and
technical assistance grants and contracts to develop policy
that reduces barriers to competitive, integrated employment for
youth and adults with disabilities.

Departmental Management

SALARIES AND EXPENSES

Appropriations, 2018.................................... $337,844,000
Budget estimate, 2019................................... 261,035,000
Committee recommendation................................ 337,844,000

The Committee recommendation includes $337,844,000 for the
Departmental Management account. Of this amount, $337,536,000
is available from general funds and $308,000 is available by
transfer from the Employment Security account of the
Unemployment Trust Fund. In addition, $31,994,000 is available
by transfer from the Black Lung Disability Trust Fund.
The Departmental Management appropriation pays the salaries
and related expenses of staff responsible for formulating and
overseeing the implementation of departmental policy and
management activities in support of that goal. In addition,
this appropriation includes a variety of operating programs and
activities that are not involved in departmental management
functions, but for which other appropriations for salaries and
expenses are not suitable.
The Committee recommendation includes $86,125,000 for the
Bureau of International Labor Affairs [ILAB], of which
$59,825,000 is available for obligation through December 31,
2019. ILAB's appropriation is available to help improve working
conditions and labor standards for workers around the world by
carrying out ILAB's statutory mandates and international
responsibilities including in promoting the elimination of
child labor and forced labor. ILAB will continue to oversee 66
active grant projects totaling over $332,000,000 in 54
countries around the world in fiscal year 2019 in addition to
new grants in fiscal year 2018 which have not yet been awarded.
The Committee directs the Department to report to the
Committees on Appropriations of the House of Representatives
and the Senate no later than 180 days following the enactment
of this act, on the obligation of all funds expended by the
Department to combat human trafficking, child labor, workers'
rights, and forced labor for fiscal year 2018 and fiscal year
2019. The report shall include a breakdown of funds by project,
country, and purpose.
The Committee recommendation provides $8,040,000 for
program evaluation and allows these funds to be available for
obligation through September 30, 2020. The Committee bill also
continues the authority of the Secretary to transfer these
funds to any other account in the Department for evaluation
purposes. The Committee bill continues authority to use up to
0.75 percent of certain Department appropriations for
evaluation activities identified by the chief evaluation
officer. The Committee expects to be notified of the planned
uses of funds derived from this authority.
The Committee also notes that, in addition to this
appropriation, the Department has reserved under its evaluation
set-aside authority an average of $17,000,000 for each of the
past 5 years for implementing the Department's annual
evaluation plan and making important contributions to building
and using evidence. While each of the Department's agencies
develops a learning agenda and many benefit from evaluation
set-aside resources, the set-aside has largely been funded in
these years from ETA programs. The Committee requests that the
Department evaluation plan required by this act include a
discussion of options for developing greater agency
contributions to the set-aside, such as a mechanism that would
require agencies to contribute to the set-aside unless such
action would cause it to be unable to meet its statutory
obligations.
The recommendation includes $23,534,000 for the Office of
the Assistant Secretary for Administration and Management. The
Committee directs the Department to provide quarterly reports
identifying the number of full time equivalent employees and
attrition by principal office, and appropriation account not
later than 30 days after the end of each quarter.
The recommendation includes $35,000,000 for the
Adjudication activity.
The Committee recommendation provides $13,530,000 for the
Women's Bureau. The Committee continues bill language allowing
the Bureau to award grants. The Committee disapproves of the
Department's reprogramming of funds from the Women's Bureau in
fiscal year 2017 and fiscal year 2018. The Committees on
Appropriations of the House of Representatives and the Senate
provided funding increases for the purpose of supporting the
programs and activities administered by the Women's Bureau and
is disappointed that the Department has taken a sizable portion
of those funds to support unrelated activities within the
Department. The Committee expects $13,530,000 to be used by the
Women's Bureau for important issues facing women in the labor
force.

VETERANS EMPLOYMENT AND TRAINING

Appropriations, 2018.................................... $295,041,000
Budget estimate, 2019................................... 281,595,000
Committee recommendation................................ 300,041,000

The Committee recommendation of $300,041,000 for the
Veterans Employment and Training Service [VETS] includes
$50,000,000 in general revenue funding and $250,041,000 to be
expended from the Employment Security Administration account of
the Unemployment Trust Fund.
This account provides resources for VETS to maximize
employment opportunities for veterans and transitioning service
members, including protecting their employment rights. VETS
carries out its mission through a combination of grants to
States, competitive grants, and Federal enforcement and
oversight.
The Committee provides $180,000,000 for the Jobs for
Veterans State Grants [JVSG] program. This funding will enable
Disabled Veterans' Outreach Program specialists and Local
Veterans' Employment Representatives to continue providing
intensive employment services to veterans and eligible spouses;
transitioning service members early in their separation from
military service; wounded warriors recuperating in military
treatment facilities or transition units; and spouses and
family caregivers to help ensure the family has income to
provide sufficient support. The Committee maintains language
providing authority for JVSG funding to be used for data
systems and contract support to allow for the tracking of
participant and performance information.
The Committee provides $24,500,000 for the Transition
Assistance Program [TAP], an increase of $5,000,000 over fiscal
year 2018, to support employment workshops at military
installations and in virtual classrooms worldwide for exiting
servicemembers and spouses.
The Committee recommendation includes $42,127,000 for
Federal administration costs. This funding level will support
oversight and administration of the VETS grant programs, TAP
employment workshops, and compliance and enforcement
activities.
The Committee recommends $50,000,000 for the Homeless
Veterans' Reintegration Program [HVRP], level with fiscal year
2018, to help homeless veterans attain the skills they need to
gain meaningful employment. This funding will allow DOL to
provide HVRP services to over 18,000 homeless veterans
nationwide, including homeless women veterans. The bill allows
Incarcerated Veterans' Transition funds to be awarded through
September 30, 2019, and to serve veterans who have recently
been released from incarceration but are at-risk of
homelessness.
The Committee recognizes the role of HVRP in decreasing
veterans' homelessness by helping homeless veterans or veterans
who are at risk of homelessness through job training,
counseling, and placement services. The Committee directs the
Secretary to conduct a pilot to demonstrate the use of
regional, multi-community awards to national organizations to
test service delivery efficiencies, improve outcomes, and
target underserved subpopulations.
The Committee recommendation includes $3,414,000 for the
National Veterans' Training Institute, which provides training
to Federal staff and veteran service providers. The Committee
includes funding to facilitate the Department's implementation
of the Honoring Investments in Recruiting and Employing
American Military Veterans Act of 2018 [HIRE Vets Act].

INFORMATION TECHNOLOGY MODERNIZATION

Appropriations, 2018.................................... $20,769,000
Budget estimate, 2019...................................................
Committee recommendation................................ 20,769,000

The Committee recommends $20,769,000 for the Information
Technology [IT] Modernization account. Funds available in this
account have been used for two primary activities. The first is
departmental support systems, for which $4,889,000 is provided.
The second activity, IT Infrastructure Modernization, supports
necessary activities associated with the Federal Data Center
Consolidation Initiative.
The Committee includes new bill language making the
appropriation for IT Modernization available until expended.
The Committee requests the Department submit a report to the
Committees on Appropriations of the House of Representatives
and the Senate not later than 90 days after enactment of this
act that includes a description of each project to be funded,
planned activities and associated timeline, expected benefits,
and planned expenditures. Future reports should provide an
update on each project, including completed activities,
remaining activities and associated timeline, actual and
remaining expenditures, explanation of any cost overruns and
delays, and corrective actions, as necessary, to keep the
project on track and within budget. While the bill does not
include requested authorities modifying the Working Capital
Fund, the Committee looks forward to the progress the
Department will make with greater certainty provided with this
extended availability and its expressed support for maintaining
the current level of investments in the Department's IT
Modernization efforts. New language proposed in the budget that
would have allowed IT modernization funding to be generated
through changes to the Working Capital Fund at the Department
is not included in the bill.

OFFICE OF THE INSPECTOR GENERAL

Appropriations, 2018.................................... $89,147,000
Budget estimate, 2019................................... 87,721,000
Committee recommendation................................ 89,147,000

The Committee recommends $89,147,000 for the DOL OIG. The
bill includes $83,487,000 in general funds and authority to
transfer $5,660,000 from the Employment Security Administration
account of the Unemployment Trust Fund. In addition, an amount
of $330,000 is available by transfer from the Black Lung
Disability Trust Fund.
Through a comprehensive program of audits, investigations,
inspections, and program evaluations, OIG attempts to reduce
the incidence of fraud, waste, abuse, and mismanagement, and to
promote economy, efficiency, and effectiveness.
The Department has reported improper payments, including
fraud, in the UI and Employee Compensation programs totaling
approximately $4,100,000,000 and $57,200,000 respectively for
fiscal year 2017. The Committee strongly supports and commends
the efforts of the OIG to identify and prosecute those who
defraud the Department's worker benefit programs and to help
protect the solvency of these important programs.

General Provisions

Section 101. The bill continues a provision limiting the
use of Job Corps funding for compensation of an individual that
is not a Federal employee at a rate not to exceed Executive
Level II.
Section 102. The bill continues a provision providing for
general transfer authority.
Section 103. The bill continues a provision prohibiting
funding for the procurement of goods and services utilizing
forced or indentured child labor in industries and host
countries already identified by the Department in accordance
with Executive Order 13126.
Section 104. The bill continues a provision requiring that
funds available under section 414(c) of the American
Competitiveness and Workforce Innovation and Opportunity Act
may only be used for competitive grants that train individuals
over the age of 16 who are not enrolled in school, in
occupations and industries for which employers are using H-1B
visas to hire foreign workers.
Section 105. The bill continues a provision limiting the
use of ETA funds by a recipient or subrecipient for
compensation of an individual at a rate not to exceed Executive
Level II.
Section 106. The bill continues a provision providing the
ETA with authority to transfer funds provided for technical
assistance services to grantees to ``Program Administration''
when it is determined that those services will be more
efficiently performed by Federal employees. The provision does
not apply to section 171 of the WIOA. In addition, authority is
provided for program integrity-related activities as requested
by the administration.
Section 107. The bill continues a provision allowing up to
0.75 percent of discretionary appropriations provided in this
act for all Department agencies to be used by the Office of the
Chief Evaluation Officer for evaluation purposes consistent
with the terms and conditions in this act applicable to such
office.
Section 108. The bill continues a provision related to
section 147 of WIOA authorizing the competitive procurement of
certain Job Corps Centers.
Section 109. The bill continues a longstanding provision
regarding the application of the Fair Labor Standards Act after
the occurrence of a major disaster.
Section 110. The bill continues a provision rescinding
advance appropriations in the Dislocated Workers' National
Reserve account.
Section 111. The bill continues a provision that provides
flexibility with respect to the crossing of H-2B nonimmigrants.
Section 112. The bill continues a provision related to the
wage methodology under the H-2B program.
Section 113. The bill continues a provision regarding the
three-fourths guarantee and definitions of corresponding
employment and temporary need for purposes of the H-2B program.
Section 114. The bill continues a provision providing
authority related to the disposition of excess property related
to the training of apprentices.
Section 115. The bill continues a provision related to
funds available to State Unemployment Insurance information
technology consortia.
Section 116. The bill continues a provision related to the
Secretary's security detail.
Section 117. The bill continues a provision related to Job
Corps property.

TITLE II

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Any references in this title of the report to the
``Secretary'' or the ``Department'' shall be interpreted to
mean the Secretary of HHS or the Department of HHS,
respectively, unless otherwise noted.

Health Resources and Services Administration

HRSA activities support programs to provide healthcare
services for mothers and infants; the underserved, elderly, and
homeless; rural residents; and disadvantaged minorities. This
agency supports cooperative programs in maternal and child
health, AIDS care, healthcare provider training, and healthcare
delivery systems and facilities.

BUREAU OF PRIMARY HEALTH CARE

Appropriations, 2018.................................... $1,626,522,000
Budget estimate, 2019................................... 5,091,522,000
Committee recommendation................................ 1,626,522,000

The Committee recommendation for the activities of the
Bureau of Primary Health Care is $1,626,522,000.

Community Health Centers

The Committee provides $1,625,522,000 in this bill for
Community Health Centers, equal to the amount provided last
year.
Programs supported by this funding include community health
centers, migrant health centers, healthcare for the homeless,
school-based, and public housing health service grants. The
Committee continues to support the ongoing effort to increase
the number of people who have access to medical services at
health centers. Health centers play a vital role in ensuring
access to primary care in underserved areas of the country,
including urban, rural, and frontier areas. The Committee
includes $200,000,000 to support, enhance, and expand
behavioral health, mental health, or substance use disorder
services.
In addition, within the amount provided, the Committee
provides up to $99,893,000 under the Federal Tort Claims Act
[FTCA], available until expended. These funds are used to pay
judgments and settlements, occasional witness fees and
expenses, and related administrative costs. The Committee
intends FTCA coverage funded through this bill to be inclusive
of all providers, activities, and services included within the
health centers' federally approved scope of project.
Home Visiting.--Enhanced integration between healthcare
providers and community programs helps transform the lives of
vulnerable infants and first-time mothers. Research has shown
that partnering first-time mothers with registered nurses or
other professionals that provide ongoing home visits
dramatically improves the health and well-being of these
families. The Committee encourages HRSA to expand partnerships
between health centers and evidence-based home visiting
programs in high need areas to improve pregnancy, child health
and development, and other health outcomes, all while reducing
costs.
Technical Assistance.--The Committee believes that enhanced
funding for the technical assistance and networking functions
available for health centers through national and State
cooperative agreements and grants is critical to the successful
operation and expansion of the health centers program. Funds
are available within the amount provided to enhance technical
assistance and training activities, further quality improvement
initiatives, and continue the development of and support for
health center-controlled networks so that new and existing
centers can improve patient access to quality health services.
Native Hawaiian Health Care.--The Committee provides no
less than $17,500,000 for the Native Hawaiian Health Care
Program.
Perinatal Transmission of Hepatitis B.--The Committee is
aware that the 2017 National Academies of Sciences Engineering
and Medicine [NASEM] report titled, ``A National Strategy for
the Elimination of Hepatitis B and C'' reported that only half
of the hepatitis B infected women who give birth each year are
identified for case management, a proportion unchanged since
2000. The NASEM report also noted that, without intervention,
about 90 percent of the infants born to hepatitis B virus
infected women contract the virus at birth and are therefore at
greater risk of premature death from liver cancer or cirrhosis
later in life. The Committee is pleased that HRSA has
implemented a strategy to increase the capacity of HRSA-funded
clinics to address perinatal hepatitis B transmission,
including the use of telehealth to link experts with clinic
providers around the U.S. The Committee requests a report
within 90 days of enactment of HRSA's findings and
recommendations on the effectiveness of this intervention.

Free Clinics Medical Malpractice Coverage

The Committee provides $1,000,000 for payments of claims
under the FTCA to be made available for free clinic health
professionals as authorized by section 224(o) of the PHS Act.
This appropriation extends FTCA coverage to medical
volunteers in free clinics to expand access to healthcare
services to low-income individuals in medically underserved
areas.

BUREAU OF HEALTH PROFESSIONS

Appropriations, 2018.................................... $1,060,695,000
Budget estimate, 2019................................... 457,798,000
Committee recommendation................................ 1,072,695,000

The Committee recommendation for the activities of the
Bureau of Health Professions is $1,072,695,000.
The Bureau of Health Professions provides policy leadership
and grant support for health professions workforce development.
The mission of the Bureau is to identify shortage areas while
working to make them obsolete. Its programs are intended to
ensure that the Nation has the right clinicians, with the right
skills, working where they are needed.
To accurately prepare for physician workforce demands, HHS
needs high quality projections by specialty, factoring in
population changes (i.e., aging population), geographic
location (i.e., rural versus urban), utilization trends, and
delivery system changes. For these reasons, Congress urges
HRSA, to study access by underserved populations to general
surgeons and provide a report to the Committee 18 months after
enactment detailing potential surgical shortages, especially as
it relates to geographic location (i.e., rural, urban, and
suburban). For the report to the Committee, HHS should consult
with relevant stakeholders, including medical societies,
organizations representing surgical facilities, organizations
with expertise in general surgery, and organizations
representing patients.

National Health Service Corps

The Committee provides $105,000,000 for the National Health
Service Corps [Corps] to continue improving access to quality
opioid and substance use disorder treatment in rural and
underserved areas nationwide. The Committee continues language
that expands eligibility for loan repayment awards through the
Corps to include substance use disorder counselors. Of the
amount provided, the Committee directs that $30,000,000 shall
be available for the Rural Communities Opioid Response
initiative within the Office of Rural Health.
The Committee continues to include section 206 of this act
to modify the rules governing the Corps to allow every Corps
member 60 days to cancel their contract.

Training for Diversity

Centers of Excellence
The Committee recommends $23,711,000 for the Centers of
Excellence Program.
The Committee supports collaborative efforts to address
American Indian and Alaskan Native health, including programs
to increase the number of Native Americans and Alaska Natives
in the U.S. health professions workforce.
Health Careers Opportunity Program
The Committee provides $14,189,000 for the Health Careers
Opportunity Program. This program provides individuals from
disadvantaged backgrounds who desire to pursue a health
professions career an opportunity to develop the skills needed
to successfully compete for, enter, and graduate from schools
of health professions or allied health professions.
Faculty Loan Repayment
The Committee provides $1,190,000 for the Faculty Loan
Repayment Program. This amount is the same as the fiscal year
2018 enacted level.
Scholarships for Disadvantaged Students
The Committee provides $48,970,000 for Scholarships for
Disadvantaged Students, equal to the fiscal year 2018 level.
The Committee supports diversity among health professionals.
This program provides grants to eligible health professions and
nursing schools to award scholarships to students from
disadvantaged backgrounds who have financial need.
Primary Care Training and Enhancement
The Committee provides $48,924,000 for Primary Care
Training and Enhancement programs, which support the expansion
of training in internal medicine, family medicine, pediatrics,
and physician assistance. Funds may be used for developing
training programs or providing direct financial assistance to
students and residents.
Clinical Training Sites.--The Committee directs HRSA to
ensure that not less than 15 percent of funds provided for this
program are used to support training of physician assistants
[PAs]. The Committee is aware of a clinical training site
shortage for primary care professionals, including PAs and
other health professionals. The Committee is aware of a
clinical training site shortage for primary care, as well as
mental and behavioral health, caused by the increasing demand
for PAs that has created shortages of preceptors and clinical
training sites among PAs and other health professionals. The
Committee recognizes that this is particularly acute in the
face of an opioid crisis that requires greater focus on
Medication Assisted Treatment training and pain management
skills that often become the responsibility of primary care
clinicians. The Committee recommends that the Secretary
leverage currently convened Advisory Committee(s), as
applicable, to study clinical training site availability in
primary care and mental and behavioral health for PAs. The
Committee encourages the Advisory Committee(s) to develop
recommendations to enhance clinical education through inter-
professional team-based education, address the shortage in
preceptors willing to provide clinical site training, and
explore reimbursement incentives to increase the number of
available clinical training sites. The Committee also urges the
integration of evidence-based trainings for health
professionals to screen, access, intervene, and refer patients
to specialized treatment for the severe mental illness of
eating disorders as authorized under section 13006 of the 21st
Century Cures Act (Public Law 114-255).

Training in Oral Health Care

The Committee provides $40,673,000 for Training in Oral
Health Care programs, which includes not less than $10,000,000
each for general and pediatric dentistry. Funds may be used to
expand training in general dentistry, pediatric dentistry,
public health dentistry, dental hygiene, and other oral health
access programs. Funds may also be used to plan and operate
training programs, as well as to provide financial assistance
to students and residents.
The agency is directed to provide continuation funding for
predoctoral and postdoctoral training grants initially awarded
in fiscal year 2015, and for Section 748 Dental Faculty Loan
Program grants initially awarded in fiscal year 2016, with
preference for pediatric dentistry faculty supervising dental
students or residents and providing clinical services in dental
clinics located in dental schools, hospitals, and community-
based affiliated sites.
Funds may be used to expand training in general dentistry,
pediatric dentistry, public health dentistry, and dental
hygiene. Funds may also be used to plan and operate training
programs, as well as to provide financial assistance to
students and residents.
The Committee continues long-standing bill language that
prohibits funding for section 340G-1 of the PHS Act.

Interdisciplinary, Community-Based Linkages

Area Health Education Centers
The Committee provides $40,250,000, an increase of
$2,000,000 for Area Health Education Centers.
The program links university health science centers with
community health service delivery systems to provide training
sites for students, faculty, and practitioners. The program
supports three types of projects: core grants to plan and
implement programs; special initiative funding for schools that
have previously received AHEC grants; and model programs to
extend AHEC programs with 50 percent Federal funding. The AHEC
community-training model provides a uniquely appropriate
opportunity to bring the training of community health workers
to scale. HRSA is encouraged to provide technical assistance on
and disseminate best practices for training community health
workers to existing AHECs. The Committee is pleased with AHEC's
efforts to improve access to quality healthcare in America's
rural and underserved areas by increasing the number of primary
healthcare professionals who practice in those areas.
Geriatric Programs
The Committee provides $40,737,000 for Geriatric Programs.
Behavioral Health Workforce Education and Training Program
The Committee provides $75,000,000 for Behavioral Health
Workforce Education and Training [BHWET] Program. The BHWET
Program is focused on developing and expanding the mental
health and substance abuse workforce serving populations across
the lifespan. HRSA will continue to leverage SAMHSA's subject
matter expertise in formatting new investments in fiscal year
2019.
In light of the recent expanded eligibility for the BHWET
program and the need for the full continuum of professions to
be involved, the Committee continues to direct HRSA to take
steps in the solicitation process and the timing of it to
ensure that the grant competition results in program funding
being distributed relatively equally among the participating
health professions.
The Committee is increasingly concerned that the Nation
remains unprepared for the looming provider shortage and
recognizes that training these postgraduate Nurse Practioners
[NPs] in federally qualified health centers [FQHCs] across the
country will address this problem in a positive way. Patients
need expert providers prepared to manage the social and
clinical complexities that exist in FQHCs. Academic literature
supports the need for postgraduate training of new NPs. The
Committee is confident that this program will provide newly
graduated NPs with the depth, breadth, volume, and intensity of
clinical training capable of preparing them for accomplishment
and fulfilling careers.
Mental and Behavioral Health Education Training Programs
The Committee provides $36,916,000 for Mental and
Behavioral Health Education Training Programs. The programs
provide grants to higher education institutions and accredited
training programs to recruit and train professionals and
faculty in the fields of social work, psychology, psychiatry,
marriage and family therapy, substance abuse prevention and
treatment, and other areas of mental and behavioral health.
The Committee continues to support funding to expand the
mental health and substance abuse workforce, including, but not
limited to, master's level social workers, psychologists,
counselors, marriage and family therapists, psychiatric mental
health nurse practitioners, occupational therapists, psychology
doctoral interns, and behavioral health paraprofessionals.
Graduate Psychology Education [GPE].--The Committee
supports interprofessional GPE and increasing the number of
health service psychologists trained to provide integrated
services to high-need, underserved populations in rural and
urban communities. In addressing the opioid epidemic, the
Committee recognizes the growing need for highly trained mental
and behavioral health professionals to deliver evidence-based
behavioral interventions for pain management. The Committee
urges HRSA to explore evidence-based approaches to leverage
workforce capacity through this program (including through
geropsychology training programs). The Committee encourages
HRSA to help integrate health services psychology trainees at
FQHCs. The Committee also urges HRSA to utilize cost-effective
methods, such as Project ECHO, to help train and support health
service psychologists across the country.

Health Professions Workforce Information and Analysis

The Committee provides $5,663,000 for health professions
workforce information and analysis. The program provides for
the collection and analysis of targeted information on the
Nation's healthcare workforce, research on high-priority
workforce questions, the development of analytic and research
infrastructure, and program evaluation and assessment.

Public Health Workforce Development

The Committee provides $17,000,000 for Public Health
Workforce Development. This program line, also called Public
Health and Preventive Medicine, funds programs that are
authorized in titles III and VII of the PHS Act and support
awards to schools of medicine, osteopathic medicine, public
health, and integrative medicine programs.

Nursing Workforce Development Programs

The Committee provides $249,472,000 for Nursing Workforce
Development programs. These programs provide funding to address
all aspects of nursing workforce demand, including education,
practice, recruitment, and retention.
The Nurse Education, Practice, Quality and Retention
Program's Veteran's Bachelor of Science Degree in Nursing [BSN]
is important to helping our nation's veterans progress and
graduate with a BSN degree. The Committee supports these
efforts aimed at helping veterans transition to civilian life,
removing barriers, and building our nursing workforce. HRSA
should continue to support these veterans moving to nursing
careers and train nurses to support the unique needs of
veterans, returning servicemembers, and their families,
including trauma-informed care and substance use disorder
prevention and treatment. The Committee encourages HRSA to
consider the successful past practice of entities that have
received funding from the Veterans to BSN program in making new
awards.
Advanced Education Nursing
The Committee recommends $74,581,000 for the Advanced
Education Nursing programs, which increases the number of
qualified nurses in the workforce by improving nursing
education through curriculum and faculty development.
The Committee provides $8,000,000 to award grants for the
clinical training of sexual assault nurse examiners to
administer medical forensic examinations and treatments to
victims of sexual assault in hospitals, health centers, and
other emergency healthcare service provider settings referenced
in Senate Report 115-150.

Children's Hospitals Graduate Medical Education

The Committee provides $325,000,000, an increase of
$10,000,000, for the Children's Hospitals Graduate Medical
Education [CHGME] program. The Committee strongly supports the
CHGME program, which provides support for graduate medical
education training programs in both ambulatory and in-patient
settings within freestanding children's teaching hospitals.
CHGME payments are determined by a per-resident formula that
includes an amount for direct training costs added to a payment
for indirect costs. Payments support training of resident
physicians as defined by Medicare in both ambulatory and
inpatient settings.

National Practitioner Data Bank

The Committee provides $18,814,000 for the National
Practitioner Data Bank. As mandated by the Health Care Quality
Improvement Act, the National Practitioner Data Bank does not
receive appropriated funds, but instead is financed by the
collection of user fees.
The National Practitioner Data Bank collects certain
adverse information, medical malpractice payment history, and
information related to healthcare fraud and abuse. The data
bank is open to healthcare agencies and organizations that make
licensing and employment decisions.

MATERNAL AND CHILD HEALTH

Appropriations, 2018.................................... $886,789,000
Budget estimate, 2019................................... 1,136,200,000
Committee recommendation................................ 924,789,000

The Committee recommendation for the Maternal and Child
Health [MCH] Bureau is $924,789,000. The mission of the Bureau
is to improve the physical and mental health, safety, and well-
being of the Nation's women, infants, children, adolescents,
and their families. This population includes fathers and
children with special healthcare needs.
Maternal and Child Health Block Grant
The Committee provides $677,700,000 for the MCH Block
Grant, which provides a flexible source of funding that allows
States to target their most urgent maternal and child health
needs. The program supports a broad range of activities
including: providing prenatal care, well child services, and
immunizations; reducing infant mortality; preventing injury and
violence; expanding access to oral healthcare; addressing
racial and ethnic disparities; and providing comprehensive care
through clinics, home visits, and school-based health programs.
Children's Health and Development.--Evidence shows that
experiences in early childhood have long-term health
consequences over the course of a person's life. These
experiences are critical for a child's educational, social,
physical, and economic well-being. Children living in States
with persistently high child poverty rates experience more
negative health outcomes than their peers elsewhere. Therefore,
the Committee provides $3,500,000 within the Special Projects
of Regional and National Significance program for the HRSA-
funded initiative focused on improving child health through a
statewide system of early childhood developmental screenings
and interventions. This funding shall be used to continue the
currently funded project for another year.
Hemophilia.--The Committee has included funding for the
Regional Hemophilia Network Program, which provides grant
funding to the national network of Hemophilia Treatment Centers
[HTCs]. This comprehensive care program supports HTCs in
providing multi-disciplinary care services, such as physical
therapy assessments, social work, and case management, which
are vital to manage rare bleeding disorders.
Maternal, Infant, and Early Childhood Home Visiting
Program.--The Committee encourages HRSA and ACF to continue
their collaboration and partnerships to improve health and
development outcomes for at-risk pregnant women, parents, and
young children through evidence-based home visiting programs.
Maternal Mortality.--The Committee recognizes the rising
maternal mortality rate in the U.S. as a pressing public health
issue. Analysis of maternal mortality review committee data
indicates that over 60 percent of pregnancy-related deaths are
preventable. The Committee provides $23,000,000 within Special
Projects of Regional and National Significance [SPRANS] for
State Maternal Health Innovation Grants to establish
demonstrations to implement evidence-based interventions to
address critical gaps in maternity care service delivery and
reduce maternal mortality. The demonstrations will be
representative of the demographic and geographic composition of
communities most affected by maternal mortality, and HRSA is
encouraged to work with States to collect comprehensive data
associated with all pregnancy-associated and pregnancy-related
deaths, regardless of the outcome of the pregnancy. In
addition, the Committee includes $3,000,000 within SPRANS to
expand implementation of the Alliance for Innovation in
Maternal Health Initiative's maternal safety bundles to all
U.S. States, the District of Columbia, and U.S. territories, as
well as tribal entities. Maternal safety bundles are a set of
targeted, straightforward, and evidence-based practices, that,
when reliably implemented, improve patient outcomes and reduce
maternal mortality and severe maternal morbidity.

Sickle Cell Anemia

The Committee provides $4,455,000 for grants and contracts
to help coordinate service delivery for individuals with sickle
cell disease, including genetic counseling and testing;
training of health professionals; and coordination of
education, treatment, and continuity of care programs.

Autism and Other Developmental Disorders

The Committee provides $49,099,000 for the Autism and Other
Developmental Disorders program. The program supports
surveillance, early detection, education, and intervention
activities on autism and other developmental disorders, as
authorized in the Combating Autism Act of 2006.
Children and families living in rural, underserved areas
have limited access to healthcare professionals trained in
effective early interventions for Autism Spectrum Disorder
[ASD]. Most of these children's services are provided through
the federally mandated Part C early intervention system and do
not incorporate effective, autism-specific interventions.
Often, Part C is the only portal to services for toddlers and
their families, particularly those living in rural and
underserved communities. Training Part C Early Interventionists
and other healthcare professionals in rural health clinics (at
all levels of training) on a parent-mediated intervention,
Project ImPACT, can serve to fill this gap in access and
provide care for ASD children. Following training, researchers
will measure the early interventionists' and healthcare
providers' adherence to Project ImPACT strategies with a client
on their caseload. Successful fidelity will indicate a step
toward reducing the disparity that exists for children with ASD
living in underserved communities. The Committee encourages
HRSA to enhance current efforts to determine whether a parent-
centered approach to providing care for ASD children can be an
effective intervention in a rural care setting.

Newborn Screening for Heritable Disorders

The Committee provides $15,883,000 for the Newborn
Heritable Disorders Screening program, as described in section
1109 of the Newborn Screening Saves Lives Act of 2008. This
program provides funding to improve States' ability to provide
newborn and child screening for heritable disorders. Newborn
screening provides early identification and follow-up for
treatment of infants affected by certain genetic, metabolic,
hormonal, and/or functional conditions.
The Committee continues to support the goals of this
important program, which helps to improve State capacity to
provide newborn screening for heritable disorders that could
result in disability or death if left undetected. In
recognizing that newborn screening provides timely and early
identification and follow-up for treatment of infants affected
by certain genetic, metabolic, hormonal, or functional
conditions, the Committee applauds the efforts of the Advisory
Committee on Heritable Disorders in Newborns and Children in
advising the Secretary on the most appropriate use of all
aspects of newborn screening to help reduce morbidity and
mortality in newborns. The Committee also encourages States in
their ongoing efforts to add conditions as recommended by the
Recommended Uniform Screening Panel.

Healthy Start

The Committee provides $122,500,000 for the Healthy Start
infant mortality initiative. The primary purpose of Healthy
Start is to reduce infant mortality and generally improve
maternal and infant health in at-risk communities. Grants are
awarded to State and local health departments and nonprofit
organizations to conduct an infant mortality review, develop a
package of innovative health and social services for pregnant
women and infants, and evaluate these efforts.
Maternal Mortality.--The Committee recognizes the rising
maternal mortality rate in the U.S. as a pressing public health
issue. Analysis of maternal mortality review committee data
indicates that over 60 percent of pregnancy-related deaths are
preventable. The Committee includes $12,000,000 for the Healthy
Start grantees to support nurse practitioners, certified nurse
midwives, physician assistants, and other maternal-child
advance practice health professionals within all program sites
nationwide. Clinical staff will provide direct access to well-
woman care and maternity care services to reduce barriers in
access to maternity care and help address maternal health
disparities among high-risk and underserved women. Clinical
staff will also support health educators by conducting training
on maternal early warning signs.

Universal Newborn Hearing Screening and Early Intervention

The Committee provides $17,818,000 for universal newborn
hearing screening and early intervention activities. This
program awards grants to 53 States and territories that support
statewide systems of newborn hearing screening, audiologic
diagnostic testing before 3 months of age, and enrollment in
early intervention programs before the age of 6 months.

Emergency Medical Services for Children

The Committee provides $22,334,000 for the Emergency
Medical Services for Children [EMSC] program which focuses on
improving the pediatric components of the emergency medical
services system and improving the quality of care provided to
children in the pre-hospital setting. Funding is available to
every State emergency medical services office to improve the
quality of emergency care for children and to pay for research
and dissemination of best practices.
The Committee recognizes the vital and unique nature of
this program that focuses specifically on improving the
pediatric components of the emergency medical services system
and improving the quality of emergency care provided to
children. The Committee supports continuation of all components
of the EMSC program in its mission to provide every child with
access to the best possible emergency care regardless of where
they live or travel within the United States.

Screening and Treatment for Maternal Depression

The Committee provides $5,000,000 for Screening and
Treatment for Maternal Depression. HRSA is directed to make
grants to States to establish, improve, or maintain programs to
train professionals to screen, assess, and treat for maternal
depression in women who are pregnant or who have given birth
within the preceding 12 months.

Pediatric Mental Health Care Access

The Committee provides $10,000,000 to expand access to
behavioral health services in pediatric primary care by
supporting the development of pediatric mental healthcare
telehealth access programs.

HIV/AIDS BUREAU

Appropriations, 2018.................................... $2,318,781,000
Budget estimate, 2019................................... 2,260,170,000
Committee recommendation................................ 2,318,781,000

The Committee recommendation includes $2,318,781,000 for
the HIV/AIDS Bureau.
The mission of the Bureau is to address the unmet care and
treatment needs of persons living with HIV/AIDS. The Bureau
administers the Ryan White Care Act, which provides a wide
range of community-based services, including primary and home
healthcare, case management, substance abuse treatment, mental
health, and nutritional services.
Screening for Sexually Transmitted Diseases [STDs].--The
Committee continues to support HRSA's efforts to include
screening and treatment for STDs as a part of the comprehensive
clinical care provided to HIV infected individuals. The
Committee requests that HIV/AIDS and Primary Health Care
Bureaus submit to the House and Senate Appropriations
Committees a report outlining the level of STD screening and
testing for the current and previous 2 fiscal years.

Emergency Assistance

The Committee provides $655,876,000 for emergency
assistance grants to eligible metropolitan areas
disproportionately affected by the HIV/AIDS epidemic.
Grants are provided to metropolitan areas meeting certain
criteria. Two-thirds of the funds are awarded by formula, and
the remainder is awarded through supplemental competitive
grants.

Comprehensive Care Programs

The Committee provides $1,315,005,000 for HIV healthcare
and support services.
Funds are awarded to States to support HIV service delivery
consortia, the provision of home- and community-based care
services for individuals with HIV disease, continuation of
health insurance coverage for low-income persons with HIV
disease, and support for State AIDS drug assistance programs
[ADAP]. The Committee provides $900,313,000 for AIDS
medications in ADAP.

Early Intervention Services

The Committee provides $201,079,000 for early intervention
grants. These funds are awarded competitively to primary
healthcare providers to enhance healthcare services available
to people at risk of HIV and AIDS. Funds are used for
comprehensive primary care, including counseling, testing,
diagnostic, and therapeutic services.

Children, Youth, Women, and Families

The Committee provides $75,088,000 for grants for
coordinated services to women, infants, children, and youth.
Funds are awarded to a variety of providers, including
community health centers, comprehensive hemophilia centers,
county and municipal health departments, and other nonprofit
community-based programs that provide comprehensive primary
healthcare services to populations with or at risk for HIV.

AIDS Dental Services

The Committee provides $13,122,000 for the AIDS Dental
Services program. This program provides grants to dental
schools, dental hygiene schools, and postdoctoral dental
education programs to assist with the cost of providing
unreimbursed oral healthcare to patients with HIV.
The Ryan White Part F program provides for the Dental
Reimbursement Program which covers the unreimbursed costs of
providing dental care to persons living with HIV/AIDS. Programs
qualifying for reimbursement are dental schools, hospitals with
postdoctoral dental education programs, and colleges with
dental hygiene programs.

AIDS Education and Training Centers

The Committee provides $33,611,000 for AIDS Education and
Training Centers [AETCs]. AETCs train healthcare practitioners,
faculty, and students who care for AIDS patients outside of the
traditional health professions education venues and support
curriculum development on the diagnosis and treatment of HIV
infection for health professions schools and training
organizations.

Special Projects of National Significance

The Committee provides $25,000,000 for the Special Projects
of National Significance program. This program supports the
development, evaluation and dissemination of innovative models
of HIV care to improve the retention and health outcomes of
Ryan White HIV/AIDS Program clients.

HEALTH CARE SYSTEMS

Appropriations, 2018.................................... $111,693,000
Budget estimate, 2019................................... 100,518,000
Committee recommendation................................ 113,693,000

The Committee recommendation for the Health Care Systems
Bureau is $113,693,000.
The Health Care Systems Bureau protects the public health
and improves the health of individuals through efforts to
support and enhance the systems by which healthcare is
delivered in America.

Organ Donation and Transplantation

The Committee provides $25,549,000 for organ donation and
transplantation activities.
Funds support a scientific registry of organ transplant
recipients and the National Organ Procurement and
Transplantation Network to match donors and potential
recipients of organs. A portion of the appropriated funds may
be used to educate the public and health professionals about
organ donations and transplants and to support clearinghouse
and technical assistance functions.

National Cord Blood Inventory

The Committee provides $15,266,000 for the National Cord
Blood Inventory [NCBI]. The purpose of this program is to
provide funds to cord blood banks to build an inventory of the
highest quality cord blood units for transplantation.
The National Cord Blood Inventory builds a racially and
ethnically diverse inventory of high-quality umbilical cord
blood for transplantation. The Committee applauds HRSA for
increasing the number of units collected and maintained under
NCBI. The Committee urges the agency to consider establishing a
mechanism for reallocation of NCBI contract funds to cord blood
banks that have reached their specified goals for bankable
units from cord blood banks that are unable or unlikely to meet
such specified goals during the contract period. The Committee
strongly supports the collection of umbilical cord blood, which
may be used to treat many blood and bone marrow disorders such
as leukemia, lymphoma, and sickle cell disease. To expand
access to life-saving transplants, the Committee urges HRSA to
fund public cord blood bank pilot demonstrations that are
focused on increasing recruitment of donors and banking of cord
blood units from diverse populations. In addition, the
Committee looks forward to the report required in the
authorization bill due in June 2019 that will review the state
of the science of using adult stem cells to develop new types
of therapies for patients.

C.W. Bill Young Cell Transplantation Program

The Committee provides $24,109,000 for the C.W. Bill Young
Cell Transplantation Program.
The Committee continues to support cell transplantation
with cord blood, bone marrow, peripheral blood stem cells, and
other sources of stem cells that may be available in the
future. The Committee appreciates HRSA's efforts to increase
the diversity of the adult volunteer donors' registry and
encourages HRSA to continue to improve the availability,
efficiency, and safety of transplants and improve outcomes for
all blood stem cell transplant recipients regardless of their
genetic variability.

Office of Pharmacy Affairs

The Committee provides $10,238,000 for the Office of
Pharmacy Affairs [OPA]. OPA administers the 340B drug pricing
program, which requires drug manufacturers to provide discounts
or rebates to a set of programs and hospitals that serve a
disproportionate share of low-income patients.

Poison Control Centers

The Committee provides $22,846,000, an increase of
$2,000,000 from fiscal year 2018, for poison control
activities. The Poison Control Centers [PCCs] program is a
national network of 55 PCCs that prevent and treat poison
exposures by providing cost effective, quality healthcare
advice to the general public and healthcare providers.
In 2016, more than 1,150,000 human exposure calls managed
by PCCs involved opioids and medications. The Committee
continues to recognize the role PCCs have played in the opioid
crisis through management of opioid overdoses by assisting
first responders and hospital personnel through the National
Poison Help Line.

National Hansen's Disease Program

The Committee includes $13,706,000 for the National
Hansen's Disease program. The program consists of inpatient,
outpatient, long-term care as well as training and research in
Baton Rouge, Louisiana; a residential facility at Carville,
Louisiana; and 11 outpatient clinic sites in the continental
United States and Puerto Rico.

National Hansen's Disease Program Buildings and Facilities

The Committee provides $122,000 for the repair and
maintenance of buildings at the Gillis W. Long Hansen's Disease
Center.

Payment to Hawaii for Hansen's Disease Treatment

The Committee provides $1,857,000 to Hawaii for Hansen's
Disease treatment. Payments are made to the State of Hawaii for
the medical care and treatment of persons with Hansen's disease
in hospital and clinic facilities at Kalaupapa, Molokai, and
Honolulu. Expenses above the level of appropriated funds are
borne by the State of Hawaii.

RURAL HEALTH

Appropriations, 2018.................................... $290,794,000
Budget estimate, 2019................................... 74,911,000
Committee recommendation................................ 318,794,000

The Committee recommendation for Rural Health programs is
$318,794,000, an increase of $28,000,000 above the fiscal year
2018 level.
The Office of Rural Health Policy [ORHP] administers HHS
rural health programs, coordinates activities related to rural
healthcare within HHS, and analyzes the possible effects of
policy on the more than 60.0 million residents of rural
communities. ORHP advises the Secretary on the effects of
Medicare and Medicaid on rural citizens' access to care, the
viability of rural hospitals, and the availability of
physicians and other health professionals.
Rural Communities Opioids Response.--The bill provides
$120,000,000 for a Rural Communities Opioids Response to
support treatment for and prevention of substance use disorder,
with a focus on rural communities at the highest risk for
substance use disorder. This initiative would include improving
access to and recruitment of new substance use disorder
providers; building sustainable treatment resources, increasing
use of telehealth; establishing cross-sector community
partnerships, and implementing new models of care, including
integrated behavioral health; and technical assistance. HRSA
may also use funds for loan repayment through the National
Health Service Corps. Within the funding provided, the
Committee also includes $20,000,000 for the establishment of
three Rural Centers of Excellence on Substance Use Disorders
that will support the dissemination of best practices related
to the treatment for and prevention of substance use disorders
within rural communities, with a focus on the current opioid
crisis and developing methods to address future substance use
disorder epidemics. The Centers' research and programming
should include science-based prevention, treatment, and other
risk reduction interventions, including community-based
approaches that may be replicable in other rural communities
and associated professional training. The Centers' should
provide scientific and technical assistance to county and State
health departments seeking guidance on how to specifically
address the substance use disorder challenges in their
community. At least one such Center shall be established at an
academic university, in a rural State where over 60 percent of
the population is defined as rural by the U.S. Census Bureau,
which is connected to an associated medical school that is
already utilizing a collaborative approach to behavioral health
care, with partnerships between the university and medical
school, and the State with an effective, systems-wide approach
to addiction treatment, such as the hub and spoke model. This
academic university shall have a demonstrated track record of:
developing innovative and effective treatment interventions for
opioids; a strong familiarity with rural workforce and service
delivery challenges, including the requirements and challenges
of rural health clinics, critical access hospitals and other
rural providers; and effective engagement with rural
populations and health care providers in general. Further, such
a university and connected medical school shall have experience
in clinical trials research and the dissemination and training
in best practices in rural communities. Finally, this
university should have experience evaluating the efficacy of
comprehensive treatment of substance use disorders, including
patient-centered and family-based approaches to address the
generational impacts of substance abuse.

Rural Health Outreach

The Committee provides $77,500,000 for the Rural Health
Outreach program, $6,000,000 above the fiscal year 2018 level.
This program supports projects that demonstrate new and
innovative modes of outreach in rural areas, such as
integration and coordination of health services. The Committee
recommendation provides not more than $12,000,000 for Outreach
Service Grants; not more than $15,300,000 for Rural Network
Development Grants; not less than $20,000,000 for Delta States
Network Grant Program; not less than $2,400,000 for Network
Planning Grants; and not less than $6,400,000 for Small
Healthcare Provider Quality Improvement Grants.
Delta States Rural Development Network Grant Program.--The
Committee encourages HRSA to continue to consult with the DRA
on the awarding, implementing, administering, and monitoring
grants under the Delta States Network Grant Program in fiscal
year 2019. The Committee continues to encourage HRSA to align
its awards as closely as possible with the DRA's strategic
vision and with DRA economic and community development plans.
In addition, of the funds provided, the Committee provides
$8,000,000 to support HRSA's collaboration with the DRA to
continue DRA's program to help underserved rural communities
identify and better address their healthcare needs and to help
small rural hospitals improve their financial and operational
performance. Within 90 days of enactment of this act, the
Committee directs HRSA and DRA, jointly, to brief the Committee
on this program's progress.
Rural Outreach Grants.--The Committee is concerned by
reports that some grant opportunities have been closed off to
certain rural health centers due to necessary, collaborative
arrangements with healthcare providers in non-rural areas. The
Committee directs HRSA to review the criteria for rural
healthcare services outreach grants and similar opportunities
to ensure that rural health centers may engage in collaborative
partnerships with health centers in non-rural locations.

Rural Health Research

The Committee provides $9,351,000 for the Rural Health
Research program. Funds are used for rural health research
centers, the National Advisory Committee on Rural Health, and a
reference and information service. Supported activities focus
on improving the delivery of health services to rural
communities and populations.

Rural Hospital Flexibility Grants

The Committee provides $49,609,000 for Rural Hospital
Flexibility grants and the Small Hospital Improvement Program.
Under these grant programs, HRSA works with States to provide
support and technical assistance to Critical Access Hospitals
to focus on quality and performance improvement and to
integrate emergency medical services.
The Committee continues to recognize the importance of
supporting hospitals located in rural or underserved
communities and recommends HRSA give preference in grant awards
to Critical Access Hospitals serving rural communities that
create community health teams to better coordinate care among
rural populations to create better outcomes in chronic disease
management.

State Offices of Rural Health

The Committee provides $10,000,000 for State Offices of
Rural Health. These offices help States strengthen rural
healthcare delivery systems by enabling them to coordinate care
and improve support and outreach in rural areas.

Black Lung Clinics

The Committee provides $10,000,000 for the Black Lung
Clinics program. This program funds clinics that treat
respiratory and pulmonary diseases of active and retired coal
miners, steel mill workers, agricultural workers, and others
with occupationally related respiratory and pulmonary
impairments. These clinics reduce the incidence of high-cost
inpatient treatment for these conditions.
The Committee continues to direct the Secretary to evaluate
funding levels for applicants based on the needs of the
populations those applicants will serve and the ability of
those applicants to provide healthcare services to miners with
respiratory illnesses, with preference given to State agency
applications over other applicants in that State, without
regard to the funding tiers and overall per-applicant funding
cap established by the Secretary in fiscal year 2014.

Radiation and Exposure Screening and Education Program

The Committee provides $1,834,000 for activities authorized
by the Radiation Exposure Compensation Act. This program
provides grants for the education, prevention, and early
detection of radiogenic cancers and diseases resulting from
exposure to uranium during mining and milling at nuclear test
sites.

Telehealth

The Committee provides $25,500,000, an increase of
$2,000,000 above the fiscal year 2018 level, for the Office for
the Advancement of Telehealth [OAT], which promotes the
effective use of technologies to improve access to health
services for people who are isolated from healthcare and to
provide distance education for health professionals. The
Committee strongly supports OAT and their mission to expand
high quality medical care to rural communities that do not have
adequate access to medical providers including many medical
specialties.
Behavioral Health.--The Committee provides $2,000,000 to
support an evidence-based tele-behavioral health system to
focus on opioids, with an emphasis on behavioral health
services. This program will provide both increased access to
behavioral healthcare services in rural communities as well as
build the evidence-base for effectiveness of tele-behavioral
healthcare for patients, providers, and payers.
Telehealth.--Access to health professionals and services to
address the mental and behavioral health needs of adolescents
remains an important challenge. According to the CDC, early
diagnosis and appropriate services for children and their
families can make a difference in the lives of children with
mental health disorders. The Committee recognizes that
telehealth is effective to improve care, allows providers
opportunities to reach underserved patients, and train
providers.
Telehealth Centers of Excellence [COEs].--The Committee
supports the continued development of the Telehealth COEs.
Telehealth can provide rural patient access to quality primary
and specialty care that would otherwise require patients to
travel long distances for diagnosis and treatment. Many states
have invested in telehealth networks to provide rural,
medically underserved areas with access to primary and
emergency care. Specialists from a central location can help
rural providers with critical care for stroke and heart attack
that can literally mean the difference between life and death.
The Telehealth COEs serve to promote the adoption of telehealth
programs across the country by validating technology,
establishing training protocols, and providing a comprehensive
template for States to integrate telehealth into their State
health provider network.
Telehealth Network Grant Program.--The Committee remains
encouraged by the ability of telehealth services to provide
access to vital care for patients in underserved areas. The
Committee encourages HRSA to continue telehealth initiatives in
school-based clinics, substance abuse treatment, and behavioral
health treatment in the Telehealth Network Grant Program.

FAMILY PLANNING

Appropriations, 2018.................................... $286,479,000
Budget estimate, 2019................................... 286,479,000
Committee recommendation................................ 286,479,000

The Committee provides $286,479,000 for the title X Family
Planning program. This program supports preventive and primary
healthcare services at clinics nationwide.

PROGRAM MANAGEMENT

Appropriations, 2018.................................... $155,000,000
Budget estimate, 2019................................... 151,993,000
Committee recommendation................................ 155,000,000

The Committee provides $155,000,000 for program management
activities.

VACCINE INJURY COMPENSATION PROGRAM TRUST FUND

Appropriations, 2018.................................... $277,200,000
Budget estimate, 2019................................... 317,200,000
Committee recommendation................................ 317,200,000

The Committee provides that $317,200,000 be released from
the Vaccine Injury Compensation Trust Fund in fiscal year 2019.
Of that amount, $9,200,000 is for administrative costs.
The National Vaccine Injury Compensation program provides
compensation for individuals with vaccine-associated injuries
or deaths. Funds are awarded to reimburse medical expenses,
lost earnings, pain and suffering, legal expenses, and death
benefits. The Vaccine Injury Compensation Trust Fund is funded
by excise taxes on certain childhood vaccines.

Centers for Disease Control and Prevention

The Committee recommendation provides a program level of
$7,868,141,000 in this bill for the Centers for Disease Control
and Prevention [CDC], which includes $55,358,000 in mandatory
funds under the terms of the Energy Employees Occupational
Illness Compensation Program Act [EEOICPA], and $808,300,000 in
transfers from the Prevention and Public Health [PPH] Fund.
The activities of CDC focus on several major priorities:
providing core public health functions; responding to urgent
health threats; monitoring the Nation's health using sound
scientific methods; assuring the Nation's preparedness for
emerging infectious diseases and potential pandemics; and
providing leadership in the implementation of nationwide
prevention strategies that are conducive to improving and
maintaining health.

IMMUNIZATION AND RESPIRATORY DISEASES

Appropriations, 2018.................................... $798,405,000
Budget estimate, 2019................................... 700,828,000
Committee recommendation................................ 798,405,000

The Committee recommendation for the activities of the
National Center for Immunization and Respiratory Diseases is
$798,405,000, which includes $324,350,000 in transfers from the
PPH Fund.
The mission of the National Center for Immunization and
Respiratory Diseases is the prevention of disease, disability,
and death through immunization and by control of respiratory
and related diseases.
The Committee recommendation includes funding for the
following activities in the following amounts:

Cost Estimates.--The Committee looks forward to reviewing
the fiscal year 2019 report on estimated funding needs of the
Section 317 Immunization Program and requests that the report
be updated and submitted no later than February 1, 2019, to
reflect fiscal year 2020 cost estimates. The updated report
should also include an estimate of optimum State and local
operations funding, as well as a discussion of the evolving
role of the 317 program as expanded coverage for vaccination
becomes available from private and public sources over the next
several years.
Immunizations.--The Committee does not support the proposed
reduction to the Section 317 Immunization Program and provides
funding at last year's level. The Committee believes a strong
public health immunization infrastructure is critical for
ensuring high vaccination coverage levels, preventing vaccine-
preventable diseases, and responding to outbreaks.
Vaccine Administration.--The Committee applauds the ongoing
innovation of these important products for children,
adolescents, and adults. As more life-saving vaccines are
developed, and patient access continues to expand, the
Committee aims to ensure that vaccines are properly
administered. As such, the Committee encourages CDC to evaluate
its outreach and provider education programs and identify
additional efforts CDC could undertake to ensure proper vaccine
administration.

HIV, VIRAL HEPATITIS, SEXUALLY TRANSMITTED DISEASES, AND TUBERCULOSIS
PREVENTION

Appropriations, 2018.................................... $1,127,278,000
Budget estimate, 2019................................... 1,117,278,000
Committee recommendation................................ 1,132,278,000

The Committee recommendation for the activities of the
National Center for HIV, Viral Hepatitis, Sexually Transmitted
Diseases [STDs], and TB Prevention is $1,132,278,000.
The Center administers CDC's activities on HIV/AIDS, viral
hepatitis, STDs, and TB, with the exception of the Global AIDS
program, which is housed in the Center on Global Health.
The Committee recommends funding for the following
activities in the following amounts:

Infectious Diseases and the Opioid Epidemic.--The Committee
provides $5,000,000 to CDC to support a new initiative
targeting infectious disease consequences of the opioid
epidemic. The Committee directs CDC to focus efforts on
improving surveillance, treatment, and education efforts around
hepatitis B, hepatitis C, and HIV infections as it relates to
the opioid epidemic. CDC is directed to prioritize funding for
those areas most at risk for outbreaks of HIV and hepatitis due
to injection drug use, including the 220 counties CDC has
previously identified. Further, CDC is encouraged to integrate
interventions across its centers aimed at preventing, tracking,
and treating infectious diseases with broader efforts to
address the opioid epidemic.
Liver Cancer Awareness Program.--The Committee notes that
liver cancer remains one of the deadliest cancers and that some
forms of liver cancer are preventable. CDC is encouraged to
partner with stakeholder organizations to promote liver cancer
awareness, appropriate screening, and proper prevention
activities.
Sexually Transmitted Infections [STIs].--The Committee is
concerned about the continuing rise in STI rates and recognizes
that direct funding to States and local health departments is
critical in order to reverse this trend. The Committee
recommends that CDC continue to provide State and local funding
at or near the current percentage of total STI prevention
funding to the extent possible given evolving public health
needs. Additionally, CDC is encouraged to collaborate with CMS
for screening and treatment under Medicaid.
Viral Hepatitis.--The Committee is concerned that even with
a hepatitis B vaccine that is 95 percent effective, CDC
estimates that there are nearly 850,000 Americans infected with
hepatitis B, with an estimated 20,900 infections occurring in
2016. The Committee notes that in 2017 the National Academies
of Sciences Engineering and Medicine [NASEM] report titled ``A
National Strategy for the Elimination of Hepatitis B and C''
made a series of recommendations for vaccination, higher rates
of diagnosis, and care and treatment which if implemented could
eliminate hepatitis B as a public health concern by 2030. The
Committee, therefore, encourages CDC, in cooperation with the
leading national hepatitis B organizations, to develop a plan
to implement the NASEM recommendations to achieve the goal of
the elimination of hepatitis B. CDC is encouraged to provide an
update in the fiscal year 2020 CJ on this effort.

EMERGING AND ZOONOTIC INFECTIOUS DISEASES

Appropriations, 2018.................................... $614,572,000
Budget estimate, 2019................................... 508,328,000
Committee recommendation................................ 617,572,000

The Committee recommendation for the activities of the
National Center for Emerging and Zoonotic Diseases is
$617,572,000, which includes $52,000,000 in transfers from PPH
Fund.
The National Center for Emerging and Zoonotic Infectious
Diseases aims to detect, prevent, and control infectious
diseases from spreading, whether they are naturally occurring,
unintentional, or the result of terrorism.
The Committee recommendation includes funding for the
following activities in the following amounts:

Chronic Fatigue Syndrome [CFS].--The Committee applauds
CDC's efforts to collaborate with disease experts in its multi-
site study to resolve the case definition issues and urges CDC
to complete that effort. The Committee also commends the CDC's
recent update of its website informing the public about CFS,
also known as Myalgic Encephalomyelitis, and encourages CDC to
work with disease experts and patients to continue to better
educate healthcare providers about the disease and its
appropriate management. However, the Committee is concerned
that neither the website updates nor CDC's current plans will
address the continued medical stigma and misinformation about
CFS and the critical lack of medical providers. CDC is
encouraged to partner with HHS agencies and other experts to
address these issues and find creative ways to bring additional
clinicians into the field.
Combating Antibiotic Resistant Bacteria [CARB].--The
Committee continues to support the CARB initiative and provides
$168,000,000 for this effort. The Committee recognizes the
importance of addressing antibiotic-resistant bacteria through
a ``One Health'' approach, simultaneously combating antibiotic
resistance in human, animal, and environmental settings. The
Committee encourages CDC to support funding for collaborations
between entities such as academic medical centers, veterinary
schools, schools of public health, State public health
departments, and other academic institutions whose proposals
are in line with CDC's strategy for addressing antibiotic
resistant bacteria. Further, the Committee notes that urinary
tract infections are one of the most common diagnoses leading
to antibiotic prescriptions and encourages CDC to continue to
study the most effective strategies to improve antibiotic
prescribing including nutritional alternatives in healthcare
settings. CDC shall include an update on these efforts in the
fiscal year 2020 CJ.
Healthcare-Associated Infections [HAI].--The Committee
acknowledges CDC has made significant progress on HAI
prevention and data collection at acute-care hospitals, but
gaps in data collection and reporting on HAI persist across
outpatient, post-acute, and long-term care facilities. The
Committee recognizes that voluntary participation in the
National Healthcare Safety Network continues to grow among
dialysis facilities, nursing homes, and ambulatory surgical
centers, and encourages CDC to continue to expand its data
collection efforts to these healthcare providers.
Lyme Disease and Related Tick-Borne Illnesses.--The
Committee recognizes the importance of prevention and control
of Lyme disease and related tick-borne diseases and encourages
CDC to support surveillance and prevention of Lyme disease and
other high-consequence tick-borne diseases in endemic areas as
well as areas not yet considered endemic. The Committee
encourages CDC to coordinate with the National Institutes of
Health, the National Institute of Mental Health, and NINDS on
publishing reports that assess diagnostic advancements, methods
for prevention, the state of treatment, and links between tick-
borne disease and psychiatric illnesses.
Responding to Emerging Threats.--The Epidemiology and
Laboratory Capacity [ELC] for Infectious Diseases Program
strengthens the epidemiologic and laboratory capacity in 50
States, 6 local health departments, and 8 territories. This
funding provides critical support to epidemiologists and
laboratory scientists who are instrumental in discovering and
responding to various food and vector-borne outbreaks. The
Committee provides funding for ELC grants to sustain core
surveillance capacity and ensure that State and local
epidemiologists are equipped to respond rapidly to emerging
threats including antimicrobial resistant superbugs and the
Zika virus.
Sepsis.--The Committee is encouraged that CDC continues to
address sepsis as a priority and supports the implementation of
the Get Ahead of Sepsis national initiative, which raises
awareness about the importance of early recognition, treatment,
and prevention. The Committee supports CDC's goal of leveraging
resources to better track and prevent disability and death from
this devastating illness. In addition, the Committee is
encouraged by CDC's ongoing efforts to work with healthcare
partners to establish innovative ways to perform sepsis
surveillance and reporting using data from the patient's
electronic health record.
Tropical Diseases.--The Committee recognizes the critical
role the National Center for Emerging and Zoonotic Infectious
Diseases and its Vector Borne Disease Program play in ongoing
efforts to prepare for and fight tropical diseases emerging on
U.S. soil, such as Dengue, Chikungunya and now Zika.

CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION

Appropriations, 2018.................................... $1,162,896,000
Budget estimate, 2019................................... 939,250,000
Committee recommendation................................ 1,166,771,000

The Committee recommendation for the activities of the
National Center for Chronic Disease Prevention and Health
Promotion is $1,166,771,000, which includes $254,950,000 in
transfers from the PPH Fund.
The mission of the National Center for Chronic Disease
Prevention is to provide national leadership in promoting
health and well-being through prevention and control of chronic
diseases. Nearly one-half of all American adults have at least
one chronic illness and such diseases account for nearly 70
percent of all U.S. deaths and three-quarters of all healthcare
costs in the United States.
The Committee does not include the administration's
proposal to create a new block grant and instead maintains the
existing program line items, including funding mechanisms as
they existed in fiscal year 2018. The Committee believes the
existing funding structure allows for the greatest
transparency, accountability, and measured outcomes for
Congress and the taxpayer. Chronic diseases, such as arthritis,
cancer, diabetes, heart disease, stroke, and obesity are the
leading causes of death and disability in the United States and
account for 86 cents of every dollar spent on healthcare.
Therefore, a robust investment in the prevention and control of
chronic diseases, including Alzheimer's disease, epilepsy,
lupus, and colorectal, prostate, and skin cancers, is essential
to curb health spending and improve health and quality of life
for millions of Americans.
Within the total provided for the National Center for
Chronic Disease Prevention and Health Promotion, the following
amounts are available for the following categories of funding:

[In thousands of dollars]
------------------------------------------------------------------------
Fiscal year 2018 Committee
Budget activity appropriation recommendation
------------------------------------------------------------------------
Tobacco............................. 210,000 210,000
Nutrition, Physical Activity and 54,920 56,920
Obesity............................
High Obesity Rate Counties (non- 15,000 15,000
add)...........................
School Health....................... 15,400 15,400
Health Promotion.................... 18,000 19,000
Glaucoma........................ 4,000 4,000
Visual Screening Education...... 1,000 1,000
Alzheimer's Disease............. 4,500 5,500
Inflammatory Bowel Disease...... 1,000 1,000
Interstitial Cystitis........... 1,000 1,000
Excessive Alcohol Use........... 4,000 4,000
Chronic Kidney Disease.......... 2,500 2,500
Prevention Research Centers......... 25,461 25,461
Heart Disease and Stroke............ 140,062 140,062
Diabetes............................ 148,129 148,129
National Diabetes Prevention Program 25,300 25,300
Cancer Prevention and Control....... 367,674 370,549
Breast and Cervical Cancer...... 218,000 218,000
WISEWOMAN (non-add)......... 21,120 21,120
Breast Cancer Awareness for 4,960 4,960
Young Women....................
Cancer Registries............... 49,440 51,440
Colorectal Cancer............... 43,294 43,294
Comprehensive Cancer............ 19,675 19,675
Johanna's Law................... 7,000 7,000
Ovarian Cancer.................. 9,500 9,500
Prostate Cancer................. 13,205 13,205
Skin Cancer..................... 2,125 3,000
Cancer Survivorship Resource 475 475
Center.........................
Oral Health......................... 19,000 19,000
Safe Motherhood/Infant Health....... 46,000 58,000
Arthritis and Other Chronic Disease. 26,000 27,000
Arthritis....................... 11,000 11,000
Epilepsy........................ 8,500 8,500
National Lupus Registry......... 6,500 7,500
Racial and Ethnic Approach to 50,950 35,950
Community Health...................
Million Hearts...................... 4,000 4,000
National Early Child Care 4,000 4,000
Collaboratives.....................
Hospitals Promoting Breastfeeding... 8,000 8,000
------------------------------------------------------------------------

Alzheimer's and Healthy Aging.--The Committee includes
$5,500,000, an increase of $1,000,000 for activities related to
Alzheimer's disease and commends the Healthy Brain Initiative
for its leadership in bringing attention to the public health
crisis of Alzheimer's disease. The Committee encourages CDC to
continue implementing the action steps listed in the updated
Road Map, including working towards a consensus on the
mortality burden of the disease. The Committee encourages CDC
to assist States in collecting cognitive decline and caregiving
data through the Behavioral Risk Factor Surveillance System.
Breast and Cervical Cancer Screening.--The Committee
encourages CDC to continue to strengthen access to preventive
screenings for women who are uninsured or underinsured and at
high risk for breast and cervical cancer through the Breast and
Cervical Cancer program. Of women aged 21-64, 5,700,000 or 14.6
percent, will remain eligible for cervical cancer screening
through this program.
Breastfeeding.--The Committee has provided funding for CDC
to continue supporting breastfeeding as a strategy to reduce
obesity and promote activities proven to increase breastfeeding
through the State Physical Activity and Nutrition program.
Cancer Survivorship.--Recognizing there are more than
15,000,000 cancer survivors in the United States, the Committee
is encouraged by CDC's ongoing work with the Cancer
Survivorship Resource Center in making cancer survivorship a
public health priority. The Committee encourages CDC to work
with public, non-profit, and private organizations to evaluate
and disseminate promising practices and interventions to
promote health and improve the quality of life of cancer
survivors.
Childhood Cancer STAR Act.--The Committee has included an
increase of $2,000,000 to be awarded to State cancer registries
to enhance and expand infrastructure to track cancer in
children, adolescents, and young adults.
Children in Adversity.--The Committee recognizes that CDC
is a key implementing partner of the United States Government
Action Plan on Children in Adversity's three principle
objectives. The Committee fully supports the use of funds
provided to CDC through this act for activities that the agency
has identified as being necessary to link representative data
to effective, sustainable, and scalable action and thus ensure
that: (1) the percentage of children achieving age-appropriate
growth and developmental milestones is increased; (2) the
percentage of children living outside of family care is
reduced; and (3) the percentage of children experiencing
violence, exploitation, abuse, and neglect is reduced. The
Committee continues to direct CDC to collaborate with USAID,
PEPFAR, and DOL to ensure monitoring and evaluation is aligned
for all of the Action Plan's objectives. The Committee asks
that the annual Public Law 109-95 report to Congress display
the amount of funding by objective to the Action Plan on
Children in Adversity.
Chronic Obstructive Pulmonary Disease [COPD].--The
Committee applauds CDC and NIH in leading a cross-agency effort
to respond to COPD. The Committee encourages the agencies to
move forward with a timely implementation of the COPD National
Action plan to address the rising burden of COPD on patients,
providers, and caregivers across the country.
Diabetes Prevention Program.--The Committee recommendation
includes $25,300,000, level with fiscal year 2018, for the
Diabetes Prevention Program [DPP]. This program promotes
lifestyle interventions proven to reduce the risk of developing
diabetes by 58 percent in individuals at high risk. The
Committee encourages CDC, in coordination with CMS, to develop
a consumer facing program locator that includes all CDC and
Medicare DPP programs. CDC is further encouraged to work with
CMS to ensure that current CDC-recognized DPPs become certified
Medicare DPP suppliers.
Division of Diabetes Translation [DDT].--The Committee
recognizes the work of CDC's DDT to address the diabetes
epidemic and encourages CDC to continue to ensure that the
prevention needs of those Americans with, and at risk for,
diabetes and prediabetes are met. The Committee believes these
activities must include clear outcomes and ensure transparency
and accountability that demonstrate how funding was used to
support diabetes prevention and specifically how diabetes
funding reached State and local communities. Additionally, the
Committee encourages CDC to support the translation of research
into better prevention, care, and surveillance. The Committee
encourages CDC to explore opportunities to expand virtual
delivery of the National Diabetes Prevention Program's
lifestyle change program in rural areas where patients have
provider care access challenges.
Early Child Care Collaboratives.--The Committee recognizes
that the early care and education setting is important for
promoting healthy habits in young children. The Committee
provides $4,000,000 to the National Early Child Care
Collaboratives to enable training of early care and education
providers in implementation of healthy eating and physical
activity best practices, including strategies for engaging
families. Funds will also support technical assistance for
integration of healthy eating and physical activity best
practices into existing State and local professional
development systems' early care and education settings, and
health initiatives. The Committee also encourages the program
to serve a mix of rural, suburban and urban areas, including
areas with high childhood obesity rates.
Endometriosis.--The Committee is aware that endometriosis
is a serious chronic condition that impacts an estimated 1 in
10 women in the United States between the ages of 18 and 49.
Women with this condition can suffer up to 10 years before
being properly diagnosed, often due to lack of awareness,
invasive methods of diagnosis, and limited treatment options.
The Committee encourages CDC, in collaboration with NICHD, to
continue to support education, outreach, and awareness to
promote early and accurate diagnosis of endometriosis.
Epilepsy in Rural Areas.--The Committee encourages CDC to
continue telehealth and educational training programs for rural
and underserved areas that reach school nurses, child care
personnel, first responders, and care providers for seniors to
recognize and respond appropriately to seizures caused by
epilepsy or resulting from trauma and other acute chronic
illness.
Farm-to-School.--The Committee notes that farm-to-school
programs can be an effective way of improving the quality of
school meals and increasing opportunities for nutrition
education. The Committee includes $2,000,000 within Nutrition,
Physical Activity, and Obesity for research and education
activities related to farm to school programs that result in
promoting healthy eating habits for students.
Heart Disease and Stroke Prevention.--While largely
preventable, cardiovascular disease, including heart disease
and stroke, continues to inflict the highest burden on our
Nation's long-term health and economic stability. The Committee
continues funding to support, strengthen, and expand heart
disease and stroke prevention and control activities within
State, local, and tribal public health departments and to
enhance surveillance and research to target high burden
populations and guide public health strategies. The Committee
encourages CDC to prioritize these funds to communities with
the highest disease burden of heart disease and stroke to
identify and disseminate novel and innovative evidence-based
strategies, including scientifically valid risk factor
reduction measures, through competitive awards.
High Obesity Rate Counties.--The Committee remains
concerned about the growing body of evidence suggesting that
obesity is one of the most significant challenges facing the
public health system. The Committee continues to include
$15,000,000 to support the rural extension and outreach
services grants for rural counties with an obesity prevalence
of over 40 percent. The Committee expects CDC to work with
State and local public health departments to support measurable
outcomes through evidenced-based obesity research,
intervention, and prevention programs. Grants should combine
basic, clinical, and population research to better understand
and treat the metabolic, medical, surgical, environmental, and
societal implications of obesity in cooperation with partners
that have existing outreach capacity to develop and implement
educational and intervention programs. Preference should be
given to States where at least 10 percent of counties meet the
requirements of this program. In addition, CDC shall focus its
efforts in areas of the country with the highest burden of
obesity and with the comorbidities of hypertension, cardiac
disease, and diabetes from county level data in the Behavioral
Risk Factor Surveillance System. The Committee encourages CDC
to support only activities that are supported by scientific
evidence.
Inflammatory Bowel Diseases [IBD].--The Committee commends
CDC for its commitment to the study of IBD epidemiology. The
Committee is particularly concerned that IBD is increasingly
recognized in minority and underserved communities and
encourages CDC to complement its existing epidemiological study
with a focus on these populations. The Committee encourages CDC
to continue to identify innovative approaches, including mixed
methods research, for determining the incidence and prevalence
of IBD.
Interstitial Cystitis.--The Committee recommendation for
Interstitial Cystitis activities provides support for the
ongoing epidemiology study, as well as education, outreach, and
public awareness activities.
Maternal Mortality.--The Committee recognizes the rising
maternal mortality rate in the U.S. as a pressing public health
issue. Each year, almost 700 women die during or within a year
of the end of their pregnancy in the U.S. as a result of
pregnancy or delivery complications. These statistics are all
the more concerning given that accurate and complete data
regarding the cause of pregnancy-related deaths is lacking. For
this reason, the Committee has included $12,000,000 in the Safe
Motherhood and Infant Health Program for CDC to continue and
expand its technical assistance to State Maternal Mortality
Review Committees [MMRCs] to build stronger data systems,
improve data collection at the State level and create
consistency in data collection across State MMRC's. The
Committee believes this investment will lead to better
information necessary to provide accurate national statistics
for U.S. maternal mortality rates and will inform data-driven
actions for preventing these deaths. CDC is directed to provide
a report, within 180 days of enactment, regarding how States
currently account for maternal mortality and the additional
steps required to achieve comprehensive surveillance and data
collection in all States regarding maternal mortality for all
pregnancy-associated and pregnancy-related deaths, regardless
of the outcome of the pregnancy.
Million Hearts 2022.--The Committee is aware that Million
Hearts, a public-private initiative, prevented an estimated
500,000 heart attacks and strokes in the first 5 years. The
Committee continues to support Million Hearts 2022 and its goal
of preventing 1,000,000 heart attacks and strokes over 5 years.
Funding and resources shall be used to continue implementation
of the ABCS (aspirin as appropriate, blood pressure control,
cholesterol management, and smoking cessation); to develop
innovative, scalable ways for communities and the healthcare
sector to execute evidence-based prevention in the highest
burden areas; and to expand focus on physical activity, cardiac
rehabilitation, and people aged 35-64 whose event rates are on
the rise.
Mississippi Delta Health Collaborative [MDHC].--Within the
funds provided for Chronic Disease Prevention and Health
Promotion, the Committee encourages CDC to build on its
longstanding investment in MDHC by working to replicate the
work in additional sites while maintaining the current
strategy. CDC shall provide an update on these activities in
the fiscal year 2020 CJ.
Physical Activity.--Regular physical activity plays a
critical role in chronic disease prevention, military
readiness, academic success, workplace productivity, and lowers
healthcare expenditures. The Committee is therefore pleased
that the second edition of the Physical Activity Guidelines for
Americans will be released in late 2018. The Committee
encourages CDC to promote these Guidelines, once released,
which should include consumer education about benefits of
physical activity. In addition, the Committee applauds CDC for
creating the new initiative, Active People, Healthy Nation and
encourages CDC to strengthen its work.
National Lupus Patient Registry.--The Committee includes
$7,500,000, an increase of $1,000,000, to continue to support
research efforts under the National Lupus Patient Registry
program. Significant progress has been made to understand the
epidemiology of lupus. The Committee encourages CDC to build on
this work and focus on natural history studies of lupus to
determine the lifetime impacts of the disease on children and
others with lupus, including through CDC support for existing
childhood lupus registries. The Committee also supports CDC's
work to establish the National Resource Center on Lupus and
encourages CDC to continue to work with national lupus
voluntary health agencies to enhance the Resource Center by
developing lupus self-management programs and new tools for use
by healthcare providers, caregivers and others to expand
physician education and reduce time to diagnosis, which can
lead to earlier interventions.
Preterm Birth.--The Committee commends CDC for funding
State-based Perinatal Collaboratives that focus on improving
birth outcomes using known prevention strategies such as
reducing early elective deliveries. CDC is encouraged to
continue support for perinatal collaboratives particularly due
to the rise in neonatal abstinence syndrome as a result of the
opioid crisis.
Psoriasis and Psoriatic Arthritis.--The Committee commends
CDC for identifying opportunities for expanded research on
psoriatic disease in its Public Health Agenda for Psoriasis and
Psoriatic Arthritis and encourages CDC to explore opportunities
for research on the comorbidities of psoriatic disease that can
be done in collaboration with or funded by other disease
programs such as Arthritis, Cardiovascular Health, or Mental
Illness.
Pulmonary Hypertension [PH].--The Committee understands
that PH causes heart failure and death. CDC is encouraged to
support education, outreach, and awareness activities that
promote early and accurate diagnosis of PH.
Safe Motherhood Initiative.--Preterm birth affects more
than 500,000 babies each year in the United States and is the
leading cause of neonatal mortality. The Committee commends CDC
for funding State-based perinatal collaboratives that focus on
improving birth outcomes using known preventative strategies
such as reducing early elective deliveries. CDC is encouraged
to improve the timeliness in data reporting by working with
existing State biosurveillance tools to report on neonatal
abstinence syndrome, hypertension, diabetes and other risk
factors.
Skin Cancer Education and Prevention.--The Committee is
concerned with the growing number of people diagnosed with
preventable forms of skin cancer, which is now the most
commonly diagnosed cancer in the United States. The Committee
has provided an increase for skin cancer education and
prevention, and encourages CDC to increase its collaboration
and partnership with local governments, business, health,
education, community, nonprofit and faith-based sectors.
Sleep Surveillance.--The Committee is pleased by CDC's work
on a national public health awareness campaign for sleep. The
Committee encourages CDC to ensure that funding for
surveillance activities on sleep disorders and sleep health is
maintained in addition to these awareness efforts.
Vision Health.--Vision impairment often occurs as a co-
morbidity with other chronic illness, such as chronic heart
disease, stroke, depression, and smoking, at substantially
higher rates than individuals without vision impairment. CDC is
encouraged to apply previous CDC vision and eye health research
findings to develop effective prevention and early detection
interventions, and to incorporate vision and eye health
promotion activities into existing State and national public
health chronic disease initiatives, with an initial focus on
early detection of diabetic retinopathy. In addition, the
Committee encourages CDC to update its reports on the estimated
burden of keratitis and contact lens-related infections.
WISEWOMAN.--The Committee lauds the WISEWOMAN program that
helps uninsured and under-insured low-income women ages 40 to
64 decrease, prevent, or control heart disease and stroke by
providing preventive health services, referrals to local
healthcare providers, lifestyle programs, and health counseling
services tailored to identified risk factors to promote
lasting, healthy behavior change. From 2008 to 2016, WISEWOMAN
provided 268,673 screenings to 192,391 women. Additionally,
with WISEWOMAN's new behavioral focus, participants received
81,653 healthy behavior support services between 2013 and 2016.
The Committee commends the Division for Heart Disease and
Stroke Prevention for increasing the number of screenings by 27
percent in 1 year.

NATIONAL CENTER ON BIRTH DEFECTS, DEVELOPMENTAL DISABILITIES,
DISABILITY AND HEALTH

Appropriations, 2018.................................... $140,560,000
Budget estimate, 2019................................... 110,000,000
Committee recommendation................................ 153,560,000

The Committee recommendation for the activities of the
National Center on Birth Defects and Developmental Disabilities
[NCBDDD] is $153,560,000.
This Center improves the health of children and adults by
preventing birth defects, developmental disabilities, and
complications of heredity blood disorders and by promoting
optimal child development and health and wellness among
children and adults living with disabilities.
Within the total provided, the following amounts are
provided for the following categories of funding:

Cerebral Palsy [CP].--The Committee encourages NCBDDD to
use existing resources in infant health to improve CP
surveillance, including but not limited to using existing data
registries, the Autism and Developmental Disabilities
Monitoring network, and other data sets available to estimate
national prevalence. From this information, the Committee
requests information in the fiscal year 2020 CJ on the cause,
earlier diagnosis, and treatment of CP across the lifespan.
Congenital Heart Disease [CHD].--CHD is the most common and
deadliest category of birth defects in the United States. The
Committee notes that children and adults with CHD require
ongoing, specialized cardiac care, and there remain gaps in
data as children and adolescents transition to adult care. The
Committee commends NCBDDD for its leadership in addressing CHD
and adult CHD surveillance efforts and requests a report in the
fiscal year 2020 CJ on CDC surveillance and research efforts
regarding CHD across the lifespan, age-specific prevalence, and
factors associated with those patients who may have dropped out
of appropriate specialty care. The report should address
current gaps in surveillance of adults with CHDs and include
action items.
Duchenne Muscular Dystrophy.--The Committee is pleased by
the publication of care standards updates for Duchenne Muscular
Dystrophy and encourages the agency to continue supporting the
widespread dissemination of these standards. The Committee is
also aware of CDC's efforts to develop an ICD 10 code for
Duchenne and requests that CDC develop a plan to leverage the
recently established ICD 10 code to shift the Muscular
Dystrophy Surveillance, Tracking and Research Network [MD
STARnet] toward a more passive surveillance effort enabling an
expansion of MD STARnet to additional sites and States.
Further, the Committee encourages CDC to continue its work to
disseminate the revised Duchenne/Becker Muscular Dystrophy care
standards, to expand surveillance of Duchenne/Becker via the MD
STARnet, and support Duchenne newborn screening efforts. In
addition, the Committee has provided sufficient funds to
support a coordinated Duchenne newborn screening initiative
through the National Center for Environmental Health Newborn
Screening Quality Assurance Program.
Emerging Threats to Mothers and Babies.--The Committee
recommendation includes $10,000,000 to support CDC's continued
collaboration with State, tribal, territorial, and local health
departments to monitor mothers and babies impacted by Zika
virus during pregnancy in highest risk jurisdictions. This
funding will allow CDC to pilot the Zika surveillance/registry
system in additional jurisdictions to capture data on other
emerging public health threats to mothers and babies, such as
opioid use during pregnancy, natural disasters, and pandemic
influenza.
Fragile X [FX].--The Committee commends CDC's efforts to
identify and define the population impacted by FX and all
conditions associated with the gene mutation with the goal of
understanding the public health impact of these conditions. The
Committee acknowledges the significant progress made by the
NCBDDD Fragile X Clinical and Research Consortium in growing
its FORWARD Database and Patient Registry, and is pleased that
a new grant was awarded in 2015 to continue and expand upon
this important work. The Committee also notes with approval the
public-private partnership meeting to set the Public Health
Research Agenda and the resulting focus on longitudinal data to
characterize the natural history of FX, to in turn better
inform the development of outcome measures and biomarkers for
new drug treatments under development. The Committee encourages
NCBDDD to explore cross-divisional funding opportunities to
accelerate data-driven public health research to reduce the
public health burdens of both FX and autism.
Hemophilia.--The Committee includes sufficient funding for
CDC hemophilia activities. These programs support inhibitor
prevention and eradication, education programs on bleeding
disorders, and Hemophilia Treatment Centers which have been
critical to the advancement of care for patients with
Hemophilia and other bleeding disorders.
Marfan Syndrome.--The Committee remains concerned that
structural cardiovascular disorders, such as Marfan syndrome,
continue to claim the lives of high school athletes across the
country who received a sports physical prior to competition.
CDC is encouraged to work with patient and professional
stakeholders to develop minimum screening guidelines that
ensure all young athletes are appropriately screened for
potentially life-threatening structural cardiovascular
disorders.
Physical Activity for People With Disabilities.--The
Committee includes an increase of $2,000,000 to continue to
strengthen existing programs that address healthy athletes. The
Committee encourages CDC to work with grant recipients to: (1)
ensure that there are systems in place to help athletes and
others with intellectual disabilities connect to care in their
home communities; and (2) improve integration of best practices
to the CDC's State-based disability and health programs to
increase access to these types of health benefits for those
with intellectual disabilities. In addition, an increase of
$1,000,000 is provided to continue to existing activities that
improve physical activity and health promotion for people with
mobility disabilities. Funds for this effort include a
demonstration project to develop and implement strategies based
on and informed by scientific evidence to reduce diabetes and
obesity among the mobility-impaired.
Sickle Cell Disease [SCD].--The Committee recognizes the
importance of surveillance to better understand and address the
long term health outcomes, complications, and healthcare access
needs of people living with SCD. CDC shall report to the
Committees on Appropriations of the House of Representatives
and the Senate within 1 year after enactment of the act,
regarding how it would expand its current sickle cell disease
surveillance efforts in California and Georgia to additional
States with the goal of covering the majority of the U.S. SCD
population over the next 5 years.
Spina Bifida.--While spina bifida and related neural tube
defects are highly preventable through education and adequate
daily folic acid consumption, they are the most common
permanently disabling birth defect in the United States. The
Committee supports the continuation of the spina bifida
Clinical Care Monitoring and Tracking program and commends the
National Spina Bifida Program in serving as a model for
programs assisting other individuals living with similar
complex conditions. The Committee encourages CDC to continue
the dissemination of information to clinicians, parents, and
families living with spina bifida.
Thalassemia.--The Committee is aware of the thalassemia
program at CDC and the critical work it does connecting
patients with this rare genetic blood disorder to life-saving
resources and treatment centers. Thalassemia patients
experience serious comorbidities which can impact almost every
aspect of their lives. The Committee requests that CDC continue
collaborating with thalassemia treatment centers, non-profits,
and patient advocates through this program.
Tuberous Sclerosis Complex [TSC].--The Committee encourages
CDC to take into consideration all the major manifestations of
TSC in its surveillance network.

PUBLIC HEALTH SCIENTIFIC SERVICES

Appropriations, 2018.................................... $490,397,000
Budget estimate, 2019................................... 468,000,000
Committee recommendation................................ 492,397,000

The Committee recommendation for Public Health Scientific
Services is $492,397,000.
This funding supports the work of all of the CDC Centers by
compiling statistical information to inform public health
policy. In particular, these activities assure the accuracy and
reliability of laboratory tests; apply digital information
technology to help detect and manage diseases, injuries, and
syndromes; and develop and inform the public health community
on sound public health surveillance, laboratory protocols, and
epidemiological practices.
The Committee recommendation includes funding for the
following activities in the following amounts:

Modernizing Vital Statistics.--The Committee encourages CDC
to continue its efforts to modernize its surveillance
infrastructure, which was started with the development of the
Surveillance Data Platform [SDP]. By selecting the National
Healthcare Safety Network [NHSN], CDC will take an important
step forward in modernizing their critical data collection
systems that will allow for better data sharing and analysis on
a common platform while also helping to help reduce redundancy
and maintenance. Further, CDC is encouraged to continue working
with States to modernize electronic systems and improve vital
statistics reporting.

ENVIRONMENTAL HEALTH

Appropriations, 2018.................................... $205,750,000
Budget estimate, 2019................................... 157,000,000
Committee recommendation................................ 205,750,000

The Committee recommendation for the National Center for
Environmental Health is $205,750,000. The Committee
recommendation includes $17,000,000 in transfers from the PPH
Fund.
The National Center for Environmental Health addresses
emerging pathogens and environmental toxins that pose
significant challenges to public health. The Center conducts
surveillance and data collection to determine which substances
in the environment are found in people and to what degree. The
Center also determines whether and at what level of exposure
these substances are harmful to humans.
The Committee recommendation includes funding for the
following activities:

Amyotrophic Lateral Sclerosis [ALS] Registry.--The
Committee continues to support the National ALS Registry and
seeks to understand how to build upon current efforts to
improve data collection. The Committee looks forward to seeing
the report requested in fiscal year 2018 to determine
compliance with Public Law 110-373.
Asthma.--The Committee supports the work of the National
Asthma Control Program, recognizing that asthma is one of the
most common and costly health conditions in the United States.
The Committee encourages CDC to continue its 618
Initiative efforts which promote evidence-based asthma medical
management and strategies aimed at improving access and
adherence to the 2007 National Asthma Education and Prevention
Program.
Newborn Screening.--The Committee requests CDC to provide
an update in the fiscal year 2020 CJ on how CDC will use the
additional funding provided in fiscal year 2018 to expand CDC's
quality assurance materials, as well as critical infrastructure
and development of tests for rare conditions. Further, the
update should note what steps can be taken to encourage States
to adopt and implement new Recommended Uniform Screening Panel
conditions within 1 year of their addition. Further, the
Committee is aware of the successful pilot project in Ohio
around Duchenne Muscular Dystrophy screening and CDC's support
of existing plans to conduct an additional state pilot. CDC is
encouraged to develop a plan to foster development and use of
disease-specific validation test panels and protocols that meet
all required standards. The plan should also include capacity-
building support for State laboratory staff to be able to
interpret results and minimize false positives as well as a
system to monitor performance of labs in this work. The
Committee recommends that CDC develop working groups involving
all stakeholders, including the newborn screening community, to
address these and future concerns.

INJURY PREVENTION AND CONTROL

Appropriations, 2018.................................... $648,559,000
Budget estimate, 2019................................... 266,309,000
Committee recommendation................................ 648,559,000

The Committee recommendation for the National Center for
Injury Prevention and Control is $648,559,000.
CDC is the lead Federal agency for injury prevention and
control. Programs are designed to prevent premature death and
disability and reduce human suffering and medical costs caused
by fires and burns, poisoning, drowning, violence, and traffic
accidents. The national injury control program at CDC
encompasses non-occupational injury and applied research in
acute care and rehabilitation of the injured.
The Committee recommendation includes funding for the
following activities:

Child Sexual Abuse Prevention.--It is estimated that 15 to
25 percent of girls and 5 to 10 percent of boys will experience
child sexual abuse. While the Federal Government has invested
in treatment for victims and punishment for offenders, the
Committee recognizes the value of also investing in prevention.
The Committee requests that the Center for Injury Prevention
and Control report on its current activities related to the
development and evaluation of primary public health
interventions targeting child sexual abuse. Additionally, the
Committee asks that the Center identify gaps in research that
can be filled to promote child sexual abuse primary prevention,
as well as what resources would be needed to conduct such
research. The Center shall provide a report to the Committee
within 180 days of enactment of this act.
Concussion Surveillance.--The 2013 NAS study ``Sports-
Related Concussions in Youth: Improving the Science, Changing
the Culture'' recommended that CDC establish and oversee a
national surveillance system to accurately determine the
incidence of sports-related concussions, including youth ages 5
to 21. The Committee encourages CDC to investigate the
establishment of a national surveillance system to accurately
determine the incidence of sports- and recreation-related
concussions among youth aged 5 to 21 years.
Opioid Abuse in Native Communities.--The Committee
understands that American Indians and Alaska Natives overdose
on opioids at the highest rate in the United States and
recognizes the importance of addressing the disproportionate
impact of the opioid crisis in Native communities. The
Committee directs CDC to work with the Indian Health Service to
ensure federally-operated and tribally-operated healthcare
facilities benefit from the Center's PDMP efforts.
Opioid Drug Overdose [PDO] Prevention.--The Committee
includes $475,579,000, and reflects continued strong support of
CDC PDO activities. CDC shall continue to use funds to advance
the understanding of the opioid overdose epidemic and scale up
prevention activities across all 50 States and the District of
Columbia. The Committee expects that this will include the
expansion of case-level syndromic surveillance data,
improvements of interventions that monitor prescribing and
dispensing practices, better timeliness, and quality of
morbidity and mortality data, as well as the enhancement of
efforts with medical examiners and coroner offices. CDC shall
promote the use of Prescription Drug Monitoring Programs
[PDMPs], including implementation of activities described in
the National All Schedules Prescription Electronic Reporting
Act of 2005 as amended by the Comprehensive Addiction and
Recovery Act of 2016. This shall include continuing to expand
efforts to enhance the utility of PDMPs in States and
communities, making them more interconnected, real-time, and
usable for public health surveillance and clinical
decisionmaking. The Committee encourages CDC to ensure State
PDMP implementation and improvements are coordinated with
respective State alcohol and drug agencies. CDC shall also
promote alternative surveillance programs for States and
communities that do not have a PDMP. CDC is encouraged to work
with the Office of the National Coordinator for Health
Information Technology to enhance the integration of PDMPs and
electronic health records. Further, the Committee is encouraged
to ensure that Federal funding allocated to respond to the
opioid epidemic flows from the States into communities and
local health departments as practicable and encourages CDC to
support local prevention activities to determine the
effectiveness of naltrexone in treating heroin and prescription
drug abuse as well as reducing diversion of buprenorphine for
illicit purposes. Finally, CDC shall use $10,000,000 of the
funds provided to conduct an opioid nationwide awareness and
education campaign.
Opioid Prescribing Guidelines.--The Committee applauds
CDC's Guidelines for Prescribing Opioids for Chronic Pain and
encourages CDC to continue its work to support uptake and use
of the Guidelines. The Committee understands that current
guidelines do not distinguish between Schedule 3 and Schedule 2
opioids and encourages CDC to adopt guidelines to reduce the
risk of addiction by starting with a Schedule 3 prescription
before considering Schedule 2. CDC is further directed to
continue robust implementation of use of the electronic tool to
train providers on incorporating and applying the CDC
Guidelines in primary care settings and through efforts to
increase continuing education. The Committee encourages CDC to
coordinate with VA and DOD on implementation and any new
developments in safe prescribing practices to ensure
consistent, high-quality care standards across the Federal
Government. The Committee notes that prescribing for acute pain
remains a significant driver of initial opioid prescriptions,
especially for youth, and that numerous States have established
limits on initial opioid prescriptions, while substantial
research has examined the use of non-opioid therapies for acute
pain. The Committee encourages CDC to continue its leadership
in prevention of the opioid epidemic by developing prescribing
guidelines for acute pain, including those which are applicable
to emergency physicians, surgeons, and dentists.
Rape Prevention.--The Committee directs that at least 75
percent of the program's funds go to States for State and local
prevention activities. CDC activities should be coordinated
with efforts at institutions to reduce the incidence of sexual
assault on their own campus.
Trauma Surveillance.--The Committee commends CDC for
providing funding to States to conduct surveillance on youth
and adult behavioral risk factors. The Committee encourages CDC
to prioritize collection and reporting of data on adverse
childhood experiences, including exposure to violence. The
Committee also encourages CDC to report on the prevalence of
adverse childhood experiences across geography, race and
ethnicity, and socioeconomic status.
Traumatic Brain Injury [TBI].--The Traumatic Brain Injury
Act of 1996 and subsequent reauthorizations, supports a variety
of activities related to TBI at several agencies within the
Department. The Committee recognizes that the Federal TBI
program supports prevention, education, surveillance, research,
protection and advocacy services, as well as support to States
and territories to help improve delivery of services and
resources for people living with TBI and their families. The
Committee applauds States for their efforts in securing
supplemental resources to help further expand their TBI
programs, and encourages them to continue improving their
systems. In addition, the Committee urges CDC to continue its
work in creating a National Concussion Surveillance System to
provide in the future comprehensive incidence estimates of
traumatic brain injury.
Violence and Injury Prevention.--The Committee commends CDC
for expansion of the Core State Violence and Injury Prevention
Program [SVIPP] to 23 States and its focus on shared risk and
protective factors. To further strengthen State decision-
making, the Committee encourages CDC to allow States to utilize
Core SVIPP funds to implement, evaluate, and disseminate
effective violence and injury prevention programs and policies
beyond the four core focus areas selected by CDC. Additional
areas may include prevention of falls, homicides, and other
areas that State deems to be high priorities. The Committee
encourages CDC to prioritize program funding for youth violence
prevention efforts in high-violence, high-poverty areas and, in
particular, large urban communities that are seeking to address
relevant impacts and root causes of community violence, and
collective trauma.

OCCUPATIONAL SAFETY AND HEALTH

Appropriations, 2018.................................... $335,200,000
Budget estimate, 2019...................................................
Committee recommendation................................ 335,300,000

The Committee recommendation for National Institute for
Occupational Safety and Health [NIOSH] programs is
$335,300,000.
NIOSH is the only Federal agency responsible for conducting
research and making recommendations for the prevention of work-
related illness and injury. The NIOSH mission is implemented by
conducting basic and applied scientific research and
translating the knowledge gained into products and services
that impact workers in settings from corporate offices to
construction sites to coal mines. The Committee does not
include the administration's proposal to consolidate NIOSH
within NIH. Further, the Committee acknowledges that NIOSH
continues to protect American workers through its work-related
illness and injury research. The Committee encourages NIOSH to
continue maintaining its objectivity so as to ensure the
highest professional and ethical standards are maintained.
The Committee recommendation includes funding for the
following activities at the following amounts:

Mesothelioma.--The Committee is aware that no formal
registry exists to keep track of mesothelioma patients, their
demographics, and other important information that could help
develop and improve standards of care, as well as identify gaps
in current treatment. The recommendation includes $100,000 for
CDC to initiate a feasibility study for a patient registry
which would include developing case finding methodology to
determine incidence and prevalence, demographics and risk
factors. The Committee expects a report from CDC after
conclusion of the feasibility study.
Total Worker Health.--The Committee commends CDC's Total
Worker Health Program. The Committee provides level funding for
the program which aims to promote and protect the health and
productivity of the American workforce through research and
dissemination of innovative and cost-effective tools and
interventions for American businesses.

ENERGY EMPLOYEES OCCUPATIONAL INJURY COMPENSATION ACT

Appropriations, 2018.................................... $55,358,000
Budget estimate, 2019...................................................
Committee recommendation................................ 55,358,000

The Committee recommendation for the Energy Employees
Occupational Illness Compensation Program Act [EEOICPA] is
$55,358,000. This mandatory funding supports NIOSH scientists
who reconstruct radiation dose levels to inform compensation
decisions. The Committee does not accept the administration's
proposal to move EEOICPA to NIH.

GLOBAL HEALTH

Appropriations, 2018.................................... $488,621,000
Budget estimate, 2019................................... 408,762,000
Committee recommendation................................ 488,621,000

The Committee recommends $488,621,000 for global health-
related activities at CDC.
The Center for Global Health leads international programs
and coordinates CDC's global efforts with the goal of promoting
health and preventing disease in the United States and abroad.
The Center has a particular focus on ensuring rapid detection
and response to emerging health threats.
The Committee recommendation includes funding for the
following activities in the following amounts:

Global Health Security [GHS] Strategy.--The Committee
reiterates strong support for the GHS strategy and notes that
funding provided in the Ebola supplemental will expire at the
end of fiscal year 2019. The Committee provides $98,400,000,
level with fiscal year 2018, which will help CDC sustain its
GHS work around the globe. The Committee looks forward to
receiving the comprehensive inter-agency strategy requested in
the Consolidated Appropriations Act, 2018 by September, 2018.
Global Water Strategy.--The Committee encourages CDC to
work with other Federal partners to initiate an effort to
assess and support water sanitation and hygiene [WASH]
improvements in healthcare facilities, aligned with the 2017 US
Global Water Strategy. Further, the Committee urges CDC to
increase its WASH efforts to contribute to the elimination of
cholera as a public health threat as outlined by Ending
Cholera--A Global Roadmap to 2030.
Malaria and Parasitic Diseases.--The Committee recognizes
the important role the Center for Global Health plays in the
fight against malaria and parasitic diseases. CDC's crucial
monitoring and surveillance of transmission, evaluation of
interventions for effectiveness and impact, and testing of
tools in a real world setting are critical to understanding how
to scale up global health programs and ensure that our global
health investments are smarter, better, and not wasteful. The
Committee encourages CDC to continue to research, monitor, and
evaluate efforts for malaria and parasitic disease in
collaboration with other divisions and agencies.
Polio.--CDC is the lead U.S. agency in the global effort to
eradicate polio and currently works with various organizations
by providing expertise in training, vaccines, epidemiology,
laboratory capacity, and surveillance. Currently, polio is
endemic in only three countries, Nigeria, Afghanistan, and
Pakistan. The Committee commends CDC's efforts to help
eradicate this disease.
Soil Transmitted Helminth [STH] and Related ``Diseases of
Poverty''.--The Committee includes $1,500,000 for surveillance,
source remediation, and clinical care aimed at reducing STH.
These funds shall be used to extend the currently funded
projects for another year.

PUBLIC HEALTH PREPAREDNESS AND RESPONSE

Appropriations, 2018.................................... $1,450,000,000
Budget estimate, 2019................................... 800,000,000
Committee recommendation................................ 1,470,000,000

The Committee recommendation for the Office of Public
Health Preparedness and Response [PHPR] is $1,470,000,000.
The mission of PHPR is to build and strengthen national
preparedness for public health emergencies including natural,
biological, chemical, radiological, and nuclear incidents. PHPR
administers national response programs and assets, as well as
grants to States and localities to enhance preparedness efforts
across the country.
The Committee recommendation includes funding for the
following activities in the following amounts:

Emergency Preparedness.--The Committee continues to request
detailed information on how PHEP funding is distributed at the
local level by States. CDC is encouraged to provide in the
fiscal year 2020 CJ an update on how much of the Federal PHEP
funding is being allocated to local health departments and what
basis or formula each State is using to make such allocations.
Strategic National Stockpile [SNS].--The Committee
appreciates the Secretary's efforts to improve the efficiency
of the Department's public health preparedness and response
programs and looks forward to considering and evaluating the
Department's proposal to shift the funding and oversight of the
SNS from CDC to ASPR, as submitted in the fiscal year 2019
budget request. The Committee notes that CDC has unique
expertise in public health preparedness and response, science-
based policy and decisionmaking, public health communications,
and coordination with State and local partners. The Committee
urges the Department to ensure that CDC has the resources
necessary to continue SNS-related and other agency-wide
activities as necessary if the SNS moves out of CDC. Should the
proposed move be implemented, the Secretary is strongly urged
to maintain a strong and central role for CDC in the medical
countermeasures enterprise. Further, the Committee encourages
HHS to continue to evaluate the latest approved advances in
influenza prevention and antiviral treatment for inclusion in
the SNS in preparation for pandemic influenza, and promising
products in development that should be considered for purchase.
The Committee requests a report within 90 days of enactment of
this Act detailing the number of FDA approved Medical
Countermeasures [MCMs] that will be needed in the SNS over the
next 3 fiscal years (including new products or products
currently in the SNS that will require replenishment), and the
anticipated costs to purchase these products while maintaining
current SNS products.
Strategic National Stockpile Inventory of Hemostatic
Agents.--The Committee directs the CDC to ensure that the
hemostatic dressings stockpile has not exceeded the recommended
shelf life and replace any hemostatic dressings that have
passed the labeled expiration date.

BUILDINGS AND FACILTIIES

Appropriations, 2018.................................... $510,000,000
Budget estimate, 2019................................... 30,000,000
Committee recommendation................................ 30,000,000

The Committee recommendation for Buildings and Facilities
is $30,000,000.
NIOSH Facility.--The Committee is aware that CDC plans to
consolidate the NIOSH Cincinnati research facilities, which are
more than 50 years old, into one modern laboratory to reduce
operational costs and strengthen scientific collaboration. The
Committee understands that CDC plans to support this facility
replacement through the Department's Nonrecurring Expenses
Fund. The Secretary and CDC are directed to prioritize
obligations for this facility and obligate such funds as
quickly as possible.
Replacement of the Lake Lynn Experimental Mine and
Laboratory.--The Secretary is directed to provide quarterly
reports to the Committees on Appropriations of the House of
Representatives and Senate detailing activities to replace the
Lake Lynn Laboratory. The Committee continues to support CDC
efforts to find a replacement facility.

CDC-WIDE ACTIVITIES

Appropriations, 2018.................................... $273,570,000
Budget estimate, 2019................................... 155,000,000
Committee recommendation................................ 273,570,000

The Committee provides $273,570,000 for public health
leadership and support activities at CDC.
The recommendation includes $160,000,000 in transfers from
the PPH Fund.
The Committee recommendation includes funding for the
following activities in the following amounts:

Preventative Health and Health Services Block Grant.--The
Committee provides $160,000,000, the same level as fiscal year
2018. These grants are crucial for States because they provide
enough flexibility necessary to resolve any emerging health
issues at the local level while tailoring those activities to
best address the diverse, complex, and constantly changing
local community. The Committee encourages CDC to enhance
reporting and accountability for the Block Grant which could
include providing technical assistance to States regarding
using funds for core public health capacities that may not be
supported through other CDC funding streams. Enhanced reporting
requirements should include how much funding is directed to
support public health needs at the local level.
The Committee does not include bill language requested by
the administration to provide additional transfer authority to
the Director beyond that which is already provided to the
Secretary.

National Institutes of Health

The National Institutes of Health [NIH] is the global
leader in medical research, and the Committee provides an
increase of $2,000,000,000. Over the past 4 years, the
Committee has provided a $9,000,000,000, or 30 percent,
increase for NIH after a decade of stagnant funding. The influx
of funding prior to this bill since fiscal year 2016 has
restored half of the purchasing power lost since the peak year
of fiscal year 2003. This year's increase is estimated to
support over 11,400 new and competing grants in fiscal year
2019.
The Committee provides $39,084,000,000 for NIH activities
within the jurisdiction of this bill, an increase of 5.4
percent above fiscal year 2018. This includes $1,018,321,000 in
transfers available under section 241 of the PHS Act. The
Committee continues a reform to section 241 allocations such
that no NIH funding will be removed from NIH under this
authority. This reform ensures that section 241 transfers are a
benefit to NIH rather than a liability. In addition, it
improves the transparency of NIH's budget, so that the enacted
total is truly the amount the Committee expects to be used for
biomedical research.
The Committee continues its commitment to funding research
on Alzheimer's disease and increases funding by $425,000,000 to
a total of approximately $2,340,000,000 in fiscal year 2019;
increases funding for the All of Us research program, part of
the Precision Medicine Initiative, by $86,000,000; increases
funding for antibiotic resistance research by $37,000,000;
increases funding for the BRAIN Initiative by $29,000,000, and
increases targeted funding for a universal flu vaccine by
$20,000,000.
In addition, every Institute and Center receives an
increase above fiscal year 2018 to continue investments in
innovative research that will advance fundamental knowledge and
speed the development of new therapies, diagnostics, and
preventive measures to improve the health of all Americans. The
Committee recognizes that many revolutionary discoveries often
come from unexpected, untargeted research. The Committee
continues to support these basic advances through the general
increase to all Institutes and Centers and also targets
investment towards clinical and translational research that
moves basic discoveries from ``bench-to-bedside.''
The Committee rejects the budget's request to create 3 new
Institutes at the NIH: (1) the National Institute for Research
on Safety and Quality; (2) the National Institute for
Occupational Safety and Health; and (3) the National Institute
on Disability, Independent Living, and Rehabilitation Research.
The Committee also does not move the Energy Employees
Occupational Illness Compensation Program from CDC to NIH.

NATIONAL CANCER INSTITUTE

Appropriations, 2018.................................... $5,957,015,000
Budget estimate, 2019................................... 5,626,312,000
Committee recommendation................................ 6,147,125,000

The Committee recommendation includes $6,147,125,000 for
the National Cancer Institute [NCI], including $400,000,000
appropriated from the NIH Innovation Account. Of this amount,
$30,000,000 is available for repairs and improvements to the
NCI facility in Frederick, Maryland.
Childhood Cancer STAR Act.--The Committee has included
sufficient additional funding for implementation of the
Childhood Cancer Survivorship, Treatment, Access, and Research
[STAR] Act. The Committee has included additional funding for
HHS operating divisions consistent with the various programs
authorized in the bill. This includes funding for NCI to
support childhood, adolescent, and young adult cancer
survivorship research, as well as biospecimen research in these
populations and funding for CDC to enhance pediatric,
adolescent, and young adult cancer surveillance.
Colorectal Cancer.--The Committee notes African-Americans
have colorectal cancer incidence and mortality rates
significantly higher than other racial groups. Furthermore, the
Committee recognizes that research into systemic inflammation
may be important for the prevention and treatment of colorectal
cancer.
Deadliest Cancers.--The Committee remains concerned that
while more effective screening methods and treatments have
lowered overall cancer incidence and death rates, there still
are very few early detection and treatment tools for
``recalcitrant cancers''-defined in statute as those whose 5-
year survival rate is below 50 percent. These cancers account
for nearly half of all cancer deaths in the U.S. and include
cancers of the brain, esophagus, liver, lung, ovary, pancreas,
and stomach. Given the toll these types of cancer exact on
society and the lack of tools currently available to help
patients, the Committee urges NIH and NCI to continue to
support research with an emphasis on developing improved
screening and early detection tools and more effective
treatments. The Committee requests an update on NCI-supported
research to advance these goals in the fiscal year 2020 CJ.
Department of Energy [DOE] Collaboration.--In 2016, DOE and
NCI began a collaboration to develop advanced computational
solutionsapplied to specific areas of cancer research,
including pre-clinical drug response, molecular dynamics, and
population level surveillance. The Committee encourages NCI to
continue this collaboration with DOE and its high performance
computing facilities to bring state-of-the-art computational
and data analytics capabilities to cancer research, and to
continue discussions with potential future collaborators in the
ATOM consortium.
Diversity in Oncology.--The Committee is aware of the lack
of diversity in the field of medicine and, particularly, in
oncology, and is also aware of the program supported by the NCI
to increase the diversity in this area. The Committee is
supportive of these actions and encourages the Institute to
continue and expand its work on this issue.
Gastric Cancer.--The Committee continues to be concerned
about the deadly outcomes of gastric cancer, particularly among
young adults. The 5-year survival rate for stomach cancer is 30
percent. The Committee encourages NCI to consider developing a
scientific framework for advancing stomach cancer research.
Gynecologic Cancer Clinical Trials.--Clinical trials have
significantly improved survival for women with gynecologic
cancers, including ovarian, endometrial, cervical, and vulvar
cancers. The Committee encourages NCI to work with stakeholders
to address priorities for the gynecologic oncology clinical
trials scientific agenda, including consideration of the
availability of trials for these patients. The Committee
requests that NCI provide an update to the Committee in the
fiscal year 2020 CJ.
Institutional Development Award [IDeA] State and Cancer
Trials.--The Committee recognizes that NCI supports clinical
trials across the country through its National Clinical Trials
Network [NCTN] and the NCI Community Oncology Research Program
[NCORP]. The Committee believes, however, that there are more
opportunities for academic medical centers in IDeA States to
become engaged in these networks. Therefore, the Committee
encourages NCI to coordinate with NIGMS to help IDeA States
that do not currently have NCORP or NCTN awards build capacity
in these regions to conduct cancer clinical trials. The
Committee also encourages NCI to continue to support NCORP in
its mission to increase diversity among patients participating
in NCI clinical trials, especially with regard to rural and
minority populations. Finally, the Committee urges NCI, in
consultation with NIGMS, to encourage collaboration between
IDeA awardees and existing NCI designate cancer centers, NCTN
lead sites, and NCORP sites.
Immunotherapy.--The Committee continues to be encouraged by
new breakthroughs in cancer immunotherapy, built upon decades
of NCI-funded research on the immune system and the ways in
which it can be harnessed to find and destroy tumors. This new
wave of treatment options has the potential to revolutionize
treatment for a growing number of cancers. Yet much remains
unknown about how immunotherapy works on a cellular level, and
especially why such treatments are successful for some
patients, but not for others. Furthermore, some patients
experience side effects that are far different than those
associated with chemotherapy. Without a better understanding of
the immune system's response to cancer, the knowledge of how
cancer escapes immune-based therapy, the capacity to quickly
recognize and manage side effects, and the ability to predict
which patients are most likely to respond well to therapy,
further advances in this field will be slowed. Therefore, the
Committee urges NCI to continue to prioritize basic research on
the mechanisms of action involved in immunotherapy, including a
focus on tumor resistance to immunotherapy and the underlying
mechanisms of cancer immunotherapy toxicities. The Committee
also recognizes the need for more basic and clinical
researchers who have the necessary education to develop new
breakthroughs in immunotherapy. The Committee encourages NCI to
continue to support training for both young and mid-career
researchers interested in immunotherapy.
Improving Patient Access to Cancer Clinical Trials.--The
Committee supports NCI efforts to improve patient access to and
participation in cancer clinical trials across the country. One
of the underappreciated barriers to enrollment in cancer
clinical trials is the ancillary costs associated with
participating in clinical trials, especially for underserved
and minority patients. NCI is encouraged to explore research
opportunities to improve accrual and retention by collaborating
with its NCTN and the NCORP. NCTN is the cornerstone of NCI's
clinical trials program that conducts phase II and III clinical
trials, and NCORP is a national network that brings clinical
trials and cancer care delivery studies to people in their own
communities. These programs encompass over 3,000 clinical
trials sites across the country, as well as collaborations with
many NCI-Designated Cancer Centers. The Committee also supports
the NCI-Designated Cancer Centers working with their local
community organizations to encourage enrollment of
underrepresented populations onto cancer trials. The Committee
requests an update on these efforts in the fiscal year 2020 CJ.
Liver Cancer.--The Committee commends the NCI on recent
efforts to encourage more research focused on liver cancer, but
urges greater priority to address the threat of liver cancer,
which has a 5-year survival rate of less than 20 percent.
Unlike many other cancers, the rates of liver cancer deaths and
incidence are rising. The Committee urges NCI to support liver
cancer research across its portfolio using a variety of methods
to stimulate research proposals. The Committee also notes that
the link between hepatitis B infection and primary liver cancer
is well established with up to 60 percent of global liver
cancer cases caused by the hepatitis B virus [HBV] and,
therefore, urges collaboration with NIAID and NIDDK on issues
related to HBV research. The Committee requests an update on
these activities in the fiscal year 2020 CJ.
Metastatic Cancer Research.--The Committee remains
supportive of early detection and prevention activities, but
also notes that research into controlling and eliminating
cancer that has already disseminated is of critical importance
to many affected individuals and families. The Committee
recognizes recent breakthroughs and innovative treatments in
this area, and requests an update in the fiscal year 2020 CJ.
Pancreatic Cancer Research.--In 2016, pancreatic cancer
rose to become the third leading cause of cancer-related death
in the U.S., claiming the lives of nearly 42,000 Americans.
Despite progress in combatting other forms of cancer, the 5-
year survival rate for pancreatic cancer is just nine percent,
in large part because there are no reliable early detection
methods or effective treatment options. To help turn the tide
against this deadly cancer, Congress in 2012 passed the
Recalcitrant Cancer Research Act (Public Law 112-239), calling
for the development of a scientific framework for certain
recalcitrant cancers. The Committee requests an update on
pancreatic cancer research in the fiscal year 2020 CJ.
Pediatric Cancer.--The Committee recognizes that cancer is
the leading cause of death by disease amongst children and,
after accidents, cancer is the second leading cause of death in
children ages 1 to 14. In 2018 alone, cancer will affect over
17,000 children, and many of these diagnoses will be rare
forms, which lack sufficient therapeutic options. Moreover,
children with cancer can suffer more severe side effects from
aggressive treatments than adult patients, and the majority of
pediatric cancer survivors live with chronic conditions because
of their treatments. Improvements in treatment are urgently
needed to address this childhood health crisis. The Committee
commends NCI for launching the novel pediatric Molecular
Analysis for Therapy Choice [MATCH] study to address some of
these challenges, and appreciates that it will add to the body
of scientific evidence necessary to determine the molecular
targets substantially relevant to the growth or progression of
pediatric cancer as required by the FDA Reauthorization Act of
2017. The Committee looks forward to receiving the report
requested in the fiscal year 2018 Omnibus regarding how NCI is
focusing on the unique needs of children, and expects to
receive the report in July 2018. The Committee appreciates that
this report will include an update on the progress of the
Pediatric MATCH trial, and that it will describe how NCI
supports research across the cancer research enterprise to make
progress against pediatric cancers.
Precision Oncology.--The Committee recognizes the potential
for significant advancements in cancer treatments from the NCI-
MATCH trial. It remains the central pillar of the precision
medicine research focused on oncology for cancers that are
unresponsive to standard interventions. NCI should also
continue to focus on the important pediatric-MATCH trial as
pediatric oncology mechanisms are very different from mutations
seen in adults. The Committee requests an update in the fiscal
year 2020 CJ.
Psycho-Social Distress Complications.--According to the
Institute of Medicine, nearly 50 percent of all cancer patients
experience distress. Further, studies suggest that distress in
cancer patients leads to higher healthcare costs, less
compliance with treatment pathways, and poorer health outcomes.
While significant advancements have been made in biomedical
treatments in cancer care, the Committee is concerned that the
unaddressed psycho-social needs of patients are adversely
impacting the effectiveness and cost of care, as well as the
individuals' overall well-being. The Committee encourages NCI
to continue to implement distress screenings in the NIH
Clinical Center and in NCI-funded clinical trials as
appropriate, coordinate and share information on this effort
with the FDA, and to support the development of appropriate
interventions through the support of extramural grantees,
including by encouraging extramural grantees to implement such
screenings.
Translational Research Program.--The Committee notes the
Specialized Programs of Research Excellence [SPORE] program is
one of NCI's cornerstone efforts to promote collaborative,
interdisciplinary translational cancer research. The Committee
continues robust support for SPORE grant programs as it works
to bring basic research into practical treatments. The
Committee commends NCI's investment in this area and notes that
over 60 percent of the NCI SPOREs are multi-center, and that 37
percent of those multi-center sites involve more than two
institutions. Likewise, the Committee notes that several of the
existing SPOREs focus on related organ site diseases (such as
the GI, Neuroendocrine, and Sarcoma SPOREs), and another SPORE
focuses on a specific pathway called hyperactive RAS in the
context of mutations in the NF1 gene. The Committee requests an
update in the fiscal year 2020 CJ.

NATIONAL HEART, LUNG, AND BLOOD INSTITUTE

Appropriations, 2018.................................... $3,382,232,000
Budget estimate, 2019................................... 3,112,032,000
Committee recommendation................................ 3,490,171,000

The Committee recommendation includes $3,490,171,000 for
the National Heart, Lung, and Blood Institute [NHLBI].
Alzheimer's Disease and Vascular Dementia.--The Committee
recognizes the value that well characterized, longitudinal,
population-based cohort studies provide in bringing to light
more information about the risk factors related to dementia. By
studying participants and their descendants over time, much can
be learned about cognitive decline and early biomarkers that
will help the understanding of the role of environmental versus
genetic factors in disease development and progression.
Therefore, the Committee commends NHLBI for its work to follow
its current and future cohort study participants for the
development and progression of risk factors and to detect signs
of cognitive decline in order to provide new insights into risk
identification and accelerated prevention efforts.
Congenital Heart Disease [CHD].--The Committee commends
NHLBI for its continued work to better understand causation,
improve treatments and outcomes, and integrate registry data
and research datasets to facilitate research on congenital
heart disease across the lifespan. The Committee encourages
NHLBI to prioritize CHD activities outlined in its strategic
plan, including improving understanding of outcomes and co-
morbidities, modifying treatment options across the lifespan,
and accelerating discovery, analysis, and translation by
leveraging CHD registries and networks. The Committee requests
NHLBI include in its fiscal year 2020 CJ a report on steps
being taken to close these research gaps.
Fibrotic Diseases.--The Committee encourages NIH to
vigorously support funding and research into fibrotic diseases
affecting different organs, including the lungs, liver,
kidneys, heart, skin, and bones, and to ensure enhanced
coordination among its Institutes as they conduct necessary
expanded single organ or cross-organ fibrotic disease research
to save lives and reduce healthcare expenses in future years.
The Committee also encourages NIH to explore naturally
occurring fibrotic disease in domestic animals to investigate
opportunities to improve human and animal lives. Since many
fibrotic diseases are individually rare diseases, a strategy
that provides collaboration across disease and organ areas is
recommended. The Committee requests a report on the current NIH
Fibrosis Interest Group and its progress no later than 90 days
after enactment. The Committee encourages the Fibrosis Interest
Group to continue its efforts to bring together key
stakeholders, at the NIH and elsewhere, to develop strategic
paths forward to maximize efforts in fibrotic disease research.
The Committee also directs NIH to include an update in its
fiscal year 2020 CJ on its work relating to idiopathic
pulmonary fibrosis following the November 2012 NHLBI workshop,
``Strategic Planning for Idiopathic Pulmonary Fibrosis.'' The
Committee commends CDC on its recent work identifying and
studying clusters of pulmonary fibrosis in workers, including
dentists and miners, and encourages NIH and CDC to collaborate
on such findings to include further research efforts and data
sharing that could lead to better understanding of this disease
and life-saving treatments. As noted in previous years, the
Committee directs NIH to report to the Committee on its
progress in meeting the goals enumerated in the November 2014
NHLBI report on Future Directions in Idiopathic Pulmonary
Fibrosis Research. The Committee applauds increases in funding
for pulmonary fibrosis at the Institute, but remains concerned
that funding lags in relation to the devastating impact of the
disease and funding for other diseases with similar patient
populations and morbidity rates. In addition, the Committee
recommends that NHLBI continue to encourage the use of patient
registries that are accessible to the pulmonary fibrosis
research community and operates in coordination with major
medical centers and patient organizations.
Heart Disease.--Heart disease is our Nation's leading cause
of death and a key source of disability, yet NIH funding is not
commensurate with its burden on long-term health outcomes,
financial stability, and novel scientific opportunities.
Concerned that NHLBI extramural heart research has dropped 17
percent in constant dollars since 2002, the Committee
encourages NHLBI, to prioritize and implement robust investment
to drastically spur, strengthen, accelerate and coordinate
heart research. This investment shall focus on expediting
innovative basic, clinical, population, and translational
research through all pertinent mechanisms. The Committee urges
NHLBI to intensify the implementation of heart research
recommendations and priorities, including promotion of
cardiovascular health and prevention of heart failure, high
blood pressure, and vascular dementia in its Strategic Vision.
On NHLBI's 70th anniversary, the Committee commends the
Institute for leadership in advancing its mission of improving
prevention and treatment of heart, lung, blood, and sleep
disorders.
Hemoglobinopathies.--The Committee acknowledges NHLBI's
leadership on gene therapy and gene editing research, and the
Institute's investment in using these transformative
technologies to seek cures for patients with hemoglobinopathies
and other genetic disorders. The Committee encourages NHLBI to
continue to support multi-centered research for expanded
treatments for thalassemia, sickle cell disease, and other
hemoglobinopathies, with specific attention paid to gene
therapy and gene editing.
Hereditary Hemorrhagic Telangiectasia [HHT].--The Committee
encourages NHLBI to examine heart manifestations of HHT,
including the correlation between liver arteriovenous
malformations caused by HHT and heart failure.
Lymphatic Research.--The Committee applauds NHLBI's work on
lymphatic diseases and encourages further collaboration and
coordination amongst relevant Institutes and Centers conducting
important research in this area.
National Chronic Obstructive Pulmonary Disease [COPD]
Action Plan.--The Committee commends NHLBI for leading the
effort to craft the comprehensive National COPD Action Plan
requested by Congress. The action plan outlines research,
public health, patient care, and awareness activities that can
be supported by Federal agencies and strategic partners. The
Committee has provided additional funding for NHLBI to begin
facilitating agency-wide implementation of the action plan by
supporting research activities and collaborating with other PHS
agencies to advance implementation of the plan's
recommendations. The Committee expects regular updates from
NHLBI on the implementation of the COPD Action Plan.
Postural Orthostatic Tachycardia Syndrome [POTS].--An
estimated 1,000,000 to 3,000,000 Americans suffer from POTS, a
debilitating neurological disorder that affects mostly
adolescent and adult women. Recent research shows that POTS is
associated with autoimmune antibodies that impact the
neurologic and cardiovascular systems, but more research is
needed to understand the role of these autoantibodies in POTS
and identify treatments that may help patients with these
antibodies. Due to the lack of effective treatments, many
patients are unable to attend school or work, causing lost
economic productivity and a financial strain on families. The
Committee encourages NHLBI and NINDS to jointly host a
symposium with participants from NIAID, NIDDK, NICHD, and
leading external researchers and stakeholders to examine the
current state of POTS research. The Committee directs NIH to
provide a report to the House and Senate Committees on
Appropriations 9 months after enactment of this act that
reflects participants' findings on: (1) the current state of
POTS research; (2) priority areas of focus for future POTS
research through 2025; (3) a summary of ongoing or upcoming
efforts by NIH to advance the scientific understanding of POTS;
and (4) an estimate of the level of funding that would be
needed annually to achieve objectives (2) and (3).
Pulmonary Hypertension [PH].--The Committee recognizes the
work NHLBI is doing to advance research into pulmonary
hypertension especially with attention on idiopathic pulmonary
arterial hypertension. The Committee encourages NHLBI to
continue working with stakeholders to advance critical research
priorities.
Sickle Cell.--The Committee understands the burden sickle
cell disease places on more than 100,000 Americans. Academic
medical centers located in States with significant populations
of sickle cell patients have made progress in treating the
disease through NIH-sponsored clinical trials and through blood
and marrow transplantation for sickle cell disease, which is
currently the only therapy that can cure the disease. However,
Federal research spending on sickle cell disease has been
disproportionately lower than other medical conditions that
affect fewer Americans. The Committee encourages the NHLBI to
consider an increased focus and innovation in treatment of
sickle cell disease and continued support for highly
meritorious research on sickle cell disease.
Sleep Disorders.--CDC estimates that between 50,000,000 and
70,000,000 Americans suffer from sleep and wakefulness
disorders. Insufficient sleep is associated with diseases
including diabetes, cardiovascular disease, obesity, and
depression. To address the public health burden of sleep
deficiency and untreated sleep disorders, there is an urgent
need to improve our understanding of these diseases, including
the identification of biomarkers to predict and manage risks to
individual health and public safety. The Committee urges the
Institute to expand discovery science efforts into sleep and
wakefulness disorders.

NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL RESEARCH

Appropriations, 2018.................................... $447,735,000
Budget estimate, 2019................................... 413,196,000
Committee recommendation................................ 462,024,000

The Committee recommendation includes $462,024,000 for the
National Institute of Dental and Craniofacial Research [NIDCR].
Temporomandibular Disorders [TMD].--The Committee is
concerned that over 36,000,000 people, primarily women in their
childbearing years, are affected physically, financially, and
emotionally by TMD. The Committee is aware that TMD are
primarily a multisystem disorder with overlapping conditions
influenced by multiple biological and environmental factors
rather than solely an orofacial pain condition. Therefore, the
Committee urges NIDCR to support multidisciplinary research and
attract scientists across other disciplines to this research.
At the same time, the Committee is encouraged by the scientific
meetings between NIDCR, several Institutes and Centers as well
as Temporomandibular Joint [TMJ] patient groups on an
integrated systems approach of precision medicine related to
cellular-molecular-genetic-epigenetic mechanisms related to
diagnosis and treatment of TMD and its comorbid conditions. The
Committee requests an update on initiatives that resulted from
the recommendations that came forth from these meetings.
Further, it applauds NIDCR's involvement in the TMJ Patient
RoundTable to advance collaboration to work toward the common
end of providing safe and effective treatments that improve
patient's quality of life. The Committee encourages continued
collaboration with governmental agencies and other stakeholders
in the project.

NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES

Appropriations, 2018.................................... $1,968,083,000
Budget estimate, 2019................................... 1,965,434,000
Committee recommendation................................ 2,030,892,000

The Committee recommendation includes $2,030,892,000 for
the National Institute of Diabetes and Digestive and Kidney
Diseases [NIDDK].
Biomarkers.--The Committee commends the efforts of NIDDK to
prioritize the discovery and validation of biomarkers and urges
NIDDK to continue to prioritize this important work that will
accelerate the designing and conducting of clinical trials to
prevent, treat, and cure type 1 diabetes. Given the growing
prevalence of diabetes, the Committee is concerned that
additional research is needed to determine how to improve the
treatment of a common complication, diabetic foot ulcers to
reduce amputations, and urges NIDDK to support such efforts.
Further, given the aging population, the Committee urges NIDDK
to work with NIA to explore the relationship between diabetes
and neurocognitive conditions, such as dementia and Alzheimer's
disease.
Diabetes.--The Committee recognizes the important work of
NIDDK, the lead Federal agency conducting research to find a
cure for diabetes and improve diabetes care. Individuals with
and at risk for diabetes benefit from life-sustaining
advancements in preventing and treating diabetes that result
from NIDDK studies. The Committee also recognizes the success
of the NIDDK supported research in the development of essential
tools to manage diabetes, including insulin pumps and blood
glucose monitors, ongoing development of artificial pancreas
technologies, and new and better medications to treat diabetes.
The Committee urges NIDDK to commit resources commensurate with
the severity and escalating costs of the epidemic to further
diabetes research that will build upon these past successes,
improve prevention and treatment, and bring the Nation closer
to a cure.
End-Stage Renal Disease [ESRD].--The Committee recognizes
the work in supporting critical kidney research that NIDDK has
accomplished including ESRD. The Committee notes the recent GAO
report on research funding and encourages NIDDK to continue
working with stakeholders to disseminate critical information
and discuss new opportunities for research.
Hepatitis B Virus [HBV].--The Committee notes that
infection with HBV is a serious public health threat and 1 in
20 Americans has been infected and more than 2,000,000 are
chronically infected, increasing by 80,000 a year. Left
undiagnosed and untreated, 1 in 4 or over 500,000 of those with
chronic HBV infection will die prematurely from cirrhosis,
liver failure, and/or liver cancer. In view of this public
health threat, the Committee remains concerned that NIH
research spending on HBV research was only $48,000,000 in 2013
and has remained flat funded since then. The Committee notes
that both the World Health Organization in 2016 and the
National Academies of Science, Engineering and Medicine in 2017
have declared that the elimination of HBV is possible.
Subsequently, the HBV research community convened a virtual
consensus conference that resulted in articles published in
2018 in two peer reviewed scientific journals, Hepatology and
Antiviral Research, identifying the most urgent research
questions that must be answered to find a cure for HBV. NIDDK
is urged to pursue multiple critical research opportunities
toward improved treatments and a cure for Hepatitis B.
Interstitial Cystitis.--The Committee is pleased with the
progress of interstitial cystitis research and continues to
encourage NIDDK and stakeholders to collaborate on a
comprehensive scientific conference to examine mechanisms for
scientific opportunity.
Inflammatory Bowel Diseases [IBD].--The Committee is
pleased by NIDDK's past support of research into inflammatory
bowel diseases (i.e. Crohn's disease and ulcerative colitis).
The Committee encourages NIDDK to build upon this foundation by
exploring ``bedside-to-bench'' approaches to regenerative
medicine by clearly defining the clinical need and subsequent
research agenda and bringing multi-disciplinary experts
together to advance progress toward new therapeutic benefit for
IBD patients.
National Commission on Digestive Disease.--The Committee
applauds NIDDK for the implementation of the recommendations of
the 2009 National Commission on Digestive Diseases and looks
forward to hearing how these recommendations have led to new
findings with respect to emerging research in digestive
diseases.

NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE

Appropriations, 2018.................................... $2,149,482,000
Budget estimate, 2019................................... 1,838,556,000
Committee recommendation................................ 2,275,580,000

The Committee recommendation includes $2,275,580,000 for
the National Institute of Neurological Disorders and Stroke
[NINDS], including $57,500,000 appropriated from the NIH
Innovation Account. This amount includes $250,000,000 in
funding for research related to opioid addiction, development
of opioid alternatives, pain management, and addiction
treatment.
Brain Research through Advancing Innovative
Neurotechnologies [BRAIN] Initiative.--The Committee continues
its strong support of the BRAIN Initiative, providing
$429,380,000. Deciphering the complexity of the human brain is
a tremendous endeavor that requires large-scale, collective
efforts. The focus of the initiative, to accelerate technology
development to show the brain's structure and function at the
level of its cellular components and the functional circuits
they form, is a grand challenge that can only be approached as
a Big Science effort. Like the Human Genome project and its
impact on genetics, the Initiative will be transformative for
neuroscience. The Committee encourages a continuation of this
unique opportunity to do Big Science in which large, multi-
disciplinary teams work together to generate and scale up
innovative technologies to produce large, publicly available
datasets. As the BRAIN Initiative moves from its early emphasis
on development of technologies to greater investment in
production and analysis of data, the Committee encourages NIH
to work with its Federal, academic and private partners, as
well as leaders in the technology sector, to continue to
jointly develop and adequately fund integrated, scalable data
analysis hubs for BRAIN data as well as methods for tool
dissemination. The goal of such an effort would be a network
that has at its core an interconnected open platform of
imaging, neurophysiological, behavioral, clinical, and
molecular data along with the metadata essential for its
interpretation. This collaborative effort would guide
development and sharing of best practices in data acquisition,
analysis, and choices in computational pipelines. Open sharing
on this scale would enable data analysis and visualization
across institutional boundaries to accelerate understanding of
brain function and dysfunction.
Dystonia.--The Committee encourages NINDS to work with
stakeholders to revitalize and expand the dystonia research
portfolio. The Committee understands the importance of a state
of the science conference and continues to encourage NINDS to
work with stakeholders and other IC's that research forms of
dystonia to examine collaborative research opportunities.
Neuroscience Research.--The Committee recognizes the
importance of neuroscience research funded by the NIH, which is
fueling a vital scientific endeavor and is the essential
foundation for understanding and treating diseases that impact
over 100,000,000 Americans each year. The Committee also
commends the NIH for its successful implementation of the BRAIN
Initiative, and for its 5 year partnership with an array of
agencies. This collaborative effort is revolutionizing our
understanding of how neural components and their dynamic
interactions result in complex behaviors, cognition, and
disease, while accelerating the development of transformative
tools to explore the brain in unprecedented ways making
information previously beyond our reach accessible. NIH should
continue to build off its 5 years of success as a leader and
partner on the BRAIN Initiative, bringing together various
disciplines and funding meritorious research to advance our
knowledge of the brain.
Parkinson's Disease.--The Committee commends NINDS for
taking critical steps in identifying priority research
recommendations to advance research on Parkinson's disease,
which impacts between 500,000 and 1,500,000 Americans and is
the second most prevalent neurodegenerative disease in the
United States. The ultimate success of these recommendations
will depend upon targeted research initiatives and increased
research capacity, even if innovative support and funding
mechanisms are required. The Committee recognizes that NINDS is
prioritizing public health concerns with severe gaps in unmet
medical needs and believes any funding increase for NINDS in
fiscal year 2019 should support the research recommendations
set forth by NINDS planning strategy towards better treatments
and, ultimately, a cure for Parkinson's disease. The Committee
also encourages NINDS to submit a report of its progress on
implementing these recommendations in the fiscal year 2020 CJ.
Peripheral Neuropathies.--The Committee is pleased at the
continued progress of ongoing research into Guillain-Barre
syndrome, chronic inflammatory demyelinating polyneuropathy,
and related conditions. The Committee encourages NINDS to work
with NIAID and stakeholders on a state of the science
conference on evolving research and scientific mechanisms.
Phelan-McDermid Syndrome.--The Committee continues to
support a multi-Institute approach to support research into
Phelan-McDermid Syndrome and encourages NIH to continue to
examine the correlation between SHANK3 and neurological
diseases and the mental health manifestations of Phelan-
McDermid Syndrome. The Committee requests an update in the
fiscal year 2020 CJ on the status of research related to this
topic.
Postural Orthostatic Tachycardia Syndrome [POTS].--An
estimated 1,000,000 to 3,000,000 Americans suffer from POTS, a
debilitating neurological disorder that affects mostly
adolescent and adult women. Recent research shows that POTS is
associated with autoimmune antibodies that impact the
neurologic and cardiovascular systems, but more research is
needed to understand the role of these autoantibodies in POTS
and identify treatments that may help patients with these
antibodies. Due to the lack of effective treatments, many
patients are unable to attend school or work, causing lost
economic productivity and a financial strain on families. The
Committee encourages NHLBI and NINDS to jointly host a
symposium with participants from NIAID, NIDDK, and NICHD and
leading external researchers and stakeholders to examine the
current state of POTS research. The Committee directs NIH to
provide a report to the House and Senate Committees on
Appropriations 9 months after enactment of this act that
reflects participants' findings on (1) the current state of
POTS research; (2) priority areas of focus for future POTS
research through 2025; (3) a summary of ongoing or upcoming
efforts by NIH to advance the scientific understanding of POTS;
and (4) an estimate of the level of funding that would be
needed annually to achieve objectives (2) and (3).
Stroke.--The Committee continues its concern that stroke
inflicts a vast burden, including topping per capita spending
for all chronic conditions in the Medicare fee-for-service
program, yet NIH spends only one percent of its budget on
stroke research. This funding level is not commensurate with
its burden on U.S. long-term health outcomes, financial
stability, and novel scientific opportunities. The Committee
strongly encourages NINDS to prioritize and implement robust
investment to drastically spur, strengthen, accelerate, and
coordinate stroke research. This investment shall focus on
expediting novel basic, clinical, and translational research by
all available and appropriate mechanisms. The Committee expects
NINDS to intensify enactment of top stroke priorities,
including prevention, endovascular therapy, and early stroke
recovery.
Tuberous Sclerosis Complex [TSC].--The Committee is
encouraged by NIH's updated TSC Research Plan published in
2016. Building on this Research Plan, the Committee encourages
the Director to coordinate the participation of multiple ICs on
a research strategy aimed at addressing the numerous medical
and neuropsychological burdens associated with TSC while
deciphering the biology underlying phenotypic heterogeneity,
applying recommendations from NIH's Neurodevelopmental
Disorders Biomarkers Workshop held in December 2017 involving
TSC and related neurodevelopmental disorders, to take advantage
of biomarker expertise and lessons learned across disease
groups. Manifestations of TSC are highly variable among
affected individuals, and TSC can be a model condition for
developing precision medicine approaches to treat each
individual's symptoms to maximize the benefit-risk ratio. NINDS
should encourage research opportunities in the five key areas
prioritized by workshop participants: understanding phenotypic
heterogeneity in TSC, gaining a deeper knowledge of TSC
signaling pathways and the cellular consequences of TSC
deficiency, improving TSC disease models, developing clinical
biomarkers of TSC, and facilitating therapeutics and clinical
trials research.

NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES

Appropriations, 2018.................................... $5,280,665,000
Budget estimate, 2019................................... 4,761,948,000
Committee recommendation................................ 5,506,190,000

The Committee recommendation includes $5,506,190,000 for
the National Institute of Allergy and Infectious Diseases
[NIAID].
Autoimmune Neuropathies.--The Committee continues to
encourage NIAID and NINDS to collaborate on a state-of-the-
science of autoimmune neuropathies research into conditions
like Guillain-Barre syndrome and chronic inflammatory
demyelinating polyneuropathy. The Committee is pleased that
NIAID and NINDS are working with stakeholders on the importance
of the patient perspective.
Combatting Antibiotic Resistant Bacteria [CARB].--The
Committee remains deeply troubled by the global rise of drug-
resistant bacteria, and provides $550,000,000, an increase of
$37,000,000 to expand efforts to develop new antimicrobials,
rapid diagnostics, and other tools and strategies against drug-
resistant bacterial infections. The Committee is encouraged by
the potential for novel approaches to addressing antimicrobial
resistance, such as vaccines, bacteriophages, and antitoxins,
but aware that these may be best suited as adjuncts and not as
replacements for antibiotics. In an analysis issued last
September, the World Health Organization noted that, despite
the efforts made in recent years, treatment options remain
``lacking for the most critical resistant bacteria, especially
for multidrug and extensively drug-resistant Gram-negative
pathogens.'' The Committee encourages NIAID to increase its
efforts to support basic science, rapid point-of-need
diagnostics, drug discovery, and clinical trials related to
Gram-negative carbapenem-resistant bacteria. It commends NIAID
for its leadership to address the threat posed by antibiotic
resistant bacteria, and its collaboration with Federal partners
to increase antibiotic stewardship, including ASPR and CDC, as
well as its support for efforts like CARB-X and its
international partnerships. The Committee directs NIAID to
track trends in Research Project Grants supporting CARB, and
requests an update on these activities in the fiscal year 2019
CJ, including an overall assessment of the progress to date of
efforts to address the rising threat of drug-resistant
bacteria.
Food Allergies.--Food allergies affect 15,000,000
Americans, can be life threatening, and have no cure. Public
research funding for food allergies occurs at a number of
sites. Currently, the Consortium of Food Allergy Research
[CoFAR] network includes seven clinical sites/centers. In
addition, approximately 10 other NIH-supported centers are
conducting basic, translational and clinical research on food
allergy. Within the funds provided, the Committee directs NIH
to expand its clinical research network to add new centers of
excellence in food allergy clinical care. Such centers shall be
selected from those with a proven expertise in food allergy
research.
Hepatitis B Virus [HBV].--The Committee notes that
infection with HBV is a serious public health threat and 1 in
20 Americans have been infected, with more than 2,000,000
chronically infected, increasing by 80,000 a year. Left
undiagnosed and untreated, 1 in 4 or over 500,000 of those with
chronic HBV infection will die prematurely from cirrhosis,
liver failure, and/or liver cancer. In view of this public
health threat, the Committee remains concerned that NIH
research spending on HBV research was only $48,000,000 in 2013
and has remained flat funded since then. The Committee notes
that both the World Health Organization in 2016 and the
National Academies of Science, Engineering and Medicine in 2017
have declared that the elimination of hepatitis B is possible.
Subsequently, the hepatitis B research community convened a
virtual consensus conference that resulted in articles
published in 2018 in two peer reviewed scientific journals,
Hepatology and Antiviral Research, identifying the most urgent
research questions that must be answered to find a cure for
hepatitis B. NIAID is urged to issue targeted calls for HBV
research to pursue the many critical research opportunities
identified by the scientific community and report to the
Committee within 90 days of enactment of this Act the NIAID
research plan to pursue a cure for HBV.
Lyme Disease.--With an estimated 300,000 new cases of Lyme
disease each year, especially in rural States across the United
States, and tens of thousands more suffering from other tick-
borne diseases, improved understanding and treatment of these
diseases is essential for the health and well-being of
Americans. The Committee encourages NIH to issue requests for
grant applications for research to investigate causes of all
forms and manifestations of Lyme disease and other high-
consequence tick-borne diseases, including post-treatment
symptoms, as well as research to develop diagnostics,
preventions, and treatments for those conditions. The Committee
notes that in patients who suffer from long-term complications
associated with Lyme disease, clear treatment pathways are
often missed as a result of inaccurate and incomplete testing.
The Committee urges NIAID, in coordination with CDC, to study
the long-term effects on patients suffering from post-treatment
Lyme disease syndrome, or ``chronic Lyme disease.''
Specifically, the Committee urges NIAID to evaluate the
effectiveness of laboratory tests associated with the detection
of Borrelia burgdorferi to diagnose the disease early, which
can improve the treatment of patients suffering from Lyme
disease. The Committee also encourages NLM, in coordination
with NIAID, to update its terminology in line with new research
to more accurately reflect the long-term effects of chronic
Lyme disease.
Neglected Tropical Diseases [NTDs].--One-sixth of the
world's population suffers from one or more NTDs. In the United
States, we have seen Chikungunya and Dengue emerge. Only 10
percent of global health science resources are directed towards
90 percent of the global disease burden, and as such, world-
class research conducted by NIH is a key component to ensuring
there are tools to treat, control, and eventually eradicate
many neglected diseases. The Committee urges NIAID to continue
its investment in NTD research, including work in late-stage
and translational research for NTDs, and to work with other
agencies to foster research and ensure that basic discoveries
are translated into much needed solutions.
Opioid-Related Infectious Diseases Research.--The Committee
urges NIAID, NIDA, NHLBI, NICHD, and NIMHD to expand research
on opioid-related infectious diseases to include endocarditis,
osteomyelitis, bacteremia, skin and soft tissue infections, and
cerebral infections, in addition to HIV and hepatitis B and C,
and respond to the unique barriers to care and treatment for
justice-involved individuals and rural populations.
Implementation studies should be conducted in collaboration
with CDC, AHRQ, and HRSA to understand the best approaches for
preventing and treating opioid related infections.
Translational Vaccine Research.--The Committee notes a very
promising area in the field of vaccine and immunology is
translational vaccinology, in which researchers use innovative
principles of vaccine design and enhancement to generate novel,
experimental vaccines suitable for assessment and development
through pre-clinical studies and clinical trials. The Committee
strongly encourages NIAID to continue to support universal flu
vaccine research and to continue to support a robust portfolio
of extramural, highly meritorious translational vaccine
research that focuses on an interdisciplinary approach to this
research. The Committee requests NIAID provide an update in the
fiscal year 2020 CJ on expansion opportunities for
interdisciplinary translational vaccinology research.
Universal Influenza Vaccine.--The Committee appreciates the
investments that NIAID has made and intends to make to improve
our response to the seasonal influenza virus. In response to
the severity of the 2017-2018 flu season, Congress encourages
NIAID to continue to prioritize investment in the basic and
clinical scientific research necessary to develop a universal
influenza vaccine. The Committee directs NIAID to allocate not
less than $100,000,000 in fiscal year 2019 to advance basic,
translational, and clinical research necessary to develop a
universal influenza vaccine. In response to the severity of the
2017-2018 influenza season, the agreement encourages NIAID to
continue to prioritize investment in the basic and clinical
scientific research necessary to develop a universal influenza
vaccine. The Committee encourages the continued support of the
long-standing NIAID Vaccine and Treatment Evaluation Units
[VTEUs] program. The NIAID VTEUs continue to play a critical
role in NIAID's effort to respond to emerging and reemerging
infectious disease threats to the public health through their
ability to rapidly test new and improved vaccine and
therapeutic candidates. The Committee encourages NIAID to
develop universal influenza vaccine candidates by utilizing the
research capacity of the VTEUs, including extended stay
research units with experience in studying human lung
responses, multi-platform 'omic analyses, and the development
of t-cell targeting universal influenza vaccines.
Vaccination Acceleration.--The Committee encourages NIH to
promote vaccination acceleration through controlled human
experimental infection models, particularly enteric challenge
models. These models may enable vaccination testing to move
more rapidly, and involve fewer subjects (smaller sample
sizes), launching vaccinations in the public faster. Supporting
these challenge models will support critical research that is
advancing responses to such diseases as salmonellosis and
cholera.

NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES

Appropriations, 2018.................................... $2,785,400,000
Budget estimate, 2019................................... 2,572,669,000
Committee recommendation................................ 2,874,292,000

The Committee recommendation includes $2,874,292,000 for
the National Institute of General Medical Sciences [NIGMS],
which includes $1,756,471,000 in transfers available under
section 241 of the PHS Act.
Institutional Development Award [IDeA].--The Committee
provides $361,763,000 for the IDeA program, an increase of
$11,188,000. The Committee believes the IDeA program has made
significant contributions to biomedical research and has led to
the creation of a skilled workforce and made the IDeA program
an essential component of NIH's research portfolio. The
Committee recognizes the IDeA program's significant
contributions to biomedical research and to the development of
our Nation's biomedical research infrastructure and workforce.
The Committee supports efforts to update IDeA eligibility to be
based on the median NIH-funding level for all States. The
Committee continues to believe that Primarily Undergraduate
Institutes in States that do not reside in an eligible State,
but that have been eligible for the National Science
Foundation's Experimental Program to Stimulate Competitive
Research program for the past 2 consecutive years, would
benefit from being able to apply to an entity that currently
holds an IDeA Networks of Biomedical Research Excellence award
for inclusion in its IDeA network.

EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN
DEVELOPMENT

Appropriations, 2018.................................... $1,460,637,000
Budget estimate, 2019................................... 1,339,592,000
Committee recommendation................................ 1,507,251,000

The Committee recommendation includes $1,507,251,000 for
the Eunice Kennedy Shriver National Institute of Child Health
and Human Development [NICHD].
Fragile X [FX].--The Committee commends NICHD for leading
the effort to map the molecular, physiological, biological, and
genetic connections between FX, the fragile X protein, and
autism. The fragile X gene and its protein continue to present
important insight into discovering the root cause of autism and
disease modifying treatments for FX and autism. The Committee
urges NIH to explore ways to utilize funding for FX and autism
in tandem to accelerate the pace of research toward
identification of the commonality between the two conditions
and the development of disease modifying treatments that will
reduce health burdens.
Opioid Use Disorders During Pregnancy and Neonatal
Abstinence Syndrome [NAS].--The Committee recognizes the
growing burden of NAS and the health care costs associated with
it. The Committee is aware of the need for more information
regarding long-term health and developmental outcomes related
to NAS, the wide variation in clinical practice and health
systems support, as well as the challenges associated with
post-discharge care. The Committee encourages NIH to coordinate
with other agencies at HHS to support additional research on
prevention, identification, and treatment of prenatal opioid
exposure and NAS, including the best methods for screening and
treating pregnant women for opioid use disorder and the best
methods for screening for NAS. Additionally, the Committee
encourages NIH to build on the ACT NOW study to enhance
understanding of the impact of pharmacological and non-
pharmacological treatment techniques on costs and outcomes in
the short-term and longitudinally. The Committee further
encourages NIH to coordinate with other agencies at HHS to
support research on innovative care models to optimize care and
long-term outcomes for families. NICHD is encouraged to
coordinate with other agencies, including CDC and HRSA, to
support additional research on preventing, screening, and
treating NAS. The Committee supports research regarding long-
term health and development outcomes related to NAS, best
practices for screening and treating pregnant women for opioid
use disorder, and challenges associated with post-discharge
care.
Cerebral Palsy [CP].--The Committee commends NINDS for
developing the CP 5-year Strategic Plan and urges NINDS to
implement Funding Opportunity Announcements in support of the
top research priorities and increase its CP research efforts
for prevention, treatment, and cure through the lifespan. The
Committee encourages funding for basic, translational, and
implementation research (including regenerative medicine and
genomic research) for understanding mechanisms underlying CP
and improving outcomes for patients with CP, and recommends
collaboration with the research and advocacy community to
accelerate clinical research in CP. Furthermore, the Committee
recommends that NIH form a trans-NIH working group of program
officers who manage their institute's CP portfolio and that the
group regularly interact with CP patient advocacy groups.
Dual Use/Dual Benefit.--The Dual Purpose with Dual Benefit
Research in Biomedicine and Agriculture Using Agriculturally
Important Domestic Species is an interagency partnership grants
program funded by NICHD and the U.S. Department of Agriculture
[USDA]. Both USDA and NIH should be commended for developing
this important interagency program. The Committee strongly
urges continuation of this partnership because it sponsors use
of farm animals as dual purpose models to better understand
developmental origins of disease, fat regulation and obesity,
stem cell biology, assisted reproductive technologies, and
infectious disease which directly benefits both agriculture and
biomedicine. This program also strengthens ties between human
medicine, veterinary medicine, and animal sciences, which is
key to success of the One Health Initiative.
Fertility Issues for Rare Disease Patients.--Patients with
rare diseases like thalassemia face a number of issues related
to reproductive health, often due to complications from their
conditions or treatments. As a consequence of improved
treatment options, many rare disease patients are now living
long enough to contemplate fertility, when it may previously
not have been feasible. The Committee requests that NICHD
report on current research and future initiatives to address
these issues and provide an update in the fiscal year 2020 CJ.
Population Research.--The NICHD Population Dynamics Branch
fosters scientific understanding of changes in human health and
development at the population level by supporting research and
research training in demographic or population research.
Through the Population Dynamics Centers Research Infrastructure
Program, the Branch promotes the development of young
scientists, efficient use of scientific resources, development
of new scientific methods, and identification and response to
emerging public health crises, such as the increased incidence
of maternal mortality in parts of the United States. The
Committee encourages NICHD to continue its commitment to this
program as well as other population research activities,
including support for longitudinal studies and efforts to
advance data sharing, all of which promote an understanding of
how the demography and health of our Nation are fundamentally
intertwined.
Trans-NIH Pediatric Research Consortium.--Children face
many challenges from illness, genetic diseases, and
environmental influences. The Committee continues to support
increased investment in pediatric research and it remains
critical that pediatric researchers are part of the NIH peer-
review panels and Advisory Committees. Further, the Committee
commends NICHD for forming a Trans-NIH Pediatric Research
Consortium to better coordinate pediatric research and identify
gaps and opportunities for collaboration. This will help ensure
that pediatric health research is harmonized across NIH's 27
Institutes and Centers. The Committee requests regular reports
from NICHD on this work going forward.

NATIONAL EYE INSTITUTE

Appropriations, 2018.................................... $772,308,000
Budget estimate, 2019................................... 711,015,000
Committee recommendation................................ 796,955,000

The Committee recommendation includes $796,955,000 for the
National Eye Institute [NEI].
Audacious Goals Initiative [AGI].--The Committee commends
NEI's leadership through its AGI, which aims to restore vision
through regeneration of the retina by replacing cells that have
been damaged by disease and injury and restoring their visual
connections to the brain. The Committee is pleased that, to-
date, NEI has funded novel imaging technologies to help
clinicians observe the function of individual neurons in human
patients and follow them over time as they test new therapies,
as well as identifying new factors that control regeneration
and comparing the regenerative process among model organisms.
The Committee is pleased that NEI has launched a third funding
mechanism to stimulate development of models for evaluating
survival and integration of regenerated photoreceptors and
retinal ganglion cells in model systems that are closer to
human visual anatomy and function than current models.
Age-Related Macular Degeneration [AMD].--The Committee
recognizes the tremendous strides in the treatment of patients
with the ``wet'' form of AMD resulting from anti-Vascular
Endothelial Growth Factor therapies--which emerged from initial
NIH-funded research--that stabilize vision loss and may improve
lost vision. The Committee commends NEI for establishing an AMD
Pathobiology Working Group within its National Advisory Eye
Council to evaluate knowledge learned from its extensive AMD
portfolio and identify what is still uncertain, such as the
relationship between genes and biological pathways, therapies
for the more-prevalent ``dry'' form of the disease, and how to
diagnose and treat the disease much earlier. The Committee is
pleased that NEI has launched a prospective international study
of patients that uses the latest advances in retinal imaging to
identify biomarkers of the disease and targets for early
therapeutic interventions.
Blepharospasm.--The Committee is pleased that NEI is
expanding research on blepharospasm, a form of dystonia. The
Committee encourages NEI to work with NINDS and stakeholders on
cross cutting research opportunities that affect all forms of
dystonia.
Glaucoma.--The Committee commends the recent FDA approval
of two new drug therapies emerging from decades of NEI research
into the role of high intraocular pressure [IOP] as a causal
risk factor for primary open-angle glaucoma, the most common
form of the disease and a leading cause of vision loss and
blindness. Targeting the eye's trabecular meshwork--which is
one of the pathways responsible for regulating fluid flow
within the eye--the new generation of therapies reflects an
expanding menu of drugs that lower IOP and better meet the
needs of patients.
National Eye Institute 50th Anniversary.--The Committee
acknowledges that 2018 marks the 50th anniversary of Congress
creating the NEI as NIH's institute leading the Federal
commitment to sight-saving and vision-restoring research. The
Committee recognizes NEI's role in basic research as a leader
in determining the genetic basis of eye disease, having
identified genes associated with both common and rare eye
diseases. The Committee also recognizes NEI's leadership in
clinical research, such as with the current Diabetic
Retinopathy Clinical Research Network, which has been
instrumental in developing the standard of care for diabetic
eye disease.

NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES

Appropriations, 2018.................................... $751,143,000
Budget estimate, 2019................................... 693,199,000
Committee recommendation................................ 775,115,000

The Committee recommendation includes $775,115,000 for the
National Institute of Environmental Health Sciences [NIEHS].

NATIONAL INSTITUTE ON AGING

Appropriations, 2018.................................... $2,577,550,000
Budget estimate, 2019................................... 1,988,200,000
Committee recommendation................................ 3,084,809,000

The Committee recommendation includes $3,084,809,000 for
the National Institute on Aging [NIA].
Alzheimer's Disease.--The Committee provides an increase of
$425,000,000 for Alzheimer's research, bringing the total
funding level in fiscal year 2019 to $2,340,000,000, meeting
and surpassing the $2,000,000,000 goal laid out in the National
Plan to Address Alzheimer's Disease 6 years earlier than the
2025 goal. The NIA is encouraged to continue addressing the
research targets outlined in the fiscal year 2019 Professional
Judgement Budget. Further, the Committee applauds the work of
NIH to support Alzheimer's disease clinical trials and for
recognizing the need to reduce the time and cost of such
trials, including those involving patients who are asymptomatic
or in the earliest stages of the disease. The Committee is
concerned about the under-representation of minority
populations in these trials and directs NIMHD to collaborate
with the NIA and other Institutes to develop an action plan to
address this gap. The action plan should include a review of
the NIA's current public reporting practices of the recruitment
and retention of underrepresented populations in Alzheimer's
research. In addition, the Committee recognizes the Institute's
leadership in driving greater access to research data and
investing in data infrastructure to accelerate the discovery of
treatments for Alzheimer's disease and related dementias. The
Committee encourages NIA to consider a comprehensive approach
to expand and enhance these efforts through policies that
prioritize data sharing, new funding that supports data sharing
and harmonization, and partnerships with other Alzheimer's
disease data efforts to promote a coordinated data ecosystem.
Finally, the Committee commends NIA for its leadership in
supporting longitudinal, population-based cohort studies into
the causes of dementia. Because rural, poor and minority
populations may be at an enhanced risk for dementia, the value
and application of these studies is enhanced when they include
individuals from various geographic, ethnic, socio-economic and
generational backgrounds. Therefore, the Committee directs NIA
to diversify its cohort studies, with the specific goal of
better understanding disease burden and biomarkers by race and
geographic region.
Alzheimer's Vaccine.--Today, 5,700,000 Americans are living
with Alzheimer's disease, yet safe and effective treatments for
the disease are still out of reach. More than 10 years ago, it
was demonstrated in transgenic mouse models that vaccination
may be a novel therapy for Alzheimer's disease by preventing,
delaying, or reversing the formation of associated pathologic
lesions. Recent evidence suggests that the next generation of
active or passive vaccines are promising therapies for
efficacious treatment. With the number of Americans diagnosed
with Alzheimer's expected to rise to nearly 14,000,000 by 2050,
the Committee encourages NIA to consider the development and
testing of promising vaccine candidates a high priority. The
Committee directs NIH to provide a report to the Committee on
the progress related to a vaccine treatment no later than 180
days after enactment of this act.
Caregiver Research.--At any given time, more than
15,000,000 Americans are providing informal care to an older
relative with dementia. However, dementia caregivers experience
considerable stress and depression; impaired subjective well-
being, self-efficacy, and physical health, and perhaps even
increased mortality. The Committee encourages the NIA to fund a
pilot community-based peer support program designed to develop
an accessible, feasible, and sustainable program that
capitalizes on the expertise of persons who best know the
demands of dementia, caregiving--former caregivers themselves.
Persons who previously cared for a person with dementia but
have transitioned out of that role can provide one-on-one
problem-solving, or coaching, for current dementia caregivers.
Family care is preferred by both family members and people with
dementia themselves, and removes a substantial burden from the
U.S. healthcare system.
Population Research.--The Committee applauds NIA for
including the population sciences in its Alzheimer's disease
research portfolio. Specifically, the Committee is pleased to
learn that NIA is collecting nationally representative data via
the Health and Retirement Study to measure cognitive function,
which will inform our understanding of national trends and
differences. In addition to enhancing data collection, NIA is
commended for developing a dementia care research agenda and
adding an Alzheimer's disease research component as part of the
Roybal Centers of Translation Research in Behavioral and Social
Sciences of Aging, Resource Centers for Minority Aging
Research, and Demography and Economics of Aging Centers
program. The Committee urges NIA to sustain these activities
while also encouraging more research from the field related to
the underlying causes of regional health disparities, including
differences in U.S. adult mortality rates.

NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN DISEASES

Appropriations, 2018.................................... $586,661,000
Budget estimate, 2019................................... 545,494,000
Committee recommendation................................ 605,383,000

The Committee recommendation includes $605,383,000 for the
National Institute of Arthritis and Musculoskeletal and Skin
Diseases [NIAMS].
Epidermolysis Bullosa.--The Committee recognizes the
promising scientific gains and applauds private partners
advancing research in pursuit of treatments for Epidermolysis
Bullosa. The Committee encourages NIH to continue to support
such research at NIAMS.

NATIONAL INSTITUTE ON DEAFNESS AND OTHER COMMUNICATION DISORDERS

Appropriations, 2018.................................... $459,974,000
Budget estimate, 2019................................... 423,992,000
Committee recommendation................................ 474,653,000

The Committee recommendation includes $474,653,000 for the
National Institute on Deafness and Other Communication
Disorders [NIDCD].
Spasmodic Dysphonia.--The Committee continues to encourage
NIDCD to expand research on spasmodic dysphonia, a form of
dystonia. The Committee also encourages NIDCD to meet with
stakeholders to link research with the needs of the community.

NATIONAL INSTITUTE OF NURSING RESEARCH

Appropriations, 2018.................................... $158,033,000
Budget estimate, 2019................................... 145,842,000
Committee recommendation................................ 163,076,000

The Committee recommendation includes $163,076,000 for the
National Institute of Nursing Research [NINR].

NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM

Appropriations, 2018.................................... $509,604,000
Budget estimate, 2019................................... 469,109,000
Committee recommendation................................ 525,867,000

The Committee recommendation includes $525,867,000 for the
National Institute on Alcohol Abuse and Alcoholism [NIAAA].
Moderate Alcohol and Cardiovascular Health Trial [MACH].--
The Committee is deeply troubled by news reports, confirmed by
NIH's own internal review, that NIAAA senior leadership and
staff colluded with potential underwriters in industry to fund
a study of the benefits of moderate drinking. The review by the
Advisory Committee to the Director [ACD] found there was early
and frequent NIAAA engagement with industry that calls into
question the impartiality of program managers, and would cast
doubts about the credibility of any scientific knowledge that
might be gained from the study. There were also interactions
that appear to provide the eventual principal investigator with
a competitive advantage not available to other applicants.
Industry and NIAAA interactions appeared to intentionally bias
the framing of the scientific premise in the direction of
demonstrating a beneficial health effect of moderate alcohol
consumption. Specifically, the study excluded some populations
that could potentially be most harmed by alcohol consumption
and did not include enough follow-up time to allow for
meaningful assessment of cancer and heart disease endpoints.
Thus, the trial could show benefits while missing harms. To its
credit, NIH moved quickly to investigate and terminate the
study, as well as to review research practices throughout the
agency to identify whether there are other inappropriate
relationships that might bias research findings. The
credibility of NIH research is central to its mission, and it
does not require many incidents like the failures related to
the MACH trial to cause longstanding damage to its reputation.
The Committee directs NIH to provide a report 30 days after
enactment of this act describing in detail how it is
implementing the ACD's recommendations to strengthen its
internal controls, including the costs associated with these
efforts. The report should also highlight the steps NIH is
taking to restore the public's confidence.

NATIONAL INSTITUTE ON DRUG ABUSE

Appropriations, 2018.................................... $1,376,657,000
Budget estimate, 2019................................... 1,137,403,000
Committee recommendation................................ 1,420,591,000

The Committee recommendation includes $1,420,591,000 for
the National Institute on Drug Abuse [NIDA]. This includes
$250,000,000 in funding for research related to opioid
addiction, development of opioid alternatives, pain management,
and addiction treatment.
Alcohol's Role in Opioid Overdose.--The Committee is
concerned that the role of alcohol in opioid and other drug
overdoses is not receiving the attention it should. CDC
estimates that alcohol contributes to over 8,000 annual
overdose deaths that are primarily attributed to other
substances, and that data suggest alcohol is commonly omitted
from death certificates leading to underreporting. To address
the opioid crisis, all avenues of investigation must be
addressed. The Committee directs NIAAA to work with NIDA and
any other appropriate agencies to better understand these
linkages and to support research that will help to address this
aspect of the problem.
Barriers to Research.--The Committee is concerned that
restrictions associated with Schedule 1 of the Controlled
Substance Act effectively limit the amount and type of research
that can be conducted on certain Schedule 1 drugs, especially
marijuana or its component chemicals and certain synthetic
drugs. At a time when we need as much information as possible
about these drugs, we should be lowering regulatory and other
barriers to conducting this research. The Committee directs
NIDA to provide a short report on the barriers to research that
result from the classification of drugs and compounds as
Schedule 1 substances.
Marijuana Research.--The Committee is concerned by the lack
of research on marijuana and marijuana products, especially
increasing potency. The Committee is concerned with the rapidly
changing landscape regarding the recreational use of
marijuana--the effects that the drug can have on brain
development; addiction; the long-term health effects in both
youth and older individuals. The Committee directs NIH to
coordinate a multi-Institute approach to increase research
related to the effect of increasing delta-9-
tetrahydrocannabinol levels on the human body as well as the
effect of various delta-tetrahydrocannabinol levels on
cognitive abilities that are required to, for example, operate
motor vehicles. The Committee requests an update on the status
of research related to these topics be included in the fiscal
year 2020 CJ. Further, the Committee remains concerned that
NIDA ceased funding for analysis of marijuana samples seized by
law enforcement in 2014. Without dedicated funding for this
activity, the number of analyzed seized samples has plummeted,
meaning that available data is no longer current or robust. The
Committee believes that such research, along with analysis of
marijuana and marijuana-derived products sold commercially in
dispensaries or online, is essential for informing substance
misuse and addiction prevention efforts, public health policy,
and law enforcement tactics across the Federal Government. The
Committee continues to direct NIDA to coordinate efforts with
the DEA and other law enforcement agencies to monitor Schedule
I marijuana and marijuana-derived products.
Neonatal Abstinence Syndrome [NAS].--The Committee is aware
that the rising untreated use of opioids by pregnant mothers is
one of the main causes for the Nation's opioid epidemic and
that it causes death or sometimes critical mental and physical
health problems in babies who do survive. The Committee
understands that until the need for interventions to reduce the
use and abuse of opioids during pregnancy is addressed, the
problem is likely to continue, with post-delivery effects on
mothers and infants continuing to be a medical, social, and
financial burden. The Committee encourages NIDA and NICHD to
continue to support research that will help clinicians and
academic research institutions to develop a comprehensive
approach to the prevention and treatment of NAS.
Opioid Misuse and Addiction.--The bill includes
$250,000,000 for targeted research related to opioid misuse and
addiction, development of opioid alternatives, pain management,
and addiction treatment. The Committee remains concerned about
the growing epidemic of opioid misuse and addiction in this
country. The widespread availability of prescription opioids
has contributed to the millions of Americans who suffer from
addiction disorders. Although NIH has studied the effectiveness
and risks associated with long-term opioid use for chronic
pain, little research has been done to investigate new and
alternative treatment options to treating chronic pain, other
than with highly addictive opioid painkillers and muscle
relaxants. The Committee directs NIH to expand scientific
activities related to research on medications used to treat and
reduce chronic pain, and the transition from acute to chronic
pain. Further, the Committee urges NIH to: (1) continue funding
research on medication development to alleviate pain and to
treat addiction, especially the development of medications with
reduced misuse liability; (2) as appropriate, work with private
companies to fund innovative research into such medications;
(3) report on what we know regarding the transition from opioid
analgesics to heroin and synthetic opioid use and addiction
within affected populations; (4) conduct pilot studies to
create a comprehensive care model in communities nationwide to
prevent opioid misuse, expand treatment capacity, enhance
access to overdose reversal medications, and enhance prescriber
practice; (5) test interventions in justice system settings to
expand the uptake of medication assisted treatment and methods
to scale up these interventions for population-based impact;
and (6) develop evidence-based strategies to integrate
screening and treatment for opioid use disorders in emergency
department and primary care settings. In addition, NIH should
continue to sponsor research to better understand the effects
of long-term prescription opioid use, especially as it relates
to the prevention and treatment of opioid misuse and addiction.
Opioid Research Centers.--The Committee supports the
creation of one or more research centers to study the
effectiveness of policies related to combatting prescription
opioid use. Preference should be given to research done in
States with high levels of prescription opioid use, opioid
overdose deaths, and racial and ethnic diversity.
Raising Awareness and Engaging the Medical Community in
Drug Abuse and Addiction Prevention and Treatment.--Education
is a critical component of any effort to curb drug use and
addiction, and it must target every segment of society,
including healthcare providers (doctors, nurses, dentists, and
pharmacists), patients, and families. Medical professionals
must be in the forefront of efforts to curb the opioid crisis.
The Committee continues to be pleased with the NIDAMeD
initiative, targeting physicians-in-training, including medical
students and resident physicians in primary care specialties
(i.e. internal medicine).

NATIONAL INSTITUTE OF MENTAL HEALTH

Appropriations, 2018.................................... $1,757,657,000
Budget estimate, 2019................................... 1,612,192,000
Committee recommendation................................ 1,871,250,000

The Committee recommendation includes $1,871,250,000 for
the National Institute of Mental Health [NIMH], including
$57,500,000 appropriated from the NIH Innovation Account.
Improving the Treatment of Mental Illness.--The Committee
encourages NIMH to continue to ensure a diverse research
portfolio of basic neuroscience, applied, and translational
research, with a continued focus on excellent science.
Post-Traumatic Stress Disorder [PTSD].--The Committee
supports NIMH's efforts to support a diverse portfolio of
research on post-traumatic stress conditions, including
research to identify risk and protective factors, develop and
test interventions, and implement models for delivering care
across settings. The Committee encourages NIMH to continue to
support the Aurora study, a comprehensive 5-year study of
mental health outcomes following trauma exposure to understand
how mental illnesses like PTSD develop to understand modifiable
factors that may be targets of new treatments. This and similar
efforts have the potential to greatly impact care for
individuals with and at-risk for PTSD.
Suicide Prevention and Risk Detection Algorithms.--The
Committee is alarmed by new data from CDC that indicates that
suicide rates have increased nationwide by 30 percent since
1999. Data also shows that the suicide rate among children, and
especially minority children, has significantly risen over the
past decade. NIMH has had some encouraging breakthroughs in
research on risk detection algorithms, and these tools can be
made increasingly sophisticated now with the power of big data
tools. The Committee urges NIMH to prioritize its suicide
prevention research efforts to produce models that are
interpretable, scalable, and practical for clinical
implementation, including mental and behavioral health care
interventions, to combat suicide in the United States. The
Committee directs NIH to provide an update on these efforts,
including its work with CDC, SAMHSA, and the Department of
Education, in the fiscal year 2020 CJ.

NATIONAL HUMAN GENOME RESEARCH INSTITUTE

Appropriations, 2018.................................... $558,072,000
Budget estimate, 2019................................... 512,979,000
Committee recommendation................................ 575,882,000

The Committee recommendation includes $575,882,000 for the
National Human Genome Research Institute [NHGRI].
Centers of Excellence in Genomic Sciences.--The Committee
notes that as genomics becomes the pathway to new cures and
therapeutics for many diseases, NHGRI and other Institutes must
continue to look for new ways to build capacity at institutions
that have strengthened their expertise in the field, but have
yet to be able to compete for the current RM1 and UM1 awards.
The Committee instructs NHGRI to conduct, and provide to the
Committee, a portfolio analysis within 180 days of enactment.
The analysis will assess the distribution of NHGRI's funding
through the RM1, UM1, and other grant mechanisms to ensure
NHGRI is effectively supporting capacity-building in genomics
research and supporting diverse and innovative institutions,
especially in academic medical research institutions that are
making significant investments in genomics tools and research,
but have not yet been the recipient of a RM1 or UM1 award.

NATIONAL INSTITUTE OF BIOMEDICAL IMAGING AND BIOENGINEERING

Appropriations, 2018.................................... $377,618,000
Budget estimate, 2019................................... 346,550,000
Committee recommendation................................ 389,672,000

The Committee recommendation includes $389,672,000 for the
National Institute of Biomedical Imaging and Bioengineering
[NIBIB].
Traumatic Brain Injury.--The Committee encourages the NIBIB
to conduct state of the art translational research in the
diagnosis, prognosis, and treatment of neurotrauma. Neurotrauma
is the umbrella term for two primary pathologies, spinal cord
injuries and traumatic brain injuries. These injuries are
unique in that they affect how and who a person is, with
incredible variation between patients. The sizable incidence of
injury and prevalence of disability resulting from neurotrauma
results in significant human and economic burden. As befits the
complexity of the challenges from neurotrauma, multiple NIH
Institutes and Centers coordinate research, which ranges across
a wide spectrum, from understanding the cellular mechanisms of
immediate and delayed damage, though development of better
prevention, treatment, and rehabilitation, and engages
scientists, engineers, and clinicians from a broad range of
disciplines. The Committee recognizes the need for cross-
disciplinary collaboration to meet these challenges and
strongly encourages NIH to support such research through all
appropriate support mechanisms.

NATIONAL CENTER FOR COMPLEMENTARY AND INTEGRATIVE HEALTH

Appropriations, 2018.................................... $142,018,000
Budget estimate, 2019................................... 130,717,000
Committee recommendation................................ 146,550,000

The Committee recommendation includes $146,550,000 for the
National Center for Complementary and Integrative Health
[NCCIH].
National Center for Complimentary and Integrative Health.--
The Committee is encouraged by the ongoing collaboration
between NCCIH, VA, DOD, and other Institutes across the NIH to
develop and test efficacious non-pharmacological approaches to
pain management and comorbidities--including opioid misuse,
abuse, and disorder--in military personnel, veterans, and their
families. The Committee is particularly encouraged by the
ongoing studies that will assess provider adherence to CDC
opioid prescribing practices and develop integrated pain care
approaches to reduce pain and opioid use in patients enrolled
in a large healthcare system. In addition, the Committee
believes it is critical to support research on non-
pharmacological treatments to ensure the best quality of care
for our Nation's veterans and servicemembers, and urges the
NIH, VA, and DOD to continue this vital research. The
Comprehensive Addiction and Recovery Act (Public Law 114-198)
calls for an expansion of research and education on and
delivery of complimentary and integrative health to veterans,
and the NCCIH can play an important role in coordinating
efforts with the VA, DOD, and other relevant agencies. The
Committee requests an update on these studies in the fiscal
year 2020 CJ.

NATIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH DISPARITIES

Appropriations, 2018.................................... $305,108,000
Budget estimate, 2019................................... 280,545,000
Committee recommendation................................ 314,845,000

The Committee recommendation includes $314,845,000 for the
National Institute on Minority Health and Health Disparities
[NIMHD].
Focal Segmental Glomerulosclerosis [FSGS].--The Committee
recognizes the work that NIMHD and NIDDK are doing to address
the connection between certain genes, including the APOL1 gene,
and the onset of FSGS. The Committee encourages NIMHD to work
with community stakeholders to identify areas of collaboration.
Hepatitis B Virus [HBV].--The Committee notes that HBV
infection is a serious public health threat with 1 in 20
Americans infected and more than 2,000,000 chronically
infected, increasing by 80,000 a year. Left undiagnosed and
untreated, 1 in 4, or over 500,000, of those with chronic HBV
infection will die prematurely from cirrhosis, liver failure,
and/or liver cancer. The Committee notes that half of all
hepatitis B patients in the U.S. are Asian-American immigrants
or Pacific Islanders, though these groups only account for
about 6 percent of the population. Further, among African
immigrants, the prevalence of hepatitis B is about 10 percent.
The Committee urges NIMHD to fund research to test scale-up
model programs that increase hepatitis B awareness, knowledge,
prevention through vaccination, testing, and treatment through
linkage to care among the disproportionately hepatitis B
impacted communities.

JOHN E. FOGARTY INTERNATIONAL CENTER FOR ADVANCED STUDY IN THE HEALTH
SCIENCES

Appropriations, 2018.................................... $75,733,000
Budget estimate, 2019................................... 70,084,000
Committee recommendation................................ 78,150,000

The Committee recommendation includes $78,150,000 for the
Fogarty International Center [FIC].
John E. Fogarty International Center.--Recent disease
outbreaks such as Ebola, Zika, and Dengue have shown the
importance of the Center's essential role in global infectious
disease health research training to help developing countries
advance their own research and health solutions and tools. FIC
has developed important partnerships to not only fight malaria,
neglected tropical diseases, and other infectious diseases but
also to have the capabilities to detect and treat infectious
diseases that are not endemic to the United States before they
travel to the United States thus protecting Americans here at
home. The Committee urges FIC to continue this important work
building relationships with scientists abroad to foster a
stronger and more effective science workforce and health
research capacity on the ground, helping to detect infectious
diseases and building the capacity to confront those diseases
while improving the image of the U.S. though health diplomacy
in their countries.

NATIONAL LIBRARY OF MEDICINE

Appropriations, 2018.................................... $428,553,000
Budget estimate, 2019................................... 395,493,000
Committee recommendation................................ 442,230,000

The Committee recommends $442,230,000 for the National
Library of Medicine [NLM]. Of the funds provided, $4,000,000 is
for the improvement of information systems, to remain available
until September 30, 2020.

NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCES

Appropriations, 2018.................................... $762,454,000
Budget estimate, 2019................................... 685,087,000
Committee recommendation................................ 806,787,000

The Committee recommendation includes $806,787,000 for the
National Center for Advancing Translational Sciences [NCATS].
The Committee includes bill language allowing up to $80,000,000
of this amount to be used for the Cures Acceleration Network
[CAN].
Clinical and Translational Science Awards [CTSA] Program.--
The Committee encourages the NCATS to fund, through the
existing CTSA Program hubs, expanded efforts to improve
translational research that address health disparities and the
significant burden of conditions that disproportionately affect
minority and special populations. Accelerating translational
research by making it more efficient and effective will reduce
the burden of disease and promote health equity. Applying the
CTSA model to address long-standing regional health disparities
can provide innovative, multi-disciplinary approaches to
reducing the burden of disease among vulnerable populations.
The Committee supports the goals of the NCATS program and
believes the principles that serve as the foundation of NCATS;
public-private partnerships, community outreach, faster access
to clinical trials, have tremendous potential for addressing
the long-standing diseases associated with health disparities.
The Committee encourages NCATS to fund institutions with a
history of serving health disparity populations.

OFFICE OF THE DIRECTOR

Appropriations, 2018.................................... $1,814,745,000
Budget estimate, 2019................................... 1,808,306,000
Committee recommendation................................ 1,922,660,000

The Committee recommendation includes $1,922,660,000 for
the Office of the Director [OD]. Within this total,
$606,885,000 is provided for the Common Fund and $12,600,000 is
included for Gabriella Miller Kids First Research Act.
Academic Research Enhancement Award [AREA] Program.--The
Committee believes that biomedical discoveries can occur
anywhere, and continues to support programs that foster
biomedical research and opportunities for students at
institutions who may not receive significant NIH funding. In
particular, the Committee continues its long-standing support
of the IDeA program. However, the Committee notes that many
institutions that may benefit from the IDeA program are
ineligible because they reside in States that are not IDeA
States. The Committee encourages NIH to enhance support for the
AREA program and is urged to develop ways to improve ties
between institutions that receive significant NIH funding and
AREA-eligible institutions.
Administrative Burdens in Grant Preparation.--The Committee
recognizes that certain administrative tasks are critical to
the research process and applauds the NIH's efforts to identify
and reduce sources of administrative burden for researchers.
The Committee encourages NIH to identify additional ways to
enable researchers to spend more productive time working on
science, rather than applying for and reporting on grants. The
Committee notes that the modular budget cap has not increased
with inflation, and that grant applications with necessary
costs above the modular budget cap incur additional
administrative responsibilities. The Committee requests an
update from NIH in the fiscal year 2020 CJ regarding the effect
of modular budget cap increases on reducing administrative
burdens while maintaining appropriate fiscal oversight of grant
costs.
All of Us Research Program, Part of the Precision Medicine
Initiative.--The Committee recommendation strongly supports the
All of Us Research Program, part of the Precision Medicine
Initiative and has provided $376,000,000 in support of this
Initiative. The Committee recognizes the potential that
precision medicine holds for all populations, including
children, and encourages NIH to prioritize timely and
meaningful enrollment for the pediatric population, including
healthy children and those with rare diseases, in the All of Us
Research Program. The Committee is encouraged that NIH
impaneled a Child Enrollment Scientific Vision Working Group,
which released a report that identifies scientific
opportunities relevant to child health. The Committee requests
an update within 60 days after the enactment on the timing for
the Special Populations Committee to provide recommendations
regarding the practical considerations of child enrollment and
data collection involving children. Additionally, the Committee
requests that NIH provide an update on plans to ensure that the
research cohort includes a sufficient number of children to
make meaningful studies possible, the target date for
enrollment to commence and how enrollment strategies will
include input from pediatric stakeholders across the country
with experience in pediatric clinical trial enrollment.
Amyloidosis.--The Committee recommends that NIH expand its
research efforts into amyloidosis, a group of rare diseases
characterized by abnormally folded protein deposits in tissues.
Amyloidosis is often fatal, and there is no known cure. Current
methods of treatment are risky and unsuitable for many
patients. The Committee directs NIH to inform the Committee on
the steps taken to increase the understanding of the causes of
amyloidosis and the measures taken to improve the diagnosis and
treatment of this devastating group of diseases.
Biomedical Research Facilities.--The Committee believes
that the Nation's biomedical research infrastructure, including
laboratories and research facilities at academic institutions,
is out of date and insufficient. Therefore, the Committee has
provided $50,000,000 for grants or contracts to public,
nonprofit, and not-for-profit entities to expand, remodel,
renovate, or alter existing research facilities or construct
new research facilities as authorized under 42 U.S.C. section
283k. The Committee urges NIH to consider recommendations made
by the NIH Working Group on Construction of Research
Facilities, including making awards that are large enough to
underwrite the cost of a significant portion of newly
constructed or renovated facilities.
Brain Research Through Application of Innovative Neuro-
technologies [BRAIN] Initiative.--The Committee continues to
strongly support the BRAIN Initiative. The bill provides the
full President's request of $429,380,000, an increase of
$29,000,000 above fiscal year 2018.
Big Data.--Two years ago, the Committee tasked NIH with
developing a strategic plan to outline how it will manage and
make the most of the data it is producing. Although medical
research benefits from the rise of unprecedented new tools,
technologies, and computational power, it also faces the
challenge of making the most of the staggering and ever-growing
amount of data that NIH and its grantees produce. NIH recently
finalized its strategic plan, which thoughtfully outlines key
areas of focus. Initial drafts of the plan called for the
agency to develop performance measures and specific milestones
for the plan's objectives during 2018, but subsequent versions
dropped this goal. The Committee assumes NIH opted to defer
making specific commitments until it fills the newly
established position of Chief Data Strategist [CDS], which is
understandable given that the CDS will have sweeping
responsibilities. These include leading efforts to develop a
next-generation technology platform to accelerate scientific
discovery, implementing innovative new approaches to increase
the skills of NIH researchers, and representing the agency in
national and global data strategy matters. While the CDS will
report directly to the NIH Director, the Committee wants to
ensure that the CDS has the support and authority needed to
successfully implement the plan. Success will require
cooperation from all 27 of the agency's Institutes and Centers
and entail relinquishing some, perhaps much, of the autonomy
they now have over data management, technology and tools, and
training. To help ensure that happens, the Committee directs
the CDS to provide quarterly briefings on NIH's efforts to
implement the strategic plan. In addition, the Committee
directs NIH to finalize an initial set of metrics and
milestones, recognizing that these may evolve as implementation
of the plan proceeds, within 60 days of enactment of this act.
Finally, the Committee has included $30,000,000 to support the
CDS' work in fiscal year 2019.
BSL-4 Laboratory.--The Committee encourages NIH to evaluate
the need for additional BSL-4 laboratory space for the purpose
of addressing the growing threat posed by current and emerging
infectious diseases. Priority should be given to organizations
with a history of efficiently and successfully conducting this
complex research.
Chronic Disease Center.--Chronic diseases and conditions,
such as heart disease, kidney diseases, stroke, cancer, type 2
diabetes, obesity, and arthritis/autoimmune diseases, are among
the most common, costly, and preventable of all health
conditions. As of 2012, about half of all adults had one or
more chronic health conditions, with 25 percent of adults
suffering with two or more chronic health problems. The
Committee strongly believes that NIH needs to focus chronic
disease efforts on those populations most affected. Therefore,
the Committee directs the NIH Director to fund a trans-NIH
initiative involving, at a minimum, NIDDK, NCI, NIAMS, NINDS,
NIAID, and NHBLI to address the increasing burden of chronic
diseases. The initiative will focus on heart and kidney
diseases, stroke, obesity, cancer, diabetes, exercise medicine,
and health disparities in these areas. Programs should have a
strong existing track record of NIH funding in all these areas,
such as a NIH-funded Nutrition Obesity Research Center,
Diabetes Research Center, O'Brien Kidney Center, Center for
Health Disparities Research, and Center for Exercise Medicine.
Additionally, regional multi-institutional consortiums are
strongly encouraged. The NIH Director will report to the
Committee within 120 days on the structure, leadership,
funding, and key areas of focus for one or more chronic disease
centers.
Chronic Fatigue Syndrome [ME/CFS].--The Committee is
pleased that NIH has begun to expedite research into ME/CFS.
However, NIH itself has acknowledged that there are too few
centers and that 10 to 20 times more funding is required to
make progress in the field. The Committee is concerned that
NIH's current plans to increase research activities and funding
will take too long to produce the FDA-approved treatments and
diagnostic tests critically needed by patients and their
doctors. The Committee urges NIH to collaborate with disease
experts and the patient community to identify additional
opportunities to expedite progress on this understudied
disease. Specifically, the Committee recommends that NIH
increase research to: (1) identify underlying causes of the
illness to enable therapies that would effectively prevent or
treat the illness; (2) identify biological markers linked to
the various forms of the illness to optimize selection of
specific patient subgroups for trials; (3) increase
investigator-initiated studies and early stage investigator
awards; (4) develop mechanisms to incentivize researchers to
enter the field.
Chronic Overlapping Pain Conditions.--The Committee is
concerned with the lack of progress in advancing a
comprehensive initiative on Chronic Overlapping Pain
Conditions, especially in light of recent findings from major
studies funded by the agency demonstrating the significant
prevalence and cost of Chronic Overlapping Pain Conditions, as
well as the associated disability and detrimental health and
quality of life outcomes for those with these debilitating
disorders. The Committee strongly encourages the Director to
continue to assess the state of science on Chronic Overlapping
Pain Conditions and use the findings to continue to advance the
scientific understanding of Chronic Overlapping Pain
Conditions, as well as the development and discovery of safe
and effective treatments.
Coffin-Siris Syndrome.--The Committee recognizes the
promising scientific gains and applauds private partners
advancing research in pursuit of treatments for Coffin-Siris
Syndrome. The Committee encourages NIH to continue to support
such research at NIH.
Confucius Institutes.--The Committee has strong concerns
with the growing influence of the People's Republic of China's
[PRC] increasingly aggressive attempts to use ``Confucius
Institutes,'' which are Chinese Government-run programs that
use the teaching of Chinese language and culture as a tool to
expand the political influence of the PRC. The PRC uses
Confucius Institutes and other means to influence foreign
academic institutions and critical analysis of China's past
history and present policies. Moreover, Confucius Institute
instructors are almost always hired in China and trained by the
Chinese Ministry of Education without any of the same
employment and hiring protections that exist in the United
States. Much more difficult to measure but no less insidious,
however, is the self-censorship that often takes place in
academic settings where there is a Chinese Government presence
in the form of a Confucius Institute. Given the growing
concerns with intellectual property protections, within 180
days, the NIH Director shall develop a publicly available list
of Confucius Institutes that have received NIH funding since
2013, along with the amount each institute received.
Data Sharing of Rare Diseases Research.--The Committee is
aware that NIH funded projects require a data-sharing plan to
encourage transparency and leverage Federal investments in
research. At the same time, project leaders and their
institutions often cite barriers to implementing these plans in
a timely and cost-effective manner. The Committee believes that
a focused initiative to show commitment and to improve data-
sharing performance in rare disease research, including
conditions that disproportionately impact the pediatric
population, can create a model for the broader research
community and recommends that the NIH develop this initiative
in collaboration with patient, provider, and research
organizations.
Directors Advisory Committees.--The Committee is aware that
there is a legal requirement of Federal statute (Title 42 of
the US Code, Subchapter III; Part B, Subsection 284A) that all
NIH Directors Advisory Councils have at least two
representatives from the fields of public health and the
behavioral or social sciences. There are a few Directors
Advisory Councils that may not be adhering to this requirement.
The Committee urges continued compliance with this statute and
requests a report on compliance including a list of each
Advisory Council's behavioral, social sciences and public heath
members.
Fragile X [FX].--The Committee commends NIH for supporting
research to understand the nature of FX and its association
with other conditions such as autism. The Committee encourages
NIH to continue to fund at least three FX research centers,
supporting interdisciplinary research in important new areas.
The Committee urges NIH to assure that the FX research centers
program includes clinical and translational research that
directly addresses the needs of affected children and their
families, and that applicants for new centers may propose
clinical trials as part of their research portfolio. Given the
inextricable connection between the FX protein and autism, the
Committee urges the Director and each Institute Director with
Fragile X and autism portfolios to explore ways to create
greater efficiency and synergy among these two research tracks
to accelerate translational research toward a better
understanding of both conditions and to shorten the time to
bring effective treatments for both conditions to market
including the funding for clinical trials for both disorders.
Gabriella Miller Kids First Research Act.--The bill
provides the full request of $12,600,000. The Committee
requests that NIH provide information on how it has disbursed
fiscal year 2016, fiscal year 2017, and fiscal year 2018
funding for the Gabriella Miller Kids First Research Act,
including any personnel that are responsible for overseeing the
allocation of designated research dollars, the criteria that
NIH employed to ensure awards will advance the objectives of
the act, and a description of the research projects that were
funded at the end of fiscal year 2018. The criteria and process
for grant awards that NIH intends to use for fiscal year 2019
and subsequent years of funding under the act should also be
included.
Gestational Diabetes.--The Committee recognizes the
importance of research funded by NIH related to gestational
diabetes, a disease affecting up to 9.2 percent of all pregnant
women. Given that both women with gestational diabetes and
their babies face long-term health consequences as a result of
the disease, such as increased risk of developing type 2
diabetes, the Committee urges NIH to explore additional
opportunities for research on gestational diabetes.
Government-Wide Collaborations.--NIH, VA, and DOD
collaborate frequently and successfully on various research
activities. The Committee looks forward to the report in the
fiscal year 2020 CJ focusing on the cooperative and strategic
approach the agencies take in areas of biomedical research that
overlap to maximize the potential of the research.
Headache Disorders.--The Committee commends NIH for
including consideration of disease burden as a `crucial' factor
for aligning its research priorities within the NIH-Wide
Strategic Plan. The Committee notes that migraine is the top
cause of global disability for people aged 15 to 49 years old
in the 2016 Global Burden of Disease study, but that migraine
and headache are among the very least funded disease
categories, relative to disease burden, in the NIH ``Research,
Condition, and Disease Categorization.'' The Committee,
therefore, encourages NIH to prioritize substantial increases
in fundamental, translational, and clinical research funding
towards migraine, cluster headache, post-traumatic headache,
and other headache disorders.
Hepatitis B Virus [HBV].--The Committee notes that both the
World Health Organization in 2016 and the National Academies of
Science, Engineering and Medicine in 2017 declared that the
elimination of hepatitis B is possible. Subsequent to that
declaration, the hepatitis B research community convened a
virtual consensus conference to prepare a ``Roadmap for a
Cure'' that resulted in articles published in 2018 in two peer
reviewed scientific journals, Hepatology and Antiviral
Research, identifying the most urgent research questions that
must be answered to find a cure for Hepatitis B. In the United
States, 1 in 20 Americans have been infected, with more than
2,000,000 chronically infected, with acute infections rising by
over 20 percent in 2015 primarily due to the opioid crisis. The
Committee further notes that the link between HBV infection and
primary liver cancer is well established with up to 60 percent
of global liver cancer cases caused by HBV. Therefore, the
Committee requests that the Office of the Director develop and
lead an inter-Institute working group to include representation
from NCI, NIAID, NIDDK, and NIMHD to coordinate their research
agendas and research infrastructure to fund the research
necessary to find a cure for hepatitis B. The Committee further
requests that it be kept informed of these efforts and that a
status report be sent to the Committee within 90 days of
enactment.
Increasing Diversity in Clinical Trials.--Inclusivity in
clinical trials is a critical solution to ensure that patients
receive the safest, most efficacious and precise care possible.
The Committee requests that the Director report to the
Committee in the fiscal year 2020 CJ regarding the status of
these efforts, also including major successes, barriers, and
best practices.
Induced Pluripotent Stem Cell [iPSC].--The Committee
continues to stress iPSC technology as a critical tool in the
realm of personalized medicine. The Committee notes that iPSCs
are derived from adult skin cells, providing increased
opportunities to develop sources of cells with great
therapeutic value and potential for curing human diseases. The
Committee recognizes that basic science leads to pre-clinical
trials, cures, diagnostics, and treatments. It encourages NIH
to further explore additional basic science opportunities. The
Committee requests an update in the fiscal year 2020 CJ on NIH
efforts to expand iPSC technology basic research, including
through collaborative research activities.
Inflammatory Bowel Diseases [IBD].--The Committee is
pleased by NIH's support of research into IBD and notes the
increasing prevalence. The Committee encourages NIH to enhance
support for research on IBD, including environmental triggers
and epigenetics of IBD, identification of disease biomarkers in
IBD, as well as interventions targeted at both pediatric and
adult patients.
Intellectual Property.--The Committee encourages the NIH
Director to work with the HHS Assistant Deputy Secretary for
National Security to improve the security of intellectual
property derived from NIH-funded research. In particular, the
NIH is encouraged to: improve the security of the peer review
system; augment the application process to identify funding
that applicants receive from a foreign government; and assist
the HHS Inspector General and appropriate law enforcement
agencies to identify violations of U.S. law or policy.
Mitochondrial Disease Research.--The Committee understands
that no fewer than 17 Institutes and Offices are involved in a
variety of research efforts related to mitochondrial disease
and dysfunction. The Committee appreciates NIH's support of the
trans-NIH Mitochondrial Disorders Working Group, the North
American Mitochondrial Disease Consortium, the Mitochondrial
Disease Sequence Data Resource Consortium, and its support for
investigator initiated intramural and extramural studies, and
urges NIH to continue its efforts to ensure that individuals
with mitochondrial disease participate in the All of Us
research program. The Committee understands that NIH is funding
research relevant to mitochondrial disease through the Office
of Research Infrastructure Programs [ORIP]. The Committee
encourages the Director to promote mitochondrial disease
research within ORIP and to provide an update to the Committee
in the fiscal year 2020 CJ on progress made through this
research. The Committee applauds the efforts made by the
agency's Office of Dietary Supplements [ODS] on nutritional
interventions for those with mitochondrial disease and requests
the agency include mitochondrial disease as a focus of its
future practices and to reengage its trans-NIH research through
the ODS on these issues.
Mucopolysaccharide Diseases [MPS].--MPS and mucolipidosis
[ML] are inherited, with death occurring for many in early
childhood. These systemic diseases cause progressive damage to
the bones, heart, respiratory system, and brain. The Committee
continues to urge NIH to put a high priority on better
understanding and treating MPS and ML diseases. The Committee
commends NIH for allocating funds to discover, develop, define,
and make available for research animal models of human genetic
disease. The Committee encourages expanded research of
treatments for neurological, chronic inflammation,
cardiovascular and skeletal manifestations of MPS, with an
emphasis on gene therapy. The Committee thanks NINDS, NIDDK,
and the Office of Rare Diseases Research for again funding the
Lysosomal Disease Network through the Rare Disease Clinical
Network and for funding lysosomal research meetings. The
Committee encourages NIH to increase funding to grantees to
incentivize MPS research, particularly given the age and small
population of current researchers. Understanding the
manifestations and treatments of both the skeletal and
neurological disease continues to be the greatest areas of
unmet need.
Neurofibromatosis [NF].--The Committee supports efforts to
increase funding and resources for NF research and treatment at
multiple NIH Institutes, including NCI, NINDS, NIDCD, NHLBI,
NICHD, NIMH, NCATS, and NEI. Children and adults with NF are at
significant risk for the development of many forms of cancer;
the Committee encourages NCI to increase its NF research
portfolio in fundamental basic science, translational research
and clinical trials focused on NF. The Committee also
encourages the NCI to support NF centers, NF clinical trials
consortia, NF preclinical mouse models consortia and NF-
associated tumor sequencing efforts. Because NF causes brain
and nerve tumors and is associated with cognitive and
behavioral problems, the Committee urges NINDS to continue to
aggressively fund fundamental basic science research on NF
relevant to nerve damage and repair. Based on emerging findings
from numerous researchers worldwide demonstrating that children
with NF are at significant risk for autism, learning
disabilities, motor delays, and attention deficits, the
Committee encourages NINDS, NIMH, and NICHD to expand their
investments in laboratory-based and clinical investigations in
these areas. Since NF2 accounts for approximately 5 percent of
genetic forms of deafness, the Committee encourages NIDCD to
expand its investment in NF2 basic and clinical research. NF1
can cause vision loss due to optic gliomas, the Committee
encourages NEI to expand its investment in NF1 basic and
clinical research.
Next Generation Researchers Initiative.--The Committee
urges NIH to continue to prioritize robust implementation of
the Next Generation Researchers Initiative within the Office,
as established in the 21st Century Cures Act, and to continue
to expand the activities under the Initiative to improve and
accelerate transitions into independent careers and enhance
workforce diversity. The Committee directs NIH to collect,
evaluate, and disseminate data, including best practices, on
implementation of the Initiative's policies as well as programs
and pilots across all Institutes and Centers aimed at promoting
the next generation of researchers, and to coordinate with
relevant agencies, professional and academic associations, and
others to inform programs related to the training, recruitment,
and retention of biomedical researchers, as required under the
law. The Committee applauds the National Academy of Sciences
publication of the study, the Next Generation of Biomedical and
Behavioral Sciences Researchers: Breaking Through, and urges
NIH to advance the recommendations in the study.
Palliative Care.--The Committee recognizes the importance
of palliative care research to strengthen clinical practice and
improve healthcare delivery for patients with serious or life-
threatening illness or multiple chronic conditions, as well as
their families/caregivers. Research funding for palliative
care, including pain and symptom management, comprises less
than 0.1 percent of the NIH annual budget. Therefore, the
Committee strongly urges NIH to develop and implement a trans-
Institute strategy to expand and intensify national research
programs in palliative care to address quality of care and
quality of life for the rapidly growing population of
individuals in the United States with serious or life-
threatening illnesses.
Pediatric Clinical Trials Authorized under Best
Pharmaceuticals for Children Act.--The Committee directs that
no less than $25,000,000 be used towards clinical trials
authorized by the Best Pharmaceuticals for Children Act.
Polycystic Ovary Syndrome [PCOS].--The Committee recognizes
the significant health burden of PCOS, which has reproductive,
metabolic, and mental health manifestations. The exact causes
of PCOS are unknown at this time; however, PCOS is the most
common cause of female infertility, affecting up to 10 to 15
percent of women, depending on diagnostic criteria used. To
date, 70 percent of NIH's investment in PCOS has focused on the
reproductive implications of the syndrome, and the Committee
commends NICHD for its leadership in PCOS research. The
Committee requests that NIH also focus on comorbidities
associated with PCOS, as they contribute to increased health
care costs and negative health outcomes. Therefore, the
Committee asks OD to direct the relevant NIH Institutes and
Centers, including NIDDK, NHLBI, NCI, ORWH, NIMH, and NICHD, to
report on the research that has been conducted on PCOS and its
comorbidities to date, identify the gaps in the research, and
develop a trans-NIH research action plan, in conjunction with
PCOS researchers, clinicians, and patients, to be shared with
the Committee. The Committee further urges NIH to support
investigator-initiated studies and early stage investigator
awards, and mechanisms to incentivize researchers to enter the
field.
Prenatal Opioid Use Disorders and Neonatal Abstinence
Syndrome [NAS].--The Committee recognizes the growing burden of
NAS and the health care costs associated with it. The Committee
is aware of the need for more information regarding long-term
health and developmental outcomes related to NAS, the wide
variation in clinical practice and health systems support, as
well as the challenges associated with post-discharge care. The
Committee encourages NIH to coordinate with other agencies at
HHS to support additional research on prevention,
identification, and treatment of prenatal opioid exposure and
NAS, including the best methods for screening and treating
pregnant women for opioid use disorder and the best methods for
screening for NAS. Additionally, the Committee encourages NIH
to build on the ACT NOW study to enhance understanding of the
impact of pharmacological and non-pharmacological treatment
techniques on costs and outcomes in the short-term and
longitudinally. The Committee further encourages NIH to
coordinate with other agencies at HHS to support research on
innovative care models to optimize care and long-term outcomes
for families.
Precision Medicine and the Pediatric Population.--The
Committee recognizes the potential that precision medicine
holds for all populations, including children, and encourages
NIH to prioritize timely and meaningful enrollment for the
pediatric population, including healthy children and those with
rare disease, in the All of Us research program. The Committee
is encouraged that NIH impaneled a Child Enrollment Scientific
Vision Working Group, which released a report that identifies
scientific opportunities relevant to child health. The
Committee requests an update within 60 days on the timing for
the Special Populations Committee to provide recommendations
regarding the practical considerations of child enrollment and
data collection involving children. Additionally, the Committee
directs that NIH provide an update on plans to ensure that the
research cohort includes a sufficient number of children to
make meaningful studies possible, the target date for
enrollment to commence and how enrollment strategies will
include input from pediatric stakeholders across the country
with experience in pediatric clinical trial enrollment.
Research Initiative on Ethnic and Racial Diversity in
Cancer.--The Committee recognizes that NIH's Cancer Moonshot
initiative aims to accelerate the discovery of new ways to cure
cancers, including through an understanding and application of
cancer genetic information to the prevention and treatment of
cancer. The Committee urges NIH to facilitate research on the
causes, prevention, and treatment of cancer in populations with
diverse cultural, racial, and ethnic composition.
Research Transparency.--As shown over the past 4 years, the
Committee remains committed to funding NIH research and
ensuring that our Nation's researchers, particularly those
early in their career, have the support to make the scientific
breakthroughs that may transform health care. It is critical
that NIH can ensure funds are used to support the most
meritorious research. Members of this Committee have raised
concerns and provided examples of questionable research.
Therefore, NIH is directed to justify, in writing made
available on a publicly accessible website, that each grant or
agreement promotes efforts to seek fundamental knowledge about
the nature and behavior of living systems and/or the
application of that knowledge to enhance health, lengthen life,
and reduce illness and disability. The Committee continues to
urge a focus on research that will yield further advancement in
life-saving treatments and cures.
Sexual Harassment Policies.--The Committee recognizes the
report recently published by the National Academies of
Sciences, Engineering, and Medicine regarding sexual harassment
of women in academic sciences, engineering, and medicine. The
Committee directs NIH to submit to the Committee within 180
days of enactment of this act its plans to remind the grantee
research community of its obligation to report to NIH any
changes of key personnel, such as when such staff are put on
administrative leave, and its plans to identify and disseminate
training or best practices that it is applying to its own
employees to support a non-discriminatory research and
research-related environment. The Committee commends NIH for
instituting expectations in all conference awards that NIH-
supported conferences must be conducted in a safe and
respectful environment for all attendees by providing an
environment free from discrimination and harassment, as well as
its efforts to develop a new NIH anti-harassment policy to
foster a safe and respectful work environment for all NIH
employees. The Committee encourages NIH to make aggregate data
of confirmed cases of harassment and their resolution available
to the public on a routine basis. Finally, the Committee looks
forward to the survey NIH intends to conduct this fall to
determine the incidence and prevalence of harassment within NIH
and the effects of workplace harassment on career trajectories
and directs NIH to make that survey instrument available to
research institutions so that comparable data can be collected
on the field at large.
Sleep Disorders.--The Committee continues to recognize
sleep disorders as a public health concern, and is encouraged
by the ongoing implementation of the NIH Sleep Disorders
Research Plan. The Committee recognizes that sleep and
circadian research play an important role across all Institutes
and Centers, and notes that the 2017 Noble Prize in Physiology
or Medicine was awarded to an NIH grantee for breakthroughs in
studying the internal biological clock. The Committee
encourages NIH to explore opportunities to appropriately
incorporate cross-cutting efforts into activities supported by
the Common Fund and the All of Us research program.
Spina Bifida.--The Committee encourages NIA, NIDDK, NICHD,
and NINDS to study the causes and care of the neurogenic
bladder and kidney disease in order to improve the quality of
life of children and adults with Spina Bifida; to support
research to address issues related to the treatment and
management of Spina Bifida and associated secondary conditions,
such as hydrocephalus; and to invest in understanding the
myriad co-morbid conditions experienced by individuals with
Spina Bifida, including those associated with both paralysis
and developmental delay.
Temporomandibular Disorders [TMD].--The Committee
understands that NIH-funded research has demonstrated that TMD
are primarily a multisystem disorder with overlapping
conditions influenced by multiple biological and environmental
factors rather than solely an orofacial pain condition.
However, diagnosis and care of patients have not changed to
reflect this major paradigm shift, with many patients
continuing to receive treatments solely focused on teeth and
jaws. Moreover, the medical community lacks education regarding
the complexity and systemic aspects of TMD as well as its many
comorbid medical conditions. Patients are treated by a
multitude of practitioners across numerous disciplines with
treatments that have the potential to cause harm. The Committee
is encouraged that NIH, led by NIDCR and in coordination with
OD is leading an effort to provide to the Committee
recommendations for a plan to most effectively study the state
of TMD science, TMD education, examine the safety and efficacy
of current clinical treatments of TMD, the burden and costs
associated with TMD, develop policies related to the future
scientific and clinical management of TMD patients. The
Committee directs NIH to provide an update on development of
such plan no later than 180 days after enactment.
Transformative High Resolution Cryo-Electron Microscopy.--
The Committee commends NIH on their initial investment in the
Transformative High Resolution Cryo-Electron Microscopy [Cryo-
EM] program. The recent Nobel Prize for chemistry was awarded
for the development of Cryo-EM research funded by NIH. Access
to this groundbreaking research method is necessary for the
continued advancement of biomedical research. The Committee
urges the NIH to expand the number of national service centers
and training opportunities to further refine and advance Cryo-
EM research and expects an update of these efforts in the NIH
fiscal year 2020 CJ.
Trisomy 21.--The Committee applauds the NIH for
prioritizing its investment in the current pipeline of Down
syndrome research and the NIH Director's leadership in
advancing the trans-NIH initiative recommended by the Committee
in the fiscal year 2018 Omnibus bill. Through the trans-NIH
Initiative and other NIH supported research efforts that
involve cohorts of individuals with Down syndrome, the
Committee urges NIH to continue to expand such cohorts and
build its current pipeline of early-stage investigators focused
on Down syndrome. NIH should prioritize funding for research to
improve the health and neurodevelopment of individuals with
Down syndrome and of typical individuals at risk for immune
system dysregulation, Alzheimer's disease, cancer,
cardiovascular disease, and autism.
Tuberous Sclerosis Complex [TSC].--The Committee is
encouraged by NIH's updated TSC Research Plan published in
2016. Building on this Research Plan, the Committee encourages
the Director to coordinate the participation of multiple
Institutes and Centers on a research strategy aimed at
addressing the numerous medical and neuropsychological burdens
associated with TSC while deciphering the biology underlying
phenotypic heterogeneity. This effort should apply
recommendations from NIH's Neurodevelopmental Disorders
Biomarkers Workshop held in December 2017 involving TSC and
related neurodevelopmental disorders, to take advantage of
biomarker expertise and lessons learned across disease groups.
Manifestations of TSC are highly variable among affected
individuals, and TSC can be a model condition for developing
precision medicine approaches to treat each individual's
symptoms to maximize the benefit-risk ratio. NIH should
encourage research opportunities in the five key areas
prioritized by workshop participants: understanding phenotypic
heterogeneity in TSC, gaining a deeper knowledge of TSC
signaling pathways and the cellular consequences of TSC
deficiency, improving TSC disease models, developing clinical
biomarkers of TSC, and facilitating therapeutics and clinical
trials research.
Undiagnosed Diseases.--The Committee supports the efforts
of the Undiagnosed Diseases Network [UDN], funded through the
Common Fund, to enhance access to patients, caregivers, and
other stakeholders as well as make information obtained through
the UDN available to Federal agencies and health-related
agencies. To that end, the Committee urges the Director to
ensure that information on diagnoses and patient populations
identified by UDN is coordinated with the NCATS' Office of Rare
Disease Research and its Genetic and Rare Diseases Information
Center. The Committee is pleased with the work of the UDN to
advance patient care and treatment options. The Committee is
particularly focused on ensuring that as research (produced at
UDN or any of the Institutes) provides more information on
treatments for rare, undiagnosed, and underdiagnosed diseases
that this information is transitioned to become more readily
accessible. This work is one example of the success of NIH and
illustrates how the UDN program's successes must be built upon.
The Director is encouraged to identify successful work
completed by UDN and disseminate it to the medical community,
and continue to engage with patient advocacy organizations.

BUILDINGS AND FACILITIES

Appropriations, 2018.................................... $128,863,000
Budget estimate, 2019................................... 200,000,000
Committee recommendation................................ 200,000,000

The Committee recommendation includes $200,000,000 for NIH
buildings and facilities. This funding will remain available
for obligation for 5 years.

NIH INNOVATION ACCOUNT, CURES ACT

Appropriations, 2018.................................... $110,000,000
Budget estimate, 2019................................... 196,000,000
Committee recommendation................................ 196,000,000

The Committee recommendation includes $196,000,000 to be
spent from the NIH Innovation Account for the following
activities:
All of Us.--$186,000,000.
Regenerative Medicine.--$10,000,000.
The Committee report reflects distribution of the remainder
of funding from the NIH Innovation Account to NCI, NINDS, and
NIMH and expects NIH to transfer funding shortly after
enactment of this act.

NATIONAL INSTITUTE FOR RESEARCH ON SAFETY AND QUALITY

Appropriations, 2018....................................................
Budget estimate, 2019................................... $255,960,000
Committee recommendation................................................

The Committee recommendation does not provide funding for
the National Institute for Research on Safety and Quality.

NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH

Appropriations, 2018....................................................
Budget estimate, 2019................................... $200,000,000
Committee recommendation................................................

The Committee recommendation does not provide funding for
the National Institute for Occupational Safety and Health.

NATIONAL INSTITUTE ON DISABILITY, INDEPENDENT LIVING, AND
REHABILITATION RESEARCH

Appropriations, 2018....................................................
Budget estimate, 2019................................... $95,127,000,000
Committee recommendation................................................

The Committee recommendation does not provide funding for
the National Institute on Disability, Independent Living, and
Rehabilitation Research.

Substance Abuse and Mental Health Services Administration

The Committee recommends $5,738,494,000 for the Substance
Abuse and Mental Health Services Administration [SAMHSA]. The
recommendation includes $133,667,000 in transfers available
under section 241 of the PHS Act and $12,000,000 in transfers
from the PPH Fund.
SAMHSA is responsible for supporting mental health programs
and alcohol and other drug abuse prevention and treatment
services throughout the country, primarily through categorical
grants and block grants to States.
Eligible applicants under SAMHSA's PRNS authorities include
States, political subdivisions of States, Indian Tribes or
tribal organizations, health facilities, or programs operated
by or in accordance with a grant or contract with the Indian
Health Service, and other public or private nonprofit entities.
The Committee strongly encourages SAMHSA to exercise maximum
flexibility allowed when developing funding opportunity
announcements to ensure that all eligible applicants are
included.
The Committee recommendation continues bill language that
instructs the Assistant Secretary of SAMHSA and the Secretary
to exempt the Mental Health Block Grant [MHBG], the Substance
Abuse Prevention and Treatment [SAPT] Block Grant, and the
State Opioid Response Grant from being used as a source for the
PHS evaluation set-aside in fiscal year 2019.

MENTAL HEALTH

Appropriations, 2018.................................... $1,487,011,000
Budget estimate, 2019................................... 1,064,922,000
Committee recommendation................................ 1,566,011,000

The Committee recommends $1,566,011,000 for mental health
services. The recommendation includes $21,039,000 in transfers
available under section 241 of the PHS Act and $12,000,000 in
transfers from the PPH Fund. Included in the recommendation is
funding for programs of regional and national significance
[PRNS], the MHBG, children's mental health services, Projects
for Assistance in Transition from Homelessness [PATH], and
Protection and Advocacy for Individuals with Mental Illness
[PAIMI].

Programs of Regional and National Significance

The Committee recommends $442,659,000 for PRNS within the
Center for Mental Health Services. The Committee recommendation
includes $12,000,000 in transfers to PRNS from the PPH Fund.
These programs address priority mental health needs by
developing and applying evidence-based practices, offering
training and technical assistance, providing targeted capacity
expansion grants, and changing the delivery system through
family, client-oriented, and consumer-run activities.
Within the total provided for PRNS, the Committee
recommendation includes funding for the following activities:

SCIENCE AND SERVICE:
GLS--Suicide Prevention Resource 5,988 5,988
Center.........................
Practice Improvement and 7,828 7,828
Training.......................
Primary and Behavioral Health 1,991 1,991
Care Integration TA............
Consumer & Consumer Support TA 1,918 1,918
Centers........................
Minority Fellowship Program..... 8,059 8,059
Disaster Response............... 1,953 1,953
Homelessness.................... 2,296 2,296
------------------------------------------------------------------------

Certified Community Behavioral Health Clinics.--The
Committee includes $150,000,000, an increase of $50,000,000.
The Committee continues to direct SAMSHA to prioritize
resources to entities within States that are part of the
section 223(a) of the Protecting Access to Medicare Act of 2014
(Public Law 113-93) demonstration and to entities within States
that were awarded planning grants. SAMHSA is directed to
coordinate these resources with its efforts focusing on areas
of high incidence of substance use disorders. SAMHSA shall
conduct an evaluation of the program and provide a report to
the Committees on Appropriations of the House of
Representatives and the Senate not later than 15 months after
the date of enactment of this act.
Child Traumatic Stress Network.--The Committee applauds the
work of the National Child Traumatic Stress Initiative and
includes an additional $2,000,000 for activities authorized
under Section 582(c) and (d) of the PHS Act.
Infant and Early Childhood Mental Health.--The Committee
recognizes the importance of building mental health services
for children under age 6. These young children can and do
experience mental health disturbances, yet their unique needs,
particularly for infants and toddlers, are often overlooked in
mental health policy and healthcare delivery systems. These
grants help fill that gap by investing in early mental health
prevention, identification, and treatment, in order to reduce
the need for treatment later in life when it becomes more
difficult, time intensive, and expensive. The Committee
recommends providing grants to entities such as State agencies,
Tribal communities, or university or medical centers that are
in different stages of developing infant and early childhood
mental health services. These entities should have the capacity
to lead partners in systems-level change as well as building or
enhancing the basic components of such early childhood
services, including an appropriately trained workforce.
Mental Health Awareness Training.--The Committee provides
$21,963,000, an increase of $2,000,000 to continue existing
activities, including Mental Health First Aid. The Committee is
pleased with the progress of the Mental Health First Aid
program. Mental Health First Aid has trained more than
1,000,000 Americans to recognize the signs and symptoms of
common mental disorders and the recent inclusion of the program
in the International Association of Chiefs of Police One Mind
Campaign. In continuing competitive funding opportunities,
SAMHSA is directed to include as eligible grantees local law
enforcement agencies, fire departments, and emergency medical
units with a special emphasis on training for crisis de-
escalation techniques. SAMHSA is also encouraged to allow
training for veterans, armed services personnel and their
family members within the Mental Health First Aid program.
National Suicide Prevention Hotline.--The Committee is
concerned with the growing number of suicide deaths in the
United States. According to data released by CDC, nearly 45,000
lives were lost to suicide in 2016. Data also shows that
suicide rates went up more than 30 percent in half of states
since 1999 and that nearly every State saw a rate increase of
some kind. The Committee recognizes the National Suicide
Prevention Lifeline program's important role in suicide
prevention and encourages SAMHSA to continue its commitment to
this program.
Primary and Behavioral Healthcare Integration [PBHCI].--The
Committee provides $49,877,000 for PBHCI to support communities
to coordinate and integrate primary care services into
community-based behavioral health settings.
Project AWARE.--The Committee continues $71,001,000 for
Project AWARE which increases awareness of mental health issues
and connects young people that have behavioral health issues
and their families with needed services. Of the amount provided
for Project AWARE, the Committee directs SAMHSA to use
$10,000,000 for discretionary grants to support efforts in
high-crime, high-poverty areas and, in particular, communities
that are seeking to address relevant impacts and root causes of
civil unrest, community violence, and collective trauma. These
grants should maintain the same focus as fiscal year 2018
grants. The Committee requests a report on progress of fiscal
year 2018 grantees 180 days after the enactment of this act

Community Mental Health Services Block Grant

The Committee recommends $747,571,000 for the MHBG. The
recommendation includes $21,039,000 in transfers available
under section 241 of the PHS Act.
The MHBG distributes funds to 59 eligible States and
territories through a formula based on specified economic and
demographic factors. Grant applications must include an annual
plan for providing comprehensive community mental health
services to adults with a serious mental illness and children
with a serious emotional disturbance.
The Committee recommendation continues bill language
requiring that at least 10 percent of the funds for the MHBG
program be set-aside for evidence-based programs that address
the needs of individuals with early serious mental illness,
including psychotic disorders. The Committee commends SAMHSA
for its collaboration with NIMH on the implementation of this
set-aside. The Committee notes that it usually takes 14-17
years to translate research findings into practice and hopes
that the joint effort between NIMH and SAMHSA may be a model
for how to reduce this timeframe. The Committee directs SAMHSA
to continue its collaboration with NIMH to ensure that funds
from this set-aside are only used for programs showing strong
evidence of effectiveness and that target the first episode of
psychosis. SAMHSA shall not expand the use of the set-aside to
programs outside of the first episode psychosis. The Committee
directs SAMHSA to include in the fiscal year 2020 CJ a detailed
table showing at a minimum each State's allotment, name of the
program being implemented, and a short description of the
program.

Children's Mental Health Services

The Committee recommends $125,000,000 for the Children's
Mental Health Services program. This program provides grants
and technical assistance to support comprehensive, community-
based systems of care for children and adolescents with serious
emotional, behavioral, or mental disorders. Grantees must
provide matching funds and services must be coordinated with
the educational, juvenile justice, child welfare, and primary
healthcare systems. The Committee continues to include a 10
percent set-aside for an early intervention demonstration
program with persons not more than 25 years of age at clinical
high risk of developing a first episode psychosis. SAMHSA is
directed to work with NIMH on the implementation of this set-
aside.

Projects for Assistance in Transition From Homelessness

The Committee recommends $64,635,000 for PATH, which
addresses the needs of individuals with serious mental illness
who are experiencing homelessness or are at risk of
homelessness. Funds are used to provide an array of services,
such as screening and diagnostic services, emergency
assistance, case management, and referrals to the most
appropriate housing environment.

Protection and Advocacy for Individuals With Mental Illness

The Committee recommends $36,146,000 for PAIMI. This
program helps ensure that the rights of mentally ill
individuals are protected while they are patients in all public
and private facilities or while they are living in the
community, including in their own homes. Funds are allocated to
States according to a formula based on population and relative
per capita incomes.

SUBSTANCE ABUSE TREATMENT

Appropriations, 2018.................................... $3,263,506,000
Budget estimate, 2019................................... 2,113,397,000
Committee recommendation................................ 3,812,006,000

The Committee recommends $3,812,006,000 for substance abuse
treatment programs, including PRNS and the substance abuse
prevention and treatment block grant to the States. The
recommendation includes $81,200,000 in transfers available
under section 241 of the PHS Act.

Programs of Regional and National Significance

The Committee recommends $453,927,000 for PRNS within the
Center for Substance Abuse Treatment [CSAT]. The recommendation
includes $2,000,000 in transfers available under section 241 of
the PHS Act.
PRNS include activities to increase capacity by
implementing service improvements using proven evidence-based
approaches as well as science-to-services activities that
promote the identification of practices thought to have
potential for broad service improvement.
Within the total provided for PRNS, the Committee
recommendation includes funding for the following activities:

SCIENCE AND SERVICE:
Addiction Technology Transfer 9,046 9,046
Centers........................
Minority Fellowship Program..... 4,539 5,039
------------------------------------------------------------------------

Building Communities of Recovery.--The Committee
appreciates SAMHSA's implementation of new funding for
communities of recovery in fiscal year 2018 and continues to
encourage SAMHSA to promote the expansion of recovery support
services as well as reduce stigma associated with addictions.
Combatting Opioid Abuse.--The Committee provides
$12,000,000 within PRNS for grants to prevent opioid overdose
related deaths. This program will help States equip and train
first responders and other community partners with the use of
devices that rapidly reverse the effects of opioids. The
agreement also provides $36,000,000 for First Responder
Training grants. Of this amount, $18,000,000 is set aside for
rural communities with high rates of substance abuse. SAMHSA is
directed to ensure applicants outline how proposed activities
in the grant would work with treatment and recovery communities
in addition to first responders. The Committee has moved this
program out of the PRNS account in the Center of Substance
Abuse Prevention into the PRNS account of the Center for
Substance Abuse Treatment. The Committee believes the funding
should be in CSAT to best ensure that, after an overdose is
reversed through the use of naloxone, these individuals are
given access to a recovery coaching and referral to treatment.
Drug Courts.--SAMHSA is directed to ensure that drug court
funding is allocated to serve people diagnosed with a substance
use disorder as their primary condition. SAMHSA is further
directed to ensure that all drug court grant recipients work
with the corresponding State substance abuse agency in the
planning, implementation, and evaluation of the grant. SAMHSA
should expand training and technical assistance to drug
treatment court grant recipients to ensure evidence-based
practices are fully implemented.
Medication-Assisted Treatment for Prescription Drug and
Opioid Addiction.--The Committee includes $84,000,000 for
Medication Assisted Treatment. SAMHSA is directed to include as
an allowable use Medication Assisted Treatment and other
clinically appropriate services to achieve and maintain
abstinence from all opioids and heroin. SAMHSA is directed to
give preference in grant awards to treatment regimens that are
less susceptible to diversion for illicit purposes. These
grants should target States with the highest age adjusted rates
of admissions, including those that have demonstrated a
dramatic age adjusted increase in admissions for the treatment
of opioid use disorders. The Committee continues to direct CSAT
to ensure that these grants include as an allowable use the
support of medication assisted treatment and other clinically
appropriate services to achieve and maintain abstinence from
all opioids and heroin and prioritize treatment regimens that
are less susceptible to diversion for illicit purposes.
Minority Fellowship Program.--The Committee provides
$5,039,000, a $500,000 increase above fiscal year 2018, and
continues to include $1,000,000 for funding to grantees to
develop and implement fellowships in psychology, addiction
psychiatry, and addiction medicine with specific focus in
addressing the needs of individuals with substance use
disorders.
Neonatal Abstinence Syndrome [NAS].--The Committee is
pleased to see SAMHSA publish guidance for healthcare
professionals for a clinical guide for national standard of
evaluation, care, and treatment of women with opioid use
disorders and infants with NAS. The Committee supports the
continued efforts of expanded implementation of Screening,
Brief Intervention, and Referral to Treatment [SBIRT], and its
possible impact on reducing the costs of NAS.
Opioid Abuse in Rural Communities.--The Committee is aware
that response to the opioid abuse crisis poses unique
challenges for rural America. The Committee encourages SAMHSA
to support initiatives to advance opioid abuse objectives in
rural areas, specifically focusing on addressing the needs of
individuals with substance use disorders in rural and
medically-underserved areas, and programs that stress a
comprehensive community-based approach involving academic
institutions, health care providers, and local criminal justice
systems.
Opioid Grants.--The Committee recognizes the work moving
forward under the SOR program and the State Targeted Response
to the Opioid Abuse Crisis grant program. The Committee directs
SAMHSA to ensure these resources are aligned with the State
plan developed by each State's alcohol and drug agency as
defined by the agency that manages the SAPT Block Grant. This
will ensure continuity of funding and coordination of efforts
within each State system.
Pregnant and Postpartum Women [PPW].--The Committee
commends SAMHSA for funding three grants in fiscal year 2017
under the new PPW pilot program authorized under the
Comprehensive Addiction and Recovery Act [CARA], which is
designed to help State alcohol and drug agencies address
treatment gaps for pregnant and postpartum women with substance
use disorders, including opioid use disorders. The Committee
looks forward to SAMHSA's expansion of the pilot program in
fiscal year 2018, and encourages the agency to prioritize
States that support best-practice collaborative models for the
treatment and support of pregnant women with opioid use
disorders.
Screening, Brief Intervention, Referral, and Treatment.--
The Committee recognizes that SBIRT is still not widely adopted
and has not yet permeated broader healthcare or social service
networks, particularly in underserved communities most affected
by the opioid epidemic. The Committee encourages SAMHSA to use
funds for the adoption of SBIRT protocols in primary care and
other appropriate settings that serve youth 12 to 21 years of
age as well as on the adoption of system-level approaches to
facilitate the uptake of SBIRT into routine health care visits
for adults.
State Opioid Response Grants.--The Committee provides
$1,500,000,000 for grants to States to address the opioid
crisis. Bill language continues to provide $50,000,000 for
grants to Indian Tribes or Tribal organizations and a 15
percent set-aside for States with the highest age-adjusted
mortality rate related to opioid overdose deaths. The Committee
urges the Assistant Secretary to ensure the formula avoids a
significant cliff between States with similar mortality rates.
Activities funded with this grant may include bonafide
treatment, prevention, and recovery support services. States
receiving these grants should ensure that comprehensive,
effective, universal prevention strategies, to stop the misuse
of opioids before it starts, are a priority for these funds.
SAMHSA is directed to work with States to include recovery
support services that may include career counseling or job
placement to help individuals in recovery from a substance use
disorder transition from treatment to the workforce. The
Committee directs the agency to ensure funds reach local
communities and counties to address the opioid crisis in areas
of unmet need. SAMHSA is also directed to provide State
agencies with technical assistance concerning how to enhance
outreach and direct support to rural and underserved
communities and providers in addressing this crisis. SAMHSA
shall submit to the Committees on Appropriations of the House
of Representatives and the Senate a work plan of the proposed
allocation of funds not later than 15 days prior to publishing
the funding opportunity announcment. In addition, not later
than 1 year after the date of enactment of this Act, SAMHSA
shall submit a report to the Committees on Appropriations of
the House of Representatives and the Senate that includes a
description of the activities for which each State has received
funding and the ultimate recipients of the funds provided to
States. In addition, SAMHSA shall submit an evaluation of the
program not later than 2 years after the date of enactment of
this Act. SAMHSA is directed to make the report and evaluation
publicly available on SAMHSA's website.
Systems of Care Models in Opioid Response.--Evidence
suggests that regional efforts to coordinate opioid abuse
treatment across entities and locations can produce effective
results. Successful examples include the development of ``no
wrong door'' treatment models, mechanisms to scale-up training
and numbers of peer coaches, and the use of mobile app
technology to enhance access to services, successful treatment
outcomes, and long-term relapse prevention. SAMHSA should
encourage State and local grantees to prioritize the
implementation of coordinated continuum of care approaches.

Substance Abuse Prevention and Treatment Block Grant

The Committee recommends $1,858,079,000 for the Substance
Abuse Prevention and Treatment Block Grant [SABG]. The
recommendation includes $79,200,000 in transfers available
under section 241 of the PHS Act. The Committee recognizes the
importance of the block grant given its flexibility to allow
States to direct resources based on their own unique needs.
This funding stream is also critical in assisting States to
address all substance use disorders, including but not limited
to those related to alcohol, cocaine and methamphetamine. The
Committee also recognizes the importance of the block grant's
20 percent primary prevention set-aside, which represents close
to 70 percent of prevention dollars managed by State alcohol
and drug agencies. The block grant provides funds to States to
support alcohol and drug abuse prevention, treatment, and
rehabilitation services. Funds are allocated to States
according to a formula.

SUBSTANCE ABUSE PREVENTION

Appropriations, 2018.................................... $248,219,000
Budget estimate, 2019................................... 220,885,000
Committee recommendation................................ 200,219,000

The Committee recommends $200,219,000 for the Center for
Substance Abuse Prevention [CSAP], the sole Federal
organization with responsibility for improving accessibility
and quality of substance abuse prevention services.
The Committee directs that all of the money appropriated
explicitly for Substance Abuse Prevention purposes both in
CSAP's PRNS lines as well as the funding from the 20 percent
prevention set-aside in the SABG be used only for bona fide
substance abuse prevention activities and not for any other
purpose to ensure the work in school-based settings is as
robust as possible.

Programs of Regional and National Significance

The Committee provides $200,219,000 for PRNS within CSAP.
Through these programs, CSAP supports: development of new
practice knowledge on substance abuse prevention;
identification of proven effective models; dissemination of
science-based intervention information; State and community
capacity building for implementation of proven, effective
substance abuse prevention programs; and programs addressing
new needs in the prevention system.
Within the total provided for PRNS, the Committee
recommendation includes funding for the following activities:

SCIENCE AND SERVICE:
Center for the Application of 7,493 7,493
Prevention Technologies........
Science and Service Program 4,072 4,072
Coordination...................
Minority Fellowship Program..... 71 71
------------------------------------------------------------------------

Best Practices for Opioid Abuse Prevention.--The Committee
encourages SAMHSA to develop and educate States and communities
on best practices for addressing the opioid abuse crisis as it
relates to opioid prescribing, pain management, screening, and
linkage to care. SAMHSA is further encouraged to develop
training materials for health care providers and trainees in
opioid use and other addictive disorders.
Centers for the Application of Prevention Technology
[CAPTs].--The Committee is aware that SAMHSA has changed the
structure of the CAPTs to mirror that of the Addiction
Technology Transfer Centers. In addition, SAMHSA has moved the
management of the CAPTs outside of CSAP, a change that was not
reflected in the fiscal year 2019 budget justification. The
Committee directs SAMHSA to submit a report on this program,
including the rationale behind the structural and
organizational changes, by September 30, 2019.
First Responder Training.--The Committee notes that
overdose reversal is a lifesaving strategy that reduces the
harm of overdoses but does not prevent the initiation of drug
use. For this reason the Committee has transferred $48,000,000
of overdose reversal funding out of the PRNS account in the
Center of Substance Abuse Prevention into the PRNS account of
the Center for Substance Abuse Treatment. The Committee
believes the funding should be in CSAT to best ensure that,
after an overdose is reversed through the use of naloxone,
these individuals are given access to a recovery coaching and
referral to treatment.
Strategic Prevention Framework-Partnerships for Success
Program.--This program supports States in addressing underage
drinking among youth and young adults and allows States to
prioritize State-identified top data-driven substance abuse
target areas. Given that substance use disorders typically
begin in adolescence and that preventing or delaying the age of
first use is cost-effective, the Committee provides last year's
funding level for this program. Of the provided amount,
$109,484,000 shall support comprehensive, multi-sector
substance use prevention strategies to stop or delay the age of
initiation of the State's top three substance use issues for 12
to 18 year old youth, as determined by State epidemiological
data, and shall not be used for any programs or services to
address substance use after it has already occurred.

HEALTH SURVEILLANCE AND PROGRAM SUPPORT

Appropriations, 2018.................................... $160,258,000
Budget estimate, 2019................................... 147,348,000
Committee recommendation................................ 160,258,000

The Committee recommends $160,258,000 for Health
Surveillance and Program Support activities. The recommendation
includes $31,428,000 in transfers available under section 241
of the PHS Act.
This activity supports Federal staff and the administrative
functions of the agency. It also provides funding to SAMHSA's
surveillance and data collection activities, including national
surveys such as the National Survey on Drug Use and Health.
Within the total provided for Health Surveillance and
Program Support, the Committee recommendation includes funding
for the following activities:

The Committee does not include bill language requested by
the administration to provide additional transfer authority to
the Director beyond that which is already provided to the
Secretary.
Technical Assistance.--The Committee notes that SAMHSA is
changing how it provides technical assistance and training to
grantees, moving from a contractor-driven model to one that
utilizes local expertise. The Committee directs the Assistant
Secretary to provide a report to the Committee that explains
the proposed changes to the provision of technical assistance,
training, and evaluation; the evidence relied on to support
these changes, including whether sufficient State capacity
exists to implement these changes; the input sought or received
from stakeholders, including State and local governments, as
well as the process by which that input was received and
considered by the agency; an analysis of the funding saved from
this proposal and the agency's planned use of these savings;
and the agency's plan to evaluate the effectiveness of these
changes.

Agency for Healthcare Research and Quality

Appropriations, 2018.................................... $334,000,000
Budget estimate, 2019...................................................
Committee recommendation................................ 334,000,000

The Committee provides $334,000,000 for the Agency for
Healthcare Research and Quality [AHRQ], which is combined with
the $99,821,000 in mandatory funding from the Patient-Centered
Outcomes Research Trust Fund. AHRQ was established to enhance
the quality, appropriateness, and effectiveness of health
services, as well as access to such services. AHRQ conducts,
supports, and disseminates scientific and policy-relevant
research on topics such as promoting high-quality care,
eliminating healthcare disparities, using information
technology, and evaluating the effectiveness of clinical
services.
The Committee does not support the administration's
proposal to consolidate AHRQ into the NIH and instead continues
to fund the agency as an independent operating division within
the Department.

HEALTH COSTS, QUALITY, AND OUTCOMES

The Committee provides $192,709,000 for research on health
costs, quality, and outcomes [HCQO]. The HCQO research activity
is focused upon improving clinical practice, improving the
healthcare system's capacity to deliver quality care, and
tracking progress toward health goals through monitoring and
evaluation.
Within the total provided for HCQO, the Committee
recommendation includes funding for the following activities:

Antibiotic Resistance.-- The Committee notes that while
AHRQ has been the leader in developing the tools and resources
to help providers improve their antibiotic stewardship
programs, the agency has not updated several publications
related to the use of procalcitonin [PCT] tests in sepsis and
antibiotic treatment programs in more than 5 years. The
Committee encourages AHRQ to collaborate with NIH, HRSA, BARDA,
CDC, FDA and other relevant agencies to review and update their
publications with the latest FDA approved uses for PCT tests in
antibiotic stewardship. The Committee requests an update on
these activities in the fiscal year 2020 CJ.
Centers of Diagnostic Excellence.--The Committee is
concerned about the lack of dedicated funding for research into
improving how medical conditions are diagnosed, considering the
size and impacts of patient harms resulting from diagnostic
safety and quality challenges. The Committee encourages AHRQ to
dedicate resources to support the creation of Centers of
Diagnostic Excellence that will create core diagnostic research
hubs for diagnostic safety and quality research; utilize
strategic partnerships that capitalize on the capabilities of
both academic research institutions and non-academic
healthcare, science, and technology stakeholders; and
incentivize high-impact research on novel solutions to improve
diagnosis.
Diabetes.--The Committee is concerned about the significant
costs associated with providing care for individuals that
suffer from diabetes, including those from medically
underserved low health literacy populations. The Committee
encourages AHRQ consider a pilot or demonstration program to
support safety net clinics in increasing health literacy and
preventing diabetes with the goal of reducing long-term costs.
Health IT Safety.--The Committee recommendation includes
$16,500,000 for AHRQ's work on safe health IT practices
specifically related to the design, implementation, usability,
and safe use of health IT systems. The Committee believes this
investment will generate new evidence regarding safe health IT
practices that will ultimately be used by ONC, FDA, CMS, and
others to inform policy interventions.
Healthcare Delivery Systems.--Within the Patient Safety
portfolio, the Committee includes $10,000,000 for Healthcare
Delivery Systems grants, or ``patient safety learning labs.''
The purpose of these grants is to test new ways of addressing
entrenched patient safety issues by using a systems engineering
approach.
Malnutrition.--The Committee greatly appreciates AHRQ's
work to better understand malnutrition in U.S. hospitals. The
Committee particularly notes AHRQ's initiative to support
studies, the ``Characteristics of Hospital Stays Involving
Malnutrition, 2013'' and follow-up ``All-Cause Readmissions
Following Hospital Stays for Patients With Malnutrition, 2013''
that illustrated the consequences of malnutrition in hospital
patients. The Committee urges AHRQ to convene a technical
expert panel to assess the evidence for a malnutrition-related
readmissions quality measure for the prevention of malnutrition
in hospitals.
Nursing.--The Committee notes that AHRQ-led research often
highlights the unique contribution of nurses, including
advanced practice and doctorally-prepared nurses. The Committee
urges AHRQ to continue supporting health services research that
takes into consideration the contributions of all providers,
including nurses.
Palliative Care.--The Committee encourages AHRQ to consult
with appropriate professional societies, hospice and palliative
care stakeholders, and relevant patient advocate organizations
to develop and disseminate information to patients, families,
and health professionals about palliative care as an essential
part of the continuum of quality care for patients with serious
or life-threatening illness. Such materials and resources
should include specific information regarding the demonstrated
benefits of patient access to palliative care and the
interdisciplinary services provided to patients by
professionals trained in hospice and palliative care. The
Secretary is encouraged to include such information and
materials on websites of relevant Federal agencies and
departments, including the Centers for Medicare & Medicaid
Services and the Administration for Community Living.
Research Training and Career Development.--The Committee
notes the important role that AHRQ plays in supporting research
training and career development activities, such as ``K''
Awards and Mentored Clinical-Scientist Development Awards.
Considering the current challenges facing physician-scientists
and the young-investigator pipeline, AHRQ is encouraged to
continue to prioritize these activities.

MEDICAL EXPENDITURES PANEL SURVEYS

The Committee provides $69,991,000 for Medical Expenditure
Panel Surveys [MEPS], which collect detailed information
annually from households, healthcare providers, and employers
regarding how Americans use and pay for healthcare. The data
from MEPS are used to develop estimates of healthcare
utilization, expenditures, sources of payment, and the degree
of health insurance coverage of the U.S. population.

PROGRAM SUPPORT

The Committee recommends $71,300,000 for program support.
This activity funds the overall management of AHRQ, including
salaries, benefits, and overhead costs such as rent.

Centers for Medicare and Medicaid Services

GRANTS TO STATES FOR MEDICAID

Appropriations, 2018

$284,798,384,000

Budget estimate, 2019

276,236,212,000
Committee recommendation
276,236,212,000

The Committee recommends $276,236,212,000 in mandatory
funding for Grants to States for Medicaid.
The fiscal year 2019 recommendation excludes
$134,847,759,000 in fiscal year 2018 advance appropriations for
fiscal year 2019. As requested by the administration,
$137,931,797,000 is provided for the first quarter of fiscal
year 2020.
The Medicaid program provides medical care for eligible
low-income individuals and families. It is administered by each
of the 50 States, the District of Columbia, and the U.S.
territories. Federal funds for medical assistance are made
available to the States according to a formula that determines
the appropriate Federal matching rate for State program costs.
This matching rate is based on the State's average per capita
income relative to the national average and cannot be less than
50 percent.

PAYMENTS TO HEALTHCARE TRUST FUNDS

Appropriations, 2018

$323,497,300,000

Budget estimate, 2019

378,343,800,000
Committee recommendation
378,343,800,000

The Committee recommends $378,343,800,000 in mandatory
funding for payments to healthcare trust funds.
This entitlement account includes the general fund subsidy
to the Federal Supplementary Medical Insurance Trust Fund for
Medicare Part B benefits and for Medicare Part D drug benefits
and administration, plus other reimbursements to the Federal
Hospital Insurance Trust Fund for Part A benefits and related
administrative costs that have not been financed by payroll
taxes or premium contributions.
The Committee provides $284,288,300,000 for the Federal
payment to the Supplementary Medical Insurance Trust Fund. This
payment provides matching funds for premiums paid by Medicare
Part B enrollees.
The Committee further provides $92,070,000,000 for the
general fund share of benefits paid under Public Law 108-173,
the Medicare Prescription Drug, Improvement and Modernization
Act of 2003. As in previous years, the Committee includes bill
language requested by the administration providing indefinite
authority for paying the general revenue portion of the Part B
premium match and provides resources for the Part D drug
benefit program in the event that the annual appropriation is
insufficient.
The Committee recommendation also includes $642,000,000 to
be transferred to the Supplementary Insurance Trust Fund as the
general fund share of Part D administrative expenses. The
Committee recommendation includes $315,000,000 in
reimbursements to the Health Care Fraud and Abuse Control
[HCFAC] fund, which reflects the portion of the HCFAC spending
to be reimbursed by the General Fund.

PROGRAM MANAGEMENT

Appropriations, 2018.................................... $3,669,744,000
Budget estimate, 2019................................... 3,543,879,000
Committee recommendation................................ 3,669,744,000

The Committee recommends $3,669,744,000 for CMS program
management, which includes funding for research, program
operations, survey and certification programs, and Federal
administration.
Research, Demonstrations and Evaluations.--The Committee
recommends $20,054,000 for research, demonstrations, and
evaluation activities.
Program Operations
The Committee recommends $2,519,823,000 for the Program
Operations account, which covers a broad range of activities
including claims processing and program safeguard activities
performed by Medicare contractors. These contractors also
provide information, guidance, and technical support to both
providers and beneficiaries.
ACA Notifications.--The Committee continues bill language
requiring the administration to provide detailed enrollment
figures to the Committees on Appropriations of the House of
Representatives and the Senate not less than two full business
days before any public release of the information.
Access to Mental Health Care.--The Committee strongly urges
CMS to pursue initiatives that expand access to quality care
and increase parity for mental health services.
Alzheimer's and Dementia Comprehensive Care and Caregiver
Support Models.--Given the current and looming health and
economic challenges posed by Alzheimer's to the Medicare
beneficiary population and to the Medicare program, the
Committee encourages CMS to evaluate existing and potential
multi-payer models like the Programs for All-inclusive Care for
the Elderly that incorporate a comprehensive continuum of care
for persons with Alzheimer's.
CT Colonography.--Due to the proven life and cost-savings
of preventative screening for colorectal cancer, the Committee
encourages CMS to consider covering CT Colonography as a
Medicare-covered colorectal cancer screening test under section
1861(pp)(1) of the Social Security Act.
Detecting Cognitive Impairment.--The Committee is concerned
that the lack of uniform, easy-to-use and modern cognitive
impairment detection tools is impeding the ability of providers
to detect potential cognitive impairment of Medicare
beneficiaries. The Committee encourages CMS to collaborate with
NIA, AHRQ, and other relevant stakeholders to assess the
current methods for detecting cognitive impairment to develop
recommendations for health professionals and continue to
monitor advancements in screening for cognitive impairment.
Direct and Indirect Remuneration Fees.--The Committee is
concerned about the dramatic increase of pharmacy direct and
indirect remuneration [DIR] fees in Medicare Part D, especially
the impact of ``pharmacy DIR fees'' on Medicare Part D
beneficiaries who incur high drug costs. The Committee is aware
that CMS has put forth a Request for Information included in
the 2019 proposed Part D rule about this issue and others and
encourages the agency to finalize their proposal without delay.
The Committee looks forward to the report requested in fiscal
year 2018 on how to best address this issue, including
consideration of options to require that all DIR fees be
accounted for a point of sale; as part of negotiated price; and
that any incentive fees be paid separately.
Drug Vial Size.--Within 30 days of enactment of this act,
CMS shall enter into an agreement with the Health and Medicine
Division of the National Academies of Sciences, Engineering,
and Medicine [the Academies] to conduct a study on the Federal
healthcare costs, safety, and quality concerns associated with
discarded drugs that results from weight-based dosing of
medicines contained in singledose vials as stated in Senate
report 114-274. The Committee recommendation includes
$1,200,000 of the resources provided in Program Operations for
this activity and CMS is directed to provide an update to the
Committee's on Appropriations 15 days after the enactment of
this act and every 90 days thereafter until the report is
completed. CMS and the Academies are encouraged to consult with
FDA.
Graduate Medical Residencies.--As of October 2013, CMS
determined that hospitals with approved residency programs
cannot claim the time that FTE residents train at CAHs for
indirect or direct GME purposes under Medicare. As a result of
this determination, some hospitals have struggled to sustain
efforts to train and retain physicians in rural communities
with medical workforce shortages. The Committee encourages CMS
to reexamine this determination and consider revisions that
better support hospitals' efforts to train more resident
physicians in rural settings like CAHs.
Health Insurance Exchange Transparency.--The Committee
continues bill language that requires CMS to provide cost
information for the following categories: Federal Payroll and
Other Administrative Costs; Exchange related Information
Technology [IT]; Non-IT Program Costs, including Health Plan
Benefit and Rate Review, Exchange Oversight, Payment and
Financial Management, Eligibility and Enrollment; Consumer
Information and Outreach, including the Call Center, Navigator
Grants and Consumer Education and Outreach; Exchange Quality
Review; Small Business Health Options Program and Employer
Activities; and Other Exchange Activities. Cost Information
should be provided for each fiscal year since the enactment of
the Patient Protection and Affordable Care Act (Public Law 111-
148). CMS is also required to include the estimated costs for
fiscal year 2020.
Home Health Services.--The Committee is supportive of
efforts to increase primary care access for low-income Medicare
beneficiaries, in particular those living in publicly assisted
housing and who have chronic health conditions. In approving
future demonstration projects, CMS is encouraged to consider
medical practices that coordinate with nonprofit housing
providers. CMS is further encouraged to prioritize existing
models of support and services at home that can show a reduced
rate of growth in Medicare spending for at least the initial
500 participants as reviewed by a third party.
Hospital-Acquired Pressure Ulcers.-- The Committee is aware
of recent data from CMS identifying that pressure ulcer
discharges have significantly increased between the first
quarter of 2016 and the first quarter of 2017. The Committee
requests the Secretary and CMS Administrator provide an update
and timeline in the fiscal year 2020 CJ on steps HHS and CMS
are taking to reverse this trend.
Initial Preventive Physical Examination/Annual Wellness
Visit.--The Committee recognizes the importance of vaccines in
preventing diseases, particularly among the Medicare
population. The Initial Preventive Physical Examination [IPPE]
under Medicare and Annual Wellness Visits [AWV] provide an
important opportunity for improving immunization rates among
Medicare beneficiaries. The National Vaccine Advisory Committee
[NVAC] Standards for Adult Immunization Practice call on all
healthcare professionals who provide care to adults to take
steps to assess the immunization status of all patients in
every clinical encounter, share a strong recommendation for
vaccines that patients need, administer vaccines, or refer to a
provider who can immunize and document administered vaccines.
The goal of the standards is to reduce the number of missed
immunization opportunities by integrating these simple steps
into clinical care. In following with the recommendations of
NVAC, the Committee directs CMS to incorporate the Standards
for Adult Immunization Practice in provider outreach and
educational materials pertaining to the IPPE and AWV.
Lymphatic System Failure.--The Committee encourages the
Secretary to promulgate rules for covering prescribed
compression garments as acknowledged by CMS' 2001 decision
memorandum [CAG-00016N] in the treatment of lymphatic system
failure.
Medicare Inpatient Hospital Wage Index.--There have been
numerous studies, analyses, and reports on disparities in
Medicare's inpatient hospital wage index and ways to improve
the wage index. Because some time has passed since these
studies were conducted, the Committee recognizes that as part
of the fiscal year 2019 Medicare Hospital Inpatient Prospective
Payment System proposed rule [CMS-1694-P] the Secretary is
currently soliciting public comments to inform future CMS
regulatory action. As part of the administration's review of
public comments, the Committee encourages the Secretary to
consider the extent to which population density, median annual
household income, cost of living, and hospital closures may
play a role in exacerbating wage index disparities.
Medicare Payment for Non-Opioid Pain Management
Therapies.--The Committee is concerned that some non-opioid
alternatives may not be adequately reimbursed by the Medicare
program which may create barriers to the appropriate use of
these alternative therapies. The Committee encourages CMS to
explore whether Medicare reimbursement should be modified for
alternatives that can reduce dependence on opioid use.
Muscular Dystrophy.--The Committee is aware of the addition
of the new ICD-10 code for Duchenne/Becker to the fiscal year
2019 CMS Addenda. The Committee requests a report be submitted
to the Committees on Appropriations 180 days after enactment of
the Act on utilization for the newly established ICD-10 code,
as compared to the former broader ICD-10 code.
National Diabetes Prevention Program.--The agreement
continues to support CMS' expansion of the Medicare Diabetes
Prevention Program beginning in 2018 to improve health outcomes
and reduce diabetes-related healthcare costs. The Committee
encourages CMS to minimize the regulatory barriers impeding
potential or existing suppliers from delivering the Diabetes
Prevention Program [DPP] to Medicare beneficiaries. The
Committee also encourages CMS to allow the full range of CDC
recognized DPP providers including online, distance learning,
and combination programs to participate as Medicare Diabetes
Prevention Program suppliers.
Out of Network Emergency Care.--The Committee recognizes
the valuable role that emergency physicians play as the
nation's healthcare safety net. The Committee believes that
beneficiary protections are important to reduce the financial
exposure of patients who receive emergency care outside of
their insurance network. The Committee is concerned that the
Center for Consumer Information and Insurance Oversight [CCIIO]
has not provided sufficient clarity on how to determine the,
``Usual, Customary & Reasonable'' [UCR] amount in its Final
Rule for patient protections. Therefore, the Committee
encourages CCIIO to publish guidance clarifying what
constitutes the UCR amount using a transparent and fair
standard.
Patient Access to Medically Necessary Foods.--The Committee
notes the recent action taken by TRICARE to advance proper
coverage for medical foods and encourages CMS to work
proactively with the stakeholder community to identify and
address barriers to access.
Patient Matching.--The Committee encourages CMS, working
with ONC, to provide technical assistance to industry to
promote patient safety by accurately identifying patients to
their health information.
Peer Support Services.--The Committee encourages HHS to
work with States to identify opportunities to employ certified
peer support specialists in Medicaid to further address the
ongoing opioid epidemic.
Physician Fee Schedule.--The Committee is aware that CMS
has recently finalized its calendar year 2018 Ambulatory
Surgical Center [ASC] Payment System. Methodology utilized for
ASC payment system is based on payments for procedures
performed in a hospital office setting compared to the same
procedure in an ASC operating room. Therefore, the Committee
encourages CMS to submit a report to the Committee on the
difference in cost to Medicare patients receiving
Interventional Pain procedures in a hospital office setting
compared to the same procedure in a hospital operating room to
determine if further changes shall be made in the
classification system for covered outpatient procedures in
ASCs.
Program Integrity.--The Committee is supportive of the
ongoing work that CMS' Center for Program Integrity [CPI] is
undergoing to tackle unacceptable levels of waste, fraud and
abuse. CPI should continue to work with Oak Ridge National
Laboratory to leverage DOE's computational facilities to bring
state-of-the-art computational and data analytics capabilities
to address complex issues in CMS to reduce waste, fraud and
abuse. Within 90 days upon enactment, the Committee requests
CMS CPI brief the Committees on Appropriations on the House of
Representatives and the Senate with an update on its progress
and funding requirements needed to continually address this
problem.
Program of All-Inclusive Care for the Elderly.--The
Committee recognizes the value that the Program of All-
Inclusive Care for the Elderly [PACE] provides for 45,000
Medicare and Medicaid beneficiaries who would otherwise require
nursing home levels of care and are instead able to stay in
their communities. The Committee is aware that CMS has not yet
finalized their update to the regulations governing the PACE
Program and encourages CMS to expeditiously publish the final
rule for proposed changes for PACE [CMS-4168-P].
Relative Values Under the Medicare Physician Fee
Schedule.--The Committee encourages CMS to increase the
representation of primary care physicians who are board
certified and actively practicing in family medicine, general
internal medicine, general pediatrics, preventive medicine,
obstetrics and gynecology, or psychiatry on any advisory board
or work group that formulates recommendations regarding any
annual updates to the physician work relative values.
Risk Corridor Program.--The Committee continues bill
language to prevent the CMS Program Management appropriation
account from being used to support risk corridor payments. The
agreement directs CMS to provide a report starting with plan
year 2014 and continuing through the duration of the program to
the Committees on Appropriations of the House of
Representatives and the Senate detailing the receipts and
transfer of payments for the Risk Corridor Program.
Robotic Stereotactic Radiosurgery.--The Committee remains
concerned that inadequate payment for robotic stereotactic
radiosurgery threatens its viability in both the hospital and
freestanding center setting. The Committee encourages CMS and
contractors administering the physician fee schedule in
Medicare Part B not to make further changes to these services
in the freestanding center as CMS complies with the Patient
Access and Medicare Protection Act, Public Law 114-115.
Rural Health Care Facilities.--The Committee encourages CMS
to work with States and associations of rural hospitals to
allow program flexibility to demonstrate sustainable service
delivery model options for rural communities, focused on
preserving access to emergency care services and supporting
future financial viability of rural facilities.
Sepsis.--The Committee is concerned that the current SEP-1
guidelines for treating septic patients do not take into
account evolving practices. The Committee encourages CMS to ask
the SEP-1 measure stewards to reevaluate their SEP-1 quality
measure taking into account expanded FDA approvals for
biomarker tests like procalcitonin in conjunction with its
impact on antibiotic stewardship. CMS is also encouraged to
identify the Medicare and Medicaid expenditures for individuals
with sepsis. The Committee requests an update on these
activities in the fiscal year 2020 CJ.
Sexually Transmitted Diseases [STDs].--The Committee
continues to be concerned about the high rate of STDs,
especially in pregnant women and young adults. To help curb the
spread of these diseases and address this public health problem
at every opportunity, and to reach at-risk and vulnerable
populations at every opportunity, the Committee encourages CMS
to collaborate with CDC's Division of STD Prevention to develop
a screening and treatment initiative under its Medicaid
program.
Survey of Surgical Procedures Involving Certified Surgical
Assistants.-- The Committee is aware of data showing that
surgical operations which utilize Certified Surgical Assistants
[CSAs] are significantly shorter in duration than the time
benchmarks CMS uses to set reimbursement for these procedures.
Peer-reviewed studies show that shorter operations result in
fewer complications, earlier post-surgery discharge and fewer
post-surgery readmissions. In order to test the beneficial
implications of this data, the Committee encourages CMS to
record, for later analysis, how CSA participation in all
Medicare-funded surgical operations may impact surgery time.
Telehealth.--The Committee looks forward to the report
requested in Senate Report 115-150 directing the Administrator,
in consultation with the relevant agencies and stakeholders, to
submit a report to the Committees of Appropriations of the
House of Representatives and the Senate evaluating the use of
telehealth and remote patient monitoring under all programs and
pilots under the Medicare and Medicaid programs.
Telehealth and the Pediatric Population.--The Committee
recognizes the potential for telehealth to help meet the needs
of patients and families across the country, including in both
rural and urban areas. The Committee encourages CMS to identify
and share with States best practices regarding ways in which
telehealth and remote patient monitoring can be leveraged
through the Medicaid and CHIP programs, particularly for the
pediatric population.
Therapeutic Foster Care.--The Committee remains concerned
about the lack of a uniform definition within the Medicaid
program for therapeutic foster care services. A uniform
definition would improve the ability for more consistent care
and treatment. The Committee requests an update in the fiscal
year 2020 CJ on the study requested in fiscal year House Report
114-699.
Workforce Capacity for Infectious Diseases and the Opioid
Epidemic.--The Committee encourages CMS to collaborate with
SAMHSA, CDC, and HRSA to support education and training for
medical providers on the frontlines of the opioid epidemic to
help expand access to comprehensive, coordinated care for
opioid addiction and related infections diseases.
Use of Social Security Numbers on Medicare Beneficiaries'
Cards.--The Committee is pleased with CMS efforts to replace
Social Security Numbers on Medicare Beneficiary's cards and
directs CMS to provide an update on the progress of this
initiative in their fiscal year 2020 CJ.
Vaccine Utilization.--The Committee is concerned about the
underutilization of vaccinations, particularly pneumococcal
vaccines and encourages CMS to support development and
implementation of electronic health records and other
technologies, such as reminder recall programs, to identify
Medicare beneficiaries who have not received the full course of
pneumococcal vaccinations and remind those beneficiaries and
their providers to adhere to the recommendations. The Committee
encourages CMS to work with National Vaccine Advisory Committee
to determine the vaccine adherence rate in the Medicaid and
CHIP populations compared to the national average pediatric
vaccine adherence rate. The Committee asks for this to be
included in the Department's CJ for fiscal year 2020.
State Survey and Certification
The Committee recommends $397,334,000 for State Survey and
Certification activities, which ensure that institutions and
agencies providing care to Medicare and Medicaid beneficiaries
meet Federal health, safety, and program standards. On-site
surveys are conducted by State survey agencies, with a pool of
Federal surveyors performing random monitoring surveys.
Certified Nurse Aids.--The Committee is aware of concerns
about the skilled nursing facility [SNF] and nursing facility
[NF] survey and certification process, particularly the
statutory mandatory loss for 2 years of the ability of SNFs and
NFs to train Certified Nurse Aids under certain circumstances.
The Committee encourages CMS and States to work with SNFs and
NFs to improve the quality of care provided to their residents
and to educate SNFs and NFs about the waivers authorized under
statute and appeal rights of disapprovals of these nurse aide
training programs.

Federal Administration

The Committee recommends $732,533,000 for Federal
Administration, which funds the majority of CMS' staff and
operating expenses for routine activities such as planning,
implementing, evaluating, and ensuring accountability in the
programs administered by CMS.

HEALTHCARE FRAUD AND ABUSE CONTROL

Appropriations, 2018.................................... $745,000,000
Budget estimate, 2019................................... 770,000,000
Committee recommendation................................ 765,000,000

The Committee recommends $765,000,000, to be transferred
from the Medicare trust funds, for Health Care Fraud and Abuse
Control [HCFAC] activities. The latest data demonstrate for
every $1.00 spent on fraud and abuse, $2.00 is recovered by the
Treasury.
The Committee recommendation includes a base amount of
$311,000,000 and an additional $454,000,000 through a budget
cap adjustment authorized by section 251(b) of the Balanced
Budget and Emergency Deficit Control Act of 1985.
Health Care Fraud.--The Committee remains concerned by the
upward growth and sophistication of healthcare fraud across the
country. The Committee's recommended funding level demonstrates
Congress' continued support for the HHS-DOJ's joint efforts to
identify healthcare fraud against the Federal government. Since
2007, the Medicare Fraud Strike Force alone has charged over
3,500 individuals involved in falsely billing Medicare for over
$12,500,000,000, including the largest healthcare fraud
takedown involving over 400 individuals who allegedly falsely
billed Federal healthcare programs $1,300,000,000. The
Committee strongly supported the Department's efforts to
curtail healthcare fraud to protect Federal healthcare programs
and their beneficiaries.

Administration for Children and Families

PAYMENTS TO STATES FOR CHILD SUPPORT ENFORCEMENT AND FAMILY SUPPORT
PROGRAMS

Appropriations, 2018.................................... $2,995,400,000
Budget estimate, 2019................................... 2,922,247,000
Committee recommendation................................ 2,922,247,000

The Committee recommendation includes $2,922,247,000 in
fiscal year 2019 mandatory funds for Child Support Enforcement
and Family Support programs. In addition, the Committee
recommends $1,400,000,000 in advance funding for the first
quarter of fiscal year 2020.
These funds support States' efforts to promote the self-
sufficiency and economic security of low-income families,
including administrative expenses matching funds and incentive
payments to States for child support enforcement; grants to
States to help establish and administer access and visitation
programs between noncustodial parents and their children;
payments to territories for benefits to certain aged, blind, or
disabled individuals; and temporary benefits for certain
repatriated citizens.

LOW INCOME HOME ENERGY ASSISTANCE PROGRAM

Appropriations, 2018.................................... $3,640,304,000
Budget estimate, 2019...................................................
Committee recommendation................................ 3,690,304,000

The Committee recommendation includes $3,690,304,000, an
increase of $50,000,000 above fiscal year 2018, for LIHEAP,
which provides home heating and cooling assistance to low-
income households, generally in the form of payments to energy
vendors on behalf of the recipient. Within the total, the
Committee recommendation includes up to $2,988,000 for program
integrity and oversight efforts, the same as the fiscal year
2018 level.

REFUGEE AND ENTRANT ASSISTANCE

Appropriations, 2018.................................... $1,864,936,000
Budget estimate, 2019................................... 1,792,311,000
Committee recommendation................................ 1,905,201,000

The Committee recommends $1,905,201,000 for Refugee and
Entrant Assistance [REA] programs. These programs provide a
variety of benefits and services to refugees, asylees, Cuban
and Haitian entrants, immigrants arriving on Special Immigrant
Visas [SIV], trafficking victims, and torture victims
(collectively referred to below as ``refugees''). These
programs also provide temporary care and services for
unaccompanied children apprehended by the Department of
Homeland Security or other law enforcement agencies, who have
no lawful immigration status in the United States until they
can be placed with a parent, guardian, or other sponsor while
awaiting adjudication of their immigration status.
The Committee reiterates the directive included in fiscal
year 2018 and directs the Department to provide monthly updates
to the Committees on Appropriations of the House of
Representatives and the Senate of arrivals each month by
category, including refugees, asylees, Cuban and Haitian
Entrants, SIVs, and unaccompanied alien children, to include
any updates in estimated funding needs as a result of changes
in trends in those categories.
The U.S. refugee admission programs reflect U.S.
humanitarian and strategic interests. The U.S. refugee
resettlement program provides for the safe resettlement of some
of the most vulnerable refugees and not only saves lives, but
also strengthens our national security by providing support and
shared responsibility for strategic allies and regions. The
Committee notes that appropriate consultation with Congress is
required by statute in advance of the President's determination
on the number of refugees to be admitted during the coming
fiscal year.
The Committee affirms the community consultation process
embedded in the U.S. refugee resettlement program, which is
grounded in its public-private partnerships and thrives on
cooperation among local, State, and Federal stakeholders. In
times of sudden reductions in refugee arrivals, the Committee
encourages HHS, to the extent practicable, to ensure that
resettlement agencies are able to maintain their infrastructure
and capacity at a level to continue to serve new refugees,
previously arrived refugees, and others who remain statutorily
eligible for integration services, and to ensure future
arrivals are adequately served.
Transitional and Medical Services
The Committee recommendation includes $354,000,000 for
Transitional and Medical Services. This program provides grants
to States and nonprofit organizations to provide up to 8 months
of cash and medical assistance to arriving refugees, as well as
foster care services to unaccompanied minors.
The recommendation is $34,000,000 more than the fiscal year
2018 level, consistent with current HHS estimates, which
indicate the funding level provided will allow HHS to at least
sustain the current level and scope of services provided to
eligible arrivals, including maintaining the number of months
refugees are eligible for benefits.
The Committee continues to support the matching grant
program and strongly encourages HHS to increase the percentage
of eligible arrivals served by the program. Further, the
Committee strongly encourages HHS to give matching grant
organizations flexibility in administering their programs,
including when justified, carrying over unexpended funding and
slots and providing exemptions to the 31 day enrollment period.
Refugee Support Services
The Committee recommendation includes $207,201,000 for
Refugee Support Services. This program provides a combination
of formula and competitive grants to States and nonprofit
organizations to help refugees become self-sufficient and
address barriers to employment.
In fiscal year 2018, the Committee accepted the
administration's proposal to consolidate funding from Social
Services, Targeted Assistance, and Preventive Health to
simplify administration of refugee services at the Federal,
State and local levels. The Committee continues to expect that
activities previously funded under these three lines will
continue at the same level as before the consolidation. Within
30 days of enactment, the Committee directs the Department to
provide a list of competitive grants and set asides within
Refugee Support Services and to include their corresponding
funding levels in fiscal years 2016 through 2019 (estimated).
Victims of Trafficking
The Committee recommendation includes $26,755,000 for
Victims of Trafficking programs. These programs support a
national network of organizations that provide a variety of
services--including case management, counseling, benefit
coordination, and housing assistance--for victims of commercial
sex and forced labor trafficking.
Within the total, the Committee recommendation includes
$19,000,000 for services for foreign national victims, and
$7,755,000 to improve services available for U.S. citizens and
legal permanent residents. The Committee directs HHS to use the
increase in funding to help address unmet needs in both
programs. The Committee recommendation also includes no less
than the fiscal year 2018 level for the national human
trafficking resource center.
Unaccompanied Alien Children
The Committee recommendation includes $1,303,245,000 for
the Unaccompanied Alien Children [UAC] program. The UAC program
provides temporary shelter and basic services to children who
have no lawful immigration status in the United States and who
have been apprehended by the Department of Homeland Security
[DHS] or other law enforcement agencies without a parent or a
guardian. HHS takes custody of the children until they can be
placed with a parent or a guardian living in the United States
pending resolution of their immigration status, or until their
immigration status otherwise changes.
The Department of HHS is responsible for the temporary care
of UACs specifically to ensure the welfare of such children,
many of whom have experienced significant trauma in their home
country and in travelling to the United States. Family unity is
a foundation of child welfare principles, and child welfare and
medical experts have expressed serious concern that separating
children from their parents can cause additional trauma that
can have lasting harmful effects.
The administration's policies related to directing that
criminal charges pursuant to 8 U.S.C. 1325 be brought against
adults apprehended at the border between ports of entry have
resulted in the separation of family units and significantly
increased the number of children referred to HHS custody. This
combined with other administrative changes and an increase in
the number of unaccompanied children crossing the border have
increased the number of children in HHS' care, putting a
significant strain on HHS resources. The Committee is concerned
about the lack of transparency and available information from
the administration regarding the effect of these and other
policy changes on the UAC program and estimated funding needs.
The Committee is also concerned about the lack of communication
regarding HHS' plan to address the unique challenges of caring
for separated children, who can be very young and require
reunification after a parent leaves the criminal justice
system. Accordingly, the Committee directs the Department to
provide, at a minimum, monthly briefings to the Committees on
Appropriations of the House of Representatives and the Senate
on the status of balances and current expenditure rates,
current trends in the UAC program, any planned or implemented
policy changes that impact the UAC program, and updated cost
estimates. Further the Department shall notify the Committees
on Appropriations of the House of Representatives and the
Senate prior to making any administrative changes to the UAC
program including, but not limited to, policies potentially
impacting the number of children referred to HHS; shelter
operations, including the placement of children with sponsors;
and any post-release services.
In addition, the Committee directs HHS to include in its
existing weekly updates additional information, including, for
both all UACs and the children who were apprehended as part of
a family unit, the number of children referred to HHS, the
number currently in their care, the age and gender distribution
of children, the average length of stay, the number of preteen
children in both shelter beds and ORR-run foster care programs,
the number of children released to sponsors, and the category
of sponsor. The weekly updates should also include historical
monthly totals for all information provided, updated as it
becomes available. The Committee directs HHS to make this
monthly information available publicly on its website, and to
provide weekly updates on its website of the number of children
who have been reunited with separated family members. The
Committee also expects that separated families will have the
opportunity to communicate regularly by telephone with one
another and directs HHS to provide any updates in the
mechanisms for facilitating contact between children and
verified family members with whom they arrived at the border,
and the number of children who have been reunited with those
family members. Finally, the Trafficking Victims Protection
Reauthorization Act of 2008 and the Flores agreement require
that all UACs should be transferred from DHS to HHS within 72
hours and promptly placed in the least restrictive setting that
is in the best interest of the child. The Committee directs HHS
to notify the Committee immediately should children remain in
DHS custody longer than 72 hours before being transferred to
HHS.
The Committee directs HHS to provide a report, within 30
days of enactment, on its process for monitoring contractors
and addressing allegations of abuse and neglect in UAC
shelters. The Committee expects all cost estimates provided by
the Department to include the resources needed to thoroughly
monitor treatment of children in ORR's care. The Committee also
expects ORR to provide sufficient oversight over any temporary
and influx care facilities and provide appropriate care for
each child in its custody. The Department should ensure that
its criteria for placing children in influx facilities, such as
the child being at least 13 years of age and having no known
behavioral or medical issues, are followed.
The Committee notes that services provided by qualified and
independent legal counsel to UACs can increase the efficiency
and effectiveness of immigration proceedings and significantly
reduce the failure-to-appear rate of children who are released
from HHS custody. The Committee recommendation directs ORR to
continue the scope and funding of these legal services at no
less than fiscal year 2017 levels.
Victims of Torture
The Committee recommendation includes $14,000,000 for the
Victims of Torture program, $3,265,000 more than the fiscal
year 2018 level, to provide increased support for non-profit
organizations providing direct services to torture survivors
and their families. This program provides treatment, social,
and legal services to victims of torture and training to
healthcare providers on treating the physical and psychological
effects of torture.

PAYMENTS TO STATES FOR THE CHILD CARE AND DEVELOPMENT BLOCK GRANT

Appropriations, 2018.................................... $5,226,000,000
Budget estimate, 2019................................... 3,006,000,000
Committee recommendation................................ 5,226,000,000

The Committee recommends $5,226,000,000 for the Child Care
and Development Block Grant [CCDBG], a formula grant to States
that provides financial assistance to families to help pay for
child care, and otherwise improve the quality of child care
programs.
The Consolidated Appropriations Act, 2018 included a
$2,370,000,000 increase in funding for CCDBG, the largest
increase in the history of the program. This additional funding
will help States meet the requirements and goals of the CCDBG
Act of 2014 to improve the safety and quality of child care
programs, including increasing provider reimbursement rates.
The Committee directs HHS to provide a report within 120 days
of enactment on how States are using or plan to use this
increased funding, and the status of States in meeting the
statutory requirements of the CCDBG Act. The funding will also
increase access to affordable high-quality child care to more
low-income working families.
The CCDBG Act of 2014 requires HHS to operate a National
Toll-Free Hotline to facilitate reports of violations of health
and safety requirements by an eligible child care provider,
including suspected child abuse or neglect, and provide
consumer education information to help parents access safe and
quality care. The Committee is concerned about the Department's
lack of information on its planned operations for this legally
mandated Hotline in fiscal year 2019. Within 30 days of
enactment, the Committee directs the Department to provide
their plan for the Hotline after September 30, 2018, to include
an assessment of the amount of time needed for a contract to be
renewed or re-competed.

SOCIAL SERVICES BLOCK GRANT

Appropriations, 2018.................................... $1,700,000,000
Budget estimate, 2019................................... 85,000,000
Committee recommendation................................ 1,700,000,000

The Committee recommends $1,700,000,000 in mandatory funds
for SSBG, a flexible source of funding that allows States to
provide a diverse array of services to low-income children and
families, the disabled, and the elderly. The budget request
does not include funding for SSBG but proposes $85,000,000 in
discretionary funding for the Health Professions Opportunity
Grants program under this heading, which under current law is
funded with mandatory funding. The Committee recommendation is
consistent with current law and does not propose to move
funding for the HPOG program from mandatory to discretionary.
The Committee strongly encourages ACF to provide guidance
to States regarding the availability of SSBG funding, and other
programs as appropriate, for job training and employment
services for non-custodial parents, including best practices
and evidence-based interventions aimed at helping get non-
custodial parents with child support enforcement involvement
into well-paying jobs.

CHILDREN AND FAMILIES SERVICES PROGRAMS

Appropriations, 2018.................................... $12,022,225,000
Budget estimate, 2019................................... 10,323,890,000
Committee recommendation................................ 12,287,225,000

The Committee recommends $12,287,225,000 for Children and
Families Services programs. These funds support a variety of
programs for children, youth, and families; Native Americans;
victims of child abuse, neglect, and domestic violence; and
other vulnerable populations.
Head Start
The Committee recommendation includes $10,113,095,000 for
Head Start. Head Start provides grants directly to local
organizations to provide comprehensive early childhood
education services to children and their families, from before
birth to age 5.
Within the total, the Committee recommendation includes a
$215,000,000 cost of living adjustment for all Head Start
grantees to help keep up with rising costs, recruit and retain
highly qualified staff, and continue to provide high-quality
services to children and families.
The Committee recommendation also includes an increase of
$35,000,000 for grantees to continue to expand the duration of
services provided to children and families. The Committee
continues to support efforts to expand the duration of Head
Start services. Research increasingly indicates that expanding
the duration of services, including lengthening the program day
and year, plays a part in achieving and sustaining the benefits
of early childhood programs. However, the Committee also
understands that expanding the duration of services may not, in
some communities, be the best way to meet the needs of the
families being served. The Committee, therefore, continues to
direct HHS to ensure that as part of the effort to expand the
duration of services, grantees continue to have flexibility to
meet the needs of their local communities, and to fund other
quality improvement activities that may be necessary to improve
the quality of their programs and meet program performance
standards.
Within the total, the Committee recommendation also
includes up to $25,000,000, the same as the comparable fiscal
year 2018 level, for transition-related costs associated with
the Head Start Designation Renewal System [DRS].
The Committee recommendation modifies existing bill
language to simplify the administration of Early Head Start
[EHS] Expansion and Child Care Partnerships program for
grantees, but does not otherwise change the statutory authority
regarding the use of such funds. Funding previously provided
for EHS Expansion and Child Care Partnerships will continue to
be used in the same amounts and for the same purposes and
activities as in prior years. Of the amount available for
obligation through March 31, 2020, for Head Start, $98,000,000
is to continue new awards under the EHS Expansion and Child
Care Partnerships program from fiscal year 2018 that will be
made by March 31, 2019. The Committee directs HHS, in future
budget justifications, to include actual and projected funding
levels for Early Head Start-Child Care Partnerships.
The Committee notes that HHS is in the process of reviewing
public comments on proposed changes to the DRS, which is a key
tool in ensuring strong standards. The Committee is also aware
of significant concerns about the use of the CLASS lowest 10
percent provision in appropriately identifying grantees subject
to re-competition. The Committee strongly encourages HHS to
complete this review as quickly as possible, and to maintain
high standards, strong accountability, and transparency to
grantees and the public while ensuring the integrity of program
evaluation measures. Finally, the Committee continues to
encourage HHS to continue to consider the unique challenges
faced by Head Start grantees in remote and frontier areas when
reviewing such grantees' compliance with health and dental
screening requirements as part of the DRS.
The Committee strongly encourages ACF to ensure that all
Head Start grantees are aware of any funding opportunities, or
funding otherwise available, for making capital improvements to
their facilities. Further, the Committee encourages ACF to
standardize this process so all grantees have equal opportunity
to apply and are aware of priorities and eligible uses of such
funds.
Individuals from low-income families are disproportionately
at risk for obesity and other hypokinetic diseases, and early
physical activity interventions can improve overall health,
cognitive ability and academic success. The Committee
encourages ACF to develop and implement strategies to improve
motor skills and physical activity levels in Head Start program
participants whenever possible.
Preschool Development Grants
The Committee recommendation includes $250,000,000 for
Preschool Development Grants. This program, as authorized in
the Every Student Succeeds Act, provides competitive grants to
States to improve the coordination, collaboration, and quality
of existing early childhood programs; improve the transition
from early childhood programs to kindergarten; implement
evidence-based practices; improve professional development for
early childhood providers; and generally improve educational
opportunities for children. All funding provided in fiscal year
2019 will support the second round of grants under the new
authorization of the program.
Consolidated Runaway and Homeless Youth Program
The Committee recommendation includes $110,280,000 for the
Consolidated Runaway and Homeless Youth program. This program
supports the Basic Centers program, which provides temporary
shelter, counseling, and after-care services to runaway and
homeless youth under age 18 and their families; the
Transitional Living Program, which provides longer-term shelter
and services for older youth; and a national toll-free runaway
and homeless youth crisis hotline.
Where allowable, the Committee supports the ability of
grantees to provide prevention services, such as counseling and
case management, regardless of enrollment in residential
services.
Education and Prevention Grants To Reduce Sexual Abuse of Runaway Youth
The Committee recommendation includes $17,141,000 for
Education and Prevention Grants to Reduce Sexual Abuse of
Runaway and Homeless Youth. This program provides competitive
grants for street-based outreach and education services for
runaway and homeless youth who are subjected to, or are at risk
of being subjected to, sexual abuse or exploitation.
Child Abuse Prevention and Treatment State Grants
The Committee recommendation includes $85,310,000 for the
Child Abuse Prevention and Treatment State Grant program. This
program provides formula grants to States to improve their
child protective service systems.
Infant Plans of Safe Care.--Within the total, the Committee
recommendation includes $60,000,000 to help States develop and
implement plans of safe care as required by section
106(b)(2)(B](iii) of CAPTA. The incidence of neonatal
abstinence syndrome has increased as the opioid crisis has
worsened, and this funding will help States improve their
response to infants affected by a substance use disorder and
their families. The Committee strongly encourages HHS to
encourage States to include in their plans specialized services
for parents whose children may be at risk of abuse or neglect
in order to the reduce the need for child welfare or foster
care system involvement. Finally, the Committee directs HHS to
provide technical assistance to States on best-practices and
evidence-based interventions in this area to help address the
health, safety, and substance use disorder treatment needs of
the child and family, and to evaluate State's activities on
plans of safe care.
Child Abuse Reporting Legal Liability.--The Committee
recognizes that trained professionals, including healthcare
providers, teachers, and law enforcement, are often asked or
required to participate in the identification, investigation,
and reporting of suspected child maltreatment. However,
individuals assisting in cases of suspected child maltreatment
have faced potential legal liability for their participation in
child maltreatment reporting. The Committee recognizes the
intent of the Child Abuse Prevention and Treatment Act to
provide legal immunity for persons acting in good faith,
including both those directly reporting and those assisting
with reports.
Child Abuse Discretionary Activities
The Committee recommendation includes $33,000,000 for Child
Abuse Discretionary Activities. This program supports
discretionary grants for research, demonstration, and technical
assistance to increase the knowledge base of evidence-based
practices and to disseminate information to State and local
child welfare programs.
Child Abuse Hotline.--Within the total, the Committee
includes $1,000,000, in annual funding, to continue support for
an innovation grant to develop text and online chat-based
intervention and education services through a national child
abuse hotline for child abuse victims and concerned adults.
Community-Based Child Abuse Prevention
The Committee recommendation includes $39,764,000 for the
Community-Based Child Abuse Prevention program. This program
provides formula grants to States that then disburse funds to
local, community-based organizations to improve local child
abuse prevention and treatment efforts, including providing
direct services and improving the coordination between State
and community-based organizations.
Child Welfare Services
The Committee recommendation includes $268,735,000 for
Child Welfare Services. This formula grant program helps State
and tribal public welfare agencies improve their child welfare
services with the goal of keeping families together. These
funds help States and tribes provide a continuum of services
that prevent child neglect, abuse or exploitation; allow
children to remain with their families, when appropriate;
promote the safety and permanence of children in foster care
and adoptive families; and provide training and professional
development to the child welfare workforce.
Child Welfare Research, Training, and Demonstration
The Committee recommendation includes $17,984,000 for child
welfare research, training, and demonstration projects. This
program provides grants to public and nonprofit organizations
for demonstration projects that encourage experimental and
promising types of child welfare services, as well as projects
that improve education and training programs for child welfare
service providers.
National Survey of Child and Adolescent Well-Being.--The
Committee recommendation includes funding for HHS to continue
the National Survey of Child and Adolescent Well-Being.
Adoption Opportunities
The Committee recommends $39,100,000 for the Adoption
Opportunities program. This program funds discretionary grants
to help facilitate the elimination of barriers to adoption and
provide technical assistance to help States increase the number
of children adopted, particularly children with special needs.
Adoption Incentives
The Committee recommends $75,000,000 for the Adoption
Incentives program. This program provides formula-based
incentive payments to States to encourage them to increase the
number of adoptions of children from the foster care system,
with an emphasis on children who are the hardest to place.
The Committee recommendation continues the significant
increase provided in fiscal year 2018 to make up a shortfall in
funding owed to States. This funding level will fully fund the
remaining amount owed to States for fiscal year 2018, and a
significant amount of the estimated amount owed to States for
fiscal year 2019, with the goal of becoming completely current
by fiscal year 2020. The Committee directs HHS to include in
future budget justifications an estimate of amounts earned by
States per year, and the total estimated amount owed to States
for the budget year, including any funding owed from prior
fiscal years.
Social Services and Income Maintenance Research
The Committee recommends $6,512,000 for Social Services and
Income Maintenance Research. These funds support research and
evaluation of cost-effective programs that increase the
stability and economic independence of families and contribute
to the healthy development of children and youth.
Native American Programs
The Committee recommends $54,050,000 for Native American
programs. These funds support a variety of programs to promote
self-sufficiency and cultural preservation activities among
Native American, Native Hawaiian, Alaska Native, and Pacific
Islander organizations and communities.
Native American Language Preservation.--Within the total,
the Committee recommendation includes $12,000,000 for Native
American language preservation activities, including no less
than $4,000,000 for Native American language nests and survival
schools, as authorized by sections 803C(b)(7)(A]-(B] of the
Native American Programs Act. The Committee directs HHS to give
priority to programs with rigorous immersion programs.
Community Services Block Grant
The Committee recommendation includes $725,000,000 for the
Community Services Block Grant [CSBG]. The CSBG is a formula
grant to States and Indian tribes to provide a wide range of
services to alleviate causes of poverty in communities and to
assist low-income individuals in becoming self-sufficient.
States are required to pass on at least 90 percent of these
funds to local community-based organizations, the vast majority
of which are community action agencies.
Supporting Community Action Agencies' Response to Opioid
Abuse and Misuse.--Individuals and families in poverty face
daunting challenges as they work toward substance use recovery
and addressing the opioid epidemic requires a multi-pronged,
community-based response. The Committee recognizes that
community action agencies are uniquely positioned to help fight
the opioid crisis and provide essential support and services
for individuals and families who experience poverty and that
these entities deliver a wide range of services to address
immediate needs while supporting long-term goals, which make
recovery sustainable. The Committee also recognizes that the
conditions of poverty compound the difficulties faced by those
struggling with substance use. The Committee recommendation
includes an increase of $10,000,000 for CSBG to help community
actions agencies continue to address these critical needs.
Community Economic Development
The Committee recommendation includes $19,883,000 for the
Community Economic Development program, which provides grants
to community development corporations to support employment and
business opportunities for low-income individuals. Community
development corporations leverage on average $10 in private
capital to every $1 in Federal funds, and the job creation
standards required by the Office of Community Services are
among the most stringent in the Federal system.
Rural Community Facilities
The Committee recommendation includes $8,000,000 for the
Rural Community Facilities program, which provides grants to
regional non-profit organizations to provide technical
assistance to small, low-income rural communities, that are not
served by other similar Federal programs, to help manage,
develop, and improve safe drinking and waste water facilities.
National Domestic Violence Hotline
The Committee recommendation includes $10,250,000 for the
National Domestic Violence Hotline. This national, toll-free
hotline provides critical emergency assistance and information
to victims of domestic violence 24 hours a day.
Family Violence Prevention and Services
The Committee recommendation includes $165,000,000 for
Family Violence Prevention and Services programs. These funds
support programs to prevent family violence and provide
immediate shelter and related assistance for victims of
domestic violence and their dependents.
Chafee Education and Training Vouchers
The Committee recommendation includes $43,257,000 for the
Chafee Education and Training Voucher program. This program
supports vouchers to foster care youth to help pay for expenses
related to postsecondary education and vocational training.
Disaster Human Services Case Management
The Committee recommends $1,864,000 for Disaster Human
Services Case Management. This program assists States in
establishing the capacity to provide case management services
in a timely manner in the event of a disaster. It ensures that
States are able to meet social service needs during disasters
by helping disaster victims prepare recovery plans, referring
them to service providers and FEMA contacts to identify needed
assistance, and providing ongoing support and monitoring
through the recovery process.
Program Administration
The Committee recommendation includes $205,000,000 for the
Federal costs of administering ACF programs.

PROMOTING SAFE AND STABLE FAMILIES

Appropriations, 2018.................................... $444,765,000
Budget estimate, 2019................................... 554,765,000
Committee recommendation................................ 444,765,000

The Committee recommends $444,765,000 for the Promoting
Safe and Stable Families program. The Committee recommendation
includes $345,000,000 in mandatory funds authorized by the
Social Security Act and $99,765,000 in discretionary
appropriations.
This program supports activities that can prevent the
emergence of family crises that might require the temporary or
permanent removal of a child from his or her home. Grants allow
States to operate coordinated programs of family preservation
services, time-limited family reunification services,
community-based family support services, and adoption promotion
and support services.
Regional Partnership Grants [RPGs] and Family-Focused
Residential Treatment Programs.--Within the total for
discretionary funding, the Committee recommendation includes
$20,000,000 for RPGs and family-focused residential treatment
programs. RPGs promote coordination and collaboration between
local child welfare and substance abuse treatment agencies, and
other related organizations, to improve services and outcomes
for children and families affected by substance use disorder,
particularly opioid use. Family-focused residential treatment
programs are trauma-informed residential programs primarily for
substance use disorder treatment for pregnant and postpartum
women and parents and guardians that allow children to reside
with their mothers, parents, or guardians during treatment to
the extent appropriate and applicable. Organizations applying
for this funding should be allowed to apply to operate one or
both programs. This funding will help build the evidence-base
of what works in anticipation of the availability of mandatory
funding for similar activities under the Family First
Prevention and Services Act.
Kinship Navigator Programs.--The Committee recommendation
includes $20,000,000, the same as the fiscal year 2018 funding
level, for Kinship Navigator Programs to improve services for
grandparents and other relatives taking primary responsibility
for children, particularly children and families affected by
opioid addiction and substance use disorder. The Committee
encourages HHS to encourage States to collaborate with agencies
with experience servicing kinship families both inside and
outside foster care and to demonstrate how they are preparing
their navigator programs to meet evidence-based kinship
navigator standards included in the Family First Prevention
Services Act. Similar to RPGs and family-focused residential
treatment programs, this funding helps build the evidence-base
in anticipation of mandatory funding being available for
similar activities under the Family First Prevention and
Services Act.

PAYMENTS FOR FOSTER CARE AND PERMANENCY

Appropriations, 2018.................................... $6,225,000,000
Budget estimate, 2019................................... 6,035,000,000
Committee recommendation................................ 6,035,000,000

The Committee recommends $6,035,000,000 in mandatory funds
for Payments for Foster Care and Permanency. In addition, the
Committee recommends $2,800,000,000 in advance mandatory
funding for the first quarter of fiscal year 2020. These funds
support programs that assist States with the costs of
maintaining eligible children in foster care, prepare children
for living on their own, assist relatives with legal
guardianship of eligible children, and find and support
adoptive homes for children with special needs.

Administration for Community Living

AGING AND DISABILITY SERVICES PROGRAMS

Appropriations, 2018.................................... $2,171,915,000
Budget estimate, 2019................................... 1,818,681,000
Committee recommendation................................ 2,177,215,000

The Committee recommends an appropriation of $2,177,215,000
for the Administration for Community Living [ACL], which
includes $27,700,000 to be transferred to ACL from the PPH
Fund.
ACL was created with the goal of increasing access to
community support for older Americans and people with
disabilities. It is charged with administering programs
authorized under the Older Americans Act [OAA] and the
Developmental Disabilities Act, as well as promoting community
living policies throughout the Federal Government for older
Americans and people with disabilities.

Home- and Community-Based Supportive Services

The Committee recommends an appropriation of $385,074,000
for the Home- and Community-Based Supportive Services program.
This program provides formula grants to States and territories
to fund a wide range of social services that enable seniors to
remain independent and in their homes for as long as possible.
State agencies on aging award funds to designated area agencies
on aging that, in turn, make awards to local service providers.
This activity supports services such as transportation, adult
day care, physical fitness programs, and in-home assistance
such as personal care and homemaker assistance. The Committee
directs ACL to work with States to prioritize innovative
service models, like naturally occurring retirement communities
[NORCs], which help older Americans remain independent as they
age. The Committee notes that NORCs, and similar settings, are
a more cost-effective alternative to long-term care that
enables older Americans to be more engaged in their communities
while living at home.

Preventive Health Services

The Committee recommends $24,848,000 for Preventive Health
Services. This program funds activities such as medication
management and enhanced fitness and wellness programs. These
programs help seniors stay healthy and avoid chronic disease,
thus reducing the need for costly medical interventions. The
Committee maintains bill language that requires States to use
these funds to support evidence-based models that enhance the
wellness of seniors.

Protection of Vulnerable Older Americans

The Committee recommends $21,658,000 for grants to States
for the Long-term Care Ombudsman program and the Prevention of
Elder Abuse program. Both programs provide formula grants to
States to prevent the abuse, neglect, and exploitation of older
individuals. The ombudsman program focuses on the needs of
residents of nursing homes and other long-term care facilities,
while the elder abuse prevention program targets the elderly
community at large.

National Family Caregiver Support Program

The Committee recommends $180,886,000 for the National
Family Caregiver Support program. Funds appropriated for this
activity establish a multifaceted support system in each State
for family caregivers, allowing them to care for their loved
ones at home for as long as possible. States may use funding to
provide information to caregivers about available services,
assistance to caregivers in gaining access to services,
caregiver counseling and training, respite care to enable
caregivers to be temporarily relieved from their caregiving
responsibilities, and limited supplemental services that fill
remaining service gaps.
National Family Caregiver Support Program.--The Committee
notes that the RAISE Family Caregivers Act (Public Law 115-119)
signed into law this year requires HHS to establish a Family
Caregiving Advisory Council and develop a new national strategy
to support family caregivers, including resources, best
practices, challenges, and programs to enhance the long-term
care caregiving workforce. The Committee includes $300,000 to
establish the Council, which shall include representatives of
relevant Departments and agencies and individuals with
expertise and experience in family caregiving and long-term
care supports, including caregivers.

Native American Caregiver Support Program

The Committee recommendation includes $9,556,000 to carry
out the Native American Caregiver Support program. This program
provides grants to tribes for the support of American Indian,
Alaskan Native, and Native Hawaiian families caring for older
relatives with chronic illness or disability, as well as for
grandparents caring for grandchildren.

Congregate and Home-Delivered Nutrition Services

The Committee recommends $490,342,000 for congregate
nutrition services and $246,342,000 for home-delivered meals.
These programs address the nutritional needs of older
individuals, thus helping them to stay healthy and reduce their
risk of disability. Funded projects must make home-delivered
and congregate meals available at least once a day, 5 days a
week, and each meal must meet a minimum of one-third of daily
dietary requirements. While States receive separate allotments
of funds for congregate meals, home-delivered meals, and
supportive services, they have flexibility to transfer funds
between these programs.
Nutrition Services Incentives Program.--The Committee
recommendation includes $160,069,000 for the Nutrition Services
Incentives Program [NSIP]. NSIP augments funding for congregate
and home-delivered meals provided to older adults. States and
tribes may choose to receive all or part of their funding in
the form of commodities from the USDA.
Aging Grants to Indian Tribes and Native Hawaiian
Organizations
The Committee recommends $33,208,000 for grants to Native
Americans. This program provides grants to eligible tribal
organizations for the delivery of nutrition and supportive
services to Native Americans.

Aging Network Support Activities

The Committee recommends $12,461,000 for Aging Network
Support activities. These funds support activities that expand
public understanding of aging and the aging process, apply
social research and analysis to improve access to and delivery
of services for older individuals, test innovative ideas and
programs, and provide technical assistance to agencies that
administer programs authorized by the OAA.
The Committee also includes $5,000,000 to help provide
supportive services for aging Holocaust survivors in the United
States.

Alzheimer's Disease Program Demonstration Grants to States

The Committee recommendation includes $23,500,000 for
Alzheimer's Disease Program which includes Demonstration Grants
to States and the Alzheimer's Disease Initiative consolidated
in the Consolidated Appropriations Act, 2018. Within this
funding, the Committee supports the continuation of the
National Alzheimer's Call Center, which is available in all
States, 24 hours a day, 7 days a week, year-round, to provide
expert advice, crisis counseling, care consultation and
information referral services in at least 140 languages, for
persons with Alzheimer's disease, their family members and
informal caregivers.

Lifespan Respite Care

The Committee recommends $4,110,000 for the Lifespan
Respite Care program. The Lifespan Respite Care program
provides grants to States to expand respite care services to
family caregivers, improve the local coordination of respite
care resources, and improve access to and quality of respite
care services, thereby reducing family caregiver strain.

Chronic Disease Self-Management Program

The Committee recommends $8,000,000 be transferred from the
PPH Fund to ACL for the Chronic Disease Self-Management Program
[CDSMP]. This program assists those with chronic disease to
manage their conditions and improve their health status. Topics
covered by the program include nutrition; appropriate use of
medications; fitness; and effective communications with
healthcare providers. CDSMP has been shown through multiple
studies to result in significant and measurable improvements in
health and quality of life, as well as reductions in
hospitalizations and emergency room visits.

Elder Falls Prevention

The Committee recommends that $5,000,000 be transferred
from the PPH Fund for Elder Falls Prevention activities at ACL.
Preventing falls will help seniors stay independent and in
their homes and avoid costly hospitalizations and hip
fractures, which frequently lead to nursing home placement. The
Committee intends that these funds should be used in
coordination with CDC for public education about the risk of
these falls, as well as implementation and dissemination of
community-based strategies that have been proven to reduce the
incidence of falls among seniors.

Elder Rights Support Activities

The Committee recommends $15,874,000 for Elder Rights
Support activities, including $12,000,000 for the Elder Justice
Initiative. These activities support programs that provide
information, training, and technical assistance to legal and
aging services organizations in order to prevent and detect
elder abuse and neglect.

Aging and Disability Resource Centers

The Committee recommendation includes $8,119,000 for Aging
and Disability Resource Centers [ADRCs]. These centers provide
information, one-on-one counseling, and access for individuals
to learn about their long-term services and support options
with the goal of allowing seniors and individuals with
disabilities to maintain their independence. The Committee
urges ACL to improve coordination among ADRCs, area agencies on
aging, and centers for independent living to ensure that there
is ``no wrong door'' to access services.

State Health Insurance Assistance Program

The Committee recommendation includes $49,115,000 for State
Health Insurance Assistance Programs, which provide accurate
and understandable health insurance information to Medicare
beneficiaries and their families.

Paralysis Resource Center

The Committee includes $8,700,000 for the National
Paralysis Resource Center [PRC], an increase of $1,000,000.
This program has long provided essential, comprehensive
information, and referral services that promote independence
and quality of life for the 5,400,000 people living with
paralysis and their families. The Committee directs ACL to
continue support for the national PRC at not less than
$7,700,000.

Limb Loss

The Committee provides $3,500,000 for the Limb Loss
program, which supports programs and activities to improve the
health of people with limb loss and promote their well-being,
quality of life, prevent disease, and provide support to their
families and caregivers. Maintaining these programs is critical
to support independent living within the disability community
across their life course.

Traumatic Brain Injury

The Committee provides $11,321,000 for the Traumatic Brain
Injury program. The program supports implementation and
planning grants to States for coordination and improvement of
services to individuals and families with traumatic brain
injuries. Such services can include: pre-hospital care,
emergency department care, hospital care, rehabilitation,
transitional services, education, employment, long-term
support, and protection and advocacy services.
The Committee includes not less than the fiscal year 2018
funding level for protection and advocacy services, as
authorized under section 1305 of Public Law 106-310.

Developmental Disabilities State Councils

The Committee includes $76,000,000 for State councils on
developmental disabilities. These councils work to develop,
improve, and expand the system of services and supports for
people with developmental disabilities at the State and local
level. Councils engage in activities such as training,
educating the public, building capacity, and advocating for
change in State policies with the goal of furthering the
inclusion and integration of individuals with developmental
disabilities in all aspects of community life.

Developmental Disabilities Protection and Advocacy

The Committee includes $40,734,000 for protection and
advocacy programs for people with developmental disabilities.
This formula grant program provides funds to States to
establish and maintain protection and advocacy systems that
protect the legal and human rights of persons with
developmental disabilities who are receiving treatment,
services, or rehabilitation.
Intermediate Care Facilities.--The Department is encouraged
to factor the needs and desires of patients, their families,
caregivers, legal representatives, and other stakeholders, as
well as the need to provide proper settings for care, into its
enforcement of the Developmental Disabilities Act.

Voting Access for Individuals With Disabilities

The Committee includes $6,963,000 to improve voting access
for individuals with disabilities. This program provides grants
to protection and advocacy organizations to ensure that
individuals with disabilities have the opportunity to
participate in every step of the electoral process, including
registering to vote, accessing polling places, and casting a
vote.

Developmental Disabilities Projects of National Significance

The Committee includes $12,000,000 for projects of national
significance to assist persons with developmental disabilities.
This program funds grants and contracts that develop new
technologies and demonstrate innovative methods to support the
independence, productivity, and integration into the community
of persons with developmental disabilities.
ABLE Act.--The Achieving a Better Life Experience Act [ABLE
Act] allows individuals and families to save for the purpose of
supporting individuals with disabilities in maintaining their
health, independence, and quality of life. The Committee
strongly encourages ACL to raise awareness on the eligibility
and benefits of these accounts.
Specialized Housing for Individuals with Developmental
Disabilities.--The Committee is aware that individuals with
intellectual and developmental disabilities, particularly older
adults, face challenges finding specialized housing with
comprehensive services and encourages ACL to continue
partnering with HUD, CMS, and other Federal agencies to support
these critical services.
Transportation.--The Committee includes $1,000,000 to fund
transportation assistance activities for older adults and
persons with disabilities. These activities should focus on the
most cost-effective and sustainable strategies that can be
replicated to other communities. The Committee is pleased with
the Inclusive Community Transportation program's efforts to
integrate rural transit systems for individuals with
disabilities and older adults to access healthcare services,
paratransit, multiple transportation providers, and other
critical community based supports. These small community
demonstration grants should be designed to include the
perspectives of individuals with disabilities and older adults
in the transportation system and service design.
University Centers for Excellence in Developmental
Disabilities
The Committee includes $40,619,000 for the University
Centers for Excellence in Developmental Disabilities [UCEDDs],
a network of 67 centers that are interdisciplinary education,
research and public service units of a university system or
public or nonprofit entities associated with universities. The
funding will keep the national network of Centers strong and
able to assist States to initiate collaborative research,
education, training, and service efforts that help States to
implement ESSA and WIOA, thereby ensuring that youth with
disabilities successfully complete elementary school and
transition from school to postsecondary education and/or
integrated employment. This funding also allows the University
Centers to continue to address the needs of the rising numbers
of individuals on the autism spectrum; demonstrate cost
effective long term services and supports for adults with
disabilities and those aging with disabilities; support
returning veterans; and provide technical assistance to
strengthen and support the national network of Centers as the
disseminate research and best practices nationwide.

Independent Living

The Committee includes $113,183,000 for the Independent
Living Program. This program helps ensure that individuals with
disabilities can live a productive and independent life in
society. Funding helps States sustain, improve, and expand
independent living services and establish and support a network
of centers for independent living.

National Institute on Disability, Independent Living, and
Rehabilitation Research

The Committee includes $108,970,000 for the National
Institute on Disability, Independent Living, and Rehabilitation
Research [NIDILRR]. NIDILRR supports research and activities
that help to maximize the full potential of individuals with
disabilities in employment, independent living, and social
activities. The Committee continues to support NIDILRR in ACL
and does not transfer the program or activities to NIH.
Assistive Technology Research.--The Committee recognizes
that there is a significant opportunity over the next decade
for the HHS to lower healthcare costs and improve quality of
life for people with disabilities through technology solutions
for daily living. The Committee provides NIDILRR $4,000,000 to
fund competitive research grants that helps individuals with
disabilities, with a particular emphasis on seniors, maintain
or improve independence.

Assistive Technology

The Committee recommendation includes $36,000,000 for
Assistive Technology [AT]. AT provides States with funding to
support individuals with disabilities of all ages to obtain
devices and services that will increase, maintain, or improve
their functional capabilities.

Program Administration

The Committee recommends $41,063,000 for program
administration at ACL. These funds support salaries and related
expenses for program management and oversight activities.

Office of the Secretary

GENERAL DEPARTMENTAL MANAGEMENT

Appropriations, 2018.................................... $535,457,000
Budget estimate, 2019................................... 342,990,000
Committee recommendation................................ 545,457,000

The Committee recommends $545,457,000 for General
Departmental Management [GDM]. The recommendation includes
$64,828,000 in transfers available under section 241 of the PHS
Act.
This appropriation supports activities that are associated
with the Secretary's role as policy officer and general manager
of the Department. It supports health activities performed by
the Office of the Assistant Secretary for Health [ASH],
including the Office of the Surgeon General. GDM funds also
support the Department's centralized services carried out by
several Office of the Secretary staff divisions, including
personnel management, administrative and management services,
information resources management, intergovernmental relations,
legal services, planning and evaluation, finance and
accounting, and external affairs.
Adverse Childhood Experience [ACE].--The Committee is aware
that more than half of children, across all socioeconomic
groups, experience an ACE such as physical abuse, substance
misuse in the household, sexual abuse, and parental divorce, or
separation. The Committee encourages the Office of the Surgeon
General to develop a report on the connection between ACE,
future substance misuse, and other health conditions. The
Surgeon General should collaborate with CDC, NIH, SAMHSA, and
ACF as they have extensive experience working on ACEs, their
relationship to future health outcomes, and associated
prevention efforts.
Antibiotic Resistance.--The Department shall include in the
fiscal year 2020 CJ a detailed update on the progress being
made to implement the CARB national strategy.
Chronic Fatigue Syndrome [ME/CFS].--The Committee is
concerned that Americans afflicted with CFS also known as
Myalgic Encephalomyelitis [ME/CFS] have very limited access to
clinical care, that there is no diagnostic test for CFS, and
that there are no FDA-approved treatments for them. HHS is
encouraged to utilize the CFS Advisory Committee to accelerate
progress on research, education, training, clinical care, and
services to better address the needs of over 1,000,000
Americans suffering from CFS.
DATA Act.--The Committee notes that in a November 2017
report, independent analysis found that the Department has made
significant progress during fiscal year 2017 in implementation
of the Digital Accountability and Transparency Act of 2014
[DATA Act], which requires Federal agencies to report on
financial and non-financial data in accordance with standards
established by the U.S. Department of the Treasury and the
Office of Management and Budget. The Committee directs the
Department to continue to take action to address the
deficiencies highlighted in the report in order to improve data
quality for the benefit of the taxpayer.
Direct-to-Consumer Advertising.--The Committee acknowledges
Secretary Azar's statements that the Department has the
authority to require direct-to-consumer advertisements include
the price of medications being advertised. The Committee is
also aware that the Department has convened a task force on
drug pricing and directs the Secretary to submit a report to
the Committees on Appropriations in the House of
Representatives and the Senate 60 days after enactment that
outlines: (1) recommendations on the specific manner and the
appropriate price that should be disclosed in direct-to-
consumer advertisements; (2) the impact on consumer behavior on
purchasing medications and the cost paid for such medications
if the Department requires price to be disclosed; (3) how the
Department can work with healthcare providers to improve real-
time access to the potential consumer cost of a medication; (4)
what specific existing statutory authorities HHS has to require
price disclosure in direct to consumer prescription drug
advertising; and (5) what HHS may need from Congress, if
anything, to help facilitate price disclosure on direct to
consumer advertising.
Disparity Populations.--The Committee recognizes the
importance of understanding and addressing the needs of
disparity populations. To ensure underserved and disadvantaged
populations continue to be best served by programs and offices
within the Department and that our Federal health programs
address the unique needs of vulnerable communities, the
Committee directs the Secretary to maintain the collection of
data on disparity populations, as defined by Healthy People
2020, on health surveys administered by the Department.
Duchenne Muscular Dystrophy.--The Committee recognizes the
potential that virally mediated gene therapy applications pose
for Duchenne and other rare diseases. As this science moves
toward translational and clinical evaluation, the Committee
recommends the Secretary convene an effort across NIH, FDA, and
CMS and other relevant entities and stakeholders, as
appropriate, to develop a comprehensive and integrated HHS
strategy to address complex, interrelated issues such as
manufacturing practices, dosing and redosing, and reimbursement
models and related data requirements so that patients have
timely access to these innovative therapies. In addition, the
Secretary is encouraged to promote data sharing across HHS and
with relevant entities and stakeholders.
Early Detection of Brain Aneurysms.--The Committee
recognizes that although 1 in 50 Americans have a brain
aneurysm, there are typically no warning signs or symptoms
unless they have bled. Even when an aneurysm has bled, the
symptoms are not widely known among healthcare professionals,
such as first responders and emergency room physicians. The
Committee encourages the Secretary, in consultation with
appropriate stakeholders, to facilitate the development of best
practices on brain aneurysm detection and diagnosis for first
responders, emergency room physicians, primary care physicians,
nurses, and advanced practice providers.
Financial Reporting.--The Committee notes that the
Department led a pilot program under the DATA Act aimed at
developing recommendations for reducing recipient reporting
burden for grantees and contractors. The Committee recognizes
the potential benefits of streamlined financial reporting for
Federal contract spending and urges the Department to highlight
the lessons learned from this pilot program.
Global Health Research Strategy.--The Committee requests an
update on how CDC, FDA, BARDA, and NIH jointly coordinate
global health research activities with specific measurable
metrics used to track progress toward agreed upon health goals.
Health Disparities.--The Committee appreciates the
Department's efforts to address health disparities but notes a
comprehensive coordinated focus would increase the probability
of reducing these disparities. Specifically, the Committee
encourages OMH, NIMHD, and HRSA to support a coordinated
approach to factors that lead to health disparities including
age, nutrition, medical conditions, and availability of medical
support and an appropriate healthcare workforce in both
underserved urban and rural settings.
HIV/AIDS Prevention.--The Committee continues to be
concerned with the negative impact poor adherence to chronic
medications has to the health of patients and to the overall
costs of healthcare. Adherence to pre-exposure prophylaxis
therapy [PrEP] significantly reduces the risk of contracting
HIV, but is much less effective when not taken consistently.
The Committee encourages the Department to investigate the use
of financial incentive structures that incorporate frequent
feedback and to assess outcomes of these interventions to
improve adherence to PrEP therapy.
Lung Cancer.--The Committee understands that lung cancer
has a disparate impact on women, particularly those who have
never smoked. The Committee encourages the Secretary, in
consultation with the Secretary of Defense and the Secretary of
Veterans Affairs, to conduct an interagency study to evaluate
the status of research on women and lung cancer and make
recommendations for additional research, increased access to
lung cancer preventive services, and strategic public awareness
and education campaigns related to lung cancer.
National Clinical Care Commission.--The Committee urges the
Secretary to convene the Commission as described in Public Law
115-80 as soon as possible. The Commission, which should be
comprised of healthcare providers, patient advocates, and
Federal agencies, is to make recommendations about developing
improved clinical resources and tools, innovative care models,
quality measures and registries, diabetes screening programs
and other prevention activities.
National Vaccine Advisory Committee [NVAC].--The Committee
recognizes that lower childhood immunization rates have been
reported in the United States among children living in poverty,
urban children, and black and Hispanic children. The Committee
requests the NVAC, in coordination with CMS, to provide the
Committee with data regarding the number of children under the
age of 35 months that received childhood vaccinations, as well
as data regarding disparities in immunization rates among these
children. The NVAC should also assess the extent to which these
children received vaccinations according to the recommendations
of the CDC Advisory Committee on Immunization Practices.
Nonrecurring Expenses Fund.-- The Committee directs the
Secretary to prioritize obligations from resources in the
Nonrecurring Expenses Fund for CDC's NIOSH facility in
Cincinnati, Ohio and for CDC cybersecurity needs.
Obligation Reports.--The Committee directs the Secretary to
submit electronically to the Committee an Excel table detailing
the obligations made in the most recent quarter for each office
and activity funded under this appropriation not later than 30
days after the end of each quarter.
Opioid Prescribing Limitations.--The Committee applauds
State efforts to address the overprescribing of opioids by
implementing CDC's Guideline for Prescribing Opioids for
Chronic Pain. Not later than 1 year after the enactment of this
act, the Secretary, in conjunction with CDC, shall submit a
report to the Committees on Appropriations in the House of
Representatives and the Senate detailing: the impact of
existing State regulations or laws to limit opioid
prescriptions on opioid abuse and overdose rates; the impact of
existing State regulations or laws to limit opioid
prescriptions on legitimate access to opioids, including the
impact on patient cost sharing (including copayments); and
recommended Federal legislative or executive actions that could
be taken to further reduce opioid abuse and overdose deaths.
Public Health in Indian Country.--The Committee supports
the Secretary's current initiatives to address public health
crises such as viral hepatitis, HIV/AIDS, Zika, the opioid
crisis, and others that disproportionally impact Indian
Country. The Committee requests that HHS provide an update on
these efforts in the fiscal year 2020 CJ.
Rural Communities.--The Committee encourages the Secretary
to ensure that rural concerns and challenges are adequately
represented in the Department's policies, programs, and
activities, including policies related to the opioid epidemic.
The Committee requests that the Secretary include a status of
these activities in the fiscal year 2020 CJ.
Safety in Health Care Facilities.--The Committee directs
the Department to work with the Department of Labor to provide
a report to the Committees on Appropriations in the House of
Representatives and the Senate 180 days after enactment on how
they can collaborate to strengthen protections and support safe
environments for healthcare workers, patients, families, and
visitors.
Staffing Reports.--The Committee includes a new general
provision requiring the Department to submit a staffing report
to the Committee by the 15th day of each month. The Excel table
will include: the names, titles, grades, agencies, and
divisions of all of the political appointees, special
government employees, and detailees that were employed by or
assigned to the Department during the previous month.
Substance Use Disorder Treatment.--The Committee directs
the Government Accountability Office [GAO] to review inpatient
and outpatient treatment capacity, availability, and needs. The
study should consider, to the extent that data is available,
the capacity of detoxification programs, transitional
residential support services, demographic specific residential
or inpatient treatment programs, and geographic differences in
the availability of recovery options. The study should also
identify barriers to treatment at the Federal, State, and local
levels, and ways to overcome such barriers. The Committee
directs GAO to complete the report and share with both House
and Senate Appropriations Committees within 24 months of the
enactment of this act.
Substance Use Disorder Treatment Facilities.--The Committee
is concerned about the lack of in-patient substance use
disorder treatment facilities in the United States and the
inability of State and local governments on the front lines who
are already incurring significant additional costs related to
the opioid epidemic to unilaterally provide the funding
necessary to construct these much-needed facilities. The
Committee directs the Secretary of HHS to submit a report to
the House and Senate Committees on Appropriations that
identifies existing sources of Federal funding that can be used
to construct and expand in-patient substance use disorder
treatment facilities along with explicit recommendations about
what the department can and should do to promote and
incentivize the creation of additional in-patient substance use
disorder treatment facilities.
Surgeon General Report on Poverty.--The Committee notes
that too many American children still live in poverty,
compromising their ability to be healthy, to succeed in school
and to raise healthy families themselves. A report by the
Surgeon General on improving the health of children could
increase awareness and generate additional effort toward
ameliorating this public health problem.
Technical Assistance.--The Committee is concerned about the
Department's responsiveness to Technical Assistance requests
and continues to note that it expects the Department to comply
in a timely manner with its requests for technical assistance
and information, consistent with past practice including timely
answers that respond to any specific inquiries.
United States/Mexico Border.--The Committee urges the
Department to continue its efforts to conduct border infectious
disease surveillance to identify and implement needed
prevention and treatment. The Department could focus on
priority surveillance, epidemiology, and preparedness
activities along the borders in order to be able to respond to
potential outbreaks and epidemics, including those caused by
potential bioterrorism agents.
Teen Pregnancy Prevention
The Committee recommendation includes $101,000,000 for the
Teen Pregnancy Prevention program. This program supports
competitive grants to public and private entities to replicate
evidence-based teen pregnancy prevention approaches.

Office of Minority Health

The Committee recommends $56,670,000 for the Office of
Minority Health. This Office focuses on strategies designed to
decrease health disparities and to improve the health status of
racial and ethnic minority populations in the United States.
OMH establishes goals and coordinates all departmental activity
related to improving health outcomes for disadvantaged and
minority individuals.
Lupus Initiative.--The Committee continues to support the
OMH National Health Education Lupus Program and its efforts to
develop a clinical trial education and implementation plan for
lupus. The action plan will focus on developing public-private
and community partnerships, evaluating current minority
clinical trial education and participation programs, and
developing a research plan for creating new clinical trial
education models in lupus. This will inform the development of
the broader actionable lupus clinical trial education plan.
Youth Violence Prevention.--The Committee encourages OMH to
explore innovative demonstration grants to hospitals to address
the cyclical nature of violence in the community. These efforts
should integrate existing community resources as well as local
law enforcement to develop best practices replicable on a
national scale.
Sexual Risk Avoidance
The Committee recommends $35,000,000 for sexual risk
avoidance education. This is a competitive grant program that
funds evidenced based abstinence models for adolescents.
Funding for competitive grants for sexual risk avoidance
shall use medically accurate information referenced to peer-
reviewed publications by educational, scientific, governmental,
or health organizations; implement an evidence-based approach;
and teach the benefits associated with self-regulation, success
sequencing for poverty prevention, healthy relationships, goal
setting, and resisting sexual coercion, dating violence, and
other youth risk behaviors.

Office of Women's Health

The Committee recommends $32,140,000 for the Office of
Women's Health. This office develops, stimulates, and
coordinates women's health research, healthcare services, and
public and healthcare professional education across the
Department. It advances important crosscutting initiatives and
develops public-private partnerships, providing leadership and
policy direction to address the disparities in women's health.
The Committee recommendation includes $3,100,000 to combat
violence against women through the State partnership
initiative. This program provides funding to State-level public
and private health programs to partner with domestic and sexual
violence organizations to improve healthcare providers' ability
to help victims of violence and improve prevention programs.

OFFICE OF MEDICARE HEARINGS AND APPEALS

Appropriations, 2018.................................... $182,381,000
Budget estimate, 2019................................... 112,381,000
Committee recommendation................................ 182,381,000

The Committee provides $182,381,000 for the Office of
Medicare Hearings and Appeals [OMHA]. This Office is
responsible for hearing Medicare appeals at the Administrative
Law Judge [ALJ] level, which is the third level of Medicare
claims appeals. OMHA ensures that Medicare beneficiaries who
are dissatisfied with the initial decisions about their
benefits or eligibility can appeal and exercise their right to
a hearing in front of an ALJ.
Appeals Backlog.--The Committee continues to be concerned
over the nearly 500,000 cases that are still pending before
ALJs at OMHA. OMHA shall provide an update to the Committee 180
days after enactment on the progress and continued challenges
with reducing the caseload backlog.

OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH INFORMATION TECHNOLOGY

Appropriations, 2018.................................... $60,367,000
Budget estimate, 2019................................... 38,381,000
Committee recommendation................................ 60,367,000

The Committee makes available $60,367,000 to the Office of
the National Coordinator for Health Information Technology
[ONC]. ONC is responsible for coordinating Federal health
information systems and collaborating with the private sector
to develop standards for a nationwide interoperable health
information technology infrastructure.

OFFICE OF INSPECTOR GENERAL

Appropriations, 2018.................................... $80,000,000
Budget estimate, 2019................................... 80,000,000
Committee recommendation................................ 80,000,000

The Committee recommends $80,000,000 for the HHS Office of
Inspector General [OIG]. In addition to discretionary funds
provided in this act, the Health Insurance Portability and
Accountability Act of 1996 provides a permanent appropriation
of $334,097,000 for OIG.
OIG conducts audits, investigations, and evaluations of the
programs administered by the Department's operating and staff
divisions, including the recipients of the Department's grant
and contract funds. In doing so, OIG addresses issues of waste,
fraud, and abuse and makes recommendations to improve the
efficiency and effectiveness of the Department's programs and
operations.

OFFICE FOR CIVIL RIGHTS

Appropriations, 2018.................................... $38,798,000
Budget estimate, 2019................................... 30,904,000
Committee recommendation................................ 38,798,000

The Committee recommends $38,798,000 for the Office for
Civil Rights [OCR] in budget authority. OCR is responsible for
enforcing civil rights-related statutes in healthcare and human
services programs. To enforce these statutes, OCR investigates
complaints of discrimination, conducts program reviews to
correct discriminatory practices, and implements programs to
generate voluntary compliance among providers and constituency
groups of health and human services.

RETIREMENT PAY AND MEDICAL BENEFITS FOR COMMISSIONED OFFICERS

Appropriations, 2018.................................... $618,689,000
Budget estimate, 2019................................... 629,209,000
Committee recommendation................................ 629,209,000

The Committee provides an estimated $629,209,000 in
mandatory funds for Retirement Pay and Medical Benefits for
Commissioned Officers of the U.S. Public Health Service. This
account provides for retirement payments to PHS officers who
are retired due to age, disability, or length of service;
payments to survivors of deceased officers; and medical care to
Active Duty and retired officers, as well as their dependents.

PUBLIC HEALTH AND SOCIAL SERVICES EMERGENCY FUND

Appropriations, 2018.................................... $1,953,458,000
Budget estimate, 2019................................... 2,303,877,000
Committee recommendation................................ 2,046,458,000

The Committee recommends $2,046,458,000 for the Public
Health and Social Services Emergency Fund. This appropriation
supports the activities of the Assistant Secretary for
Preparedness and Response [ASPR] and other components within
the Office of the Secretary to prepare for the health
consequences of bioterrorism and other public health
emergencies, including pandemic influenza. It also provides
funding for the Department's cybersecurity efforts.

Office of the Assistant Secretary for Preparedness and Response

The Committee recommendation includes $1,689,128,000 for
activities administered by ASPR. This Office was created by the
Pandemic and All-Hazards Preparedness Act to lead the
Department's activities regarding preventing, preparing for,
and responding to public health emergencies, including
disasters and acts of terrorism.
National Disaster Medical System.--The Committee continues
bill language providing coverage under the Federal Employees
Compensation Act for National Disaster Medical System
intermittent employees who are activated for training or
deployment.
Emergency Response Coordination.--The Committee recognizes
the importance of a federally coordinated public health and
medical preparedness response following a natural disaster or
public health emergency. The Committee encourages ASPR to
establish a process to facilitate the transportation and
distribution of essentials in commerce during a presidentially
declared emergency or major disaster declaration. ASPR is
further encouraged to ensure this process identifies and
minimizes gaps, duplication, and other inefficiencies in
medical and public health preparedness response activities.
PRISM Guidance.--The Committee is aware that ASPR is in the
process of updating the Primary Response Incident Scene
Management Guidance for Chemical Incidents [PRISM], which
establishes standardized decontamination procedures for use by
first responders. However, a 2017 field exercise revealed
significant gaps in decontamination procedures for individuals
with disabilities, which have not yet been fully evaluated or
addressed in the guidance. Therefore, the Committee encourages
ASPR to develop evidence-based guidance and decontamination
procedures for individuals with disabilities, as well as other
at-risk groups.
Strategic National Stockpile.--The Committee remains
concerned about plans to transfer the Strategic National
Stockpile from CDC to ASPR at the beginning of fiscal year
2019, particularly with regard to maintaining appropriate
coordination and support for State and local public health
departments. The Committee directs the Secretary to report to
Congress within 90 days of enactment of the act regarding
ASPR's plans to: (1) maintain funding for State and local
operational readiness to distribute and dispense medical
countermeasures from the Stockpile; (2) continue technical
assistance, support, and oversight for State and local health
departments' operational readiness to distribute and dispense
medical countermeasures from the Stockpile; and (3) incorporate
and access CDC expertise throughout the Public Health Emergency
Medical Countermeasures Enterprise, including decisions related
to procurement and deployment for the Stockpile.
Hospital Preparedness Program
The Committee's recommendation includes $264,555,000 for
the Hospital Preparedness Program [HPP]. This program provides
grants to States to build healthcare coalitions that enhance
regional and local hospital preparedness and improve overall
surge capacity in public health emergencies. The Committee
recognizes the vital importance of this program in helping
communities respond to tragic events and for this reason
includes the same funding level as fiscal year 2018. The
Committee believes this funding should be carefully coordinated
within communities to continue to provide our Nation's
hospitals and emergency responders the necessary tools to
respond quickly and collaboratively to these and other public
health emergencies that are inevitable in our Nation's
communities.
Emergency Response.--The Committee commends CDC for issuing
a Public Health Crisis Notice of Funding Opportunity as a novel
approach to enable CDC to more quickly award funds in the event
of a public health emergency. The Committee encourages ASPR to
assess whether similar mechanisms would increase the efficiency
of the disbursal of emergency funds through programs
administered at ASPR, including funds distributed through the
HPP and other mechanisms.
Regional Disaster Health Response System [RDHRS].--The
Committee encourages the Department to dedicate $6,000,000 to
support ongoing activities associated with the RDHRS
demonstration project aimed at increasing regional ability to
respond to 21st Century threats, leveraging local, State, and
Federal healthcare assets across State lines, and assuring
improved communications and coordination among participating
entities. The Committee encourages ASPR to consider innovative
coalitions of academic medical centers in partnership with
existing local healthcare coalitions and trauma centers that
integrate their medical response capabilities with Federal
facilities and local emergency medical services. Further, the
Committee encourages ASPR to select coalition(s) from various
regions, such as one with a high incidence and variety of
natural disasters and where disaster medical response efforts
are challenged by significant rurality.

Biomedical Advanced Research and Development Authority [BARDA]

The Committee recommendation includes $561,700,000 for
advanced research and development.
Infectious Diseases.--The Committee commends BARDA for
supporting advanced development efforts to develop vaccines,
diagnostics, drugs, and therapeutics to minimize serious
threats of infectious diseases. BARDA is encouraged to continue
to proactively prepare for emerging infectious disease
outbreaks, including investing in rapid screening technology,
and the Committee commends BARDA for supporting advanced
development efforts of industry to develop vaccines,
diagnostics, drugs, and therapeutics to minimize serious
threats of infectious disease.
Tuberculosis.--The National Strategy for CARB identified
drug resistant TB as a serious threat level pathogen and called
for new diagnostic, treatment and prevention tools to address
this global health threat. The Committee encourages BARDA to
support the development of new TB diagnostic tests, drugs and
vaccines through the CARB initiative, and the Emerging
Infectious Disease program.
Zika Vaccine Development.--The Committee directs BARDA to
use resources made available in this act to continue research
into a Zika vaccine and provide an update on progress to the
Committee 180 days after enactment of this act.

Project BioShield Special Reserve Fund

The Committee recommendation includes $735,000,000 for the
Project BioShield Special Reserve Fund. The Committee is
committed to ensuring the Nation is adequately prepared against
chemical, biological, radiological, and nuclear attacks. The
Committee recognizes a public-private partnership to develop
medical countermeasures [MCMs] is required to successfully
prepare and defend the Nation against these threats. Where
there is little or no commercial market, the Committee supports
the goal of Government financing providing a market guarantee.

Other Activities

The Committee recommendation includes the following amounts
for the following activities within ASPR:
--Operations.--$30,938,000;
--Preparedness and Emergency Operations.--$24,654,000;
--National Disaster Medical System.--$57,404,000; and
--Policy and Planning.--$14,877,000.

Office of the Assistant Secretary for Administration

The Committee recommends $58,860,000 for information
technology cybersecurity in the Office of the Assistant
Secretary for Administration. These funds provide for
continuous monitoring and security incident response
coordination for the Department's computer systems and
networks.

Office of the Assistant Secretary for Health/Medical Reserve Corps

The Committee recommendation includes $6,000,000 for the
Medical Reserve Corps [MRC] program in ASH. This program is a
national network of local volunteers who work to strengthen the
public health infrastructure and preparedness capabilities of
their communities.
The Committee maintains funding at last year's level for
the MRC which is composed of volunteer doctors, dentists,
nurses, pharmacists, and other community members. The Committee
notes that the MRC provides an important community service,
assisting in emergency response during a natural disaster,
terrorist attack, or disease outbreak and staffing exercises to
test local capacity to quickly dispense medicines and vaccines
in an emergency.

Office of the Secretary

The Committee recommendation includes $292,470,000 for
activities within the Office of the Secretary.

Pandemic Influenza Preparedness

The Committee recommendation includes $285,000,000 for
Pandemic Influenza Preparedness. Of the total, $35,000,000 is
provided in annual funding and $250,000,000 in no-year funding.
Pandemic Influenza Program.--The Committee recognizes the
critical nature of preparing for and responding to the
inevitability of pandemic influenza and directs ASPR to
continue to develop, procure, and maintain detection,
prevention, and treatment measures and countermeasures to
protect the public against pandemic influenza. The Committee
intends that ASPR use the funding provided to support
innovative technologies that enhance rapid detection and
response to threats relating to pandemic influenza, ensure
readiness to respond to pandemic influenza threats, and sustain
and replenish pandemic stockpiles of bulk antigen and adjuvant
material and necessary ancillary supplies, including annually
testing the potency and shelf-life potential of all existing
pandemic stockpiles held by HHS.

Office of Security and Strategic Information

The Committee includes $7,470,000 for the Office of
Security and Strategic Information to maintain the security of
the Department's personnel, systems, and critical
infrastructure.

PREVENTION AND PUBLIC HEALTH FUND

In fiscal year 2019, the level transferred from the fund
after accounting for sequestration is $848,000,000. The
Committee includes bill language in section 219 of this act
that requires that funds be transferred within 45 days of
enactment of this act to the following accounts, for the
following activities, and in the following amounts:

[In thousands of dollars]
------------------------------------------------------------------------
Committee
Agency Account Program recommendation
------------------------------------------------------------------------
ACL.......... Aging and Disability Alzheimer's Disease 14,700
Services Programs. Prevention
Education and
Outreach.
ACL.......... Aging and Disability Chronic Disease 8,000
Services Programs. Self Management.
ACL.......... Aging and Disability Falls Prevention... 5,000
Services Programs.
CDC.......... Immunization and Section 317 324,350
Respiratory Immunization
Diseases. Grants.
CDC.......... Emerging and Epidemiology and 40,000
Zoonotic Infectious Laboratory
Diseases. Capacity Grants.
CDC.......... Emerging and Healthcare 12,000
Zoonotic Infectious Associated
Diseases. Infections.
CDC.......... Chronic Disease Office of Smoking 129,600
Prevention and and Health
Health Promotion. (Tobacco
Prevention/Media &
Quit Lines).
CDC.......... Chronic Disease Breast Feeding 8,000
Prevention and Grants (Hospitals
Health Promotion. Promoting
Breastfeeding).
CDC.......... Chronic Disease Million Hearts 4,000
Prevention and Program.
Health Promotion.
CDC.......... Chronic Disease Heart Disease & 57,075
Prevention and Stroke Prevention
Health Promotion. Program.
CDC.......... Chronic Disease Diabetes........... 52,275
Prevention and
Health Promotion.
CDC.......... Chronic Disease Early Care 4,000
Prevention and Collaboratives.
Health Promotion.
CDC.......... Environmental Health Lead Poisoning 17,000
Prevention.
CDC.......... CDC-Wide Activities. Preventive Health 160,000
and Health
Services Block
Grants.
SAMHSA....... Mental Health....... Suicide Prevention 12,000
(Garrett Lee
Smith).
------------------------------------------------------------------------

General Provisions

Section 201. The bill continues a provision placing a
$50,000 ceiling on official representation expenses.
Section 202. The bill continues a provision limiting the
use of certain grant funds to pay individuals more than an
annual rate of Executive Level II.
Section 203. The bill continues a provision restricting the
Secretary's use of taps for program evaluation activities
unless a report is submitted to the Appropriations Committees
of the House of Representatives and the Senate on the proposed
use of funds.
Section 204. The bill modifies a provision authorizing the
transfer of up to 2.6 percent of PHS Act funds for evaluation
activities.
Section 205. The bill continues a provision restricting
transfers of appropriated funds and requires a 15-day
notification to the Committees on Appropriations of the House
of Representatives and the Senate.
Section 206. The bill continues a general provision
allowing National Health Service Corps contracts to be canceled
up to 60 days after award.
Section 207. The bill continues a provision regarding
requirements for family planning applicants.
Section 208. The bill continues language which States that
no provider services under title X of the PHS Act may be exempt
from State laws regarding child abuse.
Section 209. The bill continues language which restricts
the use of funds to carry out the Medicare Advantage Program if
the Secretary denies participation to an otherwise eligible
entity.
Section 210. The bill continues a provision prohibiting the
use of funds for lobbying activities related to gun control.
Section 211. The bill continues a provision that limits the
assignment of certain public health personnel.
Section 212. The bill continues a provision which
facilitates the expenditure of funds for international health
activities.
Section 213. The bill continues a provision permitting the
transfer of up to 3 percent of AIDS funds among ICs by the
Director of NIH and the Director of the Office of AIDS Research
at NIH.
Section 214. The bill continues language which requires
that the use of AIDS research funds be determined jointly by
the Director of NIH and the Director of the Office of AIDS
Research and that those funds be allocated directly to the
Office of AIDS Research for distribution to the ICs consistent
with the AIDS research plan.
Section 215. The bill continues a provision authorizing the
Director of NIH to enter into certain transactions to carry out
research in support of the NIH Common Fund.
Section 216. The bill continues a provision permitting NIH
to use up to $3,500,000 per project for improvements and
repairs of facilities.
Section 217. The bill continues a provision that transfers
funds from NIH to HRSA and AHRQ, to be used for National
Research Service Awards.
Section 218. The bill continues a provision that provides
BARDA with authority to enter into a multiyear contract for up
to 10 years and to repurpose unused termination costs to pay
contract invoices.
Section 219. The bill continues a provision requiring CJs
to include certain FTE information with respect to ACA.
Section 220. The bill continues a provision related to ACA
exchange funding transparency.
Section 221. The bill continues a provision related to
notifications for ACA enrollment and Community Health Centers
awards.
Section 222. The bill continues a provision prohibiting
funds for the Risk Corridor program.
Section 223. The bill continues a requirement for HHS to
conduct an analysis of the ACA's impact on eligibility for
certain discretionary programs.
Section 224. The bill includes a provision requiring the
Secretary to transfer Prevention and Public Health Fund
resources within 45 days.
Section 225. The bill continues a provision related to
breast cancer screening recommendations.
Section 226. The bill continues a provision on NIH indirect
costs.
Section 227. The bill continues a provision for Medicare
and Medicaid expenses.
Section 228. The bill continues a provision requiring
Congressional notification prior to NIH transfers of opioid
funds internally.
Section 229. The bill continues a provision regarding use
of CCDBG funds.
Section 230. The bill includes a new provision rescinding
unobligated funds from the Nonrecurring Expenses Fund.
Section 231. The bill includes a new provision on staffing
reports.
Section 232. The bill includes a new provision on HHS staff
travel for medical care.

TITLE III

DEPARTMENT OF EDUCATION

Education for the Disadvantaged

Appropriations, 2018.................................... $16,443,790,000
Budget estimate, 2019................................... 15,926,790,000
Committee recommendation................................ 16,568,790,000

The Committee recommends an appropriation of
$16,568,790,000 for education for the disadvantaged.
The programs in the Education for the Disadvantaged account
provide a foundation of support to help ensure that all
children receive a high-quality education. Funds appropriated
in this account primarily support activities in the 2019-2020
school year.

Grants to Local Educational Agencies

The Committee recommends $15,884,802,000 for the title I
grants to local educational agencies [LEAs] program. Title I
grants to LEAs provide supplemental education funding,
especially in high-poverty areas, for local programs that
provide extra academic support to help raise the achievement of
eligible students or, in the case of school-wide programs, help
all students in high-poverty schools meet challenging State
academic standards. Title I grants are distributed through four
formulas as prescribed by this act: basic, concentration,
targeted, and education finance incentive grant.
Of the funds available for title I grants to LEAs, up to
$5,000,000 shall be available on October 1, 2018 for transfer
to the Census Bureau for poverty updates; $5,038,625,000 will
become available on July 1, 2019; and $10,841,177,000 will
become available on October 1, 2019. The funds that become
available on July 1, 2019, and October 1, 2019, will remain
available for obligation through September 30, 2020.
The Committee requests that GAO initiate a review of school
improvement activities being undertaken with funding available
in this program. The Committee envisions a multi-phase process
that would allow GAO to conduct a comprehensive examination,
looking at, among other issues, the allocation and use of
funds; selection and oversight of technical assistance;
application of evidentiary requirements from ESSA;
implementation of provisions related to resource inequities;
State and local monitoring; and sustainability of effective
practices implemented in schools.
The Committee directs the Department to make publicly
available on its website a request from a State Education
Agency to waive the 1-percent alternate assessment cap under
section 1111(b)(2)(D)(i)(I) of the Elementary and Secondary
Education Act and its implementing regulations at 34 CFR
200.6(c) and the Department's response to any such request.

Comprehensive Literacy State Development Grants

The Committee recommendation includes $190,000,000 for the
Comprehensive Literacy State Development Grants program. This
program provides competitive grants to State educational
agencies [SEAs] that then subgrant at least 95 percent of such
funds to eligible entities to support efforts to improve
literacy instruction in high-need schools and early education
programs in a State for each of several age bands ranging from
birth through 12th grade.

Innovative Approaches to Literacy

The Committee recommendation includes $27,000,000 for the
Innovative Approaches to Literacy program. This program
provides competitive grants to national not-for-profit
organizations and school libraries for providing books and
childhood literacy activities to children and families living
in high-need communities.
The Committee continues to direct the Department to reserve
no less than 50 percent of funds under this program for grants
to develop and enhance effective school library programs, which
may include providing professional development to school
librarians, books, and up-to-date materials to high-need
schools. Further, the Committee continues to direct the
Department to ensure that grants are distributed among eligible
entities that will serve geographically diverse areas,
including rural areas.

Migrant Education Program

The Committee recommends $374,751,000 for the title I
Migrant Education program. This funding supports grants to SEAs
for programs to meet the special educational needs of the
children of migratory agricultural workers or migratory
fishworkers. Funding also supports activities to improve
interstate and intrastate coordination of migrant education
programs, as well as identify and improve services to the
migrant student population.

Neglected and Delinquent

The Committee recommends $47,614,000 for the title I
Neglected and Delinquent program. This program provides
financial assistance to SEAs for education services to
neglected and delinquent children and youth in State-run
institutions and for juveniles in adult correctional
institutions. States are authorized to set aside at least 15
percent, but not more than 30 percent, of their Neglected and
Delinquent funds to help students in State-operated
institutions make the transition into locally operated programs
and to support the successful reentry of youth offenders who
are age 20 or younger and have received a secondary school
diploma or its recognized equivalent.

Special Programs for Migrant Students

The Committee recommends $44,623,000 for Special Programs
for Migrant Students, which consist of the High School
Equivalency Program [HEP] and the College Assistance Migrant
Program [CAMP]. HEP projects are 5-year grants to institutions
of higher education and other nonprofit organizations to
recruit migrant students ages 16 and older and provide the
academic and support services needed to help them obtain a high
school equivalency certificate and subsequently gain
employment, attain admission to a postsecondary institution or
a job training program, or join the military. CAMP projects are
5-year grants to institutions of higher education and nonprofit
organizations to provide tutoring, counseling, and financial
assistance to migrant students during their first year of
postsecondary education.

Impact Aid

Appropriations, 2018.................................... $1,414,112,000
Budget estimate, 2019................................... 1,259,790,000
Committee recommendation................................ 1,439,112,000

The Committee recommends $1,439,112,000 for the Impact Aid
program. Impact Aid provides financial assistance to school
districts affected by the presence of Federal activities and
federally owned land. These school districts face unique
challenges because they must educate children living on
federally owned land, such as military bases, while federally
owned property is also exempt from local taxes, a primary
source of revenue for local school districts.
Basic Support Payments.--The Committee recommends
$1,294,242,000 for the Basic Support Payments program. Under
this statutory formula, payments are made on behalf of all
categories of federally connected children, with a priority
placed on making payments first to heavily impacted school
districts and providing any remaining funds for regular basic
support payments.
Payments for Children With Disabilities.--The Committee
bill includes $48,316,000 for Payments for Children With
Disabilities. Under this program, additional payments are made
for certain federally connected children eligible for services
under IDEA.
Facilities Maintenance.--The Committee recommends
$4,835,000 for Facilities Maintenance. This activity provides
funding for emergency repairs and comprehensive capital
improvements to certain school facilities owned by the
Department and used by LEAs to serve federally connected
military dependent students. Funds appropriated for this
purpose are available until expended.
Construction.--The Committee recommends $17,406,000 for
eligible LEAs for school construction activities allocated
competitively under section 7007(b) of ESEA.
Payments for Federal Property.--The Committee recommends
$74,313,000 for Payments for Federal Property. These payments
compensate LEAs specifically for revenue lost due to the
removal of Federal property from local tax rolls, regardless of
whether any federally connected children attend schools in the
district. The budget request proposed eliminating this program.
The Committee recommendation again rejects this elimination and
continues to note that this funding represents a key component
of fulfilling the Federal Government's commitment to school
districts impacted by the presence of federally owned land.
The Committee has serious concerns about the effect on
school districts of sudden changes to decades-long practice of
how the Department calculates local tax efforts for Impact Aid
eligibility purposes. The Committee expects to work with the
Department on this issue and requests a briefing within 30 days
of enactment.

School Improvement Programs

Appropriations, 2018.................................... $5,158,467,000
Budget estimate, 2019................................... 645,214,000
Committee recommendation................................ 5,291,967,000

The Committee recommendation includes $5,291,967,000 for
the School Improvement Programs account.

Supporting Effective Instruction State Grants

The Committee recommends $2,055,830,000 for Supporting
Effective Instruction State Grants. States and LEAs may use
funds for a range of activities related to the certification,
recruitment, professional development, and support of teachers
and administrators. Activities may include reforming teacher
certification and licensure requirements, addressing
alternative routes to State certification of teachers,
recruiting teachers and principals, and implementing teacher
mentoring systems, teacher testing, merit pay, and merit-based
performance systems. These funds may also be used by districts
to hire teachers to reduce class sizes.
The appropriation for this program primarily supports
activities associated with the 2019-2020 academic year. Of the
funds provided, $374,389,000 will become available on July 1,
2019, and $1,681,441,000 will become available on October 1,
2019. These funds will remain available for obligation through
September 30, 2020.

Supplemental Education Grants

The Committee recommendation includes $16,699,000 for
supplemental education grants to the Republic of Marshall
Islands [RMI] and the Federated States of Micronesia [FSM].
This grant program was authorized by the Compact of Free
Association Amendments Act of 2003. These funds will be
transferred from the Department to the Secretary of the
Interior for grants to these entities. The Committee bill
includes language requested in the budget that allows the
Secretary of Education to reserve 5 percent of these funds to
provide FSM and RMI with technical assistance.

21st Century Community Learning Centers

The Committee recommends an appropriation of $1,211,673,000
for the 21st Century Community Learning Centers program. Funds
are allocated to States by formula, which in turn, award at
least 95 percent of their allocations to LEAs, community-based
organizations, and other public and private entities. Grantees
use these resources to establish or expand community learning
centers that provide activities offering significant extended
learning opportunities, such as before- and after-school
programs, recreational activities, drug and violence
prevention, and family literacy programs for students and
related services to their families. Centers must target their
services to students who attend schools that are eligible to
operate a school-wide program under title I of the ESEA or
serve high percentages of students from low-income families.

State Assessments Grants

The Committee recommends $378,000,000 for the State
Assessments Grants program. This program provides formula
grants to States for developing and implementing standards and
assessments required by the ESEA and helping States and LEAs
carry out audits of their assessment systems to eliminate low-
quality or duplicative assessments. It also provides
competitive grants to States, including consortia of States, to
improve the quality, validity, and reliability of academic
assessments.

Education for Homeless Children and Youth

For carrying out education activities authorized by title
VII, subtitle B of the McKinney-Vento Homeless Assistance Act,
the Committee recommends $93,500,000. This program provides
assistance to each State to support an office of the
coordinator of education for homeless children and youth, to
develop and implement State plans for educating homeless
children, and to make subgrants to LEAs to support the
education of those children. Grants are made to States based on
the total that each State receives in title I grants to LEAs.
Under the McKinney-Vento Homeless Children and Youth
Program, SEAs must ensure that homeless children and youth have
equal access to the same free public education, including a
public preschool education, as is provided to other children
and youth.

Training and Advisory Services

For Training and Advisory Services authorized by title IV
of the Civil Rights Act, the Committee recommends $6,575,000.
The funds provided will support awards to operate regional
equity assistance centers [EACs]. Each EAC provides services to
school districts upon request. Activities include disseminating
information on successful practices and legal requirements
related to nondiscrimination on the basis of race, color, sex,
or national origin in education programs.

Native Hawaiian Education

The Committee recommendation includes $36,397,000 for
Native Hawaiian Education.
The Committee bill continues a provision that allows
funding provided by this program to be used for construction.
The Committee recommendation includes $650,000 for the Native
Hawaiian Education Council.

Alaska Native Education

The Committee recommends $35,453,000 for the Alaska Native
Education. These funds help address the unique educational
needs of Alaska Native schoolchildren. Funds are used for the
development of supplemental educational programs to benefit
Alaska Natives.
The Committee continues language that allows funding
provided by this program to be used for construction and
overriding the authorizing statute's requirement to make
noncompetitive awards to certain organizations.
The Committee directs the Department to make every effort
to ensure that Alaska Native organizations and tribal
representatives are able to fully engage in tribal consultation
as part of the development of regulations intended to clarify
changes made to this program by the ESSA. The Committee further
directs the Department to consult with Congress throughout the
regulatory process. Finally, the Committee continues to direct
the Department to ensure that Alaska Native tribes, Alaska
Native regional non-profits and Alaska Native corporations have
the maximum opportunity to successfully compete for grants
under this program by providing these entities multiple
opportunities for technical assistance in developing successful
applications for these funds, both in Alaska and via various
forms of telecommunications.

Rural Education

The Committee recommends $180,840,000 for rural education
programs.
The Committee expects that rural education funding will be
equally divided between the Small, Rural School Achievement
Program, which provides funds to LEAs that serve a small number
of students, and the Rural and Low-Income School Program, which
provides funds to LEAs that serve concentrations of poor
students, regardless of the number of students served.

Comprehensive Centers

The Committee recommends $52,000,000 for the Comprehensive
Centers program. These funds provide support to a network of
comprehensive centers that are operated by research
organizations, agencies, institutions of higher education, or
partnerships thereof, and provide training and technical
assistance on various issues to States, LEAs, and schools as
identified through needs assessments undertaken in each region.
The system currently includes 15 regional centers, which are
charged with providing intensive technical assistance to SEAs
to increase their capacity to assist LEAs and schools with
meeting the goals of the ESEA, and 8 content centers, which are
organized by topic area.
In selecting priorities for a new cohort of comprehensive
centers aligned with ESSA, the Committee continues to direct
the Department to recognize the unique challenges, emphasized
in ESSA, affecting rural schools. The Committee strongly
encourages the Department to establish at least one university-
led center in a State with a significant percentage of students
in rural schools. Such a center could focus on rural education
and provide assistance to rural districts that serve high
poverty and minority students.
The Committee recommendation includes continued support for
a comprehensive center, first funded in fiscal year 2016 and as
authorized in ESSA, on students at risk of not attaining full
literacy skills due to a disability, including dyslexia, or
developmental delay.

Student Support and Academic Enrichment Grants

The Committee recommendation includes $1,225,000,000 for
Student Support and Academic Enrichment [SSAE] Grants. This
program provides formula grants to States, which then sub-grant
to LEAs, to help support activities to provide students with a
well-rounded education, ensure safe and supportive learning
environments, and use technology to improve instruction.
The Committee notes that funds available to school
districts within the SSAE program for promoting safe and
supportive learning environments may be used for a wide range
of activities, including but not limited to expanding access to
or coordinating resources for school-based mental health
services and supports, which may include trauma-informed
practices and school counseling; preventing bullying and
harassment; and professional development for personnel in
crisis management and school-based violence prevention
strategies.

Indian Education

Appropriations, 2018.................................... $180,239,000
Budget estimate, 2019................................... 164,939,000
Committee recommendation................................ 180,239,000

The Committee recommends $180,239,000 for Indian education
programs.

Grants to Local Educational Agencies

For grants to LEAs, the Committee recommends $105,381,000.
These funds provide financial support to elementary and
secondary school programs that serve Indian students, including
preschool children. Funds are awarded on a formula basis to
LEAs, schools supported and operated by the Department of the
Interior/Bureau of Indian Education, and in some cases directly
to Indian tribes.

Special Programs for Indian Children

The Committee recommends $67,993,000 for special programs
for Indian children. Funds are used for demonstration grants to
improve Indian student achievement from early childhood
education through college preparation programs, and for
professional development grants for training Indians who are
preparing to begin careers in teaching and school
administration.

National Activities

The Committee recommends $6,865,000 for national
activities. Funds are used to expand efforts to improve
research, evaluation, and data collection on the status and
effectiveness of Indian education programs, and to continue
grants to tribal educational departments for education
administration and planning.
The Committee continues to note that there are significant
cognitive, psychological, and academic benefits that result
from Native American language immersion programs and that
language education programs are essential for tribal self-
determination. Within the total, the Committee recommendation
includes no less than $2,026,000, the same as the fiscal year
2018 level and the budget request, for Native American language
immersion programs authorized under section 6133 of ESEA. The
Committee intends that these funds be allocated to all types of
eligible entities, including both new and existing language
immersion programs and schools, to support the most extensive
possible geographical distribution and language diversity.
Further, the Committee directs the Department to give the same
consideration to applicants that propose to provide partial
immersion schools and programs as to full immersion, as the
local tribes, schools, and other applicants know best what type
of program will most effectively assist their youth to succeed.

Innovation and Improvement

Appropriations, 2018.................................... $982,256,000
Budget estimate, 2019................................... 1,777,647,000
Committee recommendation................................ 1,042,256,000

The Committee recommends $1,042,256,000 for programs within
the Innovation and Improvement account.

Education Innovation and Research

The Committee recommendation includes $135,000,000 for the
Education Innovation and Research [EIR] program. This program
supports the creation, development, implementation,
replication, and scaling up of evidence-based, field-initiated
innovations designed to improve student achievement and
attainment for high-need students. EIR incorporates a tiered
evidence framework that provides early-phase, mid-phase, and
expansion and replication grants. This supports interventions
throughout the pipeline, from smaller grants for early stage
projects that are willing to undergo rigorous evaluation to
test their efficacy to larger grants to scale-up proven-
effective interventions that have demonstrated significant
impacts through multiple rigorous evaluations.
Science, Technology, Education and Math [STEM] Education.--
Within the total for EIR, the Committee recommendation includes
$65,000,000 for STEM education activities, including computer
science education. The Committee continues to direct the
Department to work with other Federal agencies that issue
grants in this area, including the National Science Foundation,
to avoid duplication and ensure that activities funded under
this program build on existing evidence or provide a unique
benefit to the field. Further, within this amount, the
Committee directs the Department to include funding to expand
access to STEM education in rural areas, including grants to
institutions of higher education, in partnership with rural
school districts, to utilize virtual and remote access to
makerspace technologies, such as 3D printers, to expand
opportunities for students in rural areas where such tools are
often cost prohibitive. Further, the Committee notes the
importance of STEM knowledge and skills for individuals in and
outside of the STEM workforce, including the workforce of
national laboratories, for ensuring U.S. competitiveness
globally. Finally, the Committee directs the Department to
provide a briefing within 60 days of enactment to the
Committees on Appropriations of the House of Representatives
and the Senate on the Department's current and planned STEM
education activities within EIR and across the Department.
The Committee encourages the Department to include funding
for programs authorized under EIR that address the birth to 3rd
grade continuum and provide services for children and families
from early childhood through early elementary school, including
two generational approaches, and that propose evidence-based
strategies to mitigate the impacts of adverse childhood
experiences.

Charter School Program

The Committee recommends $445,000,000 for the Charter
School Program. This program supports the start-up,
replication, and expansion of high-quality charter schools.
Within the total, the Committee recommendation includes
$235,000,000 for grants to State entities to support high-
quality charter schools, including for grants directly to
charter school developers in a State if no State entity
receives a grant; $140,000,000 for grants for the replication
and expansion of high-quality charter schools; $55,000,000 for
facilities financing assistance, of which not less than
$45,000,000 shall be for the Credit Enhancement program; and
$15,000,000 for national activities to provide technical
assistance, disseminate best practices, and evaluate the impact
of the charter school program.
The Committee recommendation includes a $20,000,000
increase for grants to charter management organizations for the
replication and expansion of high-quality charter schools as
authorized by ESSA. This will continue to increase funding
available for this purpose, which may include replicating and
expanding very high performing charter schools that have
extensive waitlists, a track record of high academic
performance, and have demonstrated the ability to quickly scale
while maintaining high-performance. The Committee
recommendation also includes a $20,000,000 increase for State-
entity grants to support State's efforts to open and prepare
for the operation of new charter schools and replicate and
expand high-quality charter schools. The recommendation also
includes a $4,000,000 increase for the Credit Enhancement
program to support the financing of charter school facilities,
and a $1,000,000 increase for national activities.
The Committee notes that ESSA made a number of important
changes to the Charter School Program intended to strengthen
charter school authorizing practices, improve fiscal
accountability, and improve overall charter school quality,
including by allowing States to support the replication and
expansion of high-quality charter school models. The Committee
understands the Department is developing guidance for
implementation of the Charter School Program, including these
important provisions, which will be widely disseminated so
stakeholders are aware of these critical changes in law.
Charter School Authorizing.--ESSA took critical steps
toward strengthening oversight of charter schools by requiring
State entities receiving grants funds to allocate not less than
7 percent of funding received under the program to ``improve
authorizing quality, including developing capacity for, and
conducting, fiscal oversight and auditing of charter schools''.
These funds, combined with investments through national
activities including the national dissemination grant
competition being administered this year, allow for continued
improvements in authorizing quality. The Committee requests the
Department include in its CJs, starting with its submission for
fiscal year 2020, a thorough discussion of how these
investments are improving authorizing quality. Additionally,
the Committee notes that the Department's Inspector General
issued the Nationwide Assessment of Charter and Education
Management Organizations audit report in September 2016. The
Committee requests the Department to include in its fiscal year
2020 CJ a description of actions it has taken or plans to take
in response to the report's findings and recommendations.
Rural Charter School Department.--Within the total for
grants to State entities to support high quality charter
schools, the Committee recommendation includes no less than
$7,500,000, the same as the fiscal year 2018 level, for
developer grants to establish or expand charter schools in
underserved, high-poverty, rural areas. This could include
grants to institutions of higher education, or non-profit
organizations in partnership with institutions of higher
education, which are located in the region and committed to
improving educational outcomes for underserved rural students.
Institutions of higher education may be uniquely suited to help
address challenges faced by charter schools in rural areas, and
to give students opportunities to learn in non-traditional
settings. The Committee also notes that establishing charter
schools in rural, particularly underserved areas, will likely
require more start-up costs than in some other areas, and
encourages the Department to consider these factors in
determining grant award levels.

Magnet Schools Assistance

The Committee recommends $105,000,000 for the Magnet
Schools Assistance program. This program supports grants to
LEAs to establish and operate magnet schools that are part of a
court-ordered or federally approved voluntary desegregation
plan. Magnet schools are designed to attract substantial
numbers of students from different social, economic, ethnic,
and racial backgrounds. Grantees may use funds for planning and
promotional materials; salaries of instructional staff;
transportation, as long as such expenses are sustainable beyond
the grant period and not a significant portion of the grant;
and the purchase of technology, educational materials, and
equipment.

Arts in Education

The Committee recommendation includes $29,000,000 for the
Arts in Education program. The funding is used for competitive
awards for national nonprofit organizations engaged in arts
education, professional development activities, and model arts
education programs. Funds also are used for evaluation and
dissemination activities.
The Committee recommendation includes funding for each
activity within this program at no less than the fiscal year
2018 level.

Javits Gifted and Talented Students

The Committee recommendation includes $12,000,000 for the
Javits Gifted and Talented Students Education program. Funds
are used for awards to State and local educational agencies,
institutions of higher education, and other public and private
agencies for research, demonstration, and technical assistance
activities designed to enhance the capability of elementary and
secondary schools to meet the special educational needs of
gifted and talented students, including those from
disadvantaged and underrepresented populations.

American History and Civics Education

The Committee recommendation includes $1,815,000 for
Presidential and Congressional Academies for American History
and Civics. Presidential Academies for the Teaching of American
History and Civics offer residential workshops to elementary
and secondary school teachers to strengthen their knowledge
through instruction and interaction with primary scholars and
accomplished teachers in these fields. The Congressional
Academies for Students of American History and Civics provide
similar workshops to students to enrich their understanding of
American history and civics.
In addition, the Committee recommendation includes
$1,700,000 for National Activities authorized under section
2233 of ESSA.

Teacher and School Leader Incentive Grants

The Committee recommendation includes $200,000,000 for
Teacher and School Leader Incentive Grants. This program
provides competitive grants to eligible entities to develop,
implement, improve, or expand human capital management systems
or performance-based compensation systems in schools. Funds can
be used for a wide-range of activities, including developing or
improving evaluation and support systems that are based in part
on student achievement; providing principals with necessary
tools to make school-level decisions; implementing a
differentiated salary structure based on a variety of factors;
improving the recruitment and retaining of effective teachers,
principals, and other school leaders; and instituting career
advancement opportunities that reward effective teachers,
principals and other school leaders.

Ready-To-Learn Television

The Committee recommendation includes $27,741,000 for the
Ready-to-Learn Television program. This program is designed to
facilitate student academic achievement by leveraging the power
and reach of public television to develop and distribute
educational video programming for preschool and elementary
school children and their parents.

Supporting Effective Educator Development

The Committee recommendation includes $75,000,000 for the
Supporting Effective Educator Development [SEED] program. SEED
provides competitive grants to improve teacher and principal
effectiveness by supporting pathways that help teachers,
principals, or other school leaders with non-traditional
preparation and certification obtain employment in underserved
LEAs; providing evidence-based professional development; and
making services and learning opportunities freely available to
LEAs.
The Committee directs the Department to ensure that SEED
grants are awarded to diverse set of eligible entities,
including National non-profit organizations implementing
evidence-based activities (as defined in section 8101(21)(A)(i)
of the Elementary and Secondary Education Act) across a number
of sites which can help bring to scale evidence-based programs
of National significance across the country.
The Committee is aware that students in rural public
schools and public schools serving high percentages of Native
students have inequitable access to accomplished teachers.
Therefore, the Committee strongly encourages the Department to
establish a priority for SEED projects addressing this issue.
The Committee intends for funds to be awarded to increase the
number of teachers in such schools who have earned a nationally
recognized advanced credential. There are a number of ways to
support these teachers in pursuing an advanced credential,
including financial support, training, mentorship, and access
to online exemplars of accomplished teaching practice as part
of a program of support; financial incentives for those who
earn the credential and continue to teach in a rural or Native
student classroom; and training for principals to encourage and
support their teachers in earning such advanced credentials.

Statewide Family Engagement Centers

The Committee recommendation includes $10,000,000 for
Statewide Family Engagement Centers. This program provides
competitive grants to statewide organizations to promote and
implement evidence-based family engagement activities in
education programs, and provide training and technical
assistance to SEAs, LEAs, schools, and other organizations for
carrying out such activities.

Safe Schools and Citizenship Education

Appropriations, 2018.................................... $185,754,000
Budget estimate, 2019................................... 43,000,000
Committee recommendation................................ 190,754,000

The Committee recommends a total of $190,754,000 for
activities to promote safe schools, healthy students, and
citizenship education.

Promise Neighborhoods

The Committee recommendation includes $78,254,000 for the
Promise Neighborhoods program. This program awards competitive
grants to not-for-profit, community-based organizations for the
development of comprehensive neighborhood programs designed to
combat the effects of poverty and improve educational and life
outcomes for children and youth, from birth through college.
Each Promise Neighborhood grantee serves a high-poverty urban
neighborhood or rural community.

School Safety National Activities

The Committee recommendation includes $95,000,000 for the
School Safety National Activities, including up to $5,000,000
for Project SERV. This funding will help schools address the
consequences of their students witnessing or being the victim
of violence and other root causes of unhealthy school climates.
The Committee encourages the Department, in awarding School
Climate Transformation Grants, to prioritize funding for
applicants that propose to promote the social and emotional
learning of students. In addition, the Committee encourages the
Department to prioritize applicants that propose projects to
prevent opioid abuse by students, and address the mental health
needs of students, families, and communities affected by opioid
use disorder.
The Committee encourages the Department to fund a
demonstration program to test and evaluate innovative
partnerships between institutions of higher education and high-
needs State or local educational agencies to train school
counselors, social workers, psychologists, or other mental
health professionals. This could help demonstrate innovative
ideas to foster a pipeline between graduate programs that train
these professionals and local educational agencies, to expand
access to such professionals in high-need schools and
ultimately improve student outcomes.

Full Service Community Schools

The Committee recommendation includes $17,500,000 for Full
Service Community Schools. This program provides competitive
grants to support the implementation of a continuum of
coordinated supports and services for students, families, and
community members in elementary and secondary schools.

English Language Acquisition

Appropriations, 2018.................................... $737,400,000
Budget estimate, 2019................................... 737,400,000
Committee recommendation................................ 737,400,000

The Committee recommends an appropriation of $737,400,000
for the English Language Acquisition program.
The Department makes formula grants to States based on each
State's share of the Nation's limited-English-proficient and
recent immigrant student population. The program is designed to
increase the capacity of States and school districts to address
the needs of these students. The authorizing statute requires
that 6.5 percent of the appropriation be used to support
national activities, which include professional development
activities designed to increase the number of highly qualified
teachers serving limited-English-proficient students; a
National Clearinghouse for English Language Acquisition and
Language Instructional Programs. National activities funds
shall be available for 2 years.
The Committee continues to encourage the Department to
ensure States are aware of the availability of funding for
English language learners, including emergency supplemental
funding made available in response to hurricanes and other
natural disasters, as well as current guidance in this area, to
help States and school districts access and make the best use
of available funding.

Special Education

Appropriations, 2018.................................... $13,366,184,000
Budget estimate, 2019................................... 13,051,775,000
Committee recommendation................................ 13,493,684,000

The Committee recommends an appropriation of
$13,493,684,000 for special education programs.

Grants to States

The Committee recommendation includes $12,402,848,000 for
IDEA Part B Grants to States. This program provides formula
grants to assist States, outlying areas, and other entities in
meeting the costs of providing special education and related
services for children with disabilities. States pass along most
of these funds to LEAs, but may reserve some for program
monitoring, enforcement, technical assistance, and other
activities.
The appropriation for this program primarily supports
activities associated with the 2019-2020 academic year. Of the
funds available for this program, $3,119,465,000 will become
available on July 1, 2019, and $9,283,383,000 will become
available on October 1, 2019. These funds will remain available
for obligation through September 30, 2020.
The Committee is aware that earlier this year the Office of
Special Education and Rehabilitative Services [OSERS] requested
public input regarding options for the use of IDEA part B funds
for providing technical assistance to States to which
respondents overwhelmingly favored continuing to fund national
technical assistance centers from funds reserved under section
616(i) of IDEA. The Committee believes that the approach
favored by States should be given significant weight as OSERS
reviews these investments and any change must be supported by
evidence that would justify overruling State preferences for
maintaining the current approach to funding national technical
assistance centers that are improving the capacity of states to
meet their IDEA data collection requirements.

Preschool Grants

The Committee recommends $381,120,000 for Preschool Grants.
This program provides formula grants to States to assist them
in making available special education and related services for
children with disabilities aged 3 through 5. States distribute
the bulk of the funds to LEAs. States must serve all eligible
children with disabilities aged 3 through 5 and have an
approved application under the IDEA.

Grants for Infants and Families

The Committee recommends $470,000,000 for the Grants for
Infants and Families program under part C of the IDEA. Part C
of the IDEA authorizes formula grants to States, outlying
areas, and other entities to implement State-wide systems for
providing early intervention services to all children with
disabilities, ages 2 and younger, and their families. The IDEA
also gives States the option of extending eligibility for part
C services to children 3 and older if they were previously
served under part C and will continue to be served until
entrance to kindergarten.

State Personnel Development

The Committee recommends $38,630,000 for the State
Personnel Development program. Ninety percent of funds must be
used for professional development activities. The program
supports grants to SEAs to help them reform and improve their
personnel preparation and professional development related to
early intervention, educational, and transition services that
improve outcomes for students with disabilities. The bill
includes language proposed in the budget request that allows
funds under the program to be used for program evaluation.

Technical Assistance and Dissemination

The Committee recommends $61,928,000 for Technical
Assistance and Dissemination. This program supports awards for
technical assistance, model demonstration projects, the
dissemination of useful information, and other activities.
Funding supports activities that are designed to improve the
services provided under the IDEA.
Special Olympics.--Within the total, the Committee
recommendation includes $17,583,000, an increase of $2,500,000
above the fiscal year 2018 funding level, to support activities
authorized by the Special Olympics Sport and Empowerment Act,
including Project UNIFY. This funding supports efforts to
expand Special Olympics programs and the design and
implementation of Special Olympics education programs that can
be integrated into classroom instruction and are consistent
with academic content standards.

Personnel Preparation

The Committee recommends $83,700,000 for the Personnel
Preparation program. Funds support competitive awards to help
address State-identified needs for personnel who are qualified
to work with children with disabilities, including special
education teachers and related services personnel. The program
is required to fund several other broad areas, including
training leadership personnel and personnel who work with
children with low-incidence disabilities, and providing
enhanced support for beginning special educators.

Parent Information Centers

The Committee recommends $27,411,000 for Parent Information
Centers. This program makes awards to parent organizations to
support parent training and information centers, including
community parent resource centers. These centers provide
training and information to meet the needs of parents of
children with disabilities living in the areas served by the
centers, particularly underserved parents, and parents of
children who may be inappropriately identified.

Technology and Media Services

The Committee recommends $28,047,000 for Technology and
Media Services. This program makes competitive awards to
support the development, demonstration, and use of technology
and educational media activities of value to children with
disabilities.
The Committee continues to recognize the ongoing progress
made with the tools and services provided under the Educational
Technology, Media and Materials program that have allowed more
than 535,000 students with disabilities free access to more
than 600,000 books in digitally accessible formats. The
Committee strongly encourages continued effort to expand this
program's reach to K-12 students in underserved areas.

Rehabilitation Services

Appropriations, 2018.................................... $3,587,130,000
Budget estimate, 2019................................... 3,634,977,000
Committee recommendation................................ 3,656,189,000

Vocational Rehabilitation State Grants

The Committee recommends $3,521,990,000 in mandatory
funding for Vocational Rehabilitation [VR] State Grants. State
Grants assist States in providing a range of services to help
persons with physical and mental disabilities prepare for and
engage in meaningful employment.
The Rehabilitation Act requires that not less than 1
percent and not more than 1.5 percent of the appropriation for
VR State Grants be set aside for Grants for American Indians.

Client Assistance State Grants

The Committee recommends $13,000,000 in discretionary funds
for Client Assistance State Grants. This program funds State
formula grants to help VR clients or client applicants
understand the benefits available to them. States must operate
client assistance programs to receive VR State Grant funds.

Training

The Committee recommends $29,388,000 for training
rehabilitation personnel. This program supports grants to
provide training to new VR staff, or upgrade the qualifications
of existing staff.

Demonstration and Training Programs

The Committee recommendation includes $5,796,000 for
demonstration and training programs. These programs support
activities designed to increase employment opportunities for
individuals with disabilities by expanding and improving the
availability and provision of rehabilitation and other
services.
The Committee recommendation includes no less than the
fiscal year 2018 level for parent information and training
programs.

Protection and Advocacy of Individual Rights

The Committee recommends $17,650,000 for the Protection and
Advocacy of Individual Rights program. This program provides
grants to agencies to protect and advocate for the legal and
human rights of persons with disabilities who are ineligible
for the protection and advocacy services available through the
Developmental Disabilities Assistance and Bill of Rights Act or
the Protection and Advocacy for Individuals with Mental Illness
Act.

Supported Employment State Grants

The Committee recommendation includes $22,548,000 Supported
Employment State Grants Program. This program provides grants
to States to provide supported employment services for
individuals with the most significant disabilities, including
youth with disabilities.

Independent Living Services for Older Individuals Who Are Blind

The Committee recommends $33,317,000 for Independent Living
State Grants. This program supports assistance to individuals
over age 55 to help them adjust to their blindness and continue
to live independently, including daily living skills training,
counseling, community integration information and referral, the
provision of low-vision and communication devices, and low-
vision screening.

Helen Keller National Center

The Committee recommends $12,500,000 for the Helen Keller
National Center for Deaf-Blind Youth and Adults. The Helen
Keller National Center consists of a national headquarters in
Sands Point, New York, with a residential training and
rehabilitation facility where deaf-blind persons receive
intensive specialized services; a network of 10 regional field
offices that provide referral and counseling assistance to
deaf-blind persons; and an affiliate network of agencies.

Special Institutions for Persons With Disabilities

AMERICAN PRINTING HOUSE FOR THE BLIND

Appropriations, 2018.................................... $27,431,000
Budget estimate, 2019................................... 25,431,000
Committee recommendation................................ 30,431,000

The Committee recommends $30,431,000 to help support
American Printing House for the Blind [APH].
APH provides educational materials to students who are
legally blind and enrolled in programs below the college level.
The Federal subsidy provides approximately 65 percent of APH's
total sales income. Materials are distributed free of charge to
schools and States through per capita allotments based on the
total number of students who are blind. Materials provided
include textbooks and other educational aids in Braille, large
type, recorded form, and computer applications. Appropriated
funds may be used for staff salaries and expenses, as well as
equipment purchases and other acquisitions consistent with the
purpose of the Act to Promote the Education of the Blind.
Within the total, the Committee recommendation includes
$1,000,000 to establish a regional partnership with an
organization with significant experience working with students
who are blind to increase the availability of training for
teachers and students in how to use education technology
developed by APH. APH is continually developing new products
and technologies to help ensure students who are blind and
visually impaired have access to the education materials they
need to succeed in school. Establishing a partnership with an
organization to provide such training throughout a specified
region could expand the ability of students and teachers to
fully utilize available products and technologies and provide a
model for other parts of the country.

NATIONAL TECHNICAL INSTITUTE FOR THE DEAF

Appropriations, 2018.................................... $73,000,000
Budget estimate, 2019................................... 70,016,000
Committee recommendation................................ 76,500,000

The Committee recommends $76,500,000 for the National
Technical Institute for the Deaf [NTID].
NTID, located on the campus of the Rochester Institute of
Technology in Rochester, New York, was created by Congress in
1965 to provide a residential facility for postsecondary
technical training and education for persons who are deaf. NTID
also provides support services for students who are deaf,
trains professionals in the field of deafness, and conducts
applied research.
The Committee strongly supports NTID's existing regional
partnership, first established with fiscal year 2016 funds, to
expand NTID's geographical reach and improve access to
postsecondary STEM education and employment for students who
are deaf or hard of hearing in underserved areas. This has
included professional development for teachers, developing
relationships with business and industry to promote employment
opportunities, and preparing students to be successful in STEM
fields. The Committee recommendation includes $5,500,000, an
increase of $3,500,000, to expand this existing partnership in
fiscal year 2019.

GALLAUDET UNIVERSITY

Appropriations, 2018.................................... $128,000,000
Budget estimate, 2019................................... 121,275,000
Committee recommendation................................ 133,000,000

The Committee recommends $133,000,000 for Gallaudet
University.
Gallaudet University is a private, not-for-profit
institution offering undergraduate and continuing education
programs for students who are deaf, as well as graduate
programs in fields related to deafness for students who are
hearing and deaf. The university conducts basic and applied
research related to hearing impairments and provides public
service programs for the deaf community.
This funding also supports the Model Secondary School for
the Deaf, which serves as a laboratory for educational
experimentation and development; disseminates curricula,
materials, and models of instruction for students who are deaf;
and prepares adolescents who are deaf for postsecondary
academic or vocational education or the workplace. The
university's Kendall Demonstration Elementary School develops
and provides instruction for children from infancy through age
15.
Within the total the Committee recommendation includes
$2,000,000 to establish a regional partnership focused on early
language acquisition for children from birth through age three
who are deaf or hard of hearing, with an organization with
expertise in this area. This partnership would allow Gallaudet
to expand and build on its current research in this area, and
test and evaluate interventions in new and diverse geographic
areas. The partnership should also include activities to
improve early language acquisition training for early
educators, caretakers, and other professionals.

Career, Technical, and Adult Education

Appropriations, 2018.................................... $1,830,686,000
Budget estimate, 2019................................... 1,637,159,000
Committee recommendation................................ 1,855,686,000

Career and Technical Education

The Committee recommends $1,200,019,000 for the Career and
Technical Education [CTE] account.
State Grants.--The Committee recommends $1,192,598,000 for
CTE State grants. Funds provided under the State grant program
assist States, localities, and outlying areas to expand and
improve their CTE program and help ensure equal access to CTE
for populations with special needs. Persons assisted range from
secondary students in prevocational courses through adults who
need retraining to adapt to changing technological and labor
market conditions. Funds are distributed according to a formula
based on State population and State per capita income.
Under the Indian and Hawaiian Natives programs, competitive
grants are awarded to federally recognized Indian Tribes or
Tribal organizations and to organizations primarily serving and
representing Hawaiian Natives for services that are additional
to what these groups receive under other provisions of the
Perkins Act.
Of the funds available for this program, $401,598,000 will
become available July 1, 2019, and $791,000,000 will become
available on October 1, 2019. These funds will remain available
for obligation until September 30, 2020.
The Committee strongly encourages the Department to work
with States, businesses, and other stakeholders to develop a
report on the key elements of high quality CTE programs,
including the barriers to developing or expanding high-quality
CTE programs, how to strengthen the pipeline from CTE programs
to available jobs, and how to raise students' awareness of CTE
opportunities.
National Programs.--The Committee recommends $7,421,000 to
support research, development, demonstration, dissemination,
evaluation, and assessment of activities aimed at improving the
quality and effectiveness of CTE.

Adult Education

The Committee recommends $655,667,000 for Adult Education
programs.
Adult Education State Grants.--The Committee recommendation
includes $641,955,000 for Adult Education State Grants, an
increase of $25,000,000, which will provide additional funding
for States for programs that assist adults in becoming literate
and in obtaining the skills necessary for employment and self-
sufficiency.
National Leadership Activities.--The Committee recommends
$13,712,000 for adult education national leadership activities.

Student Financial Assistance

Appropriations, 2018.................................... $24,445,352,000
Budget estimate, 2019................................... 22,975,352,000
Committee recommendation................................ 24,445,352,000

The Committee recommends an appropriation of
$24,445,352,000 for programs under the Student Financial
Assistance account.

Federal Pell Grant Program

The Committee recommends $22,475,352,000 in current year
discretionary funding for the Pell grant program. Pell grants
provide need-based financial assistance that helps
undergraduate students and their families defray a portion of
the costs of postsecondary education. Awards are determined
according to a statutory need-analysis formula that takes into
account a student's family income and assets, household size,
and the number of family members, excluding parents, attending
postsecondary institutions.
The Committee recommendation includes a 1.6 percent, or
$100, increase in the discretionary maximum Pell grant award
that increases the total maximum Pell grant award from $6,095
for the 2018-2019 award year, to $6,195 for the 2019-2020 award
year. This builds on the 3.0 percent increase last year that
more than kept up with inflation. This is the second
consecutive increase in the maximum award paid for with
discretionary funding; the automatic increase in the maximum
award paid for with mandatory funding expired in fiscal year
2017.

Federal Supplemental Educational Opportunity Grant Program

The Committee recommends $840,000,000 for the Supplemental
Educational Opportunity Grant [SEOG] program. The SEOG program
provides funds to approximately 3,700 postsecondary
institutions for need-based grants to more than 1,500,000
undergraduate students. Institutions must contribute at least
25 percent toward SEOG awards. Students qualify for grants of
up to $4,000 by demonstrating financial need. Priority is given
to Pell grant recipients with exceptional need.

Federal Work-Study Program

The Committee bill provides $1,130,000,000 for the Federal
Work-Study [FWS] program. This program provides grants to
approximately 3,200 institutions and helps nearly 700,000
undergraduate, graduate, and professional students meet the
costs of postsecondary education through part-time employment.
Institutions must provide at least 25 percent of student
earnings.
Within the total for FWS, the Committee recommendation
includes $9,625,000, the same as the fiscal year 2018 level,
for the Work Colleges program authorized under section 448 of
the HEA.

Federal Direct Student Loan Program Account

Appropriations, 2018.................................... $350,000,000
Budget estimate, 2019...................................................
Committee recommendation................................ 350,000,000

The Committee recommendation includes $350,000,000 in
discretionary funding for the Federal Direct Student Loan
Program Account. This funding provides for the loan
forgiveness, under authority established by the Consolidated
Appropriations Act, 2018 and continued in this bill, for
certain borrowers who are ineligible for the traditional Public
Service Loan Forgiveness [PSLF] program because they were
enrolled in an ineligible repayment plan, but who otherwise
would be eligible for PSLF.
The Committee continues to note that there has been concern
with the level of service provided to borrowers who intend to
seek loan forgiveness under PSLF. The Committee encourages the
Department to provide borrowers more regular and current
information about the status of processing their PSLF
employment certification, the number of qualifying payments
made, and the projected date of their forgiveness. Further, the
Committee encourages the Department to expand the use of
digital technology in the PSLF program, to allow for employment
certifications and PSLF applications to be completed
electronically, and with each student loan servicer. Finally,
to ensure consistency for applicants, the Committee encourages
the Department to revisit decisions to rescind employment
certification for borrowers who were previously approved.
The Committee notes the Department has been given the
authority to administer critical student debt relief for public
servants through the Public Service Loan Forgiveness [PSLF]
program, which was expanded in the Consolidated Appropriations
Act, 2018 for borrowers whose payments were not made in a
qualifying repayment plan, later designated by the Department
as Temporary Expanded Public Service Loan Forgiveness [TEPSLF].
The Committee directs the Department to provide a biannual
report on both PSLF and TEPSLF, which shall where possible
provide for each program: the number of Employment
Certification Forms approved and rejected, the number of
Applications for Forgiveness approved and rejected, the most
common reasons for the rejection of employment certifications
and for the rejection of forgiveness applications, the
distribution of qualifying organization types for the most
recently completed employment certifications and for borrowers
receiving forgiveness, the distribution of repayment plans for
borrowers with any approved employment certification and for
borrowers with approved applications for forgiveness, the total
and average outstanding loan balances for borrowers whose
employment certifications are approved, and the total and
average outstanding loan balances for borrowers whose
applications for forgiveness are approved, to the Committees on
Appropriations of the House of Representatives and Senate and
Committee on Education and the Workforce of the House of
Representative and the Senate Committee on Health, Education,
Labor and Pensions. The Committee directs the report to include
a discussion of outreach efforts implemented and planned that
will raise awareness of PSLF for all Direct Loan borrowers and
improve the filing of employment certification (including the
expanded authority for cancellation and outreach funding
provided for TEPSLF) through improving communications and
information on program requirements, benefits, and options;
proactive contact with borrowers in ineligible repayment plans;
regular reminders for borrowers to file employment
certifications; and permitting borrowers to electronically sign
and upload all forms regardless of the borrower's student loan
servicer and on a centralized website.

Student Aid Administration

Appropriations, 2018.................................... $1,678,943,000
Budget estimate, 2019................................... 1,772,000,000
Committee recommendation................................ 1,678,943,000

The Committee recommends $1,678,943,000 for the Student Aid
Administration account. These funds are available until
September 30, 2020, and support the Department's student aid
management expenses.
The Committee recommendation includes $698,943,000 for
administrative costs and $980,000,000 for loan servicing
activities.
The Committee directs the Department to continue to provide
quarterly reports detailing its obligation plan by quarter for
student aid administrative activities broken out by servicer
and activity and detailing performance metrics, total loan
volume and number of accounts, broken out by servicer and for
each private collection agency. Further, any reallocation of
funds between administrative costs and servicing activities
within this account should be treated as a reprogramming of
funds, and the Committee should be notified in advance of any
such changes.
Criminal History Questions.--The Committee recognizes that
asking certain types of criminal history questions as part of
the higher education admissions process can have a
discriminatory effect and greatly impact who applies to and is
ultimately accepted into higher education. The Committee
encourages the Department to proactively distribute the
``Beyond the Box: Increasing Access to Higher Education for
Justice-Involved Individuals'' resource guide to institutions
of higher education, and technical assistance to institutions
of higher education conducting the ``College and University
Self-Assessment'' contained therein to help institutions
examine whether, when, and how to use criminal justice
information in the higher education admissions and enrollment
process. The Department shall report to the Committee not later
than 90 days after enactment of this act on the number and
category of contacts made pursuant to this paragraph and plans
for additional actions on this issue.
Defaulted Student Loan Servicing.--The Committee is
concerned with the Department's recent management of the
defaulted Federal student loan process and with the capacity of
current private collection agencies receiving new accounts to
be able to properly serve borrowers who have defaulted on their
loans. Accordingly, the Committee encourages the Department to
extend current contracts with private collection agencies whose
award term extensions are set to expire in April 2019, and that
are affirmatively meeting all contract requirements, serving
the fiscal interest of the United States, and complying with
applicable consumer protection laws until the Department is
able to transition to a new collections process as part of the
Department's Next Generation Financial Services Environment.
Furthermore, the Committee directs the Department not to recall
accounts that are not in repayment from such private collection
agencies and allow them to continue servicing their current
portfolio to avoid disruptions for borrowers, and to comply
with the performance reporting requirements of the explanatory
statement accompanying the Consolidated Appropriations Act,
2018.
Enforcement Disclosure.--The Committee directs the
Secretary to respond to ``Enforcement Disclosure'' requests
under the Statement of Records Notice for the Direct Loan
Program (Common Services For Borrowers, 18-11-16) within 10
days of receipt and to publish and post on a publicly
accessible website a detailed explanation of the policy that
governs such a disclosure. Further, the Committee encourages
the Secretary to make publicly available on its website a
detailed list of all individual requests made to the Department
under the ``Enforcement Disclosure'' provision.
Experimental Site Evaluation and Resources for
Participating Students.--The Committee encourages the
Department to work with an experienced third-party evaluator to
conduct an external and objective evaluation of the Second
Chance Pell Experimental Site Initiative [ESI]. The evaluation
should study in-custody outcomes and post-release outcomes,
including progress towards credential attainment, safety in
prisons with postsecondary education programs, the size of
waiting lists for in prison postsecondary education programs,
the extent to which students continue their education post-
release, employment and earnings outcomes, and recidivism. The
evaluation should track students for 1-3 years post-release. In
addition, many of the colleges participating in the Second
Chance Pell ESI have found that students who are trying to
address student loan defaults and delinquencies are having
difficulty getting clear directions from Federal Student Aid
[FSA] on how best to do so. Further, incarcerated students have
difficulty accessing the online systems and customer service
resources the Department created to streamline student loan
repayment. The Committee recommends FSA designate staff who
would specialize in working with incarcerated students and be a
primary contact and resource to address issues with their
student loans.
FAFSA Simplification.--There have been consistent efforts
in recent years to simplify the FAFSA, including eliminating
questions, implementing skip logic to reduce duplicative or
unnecessary questions based on prior answers, and implementing
prior-prior-year income information to significantly increase
the usefulness of the IRS Data Retrieval Tool. The Committee
supports efforts to further simplify the FAFSA and verification
process to reduce the burden on students and institutions of
higher education, including implementing a mobile platform,
temporarily reinstating alternative documentation options for
non-tax filers, and restoring the ability of all servicemembers
and veterans to identify their status when they apply for
student aid separate from the dependency determination to
assist States and institutions in supporting these populations.
The Committee looks forward to working on these issues as part
of changes initiated by FSA and through the Higher Education
Act reauthorization, and appreciates collaboration with the
Department on proposals and plans to do so.
Federal Student Loan Servicing.--The Committee
recommendation continues all requirements from the Consolidated
Appropriations Act, 2018, including requiring the Department to
ensure that any future student loan servicing contract provides
for the participation of multiple student loan services that
contract directly with the Department to manage a unique
portfolio of borrower accounts and the full life-cycle of loans
from disbursement to pay-off with certain limited exceptions,
and allocates student loan borrower accounts to eligible
student loan servicers based on performance. This also includes
requirements for FSA to evaluate servicers based on their
history of compliance with applicable consumer protections laws
and hold such subcontractors accountable for meeting the
requirements of the contract. The Committee continues to
believe this will help ensure high quality service to borrowers
and promote accountability and transparency to both borrowers
and taxpayers. The Committee looks forward working with the
Department on efforts to improve the student loan servicing
system that maintain key elements that promote transparency,
accountability, and competition.
Perkins Loan Program.--Colleges and universities
participating in the Perkins Loan Program have provided loan
cancellation to eligible borrowers under 20 U.S.C. 1087ee(a).
Given the wind-down of the program, the Secretary is set to
outline the process for distributing assets from institutions'
student loan funds established under 20 U.S.C. 1087ff later
this year. The Committee encourages the Secretary to use any
authority granted for reimbursing colleges and universities for
cancelled loans for which no reimbursement has been provided
and directs notification of the Committees on Appropriations of
the House of Representatives and Senate and Committee on
Education and the Workforce of the House of Representatives and
Senate Health, Education, Labor and Pensions Committee not
later than 10 days prior to any such reimbursement. The
Committee recommendation also includes new bill language
allowing funds appropriated under the Student Aid
Administration account to be used for making payments to
institutions of higher education for servicing Federal Perkins
Loans.
Return of Title IV Funds.--The Committee strongly
encourages the Department to pursue efforts to simplify and
streamline the Return of Title IV Funds process for
institutions of higher education and students.
Sharing FAFSA Information.--The Committee recommendation
reaffirms language included in the Consolidated Appropriations
Act, 2018 regarding the need to provide students with a means
to share data from the FAFSA in order to assist an applicant in
applying for and receiving financial assistance for any
components of cost of attendance with the explicit written
consent of the applicant. The Committee recommendation also
further clarifies that such sharing is also allowed with an
organization assisting the applicant in applying for and
receiving Federal, State, local, or tribal assistance in order
to fund additional components of the applicant's cost of
attendance. Additionally, consistent with the privacy
provisions of paragraph (3)(E) of section 483(a) of the Higher
Education Act, the Secretary may designate such entities to
receive data from the electronic version of the FAFSA. The
Committee encourages the Secretary to use such authority to
enable the sharing of FAFSA data for the purpose of connecting
students to State or Federal means-tested benefit programs for
which they may be eligible and for which, if eligible, could
reduce the applicant's need to borrow or work during college.
State-Based Servicing Organizations.--The Committee notes
that State-based non-profit servicing organizations may be
uniquely positioned to assist borrowers who reside in or attend
school in the same State or region. The Committee encourages
the Department to explore considering such factors in the
current performance-based allocation system and in developing
student loan servicing partnerships as part of the Next
Generation Financial Services Environment.

Higher Education

Appropriations, 2018.................................... $2,246,551,000
Budget estimate, 2019................................... 1,485,848,000
Committee recommendation................................ 2,260,551,000

The Committee recommends an appropriation of $2,260,551,000
for higher education programs.

Aid for Institutional Development

The Committee recommends $674,502,000 in discretionary
funding for Aid for Institutional Development. These totals do
not include separately authorized and appropriated mandatory
funding.
Strengthening Institutions.--The Committee bill recommends
$101,067,000 to provide competitive, 1-year planning and 5-year
development grants for institutions with a significant
percentage of financially needy students and low educational
and general expenditures per student in comparison with similar
institutions. Applicants may use these funds to develop
faculty, strengthen academic programs, improve institutional
management, and expand student services.
Hispanic-Serving Institutions [HSIs].--The Committee
recommends $125,898,000 for competitive grants to institutions
at which Hispanic students make up at least 25 percent of
enrollment. Funds may be used for acquisition, rental, or lease
of scientific or laboratory equipment; renovation of
instructional facilities; development of faculty; support for
academic programs; institutional management; and purchase of
educational materials.
Promoting Postbaccalaureate Opportunities for Hispanic
Americans.--The Committee recommends $11,296,000 for
competitive, 5-year grants to HSIs to help Hispanic Americans
gain entry into and succeed in graduate study. Institutions may
use funding to support low-income students through outreach
programs; academic support services; mentoring and financial
assistance; acquisition, rental, or lease of scientific or
laboratory equipment; construction and other facilities
improvements; and purchase of educational materials.
Strengthening Historically Black Colleges and
Universities.--The Committee recommends $285,788,000 for the
Strengthening HBCUs program. The program makes formula grants
to HBCUs that may be used to purchase equipment; construct and
renovate facilities; develop faculty; support academic
programs; strengthen institutional management; enhance
fundraising activities; provide tutoring and counseling
services to students; and conduct outreach to elementary and
secondary school students.
Strengthening Historically Black Graduate Institutions
[HBGIs].--The Committee recommends $73,908,000 for the
Strengthening HBGIs program. This program provides 5-year
grants to provide scholarships for low-income students and
academic and counseling services to improve student success.
Funds may also be used for construction, maintenance, and
renovation activities; the purchase or lease of scientific and
laboratory equipment; and the establishment of an endowment.
Strengthening Predominately Black Institutions [PBIs].--The
Committee recommends $11,611,000 for the Strengthening PBIs
program. This program provides 5-year grants to PBIs to plan
and implement programs to enhance the institutions' capacity to
serve more low- and middle-income Black American students.
Funding may be used for establishing or enhancing a program of
teacher education designed to qualify students to teach in a
public elementary school or secondary school in the State that
shall include, as part of such program, preparation for teacher
certification or licensure.
Strengthening Asian American and Native American Pacific
Islander-Serving Institutions [AANAPISIs].--The Committee
recommends $3,910,000 for competitive grants to AANAPISIs that
have an enrollment of undergraduate students that is at least
10 percent Asian American or Native American Pacific Islander
students. Grants may be used to improve their capacity to serve
Asian American and Native American Pacific Islander students
and low-income individuals.
Strengthening Alaska Native and Native Hawaiian-Serving
Institutions [ANNHs].--The Committee recommends $16,120,000 for
the Strengthening ANNHs program.
The purpose of this program is to improve and expand the
capacity of institutions serving Alaska Native and Native
Hawaiian students and low-income individuals. Funds may be used
to plan, develop, and implement activities that encourage
faculty and curriculum development; improve administrative
management; renovate educational facilities; enhance student
services; purchase library and other educational materials;
and, provide education or counseling services designed to
improve the financial and economic literacy of students or
their families.
Strengthening Native American-Serving Non-Tribal
Institutions.--The Committee recommends $3,910,000 for this
program, which serves institutions that enroll at least 10
percent Native American students and at least 50 percent low-
income students. This program helps institutions plan, develop,
and implement activities that encourage faculty and curriculum
development; improve administrative management; renovate
educational facilities; enhance student services; and purchase
library and other educational materials.
Strengthening Tribally Controlled Colleges and
Universities.--The Committee recommends $32,234,000 for this
program. Tribal colleges and universities rely on a portion of
the funds provided to address developmental needs, including
faculty development, curriculum, and student services.
Strengthening Masters Degree Programs at Historically Black
Colleges and Universities.--The Committee recommends $8,760,000
for this program, authorized by section 723 of the HEA. This
program provides grants to specified colleges and universities
making a substantial contribution to graduate education
opportunities at the masters level in mathematics, engineering,
the physical or natural sciences, computer science, information
technology, nursing, allied health, or other scientific
disciplines.

International Education and Foreign Language Studies

The bill includes a total of $72,164,000 for International
Education and Foreign Language Studies programs. Funds are used
to increase the number of experts in foreign languages and area
or international studies to meet national security needs
through visits and study in foreign countries.
Domestic Programs.--The Committee recommends $65,103,000
for domestic program activities related to international
education and foreign language studies under title VI of the
HEA. Funds are used to support centers, programs, and
fellowships. The Committee urges the Secretary to preserve the
program's longstanding focus on activities and institutions
that address the Nation's need for a strong training and
research capacity in foreign languages and international
studies, including increasing the pool of international experts
in areas that are essential to national security and economic
competitiveness.
Overseas Programs.--The Committee recommends $7,061,000 for
overseas programs authorized under the Mutual Educational and
Cultural Exchange Act of 1961, popularly known as the
Fulbright-Hays Act. Funding is provided for group, faculty, or
doctoral dissertation research abroad as well as special
bilateral projects. Grants focus on training American
instructors and students to improve foreign language and area
studies education in the United States.

Model Comprehensive Transition and Postsecondary Programs for Students
With Intellectual Disabilities

The Committee recommendation includes $11,800,000 for
competitive grants to postsecondary institutions to support
model programs that help students with intellectual
disabilities transition to and complete college, as authorized
by section 767 of the HEA. Funds may be used for student
support services; academic enrichment, socialization, or
independent living; integrated work experiences; and
partnerships with LEAs to support students with intellectual
disabilities participating in the model program who are still
eligible for special education and related services under the
IDEA.

Minority Science and Engineering Improvement

The Committee recommends $11,268,000 for the Minority
Science and Engineering Improvement program. Funds are used to
provide discretionary grants to institutions with minority
enrollments greater than 50 percent to purchase equipment,
develop curricula, and support advanced faculty training.
Grants are intended to improve science and engineering
education programs and increase the number of minority students
in the fields of science, mathematics, and engineering.

Tribally Controlled Postsecondary Career and Technical Institutions

The Committee recommends $9,678,000 for tribally controlled
postsecondary vocational institutions. This program provides
grants for the operation and improvement of tribally controlled
postsecondary vocational institutions to ensure continued and
expanding opportunities for Indian students.

Federal TRIO Programs

The Committee recommends $1,010,000,000 for Federal TRIO
programs, which provide a variety of services to improve
postsecondary education opportunities for low-income
individuals and first-generation college students.
Upward Bound offers disadvantaged high school students
academic services to develop the skills and motivation needed
to pursue and complete a postsecondary education; Student
Support Services provides developmental instruction,
counseling, summer programs, and grant aid to disadvantaged
college students to help them complete their postsecondary
education; Talent Search identifies and counsels individuals
between ages 11 and 27 regarding opportunities for completing
high school and enrolling in postsecondary education;
Educational Opportunity Centers provide information and
counseling on available financial and academic assistance to
low-income adults who are first-generation college students;
and the Ronald E. McNair Postbaccalaureate Achievement Program
supports research internships, seminars, tutoring, and other
activities to encourage disadvantaged college students to
enroll in doctoral programs.
The Committee recommendation includes no less than the
fiscal year 2018 level for each of the TRIO programs.
The Committee notes there is concern about the Department's
planned allocation of the $60,000,000 increase provided in
fiscal year 2018 for TRIO. The Committee directs the Department
to include in its fiscal year 2020 CJ information on how these
increased funds were allocated, including a detailed budget
justification. Further, the Committee expects funding
allocations like this to be included in the Department's
operating plan required under section 516 of this act in future
fiscal years.
Income Eligibility for TRIO Programs.--The Committee is
concerned with the level of burden TRIO grantees and first-
generation students face in documenting their income to meet
the definition of ``low-income individual'' as required under
section 401A(h)(4) of the Higher Education Act in order to be
eligible for Federal TRIO programs. When the Department
transitioned to ``prior-prior year'' income on the FAFSA to
benefit applicants, this created a potential discrepancy with
section 401A(h)(4) of the Higher Education Act that refers to
income from the preceding year. The Committee urges the
Department to work with grantees to allow for the use of the
student's most recently completed FAFSA as documentation of a
student's income, or family's income (as applicable), to
determine eligibility for TRIO programs.

Gaining Early Awareness and Readiness for Undergraduate Programs

The Committee recommends $350,000,000 for GEAR UP, which
provides grants to States and partnerships of colleges, middle
and high schools, and community organizations to assist cohorts
or students in middle and high schools serving a high
percentage of low-income students. Services provided help
students prepare for and pursue a postsecondary education.

Graduate Assistance in Areas of National Need and Javits Fellowships

The Committee recommends $23,047,000 to support the
Graduate Assistance in Areas of National Need [GAANN] program.
GAANN supports fellowships through 3-year competitive grants to
graduate academic departments and programs in scientific and
technical fields and other areas of national need as determined
by the Secretary. Fellowship recipients must have excellent
academic records and high financial need and must be pursuing
doctoral degrees or the highest graduate degrees in their
academic field. Each fellowship consists of a student stipend
to cover living costs and an institutional payment to cover
each fellow's tuition and other expenses. Institutions of
higher education must match 25 percent of the grant amount.

Teacher Quality Partnership Program

The Committee recommends $43,092,000 for the Teacher
Quality Partnership [TQP] program. The TQP program helps
improve the quality of teachers working in high-need schools
and early childhood education programs by creating model
teacher preparation and residency programs.

Child Care Access Means Parents in Schools

The Committee recommendation includes $50,000,000 for the
Child Care Access Means Parents in Schools program. This
program provides competitive grants to institutions of higher
education to establish or support campus-based child care
programs, to help support needs and participation of low-income
parents in post-secondary education.

Fund for the Improvement of Post-Secondary Education

The Committee recommendation includes $5,000,000 for the
Fund for the Improvement of Post-Secondary Education. The
recommendation includes the full amount the Open Textbook Pilot
first funded in the Consolidated Appropriations Act, 2018, and
for the purposes described in the accompanying explanatory
statement. This funding supports grants to one or a group of
institutions of higher education for creating new open
textbooks for use by students in courses, especially those with
high enrollments, that are part of a degree granting program
and expanding the use of open textbooks in such courses. Funds
may be used for professional development for faculty and staff
at institutions of higher education; creation or adaptation of
open textbooks; development or improvement of tools and
informational resources that support the use of open textbooks,
including accessible instructional materials for students with
disabilities; research evaluating the efficacy of the use of
open textbooks for achieving savings for students and the
impact on instruction and student learning outcomes; and
partnerships with other entities to carry out any of these
activities. In addition, the Committee directs the Department
to require any institution of higher education receiving a
grant through the Open Textbook Pilot to report to the
Secretary regarding the effectiveness of the project in
expanding the use of open textbooks and in achieving savings
for students; the impact of the project on expanding the use of
open textbooks at institutions of higher education outside of
the institution receiving the grant; open textbooks created or
adapted under the grant, including instructions on where the
public can access each open textbook; the impact of the project
on instruction and student learning outcomes; and all project
costs, including the value of any volunteer labor and
institutional capital used for the project. Such reports should
be made publicly available.

Howard University

Appropriations, 2018.................................... $232,518,000
Budget estimate, 2019................................... 221,821,000
Committee recommendation................................ 236,518,000

The Committee recommends an appropriation of $236,518,000
for Howard University. Located in the District of Columbia,
Howard offers undergraduate, graduate, and professional degrees
through 12 schools and colleges. The university also
administers the Howard University Hospital. Federal funds from
this account support approximately 38 percent of the
university's operating costs. The Committee recommends, within
the funds provided, not less than $3,405,000 for the endowment
program.
Howard University Hospital.--Within the funds provided, the
Committee recommends $27,325,000 for Howard University
Hospital. The hospital provides inpatient and outpatient care,
as well as training in the health professions. It also serves
as a major acute and ambulatory care center for the District of
Columbia and functions as a major teaching facility attached to
the university. The Federal appropriation provides partial
funding for the hospital's operations.

College Housing and Academic Facilities Loans Program

Appropriations, 2018.................................... $435,000
Budget estimate, 2019................................... 448,000
Committee recommendation................................ 435,000

Federal Administration.--The Committee bill includes
$435,000 for Federal administration of the CHAFL, College
Housing Loans, and Higher Education Facilities Loans programs.
Prior to fiscal year 1994, these programs provided financing
for the construction, reconstruction, and renovation of
housing, academic, and other educational facilities. While no
new loans have been awarded since fiscal year 1993, costs for
administering the outstanding loans will continue through 2030.
These funds will be used to reimburse the Department for
administrative expenses incurred in managing the existing loan
portfolio.

Historically Black College and University Capital Financing Program
Account

Appropriations, 2018.................................... $30,484,000
Budget estimate, 2019................................... 20,489,000
Committee recommendation................................ 30,484,000

The Committee recommends $30,484,000 for the HBCU Capital
Financing Program. The HBCU Capital Financing Program makes
capital available to HBCUs for construction, renovation, and
repair of academic facilities by providing a Federal guarantee
for private sector construction bonds. Construction loans will
be made from the proceeds of the sale of the bonds.
The Committee recommendation includes $20,150,000 for loan
subsidy costs in guaranteed loan authority under this program
(not including subsidy costs related to specific funding
available for loan deferments described below). This will
support an estimated $580,000,000 in new loan volume in fiscal
year 2019. In addition to that amount, the Committee
recommendation includes $10,000,000 specifically for loan
deferments made to private HBCUs under this program with
demonstrated financial need. Finally, the Committee
recommendations includes $334,000 for administrative expenses.
The Committee requests that the HBCU Capital Financing
Advisory Board prepare an annual report to Congress that would
provide an overview of the loans granted and recommendations to
Congress, the Department of Education, and the Department's
designated bonding authority, for addressing issues related to
construction financing for HBCUs.

Institute of Education Sciences

Appropriations, 2018.................................... $613,462,000
Budget estimate, 2019................................... 521,563,000
Committee recommendation................................ 615,462,000

The Committee recommends $615,462,000 for the Institute of
Education Sciences [IES]. This account supports education
research, development, dissemination, and evaluation; data
collection and analysis activities; and the assessment of
student progress.
Under the Education Sciences Reform Act of 2002, Congress
established IES to provide objective and valid research-driven
knowledge that was free of political influence or bias so as to
better inform effective education practices at the State and
local levels. The act required IES, in carrying out its
mission, ``to compile statistics, develop products, and conduct
research, evaluations, and wide dissemination activities in
areas of demonstrated national need and ensure that such
activities conform to high standards of quality, integrity, and
accuracy and are objective, secular, neutral, and
nonideological and are free of partisan political influence.''
The Committee directs the Director to submit an operating
plan within 90 days of enactment to the Committees on
Appropriations of the House of Representatives and the Senate
detailing how IES plans to allocate funding available to the
Institute for research, evaluation, and other activities
authorized under law.
The Committee continues to direct the Department to ensure
that its employees, contractors, and grantees, including States
that receive funds from Statewide Longitudinal Data System
grants, adhere to the strictest and highest standards for
protecting personally identifiable information.
The Committee notes that in fiscal year 2019 IES plans to
compete funding for a new National Research and Development
Center for Improving Rural Education. The Committee strongly
supports the establishment of this center which will promote
research collaborations between university experts and rural
school districts that serve high poverty and minority students
in order to improve student outcomes.

RESEARCH, DEVELOPMENT, AND DISSEMINATION

The Committee recommends $192,695,000 for education
research, development, and national dissemination activities.
Funds are available for obligation for 2 fiscal years. These
funds support activities that are aimed at expanding
fundamental knowledge of education and promoting the use of
research and development findings in the design of efforts to
improve education.

STATISTICS

The Committee recommends $109,500,000 for data gathering
and statistical analysis activities at the National Center for
Education Statistics [NCES].
NCES collects, analyzes, and reports statistics on
education in the United States. Activities are carried out
directly and through grants and contracts. The Center collects
data on educational institutions at all levels, longitudinal
data on student progress, and data relevant to public policy.
NCES also provides technical assistance to SEAs, LEAs, and
postsecondary institutions.

REGIONAL EDUCATIONAL LABORATORIES

The Committee recommends $55,423,000 to continue support
for the Regional Educational Laboratories program. Funds
available in this bill will continue to support a network of 10
laboratories. The laboratories are responsible for promoting
the use and development of knowledge and evidence in broad-
based systemic strategies to increase student learning and
further school improvement efforts. The Committee appreciates
the efforts of IES to strengthen the connections between
practitioners and the research community, so that federally
supported research is timely, relevant, and responsive to the
needs of the field.

RESEARCH AND INNOVATION IN SPECIAL EDUCATION

The Committee recommends $56,000,000 for research and
innovation in special education conducted by the National
Center for Special Education Research [NCSER].
The Center addresses gaps in scientific knowledge to
improve special education and early intervention services and
outcomes for infants, toddlers, and children with disabilities.
Funds provided to the Center are available for obligation for 2
fiscal years.
The Committee strongly encourages NCSER to manage funding
to be able to conduct research and training grant competitions
annually.

SPECIAL EDUCATION STUDIES AND EVALUATIONS

The Committee recommends $10,818,000 for special education
studies and evaluations.
This program supports competitive grants, contracts, and
cooperative agreements to assess the implementation of IDEA.
Funds are also used to evaluate the effectiveness of State and
local efforts to deliver special education services and early
intervention programs. Funds are available for obligation for 2
fiscal years.

STATEWIDE DATA SYSTEMS

The Committee recommendation includes $32,281,000 for the
Statewide Data Systems program.
This program supports competitive grants to SEAs to enable
such agencies to design, develop, and implement Statewide,
longitudinal data systems to manage, analyze, disaggregate, and
use individual data for students of all ages. Early childhood,
postsecondary, and workforce information systems may be linked
to such systems or developed with program funds. The Committee
believes the Department should continue its efforts to ensure
every State has the base support necessary to develop effective
systems. Funds are available for obligation for 2 fiscal years.

ASSESSMENT

The Committee recommends $158,745,000 to provide support
for the National Assessment of Educational Progress [NAEP], a
congressionally mandated assessment created to measure and
report the educational achievement of American students in a
range of subjects and analyze trends over time.
Within the funds appropriated, the Committee recommends
$7,745,000 for the National Assessment Governing Board [NAGB],
which is responsible for formulating policy for NAEP.
The Committee recommendation includes an increase of
$2,000,000 to help support an earlier administration of the
long-term trend NAEP assessment to ensure that the United
States has comparable data to compare student achievement over
time. The Committee directs the NAGB to report to the Committee
on Appropriations within 60 days of enactment on the resources
required to administer a long-term trend assessment by 2020.
The Committee continues to support assessments for students
in United States History, Civics, and Geography. The Committee
directs NAGB to continue administering assessments in these
three areas, at least every 4 years, in accordance with the
current NAEP schedule. The most recent assessment was in 2018,
and the next scheduled assessment is in 2022.

Departmental Management

PROGRAM ADMINISTRATION

Appropriations, 2018.................................... $430,000,000
Budget estimate, 2019................................... 459,257,000
Committee recommendation................................ 430,000,000

The Committee recommends $430,000,000 for program
administration.
Funds support personnel compensation and benefits, travel,
rent, communications, utilities, printing, equipment and
supplies, automated data processing, and other services
required to award, administer, and monitor Federal education
programs. Support for program evaluation and studies and
advisory councils is also provided under this account.
The Committee requests the Department to provide it with a
report not later than 30 days after the conclusion of each
quarter detailing the number of full time equivalent employees
and attrition by principal office and appropriations account.
College Savings Accounts.--The Committee is aware that the
2012 GAO report on college savings accounts noted that less
than 6 percent of families with children under the age of 25
saved through 529 plans or Coverdell Education Savings
Accounts, and that the families that do, had about 25 times the
median financial assets than those without. The Committee is
aware of different efforts to boost the participation of low-
and middle-income families in such savings plans and is
particularly interested in efforts that combine college savings
accounts with counseling, mentoring, and other supports for
students. Therefore, the Committee directs GAO to identify and
examine the characteristics of effective local partnerships
that support low-income students in preparation for a college
education through the use of college savings accounts. GAO
shall also report on the effectiveness of these accounts on
low-income student college matriculation and retention.
Competitive Grant Priorities for Rural Areas.--The
Committee continues to encourage the Department to continue
efforts to ensure that competitive grants are reaching rural
areas and States so that support and solutions developed with
Federal funding are relevant to and available in such areas.
Department of Interior Schools.--The Committee commends the
work being done by the Departments of Education and Interior to
improve the lives of American Indian students through a quality
education. However, the Committee remains concerned by the lack
of progress in improving the long-documented issues facing
Department of Interior schools. The Committee strongly
encourages the Departments of Education and Interior to
continue to work together to improve the quality of education
opportunities offered to Indian youth.
Disclosures of Foreign Gifts and Contracts.--The Committee
is aware that concerns have been expressed about certain
contracts held by institutions of higher education and foreign
governments, such as Confucius Institutes, and their potential
to exert influence on academic institutions. The Committee
directs the Department to report to the Committees on
Appropriations of the House of Representatives and the Senate
within 180 days of enactment of this act on foreign gifts
disclosure reports received pursuant to Section 117 of the
Higher Education Act of 1965 and data on the prevalence of
Confucius Institutes that are identified in such reports.
Improving Data Available for Post-Secondary Education.--The
Committee encourages the Department to study the feasibility of
developing data systems to help increase the information
available to students and researchers about specific post-
secondary options and outcomes. Specifically, the Committee
encourages the Department to work with IES to evaluate the
feasibility of proposals to aggregate datasets, including
through secure multi-party computation systems that allow
multiple entities to link their datasets through discreet
calculations without transferring or otherwise revealing
private data to other parties. The Committee requests a report
on such evaluation within 180 days of enactment of this act.
Performance Partnerships.--The Committee recommendation
continues authority for Performance Partnerships as included in
prior appropriations acts. Performance Partnerships allow
States and localities to demonstrate better ways of improving
outcomes for disconnected youth by giving them additional
flexibility in using discretionary funds across multiple
Federal programs. The Committee also continues to encourage the
administration to enhance its efforts working with existing and
potential sites on the full range of flexibilities that could
be employed to help better serve disconnected youth. Finally,
the Committee is interested in expanding Performance
Partnerships to other populations and programs, and has
requested reports from GAO to help explore this possibility.
Pooled Evaluation Authority.--The Committee requests that
the Department provide a report to the Committee on the planned
use of pooled evaluation funds under section 8601 of the ESEA,
consistent with the required plan under such section, not later
than 15 days prior to any transfer of funds.
Reorganization Plans.--The Committee recommendation
continues all directives included in the Consolidated
Appropriations Act, 2018 and the accompanying explanatory
statement.
Technical Assistance.--The Committee is concerned about the
Department's responsiveness to technical assistance requests
and continues to note that it expects the Department to comply
in a timely manner with its requests for technical assistance
and information, consistent with past practice including timely
answers that respond to any specific inquiries.

OFFICE FOR CIVIL RIGHTS

Appropriations, 2018.................................... $117,000,000
Budget estimate, 2019................................... 107,438,000
Committee recommendation................................ 125,000,000

The Committee recommends $125,000,000 for the Office of
Civil Rights [OCR].
OCR is responsible for the enforcement of laws that
prohibit discrimination on the basis of race, color, national
origin, sex, disability, and age in all programs and
institutions that receive financial assistance from the
Department. To carry out this responsibility, OCR investigates
and resolves discrimination complaints, monitors desegregation
and equal educational opportunity plans, reviews possible
discriminatory practices by recipients of Federal education
funds, and provides technical assistance to recipients of funds
to help them meet these civil rights requirements.
The Committee directs OCR to use this appropriation to
increase its level of full time equivalent employment in order
to effectively and timely investigate complaints; execute and
accurately report the civil rights data collection; thoroughly
monitor corrective actions of institutions and meet other
critical workloads.
The Committee is aware that OCR has made a number of
changes related to its policies on processing complaints. To
understand how OCR's new policies are affecting its enforcement
of civil rights laws under its jurisdiction, the Committee
directs OCR to provide not later than 30 days after the
conclusion of each quarter, a report to the Committees on
Appropriations of the House of Representatives and Senate, the
House of Representatives Committee on Education and the
Workforce, and the Senate Committee on Health, Education,
Labor, and Pensions on all complaints opened for investigation,
closed, or resolved including: the institution level, the date
each was opened or resolved, an issue code and an issue
description, and for all complaints closed or resolved whether
the issue was closed by dismissal, insufficient evidence, or
change without an agreement.

office of inspector general

Appropriations, 2018.................................... $61,143,000
Budget estimate, 2019................................... 63,418,000
Committee recommendation................................ 61,143,000

The Committee recommends $61,143,000 for OIG.
OIG has the authority to investigate all departmental
programs and administrative activities, including those under
contract or grant, to prevent and detect fraud and abuse, and
to ensure the quality and integrity of those programs. The
Office investigates alleged misuse of Federal funds and
conducts audits to determine compliance with laws and
regulations, efficiency of operations, and effectiveness in
achieving program goals.

General Provisions

Section 301. The bill continues a provision prohibiting the
use of funds to prevent the implementation of programs of
voluntary prayer and meditation in public schools.
Section 302. The bill continues a provision giving the
Secretary authority to transfer up to 1 percent of any
discretionary funds between appropriations.
Section 303. The bill continues a provision that allows the
Republic of Palau to receive certain Federal funds.
Section 304. The bill continues a provision making
evaluation funds pooled under section 8601 of the ESEA
available for obligation from July 1, 2019 through September
30, 2020.
Section 305. The bill continues a general provision
allowing certain institutions to continue to use endowment
income for student scholarships.
Section 306. The bill continues a provision extending
authorization of the National Advisory Committee on
Institutional Quality and Integrity.
Section 307. The bill continues a provision extending
authority to provide account maintenance fees to guarantee
agencies.
Section 308. The bill includes a general provision
rescinding discretionary unobligated balances from the Pell
grant program.
Section 309. The bill modifies a provision rescinding
fiscal year 2019 mandatory funding to pay for mandatory costs
of increasing the maximum discretionary Pell award.
Sec. 310. The bill modifies a provision clarifying current
law regarding sharing data with organizations helping students
apply for financial aid.
Sec. 311. The bill continues a provision regarding Public
Service Loan Forgiveness.
Sec. 312. The bill continues a provision regarding
administrative costs for Public Service Loan Forgiveness.

TITLE IV

RELATED AGENCIES

Committee for Purchase From People Who Are Blind or Severely Disabled

SALARIES AND EXPENSES

Appropriations, 2018.................................... $8,250,000
Budget estimate, 2019................................... 8,650,000
Committee recommendation................................ 8,250,000

The Committee recommends $8,250,000 for the Committee for
Purchase from People Who Are Blind or Severely Disabled, of
which no less than $1,250,000 shall be made available for the
Office of Inspector General.
The AbilityOne Commission [Commission] program provides
approximately 45,000 blind or severely disabled Americans with
employment opportunities each year. The primary purpose of this
program is to increase the employment opportunities for people
who are blind or have other severe disabilities and, whenever
possible, to prepare them to engage in competitive employment.
Encompassing approximately $3,300,000,000 in contracts, it is
the Federal Government's largest employment program for the
severely disabled. The Committee is encouraged by the steps the
Commission has taken to address concerns regarding the
oversight of the central nonprofit agencies [CNA], the
independent contracted organizations which administer the
program. The Committee continues to direct the Commission to
provide quarterly updates, in electronic format, regarding the
Commission's oversight of the CNA.

Corporation for National and Community Service

The Corporation for National and Community Service [CNCS],
a corporation owned by the Federal Government, was established
to enhance opportunities for national and community service.
CNCS administers programs authorized under the Domestic
Volunteer Service Act, the National and Community Service Trust
Act, and the SERVE America Act. Grants are awarded to States,
public and private nonprofit organizations, and other entities
to create service opportunities for students, out-of-school
youth, adults, and seniors.
The Committee recommendation for CNCS provides a total
program level of $1,058,279,000.

OPERATING EXPENSES

Appropriations, 2018.................................... $767,629,000
Budget estimate, 2019................................... 31,689,000
Committee recommendation................................ 770,629,000

The Committee recommends $770,629,000 for the operating
expenses of CNCS.

Volunteers in Service to America [VISTA]

The Committee recommends $92,364,000 for VISTA. This
program provides capacity building for small, community-based
organizations with a mission of combating poverty. VISTA
members raise resources, recruit and organize volunteers, and
establish and expand programs in housing, employment, health,
and economic development activities.

National Senior Volunteer Corps

The Committee recommends $202,117,000 for the National
Senior Volunteer Corps programs, a collection of programs that
connect Americans older than the age of 55 with opportunities
to contribute their job skills and expertise to community
projects and organizations. These programs include the Retired
Senior Volunteer Program [RSVP], the Foster Grandparent
Program, and the Senior Companion Program.

AmeriCorps State and National Grants

The Committee recommends $415,010,000 for AmeriCorps State
and National Grants, which provide funds to local and national
organizations and agencies to address community needs in
education, public safety, health, and the environment. Each of
these organizations and agencies, in turn, uses its AmeriCorps
funding to recruit, place, and supervise AmeriCorps members.
AmeriCorps members receive a modest living allowance and other
benefits proportional to their level of time commitment.
Commission Investment Fund [CIF].--The Committee
recommendation includes no less than $8,500,000, the same as
the fiscal year 2018 level for CIF, which provides funds to
State commissions for training and technical assistance
activities to expand the capacity of current and potential
AmeriCorps programs, particularly in underserved areas.
Community Development Financial Institutions.--The
Committee notes that CNCS has developed partnerships with
several Federal agencies to help further the agency's goals and
to support targeted human capital needs of their grantees,
including partnerships with the Federal Emergency Management
Agency, the Department of Education, the Department of
Transportation, and the U.S. Forest Service. Given that
``Economic Opportunity'' is one of CNCS's five key focus areas,
the Committee encourages CNCS to engage with the Community
Development Financial Institutions [CDFI] Fund to explore
whether there may be potential opportunities for collaboration
on initiatives to support programs under the national service
laws that train and place individuals at certified CDFIs.
Fixed Amount Grants.--The Committee continues to encourage
CNCS to expand opportunities for AmeriCorps programs to utilize
fixed amount grants, which could reduce unnecessary
administrative burdens on current and potential AmeriCorps
programs. The Committee encourages CNCS to increase the current
maximum cost per member service year of fixed amount grants to
make it more comparable to cost reimbursement grant levels and
allow new AmeriCorps programs to be eligible to apply for full-
time fixed amount grants, while also ensuring that fixed amount
grantees provide a comparable amount of matching funds and that
there is sufficient oversight and accountability of fixed
amount grantees.
Professional Corps.--The Committee continues to direct CNCS
to include a determination of need by the local community among
the factors that a professional corps program may use to
demonstrate an inadequate number of professional in a
community. Further, the Committee strongly encourages CNCS to
increase the maximum amount of operating funds per member
service year a professional corps program may request as part
of their grant application. The Committee continues to direct
CNCS to provide professional corps programs flexibility in
justifying the need for operating funds to ensure that these
programs are able to provide high-quality services in all
communities.

National Civilian Community Corps [NCCC]

The Committee recommendation includes $32,000,000 for NCCC,
a full-time, team-based residential program for men and women
ages 18 to 24. Members are assigned to one of five campuses for
a 10-month service commitment.

Innovation, Demonstration, and Assistance Activities

The Committee recommendation includes $7,600,000 for
innovation, demonstration, and assistance activities.
Volunteer Generation Fund.--Within the total, the Committee
recommendation includes $5,400,000 for the Volunteer Generation
Fund authorized under section 198P of the SERVE America Act,
the same as the comparable fiscal year 2018 funding level.
National Days of Service.--The Committee recommendation
includes a total of $2,200,000, the same as the fiscal year
2018 level, for National Days of Service to include the
September 11 National Day of Service and Remembrance and the
Martin Luther King, Jr. National Day of Service, to be
allocated equally by CNCS to support these National Days of
Service.

Evaluation

The Committee recommendation includes $4,000,000 for CNCS
evaluation activities.

State Commission Grants

The Committee recommendation includes $17,538,000 for State
Commission Grants.

PAYMENT TO THE NATIONAL SERVICE TRUST

Appropriations, 2018.................................... $206,842,000
Budget estimate, 2019...................................................
Committee recommendation................................ 198,163,000

The Committee recommends an appropriation of $198,163,000
for making payments to the National Service Trust.
The National Service Trust makes payments of Segal
education awards, pays interest that accrues on qualified
student loans for AmeriCorps participants during terms of
service in approved national service positions, and makes other
payments entitled to members who serve in the programs of CNCS.
The Committee recommendation reflects the estimated funding
needed for the Trust at overall Committee recommended funding
levels for CNCS.

SALARIES AND EXPENSES

Appropriations, 2018.................................... $83,737,000
Budget estimate, 2019................................... 87,389,000
Committee recommendation................................ 83,737,000

The Committee recommends an appropriation of $83,737,000
for CNCS salaries and expenses. The salaries and expenses
appropriation provides funds for staff salaries, benefits,
travel, training, rent, equipment, and other operating expenses
necessary for management of CNCS programs and activities.

office of inspector general

Appropriations, 2018.................................... $5,750,000
Budget estimate, 2019................................... 3,568,000
Committee recommendation................................ 5,750,000

The Committee recommends an appropriation of $5,750,000 for
the CNCS OIG. The OIG's goals are to increase organizational
efficiency and effectiveness within the Corporation and to
prevent fraud, waste, and abuse.

ADMINISTRATIVE PROVISIONS

The Committee recommendation includes the following general
provisions for CNCS: requiring CNCS to make any significant
changes to program requirements or policy through rule making
(section 401); stipulating minimum share requirements (section
402); requiring that donations supplement and not supplant
operations (section 403); aligning requirements regarding the
use of Education Awards at GI bill-eligible institutions
(section 404); allowing the required background check of
certain applicants to be processed by States under terms of the
National Child Protection Act (section 405); and allowing CNCS
to establish a new 1,200 hour member service position (section
406).

Corporation for Public Broadcasting

Appropriations, 2020.................................... $445,000,000
Budget estimate, 2021...................................................
Committee recommendation, 2021.......................... 445,000,000

The Committee recommends $445,000,000 for the Corporation
for Public Broadcasting [CPB] as an advance appropriation for
fiscal year 2021.
The majority of these funds go directly to local public
television and radio stations to support their programming. CPB
funds also support the creation of content for radio,
television, and other platforms; system support activities that
benefit the entire public broadcasting community; and CPB's
administrative costs. This funding supports America's local
public television and radio stations and their mission of
developing and ensuring universal access to noncommercial,
high-quality programming and telecommunications services for
the American public.
Technology and distribution systems have greatly evolved
since Congress established the practice of funding public
broadcasting interconnection. Recognizing technology's power in
creating further cost efficiencies across the public media
system, the Committee recommendation includes $20,000,000 for
continued support of CPB in replacing and upgrading the public
broadcasting interconnection system and further investing in
system-wide infrastructure and services that benefit the
American people.

Federal Mediation and Conciliation Service

SALARIES AND EXPENSES

Appropriations, 2018.................................... $46,650,000
Budget estimate, 2019................................... 47,200,000
Committee recommendation................................ 46,650,000

The Committee recommends $46,650,000 for the Federal
Mediation and Conciliation Service [FMCS]. FMCS provides
mediation, conciliation, and arbitration services to labor and
management organizations to prevent and minimize work stoppages
and promote stable labor-management relationships. FMCS is also
authorized to provide dispute resolution consultation and
training to all Federal agencies.
Within the total, FMCS may utilize up to $900,000 for
labor-management partnership grants. These grants support
innovative approaches to collaborative labor-management
relationships to resolve potential problems, explore ways to
improve productivity, and avert serious work stoppages.

Federal Mine Safety and Health Review Commission

SALARIES AND EXPENSES

Appropriations, 2018.................................... $17,184,000
Budget estimate, 2019................................... 17,053,000
Committee recommendation................................ 17,184,000

The Committee recommends $17,184,000 for the Federal Mine
Safety and Health Review Commission [FMSHRC], which provides
administrative trial and appellate review of legal disputes
under the Federal Mine Safety and Health Act of 1977. Most
cases involve civil penalties proposed by MSHA. FMSHRC's
administrative law judges [ALJs] decide cases at the trial
level and the five-member Commission provides review of the
ALJ's decisions. The Committee directs the Federal Mine Safety
and Health Review Commission to continue providing priority to
reducing the excessive time substantive cases on appeal are
awaiting a decision.
In allocating resources and assigning staff, the Committee
directs FMSHRC to provide priority to reducing the excessive
time substantive cases on appeal are awaiting a decision. The
Committee requests that FMSHRC describe in its fiscal year 2020
CJ the steps it is taking to reduce pendency of such cases.

Institute of Museum and Library Services

OFFICE OF MUSEUM AND LIBRARIES: GRANTS AND ADMINISTRATION

Appropriations, 2018.................................... $240,000,000
Budget estimate, 2019................................... 23,000,000
Committee recommendation................................ 242,000,000

The Committee recommends $242,000,000, an increase of
$2,000,000, for the Institute of Museum and Library Services.
This agency supports programs for museums and libraries that
encourage innovation, provide lifelong learning opportunities,
promote cultural and civic engagement, and improve access to a
variety of services and information.
Within the total for IMLS, the Committee recommendation
includes the amounts below:

Museum Services Act:
Museums for America............. 22,899,000 22,899,000
Native American/Hawaiian Museum 1,472,000 1,472,000
Services.......................
National Leadership: Museums.... 8,113,000 8,113,000
-----------------------------------
Subtotal, MSA............... 32,484,000 32,484,000

African American History and Culture 2,231,000 2,231,000
Act................................
Administration...................... 14,000,000 15,000,000
Research, Analysis and Data 2,013,000 3,013,000
Collection.........................
IMLS, Total................. 240,000,000 242,000,000
------------------------------------------------------------------------

Research, Analysis and Data Collection.--The Committee
recommends an increase of $1,000,000, for additional agency
staffing needs to continue the ongoing effort to measure the
effectiveness of museums and libraries. Furthermore, the
Committee recommends IMLS identify indicators and outcomes that
enhance efficiency and efficacy as well as promote advancement
and growth by sharing best practices and effective strategies.

Medicaid and CHIP Payment and Access Commission

SALARIES AND EXPENSES

Appropriations, 2018.................................... $8,480,000
Budget estimate, 2019................................... 8,480,000
Committee recommendation................................ 8,480,000

The Committee recommends $8,480,000 for the Medicaid and
CHIP Payment and Access Commission [MACPAC]. This commission
was established in the Children's Health Insurance Program
Reauthorization Act of 2009 and is tasked with reviewing State
and Federal Medicaid and Children's Health Insurance Program
access and payment policies and making recommendations to
Congress, the Secretary of HHS, and the States on a wide range
of issues affecting those programs. The Committee
recommendation will allow MACPAC to continue to carry out these
activities.

Medicare Payment Advisory Commission

SALARIES AND EXPENSES

Appropriations, 2018.................................... $12,545,000
Budget estimate, 2019................................... 12,545,000
Committee recommendation................................ 12,545,000

The Committee recommends $12,545,000 for the Medicare
Payment Advisory Commission [MedPAC], which provides
independent policy and technical advice on issues affecting the
Medicare program.

National Council on Disability

SALARIES AND EXPENSES

Appropriations, 2018.................................... $3,250,000
Budget estimate, 2019................................... 3,211,000
Committee recommendation................................ 3,250,000

The Committee recommends $3,250,000 for the National
Council on Disability [NCD]. NCD is mandated to make
recommendations to the President, Congress, the Rehabilitation
Services Administration, and the National Institute on
Disability and Rehabilitation Research on issues of concern to
individuals with disabilities. The Council gathers information
on the implementation, effectiveness, and impact of the
Americans with Disabilities Act and examines emerging policy
issues as they affect persons with disabilities and their
ability to enter or re-enter the Nation's workforce and to live
independently.

National Labor Relations Board

SALARIES AND EXPENSES

Appropriations, 2018.................................... $274,224,000
Budget estimate, 2019................................... 249,000,000
Committee recommendation................................ 274,224,000

The Committee recommends $274,224,000 for the National
Labor Relations Board, which administers and enforces the
National Labor Relations Act and protects employee and employer
rights provided under that act.

ADMINISTRATIVE PROVISIONS

The Committee maintains language restricting the use of
electronic voting (section 407).

National Mediation Board

SALARIES AND EXPENSES

Appropriations, 2018.................................... $13,800,000
Budget estimate, 2019................................... 13,205,000
Committee recommendation................................ 13,800,000

The Committee recommends $13,800,000 for the National
Mediation Board [NMB], which mediates labor-management
relations in the railroad and airline industries under the
Railway Labor Act. The NMB mediates collective bargaining
disputes, conducts elections to determine the choice of
employee bargaining representatives, and administers
arbitration of employee grievances.

Occupational Safety and Health Review Commission

SALARIES AND EXPENSES

Appropriations, 2018.................................... $13,225,000
Budget estimate, 2019................................... 12,615,000
Committee recommendation................................ 13,225,000

The Committee recommends $13,225,000 for the Occupational
Safety and Health Review Commission [OSHRC]. OSHRC serves as a
court to resolve disputes between OSHA and employers charged
with violations of health and safety standards enforced by
OSHA.

Railroad Retirement Board

The Railroad Retirement Board [RRB] administers the
retirement/survivor and unemployment/sickness insurance benefit
programs for railroad workers and their families under the
Railroad Retirement Act and Railroad Unemployment Insurance
Act.

DUAL BENEFITS PAYMENTS ACCOUNT

Appropriations, 2018.................................... $22,000,000
Budget estimate, 2019................................... 19,000,000
Committee recommendation................................ 19,000,000

The Committee recommends $19,000,000 for the Dual Benefits
Payments Account. This amount includes an estimated $1,000,000
derived from income taxes on vested dual benefits. This
appropriation provides for vested dual benefit payments to
beneficiaries covered under both the railroad retirement and
Social Security systems.

FEDERAL PAYMENTS TO THE RAILROAD RETIREMENT ACCOUNTS

Appropriations, 2018.................................... $150,000
Budget estimate, 2019................................... 150,000
Committee recommendation................................ 150,000

The Committee recommends $150,000 for Federal Payments to
the Railroad Retirement Account. These funds reimburse the
railroad retirement trust funds for interest earned on non-
negotiated checks.

LIMITATION ON ADMINISTRATION

Appropriations, 2018.................................... $123,500,000
Budget estimate, 2019................................... 115,225,000
Committee recommendation................................ 123,500,000

The Committee recommends $123,500,000 for RRB's costs
associated with the administration of railroad retirement/
survivor and unemployment/sickness benefit programs. This
account limits the amount of funds in the railroad retirement
and railroad unemployment insurance trust funds that may be
used by the Board for administrative expenses.
In fiscal year 2018, the Committee provided $10,000,000
within the Limitation on Administration account for the
implementation of information technology systems modernization
efforts. The Committee is again providing $10,000,000 in this
fiscal year 2019 account for this purpose. The Committee looks
forward to a comprehensive update on the project status,
timelines to completion, and the total anticipated cost of
development from the RRB and quarterly updates, beginning with
the fiscal year 2018 reporting requirement, until project
completion.
The Committee maintains bill language giving RRB the
authority to hire new attorneys in the excepted service.

limitation on the office of the inspector general

Appropriations, 2018.................................... $11,000,000
Budget estimate, 2019................................... 8,437,000
Committee recommendation................................ 11,000,000

The Committee recommends $11,000,000 for the RRB OIG. This
Office conducts audits and investigations to protect the
integrity of the RRB trust funds and provides comprehensive
oversight of all RRB operations and programs.

Social Security Administration

PAYMENTS TO SOCIAL SECURITY TRUST FUNDS

Appropriations, 2018.................................... $11,400,000
Budget estimate, 2019................................... 11,000,000
Committee recommendation................................ 11,000,000

The Committee recommends $11,000,000 in mandatory funds for
payments to Social Security trust funds. This account
reimburses the Old Age and Survivors Insurance [OASI] and
Disability Insurance [DI] trust funds for special payments to
certain uninsured persons, costs incurred administering pension
reform activities, and the value of the interest for benefit
checks issued but not negotiated. This appropriation restores
the trust funds to the same financial position they would have
been in had they not borne these costs and they were properly
charged to general revenues.

SUPPLEMENTAL SECURITY INCOME PROGRAM

Appropriations, 2018.................................... $38,487,277,000
Budget estimate, 2019................................... 41,208,000,000
Committee recommendation................................ 41,390,721,000

The Committee recommends $41,390,721,000 in fiscal year
2019 mandatory funds for the SSI program. This is in addition
to the $19,500,000,000 provided in the fiscal year 2018
appropriations act for the first quarter of fiscal year 2019.
In addition, the Committee recommends $19,700,000,000 in
advance funding for the first quarter of fiscal year 2020. The
SSI program guarantees a minimum level of income to individuals
who are disabled, blind, or older than age 65, and meet certain
income and resource limitations.

Federal Benefit Payments

The Committee recommendation includes a fiscal year 2019
program level of $55,716,000,000 for Federal benefit payments.
This will support an average monthly benefit of approximately
$577 for 8,000,000 recipients.

Beneficiary Services

The Committee recommendation includes $126,000,000 in new
mandatory budget authority for beneficiary services.
These funds reimburse vocational rehabilitation [VR]
agencies for successfully rehabilitating disabled SSI
recipients by helping them achieve and sustain productive,
self-supporting work activity. Funds also support the Ticket to
Work program that provides SSI recipients with a ticket to
offer employment networks [ENs], including VR agencies, in
exchange for employment and support services. Instead of
reimbursing ENs for specific services, the Ticket to Work
program pays ENs based on recipients achieving certain
milestones and outcomes.

Research and Demonstration

The Committee recommendation includes $101,000,000 in
mandatory funds for research and demonstration projects
conducted under sections 1110, 1115, and 1144 of the Social
Security Act. These funds support a variety of research and
demonstration projects designed to improve the disability
process, promote self-sufficiency and assist individuals in
returning to work, encourage savings and retirement planning
through financial literacy, and generally provide analytical
and data resources for use in preparing and reviewing policy
proposals.

Administrative Expenses

The Committee recommendation includes $4,947,721,000 for
SSI program administrative expenses. This appropriation funds
the SSI program's share of administrative expenses incurred
through the Limitation on Administrative Expenses [LAE]
account.

LIMITATION ON ADMINISTRATIVE EXPENSES

Appropriations, 2018.................................... $12,868,945,000
Budget estimate, 2019................................... 12,387,000,000
Committee recommendation................................ 12,945,945,000

This account provides resources for SSA to administer the
OASI, DI, and SSI programs, and to support CMS in administering
the Medicare program. The LAE account is funded by the Social
Security and Medicare trust funds for their share of
administrative expenses, the general fund for the SSI program's
share of administrative expenses, and applicable user fees.
These funds support core administrative activities including
processing retirement and disability claims, conducting
hearings to review disability determination appeals, issuing
Social Security numbers and cards, processing individuals'
annual earnings information, and ensuring the integrity of
Social Security programs through continuing disability reviews
[CDR] and SSI redeterminations of non-medical eligibility.
The Committee recommendation includes $1,683,000,000 for
program integrity activities, including CDRs, SSI
redeterminations of non-medical eligibility, and Cooperative
Disability Investigations units. This includes $273,000,000 in
base funding and $1,410,000,000 in cap adjustment funding
allowed under the Budget Control Act [BCA]. The Committee
recommendation is a $52,000,000 decrease from the fiscal year
2018 funding level, as specified in the BCA. Combined, these
activities are estimated to save approximately $9,131,000,000
over 10 years for the Social Security, Medicare, and Medicaid
programs by preventing waste, fraud, abuse, and improper
payments.
ABLE Act.--The Achieving a Better Life Experience Act [ABLE
Act] allows individuals and families to save for the purpose of
supporting individuals with disabilities in maintaining their
health, independence, and quality of life. The Committee
encourages SSA to continue to conduct outreach and disseminate
eligibility and benefit information on ABLE accounts. In
addition, the Committee supports efforts led by IRS and in
coordination with SSA and other agencies to disseminate
information on the eligibility and benefits of these accounts.
The Committee further encourages SSA to build relationships
with other agencies and government entities that support
individuals living with a disability to raise awareness,
understanding, and usage of ABLE accounts.
Continuing Disability Reviews.--The Committee notes that
SSA, as a result of directives included in the fiscal year 2017
Consolidated Appropriations Act, is in the process of reviewing
and updating its CDR prioritization models. The Committee looks
forward to an update on the results of this assessment in the
next CDR Report to Congress.
Consultative Examinations.--The Committee encourages SSA to
evaluate the feasibility and potential administrative savings
and program improvements from using competitively awarded
multi-state contracts for Consultative Exams [CEs]. Such
contracts could standardize policies, and reduce overhead by
requiring a vendor to manage scheduling, credentialing,
recruitment and training of CEs, and provide certain quality
assurances. The Committee encourages SSA to work with State
Disability Determination Services to encourage them, to the
extent practicable, to pilot such a contract.
Disability Hearings Backlog.--The Committee recommendation
includes $100,000,000, the same as the fiscal year 2018 level,
in dedicated funding for processing the backlog of disability
hearings. The Committee strongly encourages SSA to work with
ALJs and other stakeholders to evaluate and implement changes,
as appropriate, to streamline and improve the efficiency of the
disability adjudication process while maintaining the integrity
of disability programs. The Committee directs SSA to submit a
report within 90 days of enactment to the Committees on
Appropriations of the House of Representatives and the Senate
on potential administrative changes SSA has taken and could
take to streamline the disability determination and
adjudication process. This could include centralizing
administrative work and reorganizing management structures to
focus more staff on frontline workloads; reviewing the
Hearings, Appeals, and Litigation Law Manual for changes to
improve the efficiency or effectiveness of the hearing process;
establishing procedural rules for hearings (while preserving
the non-adversarial manner of hearings and ensuring that
unrepresented claimants are not disadvantaged); establishing a
list of specialists and medical personnel which can be
consulted by ALJs when they need access to medical experts;
issuing Social Security Rulings that lists common combination
of limitations for which work exists in the economy; and
assigning law clerks or clerical employees to specific ALJs to
reduce the number of clerical tasks that Judges are currently
required to perform.
Field Office Closures.--There remains concern about
decisions to close field offices that may not be in accordance
with law, regulations and SSA procedures. While the SSA's
Inspector General [IG] reviews decisions to close field
offices, the Acting Commissioner is directed to take every
action possible to maintain operations at the offices under
review. SSA is directed to provide the Senate Appropriations
Committee a response to IG field office reviews within 45 days
of the release of the IG report, addressing any recommendations
and coordinating with the General Services Administration when
appropriate.
Medical Vocational Guidelines.--The Committee notes that
SSA is in the process of updating its medical vocational
guidelines, and in 2018 will complete the third year of
production data collection, and begin collecting the first year
of a planned and ongoing five-year refresh cycle. The Committee
directs SSA to include information in future budget
justifications on its ongoing efforts to improve its medical
vocational guidelines.
Muscular Dystrophy.--The Committee continues to note that
SSA is included in the Muscular Dystrophy Coordinating
Committee under the Muscular Dystrophy CARE Act and continues
to expect SSA make data available on the rate at which persons
with Duchenne and Becker Muscular Dystrophy utilize SSA
programs, particularly those focused on promoting employment
and community independence such as the Ticket to Work program.
Vocational Experts.--The Committee directs the Acting
Commissioner to provide an update within 45 days of enactment
on SSA's plans for developing a market-based approach for
acquiring vocational expert testimony, including the status of
the report requested in the Explanatory Statement accompanying
the Consolidated Appropriations Act, 2018. The update should
address proposed scope and timeline for any planned
solicitations.
Social Security Advisory Board.--The Committee
recommendation includes not less than $2,300,000 for the Social
Security Advisory Board. This board advises the Commissioner of
Social Security and makes recommendations to Congress and the
President on policies relating to the OASI, DI, and SSI
programs.
User Fees.--Within the total for LAE, the Committee
recommendation includes up to $135,000,000 for administrative
activities funded from user fees. This includes up to
$134,000,000 in fees collected from States that request SSA to
administer State SSI supplementary payments and up to
$1,000,000 from fees collected from non-attorney claimant
representatives.
Work Incentives Planning and Assistance [WIPA] and
Protection and Advocacy for Beneficiaries of Social Security
[PABSS].--The Committee recommendation includes $23,000,000 for
WIPA and $7,000,000 for PABSS, the same as the comparable
fiscal year 2018 levels, respectively. These programs provide
valuable services to help Social Security disability
beneficiaries return to work.

office of inspector general

Appropriations, 2018.................................... $105,500,000
Budget estimate, 2019................................... 105,500,000
Committee recommendation................................ 105,500,000

The Committee recommends $105,500,000 for SSA's OIG. This
includes $75,500,000 funded from the OASI and DI trust funds
for those programs' share of OIG's expenses and $30,000,000
funded from general revenues for the SSI program's share of
expenses.

TITLE V

GENERAL PROVISIONS

Section 501. The bill continues a provision authorizing
transfers of unexpended balances.
Section 502. The bill continues a provision limiting
funding to 1-year availability unless otherwise specified.
Section 503. The bill continues a provision limiting
lobbying and related activities.
Section 504. The bill continues a provision limiting
official representation expenses.
Section 505. The bill continues a provision clarifying
Federal funding as a component of State and local grant funds.
Sections 506 and 507. The bill continues provisions
limiting the use of funds for abortion.
Section 508. The bill continues a provision restricting
human embryo research.
Section 509. The bill continues a provision limiting the
use of funds for promotion of legalization of controlled
substances.
Section 510. The bill continues a provision prohibiting the
use of funds to promulgate regulations regarding the individual
health identifier.
Section 511. The bill continues a provision limiting the
use of funds to enter into or review contracts with entities
subject to the requirement in section 4212(d) of title 38,
United States Code, if the report required by that section has
not been submitted.
Section 512. The bill continues a provision prohibiting the
transfer of funds made available in this act to any department,
agency, or instrumentality of the U.S. Government, except as
otherwise provided by this or any other act.
Section 513. The bill continues a provision prohibiting
Federal funding in this act for libraries unless they are in
compliance with the Children's Internet Protection Act.
Section 514. The bill continues a provision maintaining a
procedure for reprogramming of funds.
Section 515. The bill continues a provision prohibiting
candidates for scientific advisory committees from having to
disclose their political activities.
Section 516. The bill continues a provision requiring each
department and related agency to submit an operating plan.
Section 517. The bill continues a provision requiring the
Secretaries of Labor, Health and Human Services, and Education
to submit a report on the number and amounts of contracts,
grants, and cooperative agreements awarded by the Departments
on a noncompetitive basis.
Section 518. The bill continues a provision prohibiting SSA
from processing earnings for work performed under a fraudulent
social security number if based on a conviction for a violation
under section 208(a)(6) or (7) of the Social Security Act.
Section 519. The bill continues a provision prohibiting SSA
from establishing a totalization agreement with Mexico.
Section 520. The bill continues a provision regarding
funding for programs that carry out distribution of sterile
needles or syringes.
Section 521. The bill continues a provision requiring
computer networks to block pornography.
Section 522. The bill continues a provision prohibiting
funding from going to the Association of Community
Organizations for Reform Now [ACORN], or any of its affiliates,
subsidiaries, allied organizations, or successors.
Section 523. The bill continues a provision related to
reporting requirements for conference spending.
Section 524. The bill continues a provision related to
advertisement costs.
Section 525. The bill continues a provision on Performance
Partnerships.
Section 526. The bill modifies a provision regarding
reporting status of balances of appropriations.
Section 527. The bill modifies a provision rescinding funds
from the Children's Health Insurance Program State allotments.
Section 528. The bill modifies a provision rescinding funds
from the Children's Health Insurance Program child enrollment
contingency fund.

COMPLIANCE WITH PARAGRAPH 7, RULE XVI, OF THE STANDING RULES OF THE
SENATE

Paragraph 7 of rule XVI requires that Committee reports on
general appropriations bills identify each Committee amendment
to the House bill ``which proposes an item of appropriation
which is not made to carry out the provisions of an existing
law, a treaty stipulation, or an act or resolution previously
passed by the Senate during that session.''
The Committee is filing an original bill, which is not
covered under this rule, but reports this information in the
spirit of full disclosure.
The Committee recommends funding for the following programs
and activities which currently lack authorization: Institute of
Education Sciences; parts C and D of the Individuals with
Disabilities Education Act; Nurse Education Loan Repayment;
Education and Training Related to Geriatrics; Mental and
Behavioral Health Training; Children's Hospital Graduate
Medical Education; Title XVII of the PHS Act; Ryan White CARE
Act; Universal Newborn Hearing Screening; Organ
Transplantation; Family Planning; Rural Health programs;
Traumatic Brain Injury programs; Autism Collaboration,
Accountability, Research, Education, and Support Act; Public
Health Improvement Act; Healthy Start; Telehealth; Health
Professions Education Partnership Act; Children's Health Act;
Women's Health Research and Prevention Amendments of 1998;
Birth Defects Prevention, Preventive Health Amendments of 1993;
Substance Abuse and Mental Health Services programs; Low Income
Home Energy Assistance Program; Refugee and Entrant Assistance
programs (except for Victims of Trafficking); Head Start;
Runaway and Homeless Youth programs; Adoption Incentives;
Developmental Disabilities programs; Voting Access for
Individuals with Disabilities; Native American Programs;
Community Services Block Grant Act programs; National
Institutes of Health; Assets for Independence; Alzheimer's
Disease Demonstration Grants; Office of Disease Prevention and
Health Promotion; YouthBuild Transfer Act; Assistive Technology
Act; Carl D. Perkins Career and Technical Education Improvement
Act; Corporation for Public Broadcasting; National Council on
Disability; Older Americans Act; Second Chance Act; Work
Incentive Planning and Assistance; and Protection and Advocacy
for Beneficiaries of Social Security.

COMPLIANCE WITH PARAGRAPH 7(c), RULE XXVI OF THE STANDING RULES OF THE
SENATE

Pursuant to paragraph 7(c) of rule XXVI, on June 28, 2018,
the Committee ordered favorably reported an original bill (S.
3158) making appropriations for the Departments of Labor,
Health and Human Services, and Education, and related agencies
for the fiscal year ending September 30, 2019, and for other
purposes, provided, that the bill be subject to amendment and
that the bill be consistent with its budget allocation, and
provided that the Chairman of the Committee or his designee be
authorized to offer the substance of the original bill as a
Committee amendment in the nature of a substitute to the House
companion measure, by a recorded vote of 30-1, a quorum being
present. The vote was as follows:
Yeas Nays
Chairman Shelby Mr. Lankford
Mr. McConnell
Mr. Alexander
Ms. Collins
Ms. Murkowski
Mr. Graham
Mr. Blunt
Mr. Moran
Mr. Hoeven
Mr. Boozman
Mrs. Capito
Mr. Daines
Mr. Kennedy
Mr. Rubio
Mrs. Hyde-Smith
Mr. Leahy
Mrs. Murray
Mrs. Feinstein
Mr. Durbin
Mr. Reed
Mr. Tester
Mr. Udall
Mrs. Shaheen
Mr. Merkley
Mr. Coons
Mr. Schatz
Ms. Baldwin
Mr. Murphy
Mr. Manchin
Mr. Van Hollen

COMPLIANCE WITH PARAGRAPH 12, RULE XXVI OF THE STANDING RULES OF THE
SENATE

Paragraph 12 of rule XXVI requires that Committee reports
on a bill or a joint resolution repealing or amending any
statute include ``(a) the text of the statute or part thereof
which is proposed to be repealed; and (b) a comparative print
of that part of the bill or joint resolution making the
amendment and of the statute or part thereof proposed to be
amended, showing by stricken through type and italics, parallel
columns, or other appropriate typographical devices the
omissions and insertions which would be made by the bill or
joint resolution if enacted in the form recommended by the
committee.''
In compliance with this rule, changes in existing law
proposed to be made by the bill are shown as follows: existing
law to be omitted is enclosed in black brackets; new matter is
printed in italic; and existing law in which no change is
proposed is shown in roman.

TITLE 20--EDUCATION

CHAPTER 28--HIGHER EDUCATION RESOURCES AND STUDENT ASSISTANCE

SUBCHAPTER I--GENERAL PROVISIONS

Part B--Additional General Provisions

Sec. 1011c. National Advisory Committee on Institutional Quality and
Integrity

(a) Establishment

* * * * * * *

(f) Termination

The Committee shall terminate on September 30, [2018] 2019.

* * * * * * *

SUBCHAPTER IV--STUDENT ASSISTANCE

Part A--Grants to Students in Attendance at Institutions of Higher
Education

SUBPART 1--FEDERAL PELL GRANTS

Sec. 1070a. Federal Pell Grants: amount and determinations;
applications

(a) Program authority and method of distribution

* * * * * * *

(b) Purpose and amount of grants

(1) * * *

(7) Additional funds.--

(A) In general.--* * *

(i) * * *

* * * * * * *

(iv) to carry out this section--

(I) * * *

* * * * * * *

(IX) [$1,409,000,000]
$1,370,000,000 for fiscal year 2019;

* * * * * * *

Part C--William D. Ford Federal Direct Loan Program

Sec. 1087h. Funds for administrative expenses

(a) Program authority and method of distribution

(1) Mandatory funds for fiscal year 2006

* * * * * * *

(4) Continuing mandatory funds for account maintenance fees

For each of the fiscal years 2007 through [2018] 2019,
there shall be available to the Secretary, from funds not
otherwise appropriated, funds to be obligated for account
maintenance fees payable to guaranty agencies under part B and
calculated in accordance with subsection (b).
------

BUDGETARY IMPACT OF BILL

PREPARED IN CONSULTATION WITH THE CONGRESSIONAL BUDGET OFFICE PURSUANT TO SEC. 308(A), PUBLIC LAW 93-344, AS
AMENDED
[In millions of dollars]
----------------------------------------------------------------------------------------------------------------
Budget authority Outlays
---------------------------------------------------
Committee Amount in Committee Amount in
allocation bill allocation bill
----------------------------------------------------------------------------------------------------------------
Comparison of amounts in the bill with the subcommittee
allocation for 2019: Subcommittee on Labor, HHS, Education,
and Related Agencies:
Mandatory............................................... 783,118 783,118 782,757 \1\782,757
Discretionary........................................... 179,289 181,186 184,249 \1\185,822
Security............................................ ........... ........... NA NA
Nonsecurity......................................... 179,289 181,186 NA NA
Projections of outlays associated with the recommendation:
2019.................................................... ........... ........... ........... \2\859,720
2020.................................................... ........... ........... ........... 81,262
2021.................................................... ........... ........... ........... 22,003
2022.................................................... ........... ........... ........... 3,714
2023 and future years................................... ........... ........... ........... 1,272
Financial assistance to State and local governments for NA 482,130 NA \2\434,966
P2019......................................................

----------------------------------------------------------------------------------------------------------------
\1\Includes outlays from prior-year budget authority.
\2\Excludes outlays from prior-year budget authority.

NA: Not applicable.

NOTE.--Consistent with the funding recommended in the bill for continuing disability reviews and
redeterminations, for healthcare fraud and abuse control, and for reemployment services and eligibility
assessments and in accordance with subparagraphs (B), (C), and (E) of section 251(b)(2) of the BBEDCA of 1985,
the Committee anticipates that the Budget Committee will provide, at the appropriate time, a 302(a) allocation
for the Committee on Appropriations reflecting an upward adjustment of $1,897,000,000 in budget authority plus
associated outlays. Also, pursuant to section 1001(b)(3)(B) of the 21st Century Cures Act (Public Law 114-
255), $711,000,000 in budget authority and the resulting outlays do not count for the purposes of estimates
under the Congressional Budget and Impoundment Control Act of 1974 or the Balanced Budget and Emergency
Deficit Control Act of 1985.

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2018 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL FOR FISCAL
YEAR 2019
[In thousands of dollars]
--------------------------------------------------------------------------------------------------------------------------------------------------------
Senate Committee recommendation
compared with (+ or -)
Item 2018 Budget estimate Committee -----------------------------------
appropriation recommendation 2018
appropriation Budget estimate
--------------------------------------------------------------------------------------------------------------------------------------------------------
TITLE I--DEPARTMENT OF LABOR

EMPLOYMENT AND TRAINING ADMINISTRATION

Training and Employment Services

Grants to States:
Adult Training, current year.............................. 133,556 103,556 133,556 ................ +30,000
Advance from prior year............................... (712,000) (712,000) (712,000) ................ ................
Fiscal year 2020...................................... 712,000 712,000 712,000 ................ ................
-----------------------------------------------------------------------------------------
Subtotal............................................ 845,556 815,556 845,556 ................ +30,000

Youth Training............................................ 903,416 873,416 903,416 ................ +30,000
Dislocated Worker Assistance, current year................ 180,860 160,860 180,860 ................ +20,000
Advance from prior year............................... (860,000) (860,000) (860,000) ................ ................
Fiscal year 2020...................................... 860,000 860,000 860,000 ................ ................
-----------------------------------------------------------------------------------------
Subtotal............................................ 1,040,860 1,020,860 1,040,860 ................ +20,000
-----------------------------------------------------------------------------------------
Subtotal, Grants to States.............................. 2,789,832 2,709,832 2,789,832 ................ +80,000

Current year...................................... (1,217,832) (1,137,832) (1,217,832) ................ (+80,000)
Fiscal year 2020.................................. (1,572,000) (1,572,000) (1,572,000) ................ ................

National Programs:
Dislocated Worker Assistance National Reserve:
Current year.......................................... 20,859 20,859 20,859 ................ ................
Advance from prior year............................... (200,000) (200,000) (200,000) ................ ................
Fiscal year 2020...................................... 200,000 125,000 200,000 ................ +75,000
-----------------------------------------------------------------------------------------
Subtotal............................................ 220,859 145,859 220,859 ................ +75,000
-----------------------------------------------------------------------------------------
Subtotal, Dislocated Worker Assistance.................. 1,261,719 1,166,719 1,261,719 ................ +95,000

Native American programs.................................. 54,000 ................ 54,000 ................ +54,000
Migrant and Seasonal Farmworker programs.................. 87,896 ................ 87,896 ................ +87,896
YouthBuild activities..................................... 89,534 84,534 89,534 ................ +5,000
Technical assistance...................................... ................ 2,000 ................ ................ -2,000
Reintegration of Ex-Offenders............................. 93,079 78,324 93,079 ................ +14,755
Workforce Data Quality Initiative......................... 6,000 ................ 6,000 ................ +6,000
Apprenticeship programs................................... 145,000 200,000 160,000 +15,000 -40,000
-----------------------------------------------------------------------------------------
Total, National Programs................................ 696,368 510,717 711,368 +15,000 +200,651

Current year........................................ (496,368) (385,717) (511,368) (+15,000) (+125,651)
Fiscal year 2020.................................... (200,000) (125,000) (200,000) ................ (+75,000)
=========================================================================================
Total, Training and Employment Services [TES]........... 3,486,200 3,220,549 3,501,200 +15,000 +280,651

Current year........................................ (1,714,200) (1,523,549) (1,729,200) (+15,000) (+205,651)
Fiscal year 2020.................................... (1,772,000) (1,697,000) (1,772,000) ................ (+75,000)
=========================================================================================
Job Corps

Operations.................................................... 1,603,325 1,189,812 1,603,325 ................ +413,513
Construction, Rehabilitation and Acquisition.................. 83,000 75,016 83,000 ................ +7,984
Administration................................................ 32,330 32,110 32,330 ................ +220
-----------------------------------------------------------------------------------------
Total, Job Corps........................................ 1,718,655 1,296,938 1,718,655 ................ +421,717

Current Year........................................ (1,718,655) (1,296,938) (1,718,655) ................ (+421,717)
=========================================================================================
Community Service Employment For Older Americans.............. 400,000 ................ 400,000 ................ +400,000
Federal Unemployment Benefits and Allowances (indefinite)..... 790,000 790,000 790,000 ................ ................

State Unemployment Insurance and Employment Service Operations

Unemployment Compensation [UI]:
State Operations.......................................... 2,510,600 2,356,816 2,356,816 -153,784 ................
Reemployment eligibility assessments--UI integrity........ 120,000 130,000 150,000 +30,000 +20,000
UI Integrity Center of Excellence......................... 9,000 6,000 9,000 ................ +3,000
-----------------------------------------------------------------------------------------
Subtotal, Unemployment Compensation..................... 2,639,600 2,492,816 2,515,816 -123,784 +23,000

Federal-State UI National Activities...................... 13,897 12,000 12,000 -1,897 ................

Employment Service [ES]:
Grants to States:
Federal Funds......................................... 21,413 21,413 21,413 ................ ................
Trust Funds........................................... 645,000 650,000 645,000 ................ -5,000
-----------------------------------------------------------------------------------------
Subtotal, Grants to States.......................... 666,413 671,413 666,413 ................ -5,000

ES National Activities.................................... 19,818 19,683 19,818 ................ +135
-----------------------------------------------------------------------------------------
Subtotal, Employment Service............................ 686,231 691,096 686,231 ................ -4,865

Federal Funds................................. (21,413) (21,413) (21,413) ................ ................
Trust Funds................................... (664,818) (669,683) (664,818) ................ (-4,865)

Foreign Labor Certifications and Related Activities:
Federal Administration.................................... 48,028 47,937 48,028 ................ +91
Grants to States.......................................... 14,282 14,255 14,282 ................ +27
-----------------------------------------------------------------------------------------
Subtotal, Foreign Labor Certification................... 62,310 62,192 62,310 ................ +118

One-Stop Career Centers/Labor Market Information.............. 62,653 67,194 62,653 ................ -4,541
-----------------------------------------------------------------------------------------
Total, State UI and ES.................................. 3,464,691 3,325,298 3,339,010 -125,681 +13,712

Federal Funds....................................... (84,066) (88,607) (84,066) ................ (-4,541)
Trust Funds......................................... (3,380,625) (3,236,691) (3,254,944) (-125,681) (+18,253)
=========================================================================================
Program Administration

Training and Employment....................................... 62,040 59,744 62,040 ................ +2,296
Trust Funds............................................... 8,639 8,580 8,639 ................ +59
Employment Security........................................... 3,440 2,184 3,440 ................ +1,256
Trust Funds............................................... 39,264 38,997 39,264 ................ +267
Apprenticeship Services....................................... 36,160 35,914 36,160 ................ +246
Executive Direction........................................... 7,034 6,781 7,034 ................ +253
Trust Funds............................................... 2,079 2,065 2,079 ................ +14
-----------------------------------------------------------------------------------------
Total, Program Administration........................... 158,656 154,265 158,656 ................ +4,391

Federal Funds....................................... (108,674) (104,623) (108,674) ................ (+4,051)
Trust Funds......................................... (49,982) (49,642) (49,982) ................ (+340)
=========================================================================================
Total, Employment and Training Administration........... 10,018,202 8,787,050 9,907,521 -110,681 +1,120,471

Federal Funds....................................... 6,587,595 5,500,717 6,602,595 +15,000 +1,101,878
Current year.................................. (4,815,595) (3,803,717) (4,830,595) (+15,000) (+1,026,878)
Fiscal year 2020.............................. (1,772,000) (1,697,000) (1,772,000) ................ (+75,000)
Trust Funds......................................... 3,430,607 3,286,333 3,304,926 -125,681 +18,593
=========================================================================================
EMPLOYEE BENEFITS SECURITY ADMINISTRATION [EBSA]

Salaries and Expenses

Enforcement and Participant Assistance........................ 147,400 154,813 152,900 +5,500 -1,913
Policy and Compliance Assistance.............................. 26,901 28,033 26,901 ................ -1,132
Executive Leadership, Program Oversight and Administration.... 6,699 6,654 6,699 ................ +45
-----------------------------------------------------------------------------------------
Total, EBSA............................................. 181,000 189,500 186,500 +5,500 -3,000
=========================================================================================
PENSION BENEFIT GUARANTY CORPORATION (PBGC)

Pension Benefit Guaranty Corporation Fund

Consolidated Administrative budget............................ (424,417) (445,363) (445,363) (+20,946) ................
WAGE AND HOUR DIVISION, Salaries and Expenses................. 227,500 230,068 229,000 +1,500 -1,068
OFFICE OF LABOR-MANAGEMENT STANDARDS, Salaries and Expenses... 40,187 46,634 40,187 ................ -6,447
OFFICE OF FEDERAL CONTRACT COMPLIANCE PROGRAMS, Salaries and 103,476 91,100 103,476 ................ +12,376
Expenses.....................................................

OFFICE OF WORKERS' COMPENSATION PROGRAMS

Salaries and Expenses......................................... 115,424 113,109 115,424 ................ +2,315
Trust Funds............................................... 2,177 2,173 2,177 ................ +4
-----------------------------------------------------------------------------------------
Total, Salaries and Expenses............................ 117,601 115,282 117,601 ................ +2,319

Federal Funds....................................... (115,424) (113,109) (115,424) ................ (+2,315)
Trust Funds......................................... (2,177) (2,173) (2,177) ................ (+4)
=========================================================================================
Special Benefits

Federal Employees' Compensation Benefits...................... 217,000 227,000 227,000 +10,000 ................
Longshore and Harbor Workers' Benefits........................ 3,000 3,000 3,000 ................ ................
-----------------------------------------------------------------------------------------
Total, Special Benefits................................. 220,000 230,000 230,000 +10,000 ................
=========================================================================================
Special Benefits for Disabled Coal Miners

Benefit Payments.............................................. 65,000 20,000 20,000 -45,000 ................
Administration................................................ 5,319 5,319 5,319 ................ ................
-----------------------------------------------------------------------------------------
Subtotal, Fiscal year 2019 program level................ 70,319 25,319 25,319 -45,000 ................

Less funds advanced in prior year..................... -16,000 -15,000 -15,000 +1,000 ................
-----------------------------------------------------------------------------------------
Total, Current Year................................. 54,319 10,319 10,319 -44,000 ................

New advances, 1st quarter, fiscal year 2020....... 15,000 14,000 14,000 -1,000 ................
-----------------------------------------------------------------------------------------
Total, Special Benefits for Disabled Coal Miners........ 69,319 24,319 24,319 -45,000 ................
=========================================================================================
Administrative Expenses, Energy Employees Occupational Illness
Compensation Fund

Administrative Expenses....................................... 59,846 59,098 59,098 -748 ................

Black Lung Disability Trust Fund

Benefit Payments and Interest on Advances..................... 345,635 257,256 257,256 -88,379 ................
Workers' Compensation Programs, Salaries and Expenses......... 38,246 38,246 38,246 ................ ................
Departmental Management, Salaries and Expenses................ 31,994 31,994 31,994 ................ ................
Departmental Management, Inspector General.................... 330 330 330 ................ ................
-----------------------------------------------------------------------------------------
Subtotal, Black Lung Disability......................... 416,205 327,826 327,826 -88,379 ................

Treasury Department Administrative Costs...................... 356 356 356 ................ ................
-----------------------------------------------------------------------------------------
Total, Black Lung Disability Trust Fund................. 416,561 328,182 328,182 -88,379 ................
=========================================================================================
Total, Workers' Compensation Programs................... 883,327 756,881 759,200 -124,127 +2,319

Federal Funds......................................... 881,150 754,708 757,023 -124,127 +2,315
Current year........................................ (866,150) (740,708) (743,023) (-123,127) (+2,315)
Fiscal year 2020.................................... (15,000) (14,000) (14,000) (-1,000) ................
Trust Funds............................................. 2,177 2,173 2,177 ................ +4
=========================================================================================
OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION (OSHA)

Salaries and Expenses

Safety and Health Standards................................... 18,000 17,878 18,000 ................ +122
Federal Enforcement........................................... 208,000 212,735 210,000 +2,000 -2,735
Whistleblower enforcement..................................... 17,500 17,381 17,500 ................ +119
State Programs................................................ 100,850 100,165 102,850 +2,000 +2,685
Technical Support............................................. 24,469 23,766 24,469 ................ +703

Compliance Assistance:
Federal Assistance........................................ 70,981 75,619 70,981 ................ -4,638
State Consultation Grants................................. 59,500 59,096 59,500 ................ +404
Training Grants........................................... 10,537 ................ 10,537 ................ +10,537
-----------------------------------------------------------------------------------------
Subtotal, Compliance Assistance......................... 141,018 134,715 141,018 ................ +6,303

Safety and Health Statistics.................................. 32,900 32,677 32,900 ................ +223
Executive Direction and Administration........................ 10,050 9,716 10,050 ................ +334
-----------------------------------------------------------------------------------------
Total, OSHA............................................. 552,787 549,033 556,787 +4,000 +7,754
=========================================================================================
MINE SAFETY AND HEALTH ADMINISTRATION

Salaries and Expenses

Coal Enforcement.............................................. 160,000 156,136 160,000 ................ +3,864
Metal/Non-Metal Enforcement................................... 94,500 96,975 94,500 ................ -2,475
Standards Development......................................... 4,500 5,345 4,500 ................ -845
Assessments................................................... 6,627 7,394 6,627 ................ -767
Educational Policy and Development............................ 39,320 38,297 39,320 ................ +1,023
Technical Support............................................. 35,041 33,848 35,041 ................ +1,193
Program Evaluation and Information Resources [PEIR]........... 17,990 21,953 17,990 ................ -3,963
Program Administration........................................ 15,838 15,958 15,838 ................ -120
-----------------------------------------------------------------------------------------
Total, Mine Safety and Health Administration............ 373,816 375,906 373,816 ................ -2,090
=========================================================================================
Total, Worker Protection Agencies....................... 1,596,367 1,597,523 1,607,367 +11,000 +9,844

Federal Funds......................................... (1,594,190) (1,595,350) (1,605,190) (+11,000) (+9,840)
Trust Funds........................................... (2,177) (2,173) (2,177) ................ (+4)
=========================================================================================
BUREAU OF LABOR STATISTICS

Salaries and Expenses

Employment and Unemployment Statistics........................ 209,000 209,398 212,000 +3,000 +2,602
Labor Market Information...................................... 65,000 64,559 65,000 ................ +441
Prices and Cost of Living..................................... 209,000 207,235 209,000 ................ +1,765
Compensation and Working Conditions........................... 83,500 80,947 83,500 ................ +2,553
Productivity and Technology................................... 10,500 10,622 10,500 ................ -122
Executive Direction and Staff Services........................ 35,000 36,625 35,000 ................ -1,625
-----------------------------------------------------------------------------------------
Total, Bureau of Labor Statistics....................... 612,000 609,386 615,000 +3,000 +5,614

Federal Funds....................................... 547,000 544,827 550,000 +3,000 +5,173
Trust Funds......................................... 65,000 64,559 65,000 ................ +441
=========================================================================================
OFFICE OF DISABILITY EMPLOYMENT POLICY

Salaries and Expenses......................................... 38,203 27,000 38,203 ................ +11,203

DEPARTMENTAL MANAGEMENT

Salaries and Expenses

Executive Direction........................................... 30,250 30,045 30,250 ................ +205
Departmental Program Evaluation............................... 8,040 7,985 8,040 ................ +55
Legal Services................................................ 123,745 124,644 123,745 ................ -899
Trust Funds............................................... 308 306 308 ................ +2
International Labor Affairs................................... 86,125 18,500 86,125 ................ +67,625
Administration and Management................................. 23,534 23,808 23,534 ................ -274
Adjudication.................................................. 35,000 35,462 35,000 ................ -462
Women's Bureau................................................ 13,530 3,525 13,530 ................ +10,005
Civil Rights Activities....................................... 6,880 6,833 6,880 ................ +47
Chief Financial Officer....................................... 10,432 9,927 10,432 ................ +505
-----------------------------------------------------------------------------------------
Total, Departmental Management Salaries and expenses.... 337,844 261,035 337,844 ................ +76,809

Federal Funds....................................... (337,536) (260,729) (337,536) ................ (+76,807)
Trust Funds......................................... (308) (306) (308) ................ (+2)
=========================================================================================
Veterans Employment and Training

State Administration, Grants.................................. 180,000 173,812 180,000 ................ +6,188
Transition Assistance Program................................. 19,500 16,950 24,500 +5,000 +7,550
Federal Administration........................................ 42,127 42,748 42,127 ................ -621
National Veterans' Employment and Training Services Institute. 3,414 3,391 3,414 ................ +23
Homeless Veterans Programs.................................... 50,000 44,694 50,000 ................ +5,306
-----------------------------------------------------------------------------------------
Total, Veterans Employment and Training................. 295,041 281,595 300,041 +5,000 +18,446

Federal Funds....................................... 50,000 44,694 50,000 ................ +5,306
Trust Funds......................................... 245,041 236,901 250,041 +5,000 +13,140
=========================================================================================
IT Modernization

Departmental support systems.................................. 4,889 ................ 4,889 ................ +4,889
Infrastructure technology modernization....................... 15,880 ................ 15,880 ................ +15,880
-----------------------------------------------------------------------------------------
Total, IT Modernization................................. 20,769 ................ 20,769 ................ +20,769
=========================================================================================
Office of Inspector General

Program Activities............................................ 83,487 82,061 83,487 ................ +1,426
Trust Funds............................................... 5,660 5,660 5,660 ................ ................
-----------------------------------------------------------------------------------------
Total, Office of Inspector General...................... 89,147 87,721 89,147 ................ +1,426
=========================================================================================
Total, Departmental Management.......................... 742,801 630,351 747,801 +5,000 +117,450

Federal Funds....................................... 491,792 387,484 491,792 ................ +104,308
Current year...................................... (491,792) (387,484) (491,792) ................ (+104,308)
Trust Funds......................................... 251,009 242,867 256,009 +5,000 +13,142
=========================================================================================
Total, Workforce Investment Act Programs................ 5,204,855 4,517,487 5,219,855 +15,000 +702,368

Current year........................................ (3,432,855) (2,820,487) (3,447,855) (+15,000) (+627,368)
Fiscal year 2020.................................... (1,772,000) (1,697,000) (1,772,000) ................ (+75,000)
=========================================================================================
Total, Title I, Department of Labor..................... 13,773,299 12,292,909 13,557,491 -215,808 +1,264,582
Federal Funds....................................... 10,024,506 8,696,977 9,929,379 -95,127 +1,232,402
Current year.................................. (8,237,506) (6,985,977) (8,143,379) (-94,127) (+1,157,402)
Fiscal year 2020.............................. (1,787,000) (1,711,000) (1,786,000) (-1,000) (+75,000)
Trust Funds......................................... 3,748,793 3,595,932 3,628,112 -120,681 +32,180
=========================================================================================
TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES

HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA)

Primary Health Care

Community Health Centers...................................... 1,625,522 4,990,629 1,625,522 ................ -3,365,107
Health CenterTort Claims...................................... ................ 99,893 ................ ................ -99,893
Free Clinics Medical Malpractice.............................. 1,000 1,000 1,000 ................ ................
-----------------------------------------------------------------------------------------
Total, Primary Health Care.............................. 1,626,522 5,091,522 1,626,522 ................ -3,465,000
=========================================================================================
Health Workforce

National Health Service Corps................................. 105,000 310,000 105,000 ................ -205,000

Training for Diversity:
Centers of Excellence..................................... 23,711 ................ 23,711 ................ +23,711
Health Careers Opportunity Program........................ 14,189 ................ 14,189 ................ +14,189
Faculty Loan Repayment.................................... 1,190 ................ 1,190 ................ +1,190
Scholarships for Disadvantaged Students................... 48,970 ................ 48,970 ................ +48,970
-----------------------------------------------------------------------------------------
Total, Training for Diversity........................... 88,060 ................ 88,060 ................ +88,060
=========================================================================================
Primary Care Training and Enhancement......................... 48,924 ................ 48,924 ................ +48,924
Oral Health Training.......................................... 40,673 ................ 40,673 ................ +40,673

Interdisciplinary Community-Based Linkages:
Area Health Education Centers............................. 38,250 ................ 40,250 +2,000 +40,250
Geriatric Programs........................................ 40,737 ................ 40,737 ................ +40,737
Mental and Behavorial Health.............................. 36,916 ................ 36,916 ................ +36,916
Behavioral Health Workforce Education and Training........ 75,000 ................ 75,000 ................ +75,000
-----------------------------------------------------------------------------------------
Total, Interdisciplinary Community Linkages............. 190,903 ................ 192,903 +2,000 +192,903
=========================================================================================
Workforce Assessment.......................................... 5,663 4,663 5,663 ................ +1,000
Public Health and Preventive Medicine programs................ 17,000 ................ 17,000 ................ +17,000

Nursing Programs:
Advanced Education Nursing................................ 74,581 ................ 74,581 ................ +74,581
Nurse Education, Practice, and Retention.................. 41,913 ................ 41,913 ................ +41,913
Nursing Workforce Diversity............................... 17,343 ................ 17,343 ................ +17,343
Nursing Corps Scholarship and Loan Repayment Program...... 87,135 83,135 87,135 ................ +4,000
Nursing Faculty Loan Program.............................. 28,500 ................ 28,500 ................ +28,500
-----------------------------------------------------------------------------------------
Total, Nursing programs................................. 249,472 83,135 249,472 ................ +166,337
=========================================================================================
Children's Hospitals Graduate Medical Education............... 315,000 ................ 325,000 +10,000 +325,000
Teaching Health Center, Graduate Medical Education............ ................ 60,000 ................ ................ -60,000
National Practitioner Data Bank............................... 18,814 18,814 18,814 ................ ................
User Fees................................................. -18,814 -18,814 -18,814 ................ ................
-----------------------------------------------------------------------------------------
Total, Health Workforce................................. 1,060,695 457,798 1,072,695 +12,000 +614,897
=========================================================================================
Maternal and Child Health

Maternal and Child Health Block Grant......................... 651,700 627,700 677,700 +26,000 +50,000
Sickle Cell Anemia Demonstration Program...................... 4,455 ................ 4,455 ................ +4,455
Autism and Other Developmental Disabilities................... 49,099 ................ 49,099 ................ +49,099
Heritable Disorders in Newborns and Children.................. 15,883 ................ 15,883 ................ +15,883
Family-to-Family Health Information Centers................... ................ 5,000 ................ ................ -5,000
Maternal, Infant and Early Childhood Home Visiting Program.... ................ 400,000 ................ ................ -400,000
Healthy Start................................................. 110,500 103,500 122,500 +12,000 +19,000
Universal Newborn Hearing Screening........................... 17,818 ................ 17,818 ................ +17,818
Emergency Medical Services for Children....................... 22,334 ................ 22,334 ................ +22,334
Screening and treatment for maternal depression............... 5,000 ................ 5,000 ................ +5,000
Pediatric Mental Health Care Access........................... 10,000 ................ 10,000 ................ +10,000
-----------------------------------------------------------------------------------------
Total, Maternal and Child Health........................ 886,789 1,136,200 924,789 +38,000 -211,411
=========================================================================================
Ryan White HIV/AIDS Program

Emergency Assistance (Part A)................................. 655,876 655,876 655,876 ................ ................
Comprehensive Care Programs (Part B).......................... 1,315,005 1,315,005 1,315,005 ................ ................
AIDS Drug Assistance Program [ADAP] (NA).................. (900,313) (900,313) (900,313) ................ ................
Early Intervention Program (Part C)........................... 201,079 201,079 201,079 ................ ................
Children, Youth, Women, and Families (Part D)................. 75,088 75,088 75,088 ................ ................
AIDS Dental Services (Part F)................................. 13,122 13,122 13,122 ................ ................
Education and Training Centers (Part F)....................... 33,611 ................ 33,611 ................ +33,611
Special Projects of National Significance..................... 25,000 ................ 25,000 ................ +25,000
-----------------------------------------------------------------------------------------
Total, Ryan White HIV/AIDS program...................... 2,318,781 2,260,170 2,318,781 ................ +58,611
=========================================================================================
Health Care Systems

Organ Transplantation......................................... 25,549 23,549 25,549 ................ +2,000
National Cord Blood Inventory................................. 15,266 12,266 15,266 ................ +3,000
C.W. Bill Young Cell Transplantation.......................... 24,109 22,109 24,109 ................ +2,000
340B Drug Pricing program/Office of Pharmacy Affairs.......... 10,238 26,238 10,238 ................ -16,000
User Fees................................................. ................ -16,000 ................ ................ +16,000
Poison Control Centers........................................ 20,846 18,846 22,846 +2,000 +4,000
Hansen's Disease Program...................................... 13,706 11,653 13,706 ................ +2,053
Hansen's Disease Program--Buildings and Facilities............ 122 ................ 122 ................ +122
Payment to Hawaii, Treatment of Hansen's...................... 1,857 1,857 1,857 ................ ................
-----------------------------------------------------------------------------------------
Total, Health Care Systems.............................. 111,693 100,518 113,693 +2,000 +13,175
=========================================================================================
Rural Health

Rural Outreach Grants......................................... 71,500 50,811 77,500 +6,000 +26,689
Rural Health Research/Policy Development...................... 9,351 5,000 9,351 ................ +4,351
Rural Hospital Flexibility Grants............................. 49,609 ................ 49,609 ................ +49,609
State Offices of Rural Health................................. 10,000 ................ 10,000 ................ +10,000
Black Lung Clinics............................................ 10,000 7,266 10,000 ................ +2,734
Radiation Exposure Screening and Education Program............ 1,834 1,834 1,834 ................ ................
Telehealth.................................................... 23,500 10,000 25,500 +2,000 +15,500
Rural Communities Opioid Response............................. 100,000 ................ 120,000 +20,000 +120,000
Rural Residency Program....................................... 15,000 ................ 15,000 ................ +15,000
-----------------------------------------------------------------------------------------
Total, Rural Health..................................... 290,794 74,911 318,794 +28,000 +243,883
=========================================================================================
Family Planning............................................... 286,479 286,479 286,479 ................ ................
Program Management............................................ 155,000 151,993 155,000 ................ +3,007

Vaccine Injury Compensation Program Trust Fund

Post-Fiscal Year 1988 Claims.................................. 268,000 308,000 308,000 +40,000 ................
HRSA Administrative expenses.................................. 9,200 9,200 9,200 ................ ................
-----------------------------------------------------------------------------------------
Total, Vaccine Injury Compensation Trust Fund........... 277,200 317,200 317,200 +40,000 ................
=========================================================================================
Total, Health Resources and Services Administration..... 7,013,953 9,876,791 7,133,953 +120,000 -2,742,838
=========================================================================================
CENTERS FOR DISEASE CONTROL AND PREVENTION

Immunization and Respiratory Diseases......................... 474,055 700,828 474,055 ................ -226,773
Prevention and Public Health Fund......................... (324,350) ................ (324,350) ................ (+324,350)
-----------------------------------------------------------------------------------------
Subtotal................................................ (798,405) (700,828) (798,405) ................ (+97,577)

HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and 1,127,278 1,117,278 1,132,278 +5,000 +15,000
Tuberculosis Prevention......................................
Emerging and Zoonotic Infectious Diseases..................... 562,572 508,328 565,572 +3,000 +57,244
Prevention and Public Health Fund......................... (52,000) ................ (52,000) ................ (+52,000)
-----------------------------------------------------------------------------------------
Subtotal................................................ 614,572 508,328 617,572 +3,000 +109,244

Chronic Disease Prevention and Health Promotion............... 915,346 939,250 911,821 -3,525 -27,429
Prevention and Public Health Fund......................... (247,550) ................ (254,950) (+7,400) (+254,950)
-----------------------------------------------------------------------------------------
Subtotal................................................ 1,162,896 939,250 1,166,771 +3,875 +227,521

Birth Defects, Developmental Disabilities, Disabilities and 140,560 110,000 153,560 +13,000 +43,560
Health.......................................................
-----------------------------------------------------------------------------------------
Subtotal................................................ 140,560 110,000 153,560 +13,000 +43,560

Public Health Scientific Services............................. 490,397 332,180 492,397 +2,000 +160,217
Evaluation Tap Funding.................................... ................ (135,820) ................ ................ (-135,820)
-----------------------------------------------------------------------------------------
Subtotal................................................ (490,397) (468,000) (492,397) (+2,000) (+24,397)

Environmental Health.......................................... 188,750 157,000 188,750 ................ +31,750
Prevention and Public Health Fund......................... (17,000) ................ (17,000) ................ (+17,000)
-----------------------------------------------------------------------------------------
Subtotal................................................ 205,750 157,000 205,750 ................ +48,750

Injury Prevention and Control................................. 648,559 266,309 648,559 ................ +382,250
National Institute for Occupational Safety and Health......... 335,200 ................ 335,300 +100 +335,300
Energy Employees Occupational Illness Compensation Program.... 55,358 ................ 55,358 ................ +55,358
Global Health................................................. 488,621 408,762 488,621 ................ +79,859
Public Health Preparedness and Response....................... 1,450,000 800,000 1,470,000 +20,000 +670,000
Buildings and Facilities...................................... 270,000 30,000 30,000 -240,000 ................
Transfers from Nonrecurring Expenses Fund................. (240,000) ................ ................ (-240,000) ................
-----------------------------------------------------------------------------------------
Subtotal................................................ 510,000 30,000 30,000 -480,000 ................

CDC-Wide Activities and Program Support

Prevention and Public Health Fund............................. (160,000) ................ (160,000) ................ (+160,000)
Office of the Director........................................ 113,570 155,000 113,570 ................ -41,430
-----------------------------------------------------------------------------------------
Subtotal, CDC-Wide Activities........................... (273,570) (155,000) (273,570) ................ (+118,570)
-----------------------------------------------------------------------------------------
Total, Centers for Disease Control...................... 7,260,266 5,524,935 7,059,841 -200,425 +1,534,906

Evaluation Tap Funding (NA)......................... ................ (135,820) ................ ................ (-135,820)
Prevention and Public Health Fund................... (800,900) ................ (808,300) (+7,400) (+808,300)
Transfers from Nonrecurring Expenses Fund........... (240,000) ................ ................ (-240,000) ................
Total, Centers for Disease Control Program Level........ (8,301,166) (5,660,755) (7,868,141) (-433,025) (+2,207,386)
=========================================================================================
NATIONAL INSTITUTES OF HEALTH

National Cancer Institute (NCI)............................... 5,657,015 5,226,312 5,747,125 +90,110 +520,813
NIH Innovation Account, CURES Act............................. 300,000 400,000 400,000 +100,000 ................
-----------------------------------------------------------------------------------------
Subtotal, NCI........................................... 5,957,015 5,626,312 6,147,125 +190,110 +520,813

National Heart, Lung, and Blood Institute (NHLBI)............. 3,382,232 3,112,032 3,490,171 +107,939 +378,139
National Institute of Dental and Craniofacial Research (NIDCR) 447,735 413,196 462,024 +14,289 +48,828
National Institute of Diabetes and Digestive and Kidney 1,968,083 1,965,434 2,030,892 +62,809 +65,458
Diseases [NIDDK].............................................
Juvenile Diabetes (mandatory)............................. (150,000) (150,000) (150,000) ................ ................
-----------------------------------------------------------------------------------------
Subtotal, NIDDK program level........................... 2,118,083 2,115,434 2,180,892 +62,809 +65,458

National Institute of Neurological Disorders and Stroke 2,106,482 1,781,056 2,218,080 +111,598 +437,024
(NINDS)......................................................
NIH Innovation Account, CURES Act............................. 43,000 57,500 57,500 +14,500 ................
-----------------------------------------------------------------------------------------
Subtotal, NINDS......................................... 2,149,482 1,838,556 2,275,580 +126,098 +437,024

National Institute of Allergy and Infectious Diseases (NIAID). 5,280,665 4,761,948 5,506,190 +225,525 +744,242
National Institute of General Medical Sciences (NIGMS)........ 1,862,529 1,831,669 1,855,971 -6,558 +24,302
Evaluation Tap Funding.................................... (922,871) (741,000) (1,018,321) (+95,450) (+277,321)
-----------------------------------------------------------------------------------------
Subtotal, NIGMS program level........................... 2,785,400 2,572,669 2,874,292 +88,892 +301,623

Eunice Kennedy Shriver National Institute of Child Health and 1,460,637 1,339,592 1,507,251 +46,614 +167,659
Human Development (NICHD)....................................
National Eye Institute (NEI).................................. 772,308 711,015 796,955 +24,647 +85,940
National Institute of Environmental Health Sciences (NIEHS)... 751,143 693,199 775,115 +23,972 +81,916
National Institute on Aging (NIA)............................. 2,577,550 1,988,200 3,084,809 +507,259 +1,096,609
National Institute of Arthritis and Musculoskeletal and Skin 586,661 545,494 605,383 +18,722 +59,889
Diseases (NIAMS).............................................
National Institute on Deafness and Other Communication 459,974 423,992 474,653 +14,679 +50,661
Disorders (NIDCD)............................................
National Institute of Nursing Research (NINR)................. 158,033 145,842 163,076 +5,043 +17,234
National Institute on Alcohol Abuse and Alcoholism (NIAAA).... 509,604 469,109 525,867 +16,263 +56,758
National Institute on Drug Abuse (NIDA)....................... 1,376,657 1,137,403 1,420,591 +43,934 +283,188
National Institute of Mental Health (NIMH).................... 1,714,657 1,554,692 1,813,750 +99,093 +259,058
NIH Innovation Account, CURES Act............................. 43,000 57,500 57,500 +14,500 ................
-----------------------------------------------------------------------------------------
Subtotal, NIMH.......................................... 1,757,657 1,612,192 1,871,250 +113,593 +259,058

National Human Genome Research Institute (NHGRI).............. 558,072 512,979 575,882 +17,810 +62,903
National Institute of Biomedical Imaging and Bioengineering 377,618 346,550 389,672 +12,054 +43,122
(NIBIB)......................................................
National Center for Complementary and Integrative Health 142,018 130,717 146,550 +4,532 +15,833
(NCCIH)......................................................
National Institute on Minority Health and Health Disparities 305,108 280,545 314,845 +9,737 +34,300
(NIMHD)......................................................
John E. Fogarty International Center (FIC).................... 75,733 70,084 78,150 +2,417 +8,066
National Library of Medicine (NLM)............................ 428,553 395,493 442,230 +13,677 +46,737
National Center for Advancing Translational Sciences (NCATS).. 762,454 685,087 806,787 +44,333 +121,700
National Institute for Research on Safety and Quality (NIRSQ). ................ 255,960 ................ ................ -255,960
National Institute for Occupational Safety and Health (NIOSH). ................ 200,000 ................ ................ -200,000
National Institute on Disability, Independent Living, and ................ 95,127 ................ ................ -95,127
Rehabilitation Research (NIDILRR)............................
Energy Employees Occupational Illness Compensation Program.... ................ 55,358 ................ ................ -55,358
Office of the Director........................................ 1,802,145 1,795,706 1,910,060 +107,915 +114,354
Common Fund (non-add)..................................... (588,116) (586,181) (606,885) (+18,769) (+20,704)
Gabriella Miller Kids First Research Act (Common Fund add) 12,600 12,600 12,600 ................ ................
NIH Innovation Account, CURES Act............................. 110,000 196,000 196,000 +86,000 ................
Buildings and Facilities...................................... 128,863 200,000 200,000 +71,137 ................
=========================================================================================
Total, National Institutes of Health (NIH).............. 36,161,129 33,847,391 38,065,679 +1,904,550 +4,218,288
(Evaluation Tap Funding)............................ (922,871) (741,000) (1,018,321) (+95,450) (+277,321)
Total, NIH Program Level................................ (37,084,000) (34,588,391) (39,084,000) (+2,000,000) (+4,495,609)
=========================================================================================
SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION
(SAMHSA)

Mental Health

Programs of Regional and National Significance................ 426,659 282,544 430,659 +4,000 +148,115
Prevention and Public Health Fund......................... (12,000) ................ (12,000) ................ (+12,000)
-----------------------------------------------------------------------------------------
Subtotal................................................ 438,659 282,544 442,659 +4,000 +160,115

Mental Health block grant..................................... 701,532 541,532 726,532 +25,000 +185,000
Evaluation Tap Funding.................................... (21,039) (21,039) (21,039) ................ ................
-----------------------------------------------------------------------------------------
Subtotal................................................ (722,571) (562,571) (747,571) (+25,000) (+185,000)

Certified Community Behavioral Health Clinics................. 100,000 ................ 150,000 +50,000 +150,000
National Child Traumatic Stress Initiative.................... ................ ................ ................ ................ ................
Children's Mental Health...................................... 125,000 119,026 125,000 ................ +5,974
Grants to States for the Homeless (PATH)...................... 64,635 64,635 64,635 ................ ................
Protection and Advocacy....................................... 36,146 36,146 36,146 ................ ................
-----------------------------------------------------------------------------------------
Subtotal, Mental Health................................. 1,453,972 1,043,883 1,532,972 +79,000 +489,089
(Evaluation Tap Funding)............................ (21,039) (21,039) (21,039) ................ ................
Subtotal, Mental Health program level................... (1,487,011) (1,064,922) (1,566,011) (+79,000) (+501,089)

Substance Abuse Treatment

Programs of Regional and National Significance................ 403,427 255,318 451,927 +48,500 +196,609
Evaluation Tap Funding.................................... (2,000) ................ (2,000) ................ (+2,000)
-----------------------------------------------------------------------------------------
Subtotal................................................ (405,427) (255,318) (453,927) (+48,500) (+198,609)

Substance Abuse block grant................................... 1,778,879 1,778,879 1,778,879 ................ ................
Evaluation Tap Funding.................................... (79,200) (79,200) (79,200) ................ ................
-----------------------------------------------------------------------------------------
Subtotal, block grant................................... (1,858,079) (1,858,079) (1,858,079) ................ ................

State Opioid Response grants.................................. 1,000,000 ................ 1,500,000 +500,000 +1,500,000
-----------------------------------------------------------------------------------------
Subtotal, Substance Abuse Treatment..................... 3,182,306 2,034,197 3,730,806 +548,500 +1,696,609
(Evaluation Tap Funding)............................ (81,200) (79,200) (81,200) ................ (+2,000)
Subtotal, Program level................................. (3,263,506) (2,113,397) (3,812,006) (+548,500) (+1,698,609)

Substance Abuse Prevention

Programs of Regional and National Significance................ 248,219 220,885 200,219 -48,000 -20,666
Evaluation Tap Funding (NA)............................... ................ ................ ................ ................ ................
-----------------------------------------------------------------------------------------
Subtotal................................................ 248,219 220,885 200,219 -48,000 -20,666
-----------------------------------------------------------------------------------------
Total, Substance Abuse Prevention....................... 248,219 220,885 200,219 -48,000 -20,666
=========================================================================================
Health Surveillance and Program Support....................... 128,830 126,922 128,830 ................ +1,908
Evaluation Tap Funding (NA)............................... (31,428) (20,426) (31,428) ................ (+11,002)
-----------------------------------------------------------------------------------------
Subtotal................................................ 160,258 147,348 160,258 ................ +12,910
=========================================================================================
Total, SAMHSA........................................... 5,013,327 3,425,887 5,592,827 +579,500 +2,166,940
(Evaluation Tap Funding)............................ (133,667) (120,665) (133,667) ................ (+13,002)
(Prevention and Public Health Fund )................ (12,000) ................ (12,000) ................ (+12,000)
Total, SAMHSA Program Level............................. (5,158,994) (3,546,552) (5,738,494) (+579,500) (+2,191,942)
=========================================================================================
AGENCY FOR HEALTHCARE RESEARCH AND QUALITY (AHRQ)

Healthcare Research and Quality

Research on Health Costs, Quality, and Outcomes:
Federal Funds............................................. 197,156 ................ 192,709 -4,447 +192,709
-----------------------------------------------------------------------------------------
Subtotal, Health Costs, Quality, and Outcomes........... (197,156) ................ (192,709) (-4,447) (+192,709)
(Evaluation Tap Funding)............................ ................ ................ ................ ................ ................

Medical Expenditures Panel Surveys:
Federal Funds............................................. 66,000 ................ 69,991 +3,991 +69,991

Program Support:
Federal Funds............................................. 70,844 ................ 71,300 +456 +71,300
-----------------------------------------------------------------------------------------
Total, AHRQ Program Level............................... (334,000) ................ (334,000) ................ (+334,000)

Federal funds....................................... (334,000) ................ (334,000) ................ (+334,000)
Total, Public Health Service (PHS) appropriation........ 55,782,675 52,675,004 58,186,300 +2,403,625 +5,511,296
Total, Public Health Service Program Level.............. (57,892,113) (53,672,489) (60,158,588) (+2,266,475) (+6,486,099)
=========================================================================================
CENTERS FOR MEDICARE AND MEDICAID SERVICES

Grants to States for Medicaid

Medicaid Current Law Benefits................................. 384,608,394 384,882,625 384,882,625 +274,231 ................
State and Local Administration................................ 20,811,084 21,474,885 21,474,885 +663,801 ................
Vaccines for Children......................................... 4,598,358 4,726,461 4,726,461 +128,103 ................
-----------------------------------------------------------------------------------------
Subtotal, Medicaid Program Level........................ 410,017,836 411,083,971 411,083,971 +1,066,135 ................

Less funds advanced in prior year................... -125,219,452 -134,847,759 -134,847,759 -9,628,307 ................
-----------------------------------------------------------------------------------------
Total, Grants to States for Medicaid.................... 284,798,384 276,236,212 276,236,212 -8,562,172 ................

New advance, 1st quarter, fiscal year 2020........ 134,847,759 137,931,797 137,931,797 +3,084,038 ................
=========================================================================================
Payments to Health Care Trust Funds

Supplemental Medical Insurance................................ 245,396,000 284,288,300 284,288,300 +38,892,300 ................
Federal Uninsured Payment..................................... 132,000 127,000 127,000 -5,000 ................
Program Management............................................ 1,104,000 898,000 898,000 -206,000 ................
General Revenue for Part D Benefit............................ 76,133,000 92,070,000 92,070,000 +15,937,000 ................
General Revenue for Part D Administration..................... 422,000 642,000 642,000 +220,000 ................
HCFAC Reimbursement........................................... 307,000 315,000 315,000 +8,000 ................
State Low-Income Determination for Part D..................... 3,300 3,500 3,500 +200 ................
-----------------------------------------------------------------------------------------
Total, Payments to Trust Funds, Program Level........... 323,497,300 378,343,800 378,343,800 +54,846,500 ................
=========================================================================================
Program Management

Research, Demonstration, Evaluation........................... 20,054 18,054 20,054 ................ +2,000
Program Operations............................................ 2,519,823 2,402,089 2,519,823 ................ +117,734
State Survey and Certification................................ 397,334 421,135 397,334 ................ -23,801
Federal Administration........................................ 732,533 702,601 732,533 ................ +29,932
-----------------------------------------------------------------------------------------
Total, Program management............................... 3,669,744 3,543,879 3,669,744 ................ +125,865
=========================================================================================
Health Care Fraud and Abuse Control Account

Centers for Medicare and Medicaid Services.................... 500,368 609,766 600,464 +100,096 -9,302
HHS Office of Inspector General............................... 84,398 84,398 86,664 +2,266 +2,266
Medicaid/CHIP................................................. 84,398 ................ ................ -84,398 ................
Department of Justice......................................... 75,836 75,836 77,872 +2,036 +2,036
-----------------------------------------------------------------------------------------
Total, Health Care Fraud and Abuse Control.............. 745,000 770,000 765,000 +20,000 -5,000
=========================================================================================
Total, Centers for Medicare and Medicaid Services....... 747,558,187 796,825,688 796,946,553 +49,388,366 +120,865

Federal funds....................................... 743,143,443 792,511,809 792,511,809 +49,368,366 ................
Current year........................................ (608,295,684) (654,580,012) (654,580,012) (+46,284,328) ................
New advance, fiscal year 2020....................... (134,847,759) (137,931,797) (137,931,797) (+3,084,038) ................
Trust Funds........................................... 4,414,744 4,313,879 4,434,744 +20,000 +120,865
=========================================================================================
ADMINISTRATION FOR CHILDREN AND FAMILIES (ACF)

Payments to States for Child Support Enforcement and Family
Support Programs

Payments to Territories....................................... 33,000 33,000 33,000 ................ ................
Repatriation.................................................. 1,000 1,000 1,000 ................ ................
-----------------------------------------------------------------------------------------
Subtotal................................................ 34,000 34,000 34,000 ................ ................

Child Support Enforcement:
State and Local Administration............................ 3,763,200 3,689,574 3,689,574 -73,626 ................
Federal Incentive Payments................................ 588,200 588,673 588,673 +473 ................
Access and Visitation..................................... 10,000 10,000 10,000 ................ ................
-----------------------------------------------------------------------------------------
Subtotal, Child Support Enforcement..................... 4,361,400 4,288,247 4,288,247 -73,153 ................
-----------------------------------------------------------------------------------------
Total, Family Support Payments Program Level............ 4,395,400 4,322,247 4,322,247 -73,153 ................

Less funds advanced in previous years............... -1,400,000 -1,400,000 -1,400,000 ................ ................
=========================================================================================
Total, Family Support Payments, current year............ 2,995,400 2,922,247 2,922,247 -73,153 ................

New advance, 1st quarter, fiscal year 2020.......... 1,400,000 1,400,000 1,400,000 ................ ................
=========================================================================================
Low Income Home Energy Assistance (LIHEAP)

Formula Grants................................................ 3,640,304 ................ 3,690,304 +50,000 +3,690,304

Refugee and Entrant Assistance

Transitional and Medical Services............................. 320,000 354,000 354,000 +34,000 ................
Refugee Support Services...................................... 207,201 160,821 207,201 ................ +46,380
Victims of Trafficking........................................ 23,755 18,755 26,755 +3,000 +8,000
Unaccompanied Minors.......................................... 1,303,245 1,048,000 1,303,245 ................ +255,245
Unaccompanied Minors Contingency Fund......................... ................ 200,000 ................ ................ -200,000
Victims of Torture............................................ 10,735 10,735 14,000 +3,265 +3,265
-----------------------------------------------------------------------------------------
Total, Refugee and Entrant Assistance................... 1,864,936 1,792,311 1,905,201 +40,265 +112,890
=========================================================================================
Payments to States for the Child Care and Development Block 5,226,000 3,006,000 5,226,000 ................ +2,220,000
Grant........................................................
Social Services Block Grant (Title XX)........................ 1,700,000 1,700,000 1,700,000 ................ ................
Discretionary Funds....................................... ................ 85,000 ................ ................ -85,000
-----------------------------------------------------------------------------------------
Total, Social Services Block Grant...................... 1,700,000 1,785,000 1,700,000 ................ -85,000

Children and Families Services Programs

Programs for Children, Youth and Families:
Head Start, current funded................................ 9,863,095 9,275,000 10,113,095 +250,000 +838,095
Preschool Development Grants.............................. 250,000 ................ 250,000 ................ +250,000
Consolidated Runaway, Homeless Youth Program.............. 110,280 101,980 110,280 ................ +8,300
Prevention Grants to Reduce Abuse of Runaway Youth........ 17,141 17,141 17,141 ................ ................
Child Abuse State Grants.................................. 85,310 25,310 85,310 ................ +60,000
Child Abuse Discretionary Activities...................... 33,000 33,000 33,000 ................ ................
Community Based Child Abuse Prevention.................... 39,764 39,764 39,764 ................ ................
Child Welfare Services.................................... 268,735 268,735 268,735 ................ ................
Child Welfare Training, Research, or Demonstration 17,984 17,984 17,984 ................ ................
projects.................................................
Adoption Opportunities.................................... 39,100 39,100 39,100 ................ ................
Adoption Incentive grants................................. 75,000 37,943 75,000 ................ +37,057
Social Services and Income Maintenance Research............... 6,512 6,512 6,512 ................ ................
Native American Programs...................................... 54,050 52,050 54,050 ................ +2,000

Community Services:
Community Services Block Grant Act programs:
Grants to States for Community Services............... 715,000 ................ 725,000 +10,000 +725,000
Economic Development.................................. 19,883 ................ 19,883 ................ +19,883
Rural Community Facilities............................ 8,000 ................ 8,000 ................ +8,000
-----------------------------------------------------------------------------------------
Subtotal, Community Services............................ 742,883 ................ 752,883 +10,000 +752,883

Domestic Violence Hotline..................................... 9,250 8,250 10,250 +1,000 +2,000
Family Violence/Battered Women's Shelters..................... 160,000 151,000 165,000 +5,000 +14,000
Chafee Education and Training Vouchers........................ 43,257 43,257 43,257 ................ ................
Disaster Human Services Case Management....................... 1,864 1,864 1,864 ................ ................
Program Direction............................................. 205,000 205,000 205,000 ................ ................
-----------------------------------------------------------------------------------------
Total, Children and Families Services Programs.......... 12,022,225 10,323,890 12,288,225 +266,000 +1,964,335
=========================================================================================
Promoting Safe and Stable Families............................ 345,000 325,000 345,000 ................ +20,000
Discretionary Funds....................................... 99,765 209,765 99,765 ................ -110,000
-----------------------------------------------------------------------------------------
Total, Promoting Safe and Stable Families............... 444,765 534,765 444,765 ................ -90,000
=========================================================================================
Payments for Foster Care and Permanency

Foster Care................................................... 5,537,000 5,329,000 5,329,000 -208,000 ................
Adoption Assistance........................................... 2,867,000 3,063,000 3,063,000 +196,000 ................
Guardianship.................................................. 181,000 203,000 203,000 +22,000 ................
Independent Living............................................ 140,000 140,000 140,000 ................ ................
-----------------------------------------------------------------------------------------
Total, Payments to States............................... 8,725,000 8,735,000 8,735,000 +10,000 ................

Less Advances from Prior Year....................... -2,500,000 -2,700,000 -2,700,000 -200,000 ................
-----------------------------------------------------------------------------------------
Total, payments, current year..................... 6,225,000 6,035,000 6,035,000 -190,000 ................

New Advance, 1st quarter, fiscal year 2020........ 2,700,000 2,800,000 2,800,000 +100,000 ................
=========================================================================================
Total, ACF.............................................. 38,218,630 30,599,213 38,411,742 +193,112 +7,812,529

Current year........................................ (34,118,630) (26,399,213) (34,211,742) (+93,112) (+7,812,529)
Fiscal year 2020.................................... (4,100,000) (4,200,000) (4,200,000) (+100,000) ................
-----------------------------------------------------------------------------------------
Total, ACF Program Level.......................... 38,218,630 30,599,213 38,411,742 +193,112 +7,812,529
=========================================================================================
ADMINISTRATION FOR COMMUNITY LIVING

Aging and Disability Services Programs

Grants to States:
Home and Community-based Supportive Services.............. 385,074 350,224 385,074 ................ +34,850
Preventive Health......................................... 24,848 24,848 24,848 ................ ................
Protection of Vulnerable Older Americans-Title VII........ 21,658 20,628 21,658 ................ +1,030
-----------------------------------------------------------------------------------------
Subtotal................................................ 431,580 395,700 431,580 ................ +35,880

Family Caregivers......................................... 180,586 150,586 180,886 +300 +30,300
Native American Caregivers Support........................ 9,556 7,556 9,556 ................ +2,000
-----------------------------------------------------------------------------------------
Subtotal, Caregivers.................................... 190,142 158,142 190,442 +300 +32,300

Nutrition:
Congregate Meals...................................... 490,342 450,342 490,342 ................ +40,000
Home Delivered Meals.................................. 246,342 227,342 246,342 ................ +19,000
Nutrition Services Incentive Program.................. 160,069 160,069 160,069 ................ ................
-----------------------------------------------------------------------------------------
Subtotal............................................ 896,753 837,753 896,753 ................ +59,000
-----------------------------------------------------------------------------------------
Subtotal, Grants to States.......................... 1,518,475 1,391,595 1,518,775 +300 +127,180

Grants for Native Americans................................... 33,208 31,208 33,208 ................ +2,000
Aging Network Support Activities.............................. 12,461 8,998 12,461 ................ +3,463
Alzheimer's Disease Program................................... 8,800 19,490 8,800 ................ -10,690
Prevention and Public Health Fund......................... (14,700) ................ (14,700) ................ (+14,700)
Lifespan Respite Care......................................... 4,110 3,360 4,110 ................ +750
Chronic Disease Self-Management Program....................... ................ ................ ................ ................ ................
Prevention and Public Health Fund......................... (8,000) ................ (8,000) ................ (+8,000)
Elder Falls Prevention........................................ ................ ................ ................ ................ ................
Prevention and Public Health Fund......................... (5,000) ................ (5,000) ................ (+5,000)
Elder Rights Support Activities............................... 15,874 11,874 15,874 ................ +4,000
Aging and Disability Resources................................ 8,119 6,119 8,119 ................ +2,000
State Health Insurance Program................................ 49,115 ................ 49,115 ................ +49,115
Paralysis Resource Center..................................... 7,700 ................ 8,700 +1,000 +8,700
Limb loss..................................................... 3,500 ................ 3,500 ................ +3,500
Traumatic Brain Injury........................................ 11,321 9,321 11,321 ................ +2,000

Developmental Disabilities Programs:
State Councils............................................ 76,000 56,000 76,000 ................ +20,000
Protection and Advocacy................................... 40,734 38,734 40,734 ................ +2,000
Voting Access for Individuals with Disabilities........... 6,963 4,963 6,963 ................ +2,000
Developmental Disabilities Projects of National 12,000 1,050 12,000 ................ +10,950
Significance.............................................
University Centers for Excellence in Developmental 40,619 32,546 40,619 ................ +8,073
Disabilities.............................................
-----------------------------------------------------------------------------------------
Subtotal, Developmental Disabilities Programs........... 176,316 133,293 176,316 ................ +43,023

Workforce Innovation and Opportunity Act
Independent Living........................................ 113,183 95,997 113,183 ................ +17,186
National Institute on Disability, Independent Living, and 104,970 ................ 108,970 +4,000 +108,970
Rehabilitation Research..................................
Assistive Technology...................................... 36,000 31,939 36,000 ................ +4,061
-----------------------------------------------------------------------------------------
Subtotal, Workforce Innovation and Opportunity Act...... 254,153 127,936 258,153 +4,000 +130,217

Aging and Disability Services Programs
Area Agencies on Aging.................................... ................ 7,500 ................ ................ -7,500
National Center for Benefits Outreach and Enrollment...... ................ 12,000 ................ ................ -12,000
State Health Insurance Assistance......................... ................ 13,000 ................ ................ -13,000
Aging and Disability Resource Centers..................... ................ 5,000 ................ ................ -5,000
-----------------------------------------------------------------------------------------
Subtotal, Aging and Disability Services Programs........ ................ 37,500 ................ ................ -37,500

Program Administration........................................ 41,063 37,987 41,063 ................ +3,076
=========================================================================================
Total, Administration for Community Living (ACL)........ 2,144,215 1,818,681 2,149,515 +5,300 +330,834

Federal funds....................................... (2,095,100) (1,781,181) (2,100,400) (+5,300) (+319,219)
Trust Funds......................................... (49,115) (37,500) (49,115) ................ (+11,615)
(Prevention and Public Health Fund )................ (27,700) ................ (27,700) ................ (+27,700)
Total, ACL program level................................ 2,171,915 1,818,681 2,177,215 +5,300 +358,534
=========================================================================================
OFFICE OF THE SECRETARY

General Departmental Management

General Departmental Management, Federal Funds................ 200,919 206,135 200,919 ................ -5,216
Teen Pregnancy Prevention Community Grants.................... 101,000 ................ 101,000 ................ +101,000
Evaluation Tap Funding.................................... (6,800) ................ (6,800) ................ (+6,800)
-----------------------------------------------------------------------------------------
Subtotal, Grants........................................ (107,800) ................ (107,800) ................ (+107,800)

Sexual Risk Avoidance......................................... 25,000 ................ 35,000 +10,000 +35,000
Office of Minority Health..................................... 56,670 53,956 56,670 ................ +2,714
Office on Women's Health...................................... 32,140 28,454 32,140 ................ +3,686
Minority HIV/AIDS prevention and treatment.................... 53,900 ................ 53,900 ................ +53,900
Embryo Adoption Awareness Campaign............................ 1,000 1,000 1,000 ................ ................
Planning and Evaluation, Evaluation Tap Funding............... (58,028) (53,445) (58,028) ................ (+4,583)
-----------------------------------------------------------------------------------------
Subtotal, General Departmental Management............... 470,629 289,545 480,629 +10,000 +191,084
-----------------------------------------------------------------------------------------
Total, General Departmental Management.................. 470,629 289,545 480,629 +10,000 +191,084

Federal Funds....................................... (470,629) (289,545) (480,629) (+10,000) (+191,084)
(Evaluation Tap Funding)............................ (64,828) (53,445) (64,828) ................ (+11,383)
Total, General Departmental Management Program.......... 535,457 342,990 545,457 +10,000 +202,467
=========================================================================================
Account for the State Response to the Opioid Abuse Crisis, 500,000 ................ ................ -500,000 ................
CURES Act....................................................
Office of Medicare Hearings and Appeals....................... 182,381 112,381 182,381 ................ +70,000

Office of Medicare Hearings and Appeals and Departmental ................ 10,000 ................ ................ -10,000
Appeals Board Recovery Audit Contractor (RAC) appeals related
expenses.....................................................
Office of the National Coordinator for Health Information 60,367 38,381 60,367 ................ +21,986
Technology...................................................
Combatting Opioids Abuse and Misuse and Addressing Mental ................ 10,000,000 ................ ................ -10,000,000
Illness......................................................

Office of Inspector General

Inspector General Federal Funds............................... 80,000 80,000 80,000 ................ ................
HCFAC funding (NA)........................................ (334,097) (334,097) (334,097) ................ ................
-----------------------------------------------------------------------------------------
Total, Inspector General Program Level.................. (414,097) (414,097) (414,097) ................ ................
=========================================================================================
Office for Civil Rights

Federal Funds................................................. 38,798 30,904 38,798 ................ +7,894

Retirement Pay and Medical Benefits for Commissioned Officers

Retirement Payments........................................... 456,266 469,246 469,246 +12,980 ................
Survivors Benefits............................................ 31,583 31,756 31,756 +173 ................
Dependents' Medical Care...................................... 130,840 128,207 128,207 -2,633 ................
-----------------------------------------------------------------------------------------
Total, Benefits for Commissioned Officers............... 618,689 629,209 629,209 +10,520 ................
=========================================================================================
Public Health and Social Services Emergency Fund (PHSSEF)

Assistant Secretary for Preparedness and Response

Operations.................................................... 30,938 30,879 30,938 ................ +59
Preparedness and Emergency Operations......................... 24,654 26,596 24,654 ................ -1,942
National Disaster Medical System.............................. 57,404 49,809 57,404 ................ +7,595

Hospital Preparedness Cooperative Agreement Grants:
Formula Grants............................................ 264,555 254,555 264,555 ................ +10,000
Biomedical Advanced Research and Development Authority (BARDA) 536,700 511,700 561,700 +25,000 +50,000
Policy and Planning........................................... 14,877 14,849 14,877 ................ +28
Project BioShield............................................. 710,000 510,000 735,000 +25,000 +225,000
Strategic National Stockpile.................................. ................ 575,000 ................ ................ -575,000
-----------------------------------------------------------------------------------------
Subtotal, Preparedness and Response..................... 1,639,128 1,973,388 1,689,128 +50,000 -284,260

Assistant Secretary for Administration

Assistant Secretary for Administration, Cybersecurity......... 50,860 68,093 58,860 +8,000 -9,233
Office of Security and Strategic Information.................. 7,470 8,496 7,470 ................ -1,026

Public Health and Science

Medical Reserve Corps......................................... 6,000 3,900 6,000 ................ +2,100
Pandemic Influenza Preparedness............................... 250,000 250,000 285,000 +35,000 +35,000
-----------------------------------------------------------------------------------------
Subtotal, Non-pandemic flu/BioShield/Parklawn/Other 993,458 1,543,877 1,026,458 +33,000 -517,419
construction...........................................
-----------------------------------------------------------------------------------------
Total, PHSSEF........................................... 1,953,458 2,303,877 2,046,458 +93,000 -257,419
=========================================================================================
Total, Office of the Secretary.......................... 3,904,322 13,494,297 3,517,842 -386,480 -9,976,455

Federal Funds....................................... 3,721,941 13,381,916 3,335,461 -386,480 -10,046,455
Trust Funds......................................... 182,381 112,381 182,381 ................ +70,000
(Evaluation Tap Funding).......................... (64,828) (53,445) (64,828) ................ (+11,383)
Total, Office of the Secretary Program Level............ 3,969,150 13,547,742 3,582,670 -386,480 -9,965,072
=========================================================================================
Total, Title II, Health and Human Services.............. 847,608,029 895,412,883 899,211,952 +51,603,923 +3,799,069
Federal Funds....................................... 842,952,589 890,939,923 894,536,512 +51,583,923 +3,596,589
Current year.................................. (704,004,830) (748,808,126) (752,404,715) (+48,399,885) (+3,596,589)
Fiscal year 2020.............................. (138,947,759) (142,131,797) (142,131,797) (+3,184,038) ................
Trust Funds......................................... 4,655,440 4,472,960 4,675,440 +20,000 +202,480
Total, CURES Act........................................ (996,000) (711,000) (711,000) (-285,000) ................
Total, Prevention and Public Health Fund................ (840,600) ................ (848,000) (+7,400) (+848,000)
Total, Transfers from Nonrecurring Expenses Fund........ (240,000) ................ ................ (-240,000) ................
=========================================================================================
TITLE III--DEPARTMENT OF EDUCATION

EDUCATION FOR THE DISADVANTAGED

Grants to Local Educational Agencies (LEAs)
Basic Grants:
Advance from prior year............................... (1,840,776) (1,540,776) (1,540,776) (-300,000) ................
Forward funded........................................ 4,913,625 3,777,904 5,038,625 +125,000 +1,260,721
Current funded........................................ 5,000 ................ 5,000 ................ +5,000
-----------------------------------------------------------------------------------------
Subtotal, Basic grants current year approp.......... 4,918,625 3,777,904 5,043,625 +125,000 +1,265,721
Subtotal, Basic grants total funds available........ (6,759,401) (5,318,680) (6,584,401) (-175,000) (+1,265,721)

Basic Grants Fiscal Year 2020 Advance..................... 1,540,776 2,681,497 1,415,776 -125,000 -1,265,721
-----------------------------------------------------------------------------------------
Subtotal, Basic grants, program level................... 6,459,401 6,459,401 6,459,401 ................ ................

Concentration Grants:
Advance from prior year............................... (1,362,301) (1,362,301) (1,362,301) ................ ................
Fiscal year 2020 Advance.............................. 1,362,301 1,362,301 1,362,301 ................ ................
-----------------------------------------------------------------------------------------
Subtotal............................................ 1,362,301 1,362,301 1,362,301 ................ ................

Targeted Grants:
Advance from prior year............................... (3,819,050) (3,969,050) (3,969,050) (+150,000) ................
Fiscal year 2020 Advance.............................. 3,969,050 3,819,050 4,031,550 +62,500 +212,500
-----------------------------------------------------------------------------------------
Subtotal............................................ 3,969,050 3,819,050 4,031,550 +62,500 +212,500

Education Finance Incentive Grants:
Advance from prior year............................... (3,819,050) (3,969,050) (3,969,050) (+150,000) ................
Fiscal year 2020 Advance.............................. 3,969,050 3,819,050 4,031,550 +62,500 +212,500
-----------------------------------------------------------------------------------------
Subtotal............................................ 3,969,050 3,819,050 4,031,550 +62,500 +212,500
=========================================================================================
Subtotal, Grants to LEAs, program level................. 15,759,802 15,459,802 15,884,802 +125,000 +425,000

Innovative Approaches to Literacy............................. 27,000 ................ 27,000 ................ +27,000
Comprehensive literacy development grants..................... 190,000 ................ 190,000 ................ +190,000

State Agency Programs:
Migrant................................................... 374,751 374,751 374,751 ................ ................
Neglected and Delinquent/High Risk Youth.................. 47,614 47,614 47,614 ................ ................
-----------------------------------------------------------------------------------------
Subtotal, State Agency programs......................... 422,365 422,365 422,365 ................ ................

Special Programs for Migrant Students......................... 44,623 44,623 44,623 ................ ................
-----------------------------------------------------------------------------------------
Total, Education for the disadvantaged.................. 16,443,790 15,926,790 16,568,790 +125,000 +642,000

Current year........................................ (5,602,613) (4,244,892) (5,727,613) (+125,000) (+1,482,721)
Fiscal year 2020.................................... (10,841,177) (11,681,898) (10,841,177) ................ (-840,721)
Subtotal, Forward Funded................................ (5,525,990) (4,200,269) (5,650,990) (+125,000) (+1,450,721)
=========================================================================================
IMPACT AID

Basic Support Payments........................................ 1,270,242 1,189,233 1,294,242 +24,000 +105,009
Payments for Children with Disabilities....................... 48,316 48,316 48,316 ................ ................
Facilities Maintenance (Sec. 8008)............................ 4,835 4,835 4,835 ................ ................
Construction (Sec. 8007)...................................... 17,406 17,406 17,406 ................ ................
Payments for Federal Property (Sec. 8002)..................... 73,313 ................ 74,313 +1,000 +74,313
-----------------------------------------------------------------------------------------
Total, Impact aid....................................... 1,414,112 1,259,790 1,439,112 +25,000 +179,322
=========================================================================================
SCHOOL IMPROVEMENT PROGRAMS

Supporting Effective Instruction State Grants................. 374,389 ................ 374,389 ................ +374,389
Advance from prior year................................... (1,681,441) (1,681,441) (1,681,441) ................ ................
Fiscal year 2020.......................................... 1,681,441 ................ 1,681,441 ................ +1,681,441
-----------------------------------------------------------------------------------------
Subtotal, Supporting Effective Instruction State Grants, 2,055,830 ................ 2,055,830 ................ +2,055,830
program level..........................................

Supplemental Education Grants................................. 16,699 16,699 16,699 ................ ................
21st Century Community Learning Centers....................... 1,211,673 ................ 1,211,673 ................ +1,211,673
State Assessments............................................. 378,000 369,100 378,000 ................ +8,900
Education for Homeless Children and Youth..................... 85,000 77,000 93,500 +8,500 +16,500
Training and Advisory Services (Civil Rights)................. 6,575 6,575 6,575 ................ ................
Education for Native Hawaiians................................ 36,397 ................ 36,397 ................ +36,397
Alaska Native Education Equity................................ 35,453 ................ 35,453 ................ +35,453
Rural Education............................................... 180,840 175,840 180,840 ................ +5,000
Comprehensive Centers......................................... 52,000 ................ 52,000 ................ +52,000
Student Support and Academic Enrichment grants................ 1,100,000 ................ 1,225,000 +125,000 +1,225,000
-----------------------------------------------------------------------------------------
Total, School Improvement Programs...................... 5,158,467 645,214 5,291,967 +133,500 +4,646,753

Current year........................................ (3,477,026) (645,214) (3,610,526) (+133,500) (+2,965,312)
Fiscal year 2020.................................... (1,681,441) ................ (1,681,441) ................ (+1,681,441)
Subtotal, Forward Funded................................ (3,329,902) (621,940) (3,463,402) (+133,500) (+2,841,462)
=========================================================================================
INDIAN EDUCATION

Grants to Local Educational Agencies.......................... 105,381 100,381 105,381 ................ +5,000

Federal Programs:
Special Programs for Indian Children...................... 67,993 57,993 67,993 ................ +10,000
National Activities....................................... 6,865 6,565 6,865 ................ +300
-----------------------------------------------------------------------------------------
Subtotal, Federal Programs.............................. 74,858 64,558 74,858 ................ +10,300
-----------------------------------------------------------------------------------------
Total, Indian Education................................. 180,239 164,939 180,239 ................ +15,300
=========================================================================================
INNOVATION AND IMPROVEMENT

Opportunity Grants............................................ ................ 1,000,000 ................ ................ -1,000,000
Education Innovation and Research............................. 120,000 180,000 135,000 +15,000 -45,000
American History and Civics Academies......................... 1,815 ................ 1,815 ................ +1,815
American History and Civics National Activities............... 1,700 ................ 1,700 ................ +1,700
Charter Schools Grants........................................ 400,000 500,000 445,000 +45,000 -55,000
Magnet Schools Assistance..................................... 105,000 97,647 105,000 ................ +7,353
Teacher and School Leader Incentive Grants.................... 200,000 ................ 200,000 ................ +200,000
Ready-to-Learn Television..................................... 27,741 ................ 27,741 ................ +27,741
Supporting Effective Educator Development (SEED).............. 75,000 ................ 75,000 ................ +75,000
Arts in Education............................................. 29,000 ................ 29,000 ................ +29,000
Javits Gifted and Talented Students........................... 12,000 ................ 12,000 ................ +12,000
Statewide Family Engagement Centers........................... 10,000 ................ 10,000 ................ +10,000
-----------------------------------------------------------------------------------------
Total, Innovation and Improvement....................... 982,256 1,777,647 1,042,256 +60,000 -735,391

Current Year........................................ (982,256) (1,777,647) (1,042,256) (+60,000) (-735,391)
-----------------------------------------------------------------------------------------
SAFE SCHOOLS AND CITIZENSHIP EDUCATION

Promise Neighborhoods......................................... 78,254 ................ 78,254 ................ +78,254
School Safety National Activities............................. 90,000 43,000 95,000 +5,000 +52,000
Full-Service Community Schools................................ 17,500 ................ 17,500 ................ +17,500
-----------------------------------------------------------------------------------------
Total, Safe Schools and Citizenship Education........... 185,754 43,000 190,754 +5,000 +147,754
=========================================================================================
ENGLISH LANGUAGE ACQUISITION

Current funded................................................ 47,931 47,931 47,931 ................ ................
Forward funded................................................ 689,469 689,469 689,469 ................ ................
-----------------------------------------------------------------------------------------
Total, English Language Acquisition..................... 737,400 737,400 737,400 ................ ................
=========================================================================================
SPECIAL EDUCATION

State Grants:
Grants to States Part B current year...................... 2,994,465 1,878,745 3,119,465 +125,000 +1,240,720
Part B advance from prior year........................ (9,283,383) (9,283,383) (9,283,383) ................ ................
Grants to States Part B (fiscal year 2020)................ 9,283,383 10,124,103 9,283,383 ................ -840,720
-----------------------------------------------------------------------------------------
Subtotal, program level................................. 12,277,848 12,002,848 12,402,848 +125,000 +400,000

Preschool Grants.......................................... 381,120 368,238 381,120 ................ +12,882
Grants for Infants and Families........................... 470,000 458,556 470,000 ................ +11,444
-----------------------------------------------------------------------------------------
Subtotal, program level................................. 13,128,968 12,829,642 13,253,968 +125,000 +424,326

IDEA National Activities (current funded):
State Personnel Development............................... 38,630 38,630 38,630 ................ ................
Technical Assistance and Dissemination (including Special 59,428 44,345 61,928 +2,500 +17,583
Olympics Education)......................................
Personnel Preparation..................................... 83,700 83,700 83,700 ................ ................
Parent Information Centers................................ 27,411 27,411 27,411 ................ ................
Educational Technology, Media, and Materials.................. 28,047 28,047 28,047 ................ ................
-----------------------------------------------------------------------------------------
Subtotal, IDEA National Activities...................... 237,216 222,133 239,716 +2,500 +17,583

Adjustment to match official bill language.................... ................ 1 ................ ................ -1
-----------------------------------------------------------------------------------------
Total, Special education................................ 13,366,184 13,051,776 13,493,684 +127,500 +441,908

Current year........................................ (4,082,801) (2,927,673) (4,210,301) (+127,500) (+1,282,628)
Fiscal year 2020.................................... (9,283,383) (10,124,103) (9,283,383) ................ (-840,720)
Total, Forward Funded................................... (3,845,585) (2,705,539) (3,970,585) (+125,000) (+1,265,046)
=========================================================================================
REHABILITATION SERVICES

Vocational Rehabilitation State Grants........................ 3,452,931 3,521,990 3,521,990 +69,059 ................
Client Assistance State grants................................ 13,000 13,000 13,000 ................ ................
Training...................................................... 29,388 29,388 29,388 ................ ................
Demonstration and Training programs........................... 5,796 9,296 5,796 ................ -3,500
Protection and Advocacy of Individual Rights [PAIR]........... 17,650 17,650 17,650 ................ ................
Supported Employment State grants............................. 22,548 ................ 22,548 ................ +22,548

Independent Living:
Services for Older Blind Individuals...................... 33,317 33,317 33,317 ................ ................
Helen Keller National Center for Deaf/Blind Youth and Adults.. 12,500 10,336 12,500 ................ +2,164
-----------------------------------------------------------------------------------------
Total, Rehabilitation services.......................... 3,587,130 3,634,977 3,656,189 +69,059 +21,212
=========================================================================================
SPECIAL INSTITUTIONS FOR PERSONS WITH DISABILITIES

American Printing House for the Blind......................... 27,431 25,431 30,431 +3,000 +5,000

National Technical Institute for the Deaf [NTID]:
Operations................................................ 73,000 70,016 76,500 +3,500 +6,484

Gallaudet University:
Operations................................................ 128,000 121,275 133,000 +5,000 +11,725
-----------------------------------------------------------------------------------------
Total, Gallaudet University............................. 128,000 121,275 133,000 +5,000 +11,725
-----------------------------------------------------------------------------------------
Total, Special Institutions for Persons with 228,431 216,722 239,931 +11,500 +23,209
Disabilities...........................................
=========================================================================================
CAREER, TECHNICAL, AND ADULT EDUCATION

Career Education:
Basic State Grants/Secondary & Technical Education State 401,598 326,598 401,598 ................ +75,000
Grants, current funded...................................
Advance from prior year............................... (791,000) (791,000) (791,000) ................ ................
Fiscal year 2020...................................... 791,000 791,000 791,000 ................ ................
-----------------------------------------------------------------------------------------
Subtotal, Basic State Grants, program level......... 1,192,598 1,117,598 1,192,598 ................ +75,000

National Programs......................................... 7,421 20,000 7,421 ................ -12,579
-----------------------------------------------------------------------------------------
Subtotal, Career Education.............................. 1,200,019 1,137,598 1,200,019 ................ +62,421

Adult Education:
State Grants/Adult Basic and Literacy Education:
State Grants, current funded.......................... 616,955 485,849 641,955 +25,000 +156,106
National Leadership Activities................................ 13,712 13,712 13,712 ................ ................
-----------------------------------------------------------------------------------------
Subtotal, Adult education............................... 630,667 499,561 655,667 +25,000 +156,106
-----------------------------------------------------------------------------------------
Total, Career, Technical, and Adult Education........... 1,830,686 1,637,159 1,855,686 +25,000 +218,527

Current year........................................ (1,039,686) (846,159) (1,064,686) (+25,000) (+218,527)
Fiscal year 2020.................................... (791,000) (791,000) (791,000) ................ ................
Total, Forward Funded................................... (1,039,686) (846,159) (1,064,686) (+25,000) (+218,527)
=========================================================================================
STUDENT FINANCIAL ASSISTANCE

Pell Grants--maximum grant (NA)............................... (5,035) (4,860) (5,135) (+100) (+275)
Pell Grants................................................... 22,475,352 22,475,352 22,475,352 ................ ................
Federal Supplemental Educational Opportunity Grants........... 840,000 ................ 840,000 ................ +840,000
Federal Work Study............................................ 1,130,000 500,000 1,130,000 ................ +630,000
-----------------------------------------------------------------------------------------
Total, Student Financial Assistance [SFA]............... 24,445,352 22,975,352 24,445,352 ................ +1,470,000
=========================================================================================
FEDERAL DIRECT STUDENT LOAN PROGRAM ACCOUNT................... 350,000 ................ 350,000 ................ +350,000

STUDENT AID ADMINISTRATION

Salaries and Expenses......................................... 698,943 762,000 698,943 ................ -63,057
Servicing Activities.......................................... 980,000 1,010,000 980,000 ................ -30,000
-----------------------------------------------------------------------------------------
Total, Student Aid Administration....................... 1,678,943 1,772,000 1,678,943 ................ -93,057
=========================================================================================
HIGHER EDUCATION

Aid for Institutional Development:
Strengthening Institutions................................ 98,886 ................ 101,067 +2,181 +101,067
Hispanic Serving Institutions............................. 123,183 ................ 125,898 +2,715 +125,898
Promoting Post-Baccalaureate Opportunities for Hispanic 11,052 ................ 11,296 +244 +11,296
Americans................................................
Strengthening Historically Black Colleges (HBCUs)......... 279,624 244,694 285,788 +6,164 +41,094
Strengthening Historically Black Graduate Institutions.... 72,314 63,281 73,908 +1,594 +10,627
Strengthening Predominantly Black Institutions............ 11,361 ................ 11,611 +250 +11,611
Asian American Pacific Islander........................... 3,826 ................ 3,910 +84 +3,910
Strengthening Alaska Native and Native Hawaiian-Serving 15,772 ................ 16,120 +348 +16,120
Institutions.............................................
Strengthening Native American-Serving Nontribal 3,826 ................ 3,910 +84 +3,910
Institutions.............................................
Strengthening Tribal Colleges............................. 31,539 27,599 32,234 +695 +4,635
Strengthening HBCU Masters programs....................... 8,571 7,500 8,760 +189 +1,260
-----------------------------------------------------------------------------------------
Subtotal, Aid for Institutional development............. 659,954 343,074 674,502 +14,548 +331,428

International Education and Foreign Language:
Domestic Programs......................................... 65,103 ................ 65,103 ................ +65,103
Overseas Programs......................................... 7,061 ................ 7,061 ................ +7,061
-----------------------------------------------------------------------------------------
Subtotal, International Education & Foreign Lang........ 72,164 ................ 72,164 ................ +72,164

Postsecondary Program for Students with Intellectual 11,800 11,800 11,800 ................ ................
Disabilities.................................................
Minority Science and Engineering Improvement.................. 11,025 9,648 11,268 +243 +1,620
Tribally Controlled Postsec Voc/Tech Institutions............. 9,469 8,286 9,678 +209 +1,392
Federal TRIO Programs......................................... 1,010,000 950,000 1,010,000 ................ +60,000
GEAR UP....................................................... 350,000 ................ 350,000 ................ +350,000
Graduate Assistance in Areas of National Need................. 23,047 ................ 23,047 ................ +23,047
Teacher Quality Partnerships.................................. 43,092 ................ 43,092 ................ +43,092
Child Care Access Means Parents in School..................... 50,000 15,134 50,000 ................ +34,866
Fund for the Improvement of Postsecondary Ed. (FIPSE)......... 6,000 ................ 5,000 -1,000 +5,000
Consolidated MSI Grant........................................ ................ 147,906 ................ ................ -147,906
-----------------------------------------------------------------------------------------
Total, Higher Education................................. 2,246,551 1,485,848 2,260,551 +14,000 +774,703
=========================================================================================
HOWARD UNIVERSITY

Academic Program.............................................. 201,788 191,091 205,788 +4,000 +14,697
Endowment Program............................................. 3,405 3,405 3,405 ................ ................
Howard University Hospital.................................... 27,325 27,325 27,325 ................ ................
-----------------------------------------------------------------------------------------
Total, Howard University................................ 232,518 221,821 236,518 +4,000 +14,697
=========================================================================================
COLLEGE HOUSING AND ACADEMIC FACILITIES LOANS PROGRAM......... 435 448 435 ................ -13

HISTORICALLY BLACK COLLEGE AND UNIVERSITY (HBCU) CAPITAL
FINANCING PROGRAM ACCOUNT

HBCU Federal Administration................................... 334 339 334 ................ -5
HBCU Loan Subsidies........................................... 30,150 20,150 30,150 ................ +10,000
-----------------------------------------------------------------------------------------
Total, HBCU Capital Financing Program................... 30,484 20,489 30,484 ................ +9,995
=========================================================================================
INSTITUTE OF EDUCATION SCIENCES (IES)

Research, Development and Dissemination....................... 192,695 187,500 192,695 ................ +5,195
Statistics.................................................... 109,500 112,500 109,500 ................ -3,000
Regional Educational Laboratories............................. 55,423 ................ 55,423 ................ +55,423
Research in Special Education................................. 56,000 54,000 56,000 ................ +2,000
Special Education Studies and Evaluations..................... 10,818 10,818 10,818 ................ ................
Statewide Data Systems........................................ 32,281 ................ 32,281 ................ +32,281

Assessment:
National Assessment....................................... 149,000 149,000 151,000 +2,000 +2,000
National Assessment Governing Board....................... 7,745 7,745 7,745 ................ ................
-----------------------------------------------------------------------------------------
Subtotal, Assessment.................................... 156,745 156,745 158,745 +2,000 +2,000
-----------------------------------------------------------------------------------------
Total, IES.............................................. 613,462 521,563 615,462 +2,000 +93,899
=========================================================================================
DEPARTMENTAL MANAGEMENT

Program Administration:
Salaries and Expenses..................................... 430,000 432,506 430,000 ................ -2,506
Building Modernization.................................... ................ 26,751 ................ ................ -26,751
-----------------------------------------------------------------------------------------
Total, Program administration........................... 430,000 459,257 430,000 ................ -29,257

Office for Civil Rights....................................... 117,000 107,438 125,000 +8,000 +17,562
Office of Inspector General................................... 61,143 63,418 61,143 ................ -2,275
-----------------------------------------------------------------------------------------
Total, Departmental management.......................... 608,143 630,113 616,143 +8,000 -13,970
=========================================================================================
Total, Title III, Department of Education............... 74,320,337 66,723,048 74,929,896 +609,559 +8,206,848
Current year........................................ (51,723,336) (44,126,047) (52,332,895) (+609,559) (+8,206,848)
Fiscal year 2020.................................... (22,597,001) (22,597,001) (22,597,001) ................ ................
=========================================================================================
TITLE IV--RELATED AGENCIES

COMMITTEE FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR SEVERELY 8,250 8,650 8,250 ................ -400
DISABLED.....................................................

CORPORATION FOR NATIONAL AND COMMUNITY SERVICE

Operating Expenses

Domestic Volunteer Service Programs:
Volunteers in Service to America [VISTA].................. 92,364 4,910 92,364 ................ +87,454
National Senior Volunteer Corps:
Foster Grandparents Program........................... 107,702 117 107,702 ................ +107,585
Senior Companion Program.............................. 45,512 117 45,512 ................ +45,395
Retired Senior Volunteer Program...................... 48,903 117 48,903 ................ +48,786
-----------------------------------------------------------------------------------------
Subtotal, Senior Volunteers......................... 202,117 351 202,117 ................ +201,766
-----------------------------------------------------------------------------------------
Subtotal, Domestic Volunteer Service................ 294,481 5,261 294,481 ................ +289,220

National and Community Service Programs:
AmeriCorps State and National Grants...................... 412,010 2,341 415,010 +3,000 +412,669
Innovation, Assistance, and Other Activities.............. 7,600 ................ 7,600 ................ +7,600
Evaluation................................................ 4,000 ................ 4,000 ................ +4,000
National Civilian Community Corps (NCCC)(subtitle E)...... 32,000 24,087 32,000 ................ +7,913
State Commission Support Grants........................... 17,538 ................ 17,538 ................ +17,538
-----------------------------------------------------------------------------------------
Subtotal, National and Community Service................ 473,148 26,428 476,148 +3,000 +449,720
-----------------------------------------------------------------------------------------
Total, Operating expenses............................... 767,629 31,689 770,629 +3,000 +738,940
=========================================================================================
National Service Trust........................................ 206,842 ................ 198,163 -8,679 +198,163
Salaries and Expenses......................................... 83,737 87,389 83,737 ................ -3,652
Office of Inspector General................................... 5,750 3,568 5,750 ................ +2,182
-----------------------------------------------------------------------------------------
Total, Corp. for National and Community Service......... 1,063,958 122,646 1,058,279 -5,679 +935,633
=========================================================================================

CORPORATION FOR PUBLIC BROADCASTING:
Fiscal year 2021 (current) with fiscal year 2019 445,000 ................ 445,000 ................ +445,000
comparable...............................................
Fiscal year 2020 advance with fiscal year 2018 comparable (445,000) (445,000) (445,000) ................ ................
(NA).....................................................
Rescission of fiscal year 2020 funds (NA)............. ................ (-430,000) ................ ................ (+430,000)
-----------------------------------------------------------------------------------------
Subtotal, Fiscal year 2020 program level................ 445,000 15,000 445,000 ................ +430,000

Fiscal year 2019 advance with fiscal year 2017 comparable (445,000) (445,000) (445,000) ................ ................
(NA).....................................................
Rescission of fiscal year 2019 funds (NA)............. ................ (-429,550) ................ ................ (+429,550)
-----------------------------------------------------------------------------------------
Subtotal, Fiscal year 2019 program level................ 445,000 15,450 445,000 ................ +429,550

Public television interconnection system (current)........ 20,000 ................ 20,000 ................ +20,000

FEDERAL MEDIATION AND CONCILIATION SERVICE.................... 46,650 47,200 46,650 ................ -550
FEDERAL MINE SAFETY AND HEALTH REVIEW COMMISSION.............. 17,184 17,053 17,184 ................ +131
INSTITUTE OF MUSEUM AND LIBRARY SERVICES...................... 240,000 23,000 242,000 +2,000 +219,000
MEDICAID AND CHIP PAYMENT AND ACCESS COMMISSION............... 8,480 8,700 8,480 ................ -220
MEDICARE PAYMENT ADVISORY COMMISSION.......................... 12,545 12,471 12,545 ................ +74
NATIONAL COUNCIL ON DISABILITY................................ 3,250 3,211 3,250 ................ +39
NATIONAL LABOR RELATIONS BOARD................................ 274,224 249,000 274,224 ................ +25,224
NATIONAL MEDIATION BOARD...................................... 13,800 13,205 13,800 ................ +595
OCCUPATIONAL SAFETY AND HEALTH REVIEW COMMISSION.............. 13,225 12,615 13,225 ................ +610

RAILROAD RETIREMENT BOARD

Dual Benefits Payments Account................................ 22,000 19,000 19,000 -3,000 ................
Less Income Tax Receipts on Dual Benefits..................... -1,000 -1,000 -1,000 ................ ................
-----------------------------------------------------------------------------------------
Subtotal, Dual Benefits................................. 21,000 18,000 18,000 -3,000 ................

Federal Payments to the Railroad Retirement Accounts.......... 150 150 150 ................ ................
Limitation on Administration.................................. 123,500 115,225 123,500 ................ +8,275
Limitation on the Office of Inspector General................. 11,000 8,437 11,000 ................ +2,563

SOCIAL SECURITY ADMINISTRATION

Payments to Social Security Trust Funds....................... 11,400 11,000 11,000 -400 ................

Supplemental Security Income Program

Federal Benefit Payments...................................... 48,236,000 55,716,000 55,716,000 +7,480,000 ................
Beneficiary Services.......................................... 159,000 126,000 126,000 -33,000 ................
Research and Demonstration.................................... 101,000 101,000 101,000 ................ ................
Administration................................................ 4,991,277 4,765,000 4,947,721 -43,556 +182,721
-----------------------------------------------------------------------------------------
Subtotal, SSI program level............................. 53,487,277 60,708,000 60,890,721 +7,403,444 +182,721

Less funds advanced in prior year................... -15,000,000 -19,500,000 -19,500,000 -4,500,000 ................
-----------------------------------------------------------------------------------------
Subtotal, regular SSI current year...................... 38,487,277 41,208,000 41,390,721 +2,903,444 +182,721

New advance, 1st quarter, fiscal year 2020.......... 19,500,000 19,700,000 19,700,000 +200,000 ................
-----------------------------------------------------------------------------------------
Total, SSI program...................................... 57,987,277 60,908,000 61,090,721 +3,103,444 +182,721
=========================================================================================
Limitation on Administrative Expenses

OASI/DI Trust Funds........................................... 5,101,321 4,895,700 5,154,585 +53,264 +258,885
HI/SMI Trust Funds............................................ 2,313,197 2,220,000 2,337,339 +24,142 +117,339
Social Security Advisory Board................................ 2,300 2,300 2,300 ................ ................
SSI........................................................... 3,602,127 3,457,000 3,639,721 +37,594 +182,721
-----------------------------------------------------------------------------------------
Subtotal, regular LAE................................... 11,018,945 10,575,000 11,133,945 +115,000 +558,945

User Fees:
SSI User Fee activities................................... 118,000 134,000 134,000 +16,000 ................
CBO adjustment........................................ -3,000 -5,000 -5,000 -2,000 ................
SSPA User Fee Activities.................................. 1,000 1,000 1,000 ................ ................
CBO adjustment........................................ -1,000 -1,000 -1,000 ................ ................
-----------------------------------------------------------------------------------------
Subtotal, User fees..................................... 115,000 129,000 129,000 +14,000 ................
-----------------------------------------------------------------------------------------
Subtotal, Limitation on administrative expenses......... 11,133,945 10,704,000 11,262,945 +129,000 +558,945

Program Integrity:
OASDI Trust Funds......................................... 345,850 375,000 375,000 +29,150 ................
SSI....................................................... 1,389,150 1,308,000 1,308,000 -81,150 ................
-----------------------------------------------------------------------------------------
Subtotal, Program integrity funding..................... 1,735,000 1,683,000 1,683,000 -52,000 ................
=========================================================================================
Total, Limitation on Administrative Expenses............ 12,868,945 12,387,000 12,945,945 +77,000 +558,945

Office of Inspector General

Federal Funds................................................. 30,000 30,000 30,000 ................ ................
Trust Funds................................................... 75,500 75,500 75,500 ................ ................
-----------------------------------------------------------------------------------------
Total, Office of Inspector General...................... 105,500 105,500 105,500 ................ ................
=========================================================================================
Adjustment: Trust fund transfers from general revenues........ -4,991,277 -4,765,000 -4,947,721 +43,556 -182,721
-----------------------------------------------------------------------------------------
Total, Social Security Administration................... 65,981,845 68,646,500 69,205,445 +3,223,600 +558,945

Federal funds....................................... 58,143,677 61,078,000 61,260,721 +3,117,044 +182,721
Current year.................................. (38,643,677) (41,378,000) (41,560,721) (+2,917,044) (+182,721)
New advances, 1st quarter, fiscal year 2020... (19,500,000) (19,700,000) (19,700,000) (+200,000) ................
Trust funds......................................... 7,838,168 7,568,500 7,944,724 +106,556 +376,224
=========================================================================================
Total, Title IV, Related Agencies....................... 68,304,061 69,306,063 71,520,982 +3,216,921 +2,214,919
Federal Funds....................................... 60,318,848 61,601,430 63,429,213 +3,110,365 +1,827,783
Current Year.................................. (40,373,848) (41,901,430) (43,284,213) (+2,910,365) (+1,382,783)
Fiscal year 2020 Advance...................... (19,500,000) (19,700,000) (19,700,000) (+200,000) ................
Fiscal year 2021 Advance...................... (445,000) ................ (445,000) ................ (+445,000)
Trust Funds......................................... 7,985,213 7,704,633 8,091,769 +106,556 +387,136
=========================================================================================
OTHER APPROPRIATIONS

FURTHER ADDITIONAL SUPPLEMENTAL APPROPRIATIONS FOR DISASTER
RELIEF REQUIREMENTS ACT, 2018

TITLE VIII

DEPARTMENT OF LABOR

Employment and Training Administration

Training and Employment Services (emergency).................. 100,000 ................ ................ -100,000 ................
Job Corps (emergency)......................................... 30,900 ................ ................ -30,900 ................

General Provisions--Department of Labor

Deferment of of interest payments for U.S. Virgin Islands -1,000 ................ ................ +1,000 ................
(Sec. 20801) (emergency).....................................

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

CDC-Wide Activities and Program Support (emergency)........... 200,000 ................ ................ -200,000 ................

National Institutes of Health

Office of the Director (emergency)............................ 50,000 ................ ................ -50,000 ................

Administration for Children and Families

Children and Families Services Programs (emergency)........... 650,000 ................ ................ -650,000 ................

Office of the Secretary

Public Health and Social Services Emergency Fund (emergency).. 162,000 ................ ................ -162,000 ................

DEPARTMENT OF EDUCATION

Hurricane Education Recovery

Hurricane Education Recovery (emergency)...................... 2,700,000 ................ ................ -2,700,000 ................

Hurricane Education Recovery waiver authority for HEA of 1965 5,000 ................ ................ -5,000 ................
(Federal Direct Student Loan Program account) (emergency)....

General Provisions--Department of Education

HBCU Hurricane Supplemental Loan Program (loan forgiveness) 90,000 ................ ................ -90,000 ................
(Sec. 20804) (emergency).....................................
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Total, title VIII....................................... 3,986,900 ................ ................ -3,986,900 ................
=========================================================================================
Total, Supplemental Appropriations for Disaster Relief 3,986,900 ................ ................ -3,986,900 ................
Requirements (Public Law 115-123 (DivB, Subdivision1)).
=========================================================================================
Total, Other Appropriations............................. 3,986,900 ................ ................ -3,986,900 ................

RECAP

Federal Funds (all years)..................................... 991,603,180 1,027,961,378 1,042,825,000 +51,221,820 +14,863,622
Trust Funds (all years)....................................... 16,389,446 15,773,525 16,395,321 +5,875 +621,796
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Grand Total............................................. 1,007,992,626 1,043,734,903 1,059,220,321 +51,227,695 +15,485,418
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