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115th Congress    }                                           {    Report
                         HOUSE OF REPRESENTATIVES
 2d Session       }                                           {   115-862

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



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

                                _______
                                

 July 23, 2018.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

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

                              R E P O R T

                             together with

                             MINORITY VIEWS

                        [To accompany H.R. 6470]

    The Committee on Appropriations submits the following 
report in explanation of the accompanying bill making 
appropriations for the Departments of Labor, Health and Human 
Services (except the Food and Drug Administration, the Agency 
for Toxic Substances and Disease Registry and the Indian Health 
Service), and Education, and the Committee for Purchase from 
People Who Are Blind or Severely Disabled, Corporation for 
National and Community Service, Corporation for Public 
Broadcasting, Federal Mediation and Conciliation Service, 
Federal Mine Safety and Health Review Commission, Institute of 
Museum and Library Services, Medicaid and CHIP Payment and 
Access Commission, Medicare Payment Advisory Commission, 
National Council on Disability, National Labor Relations Board, 
National Mediation Board, Occupational Safety and Health Review 
Commission, Railroad Retirement Board, and Social Security 
Administration for the fiscal year ending September 30, 2019, 
and for other purposes.

                        INDEX TO BILL AND REPORT

_______________________________________________________________________


                                                            Page number

                                                            Bill Report
Summary of Estimates and Appropriation.....................
                                                                      3
General Summary of the Bill................................
                                                                      3
Title I--Department of Labor:                                   2
                                                                      5
        Employment and Training Administration.............     2
                                                                      5
        Employee Benefits Security Administration..........    17
                                                                     10
        Pension Benefit Guaranty Corporation...............    17
                                                                     11
        Wage and Hour Division.............................    18
                                                                     11
        Office of Labor-Management Standards...............    18
                                                                     12
        Office of Federal Contract Compliance Programs.....    19
                                                                     12
        Office of Workers' Compensation Programs...........    19
                                                                     12
        Occupational Safety and Health Administration......    23
                                                                     14
        Mine Safety and Health Administration..............    26
                                                                     15
        Bureau of Labor Statistics.........................    28
                                                                     15
        Office of Disability Employment Policy.............    28
                                                                     16
        Departmental Management............................    28
                                                                     16
        General Provisions.................................    34
                                                                     19
Title II--Department of Health and Human Services:             48
                                                                     20
        Health Resources and Services Administration.......    48
                                                                     20
        Centers for Disease Control and Prevention.........    55
                                                                     35
        National Institutes of Health......................    60
                                                                     52
        Substance Abuse and Mental Health Services 
            Administration.................................    68
                                                                     77
        Agency for Healthcare Research and Quality.........    73
                                                                     86
        Centers for Medicare & Medicaid Services...........    74
                                                                     87
        Administration for Children and Families...........    77
                                                                    102
        Administration for Community Living................    86
                                                                    109
        Office of the Secretary............................    89
                                                                    116
                Public Health and Social Services Emergency 
                    Fund...................................    92
                                                                    123
        General Provisions.................................    94
                                                                    126
Title III--Department of Education:                           111
                                                                    129
        Education for the Disadvantaged....................   111
                                                                    129
        Impact Aid.........................................   112
                                                                    131
        School Improvement Programs........................   113
                                                                    132
        Indian Education...................................   114
                                                                    135
        Innovation and Improvement.........................   115
                                                                    136
        Safe Schools and Citizenship Education.............   115
                                                                    140
        English Language Acquisition.......................   115
                                                                    141
        Special Education..................................   116
                                                                    141
        Rehabilitation Services............................   119
                                                                    143
        Special Institutions for Persons with Disabilities.   120
                                                                    145
        Career, Technical and Adult Education..............   120
                                                                    146
        Student Financial Assistance.......................   121
                                                                    148
        Student Aid Administration.........................   121
                                                                    149
        Higher Education...................................   121
                                                                    150
        Howard University..................................   122
                                                                    154
        College Housing and Academic Facilities Loans......   123
                                                                    155
        Historically Black College and University Capital 
            Financing 
            Program Account................................   123
                                                                    155
        Institute of Education Sciences....................   124
                                                                    155
        Departmental Management............................   124
                                                                    157
        General Provisions.................................   125
                                                                    159
Title IV--Related Agencies:                                   127
                                                                    160
        Committee for the Purchase from People Who Are 
            Blind or 
            Severely Disabled..............................   127
                                                                    160
        Corporation for National and Community Service.....   128
                                                                    161
        Corporation for Public Broadcasting................   133
                                                                    163
        Federal Mediation and Conciliation Service.........   134
                                                                    163
        Federal Mine Safety and Health Review Commission...   135
                                                                    163
        Institute of Museum and Library Services...........   135
                                                                    163
        Medicare Payment Advisory Commission...............   136
                                                                    164
        Medicaid and CHIP Payment and Access Commission....   135
                                                                    165
        National Council on Disability.....................   135
                                                                    166
        National Labor Relations Board.....................   136
                                                                    166
        National Mediation Board...........................   139
                                                                    167
        Occupational Safety and Health Review Commission...   139
                                                                    167
        Railroad Retirement Board..........................   139
                                                                    167
        Social Security Administration.....................   141
                                                                    168
Title V--General Provisions:                                  146
                                                                    173
        House of Representatives Report Requirements.......
                                                                    175

                Summary of Estimates and Appropriations

    The following table compares on a summary basis the 
appropriations, including trust funds for fiscal year 2019, the 
budget request for fiscal year 2019, and the Committee 
recommendation for fiscal year 2019 in the accompanying bill.

                                         2019 LABOR, HHS, EDUCATION BILL
                                 [Discretionary funding in thousands of dollars]
----------------------------------------------------------------------------------------------------------------
                                                   Fiscal Year--                   2019 Committee compared to--
         Budget Activity         -------------------------------------------------------------------------------
                                   2018 Enacted     2019 Budget   2019 Committee   2018 Enacted     2019 Budget
----------------------------------------------------------------------------------------------------------------
Department of Labor.............     $12,217,573     $10,936,310     $12,128,762         -88,811      +1,192,452
Department of Health and Human        88,157,139      86,726,260      89,290,026      +1,132,887      +2,563,766
 Services.......................
Department of Education.........      70,867,406      63,201,057      70,784,022         -83,384      +7,582,965
Related Agencies................      15,296,511      13,596,913      14,965,762        -330,749      +1,368,849
----------------------------------------------------------------------------------------------------------------

                      General Summary of the Bill

    For fiscal year 2019, the Committee recommends a total of 
$179,002,000,000 in current year discretionary funding, 
including offsets and adjustments. The fiscal year 2019 
recommendation is an increase of $6,000,000 above the fiscal 
year 2018 enacted level.
    Within the funds provided, the Committee has again focused 
increases on priority areas that will improve the health, 
safety and job opportunities for Americans of all walks of 
life.
    First and foremost, the Committee continues to build on the 
investments made over the past several years in biomedical 
research by increasing funding for the National Institutes of 
Health (NIH) by $1,250,000,000. Within the total increase, the 
Committee provides an increase of $401,000,000 for Alzheimer's 
disease research, an increase of $100,000,000 for the Cancer 
Moonshot, and an increase of $30,000,000 for research to 
develop a universal influenza vaccine. The Committee also 
expands upon the Down syndrome research initiative established 
in fiscal year 2018.
    The Committee also continues efforts to support States and 
local communities combat the national scourge of opioid 
addiction by including an additional $500,000,000 for grants to 
States. The Committee maintains funding levels for opioid abuse 
prevention, treatment, and recovery and continues to support 
robust funding for mental and behavioral health.
    To protect public health and the Nation in the event of a 
bioterrorism attack or other public health emergency, the 
Committee recommendation includes increases for the Biomedical 
Research and Advanced Development Authority (BARDA), Project 
BioShield, the Strategic National Stockpile, the National 
Disaster Management System, and grants to States and regional 
coalitions to support public health preparedness. Finally, to 
allow the Secretary of Health and Human Services greater 
flexibility to respond to an imminent public health threat 
without waiting for Congress to act on a supplemental spending 
bill, the Committee establishes $325,000,000 for a new 
Infectious Disease Rapid Response Reserve Fund. These funds 
will be held until needed in the event of an imminent 
infectious disease outbreak that threatens the health of 
Americans.
    To invest in workforce training, the Committee provides 
$6,988,602,000 in worker training programs of which 
$2,789,832,000 is for States' training grants, $150,000,000 is 
to support the Administration's apprenticeship initiatives, and 
$299,662,000 is for Veterans' Employment and Training, 
including $50,000,000 for the Homeless Veterans' Reintegration 
program, and a new initiative in the Transition Assistance 
Program to connect transitioning service members to 
apprenticeship opportunities.
    In the area of education, the Committee has included an 
increase of $100,000,000 for Student Support and Academic 
Enrichment grants, bringing this program total to 
$1,200,000,000. These funds can be used flexibly by school 
districts across the country to meet local challenges, whether 
those be in the area of counseling and preventing school based 
violence or teacher training. The Committee also provides 
funding for services to assist persons with disabilities live 
with dignity and support in their local communities.
    In the area of continuing education beyond high school, the 
Committee includes robust increases for the TRIO, $50,000,000, 
and GEAR UP, $10,000,000, programs to ensure that students from 
disadvantaged backgrounds have access to a college program. The 
Committee also includes an increase of $115,000,000 for career 
and technical education programs, to ensure that all students 
have the opportunity to continue to develop their skills after 
high school and enter into good paying jobs. Finally, the bill 
also provides sufficient funding to maintain the maximum Pell 
grant award at $6,095 in the 2019-2020 academic year.
    Finally, the Committee bill continues to invest in early 
childhood education by increasing the Head Start program by 
$50,000,000 and including $250,000,000 within the Department of 
Health and Human Services for the Preschool Development Grants 
program.
    The Committee believes that public service is a public 
trust that requires Federal employees to place ethical 
principles above private gain. Federal employees are reminded 
that they shall not advance a personal agenda or give 
preferential treatment to any outside organization or 
individual within the government programs that they administer. 
Information that is received by the employee, including 
information from other employees, offices, or Congress should 
be handled in a professional and confidential manner in 
accordance with Code of Federal Regulations regarding the basic 
obligation of public service (5 CFR 2635.101).
    The Committee directs each of the agencies funded by this 
Act to continue to report any funds derived by the agency from 
non-Federal sources, including user charges and fines, that are 
authorized by law, to be retained and used by the agency or 
credited as an offset in annual budget submissions.

                      TITLE I--DEPARTMENT OF LABOR


                 Employment and Training Administration


 
 
 
Appropriation, fiscal year 2018.......................   $10,018,202,000
Budget request, fiscal year 2019......................     8,787,050,000
Committee Recommendation..............................     9,801,934,000
    Change from enacted level.........................      -216,268,000
    Change from budget request........................    +1,014,884,000
 

    The Employment and Training Administration (ETA) 
administers Federal job training grant programs and Trade 
Adjustment Assistance, and provides funding and oversight for 
the State Unemployment Insurance and Employment Service system.

                    TRAINING AND EMPLOYMENT SERVICES

 
 
 
Appropriation, fiscal year 2018.......................    $3,486,200,000
Budget request, fiscal year 2019......................     3,220,549,000
Committee Recommendation..............................     3,474,341,000
    Change from enacted level.........................       -11,859,000
    Change from budget request........................      +253,792,000
 

    Training and Employment Services provides funding for 
Federal job training programs authorized primarily by the 
Workforce Innovation and Opportunity Act of 2014 (WIOA).
    Workforce Training.--The Committee reiterates its support 
for efforts by the Department of Labor to improve workforce 
training programs by building partnerships that will better 
serve participants by connecting them with in-demand jobs and 
helping to reduce the skills gap.
    Apprenticeship.--The Committee supports the funding and 
development of industry or sector partnerships as a means of 
closing the skills gap and expanding work-based learning 
programs and apprenticeships in in-demand industries.
    Licensing.--The Committee continues to support the 
Department's efforts to address ways in which harmonizing 
licensing requirements across States can reduce barriers to 
labor market entry and mobility, including for dislocated 
workers, transitioning service members, and veterans.
    Work Opportunity Tax Credit.--The Committee supports 
efforts by the Department to assist States with the 
implementation of the Qualified Long-Time Unemployment 
Recipients category and to reduce backlogs of Supplemental 
Security Income eligibility determinations.
    Information Technology (IT) Consortia.--The Committee 
continues to be concerned with the challenges faced by 
Unemployment Insurance IT modernization projects being carried 
out by State consortia. The Committee directs the Department to 
continue to provide annual reports to the Committees on 
Appropriations of the House of Representatives and the Senate 
on the status of all consortia projects and to implement 
appropriate policies and procedures for assessing and funding 
projects by State consortia.
    Adult Employment and Training Activities.--For Adult 
Employment and Training Activities, the Committee recommends 
$845,556,000, which is the same as the fiscal year 2018 enacted 
level and $30,000,000 more than the fiscal year 2019 budget 
request.
    Youth Employment and Training Activities.--For Youth 
Employment and Training Activities, the Committee recommends 
$903,416,000, which is the same as the fiscal year 2018 enacted 
level and $30,000,000 more than the fiscal year 2019 budget 
request.
    Dislocated Worker Employment and Training Activities.--For 
Dislocated Worker Employment and Training Activities, the 
Committee recommends $1,240,860,000 which is $20,859,000 less 
than the fiscal year 2018 enacted level and $74,141,000 more 
than the fiscal year 2019 budget request.
    Of the total provided for Dislocated Worker Employment and 
Training Activities, $1,040,860,000 is designated for State 
grants that provide core and intensive services, training, and 
supportive services for dislocated workers. In addition, States 
use these funds for rapid response assistance to help workers 
affected by mass layoffs and plant closures.
    The remaining $200,000,000 is available for the Dislocated 
Workers National Reserve (DWNR). The DWNR supports national 
emergency grants, technical assistance and demonstration 
projects as authorized by WIOA. The Committee recommendation 
eliminates advance appropriations for the DWNR by providing 
$200,000,000 in current year funds and rescinding the advance 
provided in fiscal year 2018. No advance is provided for fiscal 
year 2020. The Committee recommendation includes $30,000,000 to 
assist dislocated workers in areas of the country with the 
highest rates of poverty.
    Native Americans.--For the Indian and Native American 
programs, the Committee recommends $55,000,000, which is 
$1,000,000 more than the fiscal year 2018 enacted level. The 
fiscal year 2019 budget request proposed no funding for this 
program.
    Migrant and Seasonal Farmworkers.--For the National 
Farmworker Jobs program, the Committee recommends $87,896,000, 
which is the same as the fiscal year 2018 enacted level. The 
fiscal year 2019 budget request proposed no funding for this 
program.
    YouthBuild.--For the YouthBuild program, the Committee 
recommends $92,534,000, which is $3,000,000 more than the 
fiscal year 2018 enacted level and $8,000,000 more than the 
fiscal year 2019 budget request.
    The Committee is aware of challenges rural and Tribal 
communities have in applying for YouthBuild grants. The 
Committee encourages the Department to consider ways more rural 
and Tribal areas can participate in the YouthBuild program.
    Technical Assistance.--The Committee recommends no direct 
funding for technical assistance, which is the same as the 
fiscal year 2018 enacted level and $2,000,000 less than the 
fiscal year 2019 budget request. WIOA provides the authority to 
use DWNR funds for technical assistance.
    Reintegration of Ex-Offenders.--The Committee recommends 
$93,079,000 for ex-offender retraining and reintegration 
activities, which is the same as the fiscal year 2018 enacted 
level and $14,755,000 more than the fiscal year 2019 budget 
request.
    Workforce Data Quality Initiative.--The Committee 
recommends $6,000,000 for the Workforce Data Quality 
Initiative, which is the same as the fiscal year 2018 enacted 
level. The fiscal year 2019 budget request proposed no funding 
for this program.

                               JOB CORPS

 
 
 
Appropriation, fiscal year 2018.......................    $1,718,655,000
Budget request, fiscal year 2019......................     1,296,938,000
Committee Recommendation..............................     1,718,655,000
    Change from enacted level.........................             - - -
    Change from budget request........................      +421,717,000
 

    Operations.--For Job Corps Operations, the Committee 
recommends $1,603,325,000, which is the same as the fiscal year 
2018 enacted level and $413,513,000 more than the fiscal year 
2019 budget request.
    Construction, Rehabilitation, and Acquisition.--The 
Committee recommends $83,000,000 for construction, 
rehabilitation, and acquisition activities of Job Corps 
centers, which is the same as the fiscal year 2018 enacted 
level and $7,984,000 more than the fiscal year 2019 budget 
request.
    Administration.--The Committee recommends $32,330,000 for 
the administrative expenses of the Job Corps program, which is 
the same as the fiscal year 2018 enacted level and $220,000 
more than the fiscal year 2019 budget request.
    Job Corps is a residential education and vocational 
training program that helps young people ages 16 through 24 
improve the quality of their lives through vocational and 
academic training.
    The Committee continues to be concerned about the safety 
and security of students in the Job Corps program. With amounts 
provided in the fiscal years 2017 and 2018 Appropriations Acts, 
a total of $25,500,000 has been provided for Job Corps 
construction to address physical security at Job Corps 
campuses. The Committee directs the Department to submit a 
report within 90 days of enactment of this Act, the report 
should include the amounts and uses of funds provided to 
address physical security needs, planned uses of remaining 
funds, including funds provided in this Act, and an estimate of 
the costs of any remaining needs not addressed within current 
funding levels.
    On December 29, 2017, the Department of Labor Office of 
Inspector General (DOL-OIG) issued a report entitled ``Job 
Corps Took Action To Mitigate Violence, Drugs, and Other 
Student Misconduct At Centers, But More Needs To Be Done'' 
(Report Number: 26-18-001-03-370). The Committee directs the 
Department to work with the DOL-OIG to implement all remaining 
recommendations detailed in the report.
    The Committee is concerned that the Job Corps procurement 
process continues to experience delays or corrective actions 
that have resulted in a number of unnecessary and costly bridge 
contracts. The Committee directs the Department to review the 
Job Corps contract award process to reduce procurement 
disruptions, bid protests, corrective actions, and the use of 
bridge contracts. The Committee directs the Department to 
submit a report within 30 days of the end of the fiscal year to 
the Committees on Appropriations of the House of 
Representatives and the Senate, and to the authorizing 
Committees of jurisdiction, with detail on each Job Corps 
contract awarded during the fiscal year, any corrective actions 
taken, whether the award was protested, the outcome of the 
protest, if a bridge contact was awarded, and whether the 
bridge contract was awarded as a result of an award protest or 
procurement backlog.
    On March 30, 2018, DOL-OIG issued a report entitled ``Job 
Corps Could Not Demonstrate Beneficial Job Training Outcomes'' 
(Report Number: 04-18-001-03-370). The Committee is concerned 
with the DOL-OIG finding that Job Corps contractors could not 
demonstrate they had assisted participants in finding jobs for 
94 percent of the placements sampled. The Committee directs ETA 
to work with DOL-OIG to implement the recommendations provided 
in the report, to implement policies necessary to ensure that 
contractors report accurate and timely data to the Department 
as required, and to implement program policies that will 
improve job placement outcomes in the Job Corps program.
    The Committee remains concerned with the financial 
management of the Job Corps program and directs the Department 
to continue to work with ETA and DOL-OIG to improve financial 
and administrative oversight of the Job Corps program.

            COMMUNITY SERVICE EMPLOYMENT FOR OLDER AMERICANS

 
 
 
Appropriation, fiscal year 2018.......................      $400,000,000
Budget request, fiscal year 2019......................             - - -
Committee Recommendation..............................       400,000,000
    Change from enacted level.........................             - - -
    Change from budget request........................      +400,000,000
 

    The Community Service Employment for Older Americans 
program provides grants to public and private non-profit 
organizations that subsidize part-time work in community 
service activities for unemployed persons aged 55 and older 
whose family income is below 125 percent of the poverty level.

              FEDERAL UNEMPLOYMENT BENEFITS AND ALLOWANCES

 
 
 
Appropriation, fiscal year 2018.......................      $790,000,000
Budget request, fiscal year 2019......................       790,000,000
Committee Recommendation..............................       790,000,000
    Change from enacted level.........................             - - -
    Change from budget request........................             - - -
 

    The Trade Adjustment Assistance program (TAA) provides 
assistance to workers adversely affected by international 
trade. TAA provides training, income support, wage subsidies 
for older workers, job search and relocation allowances to 
groups of workers who file a petition and are certified as 
eligible to apply for such benefits due to job losses resulting 
from increases in imports or foreign trade.

     STATE UNEMPLOYMENT INSURANCE AND EMPLOYMENT SERVICE OPERATIONS

 
 
 
Appropriation, fiscal year 2018.......................    $3,464,691,000
Budget request, fiscal year 2019......................     3,325,298,000
Committee Recommendation..............................     3,260,282,000
    Change from enacted level.........................      -204,409,000
    Change from budget request........................       -65,016,000
 

    The total includes $3,176,216,000 from the Employment 
Security Administration Account from the Unemployment Trust 
Fund and $84,066,000 from the General Fund of the Treasury. 
These funds are used to support the administration of Federal 
and State unemployment compensation laws.
    Unemployment Insurance Compensation.--For Unemployment 
Insurance (UI) Compensation, the Committee recommends 
$2,529,713,000, which is $123,784,000 less than the fiscal year 
2018 enacted level and $24,897,000 more than the fiscal year 
2019 budget request. The total includes $2,515,816,000 for 
State Unemployment Compensation and $13,897,000 for National 
Activities.
    The recommendation provides contingency funding for 
increased workloads that States may face in the administration 
of UI. During fiscal year 2019, for every 100,000 increase in 
the total average weekly insured unemployment above 2,030,000, 
an additional $28,600,000 shall be made available from the 
Unemployment Trust Fund.
    On September 26, 2017, DOL-OIG issued a report entitled 
``Program Specific Performance Measures are Needed to Better 
Evaluate the Effectiveness of the Reemployment Services and 
Eligibility Assessment Program'' (Report Number: 04-17-002-03-
315). The Committee supports efforts detailed in the report by 
ETA to provide technical assistance, improve data quality, and 
assess performance of the Reemployment Services and Eligibility 
Assessment (RESEA) program. The Committee urges ETA to 
establish appropriate performance measures in order to 
effectively assess the impact and outcomes of the program. The 
Committee believes it is critical to obtain program data that 
will allow program administrators and policy-makers to assess 
the impact of the RESEA program on its participants and 
effectively compare RESEA program outcomes with those of other 
UI claimants.
    The Committee includes $117,000,000 for the RESEA program, 
and an additional $33,000,000 is made available pursuant to the 
Bipartisan Budget Act of 2018 (PL 115-123). The Committee 
continues to support the RESEA program and urges the Department 
to focus its efforts on reducing the rate of improper payments 
in the UI system.
    On June 13, 2017, DOL-OIG issued a report entitled DOL 
Needs to Do More to Reduce Improper Payments and Improve 
Reporting (Report Number 03-17-002-13-001). The Committee notes 
that the rate of improper payments in the UI program exceeds 
program goals and remains among the highest of any Federal 
program. The Committee directs ETA to work with DOL-OIG to 
implement the policies and controls necessary to make 
significant progress on reducing the rate of improper payments 
in the UI program. As part of this effort, the Committee 
encourages ETA to use the Unemployment Insurance Integrity 
Center of Excellence and the Reemployment Services and 
Eligibility Assessments programs to establish better monitoring 
and control over UI payments. The Committee also encourages the 
Department to promote access to data at entities funded through 
the UI system, including the Unemployment Insurance Integrity 
Center of Excellence, and the National Directory of New Hires, 
in order for ETA and DOL-OIG to better conduct their oversight 
responsibilities.
    The Committee is aware that trade-impacted dislocations are 
geographically sensitive, and that when there is a large worker 
dislocation, a particular local area or American Job Center 
(AJC) in a local area will experience a surge in the demand for 
services. The Committee urges the Department to continue 
assisting State agencies and AJCs, as appropriate, with Rapid 
Response activities to provide a surge response to these 
situations. The Committee also expects the Department to work 
closely with States and local AJCs to understand if any 
difficulties in providing TAA services are related to service 
capacity issues.
    Employment Service.--The Committee recommends $605,606,000 
for the Employment Service, which is $80,625,000 less than 
fiscal year 2018 enacted level and $85,490,000 less than the 
fiscal year 2019 budget request. The Committee directs the 
Department to limit the amount used for State administrative 
purposes to 20 percent and to ensure funding for client 
services is maintained at fiscal year 2018 enacted levels.
    Foreign Labor Certification.--The Committee recommends 
$62,310,000 for the Foreign Labor Certification (FLC) program, 
which is the same as the fiscal year 2018 enacted level and 
$118,000 more than the fiscal year 2019 budget request. The 
recommendation includes $48,028,000 for Federal administration 
and $14,282,000 for grants to States.
    The FLC program administers temporary foreign worker 
programs including the H-2A and the H-2B temporary visa 
programs. These programs are essential to employers in 
industries that have cyclical peaks or that are seasonal in 
nature, including agriculture, tourism, and hospitality.
    One-Stop Career Centers/Labor Market Information.--The 
Committee recommends $62,653,000 for One-Stop Career Centers 
and Labor Market Information, which is the same as the fiscal 
year 2018 enacted level and $4,541,000 less than the fiscal 
year 2019 budget request.

        ADVANCES TO THE UNEMPLOYMENT TRUST FUND AND OTHER FUNDS

    The Committee recommends such sums as necessary for 
Advances to the Unemployment Trust Fund and Other Funds. The 
funds are made available to accounts authorized under Federal 
and State unemployment insurance laws and the Black Lung 
Disability Trust Fund when the balances in such accounts are 
insufficient.

                         PROGRAM ADMINISTRATION

 
 
 
Appropriation, fiscal year 2018.......................      $158,656,000
Budget request, fiscal year 2019......................       154,265,000
Committee Recommendation..............................       158,656,000
    Change from enacted level.........................             - - -
    Change from budget request........................        +4,391,000
 

    The recommendation includes $108,674,000 from the General 
Fund of the Treasury and $49,982,000 from the Employment 
Security Administration Account in the Unemployment Trust Fund.

               Employee Benefits Security Administration


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2018.......................      $181,000,000
Budget request, fiscal year 2019......................       189,500,000
Committee Recommendation..............................       180,600,000
    Change from enacted level.........................          -400,000
    Change from budget request........................        -8,900,000
 

    The Employee Benefits Security Administration (EBSA) 
assures the security of retirement, health, and other 
workplace-related benefits of working Americans.
    The Committee is concerned that several large, private 
sector pension plans are increasingly at risk of becoming 
insolvent. The Committee directs EBSA, in coordination with the 
Pension Benefit Guaranty Corporation (PBGC), to submit a report 
within 180 days of enactment of this Act to the Committee on 
Appropriations of the House of Representatives and the Senate, 
and to the authorizing Committees of jurisdiction, describing 
EBSA's efforts to mitigate risks to the PBGC system through 
audits and enforcement activity.
    The Committee directs EBSA to provide information in the 
fiscal year 2020 Congressional Justification on current efforts 
at the Federal Retirement Thrift Investment Board to increase 
the participation of women, and minority-owned asset management 
firms in the management of Thrift Savings Plan funds.

                  Pension Benefit Guaranty Corporation


 
 
 
Appropriation, fiscal year 2018.......................      $424,417,000
Budget request, fiscal year 2019......................       445,363,000
Committee Recommendation..............................       445,363,000
    Change from enacted level.........................       +20,946,000
    Change from budget request........................             - - -
 

    The Pension Benefit Guaranty Corporation (PBGC) protects 
the retirement incomes of nearly 40 million American workers in 
nearly 24,000 private-sector defined benefit pension plans. 
PBGC was created by the Employee Retirement Income Security Act 
of 1974 to encourage the continuation and maintenance of 
private-sector defined benefit pension plans, provide timely 
and uninterrupted payment of pension benefits, and keep pension 
insurance premiums at a minimum.
    The recommendation includes bill language that defines 
Pension Benefit Guaranty Corporation's discretionary authority 
to incur additional unforeseen and emergency administrative 
expenses related to its multiemployer plan insurance program.
    The Committee directs PBGC to submit reports required by 
the Employee Retirement Income Security Act of 1974 and the 
Pension Protection Act of 2006.

                         Wage and Hour Division


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2018.......................      $227,500,000
Budget request, fiscal year 2019......................       230,068,000
Committee Recommendation..............................       225,500,000
    Change from enacted level.........................        -2,000,000
    Change from budget request........................        -4,568,000
 

    The Wage and Hour Division (WHD) enforces Federal minimum 
wage, overtime pay, recordkeeping, and child labor requirements 
of the Fair Labor Standards Act. WHD also has enforcement and 
other administrative responsibilities related to the Migrant 
and Seasonal Agricultural Worker Protection Act, the Employee 
Polygraph Protection Act, the Family and Medical Leave Act, the 
Davis Bacon Act, and the Service Contract Act.
    The Committee urges the WHD to consider updating relevant 
guidance, training, handbooks, or field manuals, as necessary, 
to the extent that it will help ensure that enforcement is 
current and consistent with applicable laws and regulations.
    The Committee supports the Executive Order on Exemption 
from Executive Order 13658 for Recreational Services on Federal 
Lands, issued on May 25, 2018, and the exemption prescribed in 
Section 2 of the order. Pursuant to Section 3, the Committee 
expects the Department to implement this exemption as soon as 
possible.
    The Committee notes that many Americans are on waiting 
lists for organ transplants and that waiting lists for kidney 
transplants in particular are very long. Removing barriers to 
live organ donation can help to significantly increase the 
number of transplants and reduce the amount of time recipients 
wait for transplants. The Committee supports efforts that seek 
to remove impediments to live organ donation for those willing 
to give the gift of life to others. The Committee requests that 
WHD give notice on its website, or in other public 
communications as appropriate, that living donors who are 
otherwise qualified under the Family Medical Leave Act are 
eligible for family medical leave when they donate solid 
organs, or portions thereof, to another person.

                  Office of Labor-Management Standards


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2018.......................       $40,187,000
Budget request, fiscal year 2019......................        46,634,000
Committee Recommendation..............................        42,187,000
    Change from enacted level.........................        +2,000,000
    Change from budget request........................        -4,447,000
 

    The Office of Labor Management Standards (OLMS) administers 
the Labor-Management Reporting and Disclosure Act, which 
establishes safeguards for union democracy and union financial 
integrity, and requires public disclosure reporting by unions, 
union officers, employees of unions, labor relations 
consultants, employers, and surety companies.
    The Committee urges OLMS to make more information 
publically available regarding its enforcement actions, 
including findings and remedies, as appropriate, in order to 
improve oversight and accountability under the Labor-Management 
Reporting and Disclosure Act.

             Office of Federal Contract Compliance Programs


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2018.......................      $103,476,000
Budget request, fiscal year 2019......................        91,100,000
Committee Recommendation..............................        99,476,000
    Change from enacted level.........................        -4,000,000
    Change from budget request........................        +8,376,000
 

    The OFCCP ensures equal employment opportunity in the 
Federal contracting community through enforcement, regulatory 
work, outreach and education to workers and their advocates.

                Office of Workers' Compensation Programs


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2018.......................      $117,601,000
Budget request, fiscal year 2019......................       115,282,000
Committee Recommendation..............................       117,601,000
    Change from enacted level.........................             - - -
    Change from budget request........................        +2,319,000
 

    The recommendation includes $115,424,000 in General Funds 
from the Treasury and $2,177,000 from the Special Fund 
established by the Longshore and Harbor Workers' Compensation 
Act.
    The Office of Workers' Compensation Programs (OWCP) 
administers the Federal Employees' Compensation Act, the 
Longshore and Harbor Workers' Compensation Act, the Energy 
Employees Occupational Illness Compensation Program Act, and 
the Black Lung Benefits Act. These programs provide eligible 
injured and disabled workers and their survivors with 
compensation, medical benefits, and services including 
rehabilitation, supervision of medical care, and technical and 
advisory counseling.
    The Committee continues to support the efforts of OWCP to 
reduce fraud and abuse related to the prescription of compound 
pharmaceuticals and opioids.

                            SPECIAL BENEFITS

 
 
 
Appropriation, fiscal year 2018.......................      $220,000,000
Budget request, fiscal year 2019......................       230,000,000
Committee Recommendation..............................       230,000,000
    Change from enacted level.........................       +10,000,000
    Change from budget request........................             - - -
 

    These funds provide mandatory benefits under the Federal 
Employees' Compensation Act.

               SPECIAL BENEFITS FOR DISABLED COAL MINERS

 
 
 
Appropriation, fiscal year 2018.......................       $70,319,000
Budget request, fiscal year 2019......................        25,319,000
Committee Recommendation..............................        25,319,000
    Change from enacted level.........................       -45,000,000
    Change from budget request........................             - - -
 

    The Committee recommends $25,319,000 for Special Benefits 
for Disabled Coal Miners. This amount is in addition to the 
$15,000,000 appropriated in fiscal year 2018 as an advance for 
the first quarter of fiscal year 2019. The total program level 
recommendation is $45,000,000 less than the fiscal year 2018 
enacted level and the same as the fiscal year 2019 budget 
request.
    These funds provide mandatory benefits to coal miners 
disabled by black lung disease, to their survivors and eligible 
dependents, and for necessary administrative costs. The 
Committee recommendation also provides $14,000,000 as an 
advance appropriation for the first quarter of fiscal year 
2020. These funds ensure uninterrupted payments to 
beneficiaries.

    ADMINISTRATIVE EXPENSES, ENERGY EMPLOYEES OCCUPATIONAL ILLNESS 
                           COMPENSATION FUND

 
 
 
Appropriation, fiscal year 2018.......................       $59,846,000
Budget request, fiscal year 2019......................        59,098,000
Committee Recommendation..............................        59,098,000
    Change from enacted level.........................          -748,000
    Change from budget request........................             - - -
 

    These funds provide mandatory benefits to eligible 
employees or survivors of employees of the Department of Energy 
(DOE); its contractors and subcontractors; companies that 
provided beryllium to DOE; atomic weapons employees 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; and uranium workers covered under the 
Radiation Exposure Compensation Act.

                    BLACK LUNG DISABILITY TRUST FUND

 
 
 
Appropriation, fiscal year 2018.......................      $416,561,000
Budget request, fiscal year 2019......................       328,182,000
Committee Recommendation..............................       328,182,000
    Change from enacted level.........................       -88,379,000
    Change from budget request........................             - - -
 

    The Black Lung Disability Trust Fund pays black lung 
compensation, medical and survivor benefits, and administrative 
expenses when no mine operator can be assigned liability for 
such benefits, or when mine employment ceased prior to 1970. 
The Black Lung Disability Trust Fund is financed by an excise 
tax on coal, reimbursements from responsible mine operators, 
and short-term advances from the Treasury. The Emergency 
Economic Stabilization Act of 2008 authorized a restructuring 
of the Black Lung Disability Trust Fund debt and required that 
annual operating surpluses be used to pay down the debt until 
all remaining obligations are retired.

             Occupational Safety and Health Administration


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2018.......................      $552,787,000
Budget request, fiscal year 2019......................       549,033,000
Committee Recommendation..............................       545,250,000
    Change from enacted level.........................        -7,537,000
    Change from budget request........................        -3,783,000
 

    The Occupational Safety and Health Act of 1970 established 
the Occupational Safety and Health Administration (OSHA) to 
assure safe and healthy working conditions by setting and 
enforcing standards and by providing training, outreach, 
education and assistance.
    Within the total for OHSA, the Committee provides the 
following amounts:

------------------------------------------------------------------------
                                                            FY 2019
                   Budget Activity                         Committee
------------------------------------------------------------------------
Safety and Health Standards..........................        $18,000,000
Federal Enforcement..................................        208,000,000
Whistleblower Programs...............................         17,500,000
State Programs.......................................        100,850,000
Technical Support....................................         24,469,000
Federal Compliance Assistance........................         73,981,000
State Consultation Grants............................         59,500,000
Training Grants......................................                  0
Safety and Health Statistics.........................         32,900,000
Executive Direction and Administration...............         10,050,000
------------------------------------------------------------------------

    The Committee urges OSHA to carefully consider public 
comments submitted in response to OSHA's proposed regulation on 
Cranes and Derricks in Construction: Operator Certification 
Extension published by the Department of Labor in the Federal 
Register on August 30, 2017 (82 Fed. Reg. 41184 et seq.). In 
addition, the Committee encourages OSHA to prioritize comments 
on changes to the rule that would relieve regulatory burdens 
without compromising safety.
    The explanatory statement accompanying the fiscal year 2016 
Consolidated Appropriations Act directed OSHA to notify the 
Committee on Appropriations of the House of Representatives and 
the Senate 10 days prior to the announcement of any new 
National, Regional, or Local Emphasis Program including the 
circumstances and data used to determine the need for the 
launch of the new program. The Committee directs OSHA to 
continue to provide such notices in fiscal year 2019.

                 Mine Safety and Health Administration


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2018.......................      $373,816,000
Budget request, fiscal year 2019......................       375,906,000
Committee Recommendation..............................       367,589,000
    Change from enacted level.........................        -6,227,000
    Change from budget request........................        -8,317,000
 

    The Mine Safety and Health Administration (MSHA) enforces 
the Federal Mine Safety and Health Act in underground and 
surface coalmines and metal/non-metal mines.
    The Committee continues bill language designating up to 
$2,000,000 for mine rescue recovery activities, and provides 
for the retention of fees up to $2,499,000 for the testing and 
certification of equipment.
    The Committee includes $10,537,000 for State assistance 
training grants and provides the authority to use such funds 
for the purchase and maintenance of equipment required by the 
``Lowering Miners' Exposure to Respirable Coal Mine Dust, 
Including Continuous Personal Dust Monitors'' regulation.
    The Committee supports the efforts of MSHA to reemphasize 
compliance assistance programs that help mine operators to 
improve safety and comply with regulations without the threat 
of punitive enforcement.
    The Committee appreciates the significant reductions in 
mining injury and illness rates that have been achieved in 
recent years and remains a strong proponent for vigilant mine 
safety oversight. The Committee notes significant worker 
dislocations and mine closures as a result of economic 
conditions throughout the mining industry, and in coal mining 
in particular. The Committee reiterates its support for the 
ongoing effort to bring MSHA enforcement into proportion by 
redistributing resources and activities to the areas where mine 
production is currently occurring.
    The Committee continues to support advances MSHA has made 
in mine rescue technology and communications. The Committee 
directs MSHA to assess its current mine rescue deployment 
capability and strategy and discuss ongoing operational and 
resource needs in the fiscal year 2020 Congressional 
Justification.

                       Bureau of Labor Statistics


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2018.......................      $612,000,000
Budget request, fiscal year 2019......................       609,386,000
Committee Recommendation..............................       612,000,000
    Change from enacted level.........................             - - -
    Change from budget request........................        +2,614,000
 

    The recommendation includes $547,000,000 from the General 
Fund of the Treasury and $65,000,000 from the Employment 
Security Administration Account in the Unemployment Trust Fund.
    The Bureau of Labor Statistics (BLS) is an independent 
national statistical agency that collects, processes, analyzes, 
and disseminates essential economic data to the Congress, 
Federal agencies, State and local governments, businesses, and 
the public. Its principal surveys include the Consumer Price 
Index and the monthly unemployment series.
    Within the total for BLS, the Committee provides the 
following amounts:

------------------------------------------------------------------------
                   Budget Activity                     FY 2019 Committee
------------------------------------------------------------------------
Employment and Unemployment Statistics...............       $208,000,000
Labor Market Information.............................         65,000,000
Prices and Cost of Living............................        210,000,000
Compensation and Working Conditions..................         83,000,000
Productivity and Technology..........................         10,800,000
Executive Direction and Staff Services...............         35,200,000
------------------------------------------------------------------------

                 Office of Disability Employment Policy


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2018.......................       $38,203,000
Budget request, fiscal year 2019......................        27,000,000
Committee Recommendation..............................        38,203,000
    Change from enacted level.........................             - - -
    Change from budget request........................       +11,203,000
 

    Office of Disability Employment Policy provides policy 
guidance and leadership to eliminate employment barriers to 
people with disabilities.

                        Departmental Management


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2018.......................      $337,844,000
Budget request, fiscal year 2019......................       261,035,000
Committee Recommendation..............................       270,444,000
    Change from enacted level.........................       -67,400,000
    Change from budget request........................        +9,409,000
 

    The recommendation includes $270,136,000 from the General 
Fund of the Treasury and $308,000 from the Employment Security 
Administration Account in the Unemployment Trust Fund. The 
Departmental Management appropriation provides funds for the 
staff responsible for Departmental operations, management, and 
policy development.
    Within the total for Departmental Management, the Committee 
provides the following amounts:

------------------------------------------------------------------------
                                                            FY 2019
                   Budget Activity                         Committee
------------------------------------------------------------------------
Program Direction and Support........................        $29,750,000
Departmental Evaluation..............................          8,040,000
Legal Services.......................................        124,558,000
International Labor Affairs..........................         18,500,000
Administration and Management........................         28,450,000
Adjudication.........................................         35,000,000
Women's Bureau.......................................         13,750,000
Civil Rights Activities..............................          6,880,000
Chief Financial Officer..............................          5,516,000
------------------------------------------------------------------------

    On June 13, 2017, DOL-OIG issued a report entitled ``DOL 
Needs to Do More to Reduce Improper Payments and Improve 
Reporting'' (Report Number 03-17-002-13-001). The Committee 
believes that accurate data is an important aspect of reducing 
improper payments. The Committee appreciates that the Office of 
the Chief Financial Officer agreed with the information 
presented in the report and supports the reevaluation of its 
Federal Employees' Compensation Act Improper Payments 
Methodology.
    The Committee directs the Chief Evaluation Officer to focus 
evaluation efforts on the delivery and efficiency of the 
Department of Labor programs with the goal of providing 
administrators with the information necessary to improve 
program performance and more effectively achieve agency goals.
    The Committee directs the Department to submit its annual 
Operating Plan to the Committees on Appropriations of the House 
of Representatives and the Senate within the 45-day statutory 
deadline.

                    VETERANS EMPLOYMENT AND TRAINING

 
 
 
Appropriation, fiscal year 2018.......................      $295,041,000
Budget request, fiscal year 2019......................       281,595,000
Committee Recommendation..............................       299,662,000
    Change from enacted level.........................        +4,621,000
    Change from budget request........................       +18,067,000
 

    The recommendation includes $50,000,000 from the General 
Fund of the Treasury and $249,662,000 from the Employment 
Security Administration Account in the Unemployment Trust Fund.
    The Veterans Employment and Training (VETS) program serves 
America's veterans and separating service members by preparing 
them for meaningful careers, providing employment resources and 
expertise, and protecting their employment rights.
    Within the total for VETS, the Committee provides the 
following amounts:

------------------------------------------------------------------------
                                                            FY 2019
                   Budget Activity                         Committee
------------------------------------------------------------------------
 State Administration Grants.........................       $180,000,000
Transition Assistance Program........................         23,000,000
Federal Administration...............................         43,248,000
Veterans Employment and Training Institute...........          3,414,000
Homeless Veterans Reintegration Program..............         50,000,000
------------------------------------------------------------------------

    The Committee continues to support the VETS program and 
encourages the Department to pursue opportunities to cooperate 
with other Federal, State, and private enterprises to help the 
country better serve its veterans.
    The Committee includes $3,500,000 for a pilot program 
within the authority of the Transition Assistance Program (TAP) 
to be used by the Secretary, in consultation with the 
Departments of Defense and Veterans Affairs, to prepare 
transitioning service members to qualify for apprenticeship 
programs and to assist them with placement services as 
appropriate. The Committee believes apprenticeships can offer a 
pathway to a successful career by providing broad opportunities 
for paid, work-based learning, mentorship, classroom education 
or related instruction, and the ability to earn industry-
recognized credentials in a safe, supervised work environment. 
The pilot is intended to identify effective approaches to 
obtaining qualifications and helping to place transitioning 
service members in apprenticeship programs as an additional 
training opportunity under TAP. The Committee expects the pilot 
program to include a robust evaluation component that will 
allow program administrators to assess the training strategy 
and determine, on a comparative basis, whether it is an 
effective approach to help transitioning service members enter 
the civilian workforce.
    The Committee includes $500,000 for the initiation of the 
HIRE Vets Medallion Program authorized by the Honoring 
Investments in Recruiting and Employing American Military 
Veterans Act of 2017.

                  INFORMATION TECHNOLOGY MODERNIZATION

 
 
 
Appropriation, fiscal year 2018.......................       $20,769,000
Budget request, fiscal year 2019......................             - - -
Committee Recommendation..............................        29,169,000
    Change from enacted level.........................        +8,400,000
    Change from budget request........................       +29,169,000
 

    Information Technology (IT) Modernization provides a 
dedicated source of funding for Department-wide IT 
modernization projects together with funding through the 
Department's Working Capital Fund.
    The Committee expects the Department to prioritize projects 
that will result in cost savings by decommissioning legacy 
systems.
    The Committee directs the Department to assign a qualified 
project manager that is an employee of the Department to each 
modernization project to ensure that IT modernization projects 
are executed effectively, according to Departmental 
requirements, on schedule, and within budget.

                      OFFICE OF INSPECTOR GENERAL

 
 
 
Appropriation, fiscal year 2018.......................       $89,147,000
Budget request, fiscal year 2019......................        87,721,000
Committee Recommendation..............................        89,147,000
    Change from enacted level.........................             - - -
    Change from budget request........................        +1,426,000
 

    The recommendation includes $83,487,000 from the General 
Fund of the Treasury and $5,660,000 from the Employment 
Security Administration Account in the Unemployment Trust Fund.
    The DOL-OIG conducts audits of Department programs and 
operations in order to determine that they comply with the 
applicable laws and regulations, that they use resources 
effectively, and that they are achieving their intended 
results.
    The Committee supports the DOL-OIG efforts to reduce 
improper payments in the UI program, and to reduce fraud and 
abuse in the Workers' Compensation programs related to the 
prescription of compound pharmaceuticals and opioids.

                           General Provisions

    Sec. 101. The Committee continues a provision to prohibit 
the use of Job Corps funds for the salary of an individual at a 
rate in excess of Executive Level II.

                          (TRANSFER OF FUNDS)

    Sec. 102. The Committee continues a provision providing the 
Secretary of Labor with the authority to transfer up to one 
percent of discretionary funds between appropriations, provided 
that no appropriation is increased by more than three percent 
by any such transfer.
    Sec. 103. The Committee continues a prohibition on use of 
funds to purchase goods that are in any part produced by 
indentured children.
    Sec. 104. The Committee continues a provision related to 
grants made from funds available to the Department under the 
American Competitiveness and Workforce Improvement Act.
    Sec. 105. The Committee continues a provision to prohibit 
recipients of funds provided to the Employment and Training 
Administration from using such funds for the compensation of 
any individual at a rate in excess of Executive Level II.

                          (TRANSFER OF FUNDS)

    Sec. 106. The Committee continues a provision providing the 
Secretary of Labor with the authority to transfer funds made 
available to the Employment and Training Administration to 
Program Administration for technical assistance and program 
integrity activities.

                          (TRANSFER OF FUNDS)

    Sec. 107. The Committee continues a provision allowing up 
to 0.75 percent of discretionary appropriations provided in 
this Act for specific Department of Labor agencies to be used 
by the Office of the Chief Evaluation Officer for evaluation 
purposes.
    Sec. 108. The Committee continues a provision relating to 
the Fair Labor Standards Act and certain insurance personnel 
conducting post-disaster activity.

                              (RESCISSION)

    Sec. 109. The Committee continues a provision rescinding 
advance appropriations in the Dislocated Workers' National 
Reserve account.
    Sec. 110. The Committee continues a provision relating to 
flexibility of H-2B nonimmigrant crossings.
    Sec. 111. The Committee continues a provision relating to 
the Secretary's security detail.
    Sec. 112. The Committee includes a new provision relating 
to the Working Capital Fund.

                  TITLE II--DEPARTMENT OF HEALTH AND 
                             HUMAN SERVICES


              Health Resources and Services Administration


 
 
 
Appropriation, fiscal year 2018.......................    $6,736,753,000
Budget request, fiscal year 2019......................     9,559,591,000
Committee Recommendation..............................     6,540,385,000
    Change from enacted level.........................      -196,368,000
    Change from budget request........................    -3,019,206,000
 

    The Health Resources and Services Administration (HRSA) 
supports programs that provide health services to 
disadvantaged, medically underserved, and special populations; 
decrease infant mortality rates; assist in the education of 
health professionals; and provide technical assistance 
regarding the utilization of health resources and facilities.

                          PRIMARY HEALTH CARE

 
 
 
Appropriation, fiscal year 2018.......................    $1,626,522,000
Budget request, fiscal year 2019......................     5,091,522,000
Committee Recommendation..............................     1,526,522,000
    Change from enacted level.........................      -100,000,000
    Change from budget request........................    -3,565,000,000
 

Health Centers

    The Committee recommends $1,525,522,000 for the Health 
Centers program, which is $100,000,000 less than the fiscal 
year 2018 enacted level and $3,565,000,000 less than the fiscal 
year 2019 budget request.
    The Committee includes bill language providing up to 
$114,893,000 for the Federal Tort Claims Act program, which is 
the same as the fiscal year 2018 enacted level and $15,000,000 
above the fiscal year 2019 budget request. This program 
provides medical malpractice liability protection to Federally 
supported health centers.
    The Committee provides not less than $20,000,000 for HRSA 
to perform audits and compliance reviews of all health center 
access points, with a goal of conducting a compliance or audit 
review that includes every access point location at least every 
five years for Federally Qualified Health Center Look-Alikes 
and Health Centers receiving a grant under section 330 of the 
Public Health Service Act. HRSA should provide uniform guidance 
to health center project officers, monitor project officer 
adherence to program guidance, and periodically assess whether 
program guidance is meeting program objectives. HRSA will 
conduct independent compliance reviews, ensuring all health 
center access points have policies, procedures, and training to 
comply with all applicable Federal laws. HRSA shall submit 
quarterly reports to the Committees on Appropriations of the 
House of Representatives and the Senate containing the results 
of all audits and compliance reviews of health center access 
points and oversight of health center project officers.
    Home Visiting.--Enhanced integration between health care 
providers and community programs helps transform the lives of 
vulnerable babies born to at-risk, first-time mothers. Research 
has shown that partnering first-time mothers with registered 
nurses or other professional that provide ongoing home visits 
dramatically improves the health and well-bring of these 
families. The Committee encourages HRSA to expand partnerships 
between Health Centers and evidence-based home visiting 
programs in high need areas in order to improve pregnancy, 
child health and developments, and other health outcomes, all 
while reducing costs.
    Perinatal Transmission of Hepatitis B.--The Committee is 
aware that the 2017 National Academies of Sciences Engineering 
and Medicine (NASEM) report entitled ``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 HepatitisB 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 therefore 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 US. The Committee requests an update on 
this effort in the fiscal year 2020 Congressional 
Justification. HRSA should include in its update information on 
the findings and recommendations on the effectiveness of this 
intervention.
    Tuberculosis.--The National Action Plan for Combating Drug 
Resistant Tuberculosis recommended the creation of health-care 
liaisons between State and local health departments and 
institutions, including health centers that serve hard-to-reach 
groups at risk for Tuberculosis (TB). The Committee has 
previously directed the Administrator to report on coordination 
between health centers and State and local TB control programs 
to help ensure appropriate identification, treatment, and 
prevention of TB among vulnerable populations. The Committee 
requests an update in the fiscal year 2020 Congressional 
Justification on this topic.

Free Clinics Medical Malpractice

    The Committee recommends $1,000,000 for carrying out 
responsibilities under the Federal Tort Claims Act. This amount 
is the same as fiscal year 2018 enacted level and the fiscal 
year 2019 budget request. The program provides medical 
malpractice coverage to individuals involved in the operation 
of free clinics in order to expand access to health care 
services to low-income individuals in medically underserved 
areas. A free clinic must apply, consistent with the provisions 
applicable to community health centers, to have those 
individuals ``deemed'' an employee of the Public Health 
Service, and therefore eligible for coverage.

                            HEALTH WORKFORCE

 
 
 
Appropriation, fiscal year 2018.......................    $1,060,695,000
Budget request, fiscal year 2019......................       457,798,000
Committee Recommendation..............................     1,244,006,000
    Change from enacted level.........................      +183,311,000
    Change from budget request........................      +786,208,000
 

Health Professions

    The Committee recommends $719,006,000 for the health 
professions programs, which is $26,689,000 below the fiscal 
year 2018 enacted level and $321,208,000 above the fiscal year 
2019 budget request. The Health Professions programs support 
grants for the development of the health workforce in fields 
challenged by a high need and insufficient supply of health 
professionals. Given that colleges and universities serve the 
dual role of training students and carrying out a majority of 
Federally-funded biomedical research, the Committee believes 
that they serve as an ideal setting to expose future clinicians 
to the evidence base that underlies their intended profession.
    Within the total for Health Professions, the Committee 
recommends the following amounts:

------------------------------------------------------------------------
                                                            FY 2019
                   Budget Activity                         Committee
------------------------------------------------------------------------
National Health Service Corps........................       $105,000,000
    Tribal Set-aside.................................         20,000,000
    Rural Set-aside..................................         15,000,000
Health Professions Training for Diversity:
    Centers of Excellence............................         23,711,000
    Faculty Loan Repayment...........................          1,190,000
    Scholarships for Disadvantaged Students..........         48,970,000
Workforce Information and Analysis...................          5,663,000
Primary Care Training and Enhancement................         48,924,000
Oral Health Training Programs........................         38,673,000
Dental Faculty Loan Repayment........................          2,000,000
Interdisciplinary Community-based Linkages:
    Area Health Education Centers....................         38,250,000
    Geriatric Programs...............................         40,737,000
    Graduate Psychology Education....................         24,916,000
    Behavioral Health Workforce Education and                 82,500,000
     Training........................................
Public Health and Preventive Medicine................         17,000,000
Advanced Education Nursing...........................         66,581,000
Nurse Education, Practice, and Retention.............         41,913,000
Nursing Workforce Diversity..........................         17,343,000
NURSE Corps Scholarship and Loan Repayment...........         87,135,000
Nursing Faculty Loan Program.........................         28,500,000
------------------------------------------------------------------------

Primary Care Training and Enhancement

    The Committee encourages HRSA to prioritize funds for the 
training of physician assistants.
    Eating Disorders.--The Committee encourages integration of 
evidence-based training for health professionals to screen, 
access, intervene, and refer patients to specialized treatment 
for the severe mental illness of eating disorders as authorized 
under the 21st Century Cures Act (PL 114-255).

Oral Health Training

    The Committee recommends $38,673,000 for Oral Health 
Training programs, which is the same as the fiscal year 2018 
enacted level and $38,673,000 above the fiscal year 2019 budget 
request. These programs serve to increase the number of medical 
graduates from minority and disadvantaged backgrounds and to 
encourage students and residents to choose primary care fields 
and practice in underserved urban and rural areas.
    Within the funds provided, the Committee includes not less 
than $12,000,000 for General Dentistry Programs and not less 
than $12,000,000 for Pediatric Dentistry programs. HRSA is 
directed to provide continuation funding for pre-doctoral and 
postdoctoral training grants initially awarded in fiscal year 
2015.

Dental Faculty Loan Repayment

    The Committee recommends $2,000,000 for the Dental Faculty 
Loan Repayment program, which is the same as the fiscal year 
2018 enacted level and $2,000,000 above the fiscal year 2019 
budget request. This program seeks to increase the number of 
dental and dental hygiene faculty in the workforce by assisting 
dental and dental hygiene training programs to attract and 
retain dental and dental hygiene faculty through loan 
repayment.
    The Committee directs HRSA to provide continuation funding 
for grants initially awarded in fiscal years 2016, 2017, and 
2018. The Committee strongly supports the work of pediatric 
dentistry faculty supervising residents at dental training 
institutions providing clinical services in dental clinics 
located in dental schools, hospitals, and community-based 
affiliated sites.

Area Health Education Centers

    The Committee has included funding for Area Health 
Education Centers (AHEC) oral health projects that establish 
primary points of service and address the need to help patients 
find treatment outside of hospital emergency rooms. The 
Committee is aware that some state dental associations have 
already initiated programs to refer emergency room patients to 
dental networks. HRSA is urged to work with those programs.
    The AHEC program facilitates the diversity of the 
healthcare workforce; increases access to healthcare; delivers 
vital patient care; reduces health disparities; improves health 
outcomes; and increases revenue through creating new jobs and 
services. AHEC centers are improving the distribution of the 
health professions workforce, particularly in rural and 
underserved areas and preparing health professionals to expand 
collaborative practice and team models of care. The AHEC 
programs and centers play a critical national role in 
addressing health care workforce shortages, particularly those 
in primary care through an established infrastructure. The AHEC 
Program grantees support the recruitment and retention of 
physicians, students, faculty and other primary care providers 
in rural and medically underserved areas by providing local, 
community-based, interdisciplinary primary care training.

Graduate Psychology Education

    The Committee recommendation includes $24,916,000 for the 
inter-professional Graduate Psychology Education Program to 
increase 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 encourages HRSA to invest in programs 
that expand access to treatment for substance use disorders in 
Federally Qualified Health Centers. The Committee also 
encourages HRSA to invest in geropsychology training programs 
and to help integrate health service psychology trainees at 
Federally Qualified Health Centers.

Behavioral Health Workforce Education and Training

    The Committee recommends $82,500,000 for the Behavioral 
Health Workforce Education and Training Grant Program. This 
program establishes or expands internships or field placement 
programs in behavioral health serving populations in rural and 
medically underserved areas.

Nursing Education, Practice, and Retention

    Veteran's Bachelor of Science Degree in Nursing.--The Nurse 
Education, Practice, Quality and Retention Program's Veteran's 
Bachelor of Science Degree in Nursing has been important in 
helping our nation's veterans progress and graduate with a 
Bachelor of Science in Nursing degree. The Committee supports 
the enacted level for these efforts and urges HRSA to continue 
this vital program, aimed at helping veterans transition to 
civilian life, removing barriers, and building our nursing 
workforce. HRSA should either continue to support current 
grantees or re-compete this program in fiscal year 2019, 
placing emphasis on institutions that already have a program in 
place to support these veterans moving to nursing careers.

Children's Hospitals Graduate Medical Education

    The Committee recommends $325,000,000 for the Children's 
Hospitals Graduate Medical Education Payment program, which is 
$10,000,000 more than the fiscal year 2018 enacted level and 
$325,000,000 more than the fiscal year 2019 budget request. The 
Children's Hospitals Graduate Medical Education Payment program 
helps eligible hospitals maintain graduate medical education 
programs, which support the training of residents to care for 
the pediatric population and enhance the supply of primary care 
and pediatric medical and surgical subspecialties.

Graduate Medical Education

    Numerous studies have found evidence of a future shortage 
of physicians, particularly for primary care. To ensure access 
to care for impacted areas, the Committee includes $200,000,000 
for grants to four year public universities to support expanded 
and existing graduate education programs for health care 
professions. The Committee includes bill language directing 
HRSA to prioritize applications from Colleges of Medicine 
located in States with a projected primary care provider 
shortage. Within the States in the top quartile of primary care 
provider shortage, HRSA is directed to give additional priority 
to applications from universities who serve a large percentage 
of Medicaid beneficiaries or are located in States with a 
significant proportion of Federally recognized Tribes.

National Practitioner Data Bank

    The Committee assumes $18,814,000 for the National 
Practitioner Data Bank, which is the same as the fiscal year 
2018 enacted level and the fiscal year 2019 budget request. The 
Committee recommendation and the fiscal year 2019 budget 
request assume that the data bank will be self-supporting. The 
Committee continues to include bill language to ensure that 
user fee collections cover the full costs of data bank 
operations.

                       MATERNAL AND CHILD HEALTH

 
 
 
Appropriation, fiscal year 2018.......................      $886,789,000
Budget request, fiscal year 2019......................     1,136,200,000
Committee Recommendation..............................       893,089,000
    Change from enacted level.........................        +6,300,000
    Change from budget request........................      -243,111,000
 

Maternal and Child Health Block Grant

    The Committee recommends $655,000,000 for the Maternal and 
Child Health Block Grant, which is $3,300,000 more than the 
fiscal year 2018 enacted level and $27,300,000 more than the 
fiscal year 2019 budget request. States use the block grant to 
improve access to care for mothers, children, and their 
families; reduce infant mortality; provide pre- and post-natal 
care; support screening and health assessments for children; 
and provide systems of care for children with special health 
care needs.
    Neonatal Abstinence Syndrome.--The Committee is alarmed by 
reports that the leading cause of maternal mortality in a 
growing number of States is overdose and suicide, with a direct 
connection to the opioid epidemic. The Committee also 
recognizes the work done to implement the Protecting Our 
Infants Act of 2015 (PL 114-91), which culminated in a strategy 
to address gaps in research; overlaps, duplication, or gaps in 
the relevant Federal programs; and coordination of Federal 
efforts to address neonatal abstinence syndrome with 
recommendations regarding maternal and child prevention, 
treatment, and services. An October 2017 GAO report entitled 
``Newborn Health: Federal Action Needed to Address Neonatal 
Abstinence Syndrome'' recommended that HHS expeditiously 
develop a plan for implementing the recommendations included in 
the strategy. The Committee requests an update in the fiscal 
year 2020 Congressional Justification on implementation of 
recommendations outlined in the strategy and identification of 
barriers to implementation, including specifics on any areas 
where Congressional action is needed.

Special Projects of Regional and National Significance

    The Committee continues bill language identifying specific 
amounts for Special Projects of Regional and National 
Significance (SPRANS). The Committee provides the following 
within SPRANS:

------------------------------------------------------------------------
                                                            FY 2019
                   Budget Activity                         Committee
------------------------------------------------------------------------
Set-aside for Oral Health............................         $5,250,000
Set-aside for Epilepsy...............................          3,642,000
Set-aside for Sickle Cell Disease....................          3,000,000
Set-aside for Fetal Alcohol Syndrome.................            477,000
Set-aside for Neonatal Abstinence Syndrome...........          1,300,000
------------------------------------------------------------------------

    Alliance for Innovation on Maternal Health.--The Committee 
is aware that more women in the US die from pregnancy 
complications than in any other developed country, and that the 
maternal mortality rate rose by 26 percent from 2000 to 2014, 
and continues to rise. The Committee recognizes the vital role 
of the Alliance for Innovation on Maternal Health (AIM) in 
reducing maternal mortality and morbidity in the US by engaging 
provider organizations, State-based health and public health 
systems, consumer groups, and other stakeholders within a 
national partnership to assist State-based teams in 
implementing evidence-based maternal safety bundles. 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. HRSA is encouraged to continue to 
support AIM with adequate funding to meet the growing desire of 
States and hospital systems to participate in the program.
    Cell-free DNA Prenatal Screening.--The Committee recognizes 
the importance the medical genetics workforce plays in 
delivering on the promise of precision medicine, particularly 
given the unprecedented advances in genetic testing and the 
rapid and widespread application of these tests across all of 
medicine. Appropriate pre- and posttest education and 
counseling are critical for optimal implementation and the 
avoidance of harm. The Committee requests that the GAO conduct 
a nationwide analysis of the medical genetics workforce, to 
include all medical genetics professionals. GAO's analysis 
should include a determination as to whether there are 
sufficient qualified professionals for this important and 
growing health need, as well as whether there are particular 
geographic areas of the country that lack access to genetics 
counseling.
    Childhood Cancer.--The Committee requests that GAO conduct 
a review and submit recommendations to Congress on existing 
barriers to obtaining and paying for adequate medical care for 
survivors of childhood cancer. This report would include 
identifying existing barriers to the availability of complete 
and coordinated survivorship care for survivors of childhood 
cancer and make recommendations to provide improved access and 
payment plans for childhood cancer survivorship programs and 
palliative care, including psychosocial services.
    Hemophilia Treatment Centers.--The Committee provides level 
funding for Hemophilia Treatment Centers. The Regional 
Hemophilia Network Program uses a regional infrastructure of 
hemophilia treatment centers to promote and improve the 
comprehensive care of individuals with hemophilia and related 
bleeding disorders or clotting disorders.
    Improving Child Health.--The Committee provides level 
funding for the third year of an ongoing study focused on 
improving child health through a statewide system of early 
childhood developmental screenings and interventions.
    Infant-Toddler Court Teams.--The Committee includes 
$3,000,000, within SPRANS, for the second year of a contract or 
cooperative agreement to support research-based Infant-Toddler 
Court Teams to change child welfare practices to improve well-
being for infants, toddlers, and their families. This funding 
should help to build on and continue the work of sites 
established through the Quality Improvement Center for 
Research-based Infant-Toddler Court Teams, including by 
providing training and technical assistance in support of such 
court teams' efforts across the country.
    Oral Health Literacy.--The Committee includes $1,000,000 
within SPRANS for HRSA to develop and implement an oral health 
awareness and education campaign across all of the relevant 
HRSA divisions, including the Health Centers Program, Oral 
Health Workforce, Maternal and Child Health, Ryan White HIV/
AIDS Program, and Rural Health. The Committee expects HRSA to 
ensure these divisions collaborate in developing and 
implementing the campaign. As part of this campaign, the 
Committee directs HRSA to identify oral health literacy 
strategies that are evidence-based and focused on oral 
healthcare prevention and education, including prevention of 
oral disease such as early childhood and other caries, 
periodontal disease, and oral cancer. The Committee expects the 
Chief Dental Officer to play a key role in the design, 
monitoring, oversight, and implementation of this project.
    Set-aside for Neonatal Abstinence Syndrome.--The Committee 
is alarmed by the prevalence of Neonatal Abstinence Syndrome 
(NAS), or babies born exposed to opioids and other drugs during 
pregnancy, and the health issues these newborns face. The 
Committee provides $1,300,000 to address NAS in areas where the 
reported NAS incidence rate exceeds the national average.
    Set-aside for Oral Health.--The Committee includes 250,000 
to continue demonstration projects to increase the 
implementation of integrating oral health and primary care 
practice. The projects should model the core clinical oral 
health competencies for non-dental providers that HRSA 
published and initially tested in its 2014 report, 
``Integration of Oral Health and Primary Care Practice.'' The 
Committee expects the Chief Dental Officer to continue to 
direct the design, monitoring, oversight, and implementation of 
these projects.
    Thalassemia.--HRSA has a long history of supporting 
thalassemia services. The thalassemia program has been 
instrumental in aiding patients with this inherited blood 
disorder, especially as treatments and best practices have 
evolved over time. The Committee strongly encourages HRSA to 
reconstitute this program in order to ensure the continued 
improvement of care and treatment options for patients with 
this complex and debilitating blood disorder.

Maternal and Child Health Programs

    In addition to the Maternal and Child Health Block Grant, 
the Maternal and Child Health Bureau at HRSA supports several 
programs to improve the health of all mothers, children, and 
their families. These programs support activities that develop 
systemic mechanisms for the prevention and treatment of sickle 
cell disease; provide information and research on and promote 
screening of autism and other developmental disorders; provide 
newborn and child screening of heritable disorders; provide 
grants to reduce infant mortality and improve perinatal 
outcomes; fund States to conduct newborn hearing screening; and 
provide grants to improve existing emergency medical services.
    Within the total for Maternal and Child Health Programs, 
the Committee recommends the following amounts:

------------------------------------------------------------------------
                                                            FY 2019
                   Budget Activity                         Committee
------------------------------------------------------------------------
Sickle Cell Anemia Program...........................         $4,455,000
Autism and Other Developmental Disorders.............         52,099,000
Heritable Disorders..................................         16,883,000
Healthy Start........................................        110,500,000
Universal Newborn Hearing............................         17,818,000
Emergency Medical Services for Children..............         22,334,000
Screening and Treatment for Maternal Depression......          5,000,000
Pediatric Mental Health Access.......................          9,000,000
------------------------------------------------------------------------

Autism and Other Developmental Disorders

    The Committee recommends $52,099,000 for Autism and Other 
Developmental Disorders; this funding level is $3,000,000 more 
than the fiscal year 2018 enacted level and $52,099,000 above 
the fiscal year 2019 budget request. These programs seek to 
improve the health and well-being of children and adolescents 
with autism spectrum disorder and other developmental 
disabilities and to advance best practices for the early 
identification and treatment of autism and related 
developmental disabilities.
    Leadership Education in Neurodevelopmental and Related 
Disabilities.--The Committee provides not less than $36,000,000 
for the Leadership Education in Neurodevelopmental and Related 
Disabilities (LEND) program to maintain the program's capacity 
to train professionals to screen, diagnose, and provide 
evidence-based interventions to individuals with autism 
spectrum disorder and other developmental disabilities as 
authorized by the Autism CARES Act (PL113-157). This program 
provides advanced training to students and fellows from at 
least 12 disciplines in the identification, assessment, and 
treatment of children and youth with a wide range of 
developmental disabilities, including autism. The 52 LEND 
network programs in 44 states are making significant strides 
toward improved screening and diagnosis of autism among younger 
children and helping to train healthcare professionals who 
treat a number of different developmental and intellectual 
disabilities.
    Pediatric Neurodevelopmental Delivery of Care.--The 
Committee encourages the Secretary of HHS to collaborate with 
public and private non-profit organizations with expertise in 
pediatric neurodevelopmental disabilities, including autism, to 
develop a pilot project designed to improve the delivery and 
coordination of care and to lower costs through integrated 
subspecialty outpatient service delivery models that 
incorporate comprehensive diagnostic services and therapeutic 
care for pediatric neurodevelopmental disability patients, 
including those with autism. The Committee requests an update 
on this activity in fiscal year 2020 Congressional 
Justification.

Heritable Disorders

    The Committee provides $16,883,000 for the Heritable 
Disorders program, which is $1,000,000 more than the fiscal 
year 2018 enacted level and $16,883,000 more than the fiscal 
year 2019 budget request. Newborn Screening is a complex public 
health system that relies on coordinated actions by 
stakeholders, including clinicians, hospitals, parents, labs, 
and public health professionals. HRSA's Heritable Disorders 
Program supports a number of activities that strengthen this 
system to ensure infants born in every State receive rapid 
identification, early intervention, and potentially life-saving 
treatment.
    Newborn Screening.--Newborn Screening (NBS) is a complex 
public health system that relies on coordinated actions by 
stakeholders, including clinicians, hospitals, parents, labs, 
and public health professionals. HRSA's Heritable Disorders 
Program supports a number of activities that strengthen this 
system to ensure infants born in every State receive rapid 
identification, early intervention, and potentially life-saving 
treatment. With new funding provided in fiscal year 2019, the 
Heritable Disorders program will support expansion of efforts 
to add new conditions to state newborn screening panels. 
Beginning in fiscal year 2015, Congress provided an additional 
$2,000,000 to support the wider implementation, education, and 
awareness of NBS for a single disorder, Severe Combined Immune 
Deficiency. Forty-five States now universally screen infants 
for that disorder. HRSA will build on that successful program 
by providing grants to support States with the implementation, 
education, and awareness of newborn screening for new 
conditions recently added to the Recommended Uniform Screening 
Panel, including Pompe, Mucopolysaccharidosis I, and X-linked 
adrenoleukodystrophy. The program will also disseminate 
national, regional, and State education and training resources 
for parents, families and providers.
    Pediatric Hospice Care.--The Committee recognizes the 
importance of pediatric hospice care. The Committee understands 
the unique conditions surrounding pediatric hospice care and 
grief support for families including the need to support family 
members, the recognition that child death can have more intense 
and longer grieving periods, and the need for development of 
best practices for counseling, support, medication, and other 
factors impacting the end of life experience for children. The 
Committee encourages HRSA through the Heritable Disorders 
Program to work with experienced hospice providers which are 
not conflicted by decisions of whether to provide hospice or 
curative treatments in the hospital to children nearing the end 
of life to establish a pilot program aimed at developing best 
practices.
    Severe Combined Immune Deficiency.--Within the amount for 
Heritable Disorders, the Committee provides $2,000,000 for the 
second year of a grant to continue supporting wider 
implementation, education, and awareness of newborn screening 
for Severe Combined Immune Deficiency.

Healthy Start

    The Committee recommends $110,500,000 for the Healthy Start 
program, which is the same as the fiscal year 2018 enacted 
level and $7,000,000 more than the fiscal year 2019 budget 
request. The program provides discretionary grants to 
communities with high rates of infant mortality to support 
primary and preventive health care services for mothers and 
their infants.

                      RYAN WHITE HIV/AIDS PROGRAM

 
 
 
Appropriation, fiscal year 2018.......................    $2,318,781,000
Budget request, fiscal year 2019......................     2,260,170,000
Committee Recommendation..............................     2,318,781,000
    Change from enacted level.........................             - - -
    Change from budget request........................       +58,611,000
 

    The Ryan White Human Immunodeficiency Virus/Acquired 
Immunodeficiency Syndrome (HIV/AIDS) program funds activities 
to address the care and treatment of persons living with HIV/
AIDS who are either uninsured or underinsured and need 
assistance to obtain treatment. The program provides grants to 
States and eligible metropolitan areas to improve the quality, 
availability, and coordination of health care and support 
services to include access to HIV-related medications; grants 
to service providers for early intervention outpatient 
services; grants to organizations to provide care to HIV 
infected women, infants, children, and youth; and grants to 
organizations to support the education and training of health 
care providers.
    Within the total for the Ryan White HIV/AIDS program, the 
Committee provides the following amounts:

------------------------------------------------------------------------
                                                            FY 2019
                   Budget Activity                         Committee
------------------------------------------------------------------------
Emergency Assistance.................................       $655,876,000
Comprehensive Care Programs..........................      1,315,005,000
    AIDS Drug Assistance Program.....................        900,313,000
Early Intervention Program...........................        201,079,000
Children, Youth, Women, and Families.................         75,088,000
AIDS Dental Services.................................         13,122,000
Education and Training Centers.......................         33,611,000
Special Projects of National Significance............         25,000,000
------------------------------------------------------------------------

                          HEALTH CARE SYSTEMS

 
 
 
Appropriation, fiscal year 2018.......................      $111,693,000
Budget request, fiscal year 2019......................       116,518,000
Committee Recommendation..............................       121,693,000
    Change from enacted level.........................       +10,000,000
    Change from budget request........................        +5,175,000
 

    These programs support national activities that enhance 
health care delivery in the US. Activities include maintaining 
a national system to allocate and distribute donor organs to 
individuals awaiting transplant; building an inventory of cord 
blood units; maintaining a national system for the recruitment 
of bone marrow donors; operating the 340B drug discount 
program; and operating a national toll-free poison control 
hotline.
    Within the total for Health Care Systems, the Committee 
provides the following amounts:

------------------------------------------------------------------------
                                                            FY 2019
                   Budget Activity                         Committee
------------------------------------------------------------------------
Organ Transplantation................................        $25,549,000
National Cord Blood Inventory........................         17,266,000
C.W. Bill Young Cell Transplantation Program.........         25,109,000
Office of Pharmacy Affairs...........................         15,238,000
Poison Control Centers...............................         22,846,000
Hansen's Disease Program.............................         13,706,000
Hansen's Disease Buildings and Facilities............            122,000
Hansen's Payment to Hawaii...........................          1,857,000
------------------------------------------------------------------------

National Cord Blood Inventory

    The Committee recommends $17,266,000 for the National Cord 
Blood Inventory, which is $2,000,000 more than the fiscal year 
2018 enacted level and $5,000,000 more than the fiscal year 
2019 budget request. The National Cord Blood Inventory program 
builds a genetically and ethnically diverse inventory of high-
quality umbilical cord blood for transplantation.
    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. In order 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 encourages HRSA to 
support proposals for novel pilot programs using cord blood and 
tissue-derived cellular therapies in regenerative therapies.

C.W. Bill Young Cell Transplantation Program

    The Committee recommends $25,109,000 for the C.W. Bill 
Young Cell Transplantation program, which is $1,000,000 more 
than the fiscal year 2018 enacted level and $3,000,000 more 
than the fiscal year 2019 budget request. The C.W. Bill Young 
Cell Transplantation Program provides support to patients who 
need a bone marrow transplant or umbilical cord blood 
transplant. A bone marrow or cord blood transplant may be 
needed for some patients who have leukemia, lymphoma, sickle 
cell anemia, or other inherited metabolic or immune system 
disorders.

Office of Pharmacy Affairs

    The Committee provides $15,238,000 for the Office of 
Pharmacy Affairs (OPA), which is $5,000,000 more than the 
fiscal year 2018 enacted level and $11,000,000 less than the 
fiscal year 2019 budget request. The Office of Pharmacy Affairs 
oversees the 340B Drug Pricing Program, which requires drug 
manufacturers to provide discounts on outpatient prescription 
drugs to certain safety net health care providers.
    The Committee includes an increase of $5,000,000 for 
additional oversight of the 340B program. An in-depth 
examination of the 340B program by the House Energy and 
Commerce Committee resulted in a report entitled ``Review of 
the 340B Drug Pricing Program.'' The Committee directs HRSA to 
use additional funds to implement recommendations contained in 
such report. Specifically, the Committee directs HRSA to 
conduct additional audits of covered entities, finalize 
guidance to clarify parameters of the 340B program, and 
complete the rulemaking process for areas where HRSA has 
regulatory authority.
    The Committee does not include bill language requesting 
authority to charge a user fee. The Committee does not include 
appropriations language seeking additional regulatory 
authority. The Committee believes such reform of the 340B 
program is best addressed by the authorizing committee of 
jurisdiction.
    The 340B drug pricing program was designed to help safety 
net providers maintain, improve, and expand patient access to 
healthcare services. Since its enactment in 1992, the 340B 
program has lowered the cost of outpatient drugs to government 
funded health clinics, as well as nonprofit and public 
hospitals that serve a disproportionate share of low-income 
patients or rural communities whereby these entities are able 
to provide additional services and benefits to the communities 
they serve with the savings realized. The Committee recognizes 
the 340B drug pricing program remains important, allowing 
covered entities to stretch their resources to provide 
comprehensive services to patients.
    Since the 1990s, the health care landscape and the scope of 
the 340B program has evolved significantly. A 2011 GAO report 
on the 340B program found HRSA's guidance on program 
requirements lacked the necessary level of specificity to 
provide clear direction making it difficult for covered 
entities to self-police or monitor compliance. GAO recommended 
that HRSA release more specific guidance on the definition of 
an eligible patient and issue guidance to further specify the 
criteria for participating hospitals. The Committee supports 
HRSA's continued engagement to provide program guidance to 
covered entities in the 340B program.
    The Committee is aware that the 340B statute requires HRSA 
to make 340B ceiling prices available to covered entities 
through a secure website and continues to be concerned that OPA 
has failed to meet deadlines to complete work on the secure 
website. The Committee urges OPA to complete the development of 
a secure website. The Committee directs OPA to issue a report 
to Congress on its progress implementing these security 
measures.

Poison Control Centers

    The Committee recommends $22,846,000 for Poison Control 
Centers, which is $2,000,000 more than the fiscal year 2018 
enacted level and $4,000,000 more than the fiscal year 2019 
budget request. This program funds poison centers, a national 
toll-free number (800-222-1222), and implements a nationwide 
media campaign to educate the public and health care providers 
about poison prevention, poison center services, and the 800 
number.
    The Committee recognizes the critical role of this proven 
national public health program and the value of its highly 
effective public-private/local-State-Federal partnership 
services to all citizens. In 2015, 2.8 million calls were 
managed by poison control centers, which is an average of 
approximately 8,000 calls per day. Of these calls, 47 percent 
were related to exposures to children five and under, and 22 
percent came from health care facilities. Of the approximate 
2.2 million poisonings reported in 2015, 67 percent were 
managed at the site of exposure, avoiding unnecessary visits to 
emergency departments.

Hansen's Disease Program

    The Committee recommends $15,685,000 for the Hansen's 
Disease Program, Hansen's Disease buildings and facilities, and 
payment to Hawaii for treatment, which is the same as the 
fiscal year 2018 enacted level and $2,175,000 more than the 
fiscal year 2019 budget request. The Hansen's Disease Program 
provides medical care, education, and research for Hansen's 
disease (leprosy) and related conditions.
    The Committee understands that the incidence of leprosy in 
some areas has been increasing. With level funding provided for 
this year, the Committee strongly encourages HRSA to sustain 
its contracts with satellite clinics to ensure that essential 
services are provided for these vulnerable patients and to 
allow treatment for patients' ongoing problems and the timely 
interventions for new complications and for newly diagnosed 
patients.

                              RURAL HEALTH

 
 
 
Appropriation, fiscal year 2018.......................      $290,794,000
Budget request, fiscal year 2019......................        74,911,000
Committee Recommendation..............................       281,294,000
    Change from enacted level.........................        -9,500,000
    Change from budget request........................      +206,383,000
 

    Rural Health programs provide funding to improve access, 
quality, and coordination of care in rural communities; for 
research on rural health issues; for technical assistance and 
recruitment of health care providers; for screening activities 
for individuals affected by the mining, transport, and 
processing of uranium; for the outreach and treatment of coal 
miners and others with occupation-related respiratory and 
pulmonary impairments; and for the expansion of telehealth 
services.
    Within the total for Rural Health activities, the Committee 
provides the following amounts:

------------------------------------------------------------------------
                                                            FY 2019
                   Budget Activity                         Committee
------------------------------------------------------------------------
Rural Health Outreach Programs.......................        $71,500,000
Rural Health Research................................          9,351,000
Rural Hospital Flexibility Grants....................         33,667,000
Small Hospital Improvement Grants....................         25,942,000
State Offices of Rural Health........................         11,000,000
Black Lung Clinics...................................         12,000,000
Radiation Exposure Screening and Education...........          1,834,000
Telehealth...........................................         23,500,000
Rural Communities Opioid Response....................         82,500,000
Rural Residency Program..............................         10,000,000
------------------------------------------------------------------------

Rural Health Outreach Programs

    Rural Health Outreach programs funds activities that 
improve access to and coordination of care in rural 
communities, with a focus on building sustainable health 
programs that continue beyond Federal funding. Outreach 
programs focus on supporting rural community needs related to 
issues such as such as behavioral health, oral health, care 
coordination, quality improvement, workforce training, chronic 
disease management and enhancing the rural health care delivery 
system of rural hospitals, clinics and other safety net 
providers. Programs under this heading include:
    Outreach Service Grants, which focus on improving access 
care in rural communities through the work of community 
coalitions and partnerships.
    Rural Network Development Grants, which support building 
regional or local partnerships among local hospitals, 
physicians groups, long-term care facilities, and public 
agencies to improve management of scare health care resources.
    Delta States Network Grant Program, which provides network 
development grants to the eight states in Mississippi Delta for 
network and rural health infrastructure development.
    Network Planning Grants, which bring together key parts of 
the rural healthcare delivery system to target emerging public 
health issues.
    Small Healthcare Provider Quality Improvement Grants, which 
help improve patient care and chronic disease outcomes by 
assisting rural primary care providers with the implementation 
of quality improvement activities.

Rural Hospital Flexibility Grants

    The Committee provides $33,667,000 for the Medicare Rural 
Hospital Flexibility grant program, which provides funding to 
State governments to support critical access hospitals through 
quality, performance, and financial improvements.
    Under the Rural Hospital Flexibility Grants, of the funds 
provided for section 1820(g)(6) of the Social Security Act, the 
Committee recommends a transition from supporting telehealth 
activities to other efforts to improve care for rural veterans, 
such as helping rural hospitals and clinics that seek to serve 
as access points under the Veterans Affairs (VA) Community Care 
Program or other VA-contracted care.

Small Hospital Improvement Grants

    The Committee provides $25,942,000 for the Small Rural 
Hospital Improvement Program, this program provides awards 
through States to assist eligible small rural hospitals with 
software and equipment related to quality, reporting, and 
billing, with a particular focus on transitioning from 
prospective payment system hospitals.

Telehealth

    Within the funds provided for Telehealth, the agreement 
continues support for the Telehealth Centers for Excellence, 
which identify best practices, serve as national training 
resources, and test the efficacy of different telehealth 
clinical applications.
    Given the rising rates of maternal mortality and severe 
maternal morbidity, as well as barriers to access to care in 
rural areas, the Committee encourages HRSA to explore the use 
of telemedicine for high-risk pregnant women to include, but 
not limited to pregnant women with chronic conditions, 
preeclampsia, or a need to see a maternal-fetal medicine 
specialist.

                            FAMILY PLANNING

 
 
 
Appropriation, fiscal year 2018.......................      $286,479,000
Budget request, fiscal year 2019......................       286,479,000
Committee Recommendation..............................             - - -
    Change from enacted level.........................      -286,479,000
    Change from budget request........................      -286,479,000
 

    The Committee does not recommend funding for the Family 
Planning program. The Family Planning program administers Title 
X of the Public Health Service Act.

                           PROGRAM MANAGEMENT

 
 
 
Appropriation, fiscal year 2018.......................      $155,000,000
Budget request, fiscal year 2019......................       151,993,000
Committee Recommendation..............................       155,000,000
    Change from enacted level.........................             - - -
    Change from budget request........................        +3,007,000
 

    Program management supports the cost of Federal staff and 
related activities to coordinate, direct, and manage the 
programs of HRSA.
    Chief Dental Officer.--The Committee is pleased that HRSA 
has restored the position of Chief Dental Officer (CDO) and 
looks forward to learning how the agency has ensured that the 
CDO is functioning at an executive level authority with 
resources to oversee and lead HRSA oral health programs an 
initiatives. The Committee requests an update in the fiscal 
year 2020 Congressional Justification on how the CDO is serving 
as the agency representative on oral health issues to 
international, national, State and/or local government 
agencies, universities, and oral health stakeholder 
organizations.

             VACCINE INJURY COMPENSATION PROGRAM TRUST FUND

 
 
 
Appropriation, fiscal year 2018.......................      $277,200,000
Budget request, fiscal year 2019......................       317,200,000
Committee Recommendation..............................       317,200,000
    Change from enacted level.........................       +40,000,000
    Change from budget request........................             - - -
 

    The National Vaccine Injury Compensation Program provides a 
system of compensation for individuals with vaccine-associated 
injuries or deaths. Funds for claims from vaccines administered 
on or after October 1, 1988 are generated by a per-dose excise 
tax on the sale of selected prescribed vaccines. The Vaccine 
Injury Compensation Trust Fund receives revenues raised by this 
tax. Trust funds made available will support the liability 
costs of vaccines administered after September 30, 1988.
    The Committee recommends $9,200,000 for administration of 
the program, which is the same as the fiscal year 2018 enacted 
level and the fiscal year 2019 budget request.

               Centers for Disease Control and Prevention


 
 
 
Appropriation, fiscal year 2018.......................    $8,301,166,000
Budget request, fiscal year 2019......................     5,660,755,000
Committee Recommendation..............................     7,685,266,000
    Change from enacted level.........................      -615,900,000
    Change from budget request........................    +2,024,511,000
 

    The Committee recommendation for the Centers for Disease 
Control and Prevention (CDC) program level includes 
$6,781,908,000 in discretionary budget authority, $55,358,000 
in mandatory funds under the terms of the Energy Employees 
Occupational Illness Compensation Program Act, and $848,000,000 
in transfers from the Prevention and Public Health (PPH) Fund. 
CDC's mission is to protect Americans from health, safety, and 
security threats, which it accomplishes by supporting core 
public health functions at State, local, and Tribal health 
departments, detecting and responding to new and emerging 
health threats, promoting health and safety, and providing 
leadership in the public health workforce.

                 IMMUNIZATION AND RESPIRATORY DISEASES

 
 
 
Appropriation, fiscal year 2018.......................      $798,405,000
Budget request, fiscal year 2019......................       700,828,000
Committee Recommendation..............................       808,405,000
    Change from enacted level.........................       +10,000,000
    Change from budget request........................      +107,577,000
 

    The Committee recommendation includes $484,055,000 in 
discretionary budget authority and $324,350,000 in transfers 
from the PPH Fund.
    Immunization grants are awarded to State and local public 
health departments for planning, developing, and conducting 
childhood, adolescent, and adult immunization programs, 
including enhancement of the vaccine delivery infrastructure. 
CDC directly maintains a stockpile of vaccines, supports 
consolidated purchase of vaccines for State and local health 
agencies, and conducts surveillance, investigations, and 
research into the safety and efficacy of new and presently-used 
vaccines.
    Within the total for Immunization and Respiratory Diseases, 
the Committee recommends the following amounts:

------------------------------------------------------------------------
                                                            FY 2019
                   Budget Activity                         Committee
------------------------------------------------------------------------
Section 317 Immunization Program.....................       $620,847,000
    National Immunization Survey.....................         12,864,000
Influenza Planning and Response......................        187,558,000
------------------------------------------------------------------------

    Influenza Vaccine Procurement.--The Committee encourages 
CDC to consider including vaccines produced through recombinant 
DNA technology in addition to traditionally-produced vaccines 
in future solicitations to facilitate the competitive process 
for all vaccine manufacturers.
    Section 317 Immunization Program.--The Committee believes 
that a strong public health immunization infrastructure is 
critical for ensuring high vaccination coverage levels, 
preventing the spread of vaccine-preventable diseases, and 
responding to outbreaks. During the 2015 measles outbreak, 
section 317 funds supported State and local health departments 
in rapid response, public health communication, data gathering, 
and diagnostics.

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

 
 
 
Appropriation, fiscal year 2018.......................    $1,127,278,000
Budget request, fiscal year 2019......................     1,117,278,000
Committee Recommendation..............................     1,147,278,000
    Change from enacted level.........................       +20,000,000
    Change from budget request........................       +30,000,000
 

    CDC provides national leadership and support for prevention 
research and the development, implementation, and evaluation of 
evidence-based HIV, viral hepatitis, sexually transmitted 
diseases (STD), and tuberculosis (TB) prevention programs 
serving persons affected by, or at risk for, these infections. 
Activities include surveillance, epidemiologic and laboratory 
studies, and prevention activities. CDC provides funds to 
State, local, and Tribal health departments and community-based 
organizations to develop and implement integrated community 
prevention plans.
    Within the total for HIV/AIDS, Viral Hepatitis, STD, and TB 
Prevention, the Committee recommends the following amounts:

------------------------------------------------------------------------
                                                            FY 2019
                   Budget Activity                         Committee
------------------------------------------------------------------------
Domestic HIV/AIDS Prevention and Research............       $788,712,000
    HIV Prevention by Health Departments.............        397,161,000
    HIV Surveillance.................................        119,861,000
    Activities to Improve Program Effectiveness......        103,208,000
    National, Regional, Local, Community, and Other          135,401,000
     Organizations...................................
    School Health-HIV................................         33,081,000
Viral Hepatitis......................................         39,000,000
Sexually Transmitted Diseases........................        157,310,000
Tuberculosis.........................................        142,256,000
Elimination Initiative...............................         20,000,000
------------------------------------------------------------------------

    Elimination Initiative.--The Committee includes $20,000,000 
for the Infectious Disease Elimination Initiative proposed in 
the fiscal year 2019 budget request. This new initiative will 
support efforts to eliminate new infections such as HIV, 
hepatitis B virus (HBV), hepatitis C virus (HCV), STDs, and TB 
in high-risk States and jurisdictions, including those with 
high rates of opioid-related transmission. The Committee 
requests an update on this new initiative within 60 days of 
enactment of this Act.
    Latent Tuberculosis Infection.--CDC estimates that there 
are up to 13 million individuals in the US with latent TB 
infection. The identification and preventive treatment of 
individuals with TB infection would prevent future active TB 
cases, reducing future healthcare costs. The Committee again 
urges the Director to support State and local TB programs to 
effectively identify and treat latent TB infection cases.
    Viral Hepatitis.--The Committee is concerned that as a 
result of the opioid epidemic, infections of viral hepatitis 
have spiked in many parts of the nation, including a 233 
percent increase in infections nationwide since 2010. Even 
though the HBV vaccine is more than 90 percent effective, there 
were over 41,000 new HBV infections in 2016. The Committee 
notes that the link between viral hepatitis infection and 
primary liver cancer is well-established, with up to 60 percent 
of global liver cancer cases caused by HBV. The Committee notes 
that in 2017 the National Academies of Sciences, Engineering, 
and Medicine (NASEM) report entitled ``A National Strategy for 
the Elimination of Hepatitis B and C'' made a series of 
recommendations for vaccination, higher rates of diagnosis, 
care, and treatment. The Committee urges CDC, in cooperation 
with the leading national viral hepatitis organizations, to 
develop a plan to implement the NASEM recommendations to 
achieve the goal of the elimination of hepatitis B and C. The 
Committee also requests a report on CDC's plan for 
implementation of the NASEM recommendations within 90 days of 
enactment of this Act.
    Viral Hepatitis and Injection Drug Use.--The Committee 
notes that there has been a nationwide increase in new viral 
hepatitis diagnoses and regional increases in HIV diagnoses 
attributed to injection drug use associated with the opioid 
epidemic. Research shows that awareness of one's HIV infection 
status can increase motivation to begin substance use disorder 
treatment, especially when medication-assisted treatment is 
integrated with antiretroviral treatment for HIV patients. The 
Committee looks forward to working with HHS to ensure opioid 
resources address the overlapping public health testing 
activities for affected communities.

               EMERGING AND ZOONOTIC INFECTIOUS DISEASES

 
 
 
Appropriation, fiscal year 2018.......................      $614,572,000
Budget request, fiscal year 2019......................       508,328,000
Committee Recommendation..............................       614,572,000
    Change from enacted level.........................             - - -
    Change from budget request........................      +106,244,000
 

    The Committee recommendation includes $562,572,000 in 
discretionary appropriations and $52,000,000 in transfers from 
the PPH Fund. Programs funded under Emerging and Zoonotic 
Infectious Diseases (EZID) support the prevention and control 
of infectious diseases through surveillance, outbreak 
investigation and response, research, and prevention.
    Within the total for EZID, the Committee recommends the 
following amounts:

------------------------------------------------------------------------
                                                            FY 2019
                   Budget Activity                         Committee
------------------------------------------------------------------------
Core Infectious Diseases.............................       $422,000,000
    Emerging Infectious Diseases.....................        155,457,000
    Lab Safety and Quality...........................          8,000,000
    Antibiotic Resistance Initiative.................        168,000,000
    All Other Infectious Diseases....................         29,840,000
    Vector-borne Diseases............................         38,603,000
    Lyme Disease.....................................         10,700,000
    Prion Disease....................................          6,000,000
    Chronic Fatigue Syndrome.........................          5,400,000
Food Safety..........................................         58,000,000
National Health Care Safety Network..................         21,000,000
Quarantine...........................................         31,572,000
Advanced Molecular Detection.........................         30,000,000
Epidemiology and Laboratory Capacity.................         40,000,000
Healthcare-Associated Infections.....................         12,000,000
------------------------------------------------------------------------

    Antibiotic Resistance Solutions Initiative.--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 
competitively award research activities that address aspects of 
antibiotic resistance related to ``OneHealth'' among entities, 
including public academic medical centers, veterinary schools 
with agricultural extension services, and State public health 
departments whose proposals are in line with CDC's strategy for 
addressing antibiotic resistant bacteria. The Committee 
requests that CDC provide an updated spend plan to the 
Committee within 30 days of enactment of this Act and include 
an update on these efforts in the fiscal year 2020 
Congressional Justification. The Committee encourages CDC to 
prevent spread by enhancing State, local, and regional public 
health capacity to prevent, detect, and respond to new and 
existing antibiotic resistance faster and to develop a national 
capacity to identify and catalog microbial genome sequences, 
paying attention to antibiotic-resistant microbes. Finally, the 
Committee encourages CDC to continue to pursue research 
opportunities in the area of antimicrobial stewardship in 
diverse healthcare settings and encourage regional 
collaborations to study the most effective strategies to 
improve antibiotic prescribing and stewardship.
    Eye Health and Safety.--The Committee is aware of CDC's 
long history in research related to keratitis outbreaks and 
contact lens-related infections and applauds the development of 
the healthy contact lens program. The Committee is also aware 
of concerns raised in the medical community regarding rules 
regulating the sale of contact lenses, which are Food and Drug 
Administration (FDA) Class II and III medical devices. Given 
these developments, the Committee directs CDC to update both 
its 2010 report, Estimated Burden of Keratitis, to include the 
most recent data available and its 2016 survey and reporting 
related to risk behaviors for contact lens-related eye 
infections. In addition, the Committee encourages CDC to work 
with relevant professional societies to leverage data from 
qualified clinical data registries on contact lens adverse 
events, including those that do not result in permanent loss of 
vision, to better inform the understanding of the risks 
associated with contact lens wear.
    Nutritional Alternatives to Antibiotic Use.--Each year, 
approximately 97 million outpatient visits in the US are 
associated with antibiotic prescriptions, with over half of all 
women acquiring a urinary tract infection (UTI) at least once 
in their lifetime. As E.coli, which is responsible for over 80 
percent of UTIs, is becoming resistant to many antibiotics, the 
Committee encourages support for stewardship efforts that 
further examine the role that bioactive compounds found in 
certain nutrient dense foods play in reducing antibiotic use. 
The Committee further encourages CDC to continue to pursue 
nutritional alternative opportunities in diverse healthcare 
settings to study the most effective strategies to improve 
antibiotic prescribing and stewardship.
    Tick-Borne Disease Resources and Guidelines.--The Committee 
encourages CDC to ensure transparency on its website of its 
physician education programs regarding Lyme disease, including 
scientific resources and schedules, to solicit input from the 
treating physician community at large regarding such education 
programs, and to include the broad spectrum of scientific 
viewpoints; to provide written rationale for selection of Lyme 
and tick-borne diseases treatment guidelines it displays on its 
website; and to intensify surveillance of Borrelia infections 
in non-endemic/non-high-incidence areas.
    Vector-Borne Diseases.--The Committee recognizes the 
critical role that EZID and its Vector-Borne Disease Program 
play in ongoing efforts to prepare for and fight tropical 
diseases emerging on US soil, such as Dengue, Chikungunya, and 
Zika. EZID is critical to crafting sustainable long-term 
abilities of States to prepare for vector-borne disease such as 
Zika and West Nile and is the Federal government's only central 
focus on vector control.
    Vector-Borne Disease Centers of Excellence.--The Committee 
is concerned about the Pacific Northwest being an underserved 
region for funding and representation in the Regional Centers 
of Excellence in Vector-Borne Diseases network recently 
established by CDC. The ecology, disease transmission dynamics, 
and resources for vector-borne disease training, surveillance, 
and control in the Northwest differ significantly from those in 
the five regional centers currently funded. The Committee 
encourages CDC to examine options to provide greater coverage 
the Northwest region for vector-borne disease resources.

            CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION

 
 
 
Appropriation, fiscal year 2018.......................    $1,162,896,000
Budget request, fiscal year 2019......................       939,250,000
Committee Recommendation..............................     1,205,396,000
    Change from enacted level.........................       +42,500,000
    Change from budget request........................      +266,146,000
 

    The Committee recommendation includes $910,746,000 in 
discretionary appropriations and $294,650,000 in transfers from 
the PPH Fund. Programs supported within Chronic Disease 
Prevention and Health Promotion (CDPHP) provide national 
leadership and support for State, Tribal, and community efforts 
to promote health and well-being through the prevention and 
control of chronic diseases.
    The recommendation for CDPHP maintains the existing program 
line items as they were funded in fiscal year 2018 and does not 
provide funding for the America's Health Block Grant proposed 
in the fiscal year 2019 budget request. Chronic diseases, such 
as Alzheimer's disease, diabetes, heart disease, and stroke, 
are the leading causes of death and disability in the US and 
account for 86 cents of every dollar spent on health care. Many 
of these conditions are largely preventable through improved 
nutrition and physical activity. The Committee supports 
evidence-based strategies to address public health priorities 
through proven State-based grant programs, utilizing related 
national organizations for technical assistance, and encourages 
CDC to continue and expand these successful approaches.
    Within the total provided, the Committee recommends the 
following amounts:

------------------------------------------------------------------------
                                                            FY 2019
                   Budget Activity                         Committee
------------------------------------------------------------------------
Tobacco..............................................       $210,000,000
Nutrition, Physical Activity, and Obesity............         54,920,000
    High Obesity Rate Counties.......................         15,000,000
School Health........................................         15,400,000
Health Promotion.....................................         18,000,000
    Glaucoma.........................................          4,000,000
    Visual Screening Education.......................          1,000,000
    Alzheimer's Disease..............................          4,500,000
    Inflammatory Bowel Disease.......................          1,000,000
    Interstitial Cystitis............................          1,000,000
    Excessive Alcohol Use............................          4,000,000
    Chronic Kidney Disease...........................          2,500,000
Prevention Research Centers..........................         25,461,000
Heart Disease and Stroke.............................        147,062,000
Diabetes.............................................        155,129,000
National Diabetes Prevention Program.................         26,800,000
Cancer Prevention and Control........................        367,674,000
    Breast and Cervical Cancer.......................        218,000,000
        WISEWOMAN....................................         21,120,000
    Breast Cancer Awareness for Young Women..........          4,960,000
    Cancer Registries................................         49,440,000
    Colorectal Cancer................................         43,294,000
    Comprehensive Cancer.............................         19,675,000
    Johanna's Law....................................          7,000,000
    Ovarian Cancer...................................          9,500,000
    Prostate Cancer..................................         13,205,000
    Skin Cancer......................................          2,125,000
    Cancer Survivorship Resource Center..............            475,000
Oral Health..........................................         22,000,000
Safe Motherhood/Infant Health........................         50,000,000
    Preterm Birth....................................          4,000,000
Other Chronic Diseases...............................         26,000,000
    Arthritis........................................         13,000,000
    Epilepsy.........................................          8,500,000
    National Lupus Patient Registry..................          6,500,000
Racial and Ethnic Approaches to Community Health.....         66,950,000
    Good Health and Wellness in Indian Country.......         32,000,000
Million Hearts.......................................          4,000,000
National Early Child Care Collaboratives.............          4,000,000
Hospitals Promoting Breastfeeding....................         10,000,000
------------------------------------------------------------------------

    Alzheimer's Disease Healthy Brain Initiative.--The 
Committee continues to support the Healthy Brain Initiative, 
and encourages CDC to assist States in collecting cognitive 
decline and caregiving data through the Behavioral Risk Factor 
Surveillance System and implementing the Healthy Brain 
Initiative's Public Health Roadmap for State and National 
Partnerships.
    Chronic Fatigue Syndrome.--The Committee applauds CDC's 
efforts to collaborate with disease experts in its multi-site 
study to resolve case definition issues around Myalgic 
Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and urges 
CDC to complete that effort. The Committee also commends CDC's 
recent update of its website informing the public about ME/CFS 
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 ME/CFS and the critical lack of medical 
providers. The Committee is also concerned that there are fewer 
than twelve experts in the country. The Committee urges CDC to 
partner with other HHS agencies, disease experts, and key 
medical societies to implement a proactive plan to address 
these issues and find creative ways to bring additional 
clinicians into the field.
    Chronic Obstructive Pulmonary Disease.--The Committee 
commends the release of the Chronic Obstructive Pulmonary 
Disease (COPD) National Action Plan and its comprehensive 
approach to confronting the burden of COPD. The Committee 
encourages CDC to begin implementation of the National Action 
Plan by integrating COPD surveillance, research, prevention, 
and management strategies into its chronic disease efforts.
    Eating Disorders.--The Committee encourages CDC to assist 
States in collecting data by reincluding standard questions on 
unhealthy weight control practices for eating disorders, 
including binge-eating, through the Youth Risk Behavioral 
Surveillance System.
    Inflammatory Bowel Disease.--The Committee commends CDC for 
supporting epidemiological studies on Irritable Bowel Disease 
(IBD), including a focus on minority and underserved 
communities. The Committee encourages CDC to continue to 
identify innovative approaches, including mixed methods 
research, for determining the incidence and prevalence of IBD.
    Maternal Health Pilot Project.--The Committee is aware that 
the U.S. ranks 30th among 33 nations in infant mortality rates, 
that these statistics disproportionately impact communities of 
color, and that preventing infant mortality is challenging 
because data is several years old and not consistently captured 
or analyzed during pregnancy. Using real-time data from 
maternity wards can enable public health officials, providers, 
and communities to provide care and address needs during 
pregnancy that can reduce and prevent high infant mortality and 
morbidity rates. The Committee includes $2,000,000 within the 
total available for Safe Motherhood/Infant Health, Preterm 
Birth Perinatal Collaboratives to develop a maternal health 
pilot project. This pilot should make use of existing State 
biosurveillance tools to create a real-time database of 
prenatal and newborn health data, including opioid related 
concerns, such as neonatal abstinence syndrome, during 
pregnancy and early motherhood, to forecast individual risk of 
infant mortality and morbidity and to establish plans to 
optimize care and referrals to promising or proven 
interventions. CDC should focus this pilot on States with the 
highest infant mortality rate.
    Maternal Mortality Review Committees.--The Committee 
includes $2,000,000 within the total available for Safe 
Motherhood/Infant Health to support States to implement 
maternal mortality review committees, including promoting best 
practices and providing technical assistance, training, tools, 
and resources.
    National Lupus Patient Registry.--The Committee continues 
to support research efforts under the National Lupus Patient 
Registry program and acknowledges that there has been 
significant progress to understand better the epidemiology of 
lupus. However, the Committee recognizes that challenges and 
disparities still remain. The Committee encourages CDC to focus 
on studies related to the natural history and pathogenesis of 
pediatric lupus to understand better the lifetime burden of 
disease in children and young adults. The Committee also 
encourages CDC and the Lupus Federal Working Group to 
prioritize research into the racial and ethnic disparities in 
lupus. Finally, the Committee encourages the continuing 
development of lupus self-management programs by current lupus 
registry cohorts and national voluntary health organizations 
for adults with lupus to improve quality of life and health 
outcomes.
    Ovarian Cancer.--The Committee is pleased by CDC's launch 
of Know: BRCA to help increase the public's awareness of 
hereditary breast and ovarian cancers and improve understanding 
the individual risk of having a BRCA mutation. The Committee 
strongly encourages CDC to take steps to integrate components 
of the Inside Knowledge Campaign, which works to increase 
awareness of the signs and symptoms of ovarian and other 
gynecologic cancers, and Know: BRCA to the extent possible, to 
ensure coordination of public health messages related to 
ovarian cancer, leveraging of resources, and maximizing 
economies of scale.
    Psoriatic Disease Initiative.--The Committee recognizes the 
growing body of evidence linking psoriatic disease, which 
impacts more than eight million Americans, to other 
comorbidities such as cardiovascular disease, mental health, 
substance abuse challenges, kidney disease, and other 
conditions. 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 support intramural and grant-based research 
on the comorbidities of psoriatic disease, including research 
that can be done in collaboration with or funded by other 
disease programs such as Arthritis, Cardiovascular Health, or 
Mental Illness.
    Pulmonary Hypertension.--The Committee is concerned that 
most pulmonary hypertension (PH) patients are not diagnosed for 
many years until the condition has reached a catastrophic 
stage, which leads to significant disability, greatly increased 
mortality, and the need for costly and dramatic medical 
interventions, such as heart-lung transplantation. Considering 
the availability of effective therapies for early-stage PH, the 
Committee encourages CDC to support education, awareness, and 
epidemiology activities that promote early and accurate 
diagnosis of PH.
    Racial and Ethnic Approaches to Community Health.--The 
Committee includes $32,000,000 within Racial and Ethnic 
Approaches to Community Health to significantly expand the Good 
Health and Wellness in Indian Country program. The Good Health 
initiative supports efforts by American Indian and Alaska 
Native communities to implement holistic and culturally-adapted 
approaches to reduce tobacco use, improve physical activity and 
nutrition, and increase health literacy. The Committee requests 
an update on CDC's plans for this expansion within 60 days of 
enactment of this Act.
    Safe Motherhood and Infant Health.--The Committee continues 
to support activities within this line related to maternal and 
infant health, such as State-Based Perinatal Collaboratives and 
the Pregnancy Risk Assessment Monitoring System, at the fiscal 
year 2018 enacted level. The Committee recommendation does not 
include funding for the teen pregnancy prevention cooperative 
agreement.
    Sepsis.--The Committee encourages CDC to increase its 
public awareness, outreach, and education efforts on sepsis, 
including health provider outreach and other related activities 
to prevent sepsis and improve early recognition and management 
of sepsis. The Committee requests CDC provide a report on its 
activities to improve public awareness of sepsis in the fiscal 
year 2020 Congressional Justification.
    Type 1 Diabetes and Diabetic Ketoacidosis.--The Committee 
is concerned about the increase in type 1 diabetes and the risk 
of diabetic ketoacidosis. The Committee encourages CDC to 
conduct national monitoring and epidemiologic analysis of 
recent trends and determinants in type 1 diabetes and related 
acute complications, including diabetic ketoacidosis, and to 
educate key stakeholders, such as providers and others, on 
effective diabetes management and prevention of acute 
complications such as diabetic ketoacidosis.

  BIRTH DEFECTS, DEVELOPMENTAL DISABILITIES, DISABILITIES, AND HEALTH

 
 
 
Appropriation, fiscal year 2018.......................      $140,560,000
Budget request, fiscal year 2019......................       110,000,000
Committee Recommendation..............................       150,560,000
    Change from enacted level.........................       +10,000,000
    Change from budget request........................       +40,560,000
 

    This account supports efforts to conduct research on and 
address the causes of birth defects and developmental 
disabilities, as well as reduce the complications of blood 
disorders and improve the health of people with disabilities.
    Within the total, the Committee recommends the following 
amounts:

------------------------------------------------------------------------
                                                            FY 2019
                   Budget Activity                         Committee
------------------------------------------------------------------------
Child Health and Development.........................        $65,800,000
    Birth Defects....................................         19,000,000
    Fetal Death......................................            900,000
    Fetal Alcohol Syndrome...........................         11,000,000
    Folic Acid.......................................          3,150,000
    Infant Health....................................          8,650,000
    Autism...........................................         23,100,000
Health and Development for People with Disabilities..         59,660,000
    Disability & Health incl. Child Development......         27,000,000
    Tourette Syndrome................................          2,000,000
    Early Hearing Detection and Intervention.........         10,760,000
    Muscular Dystrophy...............................          6,000,000
    Attention Deficit Hyperactivity Disorder.........          1,900,000
    Fragile X........................................          2,000,000
    Spina Bifida.....................................          6,000,000
    Congenital Heart Defects.........................          4,000,000
Blood Disorders......................................         15,100,000
    Public Health Approach to Blood Disorders........          4,400,000
    Hemophilia Activities............................          3,500,000
    Hemophilia Treatment Centers.....................          5,100,000
    Thalassemia......................................          2,100,000
Surveillance for Emerging Threats to Mothers and              10,000,000
 Babies..............................................
------------------------------------------------------------------------

    Duchenne Muscular Dystrophy and Newborn Screening.--The 
Committee continues to be encouraged by efforts to develop a 
newborn screening test for Duchenne Muscular Dystrophy. The 
Committee is aware of the successful pilot project in Ohio and 
supports CDC's plans to consider an additional State pilot.
    Duchenne Muscular Dystrophy Surveillance.--The Committee is 
pleased by the publication of updates of the care standards for 
Duchenne Muscular Dystrophy and encourages CDC to continue 
supporting widespread dissemination of these standards to all 
appropriate provider audiences. The Committee is also aware of 
CDC's efforts to support refinement of an ICD 10 code for 
Duchenne and Becker Muscular Dystrophy (DBMD) and requests that 
CDC use MD STARnet to monitor the implementation of the code 
and measure how accurately and effectively the code is being 
applied to known cases of DBMD.
    Fragile X and Fragile X-Associated Disorders.--The 
Committee commends CDC's efforts to identify and define the 
population impacted by Fragile X (FX) and all conditions 
associated with the gene mutation with the goal of 
understanding the public health impact of these conditions. To 
help this effort, the Committee urges the National Center on 
Birth Defects and Developmental Disabilities (NCBDDD) to 
support additional strategies to promote earlier identification 
of children with FX, such as newborn screening. The Committee 
acknowledges the significant progress made by NCBDDD in growing 
its FORWARD Database and Patient Registry and extending FORWARD 
participation to adults with FX. This project will have a 
highly significant impact on understanding the natural history 
of FX throughout the lifespan, and defining how to best measure 
patient outcomes. Given the potential connections among FX, the 
FX protein, and autism, the prospect of targeted treatments for 
overlapping characteristics of both conditions, the Committee 
urges the 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.
    Health Promotion for People with Disabilities.--The 
Committee supports the activities of the National Center on 
Health, Physical Activity, and Disability (NCHPAD) and its 
primary goal of promoting better health, wellness, and quality 
of life for people with disabilities. The Committee encourages 
NCHPAD to implement a demonstration project to develop and 
implement strategies to reduce diabetes and obesity among 
people with mobility limitations in coordination with CDC State 
Disability and Health Programs.
    Neonatal Abstinence Syndrome Surveillance.--The Committee 
urges CDC to expand its surveillance of adverse infant outcomes 
and long-term developmental outcomes of children who were 
diagnosed with neonatal abstinence syndrome at birth, as very 
little is currently known about the full impact of prenatal 
opioid exposure or the educational and social challenges that 
these children face as they grow and enter school. The 
Committee urges CDC to recognize the complex nature of this 
epidemic by studying the impact of poly-substance use as well 
as opioid use by pregnant women, in addition to other factors 
in the home setting that may affect the development of these 
children.
    Pre-Term Birth.--Preterm birth affects more than 380,000 
babies each year in the US and is the leading cause of neonatal 
mortality. The Committee commends CDC for funding six State-
based Perinatal Collaboratives that focus on improving birth 
outcomes and maternal health and safety using known prevention 
strategies such as reducing early elective deliveries.
    Spina Bifida.--The Committee recognizes that spina bifida 
is the most common permanently disabling birth defect in the 
US. Each year in the US, about 1,500 babies are born with spina 
bifida, and there are an estimated 166,000 individuals living 
with all forms of this complex birth defect. Spina bifida and 
related neural tube defects are largely but not entirely 
preventable through education and adequate daily folic acid 
consumption, so it is important to identify other risk factors 
in order to allow more complete prevention of this devastating 
birth defect. The Committee encourages CDC to use funding 
provided for the National Spina Bifida Program (NSBP) to 
support the continuation of the National Spina Bifida Patient 
Registry and the Spina Bifida Clinical Care Monitoring and 
Tracking program. Further, the Committee commends the NSBP for 
serving as a model for programs assisting other individuals 
living with similar complex conditions and encourages CDC to 
continue to support the dissemination of information to 
clinicians, parents, and families living with spina bifida.
    Surveillance for Emerging Threats to Mothers and Babies.--
The Committee includes $10,000,000 for Surveillance for 
Emerging Threats to Mothers and Babies, as proposed in the 
fiscal year 2019 budget request. This new initiative will build 
upon surveillance through the Zika pregnancy and infant 
registry to monitor the long-term impact of Zika and can be 
leveraged for other emerging infectious diseases and emerging 
threats. The Committee requests an update on this new 
initiative within 60 days of enactment of this Act.
    Thalassemia.--The Committee is aware of the critical work 
done by CDC's thalassemia program in 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 the CDC continue 
collaborating with thalassemia treatment centers, non-profits, 
and patient advocates through this program.

                   PUBLIC HEALTH SCIENTIFIC SERVICES

 
 
 
Appropriation, fiscal year 2018.......................      $490,397,000
Budget request, fiscal year 2019......................       468,000,000
Committee Recommendation..............................       495,397,000
    Change from enacted level.........................        +5,000,000
    Change from budget request........................       +27,397,000
 

    This account supports programs that provide leadership and 
training for the public health workforce, support 
infrastructure to modernize public health surveillance, promote 
and facilitate science standards and policies, and improve 
access to information on disease outbreaks and other threats.
    Within the total, the Committee recommends the following 
amounts:

------------------------------------------------------------------------
                                                            FY 2019
                   Budget Activity                         Committee
------------------------------------------------------------------------
Health Statistics....................................       $160,397,000
Surveillance, Epidemiology, and Informatics..........        284,000,000
    Laboratory Training and Oversight................          5,000,000
Public Health Workforce..............................         51,000,000
------------------------------------------------------------------------

    National Neurological Conditions Surveillance System.--The 
Committee provides $5,000,000 within the total for 
Surveillance, Epidemiology, and Informatics for the 
establishment of the National Neurological Conditions 
Surveillance System (NNCSS), which was authorized in the 21st 
Century Cures Act (PS 114-255). This funding will support CDC 
to enhance and expand existing infrastructure and activities to 
conduct surveillance of neurological conditions. The NNCSS will 
provide for the collection and storage of key information on 
incidence and prevalence of subset of neurological diseases in 
the U.S.
    Surveillance Data Platform.--The Committee encourages CDC 
to continue the efforts started with the development of the 
Surveillance Data Platform by using this program to modernize 
the surveillance infrastructure of the over 100 surveillance 
applications at CDC, leveraging and supporting initiatives in 
CDC's 2014 Surveillance Strategy. This would be an important 
step forward for CDC in modernizing their critical data 
collection systems that will allow for better data sharing and 
analysis on a common platform that will help reduce redundancy 
and maintenance.

                          ENVIRONMENTAL HEALTH

 
 
 
Appropriation, fiscal year 2018.......................      $205,750,000
Budget request, fiscal year 2019......................       157,000,000
Committee Recommendation..............................       201,350,000
    Change from enacted level.........................        -4,400,000
    Change from budget request........................       +44,350,000
 

    The Committee recommendation includes $184,350,000 in 
discretionary appropriations and $17,000,000 in transfers from 
the PPH Fund.
    Programs supported within Environmental Health conduct 
surveillance and data collection to detect and address emerging 
pathogens and environmental toxins that pose significant 
challenges to public health, as well as determine whether and 
at what level of exposure these substances are harmful to 
humans.
    Within the total, the Committee recommends the following 
amounts:

------------------------------------------------------------------------
                                                            FY 2019
                   Budget Activity                         Committee
------------------------------------------------------------------------
Environmental Health Laboratory......................        $68,750,000
    Newborn Screening Quality Assurance Program......         19,000,000
    Newborn Screening/Severe Combined                          1,250,000
     Immunodeficiency Diseases.......................
Environmental Health Activities......................         34,600,000
    Environmental Health Activities..................         16,000,000
    Safe Water.......................................          8,600,000
    Amyotrophic Lateral Sclerosis (ALS) Registry.....         10,000,000
    Climate Change...................................                  0
Environmental and Health Outcome Tracking Network....         34,000,000
Asthma...............................................         29,000,000
Childhood Lead Poisoning.............................         35,000,000
------------------------------------------------------------------------

    Harmful Algal Blooms.--The Committee supports the work that 
CDC is doing to conduct surveillance for and report health 
concerns related to harmful algal blooms and urges CDC to 
continue this work and (1) to provide more outreach to State 
and local public health officials to use these surveillance and 
reporting systems, and (2) to work with other agencies, 
including the Environmental Protection Agency, National Oceanic 
and Atmospheric Administration, and United States Geological 
Survey, to integrate disparate sets of data to allow for a 
broader understanding of the spatial and temporal dynamics of 
the environmental and health impacts of harmful algal blooms.
    Intermountain West Wildfire Smoke Health Monitoring.--The 
Committee is concerned with the public health impact of the 
ever-increasing number and severity of wildfires in the 
Intermountain West, noting increased long-term hospital 
admissions due to respiratory symptoms and chronic obstructive 
pulmonary disease. Through CDC's Environmental Public Health 
Tracking Network, grantees are using data on wildfires to 
educate residents in affected areas about ways to protect their 
health during wildfires. The Committee continues to encourage 
the use of the tracking network to better understand the impact 
of wildfires in the Intermountain West and inform health 
policymakers and resource managers.
    Lyme Disease.--The Committee encourages CDC to consider 
expanding activities related to developing sensitive and more 
accurate diagnostic tools and tests for Lyme disease and 
evaluating the development of a national reporting system.
    National Asthma Control Program.--The Committee encourages 
CDC to continue its 6|18 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 Quality Assurance Program.--The Committee 
is aware that State laboratories need specialized support to 
begin screening for additional newborn conditions and 
recognizes CDC's expertise in working with laboratories to 
implement accurate newborn screening tests. The Committee 
supports the Newborn Screening Quality Assurance Program to 
support State laboratories as they implement screening for new 
disorders. The Committee encourage CDC to support evaluation of 
testing methods for new conditions, expansion of CDC's quality 
assurance materials, and funding to States for critical 
335,200,000 and development of tests for rare conditions.

                     INJURY PREVENTION AND CONTROL

 
 
 
Appropriation, fiscal year 2018.......................      $648,559,000
Budget request, fiscal year 2019......................       266,309,000
Committee Recommendation..............................       690,559,000
    Change from enacted level.........................       +42,000,000
    Change from budget request........................      +424,250,000
 

    Programs supported within Injury Prevention and Control 
provide national leadership on violence and injury prevention, 
conduct research and surveillance, and promote evidence-based 
strategies to inform real-world solutions to prevent premature 
death and disability and to reduce human suffering and medical 
costs caused by injury and violence.
    Within the total, the Committee recommends the following 
amounts:

------------------------------------------------------------------------
                                                            FY 2019
                   Budget Activity                         Committee
------------------------------------------------------------------------
Intentional Injury...................................       $102,730,000
    Domestic Violence and Sexual Violence............         32,700,000
        Child Maltreatment...........................          7,250,000
    Youth Violence Prevention........................         15,100,000
    Domestic Violence Community Projects.............          5,500,000
    Rape Prevention..................................         49,430,000
National Violent Death Reporting System..............         23,500,000
Unintentional Injury.................................          8,800,000
    Traumatic Brain Injury...........................          6,750,000
    Elderly Falls....................................          2,050,000
Injury Prevention Activities.........................         28,950,000
Opioid Overdose Prevention and Surveillance..........        515,579,000
Injury Control Research Centers......................         11,000,000
------------------------------------------------------------------------

    Child Sexual Abuse Prevention.--It is estimated that 15 to 
25 percent of girls and five 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 believes that more emphasis should be placed on 
prevention. The Committee requests that the Center report on 
its current activities related to the development and 
evaluation of primary public health interventions targeting 
child sexual abuse. Additionally, the Committee requests that 
the Center identify gaps in research that can be filled to 
promote child sexual abuse primary prevention. The Committee 
requests this report within 180 days of enactment of this Act.
    Core State Violence and Injury Prevention Program.--The 
Core State Violence and Injury Prevention Program (Core SVIPP) 
is the only program of its kind in the US that uses research-
based evidence to identify the most effective strategies to 
prevent injuries caused by accidents or violence. To further 
strengthen State decision-making and support allocation of 
funds to high burden areas, the Committee encourages CDC to 
explore ways in which States can 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.
    Gun Research.--The Committee continues a general provision 
to prevent funds from being used to advocate for or promote gun 
control.
    Opioid Overdose Surveillance.--The Committee continues to 
support the use of data to support forecasting of opioid-
related overdose risk, including by geographic region. The 
Committee encourages CDC to initiate a demonstration project in 
States experiencing the highest rates of opioid-related 
overdose to use data to develop forecasts that public health 
officials can use to intervene and prevent overdoses.
    Prescription Drug Overdose.--The Committee commends CDC for 
its leadership on combatting prescription and opioid drug 
overdoses. The Committee encourages CDC to implement these 
activities based on population-adjusted burden of disease 
criteria, including mortality data (age-adjusted rate), as 
significant criteria when distributing funds for the State PDO 
Prevention activities. The Committee assumes these funds will 
be distributed via a competitive mechanism and not merely a 
mathematical formula or standard allocation to each State. 
Further, the Committee strongly encourages CDC to support local 
prevention activity to determine the effectiveness of 
medication-approved treatment modalities in treating heroin and 
prescription drug abuse and reducing diversion of buprenorphine 
for illicit purposes.

         NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH

 
 
 
Appropriation, fiscal year 2018.......................      $335,200,000
Budget request, fiscal year 2019......................             - - -
Committee Recommendation..............................       339,200,000
    Change from enacted level.........................        +4,000,000
    Change from budget request........................      +339,200,000
 

    The National Institute for Occupational Safety and Health 
(NIOSH) conducts applied research, develops criteria for 
occupational safety and health standards, and provides 
technical services to government, labor, and industry, 
including training for the prevention of work-related diseases 
and injuries. This appropriation supports surveillance, health 
hazard evaluations, intramural and extramural research, 
instrument and methods development, dissemination, and training 
grants.
    The Committee does not move NIOSH into NIH, as proposed in 
the budget request. The Committee believes NIOSH's mission does 
not align with NIH's focus on biomedical research and is better 
achieved within CDC.
    Within the total for NIOSH, the Committee recommends the 
following amounts:

------------------------------------------------------------------------
                                                            FY 2019
                   Budget Activity                         Committee
------------------------------------------------------------------------
National Occupational Research Agenda................       $118,000,000
    Agricultural, Forestry, and Fishing..............         27,500,000
Education and Research Centers.......................         31,000,000
Personal Protective Technology.......................         20,000,000
Mining Research......................................         59,500,000
National Mesothelioma Registry and Tissue Bank.......          1,100,000
Other Occupational Safety and Health Research........        109,600,000
------------------------------------------------------------------------

       ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION PROGRAM

 
 
 
Appropriation, fiscal year 2018.......................       $55,358,000
Budget request, fiscal year 2019......................             - - -
Committee Recommendation..............................        55,358,000
    Change from enacted level.........................             - - -
    Change from budget request........................       +55,358,000
 

    The Energy Employees Occupational Illness Compensation 
Program (EEOICPA) provides compensation to employees and 
survivors of employees of Department of Energy facilities and 
private contractors who have been diagnosed with a radiation-
related cancer, beryllium-related disease, or chronic silicosis 
as a result of their work. NIOSH estimates occupational 
radiation exposure for cancer cases, considers and issues 
determinations for adding classes of workers to the Special 
Exposure Cohort, and provides administrative support to the 
Advisory Board on Radiation and Worker Health.
    The Committee does not move EEOICPA into NIH, as proposed 
in the budget request. The Committee believes EEOICPA's mission 
does not align with NIH's focus on biomedical research and is 
better achieved within CDC.

                             GLOBAL HEALTH

 
 
 
Appropriation, fiscal year 2018.......................      $488,621,000
Budget request, fiscal year 2019......................       408,762,000
Committee Recommendation..............................       488,621,000
    Change from enacted level.........................             - - -
    Change from budget request........................       +79,859,000
 

    Through its Global Health activities, CDC coordinates, 
cooperates with, participates with, and provides consultation 
to other nations, Federal agencies, and international 
organizations to prevent and contain diseases and environmental 
health problems and to develop and apply health promotion 
activities. In cooperation with ministries of health and other 
appropriate organizations, CDC tracks and assesses evolving 
global health issues and identifies and develops activities to 
apply CDC's technical expertise.
    Within the total, the Committee recommends the following 
amounts:

------------------------------------------------------------------------
                                                            FY 2019
                   Budget Activity                         Committee
------------------------------------------------------------------------
Global AIDS Program..................................       $128,421,000
Global Immunization Program..........................       $226,000,000
    Polio Eradication................................       $176,000,000
    Other Global/Measles.............................        $50,000,000
Parasitic Diseases and Malaria.......................        $26,000,000
Global Disease Detection and Emergency Response......       $108,200,000
Global Public Health Capacity Development............         $9,800,000
------------------------------------------------------------------------

    Global Health Security and Global Health Research.--The 
Committee supports CDC's work to protect American and global 
health security through programs that detect, prevent, and 
respond to infectious disease and other health threats. As 
emerging infectious diseases like Ebola and Zika represent 
perpetual challenges for the US health system, the Committee 
supports continued and enhanced work in health research, 
innovation, capacity-building for disease research, detection, 
and surveillance, and robust monitoring and evaluation systems 
at home and abroad.
    Soil Transmitted Helminth and Related ``Diseases of 
Poverty''.--The Committee provides $1,500.00, the same as 
fiscal year 2018, for surveillance, source remediation, and 
clinical care aimed at reducing Soil Transmitted Helminth 
infection in areas not being addressed by the current outreach.

                PUBLIC HEALTH PREPAREDNESS AND RESPONSE

 
 
 
Appropriation, fiscal year 2018.......................    $1,450,000,000
Budget request, fiscal year 2019......................       800,000,000
Committee Recommendation..............................       860,000,000
    Change from enacted level.........................      -590,000,000
    Change from budget request........................       +60,000,000
 

    The Public Health Preparedness and Response (PHPR) account 
supports programs that build and strengthen national 
preparedness for public health emergencies, both naturally-
occurring and intentional. PHPR supports needs assessments, 
response planning, training, epidemiology and surveillance, and 
upgrades for laboratory capacity and communications systems.
    Within the total, the Committee recommends the following 
amounts:

------------------------------------------------------------------------
                                                            FY 2019
                   Budget Activity                         Committee
------------------------------------------------------------------------
State and Local Preparedness and Response Capability.       $698,200,000
    Public Health Emergency Preparedness Cooperative         690,000,000
     Agreement.......................................
    Academic Centers for Public Health Preparedness..          8,200,000
CDC Preparedness and Response........................        161,800,000
    BioSense.........................................         23,000,000
    All Other CDC Preparedness and Response..........        138,800,000
Strategic National Stockpile (SNS)...................                  0
------------------------------------------------------------------------

    Strategic National Stockpile.--The Committee includes 
funding for the Strategic National Stockpile (SNS) in the 
Office of the Assistant Secretary for Preparedness and 
Response, as requested in the fiscal year 2019 budget request. 
The Committee expects that this organizational change will 
continue to include a significant role for CDC in providing 
scientific expertise in decision-making related to procurement 
of countermeasures as well as maintaining strong relationships 
with State and local public health departments to facilitate 
efficient deployment of countermeasures in public health 
emergencies.

                        BUILDINGS AND FACILITIES

 
 
 
Appropriation, fiscal year 2018.......................      $510,000,000
Budget request, fiscal year 2019......................        30,000,000
Committee Recommendation..............................        30,000,000
    Change from enacted level.........................      -480,000,000
    Change from budget request........................             - - -
 

    This account supports capital projects as well as repairs 
and improvements to restore, maintain, and improve CDC's assets 
at facilities in seven States and San Juan, Puerto Rico.
    The Committee continues language from fiscal year 2018 to 
allow CDC to retain unobligated funds in the Individual 
Learning Accounts from departed employees to support the 
replacement of the underground and surface coal mine safety and 
health research facility.

                CDC-WIDE ACTIVITIES AND PROGRAM SUPPORT

 
 
 
Appropriation, fiscal year 2018.......................      $273,570,000
Budget request, fiscal year 2019......................       155,000,000
Committee Recommendation..............................       598,570,000
    Change from enacted level.........................      +325,000,000
    Change from budget request........................      +443,570,000
 

    The Committee recommendation includes $438,570,000 in 
discretionary funds and $160,000,000 in transfers from the PPH 
Fund.
    This account supports public health leadership and support 
activities at CDC.
    Within the total, the Committee recommends the following 
amounts:

------------------------------------------------------------------------
                                                            FY 2019
                   Budget Activity                         Committee
------------------------------------------------------------------------
nPreventive Health and Health Services Block Grant...       $160,000,000
Public Health Leadership and Support.................        113,570,000
Infectious Disease Rapid Response Reserve Fund.......        300,000,000
------------------------------------------------------------------------

    Biomonitoring.--The Committee directs CDC to examine how to 
utilize Biomonitoring Equivalents, or similar methods, to 
interpret and communicate human biomonitoring results from the 
National Biomonitoring Program in a health risk assessment 
context, including an estimate of the resources needed, and 
report their findings to the Committee within 90 days of 
enactment of this Act.
    Foundation for the CDC.--The Committee directs the 
Foundation for the Centers for Disease Control and Prevention 
(``Foundation'') to abide by section 399G(h)(7) of the Public 
Health Service Act by including in the Foundation's annual 
report the source and amount of all monetary gifts to the 
Foundation, as well as the source and description of all gifts 
of real or personal property. Each annual report shall disclose 
a specification of any restrictions on the purposes for which 
gifts to the Foundation may be used. The annual report shall 
not list ``anonymous'' as a source for any gift that includes a 
specification of any restrictions on the purpose for which the 
gift may be used.
    Infectious Disease Rapid Response Reserve Fund.--The 
Committee recommendation includes $325,000,000 within this 
account for a new Infectious Diseases Rapid Response Reserve 
Fund. The Reserve Fund, in which funds will be available until 
expended, will provide an immediate source of funding to 
quickly respond to a future, imminent infectious disease crisis 
that endangers American lives without waiting for Congress to 
act on a supplemental funding bill. Bill language establishing 
the Reserve Fund is included in section 228 of the General 
Provisions for this Title.
    Public Health Information.--The Committee notes limited 
information is available which compares controlled substances 
transactions reported to the Drug Enforcement Administration 
(DEA) with available public health information collected by the 
CDC. The Committee encourages CDC to incorporate on its website 
addressing opioid overdose, DEA data from the Automated Reports 
and Consolidated Ordering System Retail Drug Summary Report. 
The Committee further encourages CDC to include an interactive 
map to view current data provided by the DEA displaying the 
amount of grams of fentanyl, hydrocodone, oxycodone and other 
controlled substances that have been shipped to each State. The 
website should also include accessible and frequently updated 
CDC data on overdose death rates and the incidence rates of 
HIV, Hepatitis A, B, and C for each State in an interactive 
manner that allows users to compare on the same page, the 
amounts of drugs distributed with public health morbidities. 
The Committee requests an update on this effort in the fiscal 
year 2020 Congressional Justification.

                     National Institutes of Health


 
 
 
Appropriation, fiscal year 2018.......................   $37,084,000,000
Budget request, fiscal year 2019......................    34,588,391,000
Committee Recommendation..............................    38,334,000,000
    Change from enacted level.........................    +1,250,000,000
    Change from budget request........................    +3,745,609,000
 

    The Committee recommendation for the National Institutes of 
Health (NIH) program level includes $37,661,129,000 in 
discretionary appropriations and $922,871,000 in Public Health 
Service Act section 241 evaluation set-aside transfers. Within 
the total discretionary appropriation, the Committee 
recommendation includes $711,000,000 in budget authority 
authorized in the 21st Century Cures Act (PL 114-255).
    The mission of NIH is to seek fundamental knowledge about 
the nature and behavior of living systems and the application 
of that knowledge to enhance health, lengthen life, and reduce 
illness and disability. NIH conducts and supports research to 
understand the basic biology of human health and disease; 
applies this understanding towards designing new approaches for 
preventing, diagnosing, and treating disease and disability; 
and ensures that these approaches are widely available.
    The recommendation provides the following funding 
increases: $401,000,000 for Alzheimer's disease research; 
$100,000,000 for the Cancer Moonshot Initiative; $147,000,000 
for the ``All of Us'' precision medicine initiative; 
$29,000,000 for the Brain Research through Application of 
Innovative Neurotechnologies (BRAIN) Initiative; $15,000,000 
for combating antibiotic-resistant bacteria; $30,000,000 for 
the development of a universal influenza vaccine; and 
$15,000,000 for Institutional Development Awards. The Committee 
also continues and expands upon the trans-NIH Down syndrome 
research initiative that was established in fiscal year 2018. 
The Committee recommendation also provides an increase for 
every Institute and Center (IC) to support innovative research 
to advance fundamental knowledge and speed the development of 
new therapies and diagnostics to improve the health of all 
Americans.
    The Committee expects the 3.4 percent increase of funds 
over the fiscal year 2018 enacted level to support an increase 
in the number of new and competing Research Project Grants, 
with a focus on early-stage investigators and investigators 
seeking first-time renewals. The Committee expects NIH to 
provide a stipend level increase to training grantees that is 
consistent with any fiscal year 2019 Federal employee pay 
raise. The Committee continues to provide in bill language 
funding levels for Clinical and Translational Science Awards, 
Institutional Development Awards (IDeA), the Cures Acceleration 
Network, the Common Fund, and the Environmental Influences on 
Child Health Outcomes study.
    The Committee recommendation does not include the general 
provision proposed in the fiscal year 2019 budget request to 
limit the percentage of a researcher's salary that may be paid 
for using NIH grant funds, as the impact of this policy change 
is unclear. The Committee requests an analysis of the projected 
impact of such a policy change on the number and average cost 
of NIH grants, as well as on academic institutions, in the 
fiscal year 2020 Congressional Justification.

                    NATIONAL CANCER INSTITUTE (NCI)

 
 
 
Appropriation, fiscal year 2018.......................    $5,964,800,000
Budget request, fiscal year 2019......................     5,626,312,000
Committee Recommendation..............................     6,136,037,000
    Change from enacted level.........................      +471,237,000
    Change from budget request........................      +509,725,000
 

    Mission.--NCI leads, conducts, and supports cancer research 
across the nation to advance scientific knowledge and help all 
people live longer, healthier lives.
    Access to Clinical Trials.--The Committee supports NCI's 
efforts to improve equitable patient access to and 
participation in cancer clinical trials at NCI and NCI-
designated Cancer Centers across the country, including an 
emphasis on patient enrollment, retention, and minority 
participation in those trials. The Committee believes that an 
underappreciated cause of low enrollment into cancer clinical 
trials is the barrier that ancillary cost of participation 
creates, especially for underserved and minority communities. 
This creates an access issue for many patients who could 
participate in clinical trials in order to take advantage of 
the medical advances trials offer as an alternative to hospice. 
The Committee directs NCI to implement a new pilot initiative 
to investigate the impact of providing navigation and direct 
patient expense reimbursement associated with participation in 
cancer clinical trials on cancer clinical trial enrollment, 
retention, patient outcomes, and research outcomes, including 
among underrepresented and minority communities. NCI is 
encouraged to develop the pilot research program in 
consultation with NCI-designated Cancer Centers, the National 
Clinical Trials Network, the NCI Community Research Program, 
and non-profit foundations currently working in this area. The 
Committee requests a description of NCI's plans for this pilot 
program within 90 days of enactment of this Act.
    Cancer Immunotherapy.--The Committee continues to be 
encouraged by new breakthroughs in cancer immunotherapy, which 
are revolutionizing treatments for a growing number of cancers. 
This includes remarkable improvement in outcomes for an 
increasing number of cancer patients. In some cases, however, 
the side effects of such treatments are far different than 
those associated with chemotherapy. Early recognition and 
management of cancer immunotherapy-related side effects can 
result in resolution of these side effects before permanent 
damage is done, and allows for continued cancer treatment. As 
more patients benefit from cancer immunotherapy, recognizing 
and treating possible side effects will take on greater 
urgency. Therefore, the Committee urges NCI to prioritize 
research and education on the underlying mechanisms of cancer 
immunotherapy toxicities.
    Cancer Moonshot.--The Committee recommendation directs NIH 
to transfer $400,000,000 from the NIH Innovation Account to NCI 
to support the Cancer Moonshot initiative. These funds were 
authorized in the 21st Century Cures Act (PL 114-255).
    Children's Oncology Group.--The Committee continues to 
support the important work of the Children's Oncology Group and 
other pediatric research efforts to advance drug development. 
Pediatric cancer patients and their families rely heavily on 
the trials run by the Children's Oncology Group. The vast 
majority of childhood cancer patients are enrolled in trials 
conducted by the Children's Oncology Group and advances in 
treatment are dependent on the cancer research community's 
ability to conduct trials quickly and enroll as many pediatric 
patients as possible.
    Collaboration Between Agencies Regarding Pediatric 
Investigation of Appropriate New Drugs.--The Committee 
recognizes that Title V of the Food and Drug Administration 
Reauthorization Act (FDARA) amended the Pediatric Research 
Equity Act to support the early evaluation of potentially 
effective drugs by requiring pediatric investigation of 
appropriate new drugs intended for adults with cancer. The law 
directs the FDA, in collaboration with the NCI, to establish, 
publish, and regularly update a list of molecular targets 
considered on the basis of data the Agency determines to be 
adequate, to be substantially relevant to the growth or 
progression of pediatric cancers, and that may trigger the 
requirement for pediatric investigations. The Committee 
encourages NCI to collaborate with FDA as well as the patient 
community, providers, and manufacturers, and conduct a 
transparent and inclusive process to implement FDARA in a 
timely manner.
    Deadliest Cancers.--The Committee remains concerned that 
while more effective screening methods and treatments have 
lowered overall cancer incidence and death rates, there are 
still very few early detection and treatment tools for 
``recalcitrant cancers'', defined in statute as those whose 
five-year survival rate is below 50 percent. These cancers 
account for nearly half of all cancer deaths in the US 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 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 in the fiscal year 2020 
Congressional Justification on the Requests for Applications 
NCI issued in fiscal years 2017 and 2018 and funding awarded to 
specifically advance these goals.
    Gynecologic Cancer Clinical Trials.--The Committee supports 
continued investment in Federally-funded clinical trials for 
gynecologic cancers. Gynecologic cancers include ovarian, 
cervical, uterine, vaginal, and vulvar cancer. Given the high 
mortality rates for certain gynecologic cancers, the Committee 
requests NCI provide an update on access to gynecologic cancer 
clinical trials its fiscal year 2020 Congressional 
Justification.
    IDeA States 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 the National Institute of General Medical 
Sciences (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.
    Metastatic Cancer Research.--The Committee recognizes that 
the incidence of and mortality rates for liver cancer have 
risen over the past decade and that comorbid conditions such as 
hepatitis continue to be risk factors for liver cancer. The 
Committee commends the Cancer Moonshot and encourages continued 
support for its implementation.
    Office of Cancer Survivorship.--The Committee recognizes 
that the needs of childhood cancer survivors are unique. By 
2020, there will be at least 500,000 childhood cancer survivors 
in the US. Two-thirds of childhood cancer survivors suffer from 
at least one health problem caused from their treatment. The 
Committee urges NCI to continue to support childhood cancer 
survivorship, including research on survivorship following 
targeted and immune-therapies as well as a standard of care. 
The research should focus on the specific needs for childhood 
cancer survivors such as psycho-social treatments.
    Pancreatic and Other Recalcitrant Cancers.--Pancreatic 
cancer is currently the third leading cause of cancer-related 
death in the US, claiming the lives of over 44,000 Americans 
annually. Despite progress in combating other forms of cancer, 
pancreatic cancer remains the only major cancer with a five-
year survival rate in the single digits, at 9 percent, in large 
part because there are no reliable early detection methods or 
effective treatment options. The Committee urges NCI to 
continue to support research with an emphasis on developing 
improved screening and early detection tools and more effective 
treatments. The Committee specifically requests an update on 
the pancreatic cancer scientific framework in the fiscal year 
2020 Congressional Justification, including a description of 
ongoing and planned future research in this area.
    Pediatric Rare Cancer.--After accidents, cancer is the 
second leading cause of death in children ages one to fourteen. 
In 2018 alone, cancer will affect over 15,000 children and 
adolescents, and most of those diagnoses will be for rare forms 
which lack therapeutic options. While children face dozens of 
cancers, only one pediatric-specific cancer has a targeted 
therapeutic. Moreover, children with cancer can suffer more 
severe side effects from aggressive treatments than adult 
patients. The Committee strongly encourages NIH to expand 
funding for research that may contribute to the development of 
new treatments for pediatric rare cancers. TheCommittee notes 
the ongoing research and development work in this field by 
private industry and encourages NIH to work with the private 
sector to promote a focus on rapidly developing and delivering 
treatments for rare cancers.
    Precision Oncology.--The Committee recognizes the potential 
for significant advancements in cancer treatments from the NCI-
MATCH (Molecular Analysis for Therapy Choice) trial, which 
remains the central pillar of the precision medicine research 
focused on oncology for cancers that are unresponsive to 
standard interventions. The Committee requests that NCI provide 
an update on precision medicine activities in the fiscal year 
2020 Congressional Justification.
    Prostate Cancer.--The Committee is concerned that prostate 
cancer lacks treatments for men with advancing disease as well 
as adequate diagnostic and imaging methodologies common in 
other hormone-driven cancers with similar disease burden. In 
order to ensure Federal resources are leveraged to the greatest 
extent possible, the Committee encourages NCI to coordinate its 
response to these needs with other Federal agencies, including 
the Department of Defense, as well as private research 
foundations and advocacy groups.

           NATIONAL HEART, LUNG, AND BLOOD INSTITUTE (NHLBI)

 
 
 
Appropriation, fiscal year 2018.......................    $3,383,201,000
Budget request, fiscal year 2019......................     3,112,032,000
Committee Recommendation..............................     3,423,604,000
    Change from enacted level.........................       +40,403,000
    Change from budget request........................      +311,572,000
 

    Mission.--NHLBI provides global leadership for a research, 
training, and education program to promote the prevention and 
treatment of heart, lung, and blood disorders and enhance the 
health of all individuals so that they can live longer and more 
fulfilling lives.
    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 us understand the role of environmental versus 
genetic factors in disease development and progression. The 
Committee commends the 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.--The Committee commends NHLBI for 
its continued work to better understand causation and 
appropriate treatments for those with the most life-threatening 
congenital heart defects through its biomedical research 
program Bench to Bassinet and the critical multi-centered 
infrastructure of the Pediatric Heart Network. The Committee 
urges NHLBI to continue its work with other Federal agencies 
and professional and patient organizations to expand 
collaborative activities targeted toward prevention and 
treatment of the diverse lifelong needs of children and adults 
living with congenital heart disease. The Committee requests a 
report on these efforts in the fiscal year 2020 Congressional 
Justification.
    General Cardiac Research.--The Committee encourages NIH to 
pursue highly translational basic and clinical research that 
will have a near-term impact on health care of aging 
populations in States with high numbers of patients with cancer 
suffering from cardiovascular complications of chemotherapy, 
severe peripheral vascular disease, genetic cardiac diseases, 
and clotting disorders associated with aging and cardiac 
arrhythmias. Research should be conducted across the 
disciplines of medicine, immunology, imaging, chemistry, 
biomedical engineering, physics, statistics, mathematics, and 
entrepreneurship to design new drugs and drug delivery systems 
and strategies that are safer, more effective, and improve 
patient compliance, while seeking to move technologies from 
bench to bedside with private partners and local health care 
and community organizations.
    National Chronic Obstructive Pulmonary Disease Action 
Plan.--The Committee notes NHLBI's role in crafting the 
National Chronic Obstructive Pulmonary Disease Action Plan. 
NHLBI is encouraged to continue this important work by 
supporting additional research activities and collaborating 
with other Public Health Service agencies to facilitate 
implementation of the plan's recommendations.
    Pulmonary Hypertension.--The Committee recognizes NHLBI's 
work to advance research into pulmonary hypertension, 
especially with regard to idiopathic pulmonary arterial 
hypertension. The Committee encourages NHLBI to continue 
working with stakeholders to advance these critical research 
priorities.
    Sickle Cell Disease Research.--The Committee encourages 
NHLBI to devote more research to the study of sickle cell 
disease. 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, which is 
currently the only therapy that can cure the disease. However, 
more focused research is needed to augment the limited 
treatment options available.

     NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL RESEARCH (NIDCR)

 
 
 
Appropriation, fiscal year 2018.......................      $447,735,000
Budget request, fiscal year 2019......................       413,196,000
Committee Recommendation..............................       453,082,000
    Change from enacted level.........................        +5,347,000
    Change from budget request........................       +39,886,000
 

    Mission.--The mission of NIDCR is to improve dental, oral, 
and craniofacial health through research, research training, 
and the dissemination of health information.
    Biodevices.--The Committee is pleased that NIDCR is 
exploring how to leverage oral biodevices for overall health, 
including developing tools to detect bone loss. The Committee 
encourages NIDCR to continue focusing on novel products, such 
as imaging technologies and dental restorative materials, which 
can improve individuals' oral and overall health and well-
being.

           NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND 
                        KIDNEY DISEASES (NIDDK)

 
 
 
Appropriation, fiscal year 2018.......................    $2,120,797,000
Budget request, fiscal year 2019......................     1,965,434,000
Committee Recommendation..............................     2,144,333,000
    Change from enacted level.........................       +23,536,000
    Change from budget request........................      +178,899,000
 

    Mission.--The NIDDK mission is to conduct and support 
medical research and research training and disseminate science-
based information on diabetes and other endocrine and metabolic 
diseases; digestive diseases, nutritional disorders, and 
obesity; and kidney, urologic, and hematologic diseases, to 
improve people's health and quality of life.
    End-Stage Renal Disease.--The Committee recognizes NIDDK's 
accomplishments in supporting critical kidney research, 
including research on end-stage renal disease. 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.--The Committee notes that the Hepatitis B 
virus (HBV) research community convened a virtual consensus 
conference that resulted in articles published in 2018 in two 
peer reviewed scientific journals identifying the most urgent 
research questions that must be answered to find a cure for 
HBV. The Committee urges NIDDK to pursue multiple critical 
research opportunities towards improved treatments and a cure 
for HBV and to provide an update in the fiscal year 2020 
Congressional Justification.
    Inflammatory Bowel Disease.--The Committee is pleased by 
NIDDK's support of research into inflammatory bowel diseases 
and notes recent CDC prevalence data, which suggests 
inflammatory bowel disease (IBD) is twice as prevalent as 
originally thought. The Committee encourages NIDDK to respond 
to these findings by providing enhanced support for research on 
IBD. Research should include a focus on the environmental 
triggers and epigenetics of IBD as well as interventions for 
the rising prevalence of IBD, and be targeted at both pediatric 
and adult patients.
    Pediatric Kidney Disease.--The Committee is encouraged by 
the research funded by NIDDK on pediatric kidney disease. 
However, the Committee continues to urge the NIDDK to plan and 
work toward multicenter clinical trials and translational 
studies that will focus on the unique needs of children with 
kidney disease. Pediatric patients and the entire pediatric 
nephrology community have benefited extensively from the 
previous two large pediatric focused clinical studies, RIVUR 
and CKiD. These studies not only addressed important clinical 
questions but also established large biorepositories and 
databases, which can be used by the research community to gain 
important additional knowledge from the study populations. The 
Committee also encourages NIDDK to fund research aimed at 
establishing new prognostic indicators such as genomics and 
personalized medicine, novel diagnostics, and therapeutics that 
may help further understanding in pediatric kidney disease that 
may also lead to breakthroughs and applications in adult kidney 
disease. The Committee requests that NIDDK report back in the 
fiscal year 2020 Congressional Justification on the progress 
made towards additional pediatric focused clinical studies.
    Technology and Ophthalmic Disorders.--The Committee notes 
that the specific use of technology, such as web-based 
telemedicine software, centralized reading centers, hand-held 
fundus cameras, photography training programs, and internet-
based storage and transmission of images can efficiently detect 
early signs of diabetic retinopathy and glaucoma in rural and 
underserved populations.

    NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE (NINDS)

 
 
 
Appropriation, fiscal year 2018.......................    $2,145,149,000
Budget request, fiscal year 2019......................     1,838,556,000
Committee Recommendation..............................     2,228,780,000
    Change from enacted level.........................       +83,631,000
    Change from budget request........................      +390,224,000
 

    Mission.--The NINDS mission is to seek fundamental 
knowledge about the brain and nervous system and use that 
knowledge to reduce the burden of neurological disease.
    BRAIN Initiative.--The Committee recommendation includes 
bill language transferring $57,500,000 from the NIH Innovation 
Account to NINDS to support the BRAIN Initiative. These funds 
were authorized in the 21st Century Cures Act (PL 114-255). The 
Committee recognizes the importance of neuroscience research 
funded by NIH, which is fueling a vital scientific endeavor and 
is the essential foundation for understanding and treating 
diseases that impact over 100 million Americans each year. The 
Committee also commends 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 
the 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 reach accessible. The Committee 
encourages NIH to 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.
    Non-Addictive Pain Treatments.--The Committee is aware that 
many people who suffer from acute pain are exposed to opioids, 
leading to addiction, and many others who suffer from chronic 
pain turn to opioids for relief because they lack alternative 
pain treatments and management. This is a particular challenge 
in Appalachia. The Committee encourages NINDS to prioritize the 
development of non-addictive treatments for pain, recognizing 
that there are regions of the country with high per capita 
rates of opioid deaths.
    Opioids.--The Committee commends NIH for launching the HEAL 
(Helping to End Addiction Long-Term) Initiative, a trans-NIH 
effort to speed scientific solutions to stem the national 
opioid public health crisis. This initiative will build on 
extensive, well-established NIH research, including basic 
science of the complex neurological pathways involved in pain 
and addiction, implement science to develop and test treatment 
models, and research to integrate behavioral interventions with 
medication-assisted treatment for opioid use disorder. The 
Committee continues to support opioid-related research at NINDS 
and expects NINDS to expand this research in fiscal year 2019.
    Stroke Research.--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. The Committee encourages NINDS to prioritize 
and implement robust investment to spur, strengthen, 
accelerate, and coordinate stroke research. This investment 
should focus on expediting novel basic, clinical and 
translational research by all available and appropriate 
mechanisms. The Committee encourages NINDS to intensify 
enactment of top stroke priorities, including prevention, 
endovascular therapy, early stroke recovery, and tele-
rehabilitation.
    Traumatic Brain Injury.--The Committee understands that 
regenerative medicine research, including the use of adult stem 
cells, tissue engineered scaffolds, and means to promote 
neuroplasticity, may play an important role in the treatment of 
traumatic brain injury (TBI) and stroke. The Committee strongly 
encourages NINDS to work with the National Institute on Aging 
and other relevant ICs to ensure a robust and coordinated 
portfolio of research on how to leverage regenerative medicine 
research in the treatment of TBI and stroke. The Committee 
requests an update in the fiscal year 2020 Congressional 
Justification on efforts in these specific areas of research.

     NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES (NIAID)

 
 
 
Appropriation, fiscal year 2018.......................    $5,260,210,000
Budget request, fiscal year 2019......................     4,761,948,000
Committee Recommendation..............................     5,368,029,000
    Change from enacted level.........................      +107,819,000
    Change from budget request........................      +606,081,000
 

    Mission.--The NIAID mission is to conduct and support basic 
and applied research to better understand, treat, and 
ultimately prevent infectious, immunologic, and allergic 
diseases.
    Combating Antibiotic-Resistant Bacteria.--The Committee 
recommendation includes at least $538,000,000 within NIAID for 
research related to combating antibiotic-resistant bacteria. 
Many infectious organisms have adapted to the drugs designed to 
kill them, making the products less effective. Because most 
bacteria, viruses, and other microbes multiply rapidly, they 
can quickly evolve and develop resistance to antimicrobial 
drugs. Overusing or misusing antimicrobial drugs can make 
resistance develop even faster. These funds enable NIAID to 
support research on antimicrobial (drug) resistance, including 
basic research on how microbes develop resistance, new and 
faster diagnostics, and clinical trials designed to find new 
vaccines and treatments effective against drug-resistant 
microbes. The Committee requests an update on these activities 
in the fiscal year 2020 Congressional Justification.
    Hepatitis B.--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 virus (HBV) is possible. In the 
U.S., one in 20 Americans have been infected and more than two 
million are chronically infected with acute infections. 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. The Committee 
requests that NIAID develop and lead an inter-institute working 
group, to include representation from NCI, NIDDK, and the 
National Institute on Minority Health and Health Disparities 
(NIMHD), to coordinate their research agendas and 
infrastructure to find a cure for HBV. The Committee requests a 
report on these efforts within 90 days of enactment of this 
Act. Additionally, the Committee urges NIAID to issue targeted 
calls for HBV research to fund the many critical research 
opportunities identified by the scientific community in the 
Roadmap for a Cure and report to the Committee on 
Appropriations of the House of Representatives and the Senate 
within 90 days of enactment of this Act NIAID's research plan 
to pursue a cure for HBV.
    Microbicides.--The Committee recognizes that with NIH and 
United States Agency for International Development (USAID) 
leadership, research has shown the potential for antiretroviral 
(ARV) drugs to prevent HIV infection in women. The Committee 
encourages NIAID to continue coordination with USAID, the 
Department of State, and others to advance ARV-based 
microbicide development efforts with the goal of enabling 
regulatory approval of the first safe and effective microbicide 
for women and supporting an active ARV-based microbicide 
pipeline to produce additional solutions to prevent HIV and to 
help end the epidemic.
    Tick-Borne Diseases.--The Committee encourages NIAID to 
intensify research on Lyme and other tick-borne diseases, 
including research that will increase understanding of the full 
range of processes that cause Lyme disease infection, including 
any possible mechanisms of persistent infection as well as 
potential treatments for Lyme disease. This should include 
research on the pathophysiology of infection with Borrelia 
burgdorferi and Borrelia mayonii, as well as the development of 
more sensitive and accurate diagnostic tests for Lyme and other 
tick-borne diseases, including next-generation polymerase chain 
reaction and new testing methodologies such as proteomics and 
metabolomics.
    Universal Influenza Vaccine.--The Committee directs NIAID 
to allocate at least $140,000,000 to support basic, 
translational, and clinical research to develop a universal 
influenza vaccine. This funding supports research to develop an 
influenza vaccine that provides robust, long-lasting protection 
against multiple subtypes of flu, rather than a select few. 
Such a vaccine would eliminate the need to update and 
administer the seasonal flu vaccine each year and could provide 
protection against newly emerging flu strains, potentially 
including those that could cause a flu pandemic. The Committee 
requests an update on these efforts within 60 days of enactment 
of this Act.

         NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES (NIGMS)

 
 
 
Appropriation, fiscal year 2018.......................    $2,785,400,000
Budget request, fiscal year 2019......................     2,572,669,000
Committee Recommendation..............................     2,818,667,000
    Change from enacted level.........................       +33,267,000
    Change from budget request........................      +245,998,000
 

    Mission.--NIGMS supports basic research that increases our 
understanding of biological processes and lays the foundation 
for advances in disease diagnosis, treatment, and prevention.
    Institutional Development Awards.--The Committee provides 
$365,575,000 for the Institutional Development Awards (IDeA) 
program. IDeA supports high-quality research and investigators 
throughout the country in States in which the success rate for 
NIH grants has been historically low.
    Native American Research Centers for Health.--The Committee 
commends NIGMS for supporting the Native American Research 
Centers for Health program, which provides opportunities for 
Tribes and Tribal organizations to build the capacity to 
support research, research training, and faculty development to 
address health disparities in American Indian/Alaska Native 
communities.

  EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN 
                          DEVELOPMENT (NICHD)

 
 
 
Appropriation, fiscal year 2018.......................    $1,452,006,000
Budget request, fiscal year 2019......................     1,339,592,000
Committee Recommendation..............................     1,469,346,000
    Change from enacted level.........................       +17,340,000
    Change from budget request........................      +129,754,000
 

    Mission.--NICHD investigates human development throughout 
the entire life process, with a focus on understanding 
disabilities and important events that occur during pregnancy.
    Endometriosis.--The Committee is aware that endometriosis 
is a serious chronic condition that impacts one in ten women in 
the US between the ages of 10 and 49. Women with this condition 
can suffer up to ten years before being properly diagnosed, 
often due to lack of awareness and limited treatment options 
available. The Committee encourages NICHD to develop a report 
on the current state of endometriosis. Further, the Committee 
encourages NICHD, through research and in collaboration with 
CDC, to continue to support education, outreach, and awareness 
to promote early and accurate diagnosis of endometriosis.
    Long-Term and Developmental Health Effects of Zika.--The 
Committee recognizes the unique nature of NICHD research into 
how the Zika virus infection affects pregnancy and the long-
term and developmental health effects on children exposed to 
the Zika virus. The Committee urges NICHD to prioritize 
investment in long-term and developmental health effects of the 
Zika virus as the fight against the virus continues.
    Neonatal Abstinence Syndrome.--The Committee recognizes the 
importance of developing evidenced-based treatment protocols 
for babies with neonatal abstinence syndrome (NAS). The 
Committee requests that the NICHD provide a report to the 
Committee on existing research regarding evidence based-
treatment protocols for both full-term and premature babies 
with NAS and recommendations for future research within 90 days 
of enactment of this Act.
    Pre-Term Birth.--Preterm birth affects approximately 
380,000 babies each year in the U.S. and is the leading cause 
of infant mortality. The Committee applauds NICHD's research 
portfolio spanning the range of discovery, development, and 
delivery of science in order to identify the causes of 
premature birth and infant mortality. The Committee encourages 
NICHD to continue to provide robust support to extramural 
preterm birth prevention research, the Maternal-Fetal Medicine 
Units Network, the Neonatal Research Network, and the 
intramural research program related to prematurity.
    Rehabilitation Research.--The Committee recognizes the 
significant challenges faced by patients with neurological 
impairments who live in rural areas, where access to assistive 
devices, medical advice, and community resources can be 
limited. Proper rehabilitation, with the help of patient 
``navigators'', is critical to improving patients' quality of 
life and preventing further, and more costly, health problems. 
The Committee encourages the National Center for Medical 
Rehabilitation Research to provide greater support for research 
efforts on assistive health technology, particularly in 
underserved rural settings.
    Task Force on Research in Pregnant Women and Lactating 
Women.--The Committee looks forward to the Task Force's report 
to the Secretary and Congress in September 2018, and continues 
to encourage and support the important work of the Task Force 
to ensure that pregnant and lactating women are included in 
research, and that consumers and health care professionals have 
up-to-date and accurate information on the safety and efficacy 
of drugs that women are taking while pregnant or breastfeeding.

                      NATIONAL EYE INSTITUTE (NEI)

 
 
 
Appropriation, fiscal year 2018.......................      $772,317,000
Budget request, fiscal year 2019......................       711,015,000
Committee Recommendation..............................       781,540,000
    Change from enacted level.........................        +9,223,000
    Change from budget request........................       +70,525,000
 

    Mission.--NEI conducts and supports basic and clinical 
research, research training, and other programs with respect to 
blinding eye diseases, visual disorders, and mechanisms of 
visual function, preservation of sight, and the special health 
problems and needs of individuals who are visually-impaired or 
blind.
    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.
    Neuromyelitis Optica Spectrum Disorder.--The Committee 
directs NEI to provide an update in the fiscal year 2020 
Congressional Justification on research related to 
Neuromyelitis Optica Spectrum Disorder (NMO/SD), a rare 
autoimmune disease that causes blindness and/or paralysis. The 
Committee strongly encourages NEI to work with other ICs, 
including NINDS and NIAID, to support basic research into the 
causes and treatment of NMO/SD.

      NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES (NIEHS)

 
 
 
Appropriation, fiscal year 2018.......................      $751,143,000
Budget request, fiscal year 2019......................       693,199,000
Committee Recommendation..............................       760,113,000
    Change from enacted level.........................        +8,970,000
    Change from budget request........................       +66,914,000
 

    Mission.--NIEHS' mission is to discover how the environment 
affects people in order to promote healthier lives.

                   NATIONAL INSTITUTE ON AGING (NIA)

 
 
 
Appropriation, fiscal year 2018.......................    $2,574,091,000
Budget request, fiscal year 2019......................     1,988,200,000
Committee Recommendation..............................     3,005,831,000
    Change from enacted level.........................      +431,740,000
    Change from budget request........................    +1,017,631,000
 

    Mission.--NIA's mission is to understand the nature of 
aging and the aging process, and diseases and conditions 
associated with growing older, in order to extend the healthy, 
active years of life.
    Alzheimer's Disease.--In recognition that Alzheimer's 
disease poses a serious threat to the nation's long-term health 
and economic stability, the Committee recommends a total of at 
least $2,250,000,000 for Alzheimer's disease research. NIA 
should continue to address the research goals set forth in the 
National Plan to Address Alzheimer's disease, as well as the 
recommendations from the Alzheimer's disease Research Summit in 
2015.
    Alzheimer's Disease Disparities.--The Committee commends 
the 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 
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. The Committee encourages NIA to diversify its 
cohort studies, with the specific goal of better understanding 
disease burden and biomarkers by race and geographic region. 
Additionally, the Committee is concerned about the racial and 
ethnic disparities that exist in Alzheimer's disease diagnoses 
and encourages NIA to support research exploring the 
disproportionate impact Alzheimer's disease has on people of 
color, particularly African Americans who are two times more 
likely to develop late-onset Alzheimer's disease than whites.
    Azheimer's Disease Research Data.--The Committee is aware 
the advances in information technology make possible the 
ability to share research results broadly within the scientific 
community that seeks to develop a treatment for Alzheimer's. 
Therefore, the Committee encourages NIA to develop a strategy 
to share Alzheimer's research data across the research 
community as effectively and expeditiously as possible.
    Azheimer's Disease Vaccine.-- The Committee recognizes 
recent evidence suggests that the next generation of active or 
passive vaccines are one of the most promising therapies for 
efficacious treatment of Alzheimer's. The Committee encourages 
NIH to pursue these technologies to accelerate the development 
and testing of promising vaccine candidates.
    Caregiver Dementia Initiative.--At any given time, more 
than 15 million Americans are providing informal care to an 
older relative with dementia. However, dementia caregivers 
experience considerable stress and depression and impaired 
subjective well-being, self-efficacy, and physical health. The 
Committee encourages 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 
former caregivers. 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 persons with dementia themselves, and removes a 
substantial burden from the US healthcare system.
    Healthy Brain Aging.--In the context of NIA's robust 
Alzheimer's Disease research portfolio, the Committee 
recognizes the need to understand healthy brain aging and risk 
factors for Alzheimer's Disease. The Committee encourages NIA 
to continue to address the research goals and recommendations 
related to healthy brain aging and cognitive resilience 
identified during the NIH's 2015 Alzheimer's Policy Summit.

        NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND 
                         SKIN DISEASES (NIAMS)

 
 
 
Appropriation, fiscal year 2018.......................      $586,661,000
Budget request, fiscal year 2019......................       545,494,000
Committee Recommendation..............................       593,663,000
    Change from enacted level.........................        +7,002,000
    Change from budget request........................       +48,169,000
 

    Mission.--NIAMS' mission is to support research into the 
causes, treatment, and prevention of arthritis and 
musculoskeletal and skin diseases; the training of basic and 
clinical scientists to carry out this research; and the 
dissemination of information on research progress in these 
diseases.
    Alopecia Areata.--The Committee applauds NIAMS for its 
leadership in autoimmune research breakthroughs that have 
advanced treatment development for alopecia areata. The 
Committee requests an update from NIAMS on new alopecia areata 
research advances in the fiscal year 2020 Congressional 
Justification.
    Lupus.--The Committee recognizes NIAMS for implementing the 
Action Plan for Lupus Research and for leading the Lupus 
Federal Working Group. The Committee is concerned about the 
substantial racial disparities in the incidence and prevalence 
of lupus and notes that African American women experience the 
highest lupus rate. Therefore, the Committee encourages NIAMS 
to continue to support lupus research, including studies to 
understand why the disease disproportionately affects women of 
color.
    Mucopolysaccharide Diseases.--Mucopolysaccharide (MPS) 
diseases are inherited, with death occurring for many in early 
childhood. This systemic disease causes progressive damage to 
the bones, heart, respiratory system, and brain, causing 
permanent disability and early death. The Committee continues 
to urge NIH to put a high priority on better understanding and 
treating MPS 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 NCATS, NINDS, and NIDDK for again funding the 
Lysosomal Disease Network through the Rare Disease Clinical 
Network and for funding lysosomal research meetings. The 
Committee encourages NIH to expand support to incentivize MPS 
research. Understanding the manifestations and treatments of 
both the skeletal and neurological disease continues to be an 
area of great unmet need.
    Scleroderma.--The Committee recognizes the work that NIAMS 
is doing to support research of fibrotic disease and continues 
to encourage prioritizing research including scleroderma. The 
Committee also encourages NIAMS to work with other ICs on 
collaborative opportunities where feasible to advance critical 
research.

   NATIONAL INSTITUTE ON DEAFNESS AND OTHER COMMUNICATION DISORDERS 
                                (NIDCD)

 
 
 
Appropriation, fiscal year 2018.......................      $459,974,000
Budget request, fiscal year 2019......................       423,992,000
Committee Recommendation..............................       465,467,000
    Change from enacted level.........................        +5,493,000
    Change from budget request........................       +41,475,000
 

    Mission.--NIDCD conducts and supports biomedical and 
behavioral research and research training in the normal and 
disordered processes of hearing, balance, taste, smell, voice, 
speech, and language. NIDCD also conducts and supports research 
and research training related to disease prevention and health 
promotion; addresses special biomedical and behavioral problems 
associated with people who have communication impairments or 
disorders; and supports efforts to create devices which 
substitute for lost and impaired sensory and communication 
function.
    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 (NINR)

 
 
 
Appropriation, fiscal year 2018.......................      $158,033,000
Budget request, fiscal year 2019......................       145,842,000
Committee Recommendation..............................       159,920,000
    Change from enacted level.........................        +1,887,000
    Change from budget request........................       +14,078,000
 

    Mission.--The mission of NINR is to promote and improve the 
health of individuals, families, and communities. To achieve 
this mission, NINR supports and conducts clinical and basic 
research and research training on health and illness, research 
that spans and integrates the behavioral and biological 
sciences, and develops the scientific basis for clinical 
practice.

       NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM (NIAAA)

 
 
 
Appropriation, fiscal year 2018.......................      $509,573,000
Budget request, fiscal year 2019......................       469,109,000
Committee Recommendation..............................       515,658,000
    Change from enacted level.........................        +6,085,000
    Change from budget request........................       +46,549,000
 

    Mission.--NIAAA's mission is to generate and disseminate 
fundamental knowledge about the effects of alcohol on health 
and well-being, and apply that knowledge to improve diagnosis, 
prevention, and treatment of alcohol-related problems, 
including alcohol use disorder, across the lifespan.

                NATIONAL INSTITUTE ON DRUG ABUSE (NIDA)

 
 
 
Appropriation, fiscal year 2018.......................    $1,383,603,000
Budget request, fiscal year 2019......................     1,137,403,000
Committee Recommendation..............................     1,400,126,000
    Change from enacted level.........................       +16,523,000
    Change from budget request........................      +262,723,000
 

    Mission.--NIDA's mission is to advance science on the 
causes and consequences of drug use and addiction and to apply 
that knowledge to improve individual and public health.
    Neonatal Abstinence Syndrome.--The Committee recognizes the 
importance of research and prevention, identification, and 
treatment of prenatal opioid exposure and neonatal abstinence 
syndrome. The Committee encourages NIDA to ensure the review 
process includes appropriate focus on geographic locations 
where the problem is particularly acute or two or fewer 
treatment programs are available. The Committee encourages NIH, 
based on appropriate scientific review, to support meritorious 
research opportunities for institutions offering clinical 
services to women, particularly women from rural areas, who are 
at risk for opioid dependence and opioid exposure during 
pregnancy and for infants born with neonatal abstinence 
syndrome.
    Opioids.--The Committee commends NIH for launching the HEAL 
(Helping to End Addiction Long-Term) Initiative, a trans-NIH 
effort to speed scientific solutions to stem the national 
opioid public health crisis. This Initiative will build on 
extensive, well-established NIH research, including basic 
science of the complex neurological pathways involved in pain 
and addiction, implementation science to develop and test 
treatment models, and research to integrate behavioral 
interventions with medication-assisted treatment for opioid use 
disorder. The Committee continues to support opioid-related 
research at NIDA and expects NIDA to expand this research in 
fiscal year 2019.
    The Committee continues to be extremely concerned about the 
epidemic of prescription opioids, heroin, and synthetic opioid 
use, addiction, and overdose in the US. Approximately 144 
people die each day in this country from opioid overdose, 
making it one of the most common causes of non-disease-related 
deaths for adolescents and young adults. This crisis has been 
exacerbated by the availability of fentanyl and its analogs in 
many communities. The Committee appreciates the important role 
that research can and should play in the various Federal 
initiatives aimed at this crisis. The Committee urges NIDA to 
continue funding research on medication development to 
alleviate pain, especially the development of medications with 
reduced abuse liability, and to report on what we know 
regarding the transition from opioid analgesics to heroin and 
synthetic opioid abuse and addiction within affected 
populations.
    Raising Awareness and Engaging the Medical Community in 
Drug Abuse and Addiction Prevention and Treatment.--The 
Committee notes that 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 (e.g., internal medicine, family practice, and 
pediatrics). The Committee encourages NIDA to continue its 
efforts in this space, providing physicians and other medical 
professionals with the tools and skills needed to incorporate 
drug abuse screening and treatment into their clinical 
practices. The Committee encourages NIDA and CDC to develop 
strategies for increasing participation in its online 
continuing medical education course on safe prescribing for 
pain and managing patients who abuse prescription opioids. The 
Committee also encourages NIDA and CDC to develop strategies 
for increasing participation in its online continuing medical 
education courses on safe prescribing for pain and managing 
patients who abuse prescription opioids.

               NATIONAL INSTITUTE OF MENTAL HEALTH (NIMH)

 
 
 
Appropriation, fiscal year 2018.......................    $1,711,775,000
Budget request, fiscal year 2019......................     1,612,192,000
Committee Recommendation..............................     1,790,231,000
    Change from enacted level.........................       +78,456,000
    Change from budget request........................      +178,039,000
 

    Mission.--NIMH's mission is to transform the understanding 
and treatment of mental illnesses through basic and clinical 
research, paving the way for prevention, recovery, and cure.
    BRAIN Initiative.--The Committee recommendation includes 
bill language transferring $57,500,000 from the NIH Innovation 
Account to NIMH to support the BRAINInitiative. These funds are 
authorized by the 21st Century Cures Act (PL 114-255). The 
Committee recognizes the importance of NIH funded neuroscience 
research, which is fueling a vital scientific endeavor and is 
the essential foundation for understanding and treating 
diseases that impact over 100 million Americans each year. The 
Committee also commends the NIH for its successful 
implementation of the BRAIN Initiative, and for its five 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 reach 
accessible. The Committee encourages NIH to continue to build 
off its five years of success as a leader and partner on the 
BRAIN Initiative bringing together various disciplines and 
funding meritorious research to advance knowledge of the brain.
    Eating Disorder Research.--Eating disorders are a serious 
mental illness that affect 30 million Americans during their 
lifetime and has the highest mortality rate of any psychiatric 
illness. The Committee encourages NIH to continue to support 
eating disorders research, with a focus on applied research in 
prevention, early identification, and innovative treatment.

            NATIONAL HUMAN GENOME RESEARCH INSTITUTE (NHGRI)

 
 
 
Appropriation, fiscal year 2018.......................      $556,881,000
Budget request, fiscal year 2019......................       512,979,000
Committee Recommendation..............................       563,531,000
    Change from enacted level.........................        +6,650,000
    Change from budget request........................       +50,552,000
 

    Mission.--NHGRI's mission is to accelerate scientific and 
medical breakthroughs that improve human health by driving 
cutting-edge research, developing new technologies, and 
studying the impact of genomics on society.

  NATIONAL INSTITUTE OF BIOMEDICAL IMAGING AND BIOENGINEERING (NIBIB)

 
 
 
Appropriation, fiscal year 2018.......................      $377,871,000
Budget request, fiscal year 2019......................       346,550,000
Committee Recommendation..............................       382,384,000
    Change from enacted level.........................        +4,513,000
    Change from budget request........................       +35,834,000
 

    Mission.--The NIBIB mission is to improve health by leading 
the development and accelerating the application of biomedical 
technologies.

  NATIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH DISPARITIES (NIMHD)

 
 
 
Appropriation, fiscal year 2018.......................      $303,200,000
Budget request, fiscal year 2019......................       280,545,000
Committee Recommendation..............................       306,821,000
    Change from enacted level.........................        +3,621,000
    Change from budget request........................       +26,276,000
 

    Mission.--NIMHD's mission is to lead scientific research to 
improve minority health and reduce health disparities.
    Focal Segmental Glomerulosclerosis Research.--The Committee 
recognizes the work that NIMHD and NIDDK are doing to address 
the connection between the APOL1 gene and the onset of Focal 
Segmental Glomerulosclerosis (FSGS). The Committee encourages 
NIMHD to work with community stakeholders caring for the 
affected population to identify areas of collaboration.
    Hepatitis B.--The Committee notes that half of all HBV 
patients in the US are immigrant Asian-Americans or Pacific 
Islanders, though these groups only accounts for about six 
percent of the population. Further, among African immigrants, 
the prevalence of chronic HBV is about 10 percent. The 
Committee urges NIMHD to fund research to test scale-up model 
programs that increase HBV awareness, knowledge, testing and 
linkage to care for treatment among the disproportionately HBV-
impacted communities.

    NATIONAL CENTER FOR COMPLEMENTARY AND INTEGRATIVE HEALTH (NCCIH)

 
 
 
Appropriation, fiscal year 2018.......................      $142,184,000
Budget request, fiscal year 2019......................       130,717,000
Committee Recommendation..............................       143,882,000
    Change from enacted level.........................        +1,698,000
    Change from budget request........................       +13,165,000
 

    Mission.--The mission of NCCIH is to define, through 
rigorous scientific investigation, the usefulness and safety of 
complementary and integrative health interventions and their 
roles in improving health and health care.

      NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCES (NCATS)

 
 
 
Appropriation, fiscal year 2018.......................      $742,354,000
Budget request, fiscal year 2019......................       685,087,000
Committee Recommendation..............................       751,219,000
    Change from enacted level.........................        +8,865,000
    Change from budget request........................       +66,132,000
 

    Mission.--NCATS was established to transform the 
translational process so that new treatments and cures for 
disease can be delivered to patients faster.
    Clinical and Translational Science Awards.--The Committee 
expects NIH to fund Clinical and Translational Science Awards 
(CTSAs) at not less than the level provided in fiscal year 
2018.
    Rural Health Outcomes and Health Disparities.--The 
Committee notes translational science and education is critical 
to developing new treatments and healthcare approaches that can 
be disseminated to underserved and special populations to 
improve health outcomes across the life span. The Committee 
continues and encourages NCATS, through its CTSA program, to 
enhance its commitment to the value of translational science 
and funding for universities to continue to innovate by 
leveraging statewide resources and capabilities to improve 
rural health outcomes and eliminate health disparities. The 
Committee requests an update on the actions within the CTSA 
program to improve rural health outcomes and health disparities 
in the fiscal year 2020 Congressional Justification.

               JOHN E. FOGARTY INTERNATIONAL CENTER (FIC)

 
 
 
Appropriation, fiscal year 2018.......................       $75,733,000
Budget request, fiscal year 2019......................        70,084,000
Committee Recommendation..............................        76,637,000
    Change from enacted level.........................          +904,000
    Change from budget request........................        +6,553,000
 

    Mission.--FIC's mission is to support and facilitate global 
health research conducted by US and international 
investigators, building partnerships between health research 
institutions in the US and abroad, and training the next 
generation of scientists to address global health needs.

                   NATIONAL LIBRARY OF MEDICINE (NLM)

 
 
 
Appropriation, fiscal year 2018.......................      $428,553,000
Budget request, fiscal year 2019......................       395,493,000
Committee Recommendation..............................       433,671,000
    Change from enacted level.........................        +5,118,000
    Change from budget request........................       +38,178,000
 

    Mission.--The NLM collects and organizes information 
important to biomedicine; serves as a national information 
resource for medical education, research, and health service 
activities; enhances access to biomedical literature through 
electronic services; serves the public by providing electronic 
access to reliable health information for consumers; supports 
and directs the national network of libraries of medicine; 
provides grants for research in biomedical communications, 
medical library development, and training health information 
specialists; conducts and supports research in biomedical 
informatics and computational biology; and creates information 
resources for genomics, molecular biology, toxicology, medical 
images, environmental health, emergency preparedness and 
response, and health services research.

                      OFFICE OF THE DIRECTOR (OD)

 
 
 
Appropriation, fiscal year 2018.......................    $1,803,293,000
Budget request, fiscal year 2019......................     1,795,706,000
Committee Recommendation..............................     1,902,828,000
    Change from enacted level.........................       +99,535,000
    Change from budget request........................      +107,122,000
 

    Mission.--The OD provides leadership to the NIH research 
enterprise and coordinates and directs initiatives that 
crosscut NIH. OD is responsible for the development and 
management of intramural and extramural research and research 
training policy, the review of program quality and 
effectiveness, the coordination of selected NIH-wide program 
activities, and the administration of centralized support 
activities essential to the operations of NIH.
    Common Fund.--The Committee recommends $601,613,000 for the 
Common Fund (CF), and an additional $12,600,000 provided to 
support the Gabriella Miller Kids First Research Act for the 
fifth year of the ten-year Pediatric Research Initiative. NIH 
is expected to continue the longstanding CF policy for projects 
to be short-term, high-impact awards, with no projects 
receiving funding for more than ten years.
    Environmental Influences on Child Health Outcomes.--The 
Committee continues to recognize the importance of 
investigating the effects of environmental exposures on child 
health and development. The Environmental Influences on Child 
Health Outcomes (ECHO) Project has the potential to greatly 
increase understanding of these critical determinants of health 
across the lifespan, through its observational cohorts and the 
IDeA States Pediatric Clinical Trials Network. The Committee 
encourages continued communication about the program's progress 
toward goals, milestones, and projected funding estimates with 
both external stakeholders and Congress. Within 180 days of 
enactment of this Act, the Committee directs NIH to submit and 
make public a summary of progress made to date, including an 
analysis of the composition of the funded cohort studies, the 
capacity of the Network to conduct trials among rural and 
underserved children, and the short- and long-term goals of the 
program.
    Undiagnosed Diseases Network.-- The Committee continues to 
support the Undiagnosed Diseases Network (UDN) and urges UDN to 
continue efforts to enhance access to patients, caregivers, and 
other stakeholders as well as make information obtained through 
the UDN available to Federal agencies.

Multi-Institute Research Issues

    Adult Stem Cell Technology.--The Committee continues to 
recognize adult stem cell technology (including induced 
pluripotent stem cells, mesenchymal stem cells, and other types 
of adult stem cells) as a critical tool in the realm of 
personalized medicine. The Committee notes that adult stem 
cells provide promising opportunities to develop sources of 
cells with great therapeutic value and potential for curing 
human diseases. The Committee also recognizes that basic 
science leads to pre-clinical studies and clinical trials, 
which may in turn generate new diagnostics, treatments and 
cures. The Committee encourages NIH to further explore 
additional basic science opportunities. The Committee requests 
an update in the fiscal year 2020 Congressional Justification 
on NIH efforts to foster basic research on adult stem cell 
technology, including through collaborative consortiums and 
other approaches to leveraging existing research capabilities 
to further advance scientific knowledge.
    Amyloidosis.--The Committee encourages NIH to continue to 
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 requests that NIH provide an update 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 in the fiscal 
year 2020 Congressional Justification.
    Angelman Syndrome.--The Committee recognizes the promising 
scientific gains made in the pursuit of treatments for Angelman 
Syndrome. The Committee applauds the significant contributions 
of the Angelman Syndrome Natural History Study, funded by NIH, 
and the private partners working diligently to advance the 
growing body of Angelman Syndrome research towards practical 
treatments. Further research in this area holds great promise 
for both Angelman Syndrome and forms of autism also linked to 
misexpression of the UBE3A gene. With two innovative new 
treatments poised for clinical trials, the Committee urges NIH 
to support Angelman Syndrome research, and specifically to 
advance research in the roles of the UBE3A gene in brain 
functions.
    Chronic Fatigue Syndrome.--The Committee is pleased that 
NIH has begun to expedite research into Chronic Fatigue 
Syndrome. 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 encourages NIH to 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, and (4) develop 
mechanisms to incentivize researchers to enter the field.
    Cystic Fibrosis.--The Committee applauds the work of NIH to 
support research aimed at correcting the genetic defect that 
causes cystic fibrosis (CF), including recent Requests for 
Applications that will advance the fields of gene editing, lung 
stem cell biology, and nucleic acid delivery. Cystic fibrosis 
is a rare, life-threatening genetic disease that impacts the 
lungs and digestive system. There are more than 1,700 mutations 
that cause CF, some of which may only be effectively overcome 
through genetic repair approaches. The Committee also 
encourages the continuation of collaborative initiatives to 
overcome current barriers to implementing genetic repair 
approaches for treating human diseases. One such project, a 
joint workshop between the NHLBI and the Cystic Fibrosis 
Foundation, focused on identifying barriers and proposing 
solutions to deliver gene editing technologies to the lungs of 
people with CF as a means to cure the disease.
    Duchenne Muscular Dystrophy.--Duchenne muscular dystrophy 
is a severe type of muscular dystrophy for which there is no 
cure and for which the average life expectancy is 26 years. The 
Committee strongly encourages NIH to significantly expand its 
support for research on Duchenne muscular dystrophy.
    Epidermolysis Bullosa.--The Committee encourages NIH to 
continue to support research and coordination of activities 
with respect to epidermolysis bullosa and related connective 
tissue disorders.
    Fibrosis.--The Committee recognizes NIH for their work on 
addressing the need for coordination across ICs on fibrotic 
research. The Committee encourages NIH to continue working 
across ICs and with stakeholders to advance critical 
priorities.
    Food Allergies.--Food allergies affect 15 million 
Americans, can be life threatening, and have no cure. 
Currently, the Consortium of Food Allergy Research network 
includes seven clinical sites/centers. In addition, 
approximately 10 other NIH-supported centers are conducting 
basic, translational, and clinical research on food allergies. 
The Committee encourages NIH to expand its clinical research 
network to add new centers of excellence in food allergy 
clinical care and to select such centers from those with a 
proven expertise in food allergy research.
    Food is Medicine.--The Committee recognizes the important 
role of nutrition in health outcomes and encourages OD to work 
with relevant ICs, including NIDDK, NHLBI, NIA, and NICHD, to 
report on the research that has been conducted on Food is 
Medicine-related topics. This may include, but is not limited 
to, medically-tailored meals, medical nutrition therapy, 
produce prescription programs, the role of proper nutrition in 
aging, and the role of proper nutrition in reproductive health. 
The Committee further encourages additional collaboration among 
the ICs on these topics.
    Foundation for the NIH.--The Committee directs the 
Foundation for the National Institutes of Health 
(``Foundation'') to abide by section 499(j)(4) of the Public 
Health Service Act by including in the Foundation's annual 
report the source and amount of all monetary gifts to the 
Foundation, as well as the source and description of all gifts 
of real or personal property. Each annual report shall disclose 
a specification of any restrictions on the purposes for which 
gifts to the Foundation may be used. The annual report shall 
not list ``anonymous'' as a source for any gift that includes a 
specification of any restrictions on the purpose for which the 
gift may be used.
    Fragile X.--The Committee commends NIH for supporting 
research to understand the nature of fragile X (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 his counterparts at each IC 
with an FX and autism portfolio 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.
    Headache Disorders.--The Committee encourages NIH to 
prioritize fundamental, translational, and clinical research on 
headache disorders. In 2016, 36 million Americans experienced a 
migraine attack, 12 million suffered from chronic daily 
headaches, and millions further were affected by cluster 
headaches, post-traumatic headaches, or other disabling 
headache disorders.
    Heavy Ion Cancer Therapy and Research.--The Committee 
supports NIH's continued exploration of advanced therapeutic 
cancer research, specifically heavy ion irradiation technology. 
This technology will introduce a novel treatment option to 
cancer patients that is currently not available in the US. The 
Committee supports NIH's work with the heavy ion planning grant 
recipients to further advance access to novel heavy ion 
treatment within the US. The Committee encourages NIH to 
explore further the establishment of a state-of-the-art heavy 
ion research facility in the US. Furthermore, the Committee 
encourages NIH to work with the Departments of Defense and 
Energy, and other applicable Federal agencies to equip the 
first US heavy ion research center. The Committee urges NIH to 
capitalize on the expertise and potential of the heavy ion 
facility planning grant recipients in order to foster a 
multidisciplinary approach and advance heavy ion research that 
would produce novel, cutting edge treatments for cancer 
patients.
    Lymphangioleiomyomatosis.--The Committee requests an update 
on Lymphangioleiomyomatosis research in the fiscal year 2020 
Congressional Justification.
    Mitochondrial Disease Research.--The Committee understands 
that no fewer than 17 ICs are involved in research efforts 
related to mitochondrial disease and dysfunction. The Committee 
appreciates the 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. The Committee encourages NIH 
to continue its efforts to ensure that individuals with 
mitochondrial disease participate in both the All of Us 
research program and the ECHO study. The Committee understands 
that the 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 Congressional 
Justification 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 practice 
and to reengage its trans-NIH research through the ODS on these 
issues. The Committee further encourages the Director to 
competitively fund mitochondrial disease centers of excellence 
that combine a critical mass of clinical care and research on 
mitochondrial disease.
    Neurofibromatosis.--The Committee supports efforts to 
increase funding and resources for Neurofibromatosis (NF) 
research and treatment at multiple NIH ICs, 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 five 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.
    Office of AIDS Research.-- The Committee encourages the 
Offie to strategically focus resources allocated to AIDS 
research towards the highest quality peer reviewed projects 
aimed at finding a cure, creating a vaccine, and developing 
better treatments for the disease.
    Pediatric Precision Medicine.--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 30 days of enactment of this Act on: (1) the 
timing for the Special Populations Committee to provide 
recommendations regarding the practical considerations of child 
enrollment and data collection involving children, (2) plans to 
ensure that the research cohort includes a sufficient number of 
children to make meaningful studies possible, (3) the target 
date for enrollment to commence, and (4) how enrollment 
strategies will include input from pediatric stakeholders 
across the country with experience in pediatric clinical trial 
enrollment.
    Polycystic Ovary Syndrome.--The Committee recognizes the 
significant health burden of Polycystic Ovary Syndrome (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. The Committee requests that NICHD, in 
consultation with the relevant NIH ICs, including NIDDK, NHLBI, 
NCI, the Office of Research on Women's Health, NIMH, and NICHD, 
report on the research that has been conducted on PCOS and its 
comorbidities to date in the fiscal year 2020 Congressional 
Justification. The Committee further urges these ICs to support 
investigator-initiated studies and early-stage investigator 
awards, and mechanisms to incentivize researchers to enter the 
field.
    Transformative High-Resolution Cryo-Electron Microscopy.--
The Committee commends NIH on its 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. The 
Committee urges the NIH to expand the number of national 
service centers and training opportunities to further refine 
and advance Cryo-EM research. The Committee directs NIH to 
provide an update of these efforts in the fiscal year 2020 
Congressional Justification.
    Trisomy 21.--The Committee applauds the NIH for 
significantly increasing its investment in Down syndrome 
research and for the NIH Director's leadership in advancing the 
trans-NIH initiative the Committee included in the fiscal year 
2018 appropriation. The Committee directs NIH to continue to 
make new investments in Down syndrom research that prioritize 
funding for both new research grants that will significantly 
expand the current pipeline of Down syndrom research, as well 
as the implementation of the new trans-NIH intiative. In 
addition, the Committee encourages NIH to prioritize funding 
for research to improve the health and neurodevelopment of 
individuals with Down syndrome and typical individuals at risk 
for immune system dyregulation, Alzheimer's disease, cancer, 
cardiovascular disease, and autism.
    Valley Fever.--The Committee understands that based on the 
recommendation of the independent Data and Safety Monitoring 
Board (DSMB) for the Valley Fever Randomized Controlled Trial 
(RCT), NIAID has halted enrollment in the RCT due to lack of 
patient enrollment, primarily those with Valley Fever. In light 
of this, the DSMB recommended revising the study protocol. 
Accordingly, the Committee directs NIAID to expeditiously 
revise the study design to address the critical need for 
effective treatment of Valley Fever in order to restart 
enrolling patients before the end of 2018, including increasing 
the number of participating healthcare provider enrollment 
sites. Furthermore, the Committee directs NIAID to work with 
stakeholders to develop and implement a plan to maximize the 
number of health care provider patient enrollment sites and 
raise awareness of this study with the broader public with the 
goal of increasing patient enrollment. The Committee requests 
regular updates on the Valley Fever RCT revisions on quarterly 
basis until patient enrollment is restarted, as well as a 
report on maximizing health care provider enrollment sites and 
public awareness plans to increase patient enrollment in the 
revised RCT within 90 days of enactment of this Act.

                        BUILDINGS AND FACILITIES

 
 
 
Appropriation, fiscal year 2018.......................      $128,863,000
Budget request, fiscal year 2019......................       200,000,000
Committee Recommendation..............................       200,000,000
    Change from enacted level.........................       +71,137,000
    Change from budget request........................             - - -
 

    Mission.--This account provides for the design, 
construction, improvement, and major repair of clinical, 
laboratory, and office buildings and supporting facilities 
essential to the mission of the NIH. The funds in this 
appropriation support the buildings on the main NIH campus in 
Bethesda, Maryland; the Animal Center in Poolesville, Maryland; 
the NIEHS facility in Research Triangle Park, North Carolina; 
and other smaller facilities throughout the US.

                         NIH INNOVATION ACCOUNT

    This account supports NIH programs authorized in the 21st 
Century Cures Act (PL 114-255).
    All of Us.--Within the total for this account, the 
Committee includes $186,000,000 for the All of Us precision 
medicine initiative. The Committee expects that NIH will also 
include at least $251,000,000 in budget authority from other 
NIH ICs to support this initiative.
    Regenerative Medicine.--Within the total for this account, 
the Committee includes $10,000,000 for Regenerative Medicine.

       Substance Abuse and Mental Health Services Administration


 
 
 
Appropriation, fiscal year 2018.......................    $5,158,994,000
Budget request, fiscal year 2019......................     3,546,552,000
Committee Recommendation..............................     5,681,993,000
    Change from enacted level.........................      +522,999,000
    Change from budget request........................    +2,135,441,000
 

    The Substance Abuse and Mental Health Services 
Administration (SAMHSA) is the agency within the U.S. 
Department of Health and Human Services that leads public 
health efforts to advance the behavioral health of the nation. 
SAMHSA's mission is to reduce the impact of substance abuse and 
mental illness on America's communities.
    The Committee continues to include bill language that 
exempts the Mental Health Block Grant and the Substance Abuse 
Prevention and Treatment Block Grant as a source for the Public 
Health Service Act section 241 evaluation set-aside in fiscal 
year 2019.
    The Committee does not include the requested bill language 
allowing the Assistant Secretary for Mental Health and 
Substance Use to transfer three percent or less of funds 
between any of SAMHSA's accounts.
    The Committee continues to strongly encourage SAMHSA to 
ensure States are engaging meaningfully with Tribal populations 
in the planning and use of block grant funds. SAMHSA is also 
encouraged to share best practices across States.
    Where permitted in the authorizing statute, the Committee 
directs SAMHSA when issuing new funding opportunity 
announcements, to include as an eligible applicant: States, 
political subdivisions of States (local government/ 
communities/ municipalities), Indian Tribes or Tribal 
organizations, or other public or nonprofit entities or 
organizations. The Committee encourages SAMHSA to provide 
outreach and technical assistance to ensure the maximum level 
of awareness and participation in new grant announcements.

                             MENTAL HEALTH

 
 
 
Appropriation, fiscal year 2018.......................    $1,487,011,000
Budget request, fiscal year 2019......................     1,064,922,000
Committee Recommendation..............................     1,414,510,000
    Change from enacted level.........................       -72,501,000
    Change from budget request........................      +349,588,000
 

    Within the total provided for Mental Health Programs of 
Regional and National Significance, the Committee provides the 
following amounts:

------------------------------------------------------------------------
                                                            FY 2019
                   Budget Activity                         Committee
------------------------------------------------------------------------
Capacity:
    Seclusion and Restraint..........................         $1,147,000
    Project AWARE....................................         71,000,000
    Mental Health Awareness Training.................         19,963,000
    Healthy Transitions..............................         25,951,000
    Infant and Early Childhood Mental Health.........          5,000,000
    Children and Family Programs.....................          7,229,000
    Consumer and Family Network Grants...............          4,954,000
    Project LAUNCH...................................         23,605,000
    Mental Health System Transformation..............          3,779,000
    Primary and Behavioral Health Care Integration...         49,877,000
    National Strategy for Suicide Prevention.........         13,500,000
        Zero Suicide.................................         11,500,000
            American Indian and Alaska Native Set-             2,500,000
             Aside...................................
    Suicide Lifeline.................................          7,198,000
    Garrett Lee Smith-Youth Suicide Prevention:
        State Grants.................................         35,427,000
        Campus Grants................................          6,488,000
    American Indian and Alaska Native Suicide                  2,931,000
     Prevention......................................
    Tribal Behavioral Health Grants..................         20,000,000
    Homeless Prevention Programs.....................         30,696,000
    Minority AIDS....................................          9,224,000
    Criminal and Juvenile Justice Programs...........         14,269,000
    Assisted Outpatient Treatment....................         15,000,000
    Assertive Community Treatment for Individuals             15,000,000
     with Serious Mental Illness.....................
Science and Service:
    Garrett Lee Smith-Suicide Prevention Resource              5,988,000
     Center..........................................
    Practice Improvement and Training................          7,828,000
    Consumer and Consumer Support Technical                    1,918,000
     Assistance Centers..............................
    Primary and Behavioral Health Care Integration             1,991,000
     Technical Assistance............................
    Minority Fellowship Program......................          8,059,000
    Disaster Response................................          1,953,000
    Homelessness.....................................          2,296,000
------------------------------------------------------------------------

    Assertive Community Treatment.--The Committee provides 
$15,000,000 for this program, which is authorized by section 
9015 of the 21st Century Cures Act (PL 114-255).
    Mental Health Awareness Training.--The Committee is pleased 
with the progress of the Mental Health Awareness Training 
program, which has trained more than one million Americans to 
recognize the signs and symptoms of common mental disorders. 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. 
Consistent with the authorization, funds are directed to 
support grants for evidence-based programs that provide 
training and education on recognizing the signs and symptoms of 
mental illness, resources available in the community for 
individuals with a mental illness, and safely de-escalating 
crisis situations involving individuals with a mental illness.
    Project AWARE.--The Committee includes $71,000,000 for 
Project AWARE State grants. These grants are awarded to State 
Education Agencies to promote comprehensive, coordinated, an 
integrated efforts to make schools safer and increase access to 
mental health services. Project AWARE supports several 
strategies for addressing mental health in schools: supports 
for mental wellness in education settings, building awareness 
of mental health issues, and early intervention with 
coordinated supports.
    Suicide Prevention.--The Committee recognizes the rising 
rate of suicide and notes that family and friends are often in 
the best position to recognize the warning signs of suicide and 
to help an at-risk individual get treatment. The Committee 
urges SAMHSA to develop and disseminate programs to provide 
specialized training and resources on identifying and 
responding to people at risk of suicide for families and 
friends of at-risk individuals.

Mental Health Block Grant

    The Committee recommends a total of $722,571,000 for the 
Mental Health Block Grant, which is the same as the fiscal year 
2018 enacted program level and $160,000,000 above the fiscal 
year 2019 budget request program level. The block grant 
provides funds to States to support mental illness prevention, 
treatment, and rehabilitation services. Funds are allocated 
according to a statutory formula among the States that have 
submitted approved annual plans.
    The Committee continues the ten percent set-aside within 
the Mental Health Block Grant for evidence-based programs that 
address the needs of individuals with early serious mental 
illness, including psychotic disorders. The Committee expects 
SAMHSA to continue its collaboration with the National 
Institute of Mental Health to encourage States to use this 
block grant funding to support programs that demonstrate strong 
evidence of effectiveness.

National Child Traumatic Stress Initiative

    The Committee recommends $63,887,000 for the National Child 
Traumatic Stress Initiative, which is $10,000,000 more than the 
fiscal year 2018 enacted level and $15,000,000 above the fiscal 
year 2019 budget request. The National Child Traumatic Stress 
Initiative aims to improve behavioral health services and 
interventions for children and adolescents exposed to traumatic 
events. SAMHSA has provided funding for a national network of 
grantees known as the National Child Traumatic Stress Network 
to develop and promote effective community practices for 
children and adolescents exposed to a wide array of traumatic 
events.

Children's Mental Health

    The Committee recommends $125,000,000 for the Children's 
Mental Health program, which is the same as the fiscal year 
2018 enacted level and $5,974,000 above the fiscal year 2019 
budget request. Funding for this program supports grants and 
technical assistance for community-based services for children 
and adolescents with serious emotional, behavioral, or mental 
disorders. The program assists States and local jurisdictions 
in developing integrated systems of community care.

Projects for Assistance in Transition from Homelessness

    The Committee recommends $64,635,000 for the Projects for 
Assistance in Transition from Homelessness (PATH) program, 
which is the same as the fiscal year 2018 enacted level and the 
fiscal year 2019 budget request. The PATH program supports 
grants to States and territories for assistance to individuals 
suffering from severe mental illness and/or substance abuse 
disorders and who are homeless or at imminent risk of becoming 
homeless. Grants may be used for outreach, screening and 
diagnostic treatment services, rehabilitation services, 
community mental health services, alcohol or drug treatment 
services, training, case management services, supportive and 
supervisory services in residential settings, and a limited set 
of housing services.

Protection and Advocacy for Individuals with Mental Illness

    The Committee recommends $36,146,000 for the Protection and 
Advocacy for Individuals with Mental Illness program, which is 
the same as the fiscal year 2018 enacted level and the fiscal 
year 2019 budget request. This program serves to 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. Funds are allocated to States 
according to a formula based on population and relative per 
capita incomes.

                       SUBSTANCE ABUSE TREATMENT

 
 
 
Appropriation, fiscal year 2018................           $3,263,506,000
Budget request, fiscal year 2019...............            2,113,397,000
Committee Recommendation.......................            3,853,506,000
    Change from enacted level..................             +590,000,000
    Change from budget request.................           +1,740,109,000
 

Substance Abuse Prevention and Treatment Block Grant

    The Committee recommends a program level of $2,358,079,000 
for the Substance Abuse Prevention and Treatment Block Grant, 
which is $500,000,000 more than the fiscal year 2018 enacted 
program level and the fiscal year 2019 budget request program 
level. The Substance Abuse Prevention and Treatment Block Grant 
provides funds to States to support alcohol and drug abuse 
prevention, treatment, and rehabilitation services. The 
Committee recognizes the critical role the block grant plays in 
State systems across the country.
    Within the total provided for Programs of Regional and 
National Significance, the Committee recommends the following 
amounts:

------------------------------------------------------------------------
                                                            FY 2019
                   Budget Activity                         Committee
------------------------------------------------------------------------
Capacity:
    Opioid Treatment Programs and Regulatory                 $32,724,000
     Activities......................................
        Medical Provider Education on Opioid                  24,000,000
         Treatment...................................
    Reducing Underage Drinking through Screening and           2,000,000
     Brief Intervention..............................
        PHS Evaluation Funds.........................          2,000,000
    Targeted Capacity Expansion--General.............        125,192,000
        Medication-Assisted Treatment................        114,000,000
            Tribal Set-aside.........................         15,000,000
    Grants to Prevent Prescription Drug/Opioid                12,000,000
     Overdose........................................
    First Responder Training.........................         36,000,000
        Rural Focus..................................         18,000,000
    Pregnant and Postpartum Women....................         29,931,000
    Recovery Community Services Program..............          2,434,000
    Children and Families............................         29,605,000
    Treatment Systems for Homeless...................         36,386,000
    Minority AIDS....................................         65,570,000
    Criminal Justice Activities......................         99,000,000
        Drug Courts..................................         80,000,000
    Improving Access to Overdose Treatment...........          1,000,000
    Building Communities of Recovery.................         10,000,000
Science and Service:
    Addiction Technology Transfer Centers............          9,046,000
    Minority Fellowship Program......................          4,539,000
------------------------------------------------------------------------

Medical Provider Education on Opioid Treatment

    The Committee provides $24,000,000 for carrying out medical 
and other healthcare practitioner education. The Committee 
directs SAMHSA to provide grants to medical schools, schools of 
nursing, social work, physician assistants, and other colleges 
and universities to ensure that training in the field of 
substance use disorders, including opioid use disorders, is 
incorporated into the standard curriculum of the university 
programs. Activities should include both didactic and hands on 
training for students. Funds should support Drug Addiction 
Treatment Act of 2000 waiver training for designated 
practitioners to be able to engage in office based treatment 
for substance use disorders, including opioid use disorders. 
The Committee expects training and practice requirements to be 
consistent with section 303(g)(2) of the Controlled Substances 
Act, including diversion control, relapse prevention, overdose 
reversal, detoxification, and the clinical use of FDA-approved 
medications. These grants are expected to generate a well-
equipped workforce to address the behavioral health needs of 
individuals across the country and ultimately close the 
substance use disorder treatment gap.

Screening, Brief Intervention and Referral to Treatment

    The Committee does not provide funding for Screening, Brief 
Intervention and Referral to Treatment, which is $30,000,000 
below the fiscal year 2018 enacted program level, and the same 
as the fiscal year 2019 budget request program level.

Reducing Underage Drinking through Screening and 
        Brief Intervention

    The Committee provides $2,000,000 for grants to pediatric 
health care providers in accordance with the specifications 
outlined in section 9016 of the 21st Century Cures Act (PL 114-
255). Training grants should focus on screening for underage 
drinking, opioid use, and other drug use.

Targeted Capacity Expansion

    The Committee recommends $123,192,000 for Targeted Capacity 
Expansion activities. Of this amount, $114,000,000 is for 
services that address prescription drug abuse and heroin use in 
high-risk communities. Within the $114,000,000, the Committee 
provides $15,000,000 for grants to Indian Tribes, Tribal 
organizations, or consortia. SAMHSA should target funds to 
grantees located in States with the highest rates of admissions 
and that have demonstrated a dramatic increase in admissions 
for the treatment of opioid use disorders.
    The Center for Substance Abuse Treatment 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 and prioritize treatment 
regimens that are less susceptible to diversion for illicit 
purposes. Further, for the additional funds, the Committee 
directs SAMHSA to prioritize grants from nonprofit 
organizations and political subdivisions of States.

Grants to Prevent Prescription Drug/Opioid Overdose and 
        First Responder Training

    The Committee notes strong concerns about the increasing 
number of unintentional overdose deaths attributable to 
prescription and nonprescription opioids. SAMHSA is urged to 
take steps to encourage and support the use of Substance Abuse 
and Prevention Block Grant funds for opioid safety education 
and training, including initiatives that improve access for 
licensed healthcare professionals, including paramedics, to 
emergency devices used to rapidly reverse the effects of opioid 
overdoses. Such initiatives should incorporate robust evidence 
based intervention training, and facilitate linkage to 
treatment and recovery services.

Pregnant and Postpartum Women

    The Committee provides $29,931,000 for Pregnant and 
Postpartum Women, which is the same as the fiscal year 2018 
enacted level and $10,000,000 more than the fiscal year 2019 
budget request.
    The Committee recognizes the importance of treatment for 
women during pregnancy who are at risk for opioid dependence 
and opioid exposure during pregnancy, and infants born with 
neonatal abstinence syndrome. A 2015 GAO report stated that the 
most frequently cited program gap was the lack of available 
treatment programs for pregnant women. There is a need for 
increased available treatment options for pregnant women, 
especially in States with large populations and few treatment 
programs available. The Committee encourages SAMSHA to provide 
grants to expand existing treatment programs for women and 
infants in States with fewer than three available programs.
    Substance use during pregnancy, particularly the misuse of 
opioids, has increased in parallel with the national rate of 
opioid misuse. While much attention has been paid to the 
negative impacts of opioid use on the fetus and newborn, less 
attention has been given to the pregnant woman. The Committee 
encourages cross-HHS collaboration between research and public 
health programs, as well as engagement with health care 
providers and patients to ensure that the care and treatment of 
pregnant women with substance use disorder is considered and 
included in any national efforts to address the opioid 
epidemic. The Committee requests an update on these efforts in 
the fiscal year 2020 Congressional Justification.

Criminal Justice Activities

    The Committee provides $99,000,000 for the Criminal Justice 
Activities program, which is $10,000,000 above the fiscal year 
2018 enacted level and $21,000,000 more than the fiscal year 
2019 budget request. Of this amount, the Committee directs that 
not less than $80,000,000 will be used exclusively for Drug 
Court activities.
    Drug Courts.--The Committee continues to direct SAMHSA to 
ensure that all funding appropriated for Drug Treatment Courts 
is allocated to serve people diagnosed with a substance use 
disorder as their primary condition. The Committee directs 
SAMHSA to ensure that all drug treatment court grant recipients 
work directly with the corresponding State substance abuse 
agency in the planning, implementation, and evaluation of the 
grant. The Committee further directs SAMHSA to expand training 
and technical assistance to drug treatment court grant 
recipients to ensure evidence-based practices are fully 
implemented.

Center for Substance Abuse Treatment

    Addiction Medicine Awareness.--SAMHSA, in coordination with 
the Office of National Drug Control Policy, should coordinate 
efforts among Federal agencies to raise awareness among 
qualified physicians of the opportunity to sit for the 
addiction medicine subspecialty board exam. In 2016, addiction 
medicine was recognized as an American Board of Medical 
Specialties (ABMS) subspecialty under the American Board of 
Preventive Medicine. The first ABMS addiction medicine board 
exam was offered in October 2017. While the board exam will be 
open to any American physician with a primary ABMS board 
certification until 2022, after that time period, physicians 
will need to complete a year-long fellowship program to be 
qualified to sit for the exam. In five short years, the number 
of accredited and funded addiction medicine fellowship programs 
and slots will be the limiting factor in determining how many 
addiction medicine specialists can receive board certification. 
It is critical that all stakeholders work to maximize funded 
addiction medicine fellowship opportunities before their number 
begins to limit qualified examinees.
    Continuum of Care.--Evidence demonstrates that efforts to 
coordinate opioid abuse treatment that promote a continuum of 
care model can produce effective results. Successful examples 
include the development of ``no wrong door'' treatment models 
and the use of mechanisms to scale-up training and increase the 
number of peer coaches. In addition, the use of mobile app 
technology to enhance access to services promotes successful 
treatment outcomes and supports long-term relapse prevention. 
SAMHSA is encouraged to ensure that State and local grantees 
are prioritizing the implementation of coordinated continuum of 
care approaches. The Committee encourages SAMHSA to support 
projects of regional and national significance to further 
develop and validate the effectiveness of such approaches.
    Implant Delivery Opioid Deterrent Treatment.--The Committee 
requests an update in the fiscal year 2020 Congressional 
Justification on SAMHSA's efforts to increase patient coverage 
for opioid deterrent treatments and expand access of medication 
assisted treatment, including efforts to train more providers 
in this method of treatment.
    Infectious Disease and the Opioid Epidemic.--The Committee 
notes that the prevalence of hepatitis C and human 
immunodeficiency virus (HlV) have increased along with the 
opioid epidemic. New research suggests that awareness of one's 
infection status can help limit ongoing opioid abuse. The 
Committee supports efforts to address the overlapping public 
health challenges of hepatitis C and HIV, and requests an 
update in the fiscal year 2020 Congressional Justification on 
efforts to promote screening and rapid-testing activities for 
affected communities.
    Prescription Digital Therapeutics.--The Committee 
recognizes that the emerging field of prescription digital 
therapeutics is bringing to market clinically validated, Food 
and Drug Administration-cleared software treatments that 
improve clinical outcomes for patients living with substance 
and opioid use disorders. Given the opportunity to increase 
abstinence and reduce relapse among the over 21 million 
American estimated to be struggling with these disorders, the 
Committee requests that SAMHSA update the January 2015 Federal 
Guidelines for Opioid Treatment Programs and consider the role 
that prescription digital therapeutics can play as part of 
evidence-based treatment standards, and in particular their 
potential role in meeting the counseling services requirements 
under 42 CFR 8.12(f). The Committee requests that SAMHSA 
include an update on this effort in the fiscal year 2020 
Congressional Justification.

                       SUBSTANCE ABUSE PREVENTION

 
 
 
Appropriation, fiscal year 2018.......................      $248,219,000
Budget request, fiscal year 2019......................       220,885,000
Committee Recommendation..............................       248,719,000
    Change from enacted level.........................          +500,000
    Change from budget request........................       +27,834,000
 

    Within the total provided for Programs of Regional and 
National Significance, the Committee provides the following 
amounts:

------------------------------------------------------------------------
                                                            FY 2019
                   Budget Activity                         Committee
------------------------------------------------------------------------
Capacity:
    Strategic Prevention Framework...................       $137,484,000
        PHS Evaluation Funds.........................        116,560,000
        Strategic Prevention Framework Rx............         18,000,000
            PHS Evaluation Funds.....................         18,000,000
    Opioid Prevention Grants.........................         25,000,000
        PHS Evaluation Funds.........................         25,000,000
    Minority AIDS....................................         41,205,000
        PHS Evaluation Funds.........................         41,205,000
    Federal Drug-Free Workplace......................          4,894,000
    Sober Truth on Preventing Underage Drinking......          8,000,000
        PHS Evaluation Funds.........................          8,000,000
            National Adult-Oriented Media Public               1,000,000
             Service Campaign........................
            Community Based Coalition Enhancement              6,000,000
             Grants..................................
            Interagency Coordinating Committee to              1,000,000
             Prevent Underage Drinking...............
    Tribal Behavioral Health Grants..................         20,000,000
        PHS Evaluation Funds.........................         20,000,000
Science and Service:
    Center for the Application of Prevention                   7,493,000
     Technologies....................................
    Science and Service Program Coordination.........          4,072,000
    Minority Fellowship Program......................            571,000
------------------------------------------------------------------------

    Center for the Application of Prevention Technologies.--The 
Committee directs the Secretary to expand eligibility for 
grants under SAMHSA Prevention Programs of Regional and 
National Significance and the corresponding services provided 
by the Center for the Application of Prevention Technologies to 
private, non-profit, regional organizations, including faith-
based organizations. The broad coalitions orchestrated by these 
regional organizations are uniquely positioned to supplement 
the work already being done by the State, Tribal and community 
organizations currently authorized for such grants.
    Minority Fellowship Program.--Culturally competent 
behavioral health services are necessary to meet demand and 
behavioral health challenges facing communities across the US, 
including the opioid epidemic. In addition, significant 
behavioral health disparities persist in diverse communities 
across the US. There are persistent health disparities between 
different racial and ethnic populations, and health equity 
remains a challenge with minorities receiving less mental 
health and addiction treatment and lower-quality care. To meet 
this need, the Minority Fellowship Program (MFP) has been 
increasing the number of culturally competent behavioral health 
professionals providing mental health and substance use 
disorders services to underserved populations. The MFP provides 
support to behavioral health professionals in the fields of 
psychiatry, psychology, social work, nursing, marriage and 
family therapy, counseling and addictions. The MFP is the only 
Federal program supporting culturally competent mental health 
and substance use disorders professionals.
    Opioid Prevention Grants.--The Committee notes that 
substance use prevention, to stop misuse of opioids before it 
starts, has been underutilized despite its potential to reduce 
the pathway to addiction and that the most effective approach 
to dealing with prevention is comprehensive planning and 
implementation of multiple strategies across multiple sectors 
of a community. The Committee includes $25,000,000 for opioid 
prevention grants. The Committee intends for such grants to 
enable multi-sector community organizations to receive grants 
of up to $150,000 to partner with relevant community sectors to 
implement at least one strategy, program, or activity across 
the allowable uses of funds and then evaluate progress in 
reducing population levels of opioid misuse in the community 
using baseline data, which shall then be collected every two 
years for the target population. Funds may be used for the 
implementation of an array of strategies, programs, and 
activities across each of the following: reduce access to and 
availability of opioids; change social norms in the community 
about misusing opioids; build skills with scale and scope in 
parents/caregivers, youth, school personnel, the medical 
community, law enforcement, youth serving organizations, 
fraternal or faith based organizations, and the media through 
targeted education, training, and skills building; change 
community-wide incentives and policies to deter opioid misuse; 
and implement evidence based substance use prevention programs 
and curricula in schools and other venues to reach the target 
population.

                HEALTH SURVEILLANCE AND PROGRAM SUPPORT

 
 
 
Appropriation, fiscal year 2018.......................      $160,258,000
Budget request, fiscal year 2019......................       147,348,000
Committee Recommendation..............................       165,258,000
    Change from enacted level.........................        +5,000,000
    Change from budget request........................       +17,910,000
 

    The Committee provides the following amounts for Health 
Surveillance and Program Support:

------------------------------------------------------------------------
                                                            FY 2019
                   Budget Activity                         Committee
------------------------------------------------------------------------
Health Surveillance..................................        $47,258,000
    PHS Evaluation Funds.............................         30,428,000
Program Support......................................         79,000,000
Public Awareness and Support.........................         13,000,000
Performance and Quality Information Systems..........         10,000,000
Drug Abuse Warning Network...........................         15,000,000
Agency-Wide Initiatives:
    Behavioral Health Workforce Data and Development.          1,000,000
        PHS Evaluation Funds.........................          1,000,000
------------------------------------------------------------------------

               Agency for Healthcare Research and Quality


                    HEALTHCARE RESEARCH AND QUALITY

 
 
 
Appropriation, fiscal year 2018.......................      $334,000,000
Budget request, fiscal year 2019......................             - - -
Committee Recommendation..............................       334,000,000
    Change from enacted level.........................             - - -
    Change from budget request........................      +334,000,000
 

    The Agency for Healthcare Research and Quality's (AHRQ) 
mission is to produce evidence to make health care safer, 
higher quality, more accessible, equitable, and affordable, and 
to work within HHS and other partners to make sure that the 
evidence is understood and used. 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.
    Within the total for AHRQ, the agreement includes the 
following amounts:

------------------------------------------------------------------------
                                                            FY 2019
                   Budget Activity                         Committee
------------------------------------------------------------------------
Prevention/Care Management...........................         11,649,000
Health Information Technology (IT)...................         16,500,000
    Health IT to Improve Quality.....................         14,500,000
Patient Safety Research..............................         70,276,000
    Healthcare-Associated Infections (HAI) Prevention         36,000,000
    Combating Antibiotic-Resistant Bacteria (non-add          10,000,000
     within HAI).....................................
    Section 933 Grants...............................         10,000,000
    Patient Safety and Medical Errors................         19,000,000
    Patient Safety Organizations.....................          4,866,000
Crosscutting Activities Related to Quality,                   94,284,000
 Effectiveness and Efficiency Research...............
    Health Services Contract/IAA Research............         14,000,000
    Investigator-Initiated Research Grants...........         52,933,000
Medical Expenditure Panel Survey.....................         69,991,000
Program Management...................................         71,300,000
------------------------------------------------------------------------

    Sepsis Testing.--AHRQ has been the leader in developing the 
tools and resources to help providers improve their antibiotic 
stewardship programs. The Committee is concerned that AHRQ has 
not updated several publications related to the use of 
procalcitonin (PCT) tests in sepsis and antibiotic treatment 
programs in more than five years. High sensitive PCT tests are 
critical tools for initiating and discontinuing antibiotic 
therapies and play a key role in antibiotic stewardship 
programs. The Committee urges 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 
Congressional Justification.

               Centers for Medicare and Medicaid Services


                     GRANTS TO STATES FOR MEDICAID

 
 
 
Appropriation, fiscal year 2018................        *$284,798,384,000
Budget request, fiscal year 2019...............          276,236,212,000
Committee Recommendation.......................          276,236,212,000
    Change from enacted level..................           -8,562,172,000
    Change from budget request.................                    - - -
 

    Medicaid provides health coverage eligible populations, 
including eligible low-income adults, children, pregnant women, 
elderly adults, and people with disabilities. Medicaid is 
administered by States, according to Federal requirements. The 
program is funded jointly by States and the Federal government.
    This amount does not include $134,847,759,000, which was 
provided as advance funding for the first quarter of fiscal 
year 2019. In addition, the Committee recommends an advance 
appropriation of $137,931,797,000 for program costs in the 
first quarter of fiscal year 2020.
    The Committee continues bill language providing indefinite 
budget authority for unanticipated costs in fiscal year 2019. 
Federal Medicaid grants reimburse States for a portion of their 
expenditures in providing health care for individuals whose 
income and resources fall below specified levels. Subject to 
certain minimum requirements, States are provided certain 
limited authority within the law to set eligibility, coverage, 
and payment levels.

                PAYMENTS TO THE HEALTH CARE TRUST FUNDS

 
 
 
Appropriation, fiscal year 2018...........              $323,497,300,000
Budget request, fiscal year 2019..........               378,343,800,000
Committee Recommendation..................               378,343,800,000
    Change from enacted level.............               +54,846,500,000
    Change from budget request............                         - - -
 

    This account includes the general fund subsidy to the 
Federal Supplementary Medical Insurance Trust Fund for Medicare 
Part B benefits, and Medicare drug benefits and administration, 
as well as other reimbursements to the Federal Hospital 
Insurance Trust Fund for benefits and related to administrative 
costs, which have not been financed by payroll taxes or premium 
contributions. The Committee continues bill language providing 
indefinite authority to pay the general revenue portion of the 
Medicare Part B premium match and providing resources for the 
Medicare Part D drug benefit program in the event that the 
annual appropriation is insufficient.

                           PROGRAM MANAGEMENT

 
 
 
Appropriation, fiscal year 2018.......................    $3,669,744,000
Budget request, fiscal year 2019......................     3,543,879,000
Committee Recommendation..............................     3,502,024,000
    Change from enacted level.........................      -167,720,000
    Change from budget request........................       -41,855,000
 

Program Operations

    The Committee recommends $2,402,089,000 for Program 
Operations to support activities used to administer the 
programs under the Centers for Medicare & Medicaid Services 
(CMS), fund beneficiary outreach and education, maintain 
information technology infrastructure needed to support various 
claims processing systems, and continue other programmatic 
improvements.
    Addressing Regional Disparities in Medicare Access.--The 
Committee notes increasingly large regional disparities in the 
Medicare Area Wage index and is concerned that such disparities 
are negatively impacting the ability of hospitals to provide 
necessary, timely, and evidence based care to individuals 
entitled to benefits under part A or enrolled under part B of 
title XVIII of the Social Security Act. When developing 
regulations under section 1886 of the Social Security Act, the 
Committee encourages the Secretary to take into account ideas 
and suggested reforms for the area wage index stated in the 
comments received as part of the request for public comments on 
wage index disparities published in the proposed rule entitled 
``Medicare Program; Hospital Inpatient Prospective Payment 
Systems for Acute Care Hospitals and the Long-Term Care 
Hospital Prospective Payment System and Proposed Policy Changes 
and Fiscal Year 2019 Rates; Proposed Quality Reporting 
Requirements for Specific Providers; Proposed Medicare and 
Medicaid Electronic Health Record Incentive Programs (Promoting 
Interoperability Programs) Requirements for Eligible Hospitals, 
Critical Access Hospitals, and Eligible Professionals; Medicare 
Cost Reporting Requirements; and Physician Certification and 
Recertification of Claims'' (83 Fed. Reg. 20372). In addition, 
CMS is directed to submit a report to the Committees on 
Appropriations of the House of Representatives and Senate, and 
the authorizing Committees of jurisdiction, with an analysis of 
the ideas and suggested reforms received as part of the request 
for public comments on the area wage index published in such 
rule. The report should also analyze data that may demonstrate 
disparities resulting from the current area wage index 
calculation under Inpatient Prospective Payment System 
payments. Additionally, the report should analyze solutions 
presented by commenters and present possible solutions 
identified by CMS to rectify such disparities identified 
through such information collected under the request for public 
comments. Such report shall be provided not later than 180 days 
after enactment of this Act.
    Adult Immunization Rates.--The Committee recognizes the 
importance of vaccines in preventing diseases that can result 
in increased morbidity and mortality, particularly among the 
Medicare population, and is concerned about the 
underutilization of adult vaccinations in this population. The 
Committee strongly encourages CMS to work toward achievement of 
the Healthy People 2020 goals to increase the percentage of 
adults [aged 65 or older] who receive recommended vaccinations. 
In particular, CMS is encouraged to: 1) incorporate the 
National Vaccine Advisory Committee Standards for Adult 
Immunization Practice in provider outreach and educational 
materials pertaining to the Initial Preventive Physical 
Examination under Medicare and Annual Wellness Visits, 
including but not limited to the Medicare Learning Network 
Educational Tools, The ABCs of the Initial Preventive Physical 
Examination and The ABCs of The Annual Wellness Visit; 2) 
support development and implementation of electronic health 
records and other technologies, such as reminder recall 
programs, that can identify Medicare beneficiaries who have not 
received recommended vaccinations and remind those 
beneficiaries and their providers to adhere to vaccination 
schedules; and 3) to work with CDC and other relevant 
stakeholders to develop guidance for electronic health record 
systems to provide consistency and ensure greater 
interoperability between electronic health records and State 
and local immunization information systems and improve the 
value and reduce the burden of reporting for Medicare 
providers.
    Agents Used for Cosmetic Purposes or Hair Growth.--Section 
5008 of the 21st Century Cures Act (PL 114-255) eliminated 
Federal Medicaid matching funds for prescription drugs used for 
cosmetic purposes or hair growth unless they are determined to 
be ``medically necessary''. The Committee appreciates the 
important role of the physician in deciding medical necessity 
for prescription drugs used for hair growth, particularly in 
regards to patients within State Medicaid programs. The 
Committee encourages CMS to provide further guidance to States 
on this issue, including whether medical conditions that cause 
hair loss, such as the autoimmune disease alopecia areata and 
thyroid disease, are medically necessary and allow Medicaid 
coverage for hair loss products for Medicaid patients suffering 
from these diseases. The Committee requests an update on this 
effort in the fiscal year 2020 Congressional Justification.
    Ambulatory Surgical Centers.--CMS is directed to submit a 
report to the Committees on Appropriations of the House of 
Representatives and Senate, and the authorizing committees of 
jurisdiction, on the migration of procedures to ambulatory 
surgical centers (ASCs). The report should evaluate volume 
changes in hospital outpatient departments and ASCs for 
procedures that have been added to the ambulatory surgical 
center payable list since 2008. For procedures that have not 
shown any significant volume shift, the report will evaluate 
factors that may be limiting migration into ASCs as well as 
potential incentives for ownership of certain Medicare sites 
based on reimbursement disparity.
    Breast Prostehtics.--Congress enacted the Women's Health 
and Cancer Rights Act in 1998. This law requires health plans 
that provide mastectomy converage to also provide coverage for 
surgical breast reconstruction. For some women, reconstructive 
surgery is not an option. For women who do not receive 
reconstructive surgery, CMS provides coverage for a 
prefabricated breast prosthetic. However, these prosthetics can 
be difficult for regular and normal use. The Committee supports 
efforts by CMS to evaluate the coverage determinations 
concerning custom fabricatged prosthetics.
    Burden Reduction and Improved Coordination of the Medicare 
Program.--The Committee is concerned about the lack of 
coordination between the Center for Medicare and the Center for 
Clinical Standards and Quality (CCSQ) within CMS. CCSQ is 
responsible for activities, functions, and duties that create 
administrative burden on providers who serve Medicare 
beneficiaries. In order to ensure there is sufficient 
coordination across components in CMS that impact Medicare, the 
Committee urges the Director of Medicare to oversee all 
activities, functions, and duties of the Center for Clinical 
Standards and Quality of the Centers for Medicare & Medicaid 
Services that relate to activities, functions, and duties of 
the Center for Medicare and the Medicare program under title 
XVIII of the Social Security Act, including but not limited to 
activities, functions, and duties relating to Medicare 
coverage, conditions of participation, and quality measures 
applied under the Medicare program. The Committee requests an 
update on these activities in the fiscal year 2020 
Congressional Justification.
    Cardiac Quality Measures.--The Committee requests CMS 
provide an update in the fiscal year 2020 Congressional 
Justification on the inclusion of quality measures to assign 
accountability of the prevention of conditions and 
complications that are commonly associated with cardiac 
procedures, such as perioperative hemorrhage.
    Center for Medicare and Medicaid Innovation.--The Center 
for Medicare and Medicaid Innovation (CMMI) was created in the 
Patient Protection and Affordable Care Act (PL 111-148) to test 
new payment models. CMMI previously overstepped its authority 
by proposing simultaneously to make near nationwide, mandatory 
changes, including compulsory participation of providers to the 
Medicare program without appropriate debate or input from 
Congress or Medicare providers and beneficiaries. CMS recently 
released a set of principles for CMMI that would ensure CMMI 
serves as an actual testing ground, not a place to insert full-
scale policy changes by circumventing Congress. The Committee 
supports these actions, and urges CMS to formalize a process 
for testing CMMI models, and provide more transparency on the 
impact of CMMI demonstrations on patient access, care quality, 
and health care costs in the annual report to Congress. Insofar 
as CMMI is utilized for the advancement of alternative payment 
models in the implementation of the Medicare Access and CHIP 
Reauthorization Act of 2015 (PL 114-10), the Committee expects 
that CMMI will work closely with the Physician Technical 
Advisory Committee (PTAC) to ensure input from PTAC. The 
Committee also believes models recommended by PTAC and approved 
by the Secretary should be given priority in testing with the 
input of PTAC.
    Chief Dental Officer.--The Committee is concerned that the 
Chief Dental Officer position at CMS has been vacant since 
October 2017. Without a dentist to oversee oral health issues 
in Medicare and Medicaid, this vacancy leaves a significant gap 
of clinical oral health expertise within CMS. Medicaid provides 
oral health services to millions of children, pregnant women, 
and adults across the country. The Early Periodic Screening, 
Diagnosis and Treatment program requires dental services to be 
provided to beneficiaries eligible for the program. The 
Children's Health Insurance Program also requires dental 
services as part of the benefit package available to children. 
A licensed dentist clinician is an invaluable resource to these 
programs and CMS' growing oral health strategy to expand access 
to care. This position can also be utilized to study the 
potential benefits of periodontal care for patients suffering 
from chronic renal conditions. The Committee urges CMS to move 
forward with filling this vacancy.
    Clinical Laboratory Fee Schedule.--Inconsistencies in panel 
testing reimbursement in Medicare should be resolved to prevent 
wasteful government spending. The Committee encourages the 
Administrator of CMS to develop and issue a panel pricing 
policy that ensures the agency is not paying more for a single 
clinical diagnostic laboratory test, or a group of individual 
clinical diagnostic laboratory tests, than it would for a 
clinical diagnostic laboratory testing panel that tests for the 
same analyte(s). The Committee encourages the Administrator to 
apply the policy to all types of test panels.
    Colorectal Cancer Screening.--The Committee is encouraged 
by the inclusion of the proposal in the President's Budget to 
address the inequity in beneficiary cost sharing for screening 
colonoscopies. The Committee urges CMS to align its 
interpretation of the colorectal cancer screening cost-sharing 
requirements for Medicare beneficiaries with the policy of 
colorectal cancer cost-sharing requirements for other 
Federally-funded health programs. The Committee also urges CMS 
to consider coverage of blood tests that could serve to deter 
or immediately recommend the need for colonoscopy so as to 
increase the number of patients that go in for testing and 
decrease the amount of late-stage colon cancer diagnoses.
    Community Benefits Provided by Hospitals.--The Committee 
requests from GAO an update to the GAO Report entitled 
``Nonprofit, For-Profit, and Government Hospitals: 
Uncompensated Care and Other Community Benefits'' (GAO-05-
743T).
    Community Participatory Health Dashboard.--The Committee 
strongly encourages effort by CMS and CDC to devise a strategy 
on how to construct a decision-support tool that includes 
Geographic Information System epidemiologic data paired with 
Medicaid and other health program claims data that can 
contribute to community-participatory health prevention 
efforts. The effort would serve as a guide for HHS agencies to 
collaborate to construct a dashboard for community use to 
evaluate rates of disease and the associated costs.
    Competitive Bidding Program for Durable Medical Equipment, 
Prosthetics, Orthotics, and Supplies.--The Committee notes 
concern over CMS' management of the competitive bidding program 
for Durable Medical Equipment, Prosthetics, Orthotics, and 
Supplies. The Committee strongly supports efforts by CMS to 
bring greater transparency and oversight. The Committee 
supports efforts in upcoming proposed rulemaking to ensure 
continued access for rural areas.
    Congressional Justification.--The Committee directs CMS to 
include in the fiscal year 2020 Congressional Justification a 
table for current law estimates for all CMS administered 
programs listed in the table at the back of this report.
    Contractor Oversight.--The Committee expects CMS to 
increase oversight of contractors who are tasked with audit of 
claims, including Zone Program Integrity Contractor, Medicare 
Administrative Contractor, and Qualified Independent 
Contractor. CMS should have a formal process to review appeals 
to ensure CMS guidance is properly followed. The Committee 
remains concerned with the degree of independence given to 
contractors to determine sample methodology for claim review 
and assessing penalties. The Committee believes CMS should have 
standard protocols to ensure consistent principles are applied 
by contractors in all regions and for all levels of the appeal 
process. The Committee expects an update on this effort in the 
fiscal year 2020 Congressional Justification.
    Critical Access Hospitals.--The Committee supports Critical 
Access Hospitals (CAH). Reduced reimbursement could impede the 
hospital's ability to properly provide care to local residents. 
Prior to implementation of a change in reimbursement policy, 
the Committee encourages CMS to engage with stakeholders to 
ensure the change would not negatively impact a CAH's ability 
to fully operate.
    Diabetic Retinal Exams.--According to the CDC, diabetes-
related blindness costs the Nation about $500 million annually. 
The Committee recognizes that as more Medicare beneficiaries 
are diagnosed with diabetes, diabetic retinopathy remains a 
concern, and change is required to eradicate this leading cause 
of severe vision loss and blindness. Non-compliance is driving 
preventable blindness. Experts recommend that all individuals 
diagnosed with diabetes should be examined for eye health, yet 
failure to receive annual diabetic retinal exams is common. The 
Committee urges CMS to update its policy to make diabetic 
retinal exams more accessible to diabetic patients in primary 
care settings, through the use of digital retinal imaging with 
remote specialist interpretation.
    Direct and Indirect Remuneration.--The Committee is aware 
that CMS has put forth a Request for Information as part of the 
2019 proposed Part D rule. The Committee understands any 
specific policy changes must occur through a future notice and 
comment rulemaking and urges the Secretary to consider the 
impact this proposal will have on seniors' premiums and the 
taxpayer, as well as its potential to reveal competitively 
sensitive information. The Committee requests an update on this 
topic in the fiscal year 2020 Congressional Justification.
    Disaster Impacted Areas.--The Committee strongly supports 
efforts to increase access to care for local hospitals located 
in areas impacted by a National disaster. Storm damage to 
facilities and infrastructure can significantly impede a 
community's access to primary, emergency, and specialty care. 
CMS should take necessary administrative action to ensure the 
existing physical infrastructure for health care facilities is 
effectively utilized to provide for necessary care in disaster 
impacted communities.
    Drug Pricing Report.--The Committee directs the Secretary 
of Health and Human Services to submit a report to the 
Committee on appropriations of the House of Representatives not 
later than 120 days after the date of the enactment of the Bill 
to which this Committee Report pertains regarding price changes 
of prescription drugs since 2008. The report should include 
comparative prescription drug prices (net of rebates) paid by 
the following programs for the 10 most frequently prescribed 
drugs and the 10 highest-cost drugs for each of the following:
          (1) The Medicare program under part B of title XVIII 
        of the Social Security Act.
          (2) The Medicare prescription drug program under part 
        D of title XVIII of the Social Security Act.
          (3) The Medicaid program under title XIX of the 
        Social Security Act.
          (4) The Department of Veterans Affairs.
    The report should also provide a breakdown of the 
comparative prices (net of rebates) for each of the 10 most 
frequently prescribed drugs and the 10 highest-cost drugs 
between ambulatory settings and retail settings.
    Under Medicare Part D, the report should detail gross Part 
D drug costs and net Part D drug costs and the Direct and 
Indirect Remuneration for the 10 most frequently prescribed 
drugs and the 10 highest-cost drugs.
    In addition, the report should include total annual costs 
due to prescription drugs to the Medicare program under part B 
of title XVIII of the Social Security Act, the Medicare 
prescription drug program under part D of title XVIII of such 
Act, and the Medicaid program under title XIX of such Act.
    Finally, the report should list the drugs that have been 
registered for sale by the Food and Drug Administration (FDA) 
in the past five years that have benefited significantly from 
government grants or research subsidies in either the pre-
clinical or clinical stages of development, as well as the 
price (net of rebates) and total spending in Medicare and 
Medicaid for each of those drugs.
    Geographic Practice Cost Index.--The Committee supports 
efforts by CMS to create a more transparent process for the 
development of a Geographic Practice Cost Index (GPCI). The 
Committee believes more transparency is needed to understand 
the methodology used to determine input variables. The 
Committee supports a process that accounts for variables in a 
GPCI that lead to fair reimbursement for rural States.
    Health Insurance Information.--The Committee supports 
efforts by CMS to utilize private sector solutions for 
information on health insurance options.
    Hospital Acquired Pressure Ulcers.--The Committee 
understands data released in October 2017 by the CMS Office of 
Enterprise Data and Analytics identified that hospital 
discharges of patients with pressure ulcers have increased by 
over 58 percent between the first quarter of 2016 and 2017. In 
addition, HHS research shows that hospital-acquired pressure 
ulcers and their associated complications have led to roughly 
60,000 patient deaths per year. These statistics are deeply 
concerning. The Hospital-Acquired Condition (HAC) Reduction 
Program requires CMS to reduce payments for hospitals that rank 
among the lowest-performing 25 percent of hospitals with regard 
to HACs, but it also allows the Administration to adjust the 
Domain 1 and Domain 2 formulas used for that calculation. Given 
this adjustment ability, the Committee requests CMS provide 
information in the fiscal year 2020 Congressional Justification 
on steps CMS is taking to review the formulas and any other 
actions they are taking to reverse the trend of increased 
hospital-acquired pressure ulcers.
    Hospital Based Nursing.--The Committee encourages CMS to 
address the ability of hospital-based nursing programs to 
maintain their pass-through payments in light of conflicting 
eligibility requirements established by national and regional 
higher education accrediting bodies. The CMS pass-through 
payments are essential for hospital-based nursing programs to 
continue to produce well-educated nurses and address areas of 
national need and underserved populations. The Committee 
requests that CMS provide an update in the fiscal year 2020 
Congressional Justification on efforts to remedy this policy 
discrepancy.
    Hospital Surveys.--The Committee commends CMS for ensuring 
standards for safety and quality are maintained for the health 
of Medicare beneficiaries. The Committee is concerned with 
revisions to the State Operation Manual described in S&C Memo: 
17-44-All Hospitals. In this Memorandum, CMS mandates a new 
standard for a hospital survey, and retroactively applies this 
standard to facilities for the prior 12 months. The Committee 
believes such a change is rulemaking and subject to a notice 
and comment period. The Committee notes CMS had to issue two 
additional memorandums to clarify the new policy. Such 
revisions serve as evidence that the change in policy warrants 
time for stakeholders to prepare. The Committee has concerns 
that hospitals did not receive notice and requests that CMS 
provide justification for why notice was not provided for 
hospitals through notice and comment rulemaking.
    Impact of Tobacco Cessation on Medicaid.--The Committee 
notes that Medicaid coverage of tobacco cessation 
nonprescription drugs may assist individuals in efforts to 
limit tobacco usage, which could result in savings to the 
Medicaid program. The Committee requests an update in the 
fiscal year 2020 Congressional Justification on the possible 
impact of such a coverage change, including any assoicated 
savings.
    Kidney Dialysis Payment and Transplant Services.--The 
Committee is aware of an unintended issue within Medicare 
coverage of kidney dialysis and kidney transplant services 
regarding anti-rejection medication known as immunosuppressive 
drugs. Currently the Medicare program pays for a large share of 
the medication needed to prevent rejecting a transplanted 
kidney but coverage of these drugs for non-aged, non-disabled 
beneficiaries is limited to three years from the date of the 
transplant. Recipients who cannot afford the high cost of the 
drugs sometimes resort to skipping doses and stretching 
medication resulting in diminished kidney function and 
ultimately rejection, returning the patient to years of 
dialysis and another kidney transplant. The Committee 
encourages CMS to commission a study to determine the cost of 
effectiveness of the current policy of restrictive coverage for 
these lifesaving immunosuppressive medications by analyzing the 
long-term cost of dialysis for patients who have received a 
kidney transplant and subsequent transplants due to the lack of 
access to anti-rejection medications. The Committee also 
encourages CMS to consider all possible payment models for 
dialysis patients considering the immense amount of data 
showing the benefits of greater care management for this 
population.
    KidneyX.--KidneyX stimulates the commercialization of new 
therapies while providing a catalyst for investment by the 
private market in three specific ways that are not currently 
addressed by market forces or Federal efforts: de-risks the 
commercialization process by fostering coordination among NIH, 
FDA, and CMS to provide a clear, predictable path towards 
commercialization, provides non-dilutive funding to seed, 
incent, and accelerate breakthroughs to promising innovators, 
selected through a competitive process, and offers 
participating innovators access to investors and business 
experts and repositions the kidney space as an attractive and 
untapped market. While the first round of seed funding focuses 
on the development and commercialization of an artificial 
kidney, the portfolio will expand to include diagnostics, other 
devices, medications, and patient-centered tools to more 
effectively and efficiently manage kidney diseases. Revenue 
generated from breakthrough commercialized developments will be 
cycled back to support KidneyX, funding future therapies 
without the need for additional public investment beyond the 
first five years. Similar public-private accelerators, like the 
Combating Antibiotic Resistant Bacteria Biopharmaceutical 
Accelerator, have shown great success in catalyzing private 
sector investment. KidneyX is a true public-private 
partnership: the private sector is committed to providing 
matching funds to achieve the total $250 million required for 
the first five years. To date, $25 million has been committed 
to KidneyX from the private sector. KidneyX will issue its 
first round of seed funding using private contributions in 
2018.
    Lactation Support.--The Committee recognizes the important 
health and economic benefits of breastfeeding, which may reduce 
the rate of common and costly diseases in infants, acute and 
chronic diseases later in life, and provides important health 
benefits to mothers. The Committee also recognizes that certain 
medical conditions and time restrictions make low-cost 
breastfeeding supplies, such as hand pumps, insufficient for 
the needs of many mothers. The reimbursement rate offered by 
many public and private health insurance providers is less than 
the cost of high quality pumps, which include an electric 
motor, replaceable parts that meet the anatomical needs of each 
mother, and optimal suction and cycling. The Committee 
encourages HHS to work with stakeholders to better provide 
women up-to-date information on how to access quality 
counseling, education, and breastfeeding equipment and 
supplies, including a list of in-network lactation consultants 
or other trained health care providers. HHS should also include 
information in the fiscal year 2020 Congressional Justification 
on how health insurers have implemented comprehensive lactation 
services, what standards they use to set reimbursement rates 
for breastfeeding supplies, and what best practices currently 
exist to provide coverage to help women breastfeed.
    Lymphedema Compression Garments.--Nearly two million 
Medicare beneficiaries lack equal access to Lymphedema 
Compression Garments. The Department of Veterans Affairs and 
the TRICARE program provide coverage for compression garments 
used to treat lymphedema, as do 42 states and the District of 
Columbia as part of their Medicaid programs, yet the Medicare 
program does not provide access to these garments for Medicare 
beneficiaries. The Committee notes CMS decision memorandum 
(CAG-00016N) encourages patients to use compression garments to 
prevent re-accumulation of fluid. In order to ensure equal 
access to care and adherence to CMS' recommendations, the 
Committee strongly encourages CMS to take necessary steps to 
ensure Medicare beneficiaries have access to Lymphedema 
Compression Garments. The Committee requests an update on this 
effort in the fiscal year 2020 Congressional Justification.
    Medicaid 1115 Waiver.--The Committee continues to note 
concern regarding the process for approval for section 1115 
Medicaid demonstrations. The Committee expects a collaborative 
process between CMS and States. These demonstrations serve as 
vital links to care for vulnerable populations. The Committee 
strongly encourages CMS to engage with States who have 
outstanding requests. Moreover, the Committee encourages CMS to 
give priority to requests that seek to ensure access to 
physician residency training and education for underserved and 
rural populations.
    Medicare Star Quality Rating System.--The Committee is 
concerned that the CMS Star Ratings system does not accurately 
rate plans that serve a larger proportion of dual eligible 
beneficiaries. Further, the Committee understands that as 
mandated by the Improving Medicare Post-Acute Care 
Transformation Act of 2014 (PL 113-185), the Assistant 
Secretary for Planning and Evaluation (ASPE) is conducting a 
study examining the effect of socioeconomic status on quality 
measures and resource use and other measures. CMS should not 
remove plans from markets based on three consecutive years of 
low star scores until the ASPE study is completed and the 
recommendations are implemented.
    Medication Diversion.--The Committee understands the 
important role of medication-assisted treatment for 
beneficiaries with opioid use disorder. At the same time, 
several State and Federal authorities report rising rates of 
diversion of these FDA-approved medications. The Committee 
requests CMS evaluate diversion data from the Drug Enforcement 
Administration and State sources to determine the scope of this 
problem and submit an update in the fiscal year 2020 
Congressional Justification. CMS should discuss specifically 
efforts to reduce division of prescriptions.
    Muscular Dystrophy.--The Committee is aware of the addition 
of the new ICD-10 code for Duchenne/Becker to the CMS FY 2019 
Codding Addenda. The Committee requests a report on utilization 
for the newly established ICD-10 code, as compared to the 
former broader ICD-10 code in the fiscal year 2020 
Congressional Justification.
    Naloxone.--Naloxone is a community-use overdose reversal 
agent that can be ingested through the nose. Some have 
recommended co-prescription of naloxone and opioids as a tool 
in mitigating the risk of overdose death. Studies within the 
Department of Veterans Affairs have determined co-prescriptions 
can reduce long-term opioid use by 39 percent. The Committee 
requests an update in the fiscal year 2020 Congressional 
Justification on efforts by CMS to address access to naloxone 
for identified at-risk populations.
    National Health Expenditures.--The Committee requests that 
CMS include a detailed explanation in its fiscal year 2020 
Congressional Justification of CMS' methodology for including 
data in the National Health Expenditure (NHE) database, and an 
analysis of how CMS-published data compares to other comparable 
information on health expenditures. The Committee remains 
concerned there are discrepancies between CMS estimates and 
industry surveys suggesting that CMS' method may understate the 
actual growth of private health insurance and total health 
spending at the household level. If private health spending is 
underreported in NHE, estimates of total health US spending may 
be too low as well.
    National Vaccine Advisory Committee.--Historically, 
disparities in childhood immunization rates have been reported 
in the US, with lower rates among children living in poverty, 
among urban children, and among black and Hispanic children. 
Children living below the Federal poverty level have lower 
coverage with many vaccinations compared to children living at 
or above the Federal poverty level since at least 2009. The CDC 
estimates that based on 2015 data an estimated 32.9 percent of 
US children aged 19-35 months were living below the poverty 
level. The Committee requests, as part of the fiscal year 2020 
Congressional Justification, the National Vaccine Advisory 
Committee, in coordination with CMS, to review data and provide 
to the Committee: the number of children under the age of 35 
months that received childhood vaccinations and an assessment 
on the extent to which individuals under the age of 35 months 
received vaccinations according to the vaccine schedule 
recommendation put forth by CDC.
    Out of Network Emergency Care.--The Committee is concerned 
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 (80 Fed. Reg. 72191). Therefore, 
the Committee requests CCIIO publish guidance, which may come 
in the form of Frequently Asked Questions, clarifying what 
constitutes the UCR amount using a transparent and fair 
standard, such as an independent unbiased charge database.
    Patient Access to Medically Necessary Foods.--The Committee 
notes that medical foods are an essential, physician-directed 
component of managing a variety of serious medical conditions. 
The Committee notes that patients continue to face a variety of 
access challenges related to coverage and reimbursement with 
many individuals and families being forced to pay for essential 
medical foods out-of-pocket. 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 improper barriers 
to access.
    Physician Disclosure.--The Committee encourages the 
Secretary to clarify that medical text books and journal 
article re-publications are considered as non-reportable 
transfers and permissible under the patient education exclusion 
as intended by Congress. The Committee believes these 
publications serve as direct patient education and should not 
be subject to reporting requirements of section 1128G of the 
Social Security Act.
    Physician-Owned Hospitals.--The Committee notes physician-
owned hospitals provide high quality healthcare to local 
communities. The Committee supports efforts by CMS to 
demonstrate the additional value these hospitals are able to 
provide to beneficiaries.
    Pneumococcal Vaccinations.--The Committee is concerned 
about the underutilization of pneumococcal vaccinations for 
adults and in particular high risk adults where rates do not 
exceed 20 percent. The Committee strongly urges CMS to work 
toward achievement of the Healthy People 2020 goals to reduce 
invasive pneumococcal infections and increase the percentage of 
adults, aged 65 or older, who are vaccinated against 
pneumococcal disease. CMS is encouraged 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.
    Prescription Drugs.--The Committee supports efforts to 
improve patient access to prescription drugs. The Committee is 
encouraged by recent proposals to lower costs for 
beneficiaries, generate savings for the Federal government, and 
increase access to medication for Medicare beneficiaries. As 
CMS evaluates options for the Prescription Drug Benefit 
Program, the Committee expects adherence to the noninterference 
clause, which ensures robust competition and beneficiary value.
    Preliminary Determinations.--CMS previously granted 
``preliminary determinations'' to hospitals to be designated as 
a Critical Access Hospitals (CAH). Following CMS guidance, 
these facilities made preparations to receive a final CAH 
designation, including paying for expensive upgrades and an on-
site survey. Subsequently, CMS revised its guidance for 
attaining CAH designation. Due to the length of time required 
to comply with the requirements included in the preliminary 
determination, facilities that were deemed in compliance by CMS 
proceeded to comply with CMS guidance, but were then 
subsequently denied final CAH status due to the change in CMS 
policy regarding CAH designation. The Committee requests that 
CMS monitor affected facilities and their local communities to 
help ensure access to care.
    Qualified Clincial Data Registries.--The Committee supports 
the development and utilization of Qualified Clincal Data 
Registries as part of the Center for Medicare and Medication 
Innovation's purpose of testing innovate payment and service 
delivery models. The Committee requests and update in the 
fiscal year 2020 Congressional Justification regarding 
compliance with section 105(b) of the Medicare Access and CHIP 
Reauthorization Act of 2015 (PL 114-10) and how CMS will 
support data that is real-time.
    Quality Payment Program.--The Committee understands 
numerous physicians were ineligible to receive reimbursement 
from the Quality Payment Program (QPP) due to changes to their 
tax identification number (TIN) made between August 31st and 
December 31st, 2017. Claims changes to the TIN that took place 
in this time frame were ineligible and could not be 
retroactively reimbursed due to technological shortcomings. The 
Committee encourages CMS to review the QPP's procedures and 
report back to the Committee in the fiscal year 2020 
Congressional Justification on proposals for necessary 
improvements to ensure qualified physicians are not denied 
reimbursement regardless of their employment start date.
    Readmission Rates.--The Committee is supportive of efforts 
within CMS to reduce readmission rates among high-risk seniors 
living in communities challenged by poverty, poor health 
literacy, health disparities or non-compliance with treatment 
regimens. In particular, flexible, community-based multi-payer 
arrangements have encouraged health and social service 
providers to combine efforts in tailoring services to these at-
risk populations. The Committee encourages CMS to work with 
community-based organizations to help identify best practices 
and transition them to Medicare's value-based purchasing 
initiatives.
    Recovery Audit Contractors.--The Committee acknowledges 
that the Medicare Trust Funds are at risk of insolvency and 
that Recovery Audit Contractors are an industry best practice 
that play an important role in preventing wasteful government 
spending. CMS should continue to utilize private sector best 
practices, such as recovery auditing, to address Medicare 
improper payments to the fullest extent.
    Renal Replacement Therapy.--The Committee requests CMS 
provide an update in the fiscal year 2020 Congressional 
Justification on efforts to inform the healthcare community 
that new renal replacement therapy codes are available for 
reporting and encourage such code use to support additional 
research in the acute kidney injury population.
    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 Medicare Part B program not to 
make further changes to these services (G0339 and G0340) in the 
freestanding center as CMS complies with the Patient Access and 
Medicare Protection Act (PL 114-115).
    Rural Health Clinics.--The Committee continues to encourage 
CMS to engage States and other stakeholders on outstanding 
issues of payment recoupment, as it relates to CMS-designated 
Rural Health Clinics. The Committee strongly supports the Rural 
Health Clinic program, which increases access to primary care 
services for Medicaid and Medicare patients in rural 
communities.
    Rural Nursing Homes.--Long-term services and supports are 
critical for the care and wellbeing of our senior population. 
Skilled nursing facilities play an instrumental role in 
providing this care for some of the most vulnerable Americans. 
Particularly in rural areas, ensuring continued access to high-
quality nursing facility care in an individual's home community 
is an ever-increasing challenge. Similar to Medicaid's 
prioritization of funding for Critical Access Hospitals, 
adequate reimbursement helps preserve access to skilled nursing 
facility care in our country's rural and frontier regions. The 
Committee requests an update in the fiscal year 2020 
Congressional Justification on CMS' efforts to support rural 
nursing facilities.
    Sepsis Testing.--In the United States, more than 1.5 
million people are diagnosed with sepsis resulting in 
approximately 250,000 deaths each year. CMS current SEP-1 
guidelines for treating septic patients are controversial and 
need to take into account evolving practices including the use 
of FDA approved tests for biomarkers like procalcitonin. SEP-1 
is highly prescriptive, replaces physician's discretion over 
care, and could lead to excessive antibiotic use. The Committee 
urges CMS to reevaluate their SEP-1 policy taking into account 
expanded FDA approvals for biomarker tests like procalcitonin 
in conjunction with its impact on antibiotic stewardship. CMS 
is also to identify the direct and indirect cost of treating 
sepsis patients on its Medicaid and Medicare programs. The 
Committee requests an update on these activities in the fiscal 
year 2020 Congressional Justification.
    Sexually Transmitted Diseases.--The Committee notes an 
increase in sexually transmitted diseases, particularly in 
pregnant women and young adults. To address this public health 
issue the Committee supports efforts to target at-risk and 
vulnerable populations. The Committee supports collaboration 
with CDC to address appropriate screening and treatment for 
these conditions.
    Technology and Ophthalmic Disorders.--The Committee notes 
that the specific use of technology, such as web-based 
telemedicine software, centralized reading centers, hand-held 
fundus cameras, photography training programs, and internet-
based storage and transmission of images can efficiently detect 
early signs of diabetic retinopathy and glaucoma in rural and 
underserved populations.
    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. This could include identification of 
barriers to pediatric telehealth coverage, as well as ways to 
address those barriers.
    Tribal Governance.--The Secretary, in coordination with the 
Indian Health Service, CMS, and CDC, is urged to facilitate and 
support partnerships with Tribes and medical colleges and 
universities as opportunites arise, in order to foster 
leadership development, build organizations to better deliver 
and coordinate high-quality care, and to support systems of 
care and prevention that can have a positive outcome on the 
health of the community and cost of care.
    Tribal Sovereignty.--Federally-recognized Indian Tribes are 
sovereign nations residing within a State. Moreover, Indian 
Tribes are political, sovereign entities to which the Federal 
government owes a trust responsibility. As a result of this 
responsibility, the Federal government has consistently held 
Indian Tribes as a unique group when applying Federal law and 
policy. Congress has routinely codified this relationship, most 
notably in the provision of health care by establishing a 
health system for Tribal populations exclusively. In addition, 
the Federal government has enacted exemptions to ensure States 
would not bear the burden of additional costs. Specifically, 
the Social Security Act provides a 100 percent Federal match 
for Medicaid services provided by an Indian or by an Indian 
Health Service or Tribally-operated facility. No discretionary 
action taken by any Administration can impede the direct 
relationship between the Federal government and the provision 
of health care for Indian Tribes.
    Volume Decrease Payment.--The Committee notes that a change 
in the Medicare Administrative Contractor (MAC) should not 
negatively impact provider payment. The Committee encourages 
CMS to ensure consistent policy and guidance is provided to all 
MACs to ensure overpayment notices to providers are processed 
promptly. The Committee supports efforts by CMS to encourage 
MACs to reduce the interval of time between the identification 
of an overpayment and official notice sent to the provider.

Federal Administration

    The Committee recommends $702,601,000 for Federal 
Administration activities related to the Medicare and Medicaid 
programs, which is $29,932,000 below the fiscal year 2018 
enacted level and the same as the fiscal year 2019 budget 
request. The Federal Administration funding supports CMS staff, 
along with operating and administrative expenses for planning, 
developing, managing, and evaluating healthcare financing 
programs and policies.
    Health Insurance Exchange Transparency.--The Committee 
continues to include bill language requiring 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 
Bid Review, Management and 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 Marketplace 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.

              HEALTH CARE FRAUD AND ABUSE CONTROL ACCOUNT

 
 
 
Appropriation, fiscal year 2018.......................      $745,000,000
Budget request, fiscal year 2019......................       770,000,000
Committee Recommendation..............................       765,000,000
    Change from enacted level.........................       +20,000,000
    Change from budget request........................        -5,000,000
 

    This includes a base amount of $311,000,000 and an 
additional $454,000,000 through a discretionary budget cap 
adjustment authorized under section 251(b) of the Balanced 
Budget and Emergency Deficit Control Act of 1985. The Health 
Care Fraud and Abuse Control Account (HCFAC) funds support 
activities conducted by CMS, the HHS Office of Inspector 
General, and the Department of Justice. This level is 
$20,000,000 above the fiscal year 2018 enacted level and 
$5,000,000 below the fiscal year 2019 budget request.
    This funding is in addition to other mandatory funding 
provided through authorizing legislation. The funding will 
provide resources to continue efforts for Medicaid program 
integrity activities, for safeguarding the Medicare 
prescription drug benefit and the Medicare Advantage program, 
and for program integrity efforts related to these programs 
carried out by the Department of Justice.
    The Committee continues to include bill language to ensure 
the Secretary funds the Senior Medicare Patrol Program 
administered by the Administration for Community Living from 
funds provided to this account.
    The Committee expects all recipients of funds from the 
Health Care Fraud and Abuse Control Account, the Centers for 
Medicare & Medicaid Services, the Department of Health and 
Human Services Office of Inspector General, and the Department 
of Justice, to use funds for efforts to address fraud and abuse 
as described in section 1128C of the Social Security Act.

                Administration for Children and Families


  PAYMENTS TO STATES FOR CHILD SUPPORT ENFORCEMENT AND FAMILY SUPPORT 
                                PROGRAMS

 
 
 
Appropriation, fiscal year 2018.......................    $2,995,400,000
Budget request, fiscal year 2019......................     2,922,247,000
Committee Recommendation..............................     2,922,247,000
    Change from enacted level.........................       -73,153,000
    Change from budget request........................             - - -
 

    The Committee also recommends $1,400,000,000 in advance 
funding, as requested, for the first quarter of fiscal year 
2020 to ensure timely payments for Child Support Enforcement 
programs. These programs support State-administered programs of 
financial assistance and services for low-income families to 
promote their economic security and self-sufficiency.

                   LOW INCOME HOME ENERGY ASSISTANCE

 
 
 
Appropriation, fiscal year 2018.......................    $3,640,304,000
Budget request, fiscal year 2019......................             - - -
Committee Recommendation..............................     3,640,304,000
    Change from enacted level.........................             - - -
    Change from budget request........................    +3,640,304,000
 

    Within the amount available for formula grants, the 
Committee recommends up to $2,988,000 for technical assistance, 
training, and monitoring of program activities. The Low Income 
Home Energy Assistance Program supports eligible families and 
households through programs providing assistance with energy 
costs.

                     REFUGEE AND ENTRANT ASSISTANCE

 
 
 
Appropriation, fiscal year 2018.......................    $1,864,936,000
Budget request, fiscal year 2019......................     1,792,311,000
Committee Recommendation..............................     1,864,936,000
    Change from enacted level.........................             - - -
    Change from budget request........................       +72,625,000
 

    The Office of Refugee Resettlement programs are designed to 
help refugees, asylees, Cuban and Haitian entrants, and 
trafficking victims become employed and self-sufficient. These 
programs also provide for care of unaccompanied immigrant 
children in Federal custody and victims of torture.
    Within the total, the Committee recommends the following:

------------------------------------------------------------------------
                   Budget Activity                     FY 2019 Committee
------------------------------------------------------------------------
Transitional and Medical Services....................       $320,000,000
Victims of Trafficking...............................         23,755,000
Refugee Support Services.............................        207,201,000
Unaccompanied Children...............................      1,303,245,000
Victims of Torture...................................         10,735,000
------------------------------------------------------------------------

    National Human Trafficking Training and Assistance 
Center.--The Committee directs the Administration for Children 
and Families to increase funding for the National Human 
Trafficking Hotline.
    Facility Oversight.--The Committee expects the Office of 
Refugee Resettlement (ORR) to maintain strict oversight of all 
ORR-funded care provider facilities and to report and correct 
violations of Federal, State, or local codes related to 
standards of childcare or the wellbeing of children. The 
Committee directs ORR, within 90 days of the enactment of this 
Act, to submit a report to the Committee detailing the number 
and nature of facility violations, and the steps it is taking 
to work with grantees to address and prevent such infractions.
    IG Report.--Within 30 days of enactment, the Inspector 
General shall report to the Committee on the implementation of 
and any interagency coordination associated with the previous 
policy of separating migrant families, the Executive Order 
issued on June 20, 2018 entitled `Affording Congress an 
Opportunity to Address Family Separation,' and efforts made to 
reunify families separated under the previous family separation 
policy.
    Unaccompanied Children.--The Committee supports oversight 
efforts relating to forced family separation and efforts to 
mitigate the trauma experienced by separated children.
    The Committee directs the Office of Refugee Resettlement 
(ORR) to comply with its legally mandated duties as outlined in 
Section 462 of the Homeland Security Act of 2002, Section 235 
of the William Wilberforce Trafficking Victims Protection 
Reauthorization Act of 2008, and the 1997 Flores settlement 
agreement.
    Unaccompanied Children.--The Committee directs that in 
cases of separation, within 24 hours, parents, legal guardians, 
or other relatives shall be informed of the whereabouts of 
their children and children shall be informed of the 
whereabouts of their parents, legal guardians, or other 
relatives, except in cases of suspected abuse or trafficking.
    The Committee also directs the Secretary of HHS to work in 
collaboration with the Secretary of DHS to submit a report to 
the Committees on Appropriations of the House of 
Representatives and of the Senate within 60 days of this bill's 
enactment detailing actions it has taken and will take and 
policies it has implemented and will implement to facilitate: 
(1) the ability of separated children to make contact and 
maintain communication with their separated parents, relatives, 
legal guardians, or primary caregivers (for tender-age and non-
verbal children, this should include methods to facilitate in-
person visits and video chats); (2) the ability of family 
members residing abroad to utilize the hotline to receive 
information on the status and location of separated children; 
and (3) the coordinated reunification and post-release support 
of a separated child and adult family member, when it is in the 
best interest of the child.
    Protection of DNA.--The Committee understands that DNA 
testing is being used for the purpose of reunifying families 
that were separated by the Department of Homeland Security. The 
Committee directs the Office of Refugee Resettlement (ORR) to 
ensure the protection of privacy and genetic material, data, or 
information of children, parents, and of all individuals being 
tested and their relatives. The Committee prohibits any 
governmental agency or private entity from accessing using, or 
storing any genetic material, data, or information collected in 
this reunification effort, including for the purpose of 
criminal or immigration enforcement. Any genetic material, 
data, and information obtained should be fully destroyed after 
testing and the probability of a genetic relationship is 
calculated. The entities conducting the DNA testing shall 
obtain the consent of any individual over age 18 prior to 
testing, and shall make every effort to obtain the consent of a 
guardian prior to testing on anyone under age 18.

               PAYMENTS TO STATES FOR THE CHILD CARE AND 
                        DEVELOPMENT BLOCK GRANT

 
 
 
Appropriation, fiscal year 2018.......................    $5,226,000,000
Budget request, fiscal year 2019......................     3,006,000,000
Committee Recommendation..............................     5,226,000,000
    Change from enacted level.........................             - - -
    Change from budget request........................    +2,220,000,000
 

    The Child Care and Development Block Grant provides funds 
according to a formula to States, territories, and Tribes to 
provide financial assistance to help low-income working 
families and families engaged in training or education 
activities access child care and to improve the quality of 
child care for all children.
    The Committee includes $100,000,000 in bill language for 
competitive grants to States, territories, Tribes, local 
governments, and public entities to develop, implement, and 
evaluate models of providing care for working families in rural 
communities, families needing child care on an emergency basis, 
and families with non-traditional work hours.
    The Committee recognizes that many child care providers are 
small business owners and therefore may need support to 
strengthen business operations. Accordingly, the committee 
recognizes that Child Care and Development Block Grant (CCDBG) 
funds could be used to strengthen the business practices of 
child care providers to expand the supply and improve the 
quality of child care services. Areas of support for child care 
providers may include, but are not limited to, such practices 
related to fiscal management, budgeting, record-keeping, 
hiring, developing, and retaining qualified staff, risk 
management, community relationships, marketing and public 
relations, and parent-provider communications, including who 
delivers the training, education and/or technical assistance. 
Accordingly, the Committee supports efforts by the Office of 
Child Care to report on its efforts to support States with 
strengthening business practices of child care providers, 
including available data on the average salaries and retention 
of child care staff by State and type of care, in the biennial 
Childcare Development Fund Report to Congress required by 
Section 658L of the CCDBG.

                      SOCIAL SERVICES BLOCK GRANT

 
 
 
Appropriation, fiscal year 2018.......................    $1,700,000,000
Budget request, fiscal year 2019......................     1,785,000,000
Committee Recommendation..............................     1,700,000,000
    Change from enacted level.........................             - - -
    Change from budget request........................       -85,000,000
 

    The Social Services Block Grants provides grants to States 
by formula. States have the flexibility to determine what 
services and activities are supported, provided they are 
targeted at a broad set of goals, including reducing or 
eliminating poverty, achieving or maintaining self-sufficiency, 
and preventing neglect, abuse, or exploitation of children and 
adults.

                CHILDREN AND FAMILIES SERVICES PROGRAMS

 
 
 
Appropriation, fiscal year 2018.......................   $12,022,225,000
Budget request, fiscal year 2019......................    10,323,890,000
Committee Recommendation..............................    12,122,225,000
    Change from enacted level.........................      +100,000,000
    Change from budget request........................    +1,798,335,000
 

    The Children and Families Services programs fund activities 
serving children, youth, families, the developmentally 
disabled, Native Americans, victims of child abuse and neglect 
and domestic violence, and other vulnerable populations.
    The Committee recommends the following amounts:

------------------------------------------------------------------------
                                                            FY 2019
                   Budget Activity                         Committee
------------------------------------------------------------------------
Programs for Children, Youth, and Families:
    Head Start.......................................     $9,913,095,000
        Early Head Start-Child Care Partnerships.....        780,000,000
    Preschool Development Grants.....................        250,000,000
    Runaway/Homeless Youth...........................        104,280,000
    Abuse of Runaway Youth Prevention................         17,141,000
    State Child Abuse Prevention.....................         85,310,000
    Discretionary Child Abuse Prevention.............         33,000,000
    Community-based Child Abuse Prevention...........         39,764,000
    Child Welfare Services...........................        278,735,000
    Child Welfare Training...........................         17,984,000
    Adoption Opportunities...........................         39,100,000
    Adoption Incentives..............................         80,000,000
    Social Services/Income Maintenance Research......          6,512,000
    Native American Programs.........................         55,050,000
Community Services:
    Community Services Block Grant...................        750,000,000
    Community Economic Development...................         19,883,000
    Rural Community Facilities.......................         10,000,000
Domestic Violence Hotline............................          9,250,000
Family Violence/Battered Women's Shelters............        160,000,000
Independent Living Training Vouchers.................         43,257,000
Disaster Human Services Case Management..............          1,864,000
Program Direction....................................        208,000,000
------------------------------------------------------------------------

Head Start

    The Committee recommends $9,913,095,000 for the Head Start 
program, which is $50,000,000 above the fiscal year 2018 
enacted level and $638,095,000 above the fiscal year 2019 
budget request. Within the total for Head Start, the Committee 
recommends $25,000,000 for a cost-of-living adjustment and 
includes $25,000,000 for the Designation Renewal System. Head 
Start promotes school readiness of children under 5 from low-
income families through education, health, social and other 
services.
    In addition, the Committee recommends $780,000,000 for 
Early Head Start-Child Care Partnership grants, which is 
$25,000,000 above the fiscal year 2018 enacted level and 
$780,000,000 above the fiscal year 2019 budget request. The 
Early Head Start-Child Care Partnership program brings together 
Early Head Start and child care through layering of funding to 
provide comprehensive and continuous services to low-income 
infants, toddlers, and their families. The program enhances 
developmental services and supports for low-income infants and 
toddlers, and their families, by providing strong relationship-
based experiences and preparing them for the transition into 
Head Start and preschool.
    The Committee notes that HHS is in the process of reviewing 
public comments on proposed changes to the Designation Renewal 
System (DRS), which is a key tool in ensuring strong standards. 
The Committee is also aware of concerns regarding the use of 
the CLASS lowest 10 percent provision in appropriately 
identifying grantees subject to re-competition. The Committee 
encourages HHS to complete this review promptly, and to 
maintain high standards, strong accountability, and 
transparency to grantees and the public, while ensuring the 
integrity of program evaluation measures.

Preschool Development Grants

    The Committee recommends $250,000,000 for Preschool 
Development Grants, which is the same as the fiscal year 2018 
enacted level and $250,000,000 above the fiscal year 2019 
budget request. This program provides grants to States to build 
State and local capacity to provide preschool for 4-year-olds 
from low- and moderate-income families. Research confirms that 
high-quality preschool improves school readiness and long-term 
academic success of children by supporting their academic and 
social-emotional skills. Support for this grant is an important 
step to building a globally competitive 21st century workforce.

Child Abuse Discretionary Activities

    Child Abuse Hotline.--The Committee notes the lack of 
knowledge regarding effective and appropriate text-based 
intervention and education services for child abuse victims and 
concerned adults as this new communications channel becomes 
more prevalent. Therefore, the Committee provides $1,500,000 
for an extramural grant to develop and expand text capabilities 
and protocols for a national child abuse hotline to determine 
best practices in appropriate communication, identity 
verification, privacy protection, and resource sharing with 
youth seeking assistance.

Native American Programs

    The Committee recommends $55,050,000 for Native American 
Programs, which is $1,000,000 above fiscal year 2018 enacted 
level and $3,000,000 above the fiscal year 2019 budget request. 
These programs assist Tribal and village governments and Native 
American institutions and organizations in their efforts to 
support and develop stable, diversified local economies. Tribes 
and non-profit organizations use funds to develop and implement 
sustainable community-based social and economic programs and 
services to improve the well-being of Native people.
    Within the total, the Committee recommendation includes 
$12,000,000 for Native American language preservation 
activities, including $3,000,000 for Generation Indigenous, 
which focuses on improving Native American language instruction 
across the educational continuum. The Committee provides not 
less than $4,000,000 for language immersion programs as 
authorized by section 803C(b)(7)(A)-(C) of the Native American 
Programs Act, as amended by the Esther Martinez Native American 
Language Preservation Act of 2006. The Committee strongly 
encourages the Administration for Children and Families to give 
priority to grantees with rigorous immersion programs.

Community Services Programs

    Community Services Block Grant.--The Committee recommends 
$750,000,000 for the Community Services Block Grant, which is 
$35,000,000 more than the fiscal year 2018 enacted level and 
$715,000,000 more than the fiscal year 2019 budget request. The 
Community Services Block Grant provides funds to alleviate the 
causes and conditions of poverty in communities.
    Community Economic Development.--The Committee recommends 
$19,883,000 for the Community Economic Development Grants, 
which is the same as the fiscal year 2018 enacted level and 
$19,883,000 more than the fiscal year 2019 budget request. 
Community Economic Development is a grant program, which funds 
Community Development Corporations. Community Development 
Corporations seek to address the economic needs of low-income 
individuals and families through the creation of sustainable 
business development and employment opportunities.
    Rural Community Facilities Development.--The Committee 
recommends $10,000,000 for the Rural Community Facilities 
program, which is $2,000,000 more than the fiscal year 2018 
enacted level, and $10,000,000 more than the fiscal year 2019 
budget request. Rural Community Development is a grant program 
that works with regional and Tribal organizations to manage 
safe water systems in rural communities.

Family Violence Prevention and Battered Women's Shelters

    The Committee recommends $160,000,000 for the Family 
Violence Prevention and Battered Women's Shelters programs, 
which is the same as the fiscal year 2018 enacted level and 
$9,000,000 above the fiscal year 2019 budget request. The 
Family Violence Prevention and Services Act programs provide 
funding to support the prevention of incidents of family 
violence, domestic violence, and dating violence, and provide 
the immediate shelter and supportive services for adult and 
youth victims (and their dependents).

                   PROMOTING SAFE AND STABLE FAMILIES

 
 
 
Appropriation, fiscal year 2018.......................      $444,765,000
Budget request, fiscal year 2019......................       534,765,000
Committee Recommendation..............................       404,765,000
    Change from enacted level.........................       -40,000,000
    Change from budget request........................      -130,000,000
 

    The Committee recommends $345,000,000 in mandatory funds 
for the Promoting Safe and Stable Families program, which is 
the same as the fiscal year 2018 enacted level and $20,000,000 
below the fiscal year 2019 budget request. The Committee also 
recommends $59,765,000 in discretionary funds for this program, 
which is $40,000,000 below the fiscal year 2018 enacted level 
and $150,000,000 below the fiscal year 2019 budget request. 
This program enables each State to operate a coordinated 
program of family preservation services, community-based family 
support services, time-limited reunification services, and 
adoption promotion and support services. States receive funds 
based on their share of children in all States receiving food 
stamp benefits.

                PAYMENTS FOR FOSTER CARE AND PERMANENCY

 
 
 
Appropriation, fiscal year 2018.......................    $6,225,000,000
Budget request, fiscal year 2019......................     6,035,000,000
Committee Recommendation..............................     6,035,000,000
    Change from enacted level.........................      -190,000,000
    Change from budget request........................             - - -
 

    The Committee also recommends an advance appropriation of 
$2,800,000,000 for the first quarter of fiscal year 2020 to 
ensure timely completion of first quarter grant awards.
    Within the total, the Committee recommends $5,329,000,000 
for the Foster Care program, which is $208,000,000 below the 
fiscal year 2018 enacted level and the same as the fiscal year 
2019 budget request. This program provides funds to States for 
foster care maintenance payments for children living in foster 
care. These funds also reimburse States for administrative 
costs to manage the program and training for staff and parents.
    Within the total, the Committee recommends $3,063,000,000 
for Adoption Assistance, which is $196,000,000 more than the 
fiscal year 2018 enacted level and the same as the fiscal year 
2019 budget request. This program provides funds to States to 
subsidize families who adopt children with special needs, such 
as older children, a member of a minority or sibling group, or 
children with physical, mental, and emotional disabilities. In 
addition, the program provides training for adoptive parents 
and State administrative staff. This annually appropriated 
entitlement provides alternatives to long, inappropriate stays 
in foster care by developing permanent placements with 
families.
    Within the total, the Committee recommends $203,000,000 for 
the Kinship Guardianship Assistance program, which is 
$22,000,000 more than the fiscal year 2018 enacted level and 
the same as the fiscal year 2019 budget request. This program 
provides subsidies to a relative taking legal guardianship of a 
child for whom being returned home or adoption are not 
appropriate permanency options.
    Finally, within the total, the Committee recommends 
$140,000,000 for the Independent Living program, which is the 
same as the fiscal year 2018 enacted level and the fiscal year 
2019 budget request. This program assists foster children age 
16 or older make successful transitions to independence. Funds 
support a variety of services, including educational 
assistance, career exploration, vocational training, job 
placement, life skills training, home management, health 
services, substance abuse prevention, preventive health 
activities, and room and board. Each State receives funds based 
on the number of children on whose behalf the State receives 
Federal Foster Care Payments.

                  Administration for Community Living


                 AGING AND DISABILITY SERVICES PROGRAMS

 
 
 
Appropriation, fiscal year 2018.......................    $2,144,215,000
Budget request, fiscal year 2019......................     1,818,681,000
Committee Recommendation..............................     2,186,732,000
    Change from enacted level.........................       +42,517,000
    Change from budget request........................      +368,051,000
 

    Created in 2012, the Administration for Community Living 
(ACL) brings together the efforts and achievements of the 
Administration on Aging, the Administration on Intellectual and 
Developmental Disabilities, and the HHS Office on Disability to 
serve as the Federal agency responsible for increasing access 
to community supports, while focusing attention and resources 
on the unique needs of older Americans and people with 
disabilities across the lifespan.
    The Committees recommends funding for the Senior Medicare 
Patrol Program, and provides this funding under the Health Care 
Fraud and Control Abuse Account.

Home and Community-Based Supportive Services

    The Committee recommends $385,074,000 for Home and 
Community-Based Supportive Services, which is the same as the 
fiscal year 2018 enacted level and $34,850,000 above the fiscal 
year 2019 budget request. This program provides formula grants 
to States and territories to fund a wide range of social 
services that enable seniors to remain independent in their 
homes for as long as possible.

Preventive Health Services

    The Committee recommends $24,848,000 for Preventive Health 
Services, which is the same as the fiscal year 2018 enacted 
level and the fiscal year 2019 budget request. This program 
funds activities that help seniors remain healthy and avoid 
chronic diseases.

Protection of Vulnerable Older Americans

    The Committee recommends $21,658,000 for activities to 
protect vulnerable older Americans, which is the same as the 
fiscal year 2018 enacted level and $1,030,000 above the fiscal 
year 2019 budget request. These programs provide grants to 
States for protection of vulnerable older Americans through the 
Long-Term Care Ombudsman and Prevention of Elder Abuse and 
Neglect programs.

Family Caregiver Support Services

    The Committee recommends $180,586,000 for the National 
Caregiver Support program, which is the same as the fiscal year 
2018 enacted level and $30,000,000 above the fiscal year 2019 
budget request. This program supports a multifaceted support 
system in each State for family caregivers.

Native American Caregiver Support Services

    The Committee recommends $10,556,000 for the Native 
American Caregiver Support program, which is $1,000,000 above 
the fiscal year 2018 enacted level and $3,000,000 above the 
fiscal year 2019 budget request. 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 disabilities.

Congregate and Home-Delivered Nutrition Services

    The Committee recommends a total of $896,753,000 for senior 
nutrition. The Committee recommends $490,342,000 for Congregate 
Nutrition Services, which is the same as the fiscal year 2018 
enacted level and $40,000,000 above the fiscal year 2019 budget 
request. The Committee recommends $246,342,000 for Home-
Delivered Meal Services, which is the same as the fiscal year 
2018 enacted level and $19,000,000 above the fiscal year 2019 
budget request. The Committee recommends $160,069,000 for the 
Nutrition Services Incentives program, which is the same as the 
fiscal year 2018 enacted level and the fiscal year 2019 budget 
request. These programs help older Americans remain healthy and 
independent in their communities by providing meals and related 
services in a variety of settings (including congregate 
facilities such as senior centers) and via home-delivery to 
older adults who are homebound due to illness, disability, or 
geographic isolation.

Native American Nutrition and Supportive Services

    The Committee recommends $35,208,000 for Native American 
Nutrition and Supportive Services, which is $2,000,000 above 
the fiscal year 2018 enacted level and $4,000,000 above the 
fiscal year 2019 budget request. This program provides grants 
to Tribes to promote the delivery of nutrition and home and 
community-based supportive services to Native American, Alaskan 
Native, and Native Hawaiian elders.

Aging Network Support Activities

    The Committee recommends $17,461,000 for the Aging Network 
Support Activities, which is $5,000,000 more than the fiscal 
year 2018 enacted level and $8,463,000 more than the fiscal 
year 2019 budget request. This program supports activities that 
expand public understanding of aging and the aging process.
    Care Corps Grants.--The Committee recognizes the growing 
demand for services and supports to help seniors and 
individuals with disabilities live independently in their 
homes, and the need to support family caregivers who facilitate 
that independence. In addition to existing aging network 
support activities funded under Section 411 of the Older 
Americans Act, the Committee includes $5,000,000 for grants to 
public agencies or private nonprofit agencies for the purpose 
of placing volunteers in communities to assist family 
caregivers and/or assist seniors and individuals with 
disabilities in maintaining independence by providing non-
medical care. Such grants shall be consistent with the 
requirements of the Nationwide Program for National and State 
Background checks on direct patient access employees of long-
term care facilities and providers, and the worker displacement 
and grievance provisions in the AmeriCorps program.
    Holocaust Survivor's Assistance.--The Committee provides 
not less than $5,000,000 for the Holocaust Survivor's 
Assistance program. This program provides supportive services 
for aging Holocaust survivors living in the U.S.

Alzheimer's Disease Program

    The Committee recommends $23,500,000 for the Alzheimer's 
disease program, which is the same as the 2018 enacted program 
level and $4,010,000 above the fiscal year 2019 budget request. 
This program provides competitive matching grants to a limited 
number of States to encourage program innovation and 
coordination of public and private services for people with 
Alzheimer's disease and their families.
    Technology and Caregiver Health.--In 2017, Medicare and 
Medicaid spent an estimated $175 billion caring for those with 
Alzheimer's and other dementias, 68 percent of total costs 
spent nationally. It is the most expensive disease in America. 
While medical breakthroughs to prevent, slow, or stop the 
disease are critical, interventions that reduce the cost and 
increase the effectiveness of care can be an invaluable method 
to bend the cost curve. The Committee supports efforts to 
improve caregiver health through a self-management support 
system using home-based telehealth technology. Such a system 
could reduce the cost of institutional health care and 
emergency room visits for individuals with Alzheimer's and 
Dementia by providing significant support to both the informal 
caregiver and the patient in home-based care. The Committee 
supports technology solutions that can monitor, assess, guide, 
educate, and provide alerts to enhance both physical and 
psychosocial dimensions of caregiver's well-being.

Lifespan Respite Care

    The Committee recommends $4,110,000 for Lifespan Respite 
Care, which is the same as the fiscal year 2018 enacted level 
and $750,000 above the fiscal year 2019 budget request. The 
program focuses on easing the burdens of caregiving by 
providing grants to eligible State organizations to improve the 
quality of, and access to, respite care for family caregivers.

Elder Falls

    The Committee recommends $5,000,000 for the Elder Falls 
program, which is the same as the fiscal year 2018 enacted 
level and $5,000,000 above the fiscal year 2019 budget request. 
Fall prevention grants support the promotion and dissemination 
of prevention tools delivered in community settings.

Chronic Disease Self-Management Program

    The Committee recommends $8,000,000 for the Chronic Disease 
Self-Management program, which is the same as the fiscal year 
2018 enacted level and $8,000,000 above the fiscal year 2019 
budget request. This program supports grants to States for low-
cost, evidence-based prevention models that use state-of-the-
art techniques to help those with chronic conditions address 
issues related to the management of their disease.

Elder Rights Support Activities

    The Committee recommends $15,874,000 for Elder Rights 
Support Activities, which is the same as the fiscal year 2018 
enacted level and $4,000,000 above the fiscal year 2019 budget 
request. This program supports efforts that provide 
information, training, and technical assistance to legal and 
aging services organizations towards the end of preventing and 
detecting elder abuse and neglect.

Aging and Disability Resource Centers

    The Committee recommends $8,119,000 for Aging and 
Disability Resource Centers, which is the same as the fiscal 
year 2018 enacted level and $2,000,000 above the fiscal year 
2019 budget request. These centers provide information, 
counseling and access for individuals to learn about the 
services and support options available to seniors and the 
disabled so they may retain their independence.

State Health Insurance Assistance Program

    The Committee recommends $49,115,000 for the State Health 
Insurance Assistance Program, which is the same as the fiscal 
year 2018 enacted level and $49,115,000 above the fiscal year 
2019 budget request. The State Health Insurance Assistance 
Program provides Medicare beneficiaries with information, 
counseling, and enrollment assistance.

Paralysis Resource Center

    The Committee recommends $7,700,000 for the Paralysis 
Resource Center, which is the same as the fiscal year 2018 
enacted level and $7,700,000 above the fiscal year 2019 budget 
request. The Paralysis Resource Center offers activities and 
services aimed at increasing independent living for people with 
paralysis and related mobility impairments, and supporting 
integration into the physical and cultural communities in which 
they live.

Limb Loss Resource Center

    The Committee recommends $3,500,000 for the Limb Loss 
Resource Center, which is the same as the fiscal year 2018 
enacted level and $3,500,000 above the fiscal year 2019 budget 
request. The Limb Loss Resource Center supports a variety of 
programs and services for those living with limb loss, 
including a national peer support program, educational events, 
training for consumers and healthcare professionals, and 
information and referral services.

Traumatic Brain Injury

    The Committee recommends $11,321,000 for the Traumatic 
Brain Injury program, which is the same as the fiscal year 2018 
enacted level and $2,000,000 above the fiscal year 2019 budget 
request. The program provides grants to States for the 
development of a comprehensive, coordinated family and person-
centered service system at the State and community level for 
individuals who sustain a traumatic brain injury.

Developmental Disabilities State Councils

    The Committee recommends $76,000,000 for State Councils on 
Developmental Disabilities, which is the same as the fiscal 
year 2018 enacted level and $20,000,000 above the fiscal year 
2019 budget request. The Developmental Disabilities State 
Councils work to develop, improve and expand the system of 
services and supports for people with developmental 
disabilities.

Developmental Disabilities Protection and Advocacy

    The Committee recommends $40,734,000 for Developmental 
Disabilities Protection and Advocacy, which is the same as the 
2018 enacted level and $2,000,000 above the fiscal year 2019 
budget request. This formula grant program provides funding to 
States to establish and maintain protection and advocacy 
systems to protect the legal rights of persons with 
developmental disabilities.
    The Committee recognizes that the Americans with 
Disabilities Act (ADA) encourages States to administer services 
for people with Intellectual/Developmental Disabilities (I/DD) 
``in the most integrated setting appropriate to the needs of 
qualified individuals with disabilities.'' As a result of 
enactment of the ADA and the Supreme Court decision in Olmstead 
v. L.C. (1999), there has been a national trend towards 
deinstitutionalization, whereby individuals have been 
encouraged to move out of State-run and other Federally-funded, 
certified facilities and into residential settings in their 
respective communities. However, the Committee is aware that 
many family members and legal guardians of individuals residing 
in these facilities have been pressured to move their loved 
ones into the community against their wishes. The Committee is 
concerned about the adequacy of community-based housing and the 
lack of specialized care and support services available in 
these settings. In addition, the Committee notes concern 
regarding the pace of transfer to community-based settings for 
some individuals, higher rates of abuse and mortality in 
community settings, and the adequacy of opportunities for 
residents to express views and preferences throughout the 
transfer process.
    The Committee fully supports the ADA's goal of enabling 
people with I/DD to receive services ``in the most integrated 
setting appropriate to their needs.'' However, the Committee 
also notes that Olmstead held that the ADA does not condone or 
require removing individuals from institutional settings when 
they are unable to handle or benefit from a community-based 
setting and that the ADA does not require the imposition of 
community-based treatment on patients who do not desire it. 
Congress endorsed the same principle in the Developmental 
Disabilities (DD) Act of 2000. By continuing to pursue closure 
of facilities that are authorized by Federal law to provide 
services to people with I/DD under the Intermediate Care 
Facilities for Individuals with Intellectual Disabilities 
program, DD Act programs are also overriding the decisions of 
States on how to best allocate resources.
    The Committee remains concerned that the 
deinstitutionalization stance taken by both Federally-supported 
DD Act programs and the Department of Justice in its related 
prosecutorial discretion involve impact individuals who may be 
unable to handle or benefit from community integration and do 
not desire such care. The Committee strongly urges the 
Department to ensure that DD Act programs properly account for 
the needs and desires of patients, their families and 
caregivers, and the importance of affording patients the proper 
setting for their care, into enforcement of the Americans with 
Disabilities Act.

Voting Access for Individuals with Disabilities

    The Committee recommends $6,963,000 for Voting Access for 
Individuals with Disabilities program, which is the same as the 
fiscal year 2018 enacted level and $2,000,000 above the fiscal 
year 2019 budget request. The Voting Access for Individuals 
with Disabilities program authorized by the Help America Vote 
Act provides formula grants to ensure full participation in the 
electoral process for individuals with disabilities, including 
registering to vote, casting a vote, and accessing polling 
places.

Developmental Disabilities Projects of National Significance

    The Committee recommends $12,000,000 for Developmental 
Disabilities Projects of National Significance, which is the 
same as the fiscal year 2018 enacted level and $10,950,000 
above the fiscal year 2019 budget request. This program funds 
grants and contracts that develop new technologies and 
demonstrate innovative methods to support the independence, 
productivity, and integration of those living with a disability 
into the community. The Committee recommends not less than 
$1,000,000 for transportation assistance activities for older 
adults and persons with disabilities. The transportation 
activities should focus on the most cost-effective and 
sustainable strategies that can be replicated to other 
communities.

University Centers for Excellence in Developmental Disabilities

    The Committee recommends $40,619,000 for University Centers 
for Excellence in Developmental Disabilities, which is the same 
as the fiscal year 2018 enacted level and $8,073,000 above the 
fiscal year 2019 budget request. The University Centers for 
Excellence in Developmental Disabilities Education, Research, 
and Service are a nationwide network of independent but 
interlinked centers, representing a national resource for 
addressing issues, finding solutions, and advancing research 
related to the needs of individuals with developmental 
disabilities and their families.

Independent Living

    The Committee recommends $120,000,000 for the Independent 
Living program, of which $27,000,000 is for the Independent 
Living State Grants program and $93,000,000 is for the Centers 
for Independent Living program. This funding level is 
$6,817,000 above the fiscal year 2018 enacted level and 
$24,003,000 above the fiscal year 2019 budget request. 
Independent Living programs maximize the leadership, 
empowerment, independence, and productivity of individuals with 
disabilities.
    The Committee expects ACL to distribute funds as soon as 
possible. In addition, the Committee strongly supports efforts 
by ACL to engage the grantee and stakeholder community to 
assist in planning for the grant cycle.

National Institute on Disability, Independent Living, and 
        Rehabilitation Research

    The Committee recommends $104,970,000 for the National 
Institute on Disability, Independent Living, and Rehabilitation 
Research (NIDILRR), which is the same as the fiscal year 2018 
enacted level and $104,970,000 above the fiscal year 2019 
budget request. NIDILRR generates knowledge and promote its 
effective use to enhance the abilities of people with 
disabilities to perform activities of their choice in the 
community and to expand society's capacity to provide full 
opportunities for its citizens with disabilities.
    The Committee does not move NIDILRR to NIH, as proposed in 
the fiscal year 2019 budget request. The Committee believes 
NIDILRR's unique mission to improve the abilities of 
individuals with disabilities is best achieved within ACL.

Assistive Technology

    The Committee recommends $36,000,000 for Assistive 
Technology, which is the same as the fiscal year 2018 enacted 
level and $4,061,000 above the fiscal year 2019 budget request. 
Assistive Technology (AT) supports programs providing grants to 
States for addressing assistive technology needs of individuals 
with disabilities. The goal is to increase awareness of and 
access to assistive technology devices and services that may 
help with education, employment, daily activities, and 
inclusion of people with disabilities in their communities.
    Of this amount, the Committee provides $2,000,000 for 
competitive grants to support existing and new alternative 
financing programs that provide for the purchase of AT devices. 
The Committee intends for this funding to support the expansion 
of existing programs and the creation of new programs that 
allow greater access to affordable financing to help people 
with disabilities purchase the specialized technologies 
required to live independently, to succeed at school and work 
and to live active and productive lives. Programs that have 
previously received funding are eligible to compete but must 
report on how the prior funding has been used, including the 
number of loans extended and individuals served, funding 
leveraged, and asset development programs created. The 
Committee intends for applicants to incorporate credit-building 
activities into their programs, including financial education 
and information about other possible funding sources. 
Successful applicants must emphasize consumer choice and 
control and build programs that will provide financing for the 
full array of AT devices and services and ensure that all 
people, regardless of type of disability or health condition, 
age, level of income, and residence have access to the program. 
AT programs maximize the ability of individuals with 
disabilities of all ages and their family members, guardians, 
advocates, and authorized representatives to obtain AT devices 
and AT services.

Program Administration

    The Committee recommends $41,063,000 for Program 
Administration, which is the same as the fiscal year 2018 
enacted level and $3,076,000 above the fiscal year 2019 budget 
request. This funding supports Federal administrative costs 
associated with administering ACL's programs.
    The Achieving a Better Live Experience Act of 2014 or ABLE 
Act (PL 113-295) 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 the Administration on 
Community Living through its programs supporting individuals 
living with a disability to raise awareness on the eligibility 
and benefits of these accounts. The Committee requests an 
update on this effort in the fiscal year 2020 Congressional 
Justification.

                        Office of the Secretary


                OFFICE OF MEDICARE HEARINGS AND APPEALS

 
 
 
Appropriation, fiscal year 2018.......................      $182,381,000
Budget request, fiscal year 2019......................       112,381,000
Committee Recommendation..............................       172,381,000
    Change from enacted level.........................       -10,000,000
    Change from budget request........................       +60,000,000
 

    This Office supports hearings at the administrative law 
judge level, the third level of Medicare claims appeals.
    Medicare Appeals Backlog.--The Committee is concerned with 
the size the Medicare Appeals Backlog. The Committee supports 
the Office of Medicare Hearings and Appeals to take 
administrative actions that will reduce the number of cases 
awaiting a hearing with an Administrative Law Judge.

                    GENERAL DEPARTMENTAL MANAGEMENT

 
 
 
Appropriation, fiscal year 2018.......................      $535,457,000
Budget request, fiscal year 2019......................       342,990,000
Committee Recommendation..............................       433,290,000
    Change from enacted level.........................      -102,167,000
    Change from budget request........................       +90,300,000
 

    Of the funds provided, $53,445,000 shall be derived from 
evaluation set-aside funds available under section 241 of the 
Public Health Service Act, which is $11,383,000 below the 
fiscal year 2018 enacted level and the same as the fiscal year 
2019 budget request.
    This appropriation supports activities that are associated 
with the Secretary's roles as policy officer and general 
manager of the Department of Health and Human Services. The 
Office of the Secretary also implements administration and 
Congressional directives, and provides assistance, direction 
and coordination to the headquarters, regions, and field 
organizations of the department. In addition, this funding 
supports the Office of the Surgeon General and several other 
health promotion and disease prevention activities that are 
centrally administered.
    Black Men in the Medical Profession.--The Committee 
supports the efforts of the National Academies of Sciences, 
Engineering, and Medicine to explore the factors that 
contribute to the low participation of Black men in the medical 
profession. The Committee urges the Secretary, in collaboration 
with NIH, to review the proceedings of the November 2017 joint 
workshop on this topic, titled An American Crisis: The Growing 
Absence of Black Men in Medicine and Science: Proceedings of 
Joint Workshop. The Committee directs the Secretary to submit 
an action plan to address the increasing underrepresentation of 
Black men in medical schools and in the medical profession to 
the Committee within 180 days of enactment of this Act.
    Cybersecurity.--The Committee is concerned about reports 
that indicate hospitals and medical practitioners are not 
adequately protecting patient records with respect to cyber 
threats. While laws exist to provide such protection, these 
laws are weakly enforced such that there is little 
accountability for inadequate compliance with cybersecurity 
protocols. The Committee requests the Secretary assess the 
adequacy of current enforcement policy and additional measures 
that may be necessary to hold those who are responsible for 
compliance with existing regulations accountable.
    Early Detection of Brain Aneurysms.--The Committee 
recognizes that although one in 50 Americans have a brain 
aneurysm, there are typically no warning signs or symptoms. 
Unfortunately, 40 percent of patients will not survive a brain 
aneurysm hemorrhage. Even when an aneurysm has bled, the 
symptoms are not widely known among health care professionals, 
including first responders and emergency room physicians. As a 
result, individuals who experience a hemorrhage from a brain 
aneurysm can be easily misdiagnosed, potentially missing an 
opportunity to institute life-saving treatments. The Committee 
encourages the Secretary, in consultation with appropriate 
stakeholders--including neurosurgeons, neurologists, neuro-
interventional surgeons, emergency physicians, brain aneurysm 
patient advocacy foundations, brain aneurysm survivors, and 
caregivers--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. In doing so, the Committee 
encourages the Secretary to consider incorporating topics such 
as the symptoms of brain aneurysms, evidence-based risk factors 
for brain aneurysms, appropriate utilization of medical testing 
and diagnostic equipment, and screening recommendations. The 
Committee encourages the Secretary to consult appropriate 
stakeholders to develop a strategy for disseminating 
information about the best practices and begin implementing 
this strategy not later than one year after the date of 
enactment of this Act.
    Faith Based Center.--The Committee includes $1,299,000 for 
the Faith Based Center, the same as fiscal year 2018 enacted 
level and the fiscal year 2019 budget request.
    Global Health Research Strategy.--The Committee requests an 
update in the fiscal year 2020 Congressional Justification on 
how CDC, FDA, BARDA, and NIH--including the Fogarty 
International Center--jointly coordinate global health research 
activities. The update should include specific metrics used to 
track progress and collaboration toward agreed upon health 
goals.
    Nonrecurring Expenses Fund.--The Committee directs the 
Secretary to prioritize completion of projects for the Indian 
Health Service.
    Privacy in Mental Health Scenarios.--Section 11004 of the 
21st Century Cures Act (PL 114-255) directed the Secretary of 
Health and Human Services to identify model programs and 
materials for training health care providers regarding the 
permitted uses and disclosures of protected health information 
of patients seeking or undergoing mental or substance use 
disorder treatment, consistent with standards and regulations 
governing the privacy and security of individually identifiable 
health information under the Social Security Act and the Health 
Insurance Portability and Accountability Act of 1996. In 
addition, the Secretary was directed to identify a model 
program and materials for training patients and their families 
regarding their rights to protect and obtain such information. 
The Committee urges the Secretary to submit a report to the 
Committees on Appropriations of the House of Representatives 
and the Senate within 180 days of enactment of this Act 
identifying model programs and materials addressed in section 
11004 of the 21st Century Cures Act.
    Tribal Access.--The Committee is concerned that HHS grant 
programs that address public health issues are not sufficiently 
accessible to Tribal health departments, and that HHS could do 
more to support the needs for those services in Indian Country. 
Tribal health departments often do not have the funding 
available for public health initiatives such as disease 
prevention, injury prevention, education, research and wellness 
promotion. The Committee directs the Secretary to report, 
within 180 days of enactment of this Act, on the number of 
Tribal governments or Tribal consortia receiving direct 
funding, and the total percentage of that funding, from public 
health block grants--including but not limited to the 
Preventive Health and Health Services Block Grant; Community 
Mental Health Services Block Grant; Community Service Block 
Grant; Maternal and Child Health Block Grant; and the Social 
Services Block Grant. In addition, HHS is encouraged to collect 
from the States the percentage of Federal funding from such 
block grants that each State provides to Tribal health 
departments.
    Tribal Governance.--The Secretary, in coordination with the 
Indian Health Service, CMS, and CDC, is urged to facilitate and 
support partnerships with Tribes and medical colleges and 
universities as opportunities arise, in order to foster 
leadership development, build organizations to better deliver 
and coordinate high-quality care, and to support systems of 
care and prevention that can have a positive outcome on the 
health of the community and cost of care.

Office of the Assistant Secretary for Health

    Adverse Childhood Experience.--The Committee is concerned 
about the link between adverse childhood experience--such as 
physical abuse, substance misuse in the household, sexual 
abuse, and parental divorce or separation--and negative long-
term health and behavioral health outcomes, including early 
initiation of alcohol and tobacco use, substance misuse, teen 
pregnancy, violence, and increased risk of suicide. The 
Committee directs the Office of the Surgeon General to submit a 
report to the Committees on Appropriations of the House of 
Representatives and the Senate within 180 days of enactment of 
this Act on the connection between adverse childhood experience 
and negative long-term health outcomes, including future 
substance misuse. The Committee urges the Office of the Surgeon 
General to consult with CDC, NIH, SAMHSA, and ACF, in the 
process of developing the report.
    Breast Milk.--The Committee recognizes the importance of 
breast milk in improving health outcomes for babies and 
mothers. The Committee encourages HHS to provide a study within 
2 years of the date of the enactment of this Act on the impact 
of recommended breastfeeding rates on health outcomes and 
healthcare costs. HHS, through CDC or AHRQ, should review the 
most recent research (published in the last 5 years) and 
develop a report that could be provided to Congress examining 
the impact of clinically recommended breastfeeding rates on 
associated Medicaid expenditures, urgent care costs, and direct 
and indirect medical costs in order to inform health care and 
funding decisions. The Committee also encourages the Secretary 
to ensure that pregnant women have access to nutritional 
guidance, including through the 2020-2025 edition of the 
Dietary Guidelines for Americans currently under development, 
based on the latest scientific research on the health and cost 
benefits of human milk.
    Embryo Adoption Awareness Campaign.--The Committee 
recommends $1,000,000 for the Embryo Adoption Awareness 
Campaign, the same as the fiscal year 2018 enacted level and 
the fiscal year 2019 budget request. These funds will be used 
to educate Americans about the existence of frozen human 
embryos (resulting from in-vitro fertilization), which may be 
available for donation/adoption to help other couples build 
their families. The Committee includes bill language permitting 
these funds also to be used to provide medical and 
administrative services to individuals adopting embryos, deemed 
necessary for such adoptions, consistent with the Code of 
Federal Regulations.
    Stillbirth.--The Committee is aware that each year about 
24,000 babies are stillborn in the US, approximately 2,000 
babies each month. According to the CDC, this is about the same 
number of babies that die during the first year of life and it 
is more than 10 times as many deaths as the number that occur 
from Sudden Infant Death Syndrome (SIDS). Additionally the US 
has made some of the slowest progress of any country in 
reducing stillbirths, with the US rate declining by 0.4 percent 
per year between 2000 and 2015, putting us at 155th out of 159 
in the world. In order to elevate the issues surrounding 
stillbirth for consumers and providers, the Committee 
encourages the Surgeon General's Office to issue a Call to 
Action on Stillbirth that will provide a roadmap for future 
federal efforts to reduce stillbirth rates and eliminate the 
disparities that surround this condition.
    Sexual Risk Avoidance.--The Committee provides $30,000,000 
in budget authority for sexual risk avoidance programs, which 
is $5,000,000 above the fiscal year 2018 enacted level and 
$30,000,000 more than the fiscal year 2019 budget request.
    In implementing these funds, it is the intent of the 
Committee that HHS provide substantive and practical technical 
assistance to grantees so they place meaningful emphasis on 
Sexual Risk Avoidance (SRA) in all educational messaging to 
teens. The Committee notes that such technical assistance 
should be provided in the following venues: during National and 
regional conferences, webinars and one-on-one conversations 
with funded projects. The Committee further intends that SRA-
credentialed experts consult with grantees and HHS staff with 
oversight of these programs on methodologies and best practices 
in SRA for teens. The Committee also encourages all operating 
divisions at HHS that implement or inform youth programs to 
implement consistently a public health model that stresses risk 
avoidance or works to return individuals to a lifestyle without 
risk, particularly as it relates to sexual risk.

Office of Minority Health

    The Committee provides $56,670,000 for the Office of 
Minority Health (OMH), which is the same as the fiscal year 
2018 enacted level and $2,714,000 more than the fiscal year 
2019 budget request. The OMH works with US Public Health 
Service agencies and other agencies of the Department to 
address the health status and quality of life for racial and 
ethnic minority populations in the United States. OMH develops 
and implements new policies; partners with States, Tribes, and 
communities through cooperative agreements; supports research, 
demonstration, and evaluation projects; and disseminates 
information.
    Hepatitis.--The Committee commends OMH for their 
advancements in the treatment and management of hepatitis and 
requests an update in the fiscal year 2020 Congressional 
Justification on the progress of community partnerships that 
promote awareness and outreach to improve testing, diagnosis, 
and treatment.
    Hispanic Serving Institutions.--The Committee supports 
OMH's efforts to enter into or continue cooperative agreements 
with Hispanic Serving Institution medical schools in addition 
to their work with Historically Black Colleges and Universities 
medical schools.
    HIV/AIDS.--The Committee continues to be concerned about 
the HIV/AIDS epidemic in the African American and Hispanic 
communities, and is aware of the concurrent high co-infection 
rate for Hepatitis C. The Committee urges OMH to address 
opportunities to reduce the burden of HIV/AIDS and Hepatitis C 
by implementing partnerships for screening and community 
engagement programs.
    Lupus.--The Committee is encouraged by research conducted 
by the OMH National Health Education Lupus Program and 
encourages OMH to optimize that research and utilize other 
resources currently in development to further support 
populations at highest risk--specifically Hispanics, Native 
Americans, Asians and African Americans. The Committee is 
particularly concerned about the disproportionately high rates 
of Lupus among African American women and other women of color. 
The Committee recommends collaborating with the lupus community 
to expand the development of linguistically and culturally 
appropriate tools, resources and materials for these adults and 
children with lupus, their caregivers and health care 
providers.

Office on Women's Health

    The Committee includes $32,140,000 for the Office on 
Women's Health, which is the same as the fiscal year 2018 
enacted level and $3,686,000 more than the fiscal year 2019 
budget request.

             OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH 
                         INFORMATION TECHNOLOGY

 
 
 
Appropriation, fiscal year 2018.......................       $60,367,000
Budget request, fiscal year 2019......................        38,381,000
Committee Recommendation..............................        42,705,000
    Change from enacted level.........................       -17,662,000
    Change from budget request........................        +4,324,000
 

    The Office of the National Coordinator (ONC) is the 
principal Federal entity charged with coordinating efforts to 
implement and use health information technology and exchange 
electronically health information.
    Patient Data Matching.--The Committee is aware that one of 
the most significant challenges inhibiting the safe and secure 
electronic exchange of health information is the lack of a 
consistent patient data matching strategy. With the passage of 
the Health Information Technology for Economic and Clinical 
Health (HITECH) Act, a clear mandate was placed on the Nation's 
healthcare community to adopt electronic health records and 
health exchange capability. Although the committee continues to 
carry a prohibition against HHS using funds to promulgate or 
adopt any final standard providing for the assignment of a 
unique health identifier for an individual until such activity 
is authorized, the Committee notes that this limitation does 
not prohibit HHS from examining the issues around patient 
matching. Accordingly, the Committee continues to encourage the 
Secretary, acting through the ONC and CMS, to provide technical 
assistance to private-sector-led initiatives to develop a 
coordinated national strategy that will promote patient safety 
by accurately identifying patients to their health information.
    Prescription Drug Monitoring.--The Committee understands 
that the spread of the prescription drug epidemic throughout 
the Nation has made the creation, implementation, and use of 
State prescription drug monitoring programs (PDMPs) and their 
ability to communicate with electronic health record (EHR) and 
electronic prescribing (e-prescribing) systems more important 
than ever. The Committee encourages ONC to continue its support 
for pilot programs to find usability challenges among PDMP, 
EHR, and e-prescribing systems; develop and award challenge 
awards to private entities for health information technology 
innovation; and offer targeted technical assistance to help 
medical professionals use PDMP, EHR, and e-prescribing systems. 
The Committee further encourages ONC to collaborate and 
coordinate its efforts with partner agencies such as CDC and 
the Bureau of Justice Assistance in the Department of Justice.

                      OFFICE OF INSPECTOR GENERAL

 
 
 
Appropriation, fiscal year 2018.......................       $80,000,000
Budget request, fiscal year 2019......................        80,000,000
Committee Recommendation..............................        80,000,000
    Change from enacted level.........................             - - -
    Change from budget request........................             - - -
 

    The Office of Inspector General (OIG) serves as an 
independent and objective oversight unit of HHS. OIG carries 
out activities intended to prevent fraud and abuse and promote 
economy, efficiency and effectiveness of HHS programs and 
operations.

                        OFFICE FOR CIVIL RIGHTS

 
 
 
Appropriation, fiscal year 2018.......................       $38,798,000
Budget request, fiscal year 2019......................        30,904,000
Committee Recommendation..............................        38,798,000
    Change from enacted level.........................             - - -
    Change from budget request........................        +7,894,000
 

    The Office for Civil Rights (OCR) is responsible for 
enforcing civil rights statutes that prohibit discrimination in 
health and human services programs. OCR implements the civil 
rights laws through a compliance program designed to generate 
voluntary compliance among all HHS recipients.
    The Committee strongly supports efforts to investigate 
violations of Federal Conscience Rights statutes. The 
establishment of a Conscience and Religious Freedom Division is 
a necessary step to ensure appropriate application of Federal 
law. The Committee also values the vital work done by the Civil 
Rights Division and Health Information Privacy Division. 
Additional funding through the assessment of civil monetary 
penalties ensures the work for the Health Information Privacy 
Division will not be reduced. The Committee maintains funding 
for OCR and increases the program level for these divisions.
    Within the resources available to OCR, the Committee 
provides not less than $4,600,000 for the Civil Rights 
Division, which is above the fiscal year 2018 enacted level and 
the fiscal year 2019 budget request. From budget authority and 
offsetting collections, the Committee provides not less than 
$7,500,000 for the Health Information Privacy Division, which 
is above the fiscal year 2018 enacted level and the fiscal year 
2019 budget request. The Committee provides not less than 
$3,000,000 for the Conscience and Religious Freedom Division, 
which is above the fiscal year 2018 enacted level and the 
fiscal year 2019 budget request.
    The Committee commends the Secretary for establishing the 
Division on Conscience and Religious Liberty within the Office 
for Civil Rights and is encouraged by the proposed rule 
entitled Protecting Statutory Conscience Rights in Health Care; 
Delegations of Authority. The Committee urges the 
Administration to finalize the rule at the appropriate time. 
The Committee looks forward to the important work the Office 
for Civil Rights will do to safeguard Americans' civil rights.
    The Committee is concerned that the State of California, 
State of New York, State of Oregon, and State of Washington are 
requiring insurance providers to cover elective abortions. 
Furthermore, the Committee is aware that the State of 
California has enacted a law that requires pregnancy centers to 
refer patients for free or low-cost state-funded abortions. 
These laws, policies, and requirements appear to violate the 
Weldon Amendment, which prevents discrimination against health 
care entities that choose not provide abortion coverage. 
Accordingly, the Committee directs the Secretary to fully 
investigate and resolve potential violations of the Weldon 
Amendment and report findings back to Congress.

                RETIREMENT PAY AND MEDICAL BENEFITS FOR 
                         COMMISSIONED OFFICERS

 
 
 
Appropriation, fiscal year 2018.......................      $618,689,000
Budget request, fiscal year 2019......................       629,209,000
Committee Recommendation..............................       629,209,000
    Change from enacted level.........................       +10,520,000
    Change from budget request........................             - - -
 

    The Committee provides for retirement pay and medical 
benefits of Public Health Service Commissioned Officers, for 
payments under the Retired Serviceman's Family Protection Plan, 
and for medical care of dependents and retired personnel.

            PUBLIC HEALTH AND SOCIAL SERVICES EMERGENCY FUND

 
 
 
Appropriation, fiscal year 2018.......................    $1,953,458,000
Budget request, fiscal year 2019......................     2,303,877,000
Committee Recommendation..............................     2,813,128,000
    Change from enacted level.........................      +859,670,000
    Change from budget request........................      +509,251,000
 

    This account supports the activities of the Assistant 
Secretary for Preparedness and Response (ASPR) and other 
components within the Office of the Secretary to prevent, 
prepare for, and respond to the health consequences of 
bioterrorism and other public health emergencies, including 
pandemic influenza. It also includes funding for the 
Department's cybersecurity efforts.

Office of the Assistant Secretary for Preparedness and Response

    The Committee provides $2,489,128,000 for activities 
administered by ASPR. ASPR is responsible for coordinating 
national policies and plans for medical and public health 
preparedness and for administering a variety of public health 
preparedness programs.
    National Ebola Training and Education Center.--The 
Committee supports the continued efforts of the National Ebola 
Training and Education Center (NETEC), and recognizes the 
importance of NETEC's work in preventing, preparing for, and 
responding to Ebola and other special pathogen incidents.
    Regional Disaster Medical Response Demonstration Project.--
The Committee commends ASPR for its work to develop and 
evaluate regional, coalition-based disaster medical response 
systems to handle the health impacts of 21st century health 
security threats. The Committee encourages ASPR to leverage the 
Hospital Preparedness Program and National Disaster Medical 
System to strengthen regional disaster response capabilities by 
working with States that have demonstrated success in creating 
statewide disaster healthcare systems to coordinate patient 
movement, evacuation, and emergency care, particularly in areas 
with high incidence of natural disasters or high risk for 
deliberate attacks, with the goal of establishing best 
practices and maximizing Federal resources.

Operations

    The Committee recommends $30,938,000 for Operations. This 
account supports activities within the Assistant Secretary's 
Immediate Office; the Office of the Chief Operating Officer; 
the Office of Acquisitions Management, Contracts, and Grants; 
and the Office of Financial Planning and Analysis.

Preparedness and Emergency Operations

    The Committee recommends $24,654,000 for Preparedness and 
Emergency Operations. The Preparedness and Emergency Operations 
account funds the Office of Emergency Management, which support 
a full spectrum of emergency management responsibilities, 
including planning, coordination, logistics, training, and 
responding to planned events and unplanned incidents.

National Disaster Medical System

    The Committee recommends $62,404,000 for the National 
Disaster Medical System (NDMS). NDMS deploys trained medical 
teams to communities impacted by public health and medical 
emergencies due to natural and man-made incidents.

Hospital Preparedness Program

    The Committee recommends $279,555,000 for the Hospital 
Preparedness Program (HPP). HPP supports cooperative agreements 
with State, local, and territorial health departments to build 
healthcare coalitions that improve regional and local hospital 
preparedness and surge capacity in public health emergencies.

Biomedical Advanced Research and Development Authority

    The Committee provides $586,700,000 for the Biomedical 
Advanced Research and Development Authority (BARDA). BARDA 
supports the advanced development of vaccines, drugs, and 
therapeutics for potential serious public health threats, 
including chemical, biological, radiological, and nuclear 
threats, pandemic influenza, and emerging and re-emerging 
infectious diseases.
    Advanced Blood Pathogen Reduction Technologies.--The 
Committee commends BARDA for actions taken during the Zika 
virus epidemic to quickly and efficiently accelerate the use of 
modern blood pathogen reduction technologies to improve the 
safety of the nation's blood supply. The Committee encourages 
BARDA to continue to give priority to this effort in fiscal 
year 2019, which if successful will complete development of 
pathogen reduction technology for all transfused blood 
components as a countermeasure to ensure sustainability of the 
national blood supply as part of emergency preparedness for 
emerging epidemic pathogens.
    Antimicrobial-Resistant Tuberculosis.--The National 
Strategy for Combating Antibiotic-Resistant Bacteria identified 
drug resistant tuberculosis (TB) as a serious threat level 
pathogen. New diagnostic, treatment, and prevention tools are 
urgently needed to address this global health threat. The 
Committee encourages BARDA to support the development of new TB 
diagnostic tests, drugs, and vaccines and report on the 
agency's efforts in the fiscal year 2020 Congressional 
Justification.
    Antimicrobial Technologies.--The Committee notes that 
efforts to combat microbial resistance to traditional 
treatments is advancing faster than current regulatory 
frameworks. The Committee encourages BARDA to work with 
entities developing antimicrobial technologies that are not 
pharmacological in nature. The Committee sees particular 
promise in technologies which alter environments to inhibit 
microbial growth and spread.
    Zika Vaccine Development.--The number of new Zika virus 
infections has dropped dramatically because much of the 
population in Zika-endemic areas has developed an immunity to 
the virus. However, like other similar mosquito-borne 
flaviviruses, the virus is likely to reemerge in these areas in 
several years, and could emerge unpredictably in isolated areas 
in the meantime, including within the US. Given the links 
between Zika virus infections and serious birth defects, and 
the length of time necessary to develop vaccines, the Committee 
believes it is prudent to continue efforts to develop a vaccine 
for the Zika virus. Within the total funding provided for 
BARDA, the Committee directs BARDA to continue to support 
research and development on a vaccine for the Zika virus.

Policy and Planning

    The Committee recommends $14,877,000 for Policy and 
Planning. The Office of Policy and Planning leads HHS' 
emergency preparedness and response strategic direction and 
policy coordination.

Project BioShield Special Reserve Fund

    The Committee provides $780,000,000 for Project BioShield. 
These funds support the acquisition of promising medical 
countermeasures developed through BARDA contracts for the most 
serious public health threats.

Strategic National Stockpile

    The Committee provides $710,000,000 for the Strategic 
National Stockpile (SNS) in ASPR. The Committee commends the 
Department for its efforts to achieve efficiencies in its 
public health preparedness activities and looks forward to 
continuing to work with the Department to enhance the nation's 
preparedness to respond to public health threats. The Committee 
expects that this organizational change will continue to 
include a significant role for CDC in providing scientific 
expertise in decision-making related to procurement of 
countermeasures as well as maintaining strong relationships 
with State and local public health departments to facilitate 
efficient deployment of countermeasures in public health 
emergencies. Within 60 days of enactment of this Act, the 
Committee requests an update on 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.

Office of the Assistant Secretary for Administration--Cybersecurity

    The Committee provides $60,000,000 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.
    Computer Security Incident Response Center.--HHS 
established the Computer Security Incident Response Center 
(CSIRC) to serve as the primary entity within HHS responsible 
for maintaining cybersecurity situational awareness and 
determining the Department's overall cybersecurity risk 
posture. The Committee directs HHS to submit a report within 
180 days of enactment of this Act that includes an analysis and 
assessment of the effectiveness of the CSIRC in ensuring the 
Department, to include operating and staff divisions, is 
appropriately prepared for and protected against cyber threats 
and incidents.

Office of Security and Strategic Information

    The Committee provides $8,000,000 for the Office of 
Security and Strategic Information to maintain the security of 
the Department's personnel, systems, and critical 
infrastructure.

Office of Public Health and Science--Medical Reserve Corps

    The Committee provides $6,000,000 for the Medical Reserve 
Corps program, which is a network of local volunteers who work 
to strengthen the public health infrastructure and preparedness 
capabilities of their communities.

Pandemic Influenza Preparedness

    The Committee recommends $250,000,000 for the pandemic 
influenza preparedness program. This funding supports research 
and development of next-generation influenza medical 
countermeasures, preparedness testing and evaluation, and 
stockpiling.
    Pandemic Influenza Vaccine.--The Committee remains 
concerned about our nation's limited ability to rapidly respond 
to a pandemic influenza outbreak and meet the Federal 
government's desired goal of delivering pandemic vaccines 
within 12 weeks of the declaration of a pandemic. Late-stage 
pandemic and pre-clinical influenza vaccines are under 
development that can enhance current rapid response capacity in 
the US. The Committee encourages ASPR and BARDA to support 
development of promising pre-clinical as well as development 
and acquisition of late-stage vaccine candidates that can meet 
the goal of producing a pandemic vaccine within 12 weeks of a 
declaration.

                           General Provisions

    Sec. 201. The Committee continues a provision to limit the 
amount available for official reception and representation 
expenses.
    Sec. 202. The Committee continues a provision to limit the 
salary of an individual through an HHS grant or other 
extramural mechanism to not more than the rate of Executive 
Level II.
    Sec. 203. The Committee continues a provision to prohibit 
the Secretary from using evaluation set-aside funds until the 
Committees on Appropriations of the House of Representatives 
and the Senate receive a report detailing the planned use of 
such funds.
    Sec. 204. The Committee continues a provision regarding the 
level for the PHS evaluation set-aside.

                          (TRANSFER OF FUNDS)

    Sec. 205. The Committee continues a provision permitting 
the Secretary of HHS to transfer up to one percent of any 
discretionary funds between appropriations, provided that no 
appropriation is increased by more than three percent by any 
such transfer to meet emergency needs. Notification must be 
provided to the Committees on Appropriations at the program, 
project, and activity level in advance of any such transfer.
    Sec. 206. The Committee continues the 60 day flexibility 
for National Health Service Corps contract terminations.
    Sec. 207. The Committee continues a provision to prohibit 
the use of Title X funds unless the applicant for the award 
certifies to the Secretary that it encourages family 
participation in the decision of minors to seek family planning 
services and that it provides counseling to minors on how to 
resist attempts to coerce minors into engaging in sexual 
activities.
    Sec. 208. The Committee continues a provision stating that 
no provider of services under Title X shall be exempt from any 
state law requiring notification or the reporting of child 
abuse, child molestation, sexual abuse, rape, or incest.
    Sec. 209. The Committee continues a provision related to 
the Medicare Advantage program.
    Sec. 210. The Committee continues a provision prohibiting 
funds from being used to advocate or promote gun control.
    Sec. 211. The Committee continues a provision to allow 
funding for HHS international HIV/AIDS and other infectious 
disease, chronic and environmental disease, and other health 
activities abroad to be spent under the State Department Basic 
Authorities Act of 1956.
    Sec. 212. The Committee continues a provision authorizing 
certain international health activities.

                          (TRANSFER OF FUNDS)

    Sec. 213. The Committee continues a provision to provide 
the Director of NIH, jointly with the Director of the Office of 
AIDS Research, the authority to transfer up to three percent of 
human immunodeficiency virus funds.

                          (TRANSFER OF FUNDS)

    Sec. 214. The Committee continues a provision that makes 
NIH funds for human immunodeficiency virus research available 
to the Office of AIDS Research.
    Sec. 215. The Committee continues a provision granting 
authority to the Office of the Director of the NIH to enter 
directly into transactions in order to implement the NIH Common 
Fund for medical research and permitting the Director to 
utilize peer review procedures, as appropriate, to obtain 
assessments of scientific and technical merit.
    Sec. 216. The Committee continues a provision clarifying 
that funds appropriated to NIH institutes and centers may be 
used for minor repairs or improvements to their buildings, up 
to $3,500,000 per project with a total limit for NIH of 
$45,000,000.

                          (TRANSFER OF FUNDS)

    Sec. 217. The Committee continues a provision transferring 
one percent of the funding made available for National 
Institutes of Health National Research Service Awards to the 
Health Resources and Services Administration.
    Sec. 218. The Committee continues the Biomedical Advanced 
Research and Development Authority ten year contract authority.
    Sec. 219. The Committee continues language requiring HHS to 
include certain information concerning the number of full-time 
Federal employees and contractors working on the Affordable 
Care Act in the fiscal year 2020 budget request.
    Sec. 220. The Committee continues specific report 
requirements for CMS's Health Insurance Exchange activities in 
the fiscal year 2020 budget request.
    Sec. 221. The Committee continues a provision prohibiting 
CMS Program Management account from being used to support risk 
corridor payments.

                          (TRANSFER OF FUNDS)

    Sec. 222. The Committee continues language directing the 
spending of the Prevention and Public Health fund.

                   PREVENTION AND PUBLIC HEALTH FUND

    The Committee continues a provision that directs the 
transfer of the Prevention and Public Health Fund. In fiscal 
year 2019, the level appropriated for the fund is $848,000,000 
after accounting for sequestration. The Committee includes bill 
language in section 222 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:

------------------------------------------------------------------------
                                                            FY 2019
             Agency                 Budget Activity        Committee
------------------------------------------------------------------------
CDC.............................  Breastfeeding               10,000,000
                                   Grants (Hospitals
                                   Promoting
                                   Breastfeeding)..
CDC.............................  Diabetes...........         76,675,000
CDC.............................  Epidemiology and            40,000,000
                                   Laboratory
                                   Capacity Grants.
CDC.............................  Healthcare                  12,000,000
                                   Associated
                                   Infections.
CDC.............................  Heart Disease and           73,975,000
                                   Stroke Prevention
                                   Program.
CDC.............................  Million Hearts               4,000,000
                                   Program.
CDC.............................  Preventive Health          160,000,000
                                   and Health
                                   Services Block
                                   Grant.
CDC.............................  Tobacco............        126,000,000
CDC.............................  Section 317                324,350,000
                                   Immunization
                                   Grants.
CDC.............................  Lead Poisoning              17,000,000
                                   Prevention.
CDC.............................  Early Care                   4,000,000
                                   Collaboratives.
------------------------------------------------------------------------

    Sec. 223. The Committee modifies a provision relating to 
breast cancer screening.
    Sec. 224. The Committee continues a provision relating to 
indirect cost negotiated rates.

                          (TRANSFER OF FUNDS)

    Sec. 225. The Committee continues a provision permitting 
transfer of funds within NIH, if such funds are related to 
opioid and pain management research.

                          (TRANSFER OF FUNDS)

    Sec. 226. The Committee includes a new provision for 
evaluation activities within the Administration for Children 
and Families.
    Sec. 227. The Committee includes a new provision 
prohibiting funds from being used for Title X family planning 
activities.

                          (TRANSFER OF FUNDS)

    Sec 228. The Committee includes a new provision 
establishing an Infectious Diseases Rapid Response Reserve Fund 
in CDC.
    Sec. 229. The Committee includes a new provision 
prohibiting funds from being used to support the Monograph 
Programme of the International Agency for Research on Cancer 
unless NIH submits a report to Congress outlining transparency 
and conflict-of-interest requirements that are a condition of 
these awards.
    Sec. 230. The Committee includes a new provision relating 
to cervical cancer screening.
    Sec. 231. The Committee includes a new provision extending 
the authorization of Small Business Innovation Research pilot 
programs.
    Sec. 232. The Committee includes a new provision relating 
to donations for the care of unaccompanied alien children.
    Sec. 233. The Committee includes a new provision relating 
to reporting of children separated from their parents or legal 
guardians.
    Sec. 234. The Committee includes a new provision related to 
a plan to reunify children separated from their parents or 
family units.
    Sec. 235. The Committee includes a new provision ensuring 
that efforts are taken to place unaccompanied alien children 
who are siblings together.
    Sec. 236. The Committee includes a new provision requesting 
a monthly report on the status of children separated from their 
parents or legal guardians.

                   TITLE III--DEPARTMENT OF EDUCATION


                    EDUCATION FOR THE DISADVANTAGED

 
 
 
Appropriation, fiscal year 2018.......................   $16,443,790,000
Budget request, fiscal year 2019......................    15,926,790,000
Committee Recommendation..............................    16,443,790,000
    Change from enacted level.........................             - - -
    Change from budget request........................      +517,000,000
 

    Of the total amount available, $5,525,990,000 is 
appropriated for fiscal year 2019 for obligation on or after 
July 1, 2019 and $10,841,177,000 is appropriated for fiscal 
year 2019 for obligation on or after October 1, 2019. This 
appropriation account includes compensatory education programs 
authorized under title I and subpart 2 of part B of title II of 
the Elementary and Secondary Education Act of 1965 (ESEA) and 
section 418A of the Higher Education Act.

Grants to Local Educational Agencies

    For fiscal year 2019, the Committee recommends 
$15,759,802,000 for Title I grants to Local Educational 
Agencies (LEAs or school districts). Title I grants provide 
supplemental education funding for activities that offer extra 
academic support to help students from low-income families and 
in high-poverty schools to meet State academic standards.
    Of the amounts provided for Title I programs, 
$6,459,401,000 is available for Basic Grants to LEAs, which is 
the same as both the fiscal year 2018 enacted level and the 
fiscal year 2019 budget request. Basic grants are awarded to 
school districts with at least 10 low-income children who make 
up more than two percent of the school-age population.
    Within the amount for Title I Basic Grants, up to 
$5,000,000 is made available to the Secretary of Education on 
October 1, 2018, to obtain annually-updated LEA-level poverty 
data from the Bureau of the Census.
    The Committee recommends $1,362,301,000 for Title I 
Concentration Grants, which is the same as both the fiscal year 
2018 enacted level and the fiscal year 2019 budget request. 
Concentration Grants target funds to school districts in which 
the number of low-income children exceeds 6,500 or 15 percent 
of the total school-age population.
    The Committee recommends $3,969,050,000 for Title I 
Targeted Grants, which is the same as the fiscal year 2018 
enacted level and $150,000,000 above the fiscal year 2019 
budget request. Targeted Grants provide higher payments to 
school districts with high numbers or percentages of low-income 
students.
    The Committee recommends $3,969,050,000 for Title I 
Education Finance Incentive Grants (EFIGs), which is the same 
as the fiscal year 2018 enacted level and $150,000,000 above 
the fiscal year 2019 budget request. EFIGs provide payments to 
States and school districts that incorporate equity and effort 
factors to improve the equity of State funding systems.
    The Committee notes, within the fiscal year 2019 budget 
request, the inclusion of legislative proposals as well as 
grants to local educational agencies to implement weighted per-
pupil funding systems, including open enrollment systems that 
allow students to enroll in a public school selected by their 
parents. However, the Committee notes that such a program has 
not been authorized. Accordingly, the Committee has not 
provided funding for such a program within this bill. Funding 
for this approach will be considered should it be authorized in 
law.

Comprehensive Literacy Development Grants

    The Committee recommends $190,000,000 for Comprehensive 
Literacy Development Grants, which is the same as the fiscal 
year 2018 enacted level and $190,000,000 above the fiscal year 
2019 budget request. This program makes competitive grants to 
States to subgrant to school district and/or early education 
programs to improve literacy instruction for disadvantaged 
students.

Innovative Approaches to Literacy

    The Committee recommends $27,000,000 for Innovative 
Approaches to Literacy, the same as the 2018 enacted level and 
$27,000,000 above the fiscal year 2019 budget request. This 
program provides competitive grants to support school 
libraries.

State Agency Programs: Migrant

    The Committee recommends $374,751,000 for the State Agency 
Program for Migrant Education, which is the same as both the 
fiscal year 2018 enacted level and the fiscal year 2019 budget 
request. This program supports special educational and related 
services for children of migrant agricultural workers and 
fishermen, including: (1) supplementary academic education; (2) 
remedial or compensatory instruction; (3) English for limited 
English proficient students; (4) testing; (5)guidance 
counseling; and (6) other activities to promote coordination of 
services across States for migrant children whose education is 
interrupted by frequent moves.

State Agency Programs: Neglected and Delinquent

    For the State Agency Program for Neglected and Delinquent 
Children, the Committee recommends $47,614,000, which is the 
same as both the fiscal year 2018 enacted level and the fiscal 
year 2019 budget request. This formula grant program supports 
educational services for children and youth under age 21 in 
State-run institutions, attending community day programs, and 
in correctional facilities. A portion of these funds is 
provided for projects that support the successful re-entry of 
youth offenders into postsecondary and vocational programs.

Special Programs for Migrant Students

    The Committee recommends $44,623,000 for the Special 
Programs for Migrant Students, which is the same as both the 
fiscal year 2018 enacted level and the fiscal year 2019 budget 
request. These programs make grants to colleges, universities, 
and nonprofit organizations to support educational programs 
designed for students who are engaged in migrant and other 
seasonal farm work. The High School Equivalency Program (HEP) 
recruits migrant students age 16 and over and provides academic 
and support services to help those students obtain a high 
school equivalency certificate and subsequently to gain 
employment or admission to a postsecondary institution or 
training program. The College Assistance Migrant Program (CAMP) 
provides tutoring and counseling services to first-year, 
undergraduate migrant students and assists those students in 
obtaining student financial aid for their remaining 
undergraduate years. The Committee recommendation assumes the 
allocation of funds between HEP and CAMP as proposed by the 
Administration.

                               IMPACT AID

 
 
 
Appropriation, fiscal year 2018.......................    $1,414,112,000
Budget request, fiscal year 2019......................     1,259,790,000
Committee Recommendation..............................     1,466,112,000
    Change from enacted level.........................       +52,000,000
    Change from budget request........................      +206,322,000
 

    This account supports payments to school districts affected 
by Federal activities, such as those that educate children 
whose families are connected with the military or who live on 
Indian land.
    The Committee notes that documents supporting the 
Department's budget proposal references the possibility of a 
high-quality evaluation which could be used to better 
understand the economic effects of the Federal presence in 
participating school districts. The Committee requests to be 
kept informed of any steps taken in the planning for or 
development of such a study.

Basic Support Payments

    The Committee recommends $1,320,242,000 for Basic Support 
Payments to LEAs, which is $50,000,000 above the fiscal year 
2018 enacted level and $131,009,000 above the fiscal year 2019 
budget request. Basic Support Payments compensate school 
districts for lost tax revenue and are made on behalf of 
Federally-connected children, such as children of members of 
the uniformed services who live on Federal property.

Payments for Children with Disabilities

    The Committee recommends $48,316,000 for Payments for 
Children with Disabilities, which is the same as both the 
fiscal year 2018 enacted level and the fiscal year 2019 budget 
request. These payments compensate school districts for the 
increased costs of serving Federally-connected children with 
disabilities.

Facilities Maintenance

    The Committee recommends $4,835,000 for Facilities 
Maintenance, which is the same as both the fiscal year 2018 
enacted level and the fiscal year 2019 budget request. These 
capital payments are authorized for maintenance of certain 
facilities owned by the Department.

Construction

    The Committee recommends $17,406,000 for the Construction 
program, which is the same as both the fiscal year 2018 enacted 
level and the fiscal year 2019 budget request. This program 
provides competitive grants for building and renovating school 
facilities to school districts that educate Federally-connected 
students or have Federally-owned land.

Payments for Federal Property

    The Committee recommends $75,313,000 for Payments for 
Federal Property, which $2,000,000 above the fiscal year 2018 
enacted level and $75,313,000 above the fiscal year 2019 budget 
request. Funds are awarded to school districts to compensate 
for lost tax revenue as the result of Federal acquisition of 
real property since 1938.

                      SCHOOL IMPROVEMENT PROGRAMS

 
 
 
Appropriation, fiscal year 2018.......................    $5,158,467,000
Budget request, fiscal year 2019......................       645,214,000
Committee Recommendation..............................     5,258,467,000
    Change from enacted level.........................      +100,000,000
    Change from budget request........................    +4,613,253,000
 

    The School Improvement account includes programs authorized 
under Titles I, II, IV, VI, and VII of the ESEA; the McKinney-
Vento Homeless Assistance Act; Title IV-A of the Civil Rights 
Act; section 203 of the Educational Technical Assistance Act of 
2002; and section 105 of the Compact of Free Association 
Amendments Act of 2003.

Supporting Effective Instruction State Grants

    The Committee recommends $2,055,830,000 for Supporting 
Effective Instruction State Grants, which is the same as the 
fiscal year 2018 enacted level and $2,055,830,000 above the 
fiscal year 2019 budget request. These grants provide States 
and school districts with a flexible source of funding to 
strengthen the skills and knowledge of teachers, principals, 
and administrators to enable them to improve student 
achievement.

Supplemental Education Grants

    The Committee recommends $16,699,000 for Supplemental 
Education Grants to the Federated States of Micronesia and the 
Republic of the Marshall Islands, which is the same as both the 
fiscal year 2018 enacted level the fiscal year 2019 budget 
request. The Compact of Free Association Amendments Act of 2003 
(PL 108-188) authorizes these entities to receive funding for 
general education assistance. The Committee recommendation 
includes a consolidated amount for Supplemental Education 
Grants because the underlying statute determines the allocation 
between Micronesia and the Marshall Islands.

21st Century Community Learning Centers

    The Committee recommends $1,211,673,000 for 21st Century 
Community Learning Centers, which the same as the fiscal year 
2018 enacted level and $1,211,673,000 above the fiscal year 
2019 budget request. This program awards formula grants to 
States, which in turn distribute funds on a competitive basis 
to local school districts, nonprofit organizations, and other 
public entities. Funds may be used to provide activities that 
complement and reinforce the regular school-day program for 
participating students and may also fund local activities that 
are included as part of an expanded learning time program.

State Assessments

    The Committee recommends $378,000,000 for State 
Assessments, which is the same as the fiscal year 2018 enacted 
level and $8,900,000 above the fiscal year 2019 budget request. 
Funds are available to develop and implement academic standards 
and assessments. The program includes a set-aside for audits to 
identify and eliminate low-quality or duplicative assessments.

Education for Homeless Children and Youth

    The Committee recommends $85,000,000 for the Education for 
Homeless Children and Youth program, which is the same as the 
fiscal year 2018 enacted level and $8,000,000 above the fiscal 
year 2019 budget request. The Committee recognizes that without 
an education, these at-risk children and youth are unlikely to 
obtain the skills they need to become productive adults 
contributing to the economy and their communities. Grants are 
allocated to States in proportion to the total each State 
receives under the Title I program.

Training and Advisory Services

    The Committee recommends $6,575,000 for Training and 
Advisory Services authorized by Title IV-A of the Civil Rights 
Act, which is the same as both the fiscal year 2018 enacted 
level and the fiscal year 2019 budget request. Title IV-A 
authorizes technical assistance and training services for 
school districts to address problems associated with 
desegregation on the basis of race, sex, or national origin. 
The Department awards three-year grants to regional Equity 
Assistance Centers (EACs) located in each of the 10 Department 
of Education regions. The EACs provide services to school 
districts upon request. Typical activities include 
disseminating information on successful education practices and 
legal requirements related to nondiscrimination on the basis of 
race, sex, and national origin in educational programs.

Education for Native Hawaiians

    The Committee recommends $36,397,000 for the Education for 
Native Hawaiian program, which is the same as the fiscal year 
2018 level and $36,397,000 above the fiscal year 2019 budget 
request. Funds are used to provide competitive awards for 
supplemental education services to the Native Hawaiian 
population.

Alaska Native Education Equity

    The Committee recommends $35,453,000 for the Alaska Native 
Education Equity program, which is the same as the fiscal year 
2018 level and $35,453,000 above the fiscal year 2019 budget 
request. Funds are used to provide competitive awards for 
supplemental education services to the Alaska Native 
population.

Rural Education

    The Committee recommends $180,840,000 for Rural Education 
programs, which is the same as the fiscal year 2018 enacted 
level and $5,000,000 above the fiscal year 2019 budget request. 
There are two programs to assist rural school districts with 
improving teaching and learning in their schools: the Small, 
Rural Schools Achievement program, which provides funds to 
rural districts that serve a small number of students; and the 
Rural and Low-Income Schools program, which provides funds to 
rural districts that serve concentrations of poor students, 
regardless of the number of students served by the district. 
Funds appropriated for Rural Education shall be divided equally 
between these two programs.

Comprehensive Centers

    The Committee recommends $52,000,000 for Comprehensive 
Centers, which is the same as the fiscal year 2018 enacted 
level and $52,000,000 above the fiscal year 2019 budget 
request. This grant program currently supports 22 comprehensive 
centers, including 15 regional centers that provide training, 
technical assistance, and professional development to build 
State capacity to provide high-quality education to all 
students. The remaining seven centers specialize in particular 
content areas. The Committee includes bill language directing 
the Secretary to ensure that the Bureau of Indian Education 
(BIE) has access to services provided under this section.

Student Support and Academic Enrichment State Grants

    The Committee recommends $1,200,000,000 for Student Support 
and Academic Enrichment (SSAE) State Grants, which is 
$100,000,000 above the fiscal year 2018 enacted level and 
$1,200,000,000 above the fiscal year 2019 budget request. The 
Every Student Succeeds Act (ESSA) eliminated several narrowly-
focused competitive grant programs and replaced them with this 
new formula grant program. States and school districts have 
flexibility to focus these resources on locally-determined 
priorities to provide students with access to a well-rounded 
education, including rigorous coursework, and to improve school 
conditions and the use of technology.
    Non-Cognitive Factors.--The Committee notes that programs 
designed to support non-cognitive factors such as critical 
thinking skills, social skills, work ethic, problem solving, 
and community responsibility are an eligible use of funds SSAE 
grants supporting a well-rounded education.
    School-Based Mental Health Services.--School districts are 
encouraged to consider using SSAE grants funds for services 
that promote mental wellness for all students while assessing 
and addressing students with more complex needs, including 
those who may be on the pathway to violence. The Committee is 
aware that access to school mental and behavioral health 
services contribute to improved student learning, a more 
positive school climate, and increased school safety. The 
Committee notes that SSAE permits districts to use portions of 
their allocations to invest in technology solutions that could 
assist school-based mental health professionals in identifying, 
assessing and tracking treatment for students with mental 
health issues, including monitoring students for signs that 
they are a potential danger to themselves or others.
    School Climate.--The Committee notes that SSAE funds 
provide opportunities to increase students' access to STEM, 
computer science, music, physical education, the arts, college 
and career counseling, access to Advanced Placement classes, 
and other well-rounded education programs, which are critical 
to keeping students engaged in school and thriving 
academically, ultimately supporting a positive school climate.
    School Safety Measures.--Through SSAE grants, school 
districts should consider utilizing funds for security 
hardening measures. These security measures can include bullet 
resistant doors and glass with hinge-locking mechanisms, 
immediate notification systems to emergency 911, mechanisms 
that provide real time actionable intelligence direct to law 
enforcement and first responders, or installation of 
distraction devices or other countermeasures administered by 
law enforcement and first responders.

                            INDIAN EDUCATION

 
 
 
Appropriation, fiscal year 2018.......................      $180,239,000
Budget request, fiscal year 2019......................       164,939,000
Committee Recommendation..............................       180,239,000
    Change from enacted level.........................             - - -
    Change from budget request........................       +15,300,000
 

    This account supports programs authorized by part A of 
title VI of the ESEA.

Grants to Local Educational Agencies

    The Committee recommends $105,381,000 for Grants to Local 
Educational Agencies, which is the same as the fiscal year 2018 
enacted level and $5,000,000 above the fiscal year 2019 budget 
request. This program provides assistance through formula 
grants to school districts and schools supported or operated by 
the Bureau of Indian Education. The purpose of this program is 
to improve elementary and secondary school programs that serve 
American Indian students, including preschool children. 
Grantees must develop a comprehensive plan and ensure that the 
programs they carry out will help Indian students reach the 
same challenging standards that apply to all students. This 
program supplements the regular school program to help American 
Indian children sharpen their academic skills, bolster their 
self-confidence, and participate in enrichment activities that 
would otherwise be unavailable.

Special Programs for Indian Children

    The Committee recommends $67,993,000 for Special Programs 
for Indian Children, which is the same as the fiscal year 2018 
enacted level and $10,000,000 above the fiscal year 2019 budget 
request. These programs make competitive awards to improve the 
quality of education for American Indian students. The program 
also funds the American Indian Teacher Corps and the American 
Indian Administrator Corps to recruit and support American 
Indians as teachers and school administrators.

National Activities

    The Committee recommends $6,865,000 for National 
Activities, which is the same as the fiscal year 2018 enacted 
level and $300,000 above the fiscal year 2019 budget request. 
Funds under this authority support (1) research, evaluation and 
data collection to provide information about the educational 
status of Indian students and the effectiveness of Indian 
education programs; (2) grants to support Native language 
immersion schools and programs; and (3) grants to Tribes for 
education administrative planning, development, and 
coordination.
    Language Immersion Program.--Within the total for National 
Activities, the Committee continues funding for the Native 
American and Alaska Native Language Immersion Program at the 
same level as the fiscal year 2019 budget request. This 
program, which was authorized in ESSA, will make grants to 
maintain and promote the use of Native languages, support 
Native language education and development, and provide 
professional development to teachers.
    State-Tribal Education Partnership.--The Committee 
recommends continued funding for the State-Tribal Education 
Partnership (STEP) program. This program makes grants to Tribes 
to build capacity to assume certain State responsibilities for 
the administration of ESEA programs. Indian educators have long 
called for Tribal-State-Federal partnerships to involve Indian 
Tribes in educating their students and to improve American 
Indian education outcomes. STEP programs have, and will 
continue to, assist State and Tribal governments to continue 
delivering the highest quality education for Indian students.

                       INNOVATION AND IMPROVEMENT

 
 
 
Appropriation, fiscal year 2018.......................      $982,256,000
Budget request, fiscal year 2019......................     1,777,647,000
Committee Recommendation..............................     1,058,441,000
    Change from enacted level.........................       +76,185,000
    Change from budget request........................      -719,206,000
 

    This appropriation account includes programs authorized 
under portions of Titles II and IV of the ESEA.
    The Committee is aware of the proposal to include 
$1,000,000,000 for grants to local educational agencies and 
non-profit organizations to implement a program of awarding 
scholarship to students of low-income families to attend a 
private or public school selected by their families. The 
Committee notes that such a program has not been authorized. 
Accordingly, the Committee has not provided funding for such a 
program within this bill. Funding for this approach will be 
considered should a program be authorized in law.

Education Innovation and Research

    The Committee recommends $145,000,000 for the Education 
Innovation and Research program. This amount is $25,000,000 
above the fiscal year 2018 enacted level and $35,000,000 below 
the fiscal year 2019 budget request. This program makes 
competitive grants to support the replication and scaling-up of 
evidence-based education innovations. The funding will support 
a competition to promote innovation and reform in science, 
technology, engineering, and mathematics (STEM) education, 
including computer science. Coupled with dedicated funding in 
the Career, Technical, and Adult Education account, this 
increase will help support the Administration's commitment to 
STEM education.
    Partnerships with Rural Schools.--The Department is 
encouraged to work with institutions of higher learning or 
other relevant stakeholders who can partner with rural school 
districts on STEM education, including efforts to bring 
``makerspace'' opportunities to schools.
    STEM and Computer Science Education.--The Committee notes 
that funds available under this program may be used by States 
and school districts to provide or strengthen instruction in 
STEM fields, including computer science. The Committee 
recognizes the importance of funding Pre K-12 computer science 
education that addresses the enrollment and achievement gap for 
underrepresented students such as minorities, girls, and youth 
from families living at or below the poverty line. Supporting 
education in the science, technology, engineering, arts, and 
mathematics fields, particularly computer science, is critical 
to ensure that our nation continues to lead in innovation. As 
computer science is a basic skill in the 21st century global 
economy, the Committee encourages the Department to support Pre 
K-12 computer science education to schools across the country.

Teacher and School Leader Incentive Grants

    The Committee recommends $200,000,000 for the Teacher and 
School Leader Incentive Grants program, which is the same as 
the fiscal year 2018 enacted level and $200,000,000 above the 
fiscal year 2019 budget request. This program provides grants 
to States, school districts, and partnerships to develop, 
implement, improve, or expand human capital management systems 
or performance-based compensation systems in schools.

American History and Civics Academies

    The Committee recommends $4,700,000 for American History 
and Civics National Activities, which is $3,000,000 above the 
fiscal year 2018 enacted level and $4,700,000 above the fiscal 
year 2019 budget request. This program reaches a limited number 
of teachers and students since an academy may select no more 
than 300 teachers or students for participation.

American History and Civics National Activities

    The Committee recommends $1,700,000 for American History 
and Civics National Activities, the same as the fiscal year 
2018 enacted level and $1,700,000 above the fiscal year 2019 
budget request. The Committee recognizes the importance of 
improving the quality of instruction in American history, 
civics, and geography, particularly for schools in underserved 
rural and urban communities. In recognition of the fact that no 
one size fits all in effective education, and that a variety of 
approaches are required to meet the range of student and 
community needs, these competitive grants will support multiple 
grantees in making available a menu of innovative, effective 
approaches to teaching American history, civics and government, 
and geography. These validated approaches will be available to 
schools and school districts for their consideration and 
voluntary use, based on the approach that best meets the needs 
of the students and community.

Supporting Effective Educator Development

    The Committee recommends $75,000,000 for the Supporting 
Effective Educator Development (SEED) grant program, which is 
the same as the fiscal year 2018 level and $75,000,000 above 
the fiscal year 2019 budget request. SEED provides competitive 
grants to Institutions of Higher Education (IHEs), national 
nonprofit organizations, BIE, and partnerships to support 
alternative certification and other professional development 
and enrichment activities for teachers, principals, and other 
school leaders. Funds are included to fully support 
continuation costs for grants made in prior years.

Charter Schools Grants

    The Committee recommends $450,000,000 for Charter Schools 
Grants, which is $50,000,000 above the fiscal year 2018 enacted 
level and $50,000,000 below the fiscal year 2019 budget 
request. The Committee recommends an allocation of funds within 
this program that aligns with ESSA.
    In exchange for a commitment to increase student 
achievement, charter schools are exempt from many statutory and 
regulatory requirements. The Charter Schools Grants program 
awards grants to State Educational Agencies (SEAs) or, if a 
State's SEA chooses not to participate, to charter school 
developers to support the development and initial 
implementation of public charter schools. State Facilities 
Incentive Grants and Credit Enhancement for Charter School 
Facilities awards help charter schools obtain adequate school 
facilities. These programs work in tandem to support the 
development and operation of charter schools.
    Maximizing State Grant Competition Impact.--In the 
reauthorization of the ESEA, Congress determined that 65 
percent of the funding for charter schools should go to State 
grants and, in doing so, expanded the use of funds to include 
replication and expansion of high quality charter schools. 
Funds should be used to support high-quality models along with 
promising new charter schools to provide the best education 
options for students. The Committee recommends that the 
Secretary issue clarifying guidance to ensure States understand 
the flexibility they have to use charter school funds to 
support the growth of high-quality charter schools with a 
demonstrated track record of academic achievement. Guidance 
should clarify that States may look at how to meet strong 
parent demand for new or replicated or expanded charter school 
models when awarding subgrants. The Secretary should also make 
every effort to help States improve authorizing by providing 
guidance to States on utilizing the technical assistance funds.

Magnet Schools Assistance

    The Committee recommends $105,000,000 for the Magnet 
Schools Assistance program, which is the same as the fiscal 
year 2018 enacted level and $7,353,000 above the fiscal year 
2019 budget request. This program makes competitive grants to 
support the establishment and operation of magnet schools that 
are a part of a court-ordered or Federally-approved voluntary 
desegregation plan.

Ready to Learn Programming

    The Committee recommends $27,741,000 for Ready to Learn 
Programming, which is the same as the fiscal year 2018 enacted 
level and $27,741,000 above the fiscal year 2019 budget 
request. This program supports the development and distribution 
of educational video programming for preschool and elementary 
school children and their parents, caregivers, and teachers.

Arts in Education

    The Committee recommends $29,000,000 for Arts in Education, 
which is the same as the fiscal year 2018 level and $29,000,000 
above the fiscal year 2019 budget request. This program 
provides competitive grants to support professional development 
and the development of instructional materials and programming 
that integrate the arts into the curricula.

Javits Gifted and Talented Education

    The Committee recommends $12,000,000 for the Javits Gifted 
and Talented Education Program, which is the same as the fiscal 
year 2018 enacted level and $12,000,000 above the 2019 budget 
request. This program makes grants and contracts to States, 
schools districts, and other organizations to support a 
coordinated program of research, demonstration projects, 
innovative strategies, and other activities to help schools 
identify gifted and talented students and address their unique 
educational needs.

Statewide Family Engagement Centers

    The Committee recommends $10,000,000 for Statewide Family 
Engagement Center grants, which is the same as fiscal year 2018 
and $10,000,000 above the 2019 budget request. This program 
makes grants to organizations to provide technical assistance 
and training to State and local educational agencies in the 
implementation and enhancement of systemic and effective family 
engagement policies, programs, and activities that lead to 
improvements in student development and academic achievement.

                 SAFE SCHOOLS AND CITIZENSHIP EDUCATION

 
 
 
Appropriation, fiscal year 2018................             $185,754,000
Budget request, fiscal year 2019...............               43,000,000
Committee Recommendation.......................              185,754,000
    Change from enacted level..................                    - - -
    Change from budget request.................             +142,754,000
 

    This appropriation account includes programs authorized 
under parts of Title IV of the ESEA.

Promise Neighborhoods

    The Committee recommends $78,254,000 for Promise 
Neighborhoods, which is the same as the fiscal year 2018 
enacted level and $78,254,000 above the fiscal year 2019 budget 
request. Promise Neighborhoods supports grants to nonprofit, 
community-based organizations for the development of 
comprehensive neighborhood programs designed to combat the 
effects of poverty and improve educational outcomes for 
children and youth, from birth through college.

School Safety National Activities

    The Committee recommends $90,000,000 for School Safety 
National Activities, which is the same as the fiscal year 2018 
enacted level and $47,000,000 above the fiscal year 2019 budget 
request. The funding will support a new cohort of School 
Climate Transformation Grants which will enable State or local 
educational agencies to develop, adopt, or expand to more 
schools, and support the implementation of evidence-based 
practices to improve behavior and school climates. This cohort 
of grants will be used to focus on some of the effects of the 
opioid epidemic in schools. Funding could support evidence-
based strategies for prevention of opioid abuse by students, we 
all as addressing the mental health needs of students adversely 
impacted by opioid use in their family or community. The 
Committee urges the Department to prioritize communities that 
have experienced high levels of trauma due to the opioid 
crisis, as described in the fiscal year 2019 budget request.
    The Project School Emergency Response to Violence (Project 
SERV) program provides counseling and referral to mental health 
services as well as other education-related services to LEAs 
and IHEs in which the learning environment has been disrupted 
by a violent or traumatic crisis. The Committee directs the 
Department to report to the Committee on Appropriations of the 
House of Representatives and the Senate within 180 days of 
enactment of this Act on how fiscal years 2017 and 2018 grant 
recipients used Project SERV funds; recommendations from grant 
recipients on how the program could be improved; and, 
information on how these funds helped them recover from a 
violent or traumatic crisis.

Full-Service Community Schools

    The Committee recommends $17,500,000 for Full-Service 
Community Schools, which is the same as the fiscal year 2018 
level and $17,500,000 above the fiscal year 2019 budget 
request. This program makes competitive grants to support 
school-based comprehensive services for students, families, and 
communities.

                      ENGLISH LANGUAGE ACQUISITION

 
 
 
Appropriation, fiscal year 2018.......................      $737,400,000
Budget request, fiscal year 2019......................       737,400,000
Committee Recommendation..............................       737,400,000
    Change from enacted level.........................             - - -
    Change from budget request........................             - - -
 

    Of this amount provided for the 2019-2020 academic year, 
funds are appropriated for obligation on or after July 1, 2019 
and available through September 30, 2020.
    This program provides formula grants to States to serve 
English learner (EL) students. Grants are based on each State's 
share of the National EL, students and recent immigrant student 
population. Funds under this account also support professional 
development to increase the pool of teachers prepared to serve 
EL students activities and the National Clearinghouse for 
English Language Acquisition.

                           SPECIAL EDUCATION

 
 
 
Appropriation, fiscal year 2018.......................   $13,366,184,000
Budget request, fiscal year 2019......................    13,051,775,000
Committee Recommendation..............................    13,422,651,000
    Change from enacted level.........................       +56,467,000
    Change from budget request........................      +370,876,000
 

    Of the total amount available, $3,709,465,000 is available 
for obligation on July 1, 2019, and $9,483,383,000 is available 
for obligation on October 1, 2019. These grants help States and 
localities pay for a free appropriate education for 6.7 million 
students with disabilities aged 3 through 21.

Grants to States

    The Committee recommends $12,327,848,000 for Part B Grants 
to States, which is $50,000,000 above the fiscal year 2018 
enacted level and $325,000,000 above the fiscal year 2019 
budget request. This program provides formula grants to assist 
States in meeting the costs of providing special education and 
related services to children with disabilities. States 
generally transfer most of the funds to LEAs; however, they can 
reserve some funds for program monitoring, technical 
assistance, and other related activities. In order to be 
eligible for funds, States must make free appropriate public 
education available to all children with disabilities.
    The Committee continues to include bill language excluding 
any amount by which a State's allocation is reduced for failure 
to meet the maintenance of effort threshold from being used to 
calculate the State's allocation under section 611(d) of the 
Individuals with Disabilities Education Act (IDEA) in 
subsequent years. The Committee also continues to include bill 
language directing the Secretary to distribute any reduction in 
a State's allocation under said section to all other States 
based on the formula established under section 611(d), 
excluding those States that are penalized.

Preschool Grants

    The Committee recommends $395,000,000 for Preschool Grants, 
which is $13,880,000 above the fiscal year 2018 enacted level 
and $26,762,000 above the fiscal year 2019 budget request. 
These funds provide additional assistance to States to help 
them make free, appropriate public education available to 
children with disabilities ages 3 through 5.

Grants for Infants and Families

    The Committee recommends $470,000,000 for Grants for 
Infants and Families, which is the same as the fiscal year 2018 
enacted level and $11,444,000 above the fiscal year 2019 budget 
request. These funds provide additional assistance to States to 
help them make free, appropriate public education available to 
children with disabilities from birth through age 2. The 
Committee notes the Department's focus on communicating to 
States that this funding can be used to help address the needs 
of the growing population of infants and toddlers that are 
likely to require early intervention services due to substance 
use disorders, including opioid use disorder, among parents and 
families.

IDEA National Activities

    The Committee recommends $229,803,000 for the IDEA National 
Activities program, which is $7,413,000 below the fiscal year 
2018 enacted level and $7,670,000 above the fiscal year 2019 
budget request. The IDEA National Activities programs support 
State efforts to improve early intervention and education 
results for children with disabilities.
    Educational Technology, Media, and Materials.--The 
Committee recommends $28,047,000 for Educational Technology, 
Media, and Materials, which is the same as both the fiscal year 
2018 enacted level and the fiscal year 2019 budget request. 
This program makes competitive awards to support the 
development, demonstration, and use of technology and 
educational media activities of educational value to children 
with disabilities. The Committee recognizes the ongoing 
progress made with the tools and services provided under this 
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.
    Parent Information Centers.--The Committee recommends 
$27,411,000 for Parent Information Centers, which is the same 
as both the fiscal year 2018 enacted level and the fiscal year 
2019 budget request. 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. 
Technical assistance is also provided under this program for 
developing, assisting, and coordinating centers receiving 
assistance under this program.
    Personnel Preparation.--The Committee recommends 
$89,000,000 for Personnel Preparation, which is $5,300,000 
above both the fiscal year 2018 enacted level and the fiscal 
year 2019 budget request. This program supports competitive 
awards to help address State-identified needs for qualified 
personnel to work with children with disabilities, and to 
ensure that those personnel have the necessary skills and 
knowledge to serve children with special needs. Awards focus on 
addressing the need for leadership and personnel to serve low-
incidence populations. Funds are included to fully support 
continuation costs for grants made in prior years. The 
Committee is concerned about a shortage of teachers of deaf 
students and urges the Department to consider revisiting policy 
changes it has made in recent years which may have exacerbated 
this problem.
    State Personnel Development.--The Committee recommends 
$41,000,000 for State Personnel Development, which is 
$2,370,000 above both the fiscal year 2018 enacted level and 
the fiscal year 2019 budget request. This program supports 
grants to States to assist with improving personnel preparation 
and professional development related to early intervention and 
educational and transition services that improve outcomes for 
students with disabilities. Funds are included to fully support 
continuation costs for grants made in prior years.
    Technical Assistance and Dissemination.--The Committee 
recommends $44,345,000 for Technical Assistance and 
Dissemination, which is $15,083,000 below the fiscal year 2018 
enacted level and the same as the fiscal year 2019 budget 
request. This program provides funding for technical 
assistance, demonstration projects, and information 
dissemination. These funds support efforts by State and local 
educational agencies, IHEs, and other entities to build State 
and local capacity to make systemic changes and improve results 
for children with disabilities. Funds are included to fully 
support continuation costs for grants made in prior years.

                        REHABILITATION SERVICES

 
 
 
Appropriation, fiscal year 2018................           $3,587,130,000
Budget request, fiscal year 2019...............            3,634,977,000
Committee Recommendation.......................            3,657,689,000
    Change from enacted level..................              +70,559,000
    Change from budget request.................              +22,712,000
 

    The programs in this account are authorized by the 
Rehabilitation Act of 1973 and the Helen Keller National Center 
Act.
    The Achieving a Better Live Experience Act of 2014 or ABLE 
Act (PL 113-295) 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 the Department, through its 
programs supporting individuals living with a disability, to 
raise awareness on the eligibility and benefits of these 
accounts.

Vocational Rehabilitation State Grants

    The Committee recommends $3,521,990,000 for Vocational 
Rehabilitation (VR) State Grants, which is $69,059,000 above 
the fiscal year 2018 enacted level and the same as the fiscal 
year 2019 budget request.
    This program supports basic vocational rehabilitation 
services through formula grants to States. These grants support 
a wide range of services designed to help persons with physical 
and mental disabilities prepare for and engage in gainful 
employment to the extent of their capabilities. Emphasis is 
placed on providing vocational rehabilitation services to 
persons with the most significant disabilities. The Committee's 
recommendation provides the cost-of-living adjustment for 
Vocational Rehabilitation Grants to States, as authorized.
    The Committee is concerned with inconsistencies that have 
resulted from the Department of Education's final rule and 
regulations to implement the Workforce Innovation and 
Opportunity Act as it relates to State VR programs. The 
Committee is aware of reports of inconsistent implementation of 
this regulation by State vocational rehabilitation agencies and 
their work with non-profits within the AbilityOne Program and 
State use programs.
    The Committee encourages the Rehabilitation Services 
Administration to issue updated guidance to state vocational 
rehabilitation agencies that would (1) require them to give 
full consideration to all employment opportunities at 
AbilityOne and State use providers, and make determinations on 
a case-by-case basis with an emphasis on the quality of the job 
placement (i.e. more work hours, benefit eligible and overall 
compensation), and (2) honor a client's informed choice to work 
with AbilityOne and State use providers.
    Additionally, the Committee encourages the Rehabilitation 
Services Administration to restore the uncompensated outcomes 
category (Homemaker Exemption), which would allow individuals 
experiencing vision loss to have the opportunity to learn 
important life skills and be given the opportunity to regain 
personal confidence and achieve independence prior to making 
any decisions about reentering the workforce.

Client Assistance State Grants

    The Committee recommends $13,000,000 for Client Assistance 
State Grants, which is the same as both the fiscal year 2018 
enacted level the fiscal year 2019 budget request. Client 
Assistance State Grants support services for eligible 
individuals and applicants of the VR State Grants program, and 
other programs, projects, and services funded under the 
Rehabilitation Act. These formula grants are used to help 
persons with disabilities overcome problems with the service 
delivery system and improve their understanding of services 
available to them under the Rehabilitation Act.

Training

    The Committee recommends $29,388,000 for the Training 
program, which is the same as both the fiscal year 2018 enacted 
level and the fiscal year 2019 budget request. The program 
supports long-term and short-term training, in-service 
personnel training, and training of interpreters for deaf 
persons. Projects in a broad array of disciplines are funded to 
ensure that skilled personnel are available to serve the 
vocational needs of persons with disabilities. Funds are 
included to fully support continuation costs for grants made in 
prior years.

Demonstration and Training Programs

    The Committee recommends $5,796,000 for Demonstration and 
Training Programs, which is the same as the fiscal year 2018 
enacted level and $3,500,000 below the fiscal year 2019 budget 
request. These programs authorize competitive grants to public 
and private organizations to support demonstrations, direct 
services, and related activities for persons with disabilities.

Protection and Advocacy of Individual Rights

    The Committee recommends $17,650,000 for Protection and 
Advocacy of Individual Rights, which is the same as both the 
fiscal year 2018 enacted level and the fiscal year 2019 budget 
request. Grants are awarded to entities that have the authority 
to pursue legal, administrative, and other appropriate remedies 
to protect and advocate for the rights of persons with 
disabilities.

Supported Employment State Grants

    The Committee recommends $22,548,000 for Supported 
Employment State Grants, which is the same as the fiscal year 
2018 enacted level and $22,548,000 above the fiscal year 2019 
budget request. These formula grants assist States in 
developing collaborative programs with public agencies and 
nonprofit agencies for training and post-employment services 
leading to supported employment. In supported employment 
programs, persons with the most significant disabilities are 
given special supervision and assistance to enable them to work 
in an integrated setting.

Independent Living Services for Older Individuals Who Are Blind

    The Committee recommends $33,317,000 for Independent Living 
Services for Older Individuals Who Are Blind, which is the same 
as both the fiscal year 2018 enacted level and the fiscal year 
2019 budget request. Funds are distributed to States according 
to a formula based on the population of individuals who are 55 
or older, and provide support for services to persons 55 years 
old or over whose severe visual impairment makes gainful 
employment extremely difficult to obtain, but for whom 
independent living goals are feasible.

Helen Keller National Center

    The Committee recommends $14,000,000 for the Helen Keller 
National Center for Deaf-Blind Youth and Adults, which is 
$1,500,000 above the fiscal year 2018 enacted level and 
$3,664,000 above the fiscal year 2019 budget request. These 
funds are used for the operation of a national center that 
provides intensive services for deaf-blind individuals and 
their families at Sands Point, New York, and a network of ten 
regional offices that provide referral, counseling, transition 
services, and technical assistance to service providers.

           SPECIAL INSTITUTIONS FOR PERSONS WITH DISABILITIES

 
 
 
Appropriation, fiscal year 2018.......................      $228,431,000
Budget request, fiscal year 2019......................       216,722,000
Committee Recommendation..............................       237,792,000
    Change from enacted level.........................        +9,361,000
    Change from budget request........................       +21,070,000
 

    The Committee recommends $237,792,000 for Special 
Institutions for Persons with Disabilities, which is $9,361,000 
above the fiscal year 2018 enacted level and $21,070,000 above 
the fiscal year 2019 budget request.
    The Achieving a Better Live Experience Act of 2014 or ABLE 
Act (PL 113-295) 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 these Special Institutions, 
through its programs supporting individuals living with a 
disability, to raise awareness on the eligibility and benefits 
of these accounts.

                 AMERICAN PRINTING HOUSE FOR THE BLIND

 
 
 
Appropriation, fiscal year 2018.......................       $27,431,000
Budget request, fiscal year 2019......................        25,431,000
Committee Recommendation..............................        28,431,000
    Change from enacted level.........................        +1,000,000
    Change from budget request........................        +3,000,000
 

    This funding subsidizes the production of educational 
materials for legally blind persons enrolled in pre-college 
programs. The American Printing House for the Blind (Printing 
House), which is chartered by the Commonwealth of Kentucky, 
manufactures and maintains an inventory of educational 
materials in accessible formats that are distributed free of 
charge to schools and States based on the number of blind 
students in each State. The Printing House also conducts 
research and field activities to inform educators about the 
availability of materials and how to use them.

               NATIONAL TECHNICAL INSTITUTE FOR THE DEAF

 
 
 
Appropriation, fiscal year 2018.......................       $73,000,000
Budget request, fiscal year 2019......................        70,016,000
Committee Recommendation..............................        75,000,000
    Change from enacted level.........................        +2,000,000
    Change from budget request........................        +4,984,000
 

    Congress established the National Technical Institute for 
the Deaf (Institute) in 1965 to provide a residential facility 
for postsecondary technical training and education for deaf 
persons with the purpose of promoting the employment of these 
individuals. The Institute also conducts applied research and 
provides training related to various aspects of deafness. The 
Secretary of Education administers these activities through a 
contract with the Rochester Institute of Technology in 
Rochester, New York.

                          GALLAUDET UNIVERSITY

 
 
 
Appropriation, fiscal year 2018.......................      $128,000,000
Budget request, fiscal year 2019......................       121,275,000
Committee Recommendation..............................       134,361,000
    Change from enacted level.........................        +6,361,000
    Change from budget request........................       +13,086,000
 

    Gallaudet is a private, non-profit educational institution 
Federally chartered in 1864 providing elementary, secondary, 
undergraduate, and continuing education for deaf persons. In 
addition, the University offers graduate programs in fields 
related to deafness for deaf and hearing students, conducts 
research on deafness, and provides public service programs for 
deaf persons.

                 CAREER, TECHNICAL, AND ADULT EDUCATION

 
 
 
Appropriation, fiscal year 2018.......................    $1,830,686,000
Budget request, fiscal year 2019......................     1,637,159,000
Committee Recommendation..............................     1,945,265,000
    Change from enacted level.........................      +114,579,000
    Change from budget request........................      +308,106,000
 

    This account includes vocational education programs 
authorized by the Carl D. Perkins Career and Technical 
Education Act of 2006 and the Adult Education and Family 
Literacy Act (AEFLA).

Career and Technical Education: State Grants

    The Committee recommends $1,294,598,000 for Career and 
Technical Education: State Grants, which is $102,000,000 above 
the fiscal year 2018 enacted level and $177,000,000 above the 
fiscal year 2019 budget request. Funds are made available for 
obligation on October 1, 2019.
    State Grants support a variety of career and technical 
education programs developed in accordance with the State plan. 
This program focuses Federal resources on institutions with 
high concentrations of low-income students. The populations 
assisted by State Grants range from secondary students in pre-
vocational courses to adults who need retraining to adapt to 
changing technological and labor markets. Funding for State 
Grants will continue support for state-of-the art career and 
technical training to approximately 6 million students in 
secondary schools and more than 4 million students in community 
and technical colleges.

National Programs

    The Committee recommends $20,000,000 for National Programs, 
which is $12,579,000 above the fiscal year 2018 enacted level 
and the same as the fiscal year 2019 budget request. This 
authority supports the conduct and dissemination of research in 
career and technical education. It also includes support for 
the National Centers for Research and Dissemination in Career 
and Technical Education and other discretionary research. The 
funding will support a competition to promote innovation and 
reform in STEM education, including computer science. Coupled 
with dedicated funding in the Education Innovation and Research 
account, this increase will help support the Administration's 
commitment to STEM education.

Adult Basic and Literacy Education State Grants

    The Committee recommends $616,955,000 for Adult Basic and 
Literacy Education State Grants, which is the same as the 
fiscal year 2018 enacted level and $131,106,000 above the 
fiscal year 2019 budget request. State formula grants, 
authorized under the AEFLA, support programs to enable all 
adults to acquire basic literacy skills, to enable those who so 
desire to complete secondary education, and to make available 
to adults the means to become more employable, productive, and 
responsible citizens.

Adult Education National Leadership Activities

    The Committee recommends $13,712,000 for National 
Leadership Activities, which is the same as both the fiscal 
year 2018 enacted level the fiscal year 2019 budget request. 
This program supports applied research, development, 
dissemination, evaluation, and program improvement efforts to 
strengthen the quality of adult education services.

                      STUDENT FINANCIAL ASSISTANCE

 
 
 
Appropriation, fiscal year 2018.......................   $24,445,352,000
Budget request, fiscal year 2019......................    22,975,352,000
Committee Recommendation..............................    24,445,352,000
    Change from enacted level.........................             - - -
    Change from budget request........................    +1,470,000,000
 

    Financial Supports for Students.--The Committee recognizes 
that financial pressures are among the reasons why students are 
unable to complete postsecondary education programs, especially 
for low-income and non-traditional students. The Committee 
requests the Department to provide a briefing within 180 days 
of enactment of this Act on what financial supports have the 
greatest impact on student persistence and completion. The 
Department should consider students enrolled in career and 
technical education programs, community colleges, and four-year 
baccalaureate programs in developing this analysis.

Pell Grants

    The Committee recommends $22,475,352,000 for the Pell Grant 
program, which is the same as both the fiscal year 2018 enacted 
level and the fiscal year 2019 budget request. These funds will 
support Pell grants to students for the 2019-2020 academic 
year.
    The Congressional Budget Office estimates that the budget 
authority provided in this bill is sufficient to maintain the 
discretionary portion of the maximum Pell Grant award at 
$5,035. Combined with mandatory funding streams, the maximum 
Pell Grant in 2019-2020 will be maintained at $6,095.
    Pell Grants help to ensure access to higher educational 
opportunities for low- and middle-income students by providing 
need-based financial assistance. Grants are determined 
according to a statutory formula, which considers income, 
assets, household size, and the number of family members in 
college, among other factors. Pell Grants are the foundation of 
Federal postsecondary student aid programs.
    The Committee recommends that the Department take further 
steps to promote year-round Pell, in accordance with the Higher 
Education Opportunity Act of 2008 (PL 110-315), to help 
students to remain continuously enrolled and stay on track for 
graduation.

Federal Supplemental Educational Opportunity Grants

    The Committee recommends $840,000,000 for this program, 
which is the same as the fiscal year 2018 enacted level and 
$840,000,000 above the fiscal year 2019 budget request. 
Supplemental Educational Opportunity Grants (SEOG) provide 
funds to postsecondary institutions for need-based grants of up 
to $4,000 to undergraduate students, with priority given to 
students who are Pell-eligible. Approximately 68 percent of 
dependent recipients have annual family incomes under $30,000 
and nearly 74 percent of independent SEOG recipients have 
annual family incomes under $20,000. Institutions must 
contribute a 25 percent match toward their SEOG allocation.

Federal Work-Study

    The Committee recommends $1,130,000,000 for the Federal 
Work-Study program, which is the same as the fiscal year 2018 
enacted level and $630,000,000 above the fiscal year 2019 
budget request. Federal Work-Study funds are provided through 
institutions to students who work part-time. The funds assist 
with paying for the cost of education. Approximately 3,200 
colleges and universities receive funding, according to a 
statutory formula, and may allocate it for job location and job 
development centers. Work-study jobs must pay at least the 
Federal minimum wage and institutions must provide 25 percent 
of student earnings.
    Within the total funding level for the Federal Work-Study 
program, the Committee recommends $9,625,000 for the Work 
Colleges program, which is the same as the fiscal year 2018 
enacted level. The Work Colleges program is authorized under 
section 448 of the Higher Education Act (HEA) and supports 
institutions that require all resident students to participate 
in a work-learning program.

                       STUDENT AID ADMINISTRATION

 
 
 
Appropriation, fiscal year 2018.......................    $1,678,943,000
Budget request, fiscal year 2019......................     1,772,000,000
Committee Recommendation..............................     1,678,943,000
    Change from enacted level.........................             - - -
    Change from budget request........................       -93,057,000
 

    Programs administered under the Student Aid Administration 
(SAA) include Pell Grants, campus-based programs, Teacher 
Education Assistance for College and Higher Education grants, 
and Federal student loan programs.
    Salaries and Expenses.--Within the total provided for SAA, 
the Committee recommends $698,943,000 for salaries and 
expenses, which is the same as the fiscal year 2018 enacted 
level and $63,057,000 below the fiscal year 2019 request.
    Loan Servicing Activities.--Within the total provided for 
SAA, the Committee recommends $980,000,000 for Loan Servicing 
Activities, which is the same as the fiscal year 2018 enacted 
level and $30,000,000 below the fiscal year 2019 request.
    Small Business Credit.--The Committee directs the Small 
Business Administration to provide subcontracting small 
business credit under Department of Education Title IV program 
contracts where the prime contractors' award subcontracts to 
small businesses as well as to qualified State or nonprofit 
entities with expertise in assisting students and borrowers in 
support of Title IV programs. Under this authority, 
subcontracts awarded to such entities may be counted toward the 
prime contractor's small business subcontracting goals as 
established through subcontracting plans required by 15 U.S.C. 
637(d). The Small Business Administration may provide this 
small business credit for the duration of the contracts 
currently in effect for servicing or collection of student 
loans and for any contracts awarded for support of Title IV 
programs for a period of five years following publication of 
this report. Such State or nonprofit entities must meet the 
size standard for the North American Industry Classification 
System determined by the Contracting Officer to be appropriate 
for the contract.
    The Department shall coordinate the identification of all 
prime and subcontracts awarded to State and nonprofit entities 
under Title IV program contracts to the Small Business 
Administration so that subcontract reporting may be 
appropriately monitored. Five years after publication of this 
report, the Small Business Administration, in coordination with 
the Department of Education, shall examine the impact of this 
provision to small businesses in Title IV programs.
    Defaulted Student Loan Debt Collection.--The Committee 
understands the Department is continuing to consider options 
for the collection of debt from defaulted student loan 
borrowers. In considering any new contract award for debt 
collection services, the Committee encourages the Secretary to 
allocate new defaulted student loan borrower accounts to 
private collection agencies on the basis of their performance 
compared to all private collection agencies utilizing common 
performance and compliance metrics and the capacity of each 
contractor to process new and existing accounts. The Committee 
also encourages the Secretary to share the common performance 
and compliance metrics with the Committees on Appropriations of 
the House of Representatives and the Senate, as well as 
authorizing Committees of jurisdiction, and report quarterly to 
such Committees on all contractor performance concerning these 
metrics.
    Free Application for Federal Student Aid.--The Committee 
encourages the Secretary of Education to translate the Free 
Application for Federal Student Aid into additional foreign 
languages and to make the translated forms available to 
applicants and their parents in paper and electronic formats.

                            HIGHER EDUCATION

 
 
 
Appropriation, fiscal year 2018.......................    $2,246,551,000
Budget request, fiscal year 2019......................     1,485,848,000
Committee Recommendation..............................     2,300,551,000
    Change from enacted level.........................       +54,000,000
    Change from budget request........................      +814,703,000
 

Strengthening Institutions

    The Committee recommends $98,886,000 for the Part A, 
Strengthening Institutions program, which is the same as the 
fiscal year 2018 enacted level and $98,886,000 above the fiscal 
year 2019 budget request. This program provides competitive 
grants for general operating subsidies to institutions with low 
average educational and general expenditures per student and 
significant percentages of low-income students. Funds may be 
used for faculty and academic program development, management, 
joint use of libraries and laboratories, acquisition of 
equipment, and student services.

Strengthening Hispanic-Serving Institutions

    The Committee recommends $123,183,000 for the Hispanic-
Serving Institutions program, which is the same as the fiscal 
year 2018 enacted level and $123,183,000 above the fiscal year 
2019 budget request. The Hispanic-Serving Institutions program 
provides operating subsidies to schools that serve at least 25 
percent Hispanic students. Funds may be used for faculty and 
academic program development, management, joint use of 
libraries and laboratories, acquisition of equipment, and 
student services.

Promoting Postbaccalaureate Opportunities for Hispanic Americans

    The Committee recommends $11,052,000 for the Promoting 
Postbaccalaureate Opportunities for Hispanic Americans program, 
which is the same as the fiscal year 2018 enacted level and 
$11,052,000 above the fiscal year 2019 budget request. This 
program provides expanded postbaccalaureate educational 
opportunities for the academic attainment of Hispanic and low-
income students. In addition, it expands academic offerings and 
enhances program quality at IHEs educating the majority of 
Hispanic college students.

Strengthening Historically Black Colleges and Universities

    The Committee recommends $279,624,000 for Strengthening 
Historically Black Colleges and Universities (HBCUs), which is 
the same as the fiscal year 2018 enacted level and $34,930,000 
above the fiscal year 2019 budget request. This program 
provides operating subsidies to accredited, historically black 
colleges and universities that were established prior to 1964, 
with the principal mission of educating black Americans. Funds 
are distributed through a formula grant based on the enrollment 
of Pell Grant recipients, number of graduates, and the number 
of graduates entering graduate or professional schools in which 
blacks are underrepresented.

Strengthening Historically Black Graduate Institutions

    The Committee recommends $72,314,000 for the Strengthening 
Historically Black Graduate Institutions program, which is the 
same as the fiscal year 2018 enacted level and $9,033,000 above 
the fiscal year 2019 budget request. The program provides five-
year grants to 18 postsecondary institutions that are specified 
in section 326(e)(1) of the Higher Education Act. Institutions 
may use funds to build endowments, provide scholarships and 
fellowships, and to assist students with the enrollment and 
completion of postbaccalaureate and professional degrees.

Strengthening Predominantly Black Institutions

    The Committee recommends $11,361,000 for the Strengthening 
Predominantly Black Institutions (PBIs) program, which is the 
same as the fiscal year 2018 enacted level and $11,361,000 
above the fiscal year 2019 budget request. This program 
provides grants to PBIs to increase their capacity to serve the 
academic needs of students.

Strengthening Asian American and Native American
        Pacific-Islander-Serving Institutions

    The Committee recommends $3,826,000 for the Asian American 
Pacific Islander program, which is the same as the fiscal year 
2018 enacted level and $3,826,000 above the fiscal year 2019 
budget request. This program provides grants to undergraduate 
institutions that have an undergraduate student enrollment of 
at least 10 percent Asian American or Native American Pacific 
Islander.

Strengthening Alaska Native and Native Hawaiian-Serving 
        Institutions

    The Committee recommends $15,772,000 for the Strengthening 
Alaska Native and Native Hawaiian-Serving Institutions program, 
which is the same as the fiscal year 2018 enacted level and 
$15,772,000 above the fiscal year 2019 budget request, to 
provide competitive grants to improve capacity to serve Alaska 
Native and Native Hawaiian students.

Native American Serving Non-Tribal Institutions

    The Committee recommends $3,826,000 for the Native American 
Serving Non-Tribal Institutions program, which is the same as 
the fiscal year 2018 enacted level and $3,826,000 above the 
fiscal year 2019 budget request. This program makes grants to 
IHEs at which enrollment is at least 10 percent Native American 
students and that are not Tribally-Controlled Colleges or 
Universities.

Strengthening Tribally Controlled Colleges and Universities

    The Committee recommends $31,539,000 for the Strengthening 
Tribally Controlled Colleges and Universities (TCCUs) program, 
which is the same as the fiscal year 2018 enacted level and 
$3,940,000 above the fiscal year 2019 budget request. This 
program makes grants to TCCUs to increase their capacity to 
serve the academic needs of students.

Strengthening HBCU Masters Programs

    The Committee recommends $8,571,000 for the Strengthening 
HBCU Masters Programs, which is the same as the fiscal year 
2018 enacted level and $1,071,000 above the fiscal year 2019 
budget request. 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.
    The Committee does not support the budget proposal to shift 
to a Consolidated MSI grant program and does not appropriate 
funds for such a program.

International Education and Foreign Language Studies

    Domestic Programs.--The Committee recommends $65,103,000 
for the Domestic Programs of the International Education and 
Foreign Languages Studies program, which is the same as the 
fiscal year 2018 enacted level and $65,103,000 above the fiscal 
year 2019 budget request. Authorized by title VI of the Higher 
Education Act, these programs include National resource 
centers, foreign language and area studies fellowships, 
undergraduate international studies and foreign language 
programs, international research and studies projects, business 
and international education projects, international business 
education centers, language resource centers, American overseas 
research centers, and technological innovation and cooperation 
for foreign information access.
    Overseas Programs.--The Committee recommends $7,061,000 for 
the Overseas Programs, which is the same as the fiscal year 
2018 enacted level and $7,061,000 above the fiscal year 2019 
budget request. Funding for these programs support group 
projects, faculty research, special bilateral research, and 
doctoral dissertation research conducted abroad.

Postsecondary Programs for Students with Intellectual Disabilities

    The Committee recommends $11,800,000 for Postsecondary 
Programs for Students with Intellectual Disabilities, which is 
the same as both the fiscal year 2018 level and the fiscal year 
2019 budget request. This program supports grants to create 
model transition programs into higher education for students 
with intellectual disabilities.

Minority Science and Engineering Improvement

    The Committee recommends $11,025,000 for the Minority 
Science and Engineering Improvement Program, which is the same 
as the fiscal year 2018 enacted level and $1,377,000 above the 
fiscal year 2019 budget request. This program awards grants to 
improve mathematics, science, and engineering programs at 
institutions serving primarily minority students and to 
increase the number of minority students who pursue advanced 
degrees and careers in those fields.

Tribally Controlled Postsecondary Career and Technical 
        Institutions

    The Committee recommends $9,469,000 for this program, which 
is the same as the fiscal year 2018 enacted level and 
$1,183,000 above the fiscal year 2019 budget request. This 
program provides competitive grants to Tribally controlled 
postsecondary career and technical institutions to provide 
career and technical education to Native American students.

Federal TRIO Programs

    The Committee recommends $1,060,000,000 for TRIO programs, 
which is $50,000,000 above the fiscal year 2018 enacted level 
and $110,000,000 above the fiscal year 2019 budget request. The 
TRIO programs provide a variety of outreach and support 
services to encourage low-income, often first-generation 
college students to enter and complete college. Discretionary 
grants of up to four or five years are awarded competitively to 
IHEs and other nonprofit organizations. At least two thirds of 
the eligible participants in TRIO must be low-income, first-
generation college students.
    The Committee rejects the proposal to move from competitive 
grant programs to a single State formula program. The 
Department was unable to provide any information on the details 
of how the formula grant would be implemented or how 
accountability for performance would be maintained.
    The Committeee is concerned with the Department's planned 
allocation of the $60,000,000 increase provided in fiscal year 
2018 for TRIO, especially given language in the House report 
which specified the funding should be allocated as it was in 
fiscal year 2017. The Committee expects funding allocations 
such as these to be included in the Department's operating plan 
in future fiscal years.

Gaining Early Awareness and Readiness for Undergraduate 
        Programs

    The Committee recommends $360,000,000 for Gaining Early 
Awareness and Readiness for Undergraduate Programs (GEAR UP), 
which is $10,000,000 above the fiscal year 2018 enacted level 
and $360,000,000 above the fiscal year 2019 budget request. 
GEAR UP provides grants to States and partnerships of low-
income middle and high schools, IHEs, and community 
organizations to target entire grades of students and give them 
the skills, encouragement, and scholarships to pursue 
successfully postsecondary education.
    The Committee rejects the proposal to consolidate GEAR UP 
activities into a new formula funded State TRIO program. The 
Committee continues bill language allowing the Department to 
maintain the GEAR UP evaluation set-aside at 1.5 percent to 
work with the GEAR UP community and grantees to standardize 
data collection, including through the use of third-party data 
systems.

Graduate Assistance in Areas of National Need

    The Committee recommends $23,047,000 for the Graduate 
Assistance in Areas of National Need (GAANN) program, which is 
the same as the fiscal year 2018 enacted level and $23,047,000 
above the fiscal year 2019 budget request. GAANN provides 
fellowships through grants to degree granting postsecondary 
institutions, for students of high financial need studying in 
areas of national need. The Department consults with 
appropriate other agencies and organizations to designate the 
fields of study ``in areas of national need''. Recent examples 
include computer and informational sciences, engineering, 
nursing, and physics.

Teacher Quality Partnership Grants

    The Committee recommends $43,092,000 for the Teacher 
Quality Partnerships (TQP) program, which is the same as the 
fiscal year 2018 enacted level and $43,092,000 above the fiscal 
year 2019 budget request. 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 School

    The Committee recommends $50,000,000 for the Child Care 
Access Means Parents in School program, which is the same as 
the fiscal year 2018 enacted level and $34,866,000 above the 
fiscal year 2019 budget request. This program makes competitive 
grants to colleges and universities to support or establish a 
campus-based childcare program primarily serving the needs of 
low-income students enrolled at the institution.

                           HOWARD UNIVERSITY

 
 
 
Appropriation, fiscal year 2018.......................      $232,518,000
Budget request, fiscal year 2019......................       221,821,000
Committee Recommendation..............................       232,518,000
    Change from enacted level.........................             - - -
    Change from budget request........................       +10,697,000
 

    Howard University is a ``Research I'' university located in 
the District of Columbia. Howard University provides 
undergraduate liberal arts, graduate and professional 
instruction to over 10,000 students from all 50 States.
    Within the amount provided, the Committee recommends 
$27,325,000 for the Howard University Hospital, which is the 
same as both the fiscal year 2018 enacted level and $10,697,000 
above the fiscal year 2019 budget request. The hospital serves 
as a major acute and ambulatory care center for the District of 
Columbia, and functions as a teaching facility.

         COLLEGE HOUSING AND ACADEMIC FACILITIES LOANS PROGRAM

 
 
 
Appropriation, fiscal year 2018.......................          $435,000
Budget request, fiscal year 2019......................           448,000
Committee Recommendation..............................           448,000
    Change from enacted level.........................            13,000
    Change from budget request........................             - - -
 

    Previously, these programs helped to ensure that 
postsecondary institutions were able to make necessary capital 
improvements to maintain and increase their ability to provide 
a high-quality education. Since 1994, no new loans have been 
made, and the Department's role has been to manage the 
outstanding loans.

  HISTORICALLY BLACK COLLEGE AND UNIVERSITY CAPITAL FINANCING PROGRAM 
                                ACCOUNT

 
 
 
Appropriation, fiscal year 2018.......................       $30,484,000
Budget request, fiscal year 2019......................        20,489,000
Committee Recommendation..............................        30,489,000
    Change from enacted level.........................            +5,000
    Change from budget request........................       +10,000,000
 

    The Committee recommends $30,489,000 for the HBCU Capital 
Financing program, which is $5,000 above the fiscal year 2018 
enacted level and $10,000,000 above the fiscal year 2019 budget 
request. Funds are available through September 30, 2019. This 
program is authorized under part D of Title III of the HEA and 
makes capital available for repair and renovation of facilities 
at historically black colleges and universities. In exceptional 
circumstances, capital provided under the program can be used 
for construction or acquisition of facilities.
    Within the total provided for this program, the Committee 
recommendation includes $339,000 for the administrative 
expenses to carry out the program and $20,150,000 for loan 
subsidy costs that will be sufficient to guarantee up to 
$580,000,000 in new loans in fiscal year 2019. Funds will also 
be used to continue technical assistance services to help HBCUs 
improve their financial stability and access to capital 
markets.

                    INSTITUTE OF EDUCATION SCIENCES

 
 
 
Appropriation, fiscal year 2018.......................      $613,462,000
Budget request, fiscal year 2019......................       521,563,000
Committee Recommendation..............................       613,462,000
    Change from enacted level.........................             - - -
    Change from budget request........................       +91,899,000
 

    This account supports education research, statistics, 
dissemination, evaluation, and assessment activities.
    The Committee rejects the budget request to eliminate the 
Regional Education Laboratories and Statewide Longitudinal Data 
Systems.

Research, Development, and Dissemination

    The Committee recommends $192,695,000 for Research, 
Development, and Dissemination, which is the same as the fiscal 
year 2018 enacted level and $5,195,000 above the fiscal year 
2019 budget request. This budget account supports research, 
development, and National dissemination 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 the activities of 
the National Center for Education Statistics (NCES), which is 
the same as fiscal year 2018 enacted level and $3,000,000 below 
the fiscal year 2019 budget request. Statistics activities are 
authorized under title I of the Education Sciences Reform Act 
of 2002. The Center collects, analyzes, and reports statistics 
on all levels of education in the United States. Activities are 
carried out directly and through grants and contracts and 
include projections of enrollments, teacher supply and demand, 
and educational expenditures. NCES also provides technical 
assistance to State and local educational agencies and 
postsecondary institutions.
    Data for Puerto Rico.--The Committee recommends that NCES 
collect and publish data for Puerto Rico in the same manner it 
collects and publishes data for States.

Regional Educational Laboratories

    The Committee recommends $55,423,000 for Regional 
Educational Laboratories, which is the same as the fiscal year 
2018 enacted level and $55,423,000 above the fiscal year 2019 
budget request. This program supports a network of ten 
laboratories that promote the use and development of knowledge 
and evidence to increase student learning and further school 
improvement efforts. Funds are included to support fully 
continuation costs for grants made in prior years.

Research in Special Education

    The Committee recommends $56,000,000 for Research in 
Special Education, which is the same as the fiscal year 2018 
enacted level and $2,000,000 above the fiscal year 2019 budget 
request. This program supports competitive awards to produce 
and advance the use of knowledge to improve services and 
results for children with disabilities. The program focuses on 
producing new knowledge, integrating research and practice, and 
improving the use of knowledge.

Special Education Studies and Evaluations

    The Committee recommends $10,818,000 for Special Education 
Studies and Evaluations, which is the same as both the fiscal 
year 2018 enacted level and the fiscal year 2019 budget 
request. This program awards competitive grants, contracts and 
cooperative agreements to assess the implementation of the IDEA 
and the effectiveness of State and local efforts to provide 
special education and early intervention programs and services 
to infants, toddlers, and children with disabilities.

Statewide Data Systems

    The Committee recommends $32,281,000 for Statewide Data 
Systems, which is the same as the fiscal year 2018 enacted 
level and $32,281,000 above the fiscal year 2019 budget 
request. Competitive grants under this authority are made to 
SEAs to help them manage, analyze, disaggregate and use student 
data consistent with the ESEA.

Assessment

    The Committee recommends $156,745,000 for Assessment, which 
is the same as both the fiscal year 2018 enacted level and the 
fiscal year 2019 budget request. This amount includes 
$7,745,000 for the National Assessment Governing Board (NAGB), 
which is the same as both the fiscal year 2018 enacted level 
and the fiscal year 2019 budget request.
    The National Assessment of Educational Progress (NAEP) is 
the only nationally representative and continuing survey of 
educational ability and achievement of American students. The 
primary goal of the assessment is to determine and report the 
status and trends of the knowledge and skills of students, 
subject by subject. Subject areas assessed in the past have 
included reading, writing, mathematics, science, history, 
citizenship, literature, art, and music. The NAEP is operated 
by contractors through competitive awards made by the NCES. The 
NAGB formulates the policy guidelines for the program.

                        DEPARTMENTAL MANAGEMENT

 
 
 
Appropriation, fiscal year 2018.......................      $608,143,000
Budget request, fiscal year 2019......................       630,113,000
Committee Recommendation..............................       610,649,000
    Change from enacted level.........................        +2,506,000
    Change from budget request........................       -19,464,000
 

    These activities are authorized by the Department of 
Education Organization Act (PL 96-88) and include costs 
associated with the management and operation of the Department 
as well as separate costs associated with the Office for Civil 
Rights and the Office of Inspector General.

Program Administration

    The Committee recommends $432,506,000 for Program 
Administration, which is $2,506,000 above the fiscal year 2018 
enacted level and the same as the fiscal year 2019 budget 
request. These funds support the staff and other costs of 
administering programs and activities at the Department. Items 
include personnel compensation, health, retirement, and other 
benefits as well as travel, rent, telephones, utilities, 
postage fees, data processing, printing, equipment, supplies, 
technology training, consultants, and other contractual 
services.
    Developing Tomorrow's Engineering and Technical 
Workforce.--The Committee recognizes the widespread interest in 
improving STEM education in elementary and secondary schools. 
Among the STEM topics, there is a relative small focus on 
engineering education and lack of a critical mass of teachers 
qualified to deliver engineering instruction. However, 
engineering is important in its application of scientific and 
mathematical principles to innovation, analysis, design, 
evaluation, and manufacture of machines, processes, and 
systems. Therefore, the Committee encourages the expansion of 
engineering initiatives to support, develop, and implement 
formal and informal engineering education programs in 
elementary schools and secondary schools through public-private 
partnerships.
    Education Costs Related to Illegal Immigration.--The 
Committee requests an update to the report submitted to 
Congress by the Department of Education on this topic as it 
appeared in the explanatory statement accompanying division H 
of the Consolidated Appropriations Act, 2016 (PL 114-113).
    English Learners.--The Committee requests the Department 
include information on the effectiveness of English Learner 
(EL) programs in delivering adequate services and 
accommodations to qualified students, disaggregated to the 
extent possible by EL subgroups, in the fiscal year 2020 
Congressional Justification.
    Skills Development in Critical Thinking.--The Committee 
notes the growing trend of the public receiving information in 
digital formats and the subsequent need for students to be able 
to develop critical thinking and fact-finding skills. The 
Committee directs the Department to provide a briefing within 
180 days of enactment of this Act on efforts to support 
students' ability to assess media information critically and 
develop civic knowledge. This could include developing critical 
thinking skills, news literacy, investigative journalism, and 
improved digital literacy. In addition, the Department should 
be prepared to report on how a rigorous program of evaluation 
could assess effectiveness of proposed methods.
    Social and Emotional Learning Education.--The Committee 
notes interest in Social and Emotional Learning (SEL) programs 
and urges more support for evidence-based programs that promote 
positive youth development that unites the home, school, and 
community to cultivate capable and healthy young people of 
strong character through the Department of Education's Office 
of Elementary and Secondary Education and the Office of Safe 
and Healthy Students as well as other programs that support 
school counseling. The Committee notes that high-quality SEL 
instruction improves academic performance, increases the 
resistance factors that lead to the prevention of drug and 
alcohol use, and creates stronger connections to the school and 
community.
    Transparency on Foreign Source Organizations.--The 
Committee is concerned by the potential lack of transparency of 
certain foreign source organizations on institutions of higher 
education, particularly in circumstances where the laws and 
customs of the foreign source do not respect the principles of 
free expression and openness that may lead to censorship and 
other threats to academic freedom. For that reason, the 
Committee encourages institutions of higher learning to 
increase the transparency of agreements entered into with 
foreign source organizations. To ensure greater transparency 
regarding the presence of, and contractual relationship 
between, a foreign source organization and a Federally funded 
institution of higher education, the Committee encourages the 
Secretary to require institutions of higher education to file a 
disclosure report with the Department of any contractual 
agreements with foreign source organizations that do not 
respect the principles of free expression and openness. Such 
contracts should be made available to the public.

                        OFFICE FOR CIVIL RIGHTS

 
 
 
Appropriation, fiscal year 2018.......................      $117,000,000
Budget request, fiscal year 2019......................       107,438,000
Committee Recommendation..............................       117,000,000
    Change from enacted level.........................             - - -
    Change from budget request........................        +9,562,000
 

    The Office for Civil Rights (OCR) is responsible for 
enforcing laws that prohibit discrimination on the basis of 
race, color, national origin, sex, disability, and age in all 
programs and institutions that receive funds from the 
Department. These laws extend to 50 State educational agencies, 
18,200 LEAs, and nearly 7,200 IHEs, including proprietary 
schools. They also extend to 80 State rehabilitation agencies, 
libraries, museums, and other institutions receiving Federal 
funds.
    Expulsions and Suspensions.--The Committee is concerned 
about reports of expulsions and suspensions occurring in 
preschool settings and K-12 classrooms, and the potential for 
adverse impacts on children's subsequent developmental and 
educational outcomes. The Committee is particularly interested 
in reports of racial and gender disparity in such expulsions. 
The Committee therefore urges OCR to report information on 
expulsions and suspensions in preschool and elementary and 
secondary school settings, disaggregated to the extent possible 
by race/ethnicity, sex, disability status, and English Learner 
status, in the fiscal year 2020 Congressional Justification. 
OCR is also encouraged to suggest specific recommendations on 
evidence-based interventions that can reduced the rates of 
expulsions and suspensions and identify opportunities to 
improve school climate.

                      OFFICE OF INSPECTOR GENERAL

 
 
 
Appropriation, fiscal year 2018.......................       $61,143,000
Budget request, fiscal year 2019......................        63,418,000
Committee Recommendation..............................        61,143,000
    Change from enacted level.........................             - - -
    Change from budget request........................        -2,275,000
 

    This Office has authority to inquire into all program and 
administrative activities of the Department as well as into 
related activities of grant and contract recipients. It 
conducts audits and investigations to determine compliance with 
applicable laws and regulations, to check alleged fraud and 
abuse, efficiency of operations, and effectiveness of results.
    Use of Resources.--The Committee urges the Office of 
Inspector General to ensure its focus remains on the primary 
missions of the Office. The Committee cautions the Office, when 
receiving requests from the Department for investigations, to 
consider the most effective and best use of its resources.

                           General Provisions

    Sec. 301. The Committee continues a provision that 
prohibits funds in this Act from being used to prevent the 
implementation of programs of voluntary prayer and meditation 
in public schools.

                          (TRANSFER OF FUNDS)

    Sec. 302. The Committee continues a provision providing the 
Secretary of Education with the authority to transfer up to one 
percent of discretionary funds between appropriations, provided 
that no appropriation is increased by more than three percent 
by any such transfer. This transfer authority is available only 
to meet emergency needs, and may not be used to create any new 
program or fund a project or activity that is not otherwise 
funded in this Act. All transfers are subject to notification 
to the Committees on Appropriations of the House of 
Representatives and the Senate.
    Sec. 303. The Committee continues to include a provision 
that permits Palau to continue participating in Department of 
Education and other programs pending formal ratification of a 
new compact agreement.
    Sec. 304. The Committee amends a provision allowing ESEA 
funds consolidated for evaluation purposes to be available from 
July 1, 2019 through September 30, 2020.
    Sec. 305. The Committee includes a provision allowing 
certain institutions to continue to use endowment income for 
student scholarships.
    Sec. 306. The Committee continues to include a provision 
extending the authorization of the National Advisory Committee 
on Institutional Quality and Integrity.
    Sec. 307. The Committee continues to include a provision 
extending the authority to provide account maintenance fees to 
guaranty agencies for Federal student loans.
    Sec. 308. The Committee adds a provision which permits the 
Department of Education to allow universities to service 
Perkins Loan accounts.
    Sec. 309. The Committee includes a new provision related to 
student loan deferment.
    Sec. 310. The Committee includes a new provision related to 
performance targets and performance bonuses for Office of 
Federal Student Aid employees.

                       TITLE IV--RELATED AGENCIES


               Committee for Purchase From People Who Are


                       Blind or Severely Disabled


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2018.......................        $8,250,000
Budget request, fiscal year 2019......................         8,650,000
Committee Recommendation..............................         8,250,000
    Change from enacted level.........................             - - -
    Change from budget request........................          -400,000
 

    The Committee believes oversight is necessary to ensure the 
program is operating in accordance with statutory requirements 
that blind or other severely disabled individuals provide at 
least 75 percent of hours or direct labor required for the 
production or provision of the products or services to Federal 
government agencies. To ensure the Committee for Purchase from 
People Who Are Blind or Severely Disabled (AbilityOne 
Commission) maintains its oversight capacity, the Committee 
continues bill language requiring the AbilityOne Commission to 
establish written agreements with central nonprofit agencies. 
The written agreements ensure the AbilityOne Commission can 
conduct appropriate audit, oversight, and reporting functions 
in accordance with standard Federal procurement policies.
    Committee for Purchase from People Who Are Blind or 
Severely Disabled--Requested Reports.--The Committee continues 
to request the reports listed under this heading in House 
Report 115-244.
    Office of Inspector General.--The Committee recommends not 
less than $1,250,000 for the Office of Inspector General.

             Corporation for National and Community Service


                           OPERATING EXPENSES

 
 
 
Appropriation, fiscal year 2018.......................    $1,063,958,000
Budget request, fiscal year 2019......................       122,646,000
Committee Recommendation..............................     1,063,958,000
    Change from enacted level.........................             - - -
    Change from budget request........................      +941,312,000
 

Volunteers in Service to America

    The Committee recommends $92,364,000 for Volunteers in 
Service to America (VISTA), which is the same as the fiscal 
year 2018 enacted level and $87,454,000 above the fiscal year 
2019 budget request. 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.

National Senior Volunteer Corps

    The Committee recommends $202,117,000 for the National 
Senior Volunteer Corps programs, which is the same as the 
fiscal year 2018 enacted level and $201,766,000 above the 
fiscal year 2019 budget request. Senior Corps is 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. The breakout of 
funding by program is as follows:

------------------------------------------------------------------------
           National Senior Volunteer Corps:            FY 2019 Committee
------------------------------------------------------------------------
Foster Grandparents Program..........................       $107,702,000
Senior Companion Program.............................         45,512,000
Retired Senior Volunteer Program.....................         48,903,000
------------------------------------------------------------------------

AmeriCorps State and National Grants

    The Committee recommends $473,148,000 for AmeriCorps State 
and National Grants, which is the same as the fiscal year 2018 
enacted level and $446,720,000 above the fiscal year 2019 
budget request. This program provides funds to local and 
national organizations and agencies to address community needs 
in education, public safety, health, and the environment.

Innovation, Assistance, and Other Activities

    The Committee recommends $7,600,000 for Innovation, 
Assistance, and Other Activities, which is the same as the 
fiscal year 2018 enacted level and $7,600,000 above the fiscal 
year 2019 budget request.

Evaluation

    The Committee recommends $4,000,000 for evaluation, which 
is the same as the fiscal year 2018 enacted level and 
$4,000,000 above the fiscal year 2019 budget request. These 
funds support research on program effectiveness.

National Civilian Community Corps

    The Committee recommends $32,000,000 for National Civilian 
Community Corps, which is the same as the fiscal year 2018 
enacted level and $7,913,000 above the fiscal year 2019 budget 
request. This program supports residential, team-based service 
opportunities for individuals aged 18-24.

State Commission Administrative Grants

    The Committee recommends $17,538,000 for State Commission 
Administrative Grants, which is the same as the fiscal year 
2018 enacted level and $17,538,000 above the fiscal year 2019 
budget request. Funds are used for formula grants to support 
State oversight of service programs.

                 Payment to the National Service Trust


 
 
 
Appropriation, fiscal year 2018.......................      $206,842,000
Budget request, fiscal year 2019......................             - - -
Committee Recommendation..............................       206,842,000
    Change from enacted level.........................             - - -
    Change from budget request........................      +206,842,000
 

    The National Service Trust makes payments for 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 the 
Corporation for National and Community Service.

                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2018.......................       $83,737,000
Budget request, fiscal year 2019......................        87,389,000
Committee Recommendation..............................        83,737,000
    Change from enacted level.........................             - - -
    Change from budget request........................        -3,652,000
 

                      OFFICE OF INSPECTOR GENERAL

 
 
 
Appropriation, fiscal year 2018.......................        $5,750,000
Budget request, fiscal year 2019......................         3,568,000
Committee Recommendation..............................         5,750,000
    Change from enacted level.........................             - - -
    Change from budget request........................        +2,182,000
 

                       ADMINISTRATIVE PROVISIONS

    Sec. 401. The Committee continues bill language that 
combines separate matching requirements for AmeriCorps grants.
    Sec. 402. The Committee continues bill language related to 
National Service Trust minimum share requirements.
    Sec. 403. The Committee continues bill language related to 
donations.
    Sec. 404. The Committee continues bill language related to 
veterans.
    Sec. 405. The Committee continues bill language related to 
criminal history background checks.
    Sec. 406. The Committee continues bill language related to 
1,200 hour service positions.

                  Corporation for Public Broadcasting


 
 
 
Appropriation, fiscal year 2018.......................      $465,000,000
Budget request, fiscal year 2019......................             - - -
Committee Recommendation..............................       465,000,000
    Change from enacted level.........................             - - -
    Change from budget request........................      +465,000,000
 

    This appropriation will fund content development, community 
services, and other local station and system needs for the 
Corporation for Public Broadcasting (CPB).
    National Minority Consortia.--According to the Public 
Broadcasting Act, one of the greatest priorities of public 
broadcasting is to address the ``needs of unserved and 
underserved audiences, particularly children and minorities.'' 
Programming that reflects the histories and perspectives of 
diverse racial and ethnic communities is a core value and 
responsibility of public broadcasting, therefore the Committee 
supports continued investment in the National Minority 
Consortia to help accomplish this goal.

               Federal Mediation and Conciliation Service


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2018.......................       $46,650,000
Budget request, fiscal year 2019......................        47,200,000
Committee Recommendation..............................        46,800,000
    Change from enacted level.........................          +150,000
    Change from budget request........................          -400,000
 

    The Federal Mediation and Conciliation Service promotes 
labor-management cooperation through mediation and conflict 
resolution services to industry, government agencies, and 
communities.

            Federal Mine Safety and Health Review Commission


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2018.......................       $17,184,000
Budget request, fiscal year 2019......................        17,053,000
Committee Recommendation..............................        17,124,000
    Change from enacted level.........................           -60,000
    Change from budget request........................           +71,000
 

    The Federal Mine Safety and Health Review Commission is an 
independent adjudicative agency that provides administrative 
trial and appellate review of legal disputes arising under the 
Federal Mine Safety and Health Act of 1977.

                Institute of Museum and Library Services


    OFFICE OF MUSEUM AND LIBRARY SERVICES: GRANTS AND ADMINISTRATION

 
 
 
Appropriation, fiscal year 2018.......................      $240,000,000
Budget request, fiscal year 2019......................        23,000,000
Committee Recommendation..............................       240,000,000
    Change from enacted level.........................             - - -
    Change from budget request........................      +217,000,000
 

    Within the total for the Institute of Museum and Library 
Services (IMLS), the Committee recommends the following 
amounts:

------------------------------------------------------------------------
                                                            FY 2019
                   Budget Activity                         Committee
------------------------------------------------------------------------
Library Services Technology Act:
    Grants to States.................................       $160,803,000
    Native American Library Services.................          5,063,000
    National Leadership: Libraries...................         13,406,000
    Laura Bush 21st Century Librarian................         10,000,000
Museum Services Act:
    Museums for America..............................         22,899,000
    21st Century Museum Professionals................                  0
    Conservation Project Support.....................                  0
    Native American/Hawaiian Museum Service..........          1,472,000
    National Leadership: Museums.....................          8,113,000
African American History and Culture Act:
    Museum Grants for African American History and             2,231,000
     Culture.........................................
Museum and Library Services Act General Provisions:
    Research, Analysis and Data Collection...........          2,013,000
Program Administration...............................         14,000,000
------------------------------------------------------------------------

Library Services and Technology

    The Grants to State Library Agencies program provides funds 
to State Library Administrative Agencies using a population-
based formula.

Program Administration

    The Committee recommends $14,000,000 for Program 
Administration, which is the same as the fiscal year 2018 
enacted level. These funds provide administrative and 
management support for all programs administered by IMLS. The 
Committee also includes $2,013,000 for IMLS' activities in 
policy, research, and data collection, including functions 
formerly conducted by the National Commission on Libraries and 
Information Science.

                  Medicare Payment Advisory Commission


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2018.......................       $12,545,000
Budget request, fiscal year 2019......................        12,471,000
Committee Recommendation..............................        13,045,000
    Change from enacted level.........................          +500,000
    Change from budget request........................          +574,000
 

    The Medicare Payment Advisory Commission (MedPAC) is an 
independent agency tasked with advising the Congress on issues 
affecting the Medicare program. In addition to advising on 
payments to private health plans participating in Medicare and 
providers in Medicare's traditional fee-for-service program, 
MedPAC is also responsible for providing analysis on access to 
care, quality of care, and other issues affecting Medicare.
    Evaluating Barriers to Care.--The Committee recognizes 
HHS's recent focus on eliminating unnecessary paperwork 
burdens, which cause barriers to patient care. The Committee 
notes there are non-physician practitioners, such as nurse 
practitioners, that provide care for CMS beneficiaries. There 
may be way to improve or streamline the process for 
certification or authorization of CMS rembursed products or 
services. Specifically, the Committee encourages MedPAC, in 
consultation with MACPAC, to prepare a report that examines the 
relationship between the physician or post-acute care physician 
and related burdens associated with each provider involved in 
authorizing patients for home health care services, certifying 
patient's needs for diabetic shoes, conducting assessments to 
admit patients to skilled nursing facilities, and providing the 
initial certification of patients for hospice care. The 
Committee further encourages MedPAC to analyze the costs to the 
Medicare program and burdens for patients associated with the 
multiple step process for authorizing and/or certifying for 
these services, for the two most recent years of data 
available, and to submit a report of its findings to the 
Committees on Appropriations of the House of Representatives 
and the Senate and the authorizing committees of jurisdiction 
with recommendations that can be pursued to improve the 
collaboration between physicians and non-physician 
practitioners in order to reduce burdens overall and improve 
patient care.

            Medicaid and Chip Payment and Access Commission


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2018.......................        $8,480,000
Budget request, fiscal year 2019......................         8,700,000
Committee Recommendation..............................         8,480,000
    Change from enacted level.........................             - - -
    Change from budget request........................          -220,000
 

    The Medicaid and CHIP Payment and Access Commission 
(MACPAC) is an independent agency tasked with advising the 
Congress on issues affecting Medicaid and the State Children's 
Health Insurance Program (CHIP). MACPAC conducts policy and 
data analysis on Medicaid and CHIP to support policymakers and 
support program accountability.
    Puerto Rico.--Recognizing the unique conditions of Puerto 
Rico, the Committee supports efforts by MACPAC to evaluate and 
assess viable options for ensuring long-term sustainable access 
to care for Medicaid beneficiaries in the territory. The 
Committee encourages MACPAC to ensure policy recommendations 
that may result in additional outlays be accompanied by policy 
recommendations that can result in savings.
    Therapeutic Foster Care Services.--The Committee is 
concerned about the lack of a uniform definition within the 
Medicaid program for therapeutic foster care (TFC) services. A 
uniform TFC definition could improve the ability for more 
consistent care and treatment. The Committee supports efforts 
by MACPAC to conduct a review for the development of an 
operational TFC definition for the Medicaid program. Further, 
the review should examine advantages of a uniform definition, 
and include a list of potential services and interventions to 
treat mental illness and trauma that could be considered within 
the scope of the uniform definition. It is expected the report 
will be completed within 12 months after enactment of this Act. 
The Committee encourages MACPAC to ensure policy 
recommendations that may result in additional outlays be 
accompanied by policy recommendations that can result in 
savings.

                     National Council on Disability


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2018.......................        $3,250,000
Budget request, fiscal year 2019......................         3,211,000
Committee Recommendation..............................         3,250,000
    Change from enacted level.........................             - - -
    Change from budget request........................           +39,000
 

    The National Council Disability (NCD) is an independent 
Federal agency charged with advising the President, Congress, 
and other Federal agencies regarding policies, programs, 
practices, and procedures that affect people with disabilities. 
NCD is comprised of a team of Presidential and Congressional 
appointees, an Executive Director appointed by the Chair, and a 
full-time professional staff.
    The Achieving a Better Live Experience Act of 2014 or ABLE 
Act (PL 113-295) 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 is concerned about the inconsistent guidance 
provided to ABLE beneficiaries from various Federal agencies 
that administer needs-based assistance programs. As a 
consequence, participation in State ABLE programs suffers. The 
Committee strongly encourages NCD when convening stakeholders 
to conduct information sessions on ABLE accounts. In addition, 
the Committee directs NCD to serve as an interagency 
coordinator to ensure consistency across Federal agencies and 
programs. NCD through its work with disability organizations 
should raise awareness on the eligibility and benefits of these 
accounts.

                     National Labor Relations Board


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2018.......................      $274,224,000
Budget request, fiscal year 2019......................       249,000,000
Committee Recommendation..............................       261,325,000
    Change from enacted level.........................       -12,899,000
    Change from budget request........................       +12,325,000
 

    The National Labor Relations Board is an independent agency 
responsible for enforcing US labor law related to collective 
bargaining and unfair labor practices, including the National 
Labor Relations Act of 1935.

                       ADMINISTRATIVE PROVISIONS

    Sec. 407. The Committee continues a provision relating to 
electronic voting for purposes of collective bargaining.
    Sec. 408. The Committee includes a new provision relating 
to joint-employer standards.
    Sec. 409. The Committee includes a new provision relating 
to jurisdiction over Indian Tribes.

                        National Mediation Board


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2018.......................       $13,800,000
Budget request, fiscal year 2019......................        13,205,000
Committee Recommendation..............................        13,510,000
    Change from enacted level.........................          -290,000
    Change from budget request........................          +305,000
 

    The National Mediation Board is an independent agency that 
coordinates labor-management relations within the US railroads 
and airlines industries.
    The Committee is aware of the backlog of Section 3 
arbitration cases and requests an update in the 2020 
Congressional Justification on the number of pending cases in 
each of the past three fiscal years, the number of cases filed 
each year, and any efforts to reduce the backlog of cases.
    The Committee directs the National Mediation Board to 
report to the Committees on Appropriations of the House of 
Representatives and the Senate within 60 days of enactment of 
this Act on any concurrent postponement of a representation 
election under the jurisdiction of the National Mediation Board 
and the national for the postponement.

            Occupational Safety and Health Review Commission


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2018.......................       $13,225,000
Budget request, fiscal year 2019......................        12,615,000
Committee Recommendation..............................        12,975,000
    Change from enacted level.........................          -250,000
    Change from budget request........................          +360,000
 

    The Occupational Safety and Health Review Commission is an 
independent Federal agency, providing administrative trial and 
appellate review, created to decide contests of citations or 
penalties resulting from OSHA inspections of American work 
places.

                       Railroad Retirement Board


                     DUAL BENEFITS PAYMENTS ACCOUNT

 
 
 
Appropriation, fiscal year 2018.......................       $21,000,000
Budget request, fiscal year 2019......................        18,000,000
Committee Recommendation..............................        18,000,000
    Change from enacted level.........................        -3,000,000
    Change from budget request........................             - - -
 

    This appropriation is authorized by the Railroad Retirement 
Act of 1974 to fund vested dual benefits received by railroad 
retirees who, under prior law, would have become covered by 
both the railroad retirement system and the Social Security 
system because railroad retirement was not fully coordinated 
with Social Security from 1937 to 1974. The Committee includes 
a provision permitting a portion of these funds to be derived 
from income tax receipts on dual benefits as authorized by law. 
The Railroad Retirement Board estimates that approximately 
$1,000,000 may be derived in this manner.

          FEDERAL PAYMENT TO THE RAILROAD RETIREMENT ACCOUNTS

 
 
 
Appropriation, fiscal year 2018.......................          $150,000
Budget request, fiscal year 2019......................           150,000
Committee Recommendation..............................           150,000
    Change from enacted level.........................             - - -
    Change from budget request........................             - - -
 

                      LIMITATION ON ADMINISTRATION

 
 
 
Appropriation, fiscal year 2018.......................      $123,500,000
Budget request, fiscal year 2019......................       115,225,000
Committee Recommendation..............................       126,000,000
    Change from enacted level.........................        +2,500,000
    Change from budget request........................       +10,775,000
 

    The Committee maintains its position that the financial 
statements and audit of the National Railroad Retirement 
Investment Trust should remain separate from the financial 
statements and audit of the Railroad Retire Board (RRB). The 
Committee notes that the Railroad Retirement and Survivors' 
Improvement Act of 2001 mandates that the Trust function 
independently from the RRB. Further, the Act specifically 
requires a separate audit of the Trust by a nongovernmental 
auditor and requires that the results of this audit be included 
in the Trust's Annual Management Report to Congress. The 
Committee expects that the Trust shall be administered and 
audited solely in conformance with the Railroad Retirement and 
Survivors' Improvement Act of 2001.
    The Committee includes $12,500,000 for the implementation 
of information technology systems modernization efforts. Within 
180 days of enactment of this Act, the Railroad Retirement 
Board is directed to submit a comprehensive update to the 
Committees on Appropriations of the House of Representatives 
and the Senate on project status, timelines to completion, and 
total cost of development.

             LIMITATION ON THE OFFICE OF INSPECTOR GENERAL

 
 
 
Appropriation, fiscal year 2018.......................       $11,000,000
Budget request, fiscal year 2019......................         8,437,000
Committee Recommendation..............................         8,500,000
    Change from enacted level.........................        -2,500,000
    Change from budget request........................           +63,000
 

                     Social Security Administration


                PAYMENTS TO SOCIAL SECURITY TRUST FUNDS

 
 
 
Appropriation, fiscal year 2018.......................       $11,400,000
Budget request, fiscal year 2019......................        11,000,000
Committee Recommendation..............................        11,000,000
    Change from enacted level.........................          -400,000
    Change from budget request........................             - - -
 

    This appropriation provides reimbursement to the Social 
Security trust funds for non-trust fund activities.

                  SUPPLEMENTAL SECURITY INCOME PROGRAM

 
 
 
Appropriation, fiscal year 2018.......................   $38,487,277,000
Budget request, fiscal year 2019......................    41,208,000,000
Committee Recommendation..............................    41,251,000,000
    Change from enacted level.........................    +2,763,723,000
    Change from budget request........................       +43,000,000
 

    The Committee recommends $19,700,000,000 in advance funding 
for the first quarter of fiscal year 2020, as requested.

Research and Demonstration

    Section 1110 of the Social Security Act provides authority 
to the Social Security Administration (SSA) for conducting 
research and demonstration projects related to SSA's programs.
    Within the appropriation for Supplemental Security Income 
(SSI), the Committee recommends $101,000,000 for research and 
demonstration activities, which the same as the fiscal year 
2018 enacted level and the fiscal year 2019 budget request.

Administration

    Within the appropriation for SSI, the Committee recommends 
$4,808,000,000, which is $183,277,000 below the fiscal year 
2018 enacted level and $43,000,000 above the fiscal year 2019 
budget request level. This funding is for payment to the Social 
Security trust funds for SSI's share of the administrative 
expenses of SSA.

                 LIMITATION ON ADMINISTRATIVE EXPENSES

 
 
 
Appropriation, fiscal year 2018.......................   $11,018,945,000
Budget request, fiscal year 2019......................    10,575,000,000
Committee Recommendation..............................    10,739,045,000
    Change from enacted level.........................      -279,900,000
    Change from budget request........................      +164,045,000
 

    The Limitation on Administrative Expenses (LAE) funds the 
administrative and operational costs for administering the Old 
Age and Survivors Insurance, Disability Insurance, and 
Supplemental Security Income programs, and associated costs for 
support to the Centers for Medicare and Medicaid Services in 
administering their programs.
    Within the total for LAE, the Committee provides not less 
than $3,475,000,000 for Field Offices and not more than 
$1,750,000,000 for Information Technology.
    Achieving a Better Life Experience Act.--The Achieving a 
Better Life Experience Act of 2014 or ABLE Act (PL 113-295) 
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 is 
concerned about the inconsistent guidance provided to ABLE 
beneficiaries from various Federal agencies that administer 
needs-based assistance programs. As a consequence, 
participation in State ABLE programs suffers. The Committee 
strongly encourages SSA to conduct information sessions on ABLE 
accounts. In addition, the Committee supports efforts by SSA 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.
    Administrative Law Judge Hiring.--SSA's National Hearing 
Centers (NHCs) provide SSA with invaluable flexibility and 
support to address the hearings backlog. Understanding the 
value of this flexibility and support, the Committee directs 
SSA to ensure that its upcoming administrative law judge (ALJ) 
hiring decisions result in allocating additional ALJs to NHCs.
    Consultative Exams.--The SSA Inspector General has 
recommended that all State Disability Determination Service 
(DDSs) periodically assess the feasibility of using a 
competitively awarded contract for Consultative Exams (CEs) to 
improve program integrity and lower costs (Disability 
Determination Services' Use of Volume Consultative Examination 
Providers, A-07-02-12409, March, 2003). Similarly, GAO has 
recommended the use of competitive contracts finding that DDSs, 
and thus SSA, can save millions (Use of Competitive Contracts 
for Consultative Exams Can Save Millions, HRD-90-141, August 
1990). The Committee supports efforts by SSA to develop a 
multi-state pilot program, focused on States with large 
disability review backlogs, including high appeals backlog, and 
continuing disability reviews, to evaluate the use of 
competitively awarded, multiple State contract(s) for CEs. This 
contract shall require the vendor to manage the scheduling of 
CEs; to oversee provider credentialing, recruitment, and 
training; provide timely completion of the CEs and reports; and 
offer quality assurance for completed CE reports. This contract 
shall also require negotiated fees that are comparable to 
Medicare rates with volume discounts and shall assess savings 
to SSA, provide fraud prevention and improved provider 
monitoring by preventing the use of providers suspended or 
debarred from receiving Federal funds, and improved exam 
quality with adequate medical evidence that decreases the 
number of sustained appeals. The Committee recommends that SSA 
consult with the Department of Veterans Affairs on its 
successful demonstration of similar multiple State contracts 
for disability examinations.
    Disability Case Processing System.--The Committee is aware 
that SSA is undertaking efforts to modernize the Disability 
Case Processing System (DCPS). The Committee notes recent cost 
overruns of the project. The Committee continues to encourage 
SSA to engage with States to explore all possible options for 
modernization of the case processing system, to align with the 
needs of each State. The Committee continues to request regular 
updates on the effort to upgrade DCPS, the cost and anticipated 
timeline of the project, and efforts by SSA to engage 
stakeholders, including any barriers to implementation.
    Implementation of New Capability Determination 
Instructions.--The Committee recognizes the importance of SSA 
accurately assessing whether an individual needs a 
representative payee. SSA's regulations specify that the agency 
will appoint a representative payee in cases where a 
beneficiary is not able to manage or direct the management of 
his or her Social Security benefits. However, the Committee 
recognizes that generally SSA has only evaluated a 
beneficiary's ability to manage his or her benefits and has not 
considered a beneficiary's ability to direct someone else to 
manage his or her benefits. In 2017, SSA drafted new program 
instructions for its front-line employees in assessing whether 
an individual is able to direct others to manage his or her 
benefits. Despite the complexity of implementing this policy, 
and SSA's lack of experience making such evaluations, the 
instructions were developed without input from external 
stakeholders. The Committee is encouraged by the recent steps 
SSA has taken to gather stakeholder feedback and expert advice, 
including holding a National Disability Forum on representative 
payment which included some discussion of this policy. However, 
due to the complexity of this policy and the importance of 
correctly evaluating the extent to which an individual can 
manage (directly or indirectly) his or her benefits, the 
Committee believes more stakeholder engagement and expert 
consultation is required. The Committee also notes that SSA 
should consider ways to test this new policy to ensure it 
achieves its goals and can be implemented effectively by field 
office employees before expanding it program-wide. Any test of 
this policy should include specific objectives and metrics to 
assess the policy's effectiveness. Given the Committee's 
continued concerns, the Committee expects that SSA will provide 
the Committees on Appropriations of the House of 
Representatives and the Senate, the Committee on Ways and Means 
of the House of Representatives, and the Committee on Finance 
of the Senate regular updates and briefings on the agency's 
plans prior to moving forward with this policy.
    Information Technology.--The Committee requests an update 
of the plan referenced under this heading in House Report 114-
699.
    Occupational Information System.--SSA is developing a new 
Occupational Information System (OIS) that will replace the 
Dictionary of Occupational Titles as the primary source of 
occupational information used in SSA's disability adjudication 
process. SSA expects to begin a new five year data refresh 
cycle in fiscal year 2018 and to start using the OIS in 2020. 
To provide the Committee with a better understanding of the 
project's costs, the Committee directs SSA to include in its 
annual Report on the Occupational Information System Project 
the estimated costs for each future fiscal year until the 
project is expected to be completed and the estimated cost for 
a five-year data refresh cycle.
    Pilot Program Metrics.--Pilot programs are valuable 
opportunities to test the effects of potential process changes 
but require a well thought out design that includes clear 
objectives and appropriate measures to evaluate the pilot's 
effectiveness. Although sometimes terms are used 
interchangeably, the Committee uses the term ``pilots'' as 
distinct from ``demonstration programs,'' which relate to 
programmatic changes, such as changes in eligibility rules. In 
addition, the Committee notes that there is not always a clear 
distinction between what constitutes a pilot, compared to an 
initiative, or a test. The Committee uses the term ``pilot'' to 
encompass all efforts to test the effects of process changes. 
The Committee continues to be concerned about pilot programs 
that lack clear objectives, evaluation plans, or metrics. The 
Committee expects that, prior to undertaking any new pilots, 
SSA will ensure that it has developed a research design that 
includes clear objectives for the pilot and an evaluation plan, 
including adequate metrics to determine the pilot's 
effectiveness. Metrics should be specific, quantifiable 
measures that can be used to evaluate success. The Committee 
directs SSA to submit a report to the Committees on 
Appropriations of the House of Representatives and the Senate, 
the Committee on Ways and Means of the House of Representatives 
and the Committee on Finance of the Senate not later than 90 
days after the enactment of this act with a description of any 
new pilot, initiative or test of process changes launched in 
fiscal year 2018, or proposed for fiscal year 2019; the 
objective of the pilot; the plan and timeline for evaluation; 
which SSA components are involved in the pilot; and the 
measures or metrics the SSA will use to determine the pilot's 
effectiveness. In addition to the requested information for new 
pilots, the report should include a list of the SSA's ongoing 
pilots, along with the start date for each of these pilots. 
Similar information should be provided in the fiscal year 2020 
Congressional Justification. All SSA pilots should be included 
in the requested report and justification, including those 
undertaken as part of the Compassionate and Responsive Service 
(CARES) plan and in other parts of the agency. The report (and 
section in the justification) does not need to include 
programmatic demonstrations.
    Muscular Dystrophy.--The Committee is aware that SSA is 
included in the Muscular Dystrophy Coordinating Committee under 
the Muscular Dystrophy CARE Act Amendments enacted in September 
2014. The Committee requests SSA to include in the fiscal year 
2020 Congressional Justification 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.
    Report on LAE Expenditures.--The Committee continues to 
request the report referenced under this heading in House 
Report 114-699 as part of the fiscal year 2020 Congressional 
Justification.

Social Security Advisory Board

    The Committee recommends not less than $2,400,000 for the 
Social Security Advisory Board (SSAB), which is $100,000 above 
the fiscal year 2018 enacted level and the fiscal year 2019 
budget request.
    The Committee continues to support SSAB in the development 
of new and innovative ways SSA can achieve its mission and 
improve the quality of service to the public.
    The Committee does not include bill language providing SSAB 
reception and representation authority. The Committee requests 
information on SSAB's need for such authority in the fiscal 
year 2020 Congressional Justification.

User Fees

    In addition to the other amounts provided, the Committee 
recommends $135,000,000 for administrative activities funded 
from user fees. Of this amount, $134,000,000 is derived from 
fees collected from States that request SSA to administer State 
SSI supplementary payments. The remaining $1,000,000 is derived 
from fees charged to non-attorneys who apply for certification 
to represent claimants under titles II and XVI of the Social 
Security Act.

Continuing Disability Reviews and Redeterminations

    The Committee recommends $1,683,000,000 for program 
integrity activities. In the wake of multiple large-scale 
disability fraud cases, the Committee believes that successful 
program integrity activities are vital to maintaining the 
public's support for benefit payments to recipients deserving 
of assistance. The Committee includes bill language 
transferring $10,000,000 to the Office of the Inspector General 
for the cost of jointly operating co-operative disability 
investigation units.

                    OFFICE OF THE INSPECTOR GENERAL

 
 
 
Appropriation, fiscal year 2018.......................      $105,500,000
Budget request, fiscal year 2019......................       105,500,000
Committee Recommendation..............................       108,500,000
    Change from enacted level.........................        +3,000,000
    Change from budget request........................        +3,000,000
 

    The Office of the Inspector General (OIG) is responsible 
for meeting the statutory mission of promoting economy, 
efficiency, and effectiveness in the administration of SSA 
programs and operations and to prevent and detect fraud, waste, 
abuse, and mismanagement in such programs and operations. To 
accomplish this mission, the OIG directs, conducts, and 
supervises audits, evaluations, and investigations relating to 
SSA's programs and operations. In addition, the OIG searches 
for and reports on systemic weaknesses in SSA programs and 
operations, and makes recommendations for needed improvements 
and corrective actions.

                      TITLE V--GENERAL PROVISIONS


                          (TRANSFER OF FUNDS)

    Sec. 501. The Committee continues a provision allowing the 
Secretaries of Labor, Health and Human Services, and Education 
to transfer unexpended balances of prior appropriations to 
accounts corresponding to current appropriations to be used for 
the same purposes and for the same periods of time for which 
they were originally appropriated.
    Sec. 502. The Committee continues a provision prohibiting 
the obligation of funds beyond the current fiscal year unless 
expressly so provided.
    Sec. 503. The Committee continues a provision prohibiting 
funds from being used to support or defeat legislation.
    Sec. 504. The Committee continues a provision limiting the 
amount available for official reception and representation 
expenses for the Secretaries of Labor and Education, the 
Director of the Federal Mediation and Conciliation Service, and 
the Chairman of the National Mediation Board.
    Sec. 505. The Committee continues a provision requiring 
grantees receiving Federal funds to clearly state the 
percentage of the total cost of the program or project that 
will be financed with Federal money.
    Sec. 506. The Committee continues a provision prohibiting 
the use of funds for any abortion.
    Sec. 507. The Committee continues a provision providing 
exceptions to section 506 and a provision prohibiting funds 
from being made available to a Federal agency or program, or to 
a State or local government, if such agency, program or 
government discriminates against institutional or individual 
health care entities because they do not provide, pay for, 
provide coverage of, or refer for abortions.
    Sec. 508. The Committee continues a provision prohibiting 
use of funds for certain research involving human embryos.
    Sec. 509. The Committee continues a provision prohibiting 
use of funds for any activity that promotes the legalization of 
any drug or substance included in schedule I of the schedules 
of controlled substances.
    Sec. 510. The Committee continues a provision prohibiting 
use of funds to promulgate or adopt any final standard 
providing for a unique health identifier until legislation is 
enacted specifically approving the standard.
    Sec. 511. The Committee continues a provision related to 
annual reports to the Secretary of Labor.
    Sec. 512. The Committee continues a provision prohibiting 
transfer of funds made available in this Act except by 
authority provided in this Act or another appropriations Act.
    Sec. 513. The Committee continues a provision to limit 
funds in the bill for public libraries to those that comply 
with the requirements of the Children's Internet Protection 
Act.
    Sec. 514. The Committee continues a provision regarding 
procedures for reprogramming of funds.
    Sec. 515. The Committee continues a provision pertaining to 
appointments to scientific advisory committees.
    Sec. 516. The Committee continues a provision requiring 
each department and related agency funded through this Act to 
submit an operating plan within 45 days of enactment, detailing 
any funding allocations that are different than those specified 
in this Act, the accompanying detailed table, or budget 
request.
    Sec. 517. The Committee continues a provision requiring the 
Secretaries of Labor, Health and Human Services, and Education 
to submit a quarterly report to the Committees on 
Appropriations of the House of Representatives and the Senate 
containing certain information on noncompetitive contracts, 
grants, and cooperative agreements exceeding $500,000 in value.
    Sec. 518. The Committee continues a provision prohibiting 
the use of funds to process claims for credit for quarters of 
coverage based on work performed under a Social Security number 
that was not the claimant's number, where the performance of 
such work under such number has formed the basis for a 
conviction of the claimant of a violation of section 208(a)(6) 
or (7) of the Social Security Act.
    Sec. 519. The Committee continues a provision prohibiting 
the use of funds to implement a Social Security totalization 
agreement with Mexico.
    Sec. 520. The Committee modifies a provision related to 
needle exchange.
    Sec. 521. The Committee continues a provision prohibiting 
the use of funds for the downloading or exchanging of 
pornography.
    Sec. 522. The Committee continues a provision that 
prohibits funding from going to the Association of Community 
Organizations for Reform Now (ACORN), or any of its affiliates, 
subsidiaries, allied organizations, or successors.
    Sec. 523. The Committee continues a provision relating to 
reporting requirements for conference expenditures.
    Sec. 524. The Committee continues a provision relating to 
disclosure of U.S. taxpayer funding for programs used in 
advertising.
    Sec. 525. The Committee continues a provision relating to 
performance partnership pilots.
    Sec. 526. The Committee continues provision requesting 
quarterly reports on the status of balances of appropriations 
from the Departments of Labor, Health and Human Services and 
Education.
    Sec. 527. The Committee includes a new provision 
prohibiting use of funds to implement, administer, enforce or 
further the provisions of Public Law 111-148 and portions of 
public Law 111-152 with certain exceptions.
    Sec. 528. The Committee includes a new provision 
prohibiting use of funds to implement, administer, enforce or 
further advance the Navigators program.

                              (RESCISSION)

    Sec. 529. The Committee rescinds $3,345,000,000 in unused 
funds provided under section 2104(a)(22) of the Social Security 
Act for the Children's Health Insurance Program.

                              (RESCISSION)

    Sec. 530. The Committee rescinds $400,000,000 from the 
Nonrecurring Expenses Fund.

                              (RESCISSION)

    Sec. 531. The Committee permanently rescinds $3,378,613,000 
in unused funds provided under section 2104(n)(2) of the Social 
Security Act for the Child Enrollment Contingency Fund.
    Sec. 532. The Committee includes a new provision 
prohibiting use of funds for research on fetal tissue obtained 
from an induced abortion.
    Sec. 533. The Committee includes a new provision 
restricting funding to certain health care entities.
    Sec. 534. The Committee includes a new provision relating 
to conscience protection with respect to health care entities 
that refuse to participate in abortions.
    Sec. 535. The Committee includes a new provision ensuring 
members of the United States Congress may, for oversight 
purposes, enter facilities used to house unaccompanied alien 
children.
    Sec. 536. The Committee includes a new provision related to 
family detention centers.
    Sec. 537. The Committee includes a new provision related to 
conscience protection with respect to child welfare service 
providers.
    Sec. 538. The Committee includes a new provision related to 
administration of medication to unaccompanied alien children.
    Sec. 539. The Committee includes a sense of Congress 
regarding family separation.
    Sec. 540. The Committee includes a new provision related to 
religious practices of a potential sponsor of unaccompanied 
alien children.
    Sec. 541. The Committee includes a new provision requesting 
a report related to the communication needs of young 
unaccompanied alien children.
    Sec. 542. The Committee includes a new provision requesting 
a report related to mental health services for unaccompanied 
alien children.
    Sec. 543. The Committee includes a Spending Reduction 
Account.

            House of Representatives Reporting Requirements

    The following materials are submitted in accordance with 
various requirements of the Rules of the House of 
Representatives:

         STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES

    Pursuant to clause 3(c)(4) of rule XIII of the Rules of the 
House of Representatives, the following is a statement of 
general performance goals and objectives for which this measure 
authorizes funding: The Committee on Appropriations considers 
program performance, including a program's success in 
developing and attaining outcome-related goals and objectives, 
in developing funding recommendations.

                          RESCISSION OF FUNDS

    Pursuant to clause 3(f)(2) of rule XIII of the Rules of the 
House of Representatives, the following lists the rescissions 
of unexpended balances included in the accompanying bill:

                  RESCISSIONS RECOMMENDED IN THE BILL

------------------------------------------------------------------------
                       Account                               Amount
------------------------------------------------------------------------
Department of Labor:
    Dislocated Workers National Reserve..............       $200,000,000
Department of Health and Human Services:
    Children's Health Insurance Program..............      3,345,000,000
    Nonrecurring Expenses Fund.......................        400,000,000
    Child Enrollment Contingency Fund................      3,378,613,000
------------------------------------------------------------------------

                           TRANSFER OF FUNDS

    Pursuant to clause 3(f)(2) of rule XIII of the Rules of the 
House of Representatives, the following lists the transfers of 
unexpended balances included in the accompanying bill:

                                TITLE I

    Language is included under ``Job Corps'' permitting the 
transfer of funds for Job Corps Center construction, 
rehabilitation and acquisition to meet the operational needs of 
Job Corps Centers or to achieve administrative efficiencies.
    Language is included under ``Special Benefits'' which 
provides for the transfer of such sums as necessary from the 
``Postal Service'' account.
    Language is included under ``Black Lung Disability Trust 
Fund'' which provides for the transfer of funds to the 
``Department of Labor, Office of Workers' Compensation Program, 
Salaries and Expenses.''
    Language is included under ``Black Lung Disability Trust 
Fund'' which provides for the transfer of funds to the 
``Department of Labor, Departmental Management, Salaries and 
Expenses.''
    Language is included under ``Black Lung Disability Trust 
Fund'' which provides for the transfer of funds to the 
``Department of Labor, Departmental Management, Office of 
Inspector General.''
    Language is included under ``Black Lung Disability Trust 
Fund'' which provides for the transfer of funds to the 
``Department of the Treasury.''
    Language is included under ``Departmental Management, 
Salaries and Expenses'' authorizing the transfer of funds 
available for program evaluation to any other account within 
the Department to carry out evaluation activities.
    A general provision is included permitting up to one 
percent of any discretionary appropriation to be transferred to 
another appropriation of the Department of Labor, provided that 
no such appropriation is increased by more than three percent 
by any such transfer.
    A general provision is included that provides for the 
transfer of funds from the ``Employment and Training 
Administration'' for technical assistance services to grantees 
to ``Program Administration,'' and authorizes the transfer of 
up 0.5 percent of each discretionary appropriation for 
``Employment and Training Administration'' to carry out program 
integrity activities subject to certain limitations related to 
``Job Corps.''
    A general provision is included that provides for the 
transfer of up to 0.75 percent of appropriated funds to carry 
out program evaluations of ``Training and Employment 
Services'', ``Job Corps'', ``Community Service Employment for 
Older Americans,'' ``State Unemployment Insurance and 
Employment Service Operations'', ``Employee Benefits Security 
Administration'', ``Office of Workers' Compensation Programs'', 
``Wage and Hour Division'', ``Office of Federal Contract 
Compliance Programs'', ``Office of Labor-Management 
Standards'', ``Occupational Safety and Health Administration'', 
``Mine Safety and Health Administration'', Office of Disability 
Employment Policy, ``Bureau of International Affairs'' and 
``Women's Bureau'' within the Departmental Management, Salaries 
and Expenses'' account, and ``Veterans Employment and 
Training'' for use by the Office of the Chief Evaluation 
Officer.

                                TITLE II

    Language is included under ``Centers for Disease Control 
and Prevention, Buildings and Facilities'' to allow the 
transfer of prior year unobligated Individual Learning Account 
funds to be transferred to this account to carry out the 
purpose of this account.
    Language is included under ``Administration for Children 
and Families-Refugee and Entrant Assistance'' permitting 
transfers pursuant to a general provision to increase an 
appropriation under this heading by ten percent.
    Language is included under ``Administration for Community 
Living, Aging and Disability Services Programs'' for transfer 
to the Secretary of Agriculture to carryout section 311 of the 
Older Americans Act of 1965.
    A general provision is included that allows not to exceed 
one percent of any discretionary funds to be transferred 
between appropriation accounts of the ``Department of Health 
and Human Services'', provided that no appropriation account is 
increased by more than three percent by such transfer.
    A general provision is included that allows the transfer of 
up to three percent among the institutes and centers of the 
``National Institutes of Health'' from amounts identified as 
pertaining to the human immunodeficiency virus.
    A general provision is included that allows the transfer of 
funding determined to be related to the human immunodeficiency 
virus to the ``Office of AIDS Research''.
    A general provision is included that transfers one percent 
of the amount made available for ``National Research Service 
Awards'' at the ``National Institutes of Health'' to the 
``Health Resources and Services Administration''.
    A general provision is included to direct the transfer of 
the ``Prevention and Public Health Fund'' as specified in the 
committee report accompanying this Act.
    Language is included under ``National Institutes of Health, 
Innovation Account'' to allow the transfer of funds to other 
Institutes and Centers to support activities authorized in the 
21st Century Cures Act (PL 114-255).
    Language is included permitting transfer authority for 
evaluation activities for discretionary appropriations in the 
Administration for Children and Families.
    Language is included establishing an Infectious Disease 
Rapid Respond fund for emergency usage by the Secretary under 
certain conditions.

                               TITLE III

    A general provision is included that allows not to exceed 
one percent of any discretionary funds to be transferred 
between appropriation accounts of the Department of Education, 
provided that no appropriation account is increased by more 
than three percent by such transfer.

                                TITLE IV

    Language is included under Payment to the National Service 
Trust authorizing the transfer of funds from the ``Corporation 
for National and Community Service, Operating Expenses'' to 
support the activities of national service participants.
    Language is included under ``Social Security 
Administration'' authorizing the transfer of up to three 
percent of the Social Security Administration's ``Limitation on 
Administration Expenses'' account to be available for purposes 
of the Office of Inspector General.

                                TITLE V

    A general provision is included that allows the Secretaries 
of Labor, Health and Human Services, and Education to transfer 
balances of prior appropriation to accounts corresponding to 
current appropriations.

   DISCLOSURE OF EARMARKS AND CONGRESSIONALLY DIRECTED SPENDING ITEMS

    Neither the bill nor the report contains any Congressional 
earmarks, limited tax benefits, or limited tariff benefits as 
defined in clause 9 of rule XXI.

          COMPLIANCE WITH RULE XIII, CL. 3(E) (RAMSEYER RULE)

    In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italics, existing law in which no change 
is proposed is shown in roman):

          Compliance With Rule XIII, Cl. 3(e) (Ramseyer Rule)

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italics, existing law in which no change 
is proposed is shown in roman):

              DEPARTMENT OF LABOR APPROPRIATIONS ACT, 1958

Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled, That the 
following sums are appropriated, out of any money in the 
Treasury not otherwise appropriated, for the Departments of 
Labor, and Heath, Education, and Welfare, and related agencies, 
for the fiscal year ending June 30, 1958, namely:

                      TITLE I--DEPARTMENT OF LABOR

OFFICE OF THE SECRETARY

           *       *       *       *       *       *       *


  Working capital fund: There is hereby established a working 
capital fund, to be available without fiscal year limitation, 
for expenses necessary for the maintenance and operation of 
[(1) a central reproduction service; (2) a central visual 
exhibit service; (3) a central supply service for supplies and 
equipment for which adequate stocks may be maintained to meet 
in whole or in part the requirements of the Department; (4) a 
central tabulating service; (5) telephone, mail and messenger 
services; (6) a central accounting and payroll service; and (7) 
a central laborers' service: Provided, That any stocks of 
supplies and equipment on hand or on order shall be used to 
capitalize such fund: Provided further, That such fund shall be 
reimbursed in advance from funds available to bureaus, offices, 
and agencies for which such centralized services are performed 
at rates which will return in full all expenses of operation, 
including reserves for accrued annual leave and depreciation of 
equipment: Provided further, That the Secretary of Labor may 
transfer annually an amount not to exceed $3,000,000 from 
unobligated balances in the Department's salaries and expenses 
accounts, to the unobligated balance of the Working Capital 
Fund, to be merged with such Fund and used for the acquisition 
of capital equipment and the improvement of financial 
management, information technology and other support systems, 
and to remain available until expended: Provided further, That 
the unobligated balance of the Fund shall not exceed 
$20,000,000..] a comprehensive program of centralized services 
which the Secretary of Labor may prescribe and deem appropriate 
and advantageous to provide on a reimbursable basis: Provided, 
That such fund may receive advances and reimbursements from 
funds available to bureaus, offices, and agencies for which 
such centralized services are performed at rates which will 
return in full all expenses of operation, including reserves 
for accrued annual leave, worker's compensation, depreciation 
of capitalized equipment and amortization of human resources 
software and systems (either acquired or donated): Provided 
further, That the Secretary of Labor may transfer annually an 
amount not to exceed $9,000,000 from unobligated balances in 
the Department's salaries and expenses accounts, to the 
unobligated balance of the Working Capital Fund, to be merged 
with such Fund and used for the acquisition of capital 
equipment and the improvement of financial management, 
information technology and other support systems, and to remain 
available for obligation for an additional five fiscal years: 
Provided further, That such fund may receive reimbursements 
from entities or persons for use of Departmental facilities, 
including associated utilities and security services, and such 
reimbursements shall be credited to and merged with this fund: 
Provided further, That none of the funds shall be available 
unless the Chief Information Officer of the Department of Labor 
has submitted a plan, approved by the Office of Management and 
Budget, describing the amounts to be transferred by account, 
the planned use of funds, including descriptions of projects, 
project status, including any scheduled delays and cost 
overruns, financial expenditures, planned activities, and 
expected benefits, to the Committees on Appropriations of the 
House of Representatives and the Senate by July 31 of the 
calendar year prior to the fiscal year in which the transfer 
will occur: Provided further, That pursuant to section 11319 of 
title 40, United States Code, the Secretary shall ensure that 
the Department's Chief Information Officer shall, at a minimum, 
be a principal advisor to the Secretary and a member on any 
board or governance structure of the Department responsible for 
advising and setting Department-wide information technology 
budgets: Provided further, That none of the funds available for 
information technology modernization under this section or 
under the heading ``IT Modernization'' shall be used for 
information technology modernization projects unless an 
experienced project manager, employed by the Department of 
Labor, is assigned oversight responsibility, including but not 
limited to, ensuring such projects are completed within 
established timeframes and budgets 

           *       *       *       *       *       *       *

                              ----------                              


 DEPARTMENT OF LABOR, AND HEALTH, EDUCATION, AND WELFARE, AND RELATED 
                   AGENCIES APPROPRIATIONS ACT, 1970

Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled, That the 
following sums are appropriated, out of any money in the 
Treasury not otherwise appropriated, for the Departments of 
Labor, and Health, Education, and Welfare, and related 
agencies, for the fiscal year ending June 30, 1970, and for 
other purposes, namely:

TITLE I--DEPARTMENT OF LABOR

           *       *       *       *       *       *       *


Office of the Secretary

           *       *       *       *       *       *       *


                         [WORKING CAPITAL FUND]

  [The Working Capital Fund of the Department of Labor shall 
hereafter be available for expenses necessary for personnel 
functions in regional administrative offices.]

           *       *       *       *       *       *       *

                              ----------                              


  DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND 
               RELATED AGENCIES APPROPRIATIONS ACT, 19994

Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled, That the 
following sums are appropriated, out of any money in the 
Treasury not otherwise appropriated, for the Departments of 
Labor, Health and Human Services, and Education, and related 
agencies for the fiscal year ending September 30, 1994, and for 
other purposes, namely:

TITLE I--DEPARTMENT OF LABOR

           *       *       *       *       *       *       *


Departmental Management

           *       *       *       *       *       *       *


                         [WORKING CAPITAL FUND]

  [For expenses necessary during the fiscal year ending 
September 30, 1994, and each fiscal year thereafter, for the 
maintenance and operation of a comprehensive program of 
centralized services which the Secretary of Labor may prescribe 
and deem appropriate and advantageous to provide on a 
reimbursable basis under the provisions of the Economy Act 
(subject to prior notice to OMB) in the national office and 
field: Provided, That such fund shall be reimbursed in advance 
from funds available to agencies, bureaus, and offices for 
which such centralized services are performed at rates which 
will return in full cost of operations including services 
obtained through cooperative administrative services units 
under the Economy Act, including reserves for accrued annual 
leave, worker's compensation, depreciation of capitalized 
equipment, and amortization of ADP software and systems (either 
acquired or donated): Provided further, That funds received for 
services rendered to any entity or person for use of 
Departmental facilities, including associated utilities and 
security services, shall be credited to and merged with this 
fund.]

           *       *       *       *       *       *       *

                              ----------                              


                      HIGHER EDUCATION ACT OF 1965



           *       *       *       *       *       *       *
TITLE I--GENERAL PROVISIONS

           *       *       *       *       *       *       *


PART B--ADDITIONAL GENERAL PROVISIONS

           *       *       *       *       *       *       *


SEC. 114. NATIONAL ADVISORY COMMITTEE ON INSTITUTIONAL QUALITY AND 
                    INTEGRITY.

  (a) Establishment.--There is established in the Department a 
National Advisory Committee on Institutional Quality and 
Integrity (in this section referred to as the ``Committee'') to 
assess the process of accreditation and the institutional 
eligibility and certification of institutions of higher 
education (as defined in section 102) under title IV.
  (b) Membership.--
          (1) In general.--The Committee shall have 18 members, 
        of which--
                  (A) six members shall be appointed by the 
                Secretary;
                  (B) six members shall be appointed by the 
                Speaker of the House of Representatives, three 
                of whom shall be appointed on the 
                recommendation of the majority leader of the 
                House of Representatives, and three of whom 
                shall be appointed on the recommendation of the 
                minority leader of the House of 
                Representatives; and
                  (C) six members shall be appointed by the 
                President pro tempore of the Senate, three of 
                whom shall be appointed on the recommendation 
                of the majority leader of the Senate, and three 
                of whom shall be appointed on the 
                recommendation of the minority leader of the 
                Senate.
          (2) Qualifications.--Individuals shall be appointed 
        as members of the Committee--
                  (A) on the basis of the individuals' 
                experience, integrity, impartiality, and good 
                judgment;
                  (B) from among individuals who are 
                representatives of, or knowledgeable 
                concerning, education and training beyond 
                secondary education, representing all sectors 
                and types of institutions of higher education 
                (as defined in section 102); and
                  (C) on the basis of the individuals' 
                technical qualifications, professional 
                standing, and demonstrated knowledge in the 
                fields of accreditation and administration in 
                higher education.
          (3) Terms of members.--Except as provided in 
        paragraph (5), the term of office of each member of the 
        Committee shall be for six years, except that any 
        member appointed to fill a vacancy occurring prior to 
        the expiration of the term for which the member's 
        predecessor was appointed shall be appointed for the 
        remainder of such term.
          (4) Vacancy.--A vacancy on the Committee shall be 
        filled in the same manner as the original appointment 
        was made not later than 90 days after the vacancy 
        occurs. If a vacancy occurs in a position to be filled 
        by the Secretary, the Secretary shall publish a Federal 
        Register notice soliciting nominations for the position 
        not later than 30 days after being notified of the 
        vacancy.
          (5) Initial terms.--The terms of office for the 
        initial members of the Committee shall be--
                  (A) three years for members appointed under 
                paragraph (1)(A);
                  (B) four years for members appointed under 
                paragraph (1)(B); and
                  (C) six years for members appointed under 
                paragraph (1)(C).
          (6) Chairperson.--The members of the Committee shall 
        select a chairperson from among the members.
  (c) Functions.--The Committee shall--
          (1) advise the Secretary with respect to 
        establishment and enforcement of the standards of 
        accrediting agencies or associations under subpart 2 of 
        part H of title IV;
          (2) advise the Secretary with respect to the 
        recognition of a specific accrediting agency or 
        association;
          (3) advise the Secretary with respect to the 
        preparation and publication of the list of nationally 
        recognized accrediting agencies and associations;
          (4) advise the Secretary with respect to the 
        eligibility and certification process for institutions 
        of higher education under title IV, together with 
        recommendations for improvements in such process;
          (5) advise the Secretary with respect to the 
        relationship between--
                  (A) accreditation of institutions of higher 
                education and the certification and eligibility 
                of such institutions; and
                  (B) State licensing responsibilities with 
                respect to such institutions; and
          (6) carry out such other advisory functions relating 
        to accreditation and institutional eligibility as the 
        Secretary may prescribe by regulation.
  (d) Meeting Procedures.--
          (1) Schedule.--
                  (A) Biannual meetings.--The Committee shall 
                meet not less often than twice each year, at 
                the call of the Chairperson.
                  (B) Publication of date.--The Committee shall 
                submit the date and location of each meeting in 
                advance to the Secretary, and the Secretary 
                shall publish such information in the Federal 
                Register not later than 30 days before the 
                meeting.
          (2) Agenda.--
                  (A) Establishment.--The agenda for a meeting 
                of the Committee shall be established by the 
                Chairperson and shall be submitted to the 
                members of the Committee upon notification of 
                the meeting.
                  (B) Opportunity for public comment.--The 
                agenda shall include, at a minimum, opportunity 
                for public comment during the Committee's 
                deliberations.
          (3) Secretary's designee.--The Secretary shall 
        designate an employee of the Department to serve as the 
        Secretary's designee to the Committee, and the 
        Chairperson shall invite the Secretary's designee to 
        attend all meetings of the Committee.
          (4) Federal advisory committee act.--The Federal 
        Advisory Committee Act (5 U.S.C. App.) shall apply to 
        the Committee, except that section 14 of such Act shall 
        not apply.
  (e) Report and Notice.--
          (1) Notice.--The Secretary shall annually publish in 
        the Federal Register--
                  (A) a list containing, for each member of the 
                Committee--
                          (i) the member's name;
                          (ii) the date of the expiration of 
                        the member's term of office; and
                          (iii) the name of the individual 
                        described in subsection (b)(1) who 
                        appointed the member; and
                  (B) a solicitation of nominations for each 
                expiring term of office on the Committee of a 
                member appointed by the Secretary.
          (2) Report.--Not later than the last day of each 
        fiscal year, the Committee shall make available an 
        annual report to the Secretary, the authorizing 
        committees, and the public. The annual report shall 
        contain--
                  (A) a detailed summary of the agenda and 
                activities of, and the findings and 
                recommendations made by, the Committee during 
                the fiscal year preceding the fiscal year in 
                which the report is made;
                  (B) a list of the date and location of each 
                meeting during the fiscal year preceding the 
                fiscal year in which the report is made;
                  (C) a list of the members of the Committee; 
                and
                  (D) a list of the functions of the Committee, 
                including any additional functions established 
                by the Secretary through regulation.
  (f) Termination.--The Committee shall terminate on September 
30, [2018] 2019.

           *       *       *       *       *       *       *


TITLE IV--STUDENT ASSISTANCE

           *       *       *       *       *       *       *


Part B--Federal Family Education Loan Program

           *       *       *       *       *       *       *


SEC. 427. ELIGIBILITY OF STUDENT BORROWERS AND TERMS OF FEDERALLY 
                    INSURED STUDENT LOANS.

  (a) List of Requirements.--Except as provided in section 
428C, a loan by an eligible lender shall be insurable by the 
Secretary under the provisions of this part only if--
          (1) made to a student who (A) is an eligible student 
        under section 484, (B) has agreed to notify promptly 
        the holder of the loan concerning any change of 
        address, and (C) is carrying at least one-half the 
        normal full-time academic workload for the course of 
        study the student is pursuing (as determined by the 
        institution); and
          (2) evidenced by a note or other written agreement 
        which--
                  (A) is made without security and without 
                endorsement;
                  (B) provides for repayment (except as 
                provided in subsection (c)) of the principal 
                amount of the loan in installments over a 
                period of not less than 5 years (unless sooner 
                repaid or unless the student, during the 6 
                months preceding the start of the repayment 
                period, specifically requests that repayment be 
                made over a shorter period) nor more than 10 
                years beginning 6 months after the month in 
                which the student ceases to carry at an 
                eligible institution at least one-half the 
                normal full-time academic workload as 
                determined by the institution, except--
                          (i) as provided in subparagraph (C);
                          (ii) that the note or other written 
                        instrument may contain such reasonable 
                        provisions relating to repayment in the 
                        event of default in the payment of 
                        interest or in the payment of the cost 
                        of insurance premiums, or other default 
                        by the borrower, as may be authorized 
                        by regulations of the Secretary in 
                        effect at the time the loan is made; 
                        and
                          (iii) that the lender and the 
                        student, after the student ceases to 
                        carry at an eligible institution at 
                        least one-half the normal full-time 
                        academic workload as determined by the 
                        institution, may agree to a repayment 
                        schedule which begins earlier, or is of 
                        shorter duration, than required by this 
                        subparagraph, but in the event a 
                        borrower has requested and obtained a 
                        repayment period of less than 5 years, 
                        the borrower may at any time prior to 
                        the total repayment of the loan, have 
                        the repayment period extended so that 
                        the total repayment period is not less 
                        than 5 years;
                  (C) provides that periodic installments of 
                principal need not be paid, but interest shall 
                accrue and be paid, during any period--
                          (i) during which the borrower--
                                  (I) is pursuing at least a 
                                half-time course of study as 
                                determined by an eligible 
                                institution; or
                                  (II) is pursuing a course of 
                                study pursuant to a graduate 
                                fellowship program approved by 
                                the Secretary, or pursuant to a 
                                rehabilitation training program 
                                for individuals with 
                                disabilities approved by the 
                                Secretary,
                        except that no borrower shall be 
                        eligible for a deferment under this 
                        clause, or a loan made under this part 
                        (other than a loan made under section 
                        428B or 428C), while serving in a 
                        medical internship or residency 
                        program;
                          (ii) not in excess of 3 years during 
                        which the borrower is seeking and 
                        unable to find full-time employment[; 
                        or];
                          (iii) not in excess of 3 years for 
                        any reason which the lender determines, 
                        in accordance with regulations 
                        prescribed by the Secretary under 
                        section 435(o), has caused or will 
                        cause the borrower to have an economic 
                        hardship; or
                          (iv) in which the borrower is 
                        receiving treatment for cancer and the 
                        6 months after such period.
                and provides that any such period shall not be 
                included in determining the 10-year period 
                described in subparagraph (B);
                  (D) provides for interest on the unpaid 
                principal balance of the loan at a yearly rate, 
                not exceeding the applicable maximum rate 
                prescribed in section 427A, which interest 
                shall be payable in installments over the 
                period of the loan except that, if provided in 
                the note or other written agreement, any 
                interest payable by the student may be deferred 
                until not later than the date upon which 
                repayment of the first installment of principal 
                falls due, in which case interest accrued 
                during that period may be added on that date to 
                the principal;
                  (E) provides that the lender will not collect 
                or attempt to collect from the borrower any 
                portion of the interest on the note which is 
                payable by the Secretary under this part, and 
                that the lender will enter into such agreements 
                with the Secretary as may be necessary for the 
                purpose of section 437;
                  (F) entitles the student borrower to 
                accelerate without penalty repayment of the 
                whole or any part of the loan;
                  (G)(i) contains a notice of the system, of 
                disclosure of information concerning such loan 
                to consumer reporting agencies under section 
                430A, and (ii) provides that the lender on 
                request of the borrower will provide 
                information on the repayment status of the note 
                to such consumer reporting agencies;
                  (H) provides that, no more than 6 months 
                prior to the date on which the borrower's first 
                payment on a loan is due, the lender shall 
                offer the borrower the option of repaying the 
                loan in accordance with a graduated or income-
                sensitive repayment schedule established by the 
                lender and in accordance with the regulations 
                of the Secretary; and
                  (I) contains such other terms and conditions, 
                consistent with the provisions of this part and 
                with the regulations issued by the Secretary 
                pursuant to this part, as may be agreed upon by 
                the parties to such loan, including, if agreed 
                upon, a provision requiring the borrower to pay 
                the lender, in addition to principal and 
                interest, amounts equal to the insurance 
                premiums payable by the lender to the Secretary 
                with respect to such loan;
          (3) the funds borrowed by a student are disbursed to 
        the institution by check or other means that is payable 
        to and requires the endorsement or other certification 
        by such student, except--
                  (A) that nothing in this title shall be 
                interpreted--
                          (i) to allow the Secretary to require 
                        checks to be made copayable to the 
                        institution and the borrower; or
                          (ii) to prohibit the disbursement of 
                        loan proceeds by means other than by 
                        check; and
                  (B) in the case of any student who is 
                studying outside the United States in a program 
                of study abroad that is approved for credit by 
                the home institution at which such student is 
                enrolled, the funds shall, at the request of 
                the borrower, be delivered directly to the 
                student and the checks may be endorsed, and 
                fund transfers authorized, pursuant to an 
                authorized power-of-attorney; and
          (4) the funds borrowed by a student are disbursed in 
        accordance with section 428G.
  (b) Special Rules for Multiple Disbursement.--For the purpose 
of subsection (a)(4)--
          (1) all loans issued for the same period of 
        enrollment shall be considered as a single loan; and
          (2) the requirements of such subsection shall not 
        apply in the case of a loan made under section 428B or 
        428C, or made to a student to cover the cost of 
        attendance at an eligible institution outside the 
        United States.
  (c) Special Repayment Rules.--Except as provided in 
subsection (a)(2)(H), the total of the payments by a borrower 
during any year of any repayment period with respect to the 
aggregate amount of all loans to that borrower which are 
insured under this part shall not, unless the borrower and the 
lender otherwise agree, be less than $600 or the balance of all 
such loans (together with interest thereon), whichever amount 
is less (but in no instance less than the amount of interest 
due and payable).

           *       *       *       *       *       *       *


SEC. 428. FEDERAL PAYMENTS TO REDUCE STUDENT INTEREST COSTS.

  (a) Federal Interest Subsidies.--
          (1) Types of loans that qualify.--Each student who 
        has received a loan for study at an eligible 
        institution for which the first disbursement is made 
        before July 1, 2010, and--
                  (A) which is insured by the Secretary under 
                this part; or
                  (B) which is insured under a program of a 
                State or of a nonprofit private institution or 
                organization which was contracted for, and paid 
                to the student, within the period specified in 
                paragraph (5), and which--
                          (i) in the case of a loan insured 
                        prior to July 1, 1967, was made by an 
                        eligible lender and is insured under a 
                        program which meets the requirements of 
                        subparagraph (E) of subsection (b)(1) 
                        and provides that repayment of such 
                        loan shall be in installments beginning 
                        not earlier than 60 days after the 
                        student ceases to pursue a course of 
                        study (as described in subparagraph (D) 
                        of subsection (b)(1)) at an eligible 
                        institution, or
                          (ii) in the case of a loan insured 
                        after June 30, 1967, was made by an 
                        eligible lender and is insured under a 
                        program covered by an agreement made 
                        pursuant to subsection (b),
        shall be entitled to have paid on his or her behalf and 
        for his or her account to the holder of the loan a 
        portion of the interest on such loan under 
        circumstances described in paragraph (2).
          (2) Additional requirements to receive subsidy.--(A) 
        Each student qualifying for a portion of an interest 
        payment under paragraph (1) shall--
                  (i) have provided to the lender a statement 
                from the eligible institution, at which the 
                student has been accepted for enrollment, or at 
                which the student is in attendance, which--
                          (I) sets forth the loan amount for 
                        which the student shows financial need; 
                        and
                          (II) sets forth a schedule for 
                        disbursement of the proceeds of the 
                        loan in installments, consistent with 
                        the requirements of section 428G;
                  (ii) meet the requirements of subparagraph 
                (B); and
                          (iii) have provided to the lender at 
                        the time of application for a loan 
                        made, insured, or guaranteed under this 
                        part, the student's driver's number, if 
                        any.
          (B) For the purpose of clause (ii) of subparagraph 
        (A), a student shall qualify for a portion of an 
        interest payment under paragraph (1) if the eligible 
        institution has determined and documented the student's 
        amount of need for a loan based on the student's 
        estimated cost of attendance, estimated financial 
        assistance, and, for the purpose of an interest payment 
        pursuant to this section, expected family contribution 
        (as determined under part F), subject to the provisions 
        of subparagraph (D).
          (C) For the purpose of this paragraph--
                  (i) a student's cost of attendance shall be 
                determined under section 472;
                  (ii) a student's estimated financial 
                assistance means, for the period for which the 
                loan is sought--
                          (I) the amount of assistance such 
                        student will receive under subpart 1 of 
                        part A (as determined in accordance 
                        with section 484(b)), subpart 3 of part 
                        A, and parts C and E; plus
                          (II) other scholarship, grant, or 
                        loan assistance, but excluding--
                                  (aa) any national service 
                                education award or post-service 
                                benefit under title I of the 
                                National and Community Service 
                                Act of 1990; and
                                  (bb) any veterans' education 
                                benefits as defined in section 
                                480(c); and
                  (iii) the determination of need and of the 
                amount of a loan by an eligible institution 
                under subparagraph (B) with respect to a 
                student shall be calculated in accordance with 
                part F.
          (D) An eligible institution may not, in carrying out 
        the provisions of subparagraphs (A) and (B) of this 
        paragraph, provide a statement which certifies the 
        eligibility of any student to receive any loan under 
        this part in excess of the maximum amount applicable to 
        such loan.
          (E) For the purpose of subparagraphs (B) and (C) of 
        this paragraph, any loan obtained by a student under 
        section 428A or 428H or a parent under section 428B of 
        this Act or under any State-sponsored or private loan 
        program for an academic year for which the 
        determination is made may be used to offset the 
        expected family contribution of the student for that 
        year.
          (3) Amount of interest subsidy.--(A)(i) Subject to 
        section 438(c), the portion of the interest on a loan 
        which a student is entitled to have paid, on behalf of 
        and for the account of the student, to the holder of 
        the loan pursuant to paragraph (1) of this subsection 
        shall be equal to the total amount of the interest on 
        the unpaid principal amount of the loan--
                                  (I) which accrues prior to 
                                the date the student ceases to 
                                carry at least one-half the 
                                normal full-time academic 
                                workload (as determined by the 
                                institution), or
                  (II) which accrues during a period in which 
                principal need not be paid (whether or not such 
                principal is in fact paid) by reason of a 
                provision described in subsection (b)(1)(M) of 
                this section or in section 427(a)(2)(C).
          (ii) Such portion of the interest on a loan shall not 
        exceed, for any period, the amount of the interest on 
        that loan which is payable by the student after taking 
        into consideration the amount of any interest on that 
        loan which the student is entitled to have paid on his 
        or her behalf for that period under any State or 
        private loan insurance program.
          (iii) The holder of a loan with respect to which 
        payments are required to be made under this section 
        shall be deemed to have a contractual right, as against 
        the United States, to receive from the Secretary the 
        portion of interest which has been so determined 
        without administrative delay after the receipt by the 
        Secretary of an accurate and complete request for 
        payment pursuant to paragraph (4).
          (iv) The Secretary shall pay this portion of the 
        interest to the holder of the loan on behalf of and for 
        the account of the borrower at such times as may be 
        specified in regulations in force when the applicable 
        agreement entered into pursuant to subsection (b) was 
        made, or, if the loan was made by a State or is insured 
        under a program which is not covered by such an 
        agreement, at such times as may be specified in 
        regulations in force at the time the loan was paid to 
        the student.
          (v) A lender may not receive interest on a loan for 
        any period that precedes the date that is--
                  (I) in the case of a loan disbursed by check, 
                10 days before the first disbursement of the 
                loan;
                  (II) in the case of a loan disbursed by 
                electronic funds transfer, 3 days before the 
                first disbursement of the loan; or
                  (III) in the case of a loan disbursed through 
                an escrow agent, 3 days before the first 
                disbursement of the loan.
          (B) If--
                  (i) a State student loan insurance program is 
                covered by an agreement under subsection (b),
                  (ii) a statute of such State limits the 
                interest rate on loans insured by such program 
                to a rate which is less than the applicable 
                interest rate under this part, and
                  (iii) the Secretary determines that 
                subsection (d) does not make such statutory 
                limitation inapplicable and that such statutory 
                limitation threatens to impede the carrying out 
                of the purpose of this part,
        then the Secretary may pay an administrative cost 
        allowance to the holder of each loan which is insured 
        under such program and which is made during the period 
        beginning on the 60th day after the date of enactment 
        of the Higher Education Amendments of 1968 and ending 
        120 days after the adjournment of such State's first 
        regular legislative session which adjourns after 
        January 1, 1969. Such administrative cost allowance 
        shall be paid over the term of the loan in an amount 
        per year (determined by the Secretary) which shall not 
        exceed 1 percent of the unpaid principal balance of the 
        loan.
          (4) Submission of statements by holders on amount of 
        payment.--Each holder of a loan with respect to which 
        payments of interest are required to be made by the 
        Secretary shall submit to the Secretary, at such time 
        or times and in such manner as the Secretary may 
        prescribe, statements containing such information as 
        may be required by or pursuant to regulation for the 
        purpose of enabling the Secretary to determine the 
        amount of the payment which he must make with respect 
        to that loan.
          (5) Duration of authority to make interest subsidized 
        loans.--The period referred to in subparagraph (B) of 
        paragraph (1) of this subsection shall begin on the 
        date of enactment of this Act and end at the close of 
        June 30, 2010.
          (6) Assessment of borrower's financial condition not 
        prohibited or required.--Nothing in this or any other 
        Act shall be construed to prohibit or require, unless 
        otherwise specifically provided by law, a lender to 
        evaluate the total financial situation of a student 
        making application for a loan under this part, or to 
        counsel a student with respect to any such loan, or to 
        make a decision based on such evaluation and counseling 
        with respect to the dollar amount of any such loan.
          (7) Loans that have not been consummated.--Lenders 
        may not charge interest or receive interest subsidies 
        or special allowance payments for loans for which the 
        disbursement checks have not been cashed or for which 
        electronic funds transfers have not been completed.
  (b) Insurance Program Agreements To Qualify Loans for 
Interest Subsidies.--
          (1) Requirements of insurance program.--Any State or 
        any nonprofit private institution or organization may 
        enter into an agreement with the Secretary for the 
        purpose of entitling students who receive loans which 
        are insured under a student loan insurance program of 
        that State, institution, or organization to have made 
        on their behalf the payments provided for in subsection 
        (a) if the Secretary determines that the student loan 
        insurance program--
                  (A) authorizes the insurance in any academic 
                year, as defined in section 481(a)(2), or its 
                equivalent (as determined under regulations of 
                the Secretary) for any student who is carrying 
                at an eligible institution or in a program of 
                study abroad approved for credit by the 
                eligible home institution at which such student 
                is enrolled at least one-half the normal full-
                time academic workload (as determined by the 
                institution) in any amount up to a maximum of--
                          (i) in the case of a student at an 
                        eligible institution who has not 
                        successfully completed the first year 
                        of a program of undergraduate 
                        education--
                                  (I) $3,500, if such student 
                                is enrolled in a program whose 
                                length is at least one academic 
                                year in length; and
                                  (II) if such student is 
                                enrolled in a program of 
                                undergraduate education which 
                                is less than 1 academic year, 
                                the maximum annual loan amount 
                                that such student may receive 
                                may not exceed the amount that 
                                bears the same ratio to the 
                                amount specified in subclause 
                                (I) as the length of such 
                                program measured in semester, 
                                trimester, quarter, or clock 
                                hours bears to 1 academic year;
                          (ii) in the case of a student at an 
                        eligible institution who has 
                        successfully completed such first year 
                        but has not successfully completed the 
                        remainder of a program of undergraduate 
                        education--
                                  (I) $4,500; or
                                  (II) if such student is 
                                enrolled in a program of 
                                undergraduate education, the 
                                remainder of which is less than 
                                one academic year, the maximum 
                                annual loan amount that such 
                                student may receive may not 
                                exceed the amount that bears 
                                the same ratio to the amount 
                                specified in subclause (I) as 
                                such remainder measured in 
                                semester, trimester, quarter, 
                                or clock hours bears to one 
                                academic year;
                          (iii) in the case of a student at an 
                        eligible institution who has 
                        successfully completed the first and 
                        second years of a program of 
                        undergraduate education but has not 
                        successfully completed the remainder of 
                        such program--
                                  (I) $5,500; or
                                  (II) if such student is 
                                enrolled in a program of 
                                undergraduate education, the 
                                remainder of which is less than 
                                one academic year, the maximum 
                                annual loan amount that such 
                                student may receive may not 
                                exceed the amount that bears 
                                the same ratio to the amount 
                                specified in subclause (I) as 
                                such remainder measured in 
                                semester, trimester, quarter, 
                                or clock hours bears to one 
                                academic year;
                          (iv) in the case of a student who has 
                        received an associate or baccalaureate 
                        degree and is enrolled in an eligible 
                        program for which the institution 
                        requires such degree for admission, the 
                        number of years that a student has 
                        completed in a program of undergraduate 
                        education shall, for the purposes of 
                        clauses (ii) and (iii), include any 
                        prior enrollment in the eligible 
                        program of undergraduate education for 
                        which the student was awarded such 
                        degree;
                          (v) in the case of a graduate or 
                        professional student (as defined in 
                        regulations of the Secretary) at an 
                        eligible institution, $8,500; and
                          (vi) in the case of a student 
                        enrolled in coursework specified in 
                        sections 484(b)(3)(B) and 
                        484(b)(4)(B)--
                                  (I) $2,625 for coursework 
                                necessary for enrollment in an 
                                undergraduate degree or 
                                certificate program, and, in 
                                the case of a student who has 
                                obtained a baccalaureate 
                                degree, $5,500 for coursework 
                                necessary for enrollment in a 
                                graduate or professional degree 
                                or certification program; and
                                  (II) in the case of a student 
                                who has obtained a 
                                baccalaureate degree, $5,500 
                                for coursework necessary for a 
                                professional credential or 
                                certification from a State 
                                required for employment as a 
                                teacher in an elementary school 
                                or secondary school;
                except in cases where the Secretary determines, 
                pursuant to regulations, that a higher amount 
                is warranted in order to carry out the purpose 
                of this part with respect to students engaged 
                in specialized training requiring exceptionally 
                high costs of education, but the annual 
                insurable limit per student shall not be deemed 
                to be exceeded by a line of credit under which 
                actual payments by the lender to the borrower 
                will not be made in any years in excess of the 
                annual limit;
                  (B) provides that the aggregate insured 
                unpaid principal amount for all such insured 
                loans made to any student shall be any amount 
                up to a maximum of--
                          (i) $23,000, in the case of any 
                        student who has not successfully 
                        completed a program of undergraduate 
                        education, excluding loans made under 
                        section 428A or 428B; and
                          (ii) $65,500, in the case of any 
                        graduate or professional student (as 
                        defined by regulations of the 
                        Secretary), and (I) including any loans 
                        which are insured by the Secretary 
                        under this section, or by a guaranty 
                        agency, made to such student before the 
                        student became a graduate or 
                        professional student, but (II) 
                        excluding loans made under section 428A 
                        or 428B,
                except that the Secretary may increase the 
                limit applicable to students who are pursuing 
                programs which the Secretary determines are 
                exceptionally expensive;
                  (C) authorizes the insurance of loans to any 
                individual student for at least 6 academic 
                years of study or their equivalent (as 
                determined under regulations of the Secretary);
                  (D) provides that (i) the student borrower 
                shall be entitled to accelerate without penalty 
                the whole or any part of an insured loan, (ii) 
                the student borrower may annually change the 
                selection of a repayment plan under this part, 
                and (iii) the note, or other written evidence 
                of any loan, may contain such reasonable 
                provisions relating to repayment in the event 
                of default by the borrower as may be authorized 
                by regulations of the Secretary in effect at 
                the time such note or written evidence was 
                executed, and shall contain a notice that 
                repayment may, following a default by the 
                borrower, be subject to income contingent 
                repayment in accordance with subsection (m);
                  (E) subject to subparagraphs (D) and (L), and 
                except as provided by subparagraph (M), 
                provides that--
                          (i) not more than 6 months prior to 
                        the date on which the borrower's first 
                        payment is due, the lender shall offer 
                        the borrower of a loan made, insured, 
                        or guaranteed under this section or 
                        section 428H, the option of repaying 
                        the loan in accordance with a standard, 
                        graduated, income-sensitive, or 
                        extended repayment schedule (as 
                        described in paragraph (9)) established 
                        by the lender in accordance with 
                        regulations of the Secretary; and
                          (ii) repayment of loans shall be in 
                        installments in accordance with the 
                        repayment plan selected under paragraph 
                        (9) and commencing at the beginning of 
                        the repayment period determined under 
                        paragraph (7);
                  (F) authorizes interest on the unpaid balance 
                of the loan at a yearly rate not in excess 
                (exclusive of any premium for insurance which 
                may be passed on to the borrower) of the rate 
                required by section 427A;
                  (G) insures 98 percent of the unpaid 
                principal of loans insured under the program, 
                except that--
                          (i) such program shall insure 100 
                        percent of the unpaid principal of 
                        loans made with funds advanced pursuant 
                        to section 428(j);
                          (ii) for any loan for which the first 
                        disbursement of principal is made on or 
                        after July 1, 2006, and before July 1, 
                        2010, the preceding provisions of this 
                        subparagraph shall be applied by 
                        substituting ``97 percent'' for ``98 
                        percent''; and
                          (iii) notwithstanding the preceding 
                        provisions of this subparagraph, such 
                        program shall insure 100 percent of the 
                        unpaid principal amount of exempt 
                        claims as defined in subsection 
                        (c)(1)(G);
                  (H) provides--
                          (i) for loans for which the date of 
                        guarantee of principal is before July 
                        1, 2006, for the collection of a single 
                        insurance premium equal to not more 
                        than 1.0 percent of the principal 
                        amount of the loan, by deduction 
                        proportionately from each installment 
                        payment of the proceeds of the loan to 
                        the borrower, and ensures that the 
                        proceeds of the premium will not be 
                        used for incentive payments to lenders; 
                        or
                          (ii) for loans for which the date of 
                        guarantee of principal is on or after 
                        July 1, 2006, and that are first 
                        disbursed before July 1, 2010, for the 
                        collection, and the deposit into the 
                        Federal Student Loan Reserve Fund under 
                        section 422A of a Federal default fee 
                        of an amount equal to 1.0 percent of 
                        the principal amount of the loan, which 
                        fee shall be collected either by 
                        deduction from the proceeds of the loan 
                        or by payment from other non-Federal 
                        sources, and ensures that the proceeds 
                        of the Federal default fee will not be 
                        used for incentive payments to lenders;
                  (I) provides that the benefits of the loan 
                insurance program will not be denied any 
                student who is eligible for interest benefits 
                under subsection (a) (1) and (2);
                  (J) provides that a student may obtain 
                insurance under the program for a loan for any 
                year of study at an eligible institution;
                  (K) in the case of a State program, provides 
                that such State program is administered by a 
                single State agency, or by one or more 
                nonprofit private institutions or organizations 
                under supervision of a single State agency;
                  (L) provides that the total of the payments 
                by a borrower--
                          (i) except as otherwise provided by a 
                        repayment plan selected by the borrower 
                        under clause (ii), (iii), or (v) of 
                        paragraph (9)(A), during any year of 
                        any repayment period with respect to 
                        the aggregate amount of all loans to 
                        that borrower which are insured under 
                        this part shall not, unless the 
                        borrower and the lender otherwise 
                        agree, be less than $600 or the balance 
                        of all such loans (together with 
                        interest thereon), whichever amount is 
                        less (but in no instance less than the 
                        amount of interest due and payable, 
                        notwithstanding any payment plan under 
                        paragraph (9)(A)); and
                          (ii) for a monthly or other similar 
                        payment period with respect to the 
                        aggregate of all loans held by the 
                        lender may, when the amount of a 
                        monthly or other similar payment is not 
                        a multiple of $5, be rounded to the 
                        next highest whole dollar amount that 
                        is a multiple of $5;
                  (M) provides that periodic installments of 
                principal need not be paid, but interest shall 
                accrue and be paid by the Secretary, during any 
                period--
                          (i) during which the borrower--
                                  (I) is pursuing at least a 
                                half-time course of study as 
                                determined by an eligible 
                                institution, except that no 
                                borrower, notwithstanding the 
                                provisions of the promissory 
                                note, shall be required to 
                                borrow an additional loan under 
                                this title in order to be 
                                eligible to receive a deferment 
                                under this clause; or
                                  (II) is pursuing a course of 
                                study pursuant to a graduate 
                                fellowship program approved by 
                                the Secretary, or pursuant to a 
                                rehabilitation training program 
                                for disabled individuals 
                                approved by the Secretary,
                        except that no borrower shall be 
                        eligible for a deferment under this 
                        clause, or loan made under this part 
                        (other than a loan made under section 
                        428B or 428C), while serving in a 
                        medical internship or residency 
                        program;
                          (ii) not in excess of 3 years during 
                        which the borrower is seeking and 
                        unable to find full-time employment, 
                        except that no borrower who provides 
                        evidence of eligibility for 
                        unemployment benefits shall be required 
                        to provide additional paperwork for a 
                        deferment under this clause;
                          (iii) during which the borrower--
                                  (I) is serving on active duty 
                                during a war or other military 
                                operation or national 
                                emergency; or
                                  (II) is performing qualifying 
                                National Guard duty during a 
                                war or other military operation 
                                or national emergency,
                        and for the 180-day period following 
                        the demobilization date for the service 
                        described in subclause (I) [or (II); 
                        or] or (II);
                          (iv) not in excess of 3 years for any 
                        reason which the lender determines, in 
                        accordance with regulations prescribed 
                        by the Secretary under section 435(o), 
                        has caused or will cause the borrower 
                        to have an economic hardship; or
                          (v) during which the borrower is 
                        receiving treatment for cancer and the 
                        6 months after such period;
                  (N) provides that funds borrowed by a 
                student--
                          (i) are disbursed to the institution 
                        by check or other means that is payable 
                        to, and requires the endorsement or 
                        other certification by, such student;
                          (ii) in the case of a student who is 
                        studying outside the United States in a 
                        program of study abroad that is 
                        approved for credit by the home 
                        institution at which such student is 
                        enrolled, and only after verification 
                        of the student's enrollment by the 
                        lender or guaranty agency, are, at the 
                        request of the student, disbursed 
                        directly to the student by the means 
                        described in clause (i), unless such 
                        student requests that the check be 
                        endorsed, or the funds transfer be 
                        authorized, pursuant to an authorized 
                        power-of-attorney; or
                          (iii) in the case of a student who is 
                        studying outside the United States in a 
                        program of study at an eligible foreign 
                        institution, are, at the request of the 
                        foreign institution, disbursed directly 
                        to the student, only after verification 
                        of the student's enrollment by the 
                        lender or guaranty agency by the means 
                        described in clause (i).
                  (O) provides that the proceeds of the loans 
                will be disbursed in accordance with the 
                requirements of section 428G;
                  (P) requires the borrower to notify the 
                institution concerning any change in local 
                address during enrollment and requires the 
                borrower and the institution at which the 
                borrower is in attendance promptly to notify 
                the holder of the loan, directly or through the 
                guaranty agency, concerning (i) any change of 
                permanent address, (ii) when the student ceases 
                to be enrolled on at least a half-time basis, 
                and (iii) any other change in status, when such 
                change in status affects the student's 
                eligibility for the loan;
                  (Q) provides for the guarantee of loans made 
                to students and parents under sections 428A and 
                428B;
                  (R) with respect to lenders which are 
                eligible institutions, provides for the 
                insurance of loans by only such institutions as 
                are located within the geographic area served 
                by such guaranty agency;
                  (S) provides no restrictions with respect to 
                the insurance of loans for students who are 
                otherwise eligible for loans under such program 
                if such a student is accepted for enrollment in 
                or is attending an eligible institution within 
                the State, or if such a student is a legal 
                resident of the State and is accepted for 
                enrollment in or is attending an eligible 
                institution outside that State;
                  (T) authorizes (i) the limitation of the 
                total number of loans or volume of loans, made 
                under this part to students attending a 
                particular eligible institution during any 
                academic year; and (ii) the emergency action, 
                limitation, suspension, or termination of the 
                eligibility of an eligible institution if--
                          
                          (I) such institution is ineligible 
                        for the emergency action, limitation, 
                        suspension, or termination of eligible 
                        institutions under regulations issued 
                        by the Secretary or is ineligible 
                        pursuant to criteria, rules, or 
                        regulations issued under the student 
                        loan insurance program which are 
                        substantially the same as regulations 
                        with respect to emergency action, 
                        limitation, suspension, or termination 
                        of such eligibility issued by the 
                        Secretary;
                          (II) there is a State constitutional 
                        prohibition affecting the eligibility 
                        of such an institution;
                          (III) such institution fails to make 
                        timely refunds to students as required 
                        by regulations issued by the Secretary 
                        or has not satisfied within 30 days of 
                        issuance a final judgment obtained by a 
                        student seeking such a refund;
                          (IV) such institution or an owner, 
                        director, or officer of such 
                        institution is found guilty in any 
                        criminal, civil, or administrative 
                        proceeding, or such institution or an 
                        owner, director, or officer of such 
                        institution is found liable in any 
                        civil or administrative proceeding, 
                        regarding the obtaining, maintenance, 
                        or disbursement of State or Federal 
                        grant, loan, or work assistance funds; 
                        or
                          (V) such institution or an owner, 
                        director, or officer of such 
                        institution has unpaid financial 
                        liabilities involving the improper 
                        acquisition, expenditure, or refund of 
                        State or Federal financial assistance 
                        funds;
                except that, if a guaranty agency limits, 
                suspends, or terminates the participation of an 
                eligible institution, the Secretary shall apply 
                that limitation, suspension, or termination to 
                all locations of such institution, unless the 
                Secretary finds, within 30 days of notification 
                of the action by the guaranty agency, that the 
                guaranty agency's action did not comply with 
                the requirements of this section;
                  (U) provides (i) for the eligibility of all 
                lenders described in section 435(d)(1) under 
                reasonable criteria, unless (I) that lender is 
                eliminated as a lender under regulations for 
                the emergency action, limitation, suspension, 
                or termination of a lender under the Federal 
                student loan insurance program or is eliminated 
                as a lender pursuant to criteria issued under 
                the student loan insurance program which are 
                substantially the same as regulations with 
                respect to such eligibility as a lender issued 
                under the Federal student loan insurance 
                program, or (II) there is a State 
                constitutional prohibition affecting the 
                eligibility of a lender, (ii) assurances that 
                the guaranty agency will report to the 
                Secretary concerning changes in such criteria, 
                including any procedures in effect under such 
                program to take emergency action, limit, 
                suspend, or terminate lenders, and (iii) for 
                (I) a compliance audit of each lender that 
                originates or holds more than $5,000,000 in 
                loans made under this title for any lender 
                fiscal year (except that each lender described 
                in section 435(d)(1)(A)(ii)(III) shall annually 
                submit the results of an audit required by this 
                clause), at least once a year and covering the 
                period since the most recent audit, conducted 
                by a qualified, independent organization or 
                person in accordance with standards established 
                by the Comptroller General for the audit of 
                governmental organizations, programs, and 
                functions, and as prescribed in regulations of 
                the Secretary, the results of which shall be 
                submitted to the Secretary, or (II) with regard 
                to a lender that is audited under chapter 75 of 
                title 31, United States Code, such audit shall 
                be deemed to satisfy the requirements of 
                subclause (I) for the period covered by such 
                audit, except that the Secretary may waive the 
                requirements of this clause (iii) if the lender 
                submits to the Secretary the results of an 
                audit conducted for other purposes that the 
                Secretary determines provides the same 
                information as the audits required by this 
                clause;
                  (V) provides authority for the guaranty 
                agency to require a participation agreement 
                between the guaranty agency and each eligible 
                institution within the State in which it is 
                designated, as a condition for guaranteeing 
                loans made on behalf of students attending the 
                institution;
                  (W) provides assurances that the agency will 
                implement all requirements of the Secretary for 
                uniform claims and procedures pursuant to 
                section 432(l);
                  (X) provides information to the Secretary in 
                accordance with section 428(c)(9) and maintains 
                reserve funds determined by the Secretary to be 
                sufficient in relation to such agency's 
                guarantee obligations; and
                  (Y) provides that--
                          (i) the lender shall determine the 
                        eligibility of a borrower for a 
                        deferment described in subparagraph 
                        (M)(i) based on--
                                  (I) receipt of a request for 
                                deferment from the borrower and 
                                documentation of the borrower's 
                                eligibility for the deferment;
                                  (II) receipt of a newly 
                                completed loan application that 
                                documents the borrower's 
                                eligibility for a deferment;
                                  (III) receipt of student 
                                status information documenting 
                                that the borrower is enrolled 
                                on at least a half-time basis; 
                                or
                                  (IV) the lender's 
                                confirmation of the borrower's 
                                half-time enrollment status 
                                through use of the National 
                                Student Loan Data System, if 
                                the confirmation is requested 
                                by the institution of higher 
                                education;
                          (ii) the lender will notify the 
                        borrower of the granting of any 
                        deferment under clause (i)(II) or (III) 
                        of this subparagraph and of the option 
                        to continue paying on the loan; and
                          (iii) the lender shall, at the time 
                        the lender grants a deferment to a 
                        borrower who received a loan under 
                        section 428H and is eligible for a 
                        deferment under subparagraph (M) of 
                        this paragraph, provide information to 
                        the borrower to assist the borrower in 
                        understanding the impact of the 
                        capitalization of interest on the 
                        borrower's loan principal and on the 
                        total amount of interest to be paid 
                        during the life of the loan.
          (2) Contents of insurance program agreement.--Such an 
        agreement shall--
                  (A) provide that the holder of any such loan 
                will be required to submit to the Secretary, at 
                such time or times and in such manner as the 
                Secretary may prescribe, statements containing 
                such information as may be required by or 
                pursuant to regulation for the purpose of 
                enabling the Secretary to determine the amount 
                of the payment which must be made with respect 
                to that loan;
                  (B) include such other provisions as may be 
                necessary to protect the United States from the 
                risk of unreasonable loss and promote the 
                purpose of this part, including such provisions 
                as may be necessary for the purpose of section 
                437, and as are agreed to by the Secretary and 
                the guaranty agency, as the case may be;
                  (C) provide for making such reports, in such 
                form and containing such information, including 
                financial information, as the Secretary may 
                reasonably require to carry out the Secretary's 
                functions under this part and protect the 
                financial interest of the United States, and 
                for keeping such records and for affording such 
                access thereto as the Secretary may find 
                necessary to assure the correctness and 
                verification of such reports;
                  (D) provide for--
                          (i) conducting, except as provided in 
                        clause (ii), financial and compliance 
                        audits of the guaranty agency on at 
                        least an annual basis and covering the 
                        period since the most recent audit, 
                        conducted by a qualified, independent 
                        organization or person in accordance 
                        with standards established by the 
                        Comptroller General for the audit of 
                        governmental organizations, programs, 
                        and functions, and as prescribed in 
                        regulations of the Secretary, the 
                        results of which shall be submitted to 
                        the Secretary; or
                          (ii) with regard to a guaranty 
                        program of a State which is audited 
                        under chapter 75 of title 31, United 
                        States Code, deeming such audit to 
                        satisfy the requirements of clause (i) 
                        for the period of time covered by such 
                        audit;
                  (E)(i) provide that any guaranty agency may 
                transfer loans which are insured under this 
                part to any other guaranty agency with the 
                approval of the holder of the loan and such 
                other guaranty agency; and
                  (ii) provide that the lender (or the holder 
                of the loan) shall, not later than 120 days 
                after the borrower has left the eligible 
                institution, notify the borrower of the date on 
                which the repayment period begins; and
                  (F) provide that, if the sale, other 
                transfer, or assignment of a loan made under 
                this part to another holder will result in a 
                change in the identity of the party to whom the 
                borrower must send subsequent payments or 
                direct any communications concerning the loans, 
                then--
                          (i) the transferor and the transferee 
                        will be required, not later than 45 
                        days from the date the transferee 
                        acquires a legally enforceable right to 
                        receive payment from the borrower on 
                        such loan, either jointly or separately 
                        to provide a notice to the borrower 
                        of--
                                  (I) the sale or other 
                                transfer;
                                  (II) the identity of the 
                                transferee;
                                  (III) the name and address of 
                                the party to whom subsequent 
                                payments or communications must 
                                be sent;
                                  (IV) the telephone numbers of 
                                both the transferor and the 
                                transferee;
                                  (V) the effective date of the 
                                transfer;
                                  (VI) the date on which the 
                                current servicer (as of the 
                                date of the notice) will stop 
                                accepting payments; and
                                  (VII) the date on which the 
                                new servicer will begin 
                                accepting payments; and
                          (ii) the transferee will be required 
                        to notify the guaranty agency, and, 
                        upon the request of an institution of 
                        higher education, the guaranty agency 
                        shall notify the last such institution 
                        the student attended prior to the 
                        beginning of the repayment period of 
                        any loan made under this part, of--
                                  (I) any sale or other 
                                transfer of the loan; and
                                  (II) the address and 
                                telephone number by which 
                                contact may be made with the 
                                new holder concerning repayment 
                                of the loan,
                except that this subparagraph (F) shall only 
                apply if the borrower is in the grace period 
                described in section 427(a)(2)(B) or 428(b)(7) 
                or is in repayment status.
          (3) Restrictions on inducements, payments, mailings, 
        and advertising.--A guaranty agency shall not--
                  (A) offer, directly or indirectly, premiums, 
                payments, stock or other securities, prizes, 
                travel, entertainment expenses, tuition payment 
                or reimbursement, or other inducements to--
                          (i) any institution of higher 
                        education, any employee of an 
                        institution of higher education, or any 
                        individual or entity in order to secure 
                        applicants for loans made under this 
                        part; or
                          (ii) any lender, or any agent, 
                        employee, or independent contractor of 
                        any lender or guaranty agency, in order 
                        to administer or market loans made 
                        under this part (other than a loan made 
                        as part of the guaranty agency's 
                        lender-of-last-resort program pursuant 
                        to section 428(j)), for the purpose of 
                        securing the designation of the 
                        guaranty agency as the insurer of such 
                        loans;
                  (B) conduct unsolicited mailings, by postal 
                or electronic means, of student loan 
                application forms to students enrolled in 
                secondary schools or postsecondary educational 
                institutions, or to the families of such 
                students, except that applications may be 
                mailed, by postal or electronic means, to 
                students or borrowers who have previously 
                received loans guaranteed under this part by 
                the guaranty agency;
                  (C) perform, for an institution of higher 
                education participating in a program under this 
                title, any function that such institution is 
                required to perform under this title, except 
                that the guaranty agency may perform functions 
                on behalf of such institution in accordance 
                with section 485(b) or 485(l);
                  (D) pay, on behalf of an institution of 
                higher education, another person to perform any 
                function that such institution is required to 
                perform under this title, except that the 
                guaranty agency may perform functions on behalf 
                of such institution in accordance with section 
                485(b) or 485(l); or
                  (E) conduct fraudulent or misleading 
                advertising concerning loan availability, 
                terms, or conditions.
        It shall not be a violation of this paragraph for a 
        guaranty agency to provide technical assistance to 
        institutions of higher education comparable to the 
        technical assistance provided to institutions of higher 
        education by the Department.
          (4) Special rule.--With respect to the graduate 
        fellowship program referred to in paragraph 
        (1)(M)(i)(II), the Secretary shall approve any course 
        of study at a foreign university that is accepted for 
        the completion of a recognized international fellowship 
        program by the administrator of such a program. 
        Requests for deferment of repayment of loans under this 
        part by students engaged in graduate or postgraduate 
        fellowship-supported study (such as pursuant to a 
        Fulbright grant) outside the United States shall be 
        approved until completion of the period of the 
        fellowship.
          (5) Guaranty agency information transfers.--(A) Until 
        such time as the Secretary has implemented section 485B 
        and is able to provide to guaranty agencies the 
        information required by such section, any guaranty 
        agency may request information regarding loans made 
        after January 1, 1987, to students who are residents of 
        the State for which the agency is the designated 
        guarantor, from any other guaranty agency insuring 
        loans to such students.
          (B) Upon a request pursuant to subparagraph (A), a 
        guaranty agency shall provide--
                  (i) the name and the social security number 
                of the borrower; and
                  (ii) the amount borrowed and the cumulative 
                amount borrowed.
          (C) Any costs associated with fulfilling the request 
        of a guaranty agency for information on students shall 
        be paid by the guaranty agency requesting the 
        information.
          (6) State guaranty agency information request of 
        state licensing boards.--Each guaranty agency is 
        authorized to enter into agreements with each 
        appropriate State licensing board under which the State 
        licensing board, upon request, will furnish the 
        guaranty agency with the address of a student borrower 
        in any case in which the location of the student 
        borrower is unknown or unavailable to the guaranty 
        agency.
          (7) Repayment period.--(A) In the case of a loan made 
        under section 427 or 428, the repayment period shall 
        exclude any period of authorized deferment or 
        forbearance and shall begin the day after 6 months 
        after the date the student ceases to carry at least 
        one-half the normal full-time academic workload (as 
        determined by the institution).
          (B) In the case of a loan made under section 428H, 
        the repayment period shall exclude any period of 
        authorized deferment or forbearance, and shall begin as 
        described in subparagraph (A), but interest shall begin 
        to accrue or be paid by the borrower on the day the 
        loan is disbursed.
          (C) In the case of a loan made under section 428B or 
        428C, the repayment period shall begin on the day the 
        loan is disbursed, or, if the loan is disbursed in 
        multiple installments, on the day of the last such 
        disbursement, and shall exclude any period of 
        authorized deferment or forbearance.
          (D) There shall be excluded from the 6-month period 
        that begins on the date on which a student ceases to 
        carry at least one-half the normal full-time academic 
        workload as described in subparagraph (A) any period 
        not to exceed 3 years during which a borrower who is a 
        member of a reserve component of the Armed Forces named 
        in section 10101 of title 10, United States Code, is 
        called or ordered to active duty for a period of more 
        than 30 days (as defined in section 101(d)(2) of such 
        title). Such period of exclusion shall include the 
        period necessary to resume enrollment at the borrower's 
        next available regular enrollment period.
          (8) Means of disbursement of loan proceeds.--Nothing 
        in this title shall be interpreted to prohibit the 
        disbursement of loan proceeds by means other than by 
        check or to allow the Secretary to require checks to be 
        made co-payable to the institution and the borrower.
          (9) Repayment plans.--
                  (A) Design and selection.--In accordance with 
                regulations promulgated by the Secretary, the 
                lender shall offer a borrower of a loan made 
                under this part the plans described in this 
                subparagraph for repayment of such loan, 
                including principal and interest thereon. No 
                plan may require a borrower to repay a loan in 
                less than 5 years unless the borrower, during 
                the 6 months immediately preceding the start of 
                the repayment period, specifically requests 
                that repayment be made over of a shorter 
                period. The borrower may choose from--
                          (i) a standard repayment plan, with a 
                        fixed annual repayment amount paid over 
                        a fixed period of time, not to exceed 
                        10 years;
                          (ii) a graduated repayment plan paid 
                        over a fixed period of time, not to 
                        exceed 10 years;
                          (iii) an income-sensitive repayment 
                        plan, with income-sensitive repayment 
                        amounts paid over a fixed period of 
                        time, not to exceed 10 years, except 
                        that the borrower's scheduled payments 
                        shall not be less than the amount of 
                        interest due;
                          (iv) for new borrowers on or after 
                        the date of enactment of the Higher 
                        Education Amendments of 1998 who 
                        accumulate (after such date) 
                        outstanding loans under this part 
                        totaling more than $30,000, an extended 
                        repayment plan, with a fixed annual or 
                        graduated repayment amount paid over an 
                        extended period of time, not to exceed 
                        25 years, except that the borrower 
                        shall repay annually a minimum amount 
                        determined in accordance with paragraph 
                        (1)(L)(i); and
                          (v) beginning July 1, 2009, an 
                        income-based repayment plan that 
                        enables a borrower who has a partial 
                        financial hardship to make a lower 
                        monthly payment in accordance with 
                        section 493C, except that the plan 
                        described in this clause shall not be 
                        available to a borrower for a loan 
                        under section 428B made on behalf of a 
                        dependent student or for a 
                        consolidation loan under section 428C, 
                        if the proceeds of such loan were used 
                        to discharge the liability of a loan 
                        under section 428B made on behalf of a 
                        dependent student.
                  (B) Lender selection of option if borrower 
                does not select.--If a borrower of a loan made 
                under this part does not select a repayment 
                plan described in subparagraph (A), the lender 
                shall provide the borrower with a repayment 
                plan described in subparagraph (A)(i).
  (c) Guaranty Agreements for Reimbursing Losses.--
          (1) Authority to enter into agreements.--(A) The 
        Secretary may enter into a guaranty agreement with any 
        guaranty agency, whereby the Secretary shall undertake 
        to reimburse it, under such terms and conditions as the 
        Secretary may establish, with respect to losses 
        (resulting from the default of the student borrower) on 
        the unpaid balance of the principal and accrued 
        interest of any insured loan. The guaranty agency 
        shall, be deemed to have a contractual right against 
        the United States, during the life of such loan, to 
        receive reimbursement according to the provisions of 
        this subsection. Upon receipt of an accurate and 
        complete request by a guaranty agency for reimbursement 
        with respect to such losses, the Secretary shall pay 
        promptly and without administrative delay. Except as 
        provided in subparagraph (B) of this paragraph and in 
        paragraph (7), the amount to be paid a guaranty agency 
        as reimbursement under this subsection shall be equal 
        to 100 percent of the amount expended by it in 
        discharge of its insurance obligation incurred under 
        its loan insurance program. A guaranty agency shall 
        file a claim for reimbursement with respect to losses 
        under this subsection within 30 days after the guaranty 
        agency discharges its insurance obligation on the loan.
          (B) Notwithstanding subparagraph (A)--
                  (i) if, for any fiscal year, the amount of 
                such reimbursement payments by the Secretary 
                under this subsection exceeds 5 percent of the 
                loans which are insured by such guaranty agency 
                under such program and which were in repayment 
                at the end of the preceding fiscal year, the 
                amount to be paid as reimbursement under this 
                subsection for such excess shall be equal to 85 
                percent of the amount of such excess; and
                  (ii) if, for any fiscal year, the amount of 
                such reimbursement payments exceeds 9 percent 
                of such loans, the amount to be paid as 
                reimbursement under this subsection for such 
                excess shall be equal to 75 percent of the 
                amount of such excess.
          (C) For the purpose of this subsection, the amount of 
        loans of a guaranty agency which are in repayment shall 
        be the original principal amount of loans made by a 
        lender which are insured by such a guaranty agency 
        reduced by--
                  (i) the amount the insurer has been required 
                to pay to discharge its insurance obligations 
                under this part;
                  (ii) the original principal amount of loans 
                insured by it which have been fully repaid; and
                  (iii) the original principal amount insured 
                on those loans for which payment of the first 
                installment of principal has not become due 
                pursuant to subsection (b)(1)(E) of this 
                section or such first installment need not be 
                paid pursuant to subsection (b)(1)(M) of this 
                section.
          (D) Notwithstanding any other provisions of this 
        section, in the case of a loan made pursuant to a 
        lender-of-last-resort program, the Secretary shall 
        apply the provisions of--
                  (i) the fourth sentence of subparagraph (A) 
                by substituting ``100 percent'' for ``95 
                percent'';
                  (ii) subparagraph (B)(i) by substituting 
                ``100 percent'' for ``85 percent''; and
                  (iii) subparagraph (B)(ii) by substituting 
                ``100 percent'' for ``75 percent''.
          (E) Notwithstanding any other provisions of this 
        section, in the case of an outstanding loan transferred 
        to a guaranty agency from another guaranty agency 
        pursuant to a plan approved by the Secretary in 
        response to the insolvency of the latter such guarantee 
        agency, the Secretary shall apply the provision of--
                  (i) the fourth sentence of subparagraph (A) 
                by substituting ``100 percent'' for ``95 
                percent'';
                  (ii) subparagraph (B)(i) by substituting ``90 
                percent'' for ``85 percent''; and
                  (iii) subparagraph (B)(ii) by substituting 
                ``80 percent'' for ``75 percent''.
          (F)(i) Notwithstanding any other provisions of this 
        section, in the case of exempt claims, the Secretary 
        shall apply the provisions of--
                  (I) the fourth sentence of subparagraph (A) 
                by substituting ``100 percent'' for ``95 
                percent'';
                  (II) subparagraph (B)(i) by substituting 
                ``100 percent'' for ``85 percent''; and
                  (III) subparagraph (B)(ii) by substituting 
                ``100 percent'' for ``75 percent''.
          (ii) For purposes of clause (i) of this subparagraph, 
        the term ``exempt claims'' means claims with respect to 
        loans for which it is determined that the borrower (or 
        the student on whose behalf a parent has borrowed), 
        without the lender's or the institution's knowledge at 
        the time the loan was made, provided false or erroneous 
        information or took actions that caused the borrower or 
        the student to be ineligible for all or a portion of 
        the loan or for interest benefits thereon.
          (G) Notwithstanding any other provision of this 
        section, the Secretary shall exclude a loan made 
        pursuant to a lender-of-last-resort program when making 
        reimbursement payment calculations under subparagraphs 
        (B) and (C).
          (2) Contents of guaranty agreements.--The guaranty 
        agreement--
                  (A) shall set forth such administrative and 
                fiscal procedures as may be necessary to 
                protect the United States from the risk of 
                unreasonable loss thereunder, to ensure proper 
                and efficient administration of the loan 
                insurance program, and to assure that due 
                diligence will be exercised in the collection 
                of loans insured under the program, including 
                (i) a requirement that each beneficiary of 
                insurance on the loan submit proof that the 
                institution was contacted and other reasonable 
                attempts were made to locate the borrower (when 
                the location of the borrower is unknown) and 
                proof that contact was made with the borrower 
                (when the location is known) and (ii) 
                requirements establishing procedures to 
                preclude consolidation lending from being an 
                excessive proportion of guaranty agency 
                recoveries on defaulted loans under this part;
                  (B) shall provide for making such reports, in 
                such form and containing such information, as 
                the Secretary may reasonably require to carry 
                out the Secretary's functions under this 
                subsection, and for keeping such records and 
                for affording such access thereto as the 
                Secretary may find necessary to assure the 
                correctness and verification of such reports;
                  (C) shall set forth adequate assurances that, 
                with respect to so much of any loan insured 
                under the loan insurance program as may be 
                guaranteed by the Secretary pursuant to this 
                subsection, the undertaking of the Secretary 
                under the guaranty agreement is acceptable in 
                full satisfaction of State law or regulation 
                requiring the maintenance of a reserve;
                  (D) shall provide that if, after the 
                Secretary has made payment under the guaranty 
                agreement pursuant to paragraph (1) of this 
                subsection with respect to any loan, any 
                payments are made in discharge of the 
                obligation incurred by the borrower with 
                respect to such loan (including any payments of 
                interest accruing on such loan after such 
                payment by the Secretary), there shall be paid 
                over to the Secretary (for deposit in the fund 
                established by section 431) such proportion of 
                the amounts of such payments as is determined 
                (in accordance with paragraph (6)(A)) to 
                represent his equitable share thereof, but (i) 
                shall provide for subrogation of the United 
                States to the rights of any insurance 
                beneficiary only to the extent required for the 
                purpose of paragraph (8); and (ii) except as 
                the Secretary may otherwise by or pursuant to 
                regulation provide, amounts so paid by a 
                borrower on such a loan shall be first applied 
                in reduction of principal owing on such loan;
                  (E) shall set forth adequate assurance that 
                an amount equal to each payment made under 
                paragraph (1) will be promptly deposited in or 
                credited to the accounts maintained for the 
                purpose of section 422(c);
                  (F) set forth adequate assurances that the 
                guaranty agency will not engage in any pattern 
                or practice which results in a denial of a 
                borrower's access to loans under this part 
                because of the borrower's race, sex, color, 
                religion, national origin, age, handicapped 
                status, income, attendance at a particular 
                eligible institution within the area served by 
                the guaranty agency, length of the borrower's 
                educational program, or the borrower's academic 
                year in school;
                  (G) shall prohibit the Secretary from making 
                any reimbursement under this subsection to a 
                guaranty agency when a default claim is based 
                on an inability to locate the borrower, unless 
                the guaranty agency, at the time of filing for 
                reimbursement, certifies to the Secretary that 
                diligent attempts, including contact with the 
                institution, have been made to locate the 
                borrower through the use of reasonable skip-
                tracing techniques in accordance with 
                regulations prescribed by the Secretary; and
                  (H) set forth assurances that--
                          (i) upon the request of an eligible 
                        institution, the guaranty agency shall, 
                        subject to clauses (ii) and (iii), 
                        furnish to the institution information 
                        with respect to students (including the 
                        names and addresses of such students) 
                        who received loans made, insured, or 
                        guaranteed under this part for 
                        attendance at the eligible institution 
                        and for whom default aversion 
                        assistance activities have been 
                        requested under subsection (l);
                          (ii) the guaranty agency shall not 
                        require the payment from the 
                        institution of any fee for such 
                        information; and
                          (iii) the guaranty agency will 
                        require the institution to use such 
                        information only to assist the 
                        institution in reminding students of 
                        their obligation to repay student loans 
                        and shall prohibit the institution from 
                        disseminating the information for any 
                        other purpose.
                  (I) may include such other provisions as may 
                be necessary to promote the purpose of this 
                part.
          (3) Forbearance.--A guaranty agreement under this 
        subsection--
                  (A) shall contain provisions providing that--
                          (i) upon request, a lender shall 
                        grant a borrower forbearance, renewable 
                        at 12-month intervals, on terms agreed 
                        to by the parties to the loan with the 
                        approval of the insurer and documented 
                        in accordance with paragraph (10), and 
                        otherwise consistent with the 
                        regulations of the Secretary, if the 
                        borrower--
                                  (I) is serving in a medical 
                                or dental internship or 
                                residency program, the 
                                successful completion of which 
                                is required to begin 
                                professional practice or 
                                service, or is serving in a 
                                medical or dental internship or 
                                residency program leading to a 
                                degree or certificate awarded 
                                by an institution of higher 
                                education, a hospital, or a 
                                health care facility that 
                                offers postgraduate training, 
                                provided that if the borrower 
                                qualifies for a deferment under 
                                section 427(a)(2)(C)(vii) or 
                                subsection (b)(1)(M)(vii) of 
                                this section as in effect prior 
                                to the enactment of the Higher 
                                Education Amendments of 1992, 
                                or section 427(a)(2)(C) or 
                                subsection (b)(1)(M) of this 
                                section as amended by such 
                                amendments, the borrower has 
                                exhausted his or her 
                                eligibility for such deferment;
                                  (II) has a debt burden under 
                                this title that equals or 
                                exceeds 20 percent of income;
                                  (III) is serving in a 
                                national service position for 
                                which the borrower receives a 
                                national service educational 
                                award under the National and 
                                Community Service Trust Act of 
                                1993; or
                                  (IV) is eligible for interest 
                                payments to be made on such 
                                loan for service in the Armed 
                                Forces under section 2174 of 
                                title 10, United States Code, 
                                and, pursuant to that 
                                eligibility, the interest is 
                                being paid on such loan under 
                                subsection (o);
                          (ii) the length of the forbearance 
                        granted by the lender--
                                  (I) under clause (i)(I) shall 
                                equal the length of time 
                                remaining in the borrower's 
                                medical or dental internship or 
                                residency program, if the 
                                borrower is not eligible to 
                                receive a deferment described 
                                in such clause, or such length 
                                of time remaining in the 
                                program after the borrower has 
                                exhausted the borrower's 
                                eligibility for such deferment;
                                  (II) under clause (i)(II) or 
                                (IV) shall not exceed 3 years; 
                                or
                                  (III) under clause (i)(III) 
                                shall not exceed the period for 
                                which the borrower is serving 
                                in a position described in such 
                                clause; and
                          (iii) no administrative or other fee 
                        may be charged in connection with the 
                        granting of a forbearance under clause 
                        (i), and no adverse information 
                        regarding a borrower may be reported to 
                        a consumer reporting agency solely 
                        because of the granting of such 
                        forbearance;
                  (B) may, to the extent provided in 
                regulations of the Secretary, contain 
                provisions that permit such forbearance for the 
                benefit of the student borrower as may be 
                agreed upon by the parties to an insured loan 
                and approved by the insurer;
                  (C) shall contain provisions that specify 
                that--
                          (i) the form of forbearance granted 
                        by the lender pursuant to this 
                        paragraph, other than subparagraph 
                        (A)(i)(IV), shall be temporary 
                        cessation of payments, unless the 
                        borrower selects forbearance in the 
                        form of an extension of time for making 
                        payments, or smaller payments than were 
                        previously scheduled;
                          (ii) the form of forbearance granted 
                        by the lender pursuant to subparagraph 
                        (A)(i)(IV) shall be the temporary 
                        cessation of all payments on the loan 
                        other than payments of interest on the 
                        loan that are made under subsection 
                        (o);
                          (iii) the lender shall, at the time 
                        of granting a borrower forbearance, 
                        provide information to the borrower to 
                        assist the borrower in understanding 
                        the impact of capitalization of 
                        interest on the borrower's loan 
                        principal and total amount of interest 
                        to be paid during the life of the loan; 
                        and
                          (iv) the lender shall contact the 
                        borrower not less often than once every 
                        180 days during the period of 
                        forbearance to inform the borrower of--
                                  (I) the amount of unpaid 
                                principal and the amount of 
                                interest that has accrued since 
                                the last statement of such 
                                amounts provided to the 
                                borrower by the lender;
                                  (II) the fact that interest 
                                will accrue on the loan for the 
                                period of forbearance;
                                  (III) the amount of interest 
                                that will be capitalized, and 
                                the date on which 
                                capitalization will occur;
                                  (IV) the option of the 
                                borrower to pay the interest 
                                that has accrued before the 
                                interest is capitalized; and
                                  (V) the borrower's option to 
                                discontinue the forbearance at 
                                any time; and
                  (D) shall contain provisions that specify 
                that--
                          (i) forbearance for a period not to 
                        exceed 60 days may be granted if the 
                        lender reasonably determines that such 
                        a suspension of collection activity is 
                        warranted following a borrower's 
                        request for deferment, forbearance, a 
                        change in repayment plan, or a request 
                        to consolidate loans, in order to 
                        collect or process appropriate 
                        supporting documentation related to the 
                        request, and
                          (ii) during such period interest 
                        shall accrue but not be capitalized.
        Guaranty agencies shall not be precluded from 
        permitting the parties to such a loan from entering 
        into a forbearance agreement solely because the loan is 
        in default. The Secretary shall permit lenders to 
        exercise administrative forbearances that do not 
        require the agreement of the borrower, under conditions 
        authorized by the Secretary. Such forbearances shall 
        include (i) forbearances for borrowers who are 
        delinquent at the time of the granting of an authorized 
        period of deferment under section 428(b)(1)(M) or 
        427(a)(2)(C), and (ii) if the borrower is less than 60 
        days delinquent on such loans at the time of sale or 
        transfer, forbearances for borrowers on loans which are 
        sold or transferred.
          (4) Definitions.--For the purpose of this subsection, 
        the terms ``insurance beneficiary'' and ``default'' 
        have the meanings assigned to them by section 435.
          (5) Applicability to existing loans.--In the case of 
        any guaranty agreement with a guaranty agency, the 
        Secretary may, in accordance with the terms of this 
        subsection, undertake to guarantee loans described in 
        paragraph (1) which are insured by such guaranty agency 
        and are outstanding on the date of execution of the 
        guaranty agreement, but only with respect to defaults 
        occurring after the execution of such guaranty 
        agreement or, if later, after its effective date.
          (6) Secretary's equitable share.--(A) For the purpose 
        of paragraph (2)(D), the Secretary's equitable share of 
        payments made by the borrower shall be that portion of 
        the payments remaining after the guaranty agency with 
        which the Secretary has an agreement under this 
        subsection has deducted from such payments--
                  (i) a percentage amount equal to the 
                complement of the reinsurance percentage in 
                effect when payment under the guaranty 
                agreement was made with respect to the loan; 
                and
                          (ii) an amount equal to 24 percent of 
                        such payments for use in accordance 
                        with section 422B, except that--
                                  (I) beginning October 1, 2003 
                                and ending September 30, 2007, 
                                this clause shall be applied by 
                                substituting ``23 percent'' for 
                                ``24 percent''; and
                                  (II) beginning October 1, 
                                2007, this clause shall be 
                                applied by substituting ``16 
                                percent'' for ``24 percent''.
          (B) A guaranty agency shall--
                  (i) on or after October 1, 2006--
                          (I) not charge the borrower 
                        collection costs in an amount in excess 
                        of 18.5 percent of the outstanding 
                        principal and interest of a defaulted 
                        loan that is paid off through 
                        consolidation by the borrower under 
                        this title; and
                          (II) remit to the Secretary a portion 
                        of the collection charge under 
                        subclause (I) equal to 8.5 percent of 
                        the outstanding principal and interest 
                        of such defaulted loan; and
                  (ii) on and after October 1, 2009, remit to 
                the Secretary the entire amount charged under 
                clause (i)(I) with respect to each defaulted 
                loan that is paid off with excess consolidation 
                proceeds.
          (C) For purposes of subparagraph (B), the term 
        ``excess consolidation proceeds'' means, with respect 
        to any guaranty agency for any Federal fiscal year 
        beginning on or after October 1, 2009, the proceeds of 
        consolidation of defaulted loans under this title that 
        exceed 45 percent of the agency's total collections on 
        defaulted loans in such Federal fiscal year.
          (7) New programs eligible for 100 percent 
        reinsurance.--(A) Notwithstanding paragraph (1)(C), the 
        amount to be paid a guaranty agency for any fiscal 
        year--
                  (i) which begins on or after October 1, 1977 
                and ends before October 1, 1991; and
                  (ii) which is either the fiscal year in which 
                such guaranty agency begins to actively carry 
                on a student loan insurance program which is 
                subject to a guaranty agreement under 
                subsection (b) of this section, or is one of 
                the 4 succeeding fiscal years,
        shall be 100 percent of the amount expended by such 
        guaranty agency in discharge of its insurance 
        obligation insured under such program.
          (B) Notwithstanding the provisions of paragraph 
        (1)(C), the Secretary may pay a guaranty agency 100 
        percent of the amount expended by such agency in 
        discharge of such agency's insurance obligation for any 
        fiscal year which--
                  (i) begins on or after October 1, 1991; and
                  (ii) is the fiscal year in which such 
                guaranty agency begins to actively carry on a 
                student loan insurance program which is subject 
                to a guaranty agreement under subsection (b) or 
                is one of the 4 succeeding fiscal years.
          (C) The Secretary shall continuously monitor the 
        operations of those guaranty agencies to which the 
        provisions of subparagraph (A) or (B) are applicable 
        and revoke the application of such subparagraph to any 
        such guaranty agency which the Secretary determines has 
        not exercised reasonable prudence in the administration 
        of such program.
          (8) Assignment to protect federal fiscal interest.--
        If the Secretary determines that the protection of the 
        Federal fiscal interest so requires, a guaranty agency 
        shall assign to the Secretary any loan of which it is 
        the holder and for which the Secretary has made a 
        payment pursuant to paragraph (1) of this subsection.
          (9) Guaranty agency reserve level.--(A) Each guaranty 
        agency which has entered into an agreement with the 
        Secretary pursuant to this subsection shall maintain in 
        the agency's Federal Student Loan Reserve Fund 
        established under section 422A a current minimum 
        reserve level of at least 0.25 percent of the total 
        attributable amount of all outstanding loans guaranteed 
        by such agency. For purposes of this paragraph, such 
        total attributable amount does not include amounts of 
        outstanding loans transferred to the guaranty agency 
        from another guaranty agency pursuant to a plan of the 
        Secretary in response to the insolvency of the latter 
        such guaranty agency.
          (B) The Secretary shall collect, on an annual basis, 
        information from each guaranty agency having an 
        agreement under this subsection to enable the Secretary 
        to evaluate the financial solvency of each such agency. 
        The information collected shall include the level of 
        such agency's current reserves, cash disbursements and 
        accounts receivable.
          (C) If (i) any guaranty agency falls below the 
        required minimum reserve level in any 2 consecutive 
        years, (ii) any guaranty agency's Federal reimbursement 
        payments are reduced to 85 percent pursuant to 
        paragraph (1)(B)(i), or (iii) the Secretary determines 
        that the administrative or financial condition of a 
        guaranty agency jeopardizes such agency's continued 
        ability to perform its responsibilities under its 
        guaranty agreement, then the Secretary shall require 
        the guaranty agency to submit and implement a 
        management plan acceptable to the Secretary within 45 
        working days of any such event.
          (D)(i) If the Secretary is not seeking to terminate 
        the guaranty agency's agreement under subparagraph (E), 
        or assuming the guaranty agency's functions under 
        subparagraph (F), a management plan described in 
        subparagraph (C) shall include the means by which the 
        guaranty agency will improve its financial and 
        administrative condition to the required level within 
        18 months.
          (ii) If the Secretary is seeking to terminate the 
        guaranty agency's agreement under subparagraph (E), or 
        assuming the guaranty agency's functions under 
        subparagraph (F), a management plan described in 
        subparagraph (C) shall include the means by which the 
        Secretary and the guaranty agency shall work together 
        to ensure the orderly termination of the operations, 
        and liquidation of the assets, of the guaranty agency.
          (E) The Secretary may terminate a guaranty agency's 
        agreement in accordance with subparagraph (F) if--
                  (i) a guaranty agency required to submit a 
                management plan under this paragraph fails to 
                submit a plan that is acceptable to the 
                Secretary;
                  (ii) the Secretary determines that a guaranty 
                agency has failed to improve substantially its 
                administrative and financial condition;
                  (iii) the Secretary determines that the 
                guaranty agency is in danger of financial 
                collapse;
                  (iv) the Secretary determines that such 
                action is necessary to protect the Federal 
                fiscal interest; or
                  (v) the Secretary determines that such action 
                is necessary to ensure the continued 
                availability of loans to student or parent 
                borrowers.
          (F) If a guaranty agency's agreement under this 
        subsection is terminated pursuant to subparagraph (E), 
        then the Secretary shall assume responsibility for all 
        functions of the guaranty agency under the loan 
        insurance program of such agency. In performing such 
        functions the Secretary is authorized to--
                  (i) permit the transfer of guarantees to 
                another guaranty agency;
                  (ii) revoke the reinsurance agreement of the 
                guaranty agency at a specified date, so as to 
                require the merger, consolidation, or 
                termination of the guaranty agency;
                  (iii) transfer guarantees to the Department 
                of Education for the purpose of payment of such 
                claims and process such claims using the claims 
                standards of the guaranty agency, if such 
                standards are determined by the Secretary to be 
                in compliance with this Act;
                  (iv) design and implement a plan to restore 
                the guaranty agency's viability;
                  (v) provide the guaranty agency with 
                additional advance funds in accordance with 
                section 422(c)(7), with such restrictions on 
                the use of such funds as is determined 
                appropriate by the Secretary, in order to--
                          (I) meet the immediate cash needs of 
                        the guaranty agency;
                          (II) ensure the uninterrupted payment 
                        of claims; or
                          (III) ensure that the guaranty agency 
                        will make loans as the lender-of-last-
                        resort, in accordance with subsection 
                        (j);
                  (vi) use all funds and assets of the guaranty 
                agency to assist in the activities undertaken 
                in accordance with this subparagraph and take 
                appropriate action to require the return, to 
                the guaranty agency or the Secretary, of any 
                funds or assets provided by the guaranty 
                agency, under contract or otherwise, to any 
                person or organization; or
                  (vii) take any other action the Secretary 
                determines necessary to ensure the continued 
                availability of loans made under this part to 
                residents of the State or States in which the 
                guaranty agency did business, the full honoring 
                of all guarantees issued by the guaranty agency 
                prior to the Secretary's assumption of the 
                functions of such agency, and the proper 
                servicing of loans guaranteed by the guaranty 
                agency prior to the Secretary's assumption of 
                the functions of such agency, and to avoid 
                disruption of the student loan program.
          (G) Notwithstanding any other provision of Federal or 
        State law, if the Secretary has terminated or is 
        seeking to terminate a guaranty agency's agreement 
        under subparagraph (E), or has assumed a guaranty 
        agency's functions under subparagraph (F)--
                  (i) no State court may issue any order 
                affecting the Secretary's actions with respect 
                to such guaranty agency;
                  (ii) any contract with respect to the 
                administration of a guaranty agency's reserve 
                funds, or the administration of any assets 
                purchased or acquired with the reserve funds of 
                the guaranty agency, that is entered into or 
                extended by the guaranty agency, or any other 
                party on behalf of or with the concurrence of 
                the guaranty agency, after the date of 
                enactment of this subparagraph shall provide 
                that the contract is terminable by the 
                Secretary upon 30 days notice to the 
                contracting parties if the Secretary determines 
                that such contract includes an impermissible 
                transfer of the reserve funds or assets, or is 
                otherwise inconsistent with the terms or 
                purposes of this section; and
                  (iii) no provision of State law shall apply 
                to the actions of the Secretary in terminating 
                the operations of a guaranty agency.
          (H) Notwithstanding any other provision of law, the 
        Secretary's liability for any outstanding liabilities 
        of a guaranty agency (other than outstanding student 
        loan guarantees under this part), the functions of 
        which the Secretary has assumed, shall not exceed the 
        fair market value of the reserves of the guaranty 
        agency, minus any necessary liquidation or other 
        administrative costs.
          (I) The Secretary shall not take any action under 
        subparagraph (E) or (F) without giving the guaranty 
        agency notice and the opportunity for a hearing that, 
        if commenced after September 24, 1998, shall be on the 
        record.
          (J) Notwithstanding any other provision of law, the 
        information transmitted to the Secretary pursuant to 
        this paragraph shall be confidential and exempt from 
        disclosure under section 552 of title 5, United States 
        Code, relating to freedom of information, or any other 
        Federal law.
          (K) The Secretary, within 6 months after the end of 
        each fiscal year, shall submit to the authorizing 
        committees a report specifying the Secretary's 
        assessment of the fiscal soundness of the guaranty 
        agency system.
          (10) Documentation of forbearance agreements.--For 
        the purposes of paragraph (3), the terms of forbearance 
        agreed to by the parties shall be documented by 
        confirming the agreement of the borrower by notice to 
        the borrower from the lender, and by recording the 
        terms in the borrower's file.
  (d) Usury Laws Inapplicable.--No provision of any law of the 
United States (other than this Act and section 207 of the 
Servicemembers Civil Relief Act (50 U.S.C. App. 527)) or of any 
State (other than a statute applicable principally to such 
State's student loan insurance program) which limits the rate 
or amount of interest payable on loans shall apply to a loan--
          (1) which bears interest (exclusive of any premium 
        for insurance) on the unpaid principal balance at a 
        rate not in excess of the rate specified in this part; 
        and
          (2) which is insured (i) by the United States under 
        this part, or (ii) by a guaranty agency under a program 
        covered by an agreement made pursuant to subsection (b) 
        of this section.
  (f) Payments of Certain Costs.--
          (1) Payment for certain activities.--
                  (A) In general.--The Secretary--
                          (i) for loans originated during 
                        fiscal years beginning on or after 
                        October 1, 1998, and before October 1, 
                        2003, and in accordance with the 
                        provisions of this paragraph, shall, 
                        except as provided in subparagraph (C), 
                        pay to each guaranty agency, a loan 
                        processing and issuance fee equal to 
                        0.65 percent of the total principal 
                        amount of the loans on which insurance 
                        was issued under this part during such 
                        fiscal year by such agency; and
                          (ii) for loans originated on or after 
                        October 1, 2003, and first disbursed 
                        before July 1, 2010, and in accordance 
                        with the provisions of this paragraph, 
                        shall, except as provided in 
                        subparagraph (C), pay to each guaranty 
                        agency, a loan processing and issuance 
                        fee equal to 0.40 percent of the total 
                        principal amount of the loans on which 
                        insurance was issued under this part 
                        during such fiscal year by such agency.
                  (B) Payment.--The payment required by 
                subparagraph (A) shall be paid on a quarterly 
                basis. The guaranty agency shall be deemed to 
                have a contractual right against the United 
                States to receive payments according to the 
                provisions of this paragraph. Payments shall be 
                made promptly and without administrative delay 
                to any guaranty agency submitting an accurate 
                and complete application under this 
                subparagraph.
                  (C) Requirement for payment.--No payment may 
                be made under this paragraph for loans for 
                which the disbursement checks have not been 
                cashed or for which electronic funds transfers 
                have not been completed.
  (g) Action on Insurance Program and Guaranty Agreements.--If 
a nonprofit private institution or organization--
          (1) applies to enter into an agreement with the 
        Secretary under subsections (b) and (c) with respect to 
        a student loan insurance program to be carried on in a 
        State with which the Secretary does not have an 
        agreement under subsection (b), and
          (2) as provided in the application, undertakes to 
        meet the requirements of section 422(c)(6)(B) (i), 
        (ii), and (iii),
the Secretary shall consider and act upon such application 
within 180 days, and shall forthwith notify the authorizing 
committees of his actions.
  (i) Multiple Disbursement of Loans.--
          (1) Escrow accounts administered by escrow agent.--
        Any guaranty agency or eligible lender (hereafter in 
        this subsection referred to as the ``escrow agent'') 
        may enter into an agreement with any other eligible 
        lender that is not an eligible institution or an agency 
        or instrumentality of the State (hereafter in this 
        subsection referred to as the ``lender'') for the 
        purpose of authorizing disbursements of the proceeds of 
        a loan to a student. Such agreement shall provide that 
        the lender will pay the proceeds of such loans into an 
        escrow account to be administered by the escrow agent 
        in accordance with the provisions of paragraph (2) of 
        this subsection. Such agreement may allow the lender to 
        make payments into the escrow account in amounts that 
        do not exceed the sum of the amounts required for 
        disbursement of initial or subsequent installments to 
        borrowers and to make such payments not more than 10 
        days prior to the date of the disbursement of such 
        installment to such borrowers. Such agreement shall 
        require the lender to notify promptly the eligible 
        institution when funds are escrowed under this 
        subsection for a student at such institution.
          (2) Authority of escrow agent.--Each escrow agent 
        entering into an agreement under paragraph (1) of this 
        subsection is authorized to--
                  (A) make the disbursements in accordance with 
                the note evidencing the loan;
                  (B) commingle the proceeds of all loans paid 
                to the escrow agent pursuant to the escrow 
                agreement entered into under such paragraph 
                (1);
                  (C) invest the proceeds of such loans in 
                obligations of the Federal Government or 
                obligations which are insured or guaranteed by 
                the Federal Government;
                  (D) retain interest or other earnings on such 
                investment; and
                  (E) return to the lender undisbursed funds 
                when the student ceases to carry at an eligible 
                institution at least one-half of the normal 
                full-time academic workload as determined by 
                the institution.
  (j) Lenders-of-Last-Resort.--
          (1) General requirement.--In each State, the guaranty 
        agency or an eligible lender in the State described in 
        section 435(d)(1)(D) of this Act shall, before July 1, 
        2010, make loans directly, or through an agreement with 
        an eligible lender or lenders, to eligible students and 
        parents who are otherwise unable to obtain loans under 
        this part (except for consolidation loans under section 
        428C) or who attend an institution of higher education 
        in the State that is designated under paragraph (4). 
        Loans made under this subsection shall not exceed the 
        amount of the need of the borrower, as determined under 
        subsection (a)(2)(B), nor be less than $200. No loan 
        under section 428, 428B, or 428H that is made pursuant 
        to this subsection shall be made with interest rates, 
        origination or default fees, or other terms and 
        conditions that are more favorable to the borrower than 
        the maximum interest rates, origination or default 
        fees, or other terms and conditions applicable to that 
        type of loan under this part. The guaranty agency shall 
        consider the request of any eligible lender, as defined 
        under section 435(d)(1)(A) of this Act, to serve as the 
        lender-of-last-resort pursuant to this subsection.
          (2) Rules and operating procedures.--The guaranty 
        agency shall develop rules and operating procedures for 
        the lender-of-last-resort program designed to ensure 
        that--
                  (A) the program establishes operating hours 
                and methods of application designed to 
                facilitate application by students and ensure a 
                response within 60 days after the student's 
                original complete application is filed under 
                this subsection;
                  (B) consistent with standards established by 
                the Secretary, students applying for loans 
                under this subsection shall not be subject to 
                additional eligibility requirements or requests 
                for additional information beyond what is 
                required under this title in order to receive a 
                loan under this part from an eligible lender, 
                nor, in the case of students and parents 
                applying for loans under this subsection 
                because of an inability to otherwise obtain 
                loans under this part (except for consolidation 
                loans under section 428C), be required to 
                receive more than two rejections from eligible 
                lenders in order to obtain a loan under this 
                subsection;
                  (C) information about the availability of 
                loans under the program is made available to 
                institutions of higher education in the State; 
                and
                  (D) appropriate steps are taken to ensure 
                that borrowers receiving loans under the 
                program are appropriately counseled on their 
                loan obligation.
          (3) Advances to guaranty agencies for lender-of-last-
        resort services.--(A) In order to ensure the 
        availability of loan capital, the Secretary is 
        authorized to provide a guaranty agency designated for 
        a State with additional advance funds in accordance 
        with subparagraph (C) and section 422(c)(7), with such 
        restrictions on the use of such funds as are determined 
        appropriate by the Secretary, in order to ensure that 
        the guaranty agency will make loans as the lender-of-
        last-resort. Such agency shall make such loans in 
        accordance with this subsection and the requirements of 
        the Secretary.
          (B) Notwithstanding any other provision in this part, 
        a guaranty agency serving as a lender-of-last-resort 
        under this paragraph shall be paid a fee, established 
        by the Secretary, for making such loans in lieu of 
        interest and special allowance subsidies, and shall be 
        required to assign such loans to the Secretary on 
        demand. Upon such assignment, the portion of the 
        advance represented by the loans assigned shall be 
        considered repaid by such guaranty agency.
          (C) The Secretary shall exercise the authority 
        described in subparagraph (A) only if the Secretary 
        determines that eligible borrowers are seeking and are 
        unable to obtain loans under this part or designates an 
        institution of higher education for participation in 
        the program under this subsection under paragraph (4), 
        and that the guaranty agency designated for that State 
        has the capability to provide lender-of-last-resort 
        loans in a timely manner, in accordance with the 
        guaranty agency's obligations under paragraph (1), but 
        cannot do so without advances provided by the Secretary 
        under this paragraph. If the Secretary makes the 
        determinations described in the preceding sentence and 
        determines that it would be cost-effective to do so, 
        the Secretary may provide advances under this paragraph 
        to such guaranty agency. If the Secretary determines 
        that such guaranty agency does not have such 
        capability, or will not provide such loans in a timely 
        fashion, the Secretary may provide such advances to 
        enable another guaranty agency, that the Secretary 
        determines to have such capability, to make lender-of-
        last-resort loans to eligible borrowers in that State 
        who are experiencing loan access problems or to 
        eligible borrowers who attend an institution in the 
        State that is designated under paragraph (4).
          (4) Institution-wide student qualification.--Upon the 
        request of an institution of higher education and 
        pursuant to standards developed by the Secretary, the 
        Secretary shall designate such institution for 
        participation in the lender-of-last-resort program 
        under this paragraph. If the Secretary designates an 
        institution under this paragraph, the guaranty agency 
        designated for the State in which the institution is 
        located shall make loans, in the same manner as such 
        loans are made under paragraph (1), to students and 
        parent borrowers of the designated institution, 
        regardless of whether the students or parent borrowers 
        are otherwise unable to obtain loans under this part 
        (other than a consolidation loan under section 428C).
          (5) Standards developed by the secretary.--In 
        developing standards with respect to paragraph (4), the 
        Secretary may require--
                  (A) an institution of higher education to 
                demonstrate that, despite due diligence on the 
                part of the institution, the institution has 
                been unable to secure the commitment of 
                eligible lenders willing to make loans under 
                this part to a significant number of students 
                attending the institution;
                  (B) that, prior to making a request under 
                such paragraph for designation for 
                participation in the lender-of-last-resort 
                program, an institution of higher education 
                shall demonstrate that the institution has met 
                a minimum threshold, as determined by the 
                Secretary, for the number or percentage of 
                students at such institution who have received 
                rejections from eligible lenders for loans 
                under this part; and
                  (C) any other standards and guidelines the 
                Secretary determines to be appropriate.
          (6) Expiration of authority.--The Secretary's 
        authority under paragraph (4) to designate institutions 
        of higher education for participation in the program 
        under this subsection shall expire on June 30, 2010.
          (7) Expiration of designation.--The eligibility of an 
        institution of higher education, or borrowers from such 
        institution, to participate in the program under this 
        subsection pursuant to a designation of the institution 
        by the Secretary under paragraph (4) shall expire on 
        June 30, 2010. After such date, borrowers from an 
        institution designated under paragraph (4) shall be 
        eligible to participate in the program under this 
        subsection as such program existed on the day before 
        the date of enactment of the Ensuring Continued Access 
        to Student Loans Act of 2008.
          (8) Prohibition on inducements and marketing.--Each 
        guaranty agency or eligible lender that serves as a 
        lender-of-last-resort under this subsection--
                  (A) shall be subject to the prohibitions on 
                inducements contained in subsection (b)(3) and 
                the requirements of section 435(d)(5); and
                  (B) shall not advertise, market, or otherwise 
                promote loans under this subsection, except 
                that nothing in this paragraph shall prohibit a 
                guaranty agency from fulfilling its 
                responsibilities under paragraph (2)(C).
          (9) Dissemination and reporting.--
                  (A) In general.--The Secretary shall--
                          (i) broadly disseminate information 
                        regarding the availability of loans 
                        made under this subsection;
                          (ii) during the period beginning July 
                        1, 2008 and ending June 30, 2011, 
                        provide to the authorizing committees 
                        and make available to the public--
                                  (I) copies of any new or 
                                revised plans or agreements 
                                made by guaranty agencies or 
                                the Department related to the 
                                authorities under this 
                                subsection;
                                  (II) quarterly reports on--
                                          (aa) the number and 
                                        amounts of loans 
                                        originated or approved 
                                        pursuant to this 
                                        subsection by each 
                                        guaranty agency and 
                                        eligible lender; and
                                          (bb) any related 
                                        payments by the 
                                        Department, a guaranty 
                                        agency, or an eligible 
                                        lender; and
                                  (III) a budget estimate of 
                                the costs to the Federal 
                                Government (including subsidy 
                                and administrative costs) for 
                                each 100 dollars loaned, of 
                                loans made pursuant to this 
                                subsection between the date of 
                                enactment of the Ensuring 
                                Continued Access to Student 
                                Loans Act of 2008 and June 30, 
                                2010, disaggregated by type of 
                                loan, compared to such costs to 
                                the Federal Government during 
                                such time period of comparable 
                                loans under this part and part 
                                D, disaggregated by part and by 
                                type of loan; and
                          (iii) beginning July 1, 2011, provide 
                        to the authorizing committees and make 
                        available to the public--
                                  (I) copies of any new or 
                                revised plans or agreements 
                                made by guaranty agencies or 
                                the Department related to the 
                                authorities under this 
                                subsection; and
                                  (II) annual reports on--
                                          (aa) the number and 
                                        amounts of loans 
                                        originated or approved 
                                        pursuant to this 
                                        subsection by each 
                                        guaranty agency and 
                                        eligible lender; and
                                          (bb) any related 
                                        payments by the 
                                        Department, a guaranty 
                                        agency, or an eligible 
                                        lender.
                  (B) Separate reporting.--The information 
                required to be reported under subparagraph 
                (A)(ii)(II) shall be reported separately for 
                loans originated or approved pursuant to 
                paragraph (4), or payments related to such 
                loans, for the time period in which the 
                Secretary is authorized to make designations 
                under paragraph (4).
  (k) Information on Defaults.--
          (1) Provision of information to eligible 
        institutions.--Notwithstanding any other provision of 
        law, in order to notify eligible institutions of former 
        students who are in default of their continuing 
        obligation to repay student loans, each guaranty agency 
        shall, upon the request of an eligible institution, 
        furnish information with respect to students who were 
        enrolled at the eligible institution and who are in 
        default on the repayment of any loan made, insured, or 
        guaranteed under this part. The information authorized 
        to be furnished under this subsection shall include the 
        names and addresses of such students.
          (2) Public dissemination not authorized.--Nothing in 
        paragraph (1) of this subsection shall be construed to 
        authorize public dissemination of the information 
        described in paragraph (1).
          (3) Borrower location information.--Any information 
        provided by the institution relating to borrower 
        location shall be used by the guaranty agency in 
        conducting required skip-tracing activities.
          (4) Provision of information to borrowers in 
        default.--Each guaranty agency that has received a 
        default claim from a lender regarding a borrower, shall 
        provide the borrower in default, on not less than two 
        separate occasions, with a notice, in simple and 
        understandable terms, of not less than the following 
        information:
                  (A) The options available to the borrower to 
                remove the borrower's loan from default.
                  (B) The relevant fees and conditions 
                associated with each option.
  (l) Default Aversion Assistance.--
          (1) Assistance required.--Upon receipt of a complete 
        request from a lender received not earlier than the 
        60th day of delinquency, a guaranty agency having an 
        agreement with the Secretary under subsection (c) shall 
        engage in default aversion activities designed to 
        prevent the default by a borrower on a loan covered by 
        such agreement.
          (2) Reimbursement.--
                  (A) In general.--A guaranty agency, in 
                accordance with the provisions of this 
                paragraph, may transfer from the Federal 
                Student Loan Reserve Fund under section 422A to 
                the Agency Operating Fund under section 422B a 
                default aversion fee. Such fee shall be paid 
                for any loan on which a claim for default has 
                not been paid as a result of the loan being 
                brought into current repayment status by the 
                guaranty agency on or before the 300th day 
                after the loan becomes 60 days delinquent.
                  (B) Amount.--The default aversion fee shall 
                be equal to 1 percent of the total unpaid 
                principal and accrued interest on the loan at 
                the time the request is submitted by the 
                lender. A guaranty agency may transfer such 
                fees earned under this subsection not more 
                frequently than monthly. Such a fee shall not 
                be paid more than once on any loan for which 
                the guaranty agency averts the default unless--
                          (i) at least 18 months has elapsed 
                        between the date the borrower entered 
                        current repayment status and the date 
                        the lender filed a subsequent default 
                        aversion assistance request; and
                          (ii) during the period between such 
                        dates, the borrower was not more than 
                        30 days past due on any payment of 
                        principal and interest on the loan.
                  (C) Definition.--For the purpose of earning 
                the default aversion fee, the term ``current 
                repayment status'' means that the borrower is 
                not delinquent in the payment of any principal 
                or interest on the loan.
  (m) Income Contingent and Income-Based Repayment.--
          (1) Authority of secretary to require.--The Secretary 
        may require borrowers who have defaulted on loans made 
        under this part that are assigned to the Secretary 
        under subsection (c)(8) to repay those loans under an 
        income contingent repayment plan or income-based 
        repayment plan, the terms and conditions of which shall 
        be established by the Secretary and the same as, or 
        similar to, an income contingent repayment plan 
        established for purposes of part D of this title or an 
        income-based repayment plan under section 493C, as the 
        case may be.
          (2) Loans for which income contingent or income-based 
        repayment may be required.--A loan made under this part 
        may be required to be repaid under this subsection if 
        the note or other evidence of the loan has been 
        assigned to the Secretary pursuant to subsection 
        (c)(8).
  (n) Blanket Certificate of Loan Guaranty.--
          (1) In general.--Subject to paragraph (3), any 
        guaranty agency that has entered into or enters into 
        any insurance program agreement with the Secretary 
        under this part may--
                  (A) offer eligible lenders participating in 
                the agency's guaranty program a blanket 
                certificate of loan guaranty that permits the 
                lender to make loans without receiving prior 
                approval from the guaranty agency of individual 
                loans for eligible borrowers enrolled in 
                eligible programs at eligible institutions; and
                  (B) provide eligible lenders with the ability 
                to transmit electronically data to the agency 
                concerning loans the lender has elected to make 
                under the agency's insurance program via 
                standard reporting formats, with such reporting 
                to occur at reasonable and standard intervals.
          (2) Limitations on blanket certificate of guaranty.--
        (A) An eligible lender may not make a loan to a 
        borrower under this section after such lender receives 
        a notification from the guaranty agency that the 
        borrower is not an eligible borrower.
          (B) A guaranty agency may establish limitations or 
        restrictions on the number or volume of loans issued by 
        a lender under the blanket certificate of guaranty.
          (3) Participation level.--During fiscal years 1999 
        and 2000, the Secretary may permit, on a pilot basis, a 
        limited number of guaranty agencies to offer blanket 
        certificates of guaranty under this subsection. 
        Beginning in fiscal year 2001, any guaranty agency that 
        has an insurance program agreement with the Secretary 
        may offer blanket certificates of guaranty under this 
        subsection.
          (4) Report required.--The Secretary shall, at the 
        conclusion of the pilot program under paragraph (3), 
        provide a report to the authorizing committees on the 
        impact of the blanket certificates of guaranty on 
        program efficiency and integrity.
  (o) Armed Forces Student Loan Interest Payment Program.--
          (1) Authority.--Using funds received by transfer to 
        the Secretary under section 2174 of title 10, United 
        States Code, for the payment of interest and any 
        special allowance on a loan to a member of the Armed 
        Forces that is made, insured, or guaranteed under this 
        part, the Secretary shall pay the interest and special 
        allowance on such loan as due for a period not in 
        excess of 36 consecutive months. The Secretary may not 
        pay interest or any special allowance on such a loan 
        out of any funds other than funds that have been so 
        transferred.
          (2) Forbearance.--During the period in which the 
        Secretary is making payments on a loan under paragraph 
        (1), the lender shall grant the borrower forbearance in 
        accordance with the guaranty agreement under subsection 
        (c)(3)(A)(i)(IV).
          (3) Special allowance defined.--For the purposes of 
        this subsection, the term ``special allowance'', means 
        a special allowance that is payable with respect to a 
        loan under section 438.

           *       *       *       *       *       *       *


SEC. 428H. UNSUBSIDIZED STAFFORD LOANS FOR MIDDLE-INCOME BORROWERS.

  (a) In General.--It is the purpose of this section to 
authorize insured loans under this part that are first 
disbursed before July 1, 2010, for borrowers who do not qualify 
for Federal interest subsidy payments under section 428 of this 
Act. Except as provided in this section, all terms and 
conditions for Federal Stafford loans established under section 
428 shall apply to loans made pursuant to this section.
  (b) Eligible Borrowers.--Prior to July 1, 2010, any student 
meeting the requirements for student eligibility under section 
484 (including graduate and professional students as defined in 
regulations promulgated by the Secretary) shall be entitled to 
borrow an unsubsidized Federal Stafford Loan for which the 
first disbursement is made before such date if the eligible 
institution at which the student has been accepted for 
enrollment, or at which the student is in attendance, has--
          (1) determined and documented the student's need for 
        the loan based on the student's estimated cost of 
        attendance (as determined under section 472) and the 
        student's estimated financial assistance, including a 
        loan which qualifies for interest subsidy payments 
        under section 428; and
          (2) provided the lender a statement--
                  (A) certifying the eligibility of the student 
                to receive a loan under this section and the 
                amount of the loan for which such student is 
                eligible, in accordance with subsection (c); 
                and
                  (B) setting forth a schedule for disbursement 
                of the proceeds of the loan in installments, 
                consistent with the requirements of section 
                428G.
  (c) Determination of Amount of Loan.--The determination of 
the amount of a loan by an eligible institution under 
subsection (b) shall be calculated by subtracting from the 
estimated cost of attendance at the eligible institution any 
estimated financial assistance reasonably available to such 
student. An eligible institution may not, in carrying out the 
provisions of subsection (b) of this section, provide a 
statement which certifies the eligibility of any student to 
receive any loan under this section in excess of the amount 
calculated under the preceding sentence.
  (d) Loan Limits.--
          (1) In general.--Except as provided in paragraphs 
        (2), (3), and (4), the annual and aggregate limits for 
        loans under this section shall be the same as those 
        established under section 428(b)(1), less any amount 
        received by such student pursuant to the subsidized 
        loan program established under section 428.
          (2) Limits for graduate, professional, and 
        independent postbaccalaureate students.--
                  (A) Annual limits.--The maximum annual amount 
                of loans under this section a graduate or 
                professional student, or a student described in 
                clause (ii), may borrow in any academic year 
                (as defined in section 481(a)(2)) or its 
                equivalent shall be the amount determined under 
                paragraph (1), plus--
                          (i) in the case of such a student who 
                        is a graduate or professional student 
                        attending an eligible institution, 
                        $12,000; and
                          (ii) notwithstanding paragraph (4), 
                        in the case of an independent student, 
                        or a dependent student whose parents 
                        are unable to borrow under section 428B 
                        or the Federal Direct PLUS Loan 
                        Program, who has obtained a 
                        baccalaureate degree and who is 
                        enrolled in coursework specified in 
                        paragraph (3)(B) or (4)(B) of section 
                        484(b)--
                                  (I) $7,000 for coursework 
                                necessary for enrollment in a 
                                graduate or professional 
                                program; and
                                  (II) $7,000 for coursework 
                                necessary for a professional 
                                credential or certification 
                                from a State required for 
                                employment as a teacher in an 
                                elementary or secondary school,
                except in cases where the Secretary determines 
                that a higher amount is warranted in order to 
                carry out the purpose of this part with respect 
                to students engaged in specialized training 
                requiring exceptionally high costs of 
                education, but the annual insurable limit per 
                student shall not be deemed to be exceeded by a 
                line of credit under which actual payments by 
                the lender to the borrower will not be made in 
                any years in excess of the annual limit.
                  (B) Aggregate limit.--The maximum aggregate 
                amount of loans under this section a student 
                described in subparagraph (A) may borrow shall 
                be the amount described in paragraph (1), 
                adjusted to reflect the increased annual limits 
                described in subparagraph (A), as prescribed by 
                the Secretary by regulation.
          (3) Limits for undergraduate dependent students.--
                  (A) Annual limits.--The maximum annual amount 
                of loans under this section an undergraduate 
                dependent student (except an undergraduate 
                dependent student whose parents are unable to 
                borrow under section 428B or the Federal Direct 
                PLUS Loan Program) may borrow in any academic 
                year (as defined in section 481(a)(2)) or its 
                equivalent shall be the sum of the amount 
                determined under paragraph (1), plus $2,000.
                  (B) Aggregate limits.--The maximum aggregate 
                amount of loans under this section a student 
                described in subparagraph (A) may borrow shall 
                be $31,000.
          (4) Limits for undergraduate independent students.--
                  (A) Annual limits.--The maximum annual amount 
                of loans under this section an undergraduate 
                independent student, or an undergraduate 
                dependent student whose parents are unable to 
                borrow under section 428B or the Federal Direct 
                PLUS Loan Program, may borrow in any academic 
                year (as defined in section 481(a)(2)) or its 
                equivalent shall be the sum of the amount 
                determined under paragraph (1), plus--
                          (i) in the case of such a student 
                        attending an eligible institution who 
                        has not completed such student's first 
                        2 years of undergraduate study--
                                  (I) $6,000, if such student 
                                is enrolled in a program whose 
                                length is at least one academic 
                                year in length; or
                                  (II) if such student is 
                                enrolled in a program of 
                                undergraduate education which 
                                is less than one academic year, 
                                the maximum annual loan amount 
                                that such student may receive 
                                may not exceed the amount that 
                                bears the same ratio to the 
                                amount specified in subclause 
                                (I) as the length of such 
                                program measured in semester, 
                                trimester, quarter, or clock 
                                hours bears to one academic 
                                year;
                          (ii) in the case of such a student at 
                        an eligible institution who has 
                        successfully completed such first and 
                        second years but has not successfully 
                        completed the remainder of a program of 
                        undergraduate education--
                                  (I) $7,000; or
                                  (II) if such student is 
                                enrolled in a program of 
                                undergraduate education, the 
                                remainder of which is less than 
                                one academic year, the maximum 
                                annual loan amount that such 
                                student may receive may not 
                                exceed the amount that bears 
                                the same ratio to the amount 
                                specified in subclause (I) as 
                                such remainder measured in 
                                semester, trimester, quarter, 
                                or clock hours bears to one 
                                academic year; and
                          (iii) in the case of such a student 
                        enrolled in coursework specified in--
                                  (I) section 484(b)(3)(B), 
                                $6,000; or
                                  (II) section 484(b)(4)(B), 
                                $7,000.
                  (B) Aggregate limits.--The maximum aggregate 
                amount of loans under this section a student 
                described in subparagraph (A) may borrow shall 
                be $57,500.
          (5) Capitalized interest.--Interest capitalized shall 
        not be deemed to exceed a maximum aggregate amount 
        determined under subparagraph (B) of paragraph (2), 
        (3), or (4).
  (e) Payment of Principal and Interest.--
          (1) Commencement of repayment.--Repayment of 
        principal on loans made under this section shall begin 
        at the beginning of the repayment period described in 
        section 428(b)(7). Not less than 30 days prior to the 
        anticipated commencement of such repayment period, the 
        holder of such loan shall provide notice to the 
        borrower that interest will accrue before repayment 
        begins and of the borrower's option to begin loan 
        repayment at an earlier date.
          (2) Capitalization of interest.--(A) [Interest] 
        Except as provided in subparagraph (C), interest on 
        loans made under this section for which payments of 
        principal are not required during the in-school and 
        grace periods or for which payments are deferred under 
        sections 427(a)(2)(C) and 428(b)(1)(M) shall, if agreed 
        upon by the borrower and the lender--
                  (i) be paid monthly or quarterly; or
                  (ii) be added to the principal amount of the 
                loan by the lender only--
                          (I) when the loan enters repayment;
                          (II) at the expiration of a grace 
                        period, in the case of a loan that 
                        qualifies for a grace period;
                          (III) at the expiration of a period 
                        of deferment or forbearance; or
                          (IV) when the borrower defaults.
          (B) The capitalization of interest described in 
        subparagraph (A) shall not be deemed to exceed the 
        annual insurable limit on account of the student.
          (C) Interest shall not accrue on a loan deferred 
        under section 428(b)(1)(M)(v) or 427(a)(2)(C)(iv).
          (3) Subsidies prohibited.--No payments to reduce 
        interest costs shall be paid pursuant to section 428(a) 
        of this part on loans made pursuant to this section.
          (4) Applicable rates of interest.--Interest on loans 
        made pursuant to this section shall be at the 
        applicable rate of interest provided in section 427A.
          (5) Amortization.--The amount of the periodic payment 
        and the repayment schedule for any loan made pursuant 
        to this section shall be established by assuming an 
        interest rate equal to the applicable rate of interest 
        at the time the repayment of the principal amount of 
        the loan commences. At the option of the lender, the 
        note or other written evidence of the loan may require 
        that--
                  (A) the amount of the periodic payment will 
                be adjusted annually; or
                  (B) the period of repayment of principal will 
                be lengthened or shortened,
        in order to reflect adjustments in interest rates 
        occurring as a consequence of section 427A(c)(4).
          (6) Repayment period.--For purposes of calculating 
        the repayment period under section 428(b)(9), such 
        period shall commence at the time the first payment of 
        principal is due from the borrower.
          (7) Qualification for forbearance.--A lender may 
        grant the borrower of a loan under this section a 
        forbearance for a period not to exceed 60 days if the 
        lender reasonably determines that such a forbearance 
        from collection activity is warranted following a 
        borrower's request for forbearance, deferment, or a 
        change in repayment plan, or a request to consolidate 
        loans in order to collect or process appropriate 
        supporting documentation related to the request. During 
        any such period, interest on the loan shall accrue but 
        not be capitalized.
  [(f) Repealed]
  (g) Single Application Form and Loan Repayment Schedule.--A 
guaranty agency shall use a single application form and a 
single repayment schedule for subsidized Federal Stafford loans 
made pursuant to section 428 and for unsubsidized Federal 
Stafford loans made pursuant to this section.
  (h) Insurance Premium.--Each State or nonprofit private 
institution or organization having an agreement with the 
Secretary under section 428(b)(1) may charge a borrower under 
this section an insurance premium equal to not more than 1.0 
percent of the principal amount of the loan, if such premium 
will not be used for incentive payments to lenders. Effective 
for loans for which the date of guarantee of principal is on or 
after July 1, 2006, and that are first disbursed before July 1, 
2010, in lieu of the insurance premium authorized under the 
preceding sentence, each State or nonprofit private institution 
or organization having an agreement with the Secretary under 
section 428(b)(1) shall collect and deposit into the Federal 
Student Loan Reserve Fund under section 422A, a Federal default 
fee of an amount equal to 1.0 percent of the principal amount 
of the loan, which fee shall be collected either by deduction 
from the proceeds of the loan or by payment from other non-
Federal sources. The Federal default fee shall not be used for 
incentive payments to lenders.

           *       *       *       *       *       *       *


PART D--WILLIAM D. FORD FEDERAL DIRECT LOAN PROGRAM

           *       *       *       *       *       *       *


SEC. 455. TERMS AND CONDITIONS OF LOANS.

  (a) In General.--
          (1) Parallel terms, conditions, benefits, and 
        amounts.--Unless otherwise specified in this part, 
        loans made to borrowers under this part shall have the 
        same terms, conditions, and benefits, and be available 
        in the same amounts, as loans made to borrowers, and 
        first disbursed on June 30, 2010, under sections 428, 
        428B, 428C, and 428H of this title.
          (2) Designation of loans.--Loans made to borrowers 
        under this part that, except as otherwise specified in 
        this part, have the same terms, conditions, and 
        benefits as loans made to borrowers under--
                  (A) section 428 shall be known as ``Federal 
                Direct Stafford Loans'';
                  (B) section 428B shall be known as ``Federal 
                Direct PLUS Loans'';
                  (C) section 428C shall be known as ``Federal 
                Direct Consolidation Loans''; and
                  (D) section 428H shall be known as ``Federal 
                Direct Unsubsidized Stafford Loans''.
          (3) Termination of authority to make interest 
        subsidized loans to graduate and professional 
        students.--
                  (A) In general.--Subject to subparagraph (B) 
                and notwithstanding any provision of this part 
                or part B, for any period of instruction 
                beginning on or after July 1, 2012--
                          (i) a graduate or professional 
                        student shall not be eligible to 
                        receive a Federal Direct Stafford loan 
                        under this part; and
                          (ii) the maximum annual amount of 
                        Federal Direct Unsubsidized Stafford 
                        loans such a student may borrow in any 
                        academic year (as defined in section 
                        481(a)(2)) or its equivalent shall be 
                        the maximum annual amount for such 
                        student determined under section 428H, 
                        plus an amount equal to the amount of 
                        Federal Direct Stafford loans the 
                        student would have received in the 
                        absence of this subparagraph.
                  (B) Exception.--Subparagraph (A) shall not 
                apply to an individual enrolled in course work 
                specified in paragraph (3)(B) or (4)(B) of 
                section 484(b).
  (b) Interest Rate.--
          (1) Rates for fdsl and fdusl.--For Federal Direct 
        Stafford Loans and Federal Direct Unsubsidized Stafford 
        Loans for which the first disbursement is made on or 
        after July 1, 1994, the applicable rate of interest 
        shall, during any 12-month period beginning on July 1 
        and ending on June 30, be determined on the preceding 
        June 1 and be equal to--
                  (A) the bond equivalent rate of 91-day 
                Treasury bills auctioned at the final auction 
                held prior to such June 1; plus
                  (B) 3.1 percent,
        except that such rate shall not exceed 8.25 percent.
          (2) In school and grace period rules.--(A) 
        Notwithstanding the provisions of paragraph (1), but 
        subject to paragraph (3), with respect to any Federal 
        Direct Stafford Loan or Federal Direct Unsubsidized 
        Stafford Loan for which the first disbursement is made 
        on or after July 1, 1995, the applicable rate of 
        interest for interest which accrues--
                  (i) prior to the beginning of the repayment 
                period of the loan; or
                  (ii) during the period in which principal 
                need not be paid (whether or not such principal 
                is in fact paid) by reason of a provision 
                described in section 428(b)(1)(M) or 
                427(a)(2)(C),
        shall not exceed the rate determined under subparagraph 
        (B).
          (B) For the purpose of subparagraph (A), the rate 
        determined under this subparagraph shall, during any 
        12-month period beginning on July 1 and ending on June 
        30, be determined on the preceding June 1 and be equal 
        to--
                  (i) the bond equivalent rate of 91-day 
                Treasury bills auctioned at the final auction 
                prior to such June 1; plus
                  (ii) 2.5 percent,
        except that such rate shall not exceed 8.25 percent.
          (3) Out-year rule.--Notwithstanding paragraphs (1) 
        and (2), for Federal Direct Stafford Loans and Federal 
        Direct Unsubsidized Stafford Loans made on or after 
        July 1, 1998, the applicable rate of interest shall, 
        during any 12-month period beginning on July 1 and 
        ending on June 30, be determined on the preceding June 
        1 and be equal to--
                  (A) the bond equivalent rate of the security 
                with a comparable maturity as established by 
                the Secretary; plus
                  (B) 1.0 percent,
        except that such rate shall not exceed 8.25 percent.
          (4) Rates for fdplus.--
                  (A)(i) For Federal Direct PLUS Loans for 
                which the first disbursement is made on or 
                after July 1, 1994, the applicable rate of 
                interest shall, during any 12-month period 
                beginning on July 1 and ending on or before 
                June 30, 2001, be determined on the preceding 
                June 1 and be equal to--
                          (I) the bond equivalent rate of 52-
                        week Treasury bills auctioned at final 
                        auction held prior to such June 1; plus
                          (II) 3.1 percent,
                except that such rate shall not exceed 9 
                percent.
                  (ii) For any 12-month period beginning on 
                July 1 of 2001 or any succeeding year, the 
                applicable rate of interest determined under 
                this subparagraph shall be determined on the 
                preceding June 26 and be equal to--
                          (I) the weekly average 1-year 
                        constant maturity Treasury yield, as 
                        published by the Board of Governors of 
                        the Federal Reserve System, for the 
                        last calendar week ending on or before 
                        such June 26; plus
                          (II) 3.1 percent,
                except that such rate shall not exceed 9 
                percent.
          (B) For Federal Direct PLUS loans made on or after 
        July 1, 1998, the applicable rate of interest shall, 
        during any 12-month period beginning on July 1 and 
        ending on June 30, be determined on the preceding June 
        1 and be equal to--
                  (i) the bond equivalent rate of the security 
                with a comparable maturity as established by 
                the Secretary; plus
                  (ii) 2.1 percent,
        except that such rate shall not exceed 9 percent.
          (5) Temporary interest rate provision.--
                  (A) Rates for fdsl and fdusl.--
                Notwithstanding the preceding paragraphs of 
                this subsection, for Federal Direct Stafford 
                Loans and Federal Direct Unsubsidized Stafford 
                Loans for which the first disbursement is made 
                on or after July 1, 1998, and before October 1, 
                1998, the applicable rate of interest shall, 
                during any 12-month period beginning on July 1 
                and ending on June 30, be determined on the 
                preceding June 1 and be equal to--
                          (i) the bond equivalent rate of 91-
                        day Treasury bills auctioned at the 
                        final auction held prior to such June 
                        1; plus
                          (ii) 2.3 percent,
                except that such rate shall not exceed 8.25 
                percent.
                  (B) In school and grace period rules.--
                Notwithstanding the preceding paragraphs of 
                this subsection, with respect to any Federal 
                Direct Stafford Loan or Federal Direct 
                Unsubsidized Stafford Loan for which the first 
                disbursement is made on or after July 1, 1998, 
                and before October 1, 1998, the applicable rate 
                of interest for interest which accrues--
                          (i) prior to the beginning of the 
                        repayment period of the loan; or
                          (ii) during the period in which 
                        principal need not be paid (whether or 
                        not such principal is in fact paid) by 
                        reason of a provision described in 
                        section 428(b)(1)(M) or 427(a)(2)(C),
                shall be determined under subparagraph (A) by 
                substituting ``1.7 percent'' for ``2.3 
                percent''.
                  (C) PLUS loans.--Notwithstanding the 
                preceding paragraphs of this subsection, with 
                respect to Federal Direct PLUS Loan for which 
                the first disbursement is made on or after July 
                1, 1998, and before October 1, 1998, the 
                applicable rate of interest shall be determined 
                under subparagraph (A)--
                          (i) by substituting ``3.1 percent'' 
                        for ``2.3 percent''; and
                          (ii) by substituting ``9.0 percent'' 
                        for ``8.25 percent''.
          (6) Interest rate provision for new loans on or after 
        october 1, 1998, and before july 1, 2006.--
                  (A) Rates for fdsl and fdusl.--
                Notwithstanding the preceding paragraphs of 
                this subsection, for Federal Direct Stafford 
                Loans and Federal Direct Unsubsidized Stafford 
                Loans for which the first disbursement is made 
                on or after October 1, 1998, and before July 1, 
                2006, the applicable rate of interest shall, 
                during any 12-month period beginning on July 1 
                and ending on June 30, be determined on the 
                preceding June 1 and be equal to--
                          (i) the bond equivalent rate of 91-
                        day Treasury bills auctioned at the 
                        final auction held prior to such June 
                        1; plus
                          (ii) 2.3 percent,
                except that such rate shall not exceed 8.25 
                percent.
                  (B) In school and grace period rules.--
                Notwithstanding the preceding paragraphs of 
                this subsection, with respect to any Federal 
                Direct Stafford Loan or Federal Direct 
                Unsubsidized Stafford Loan for which the first 
                disbursement is made on or after October 1, 
                1998, and before July 1, 2006, the applicable 
                rate of interest for interest which accrues--
                          (i) prior to the beginning of the 
                        repayment period of the loan; or
                          (ii) during the period in which 
                        principal need not be paid (whether or 
                        not such principal is in fact paid) by 
                        reason of a provision described in 
                        section 428(b)(1)(M) or 427(a)(2)(C),
                shall be determined under subparagraph (A) by 
                substituting ``1.7 percent'' for ``2.3 
                percent''.
                  (C) PLUS loans.--Notwithstanding the 
                preceding paragraphs of this subsection, with 
                respect to Federal Direct PLUS Loan for which 
                the first disbursement is made on or after 
                October 1, 1998, and before July 1, 2006, the 
                applicable rate of interest shall be determined 
                under subparagraph (A)--
                          (i) by substituting ``3.1 percent'' 
                        for ``2.3 percent''; and
                          (ii) by substituting ``9.0 percent'' 
                        for ``8.25 percent''.
                  (D) Consolidation loans.--Notwithstanding the 
                preceding paragraphs of this subsection, any 
                Federal Direct Consolidation loan for which the 
                application is received on or after February 1, 
                1999, and before July 1, 2006, shall bear 
                interest at an annual rate on the unpaid 
                principal balance of the loan that is equal to 
                the lesser of--
                          (i) the weighted average of the 
                        interest rates on the loans 
                        consolidated, rounded to the nearest 
                        higher one-eighth of one percent; or
                          (ii) 8.25 percent.
                  (E) Temporary rules for consolidation 
                loans.--Notwithstanding the preceding 
                paragraphs of this subsection, any Federal 
                Direct Consolidation loan for which the 
                application is received on or after October 1, 
                1998, and before February 1, 1999, shall bear 
                interest at an annual rate on the unpaid 
                principal balance of the loan that is equal 
                to--
                          (i) the bond equivalent rate of 91-
                        day Treasury bills auctioned at the 
                        final auction held prior to such June 
                        1; plus
                          (ii) 2.3 percent,
                except that such rate shall not exceed 8.25 
                percent.
          (7) Interest rate provision for new loans on or after 
        july 1, 2006 and before july 1, 2013.--
                  (A) Rates for fdsl and fdusl.--
                Notwithstanding the preceding paragraphs of 
                this subsection, for Federal Direct Stafford 
                Loans and Federal Direct Unsubsidized Stafford 
                Loans for which the first disbursement is made 
                on or after July 1, 2006, and before July 1, 
                2013, the applicable rate of interest shall be 
                6.8 percent on the unpaid principal balance of 
                the loan.
                  (B) PLUS loans.--Notwithstanding the 
                preceding paragraphs of this subsection, with 
                respect to any Federal Direct PLUS loan for 
                which the first disbursement is made on or 
                after July 1, 2006, and before July 1, 2013, 
                the applicable rate of interest shall be 7.9 
                percent on the unpaid principal balance of the 
                loan.
                  (C) Consolidation loans.--Notwithstanding the 
                preceding paragraphs of this subsection, any 
                Federal Direct Consolidation loan for which the 
                application is received on or after July 1, 
                2006, and before July 1, 2013, shall bear 
                interest at an annual rate on the unpaid 
                principal balance of the loan that is equal to 
                the lesser of--
                          (i) the weighted average of the 
                        interest rates on the loans 
                        consolidated, rounded to the nearest 
                        higher one-eighth of one percent; or
                          (ii) 8.25 percent.
                  (D) Reduced rates for undergraduate fdsl.--
                Notwithstanding the preceding paragraphs of 
                this subsection and subparagraph (A) of this 
                paragraph, for Federal Direct Stafford Loans 
                made to undergraduate students for which the 
                first disbursement is made on or after July 1, 
                2006, and before July 1, 2013, the applicable 
                rate of interest shall be as follows:
                          (i) For a loan for which the first 
                        disbursement is made on or after July 
                        1, 2006, and before July 1, 2008, 6.8 
                        percent on the unpaid principal balance 
                        of the loan.
                          (ii) For a loan for which the first 
                        disbursement is made on or after July 
                        1, 2008, and before July 1, 2009, 6.0 
                        percent on the unpaid principal balance 
                        of the loan.
                          (iii) For a loan for which the first 
                        disbursement is made on or after July 
                        1, 2009, and before July 1, 2010, 5.6 
                        percent on the unpaid principal balance 
                        of the loan.
                          (iv) For a loan for which the first 
                        disbursement is made on or after July 
                        1, 2010, and before July 1, 2011, 4.5 
                        percent on the unpaid principal balance 
                        of the loan.
                          (v) For a loan for which the first 
                        disbursement is made on or after July 
                        1, 2011, and before July 1, 2013, 3.4 
                        percent on the unpaid principal balance 
                        of the loan.
          (8) Interest rate provisions for new loans on or 
        after july 1, 2013.--
                  (A) Rates for undergraduate fdsl and fdusl.--
                Notwithstanding the preceding paragraphs of 
                this subsection, for Federal Direct Stafford 
                Loans and Federal Direct Unsubsidized Stafford 
                Loans issued to undergraduate students, for 
                which the first disbursement is made on or 
                after July 1, 2013, the applicable rate of 
                interest shall, for loans disbursed during any 
                12-month period beginning on July 1 and ending 
                on June 30, be determined on the preceding June 
                1 and be equal to the lesser of--
                          (i) a rate equal to the high yield of 
                        the 10-year Treasury note auctioned at 
                        the final auction held prior to such 
                        June 1 plus 2.05 percent; or
                          (ii) 8.25 percent.
                  (B) Rates for graduate and professional 
                fdusl.--Notwithstanding the preceding 
                paragraphs of this subsection, for Federal 
                Direct Unsubsidized Stafford Loans issued to 
                graduate or professional students, for which 
                the first disbursement is made on or after July 
                1, 2013, the applicable rate of interest shall, 
                for loans disbursed during any 12-month period 
                beginning on July 1 and ending on June 30, be 
                determined on the preceding June 1 and be equal 
                to the lesser of--
                          (i) a rate equal to the high yield of 
                        the 10-year Treasury note auctioned at 
                        the final auction held prior to such 
                        June 1 plus 3.6 percent; or
                          (ii) 9.5 percent.
                  (C) PLUS loans.--Notwithstanding the 
                preceding paragraphs of this subsection, for 
                Federal Direct PLUS Loans, for which the first 
                disbursement is made on or after July 1, 2013, 
                the applicable rate of interest shall, for 
                loans disbursed during any 12-month period 
                beginning on July 1 and ending on June 30, be 
                determined on the preceding June 1 and be equal 
                to the lesser of--
                          (i) a rate equal to the high yield of 
                        the 10-year Treasury note auctioned at 
                        the final auction held prior to such 
                        June 1 plus 4.6 percent; or
                          (ii) 10.5 percent.
                  (D) Consolidation loans.--Notwithstanding the 
                preceding paragraphs of this subsection, any 
                Federal Direct Consolidation Loan for which the 
                application is received on or after July 1, 
                2013, shall bear interest at an annual rate on 
                the unpaid principal balance of the loan that 
                is equal to the weighted average of the 
                interest rates on the loans consolidated, 
                rounded to the nearest higher one-eighth of one 
                percent.
                  (E) Consultation.--The Secretary shall 
                determine the applicable rate of interest under 
                this paragraph after consultation with the 
                Secretary of the Treasury and shall publish 
                such rate in the Federal Register as soon as 
                practicable after the date of determination.
                  (F) Rate.--The applicable rate of interest 
                determined under this paragraph for a Federal 
                Direct Stafford Loan, a Federal Direct 
                Unsubsidized Stafford Loan, or a Federal Direct 
                PLUS Loan shall be fixed for the period of the 
                loan.
          (9) Repayment incentives.--
                  (A)(A) Incentives for loans disbursed before 
                july 1, 2012.--Notwithstanding any other 
                provision of this part with respect to loans 
                for which the first disbursement of principal 
                is made before July 1, 2012,, the Secretary is 
                authorized to prescribe by regulation such 
                reductions in the interest or origination fee 
                rate paid by a borrower of a loan made under 
                this part as the Secretary determines 
                appropriate to encourage on-time repayment of 
                the loan. Such reductions may be offered only 
                if the Secretary determines the reductions are 
                cost neutral and in the best financial interest 
                of the Federal Government. Any increase in 
                subsidy costs resulting from such reductions 
                shall be completely offset by corresponding 
                savings in funds available for the William D. 
                Ford Federal Direct Loan Program in that fiscal 
                year from section 458 and other administrative 
                accounts.
                  (B) Accountability.--Prior to publishing 
                regulations proposing repayment incentives with 
                respect to loans for which the first 
                disbursement of principal is made before July 
                1, 2012, the Secretary shall ensure the cost 
                neutrality of such reductions. The Secretary 
                shall not prescribe such regulations in final 
                form unless an official report from the 
                Director of the Office of Management and Budget 
                to the Secretary and a comparable report from 
                the Director of the Congressional Budget Office 
                to the Congress each certify that any such 
                reductions will be completely cost neutral. 
                Such reports shall be transmitted to the 
                authorizing committees not less than 60 days 
                prior to the publication of regulations 
                proposing such reductions.
                  (C) No repayment incentives for new loans 
                disbursed on or after july 1, 2012.--
                Notwithstanding any other provision of this 
                part, the Secretary is prohibited from 
                authorizing or providing any repayment 
                incentive not otherwise authorized under this 
                part to encourage on-time repayment of a loan 
                under this part for which the first 
                disbursement of principal is made on or after 
                July 1, 2012, including any reduction in the 
                interest or origination fee rate paid by a 
                borrower of such a loan, except that the 
                Secretary may provide for an interest rate 
                reduction for a borrower who agrees to have 
                payments on such a loan automatically 
                electronically debited from a bank account.
          (10) Publication.--The Secretary shall determine the 
        applicable rates of interest under this subsection 
        after consultation with the Secretary of the Treasury 
        and shall publish such rate in the Federal Register as 
        soon as practicable after the date of determination.
  (c) Loan Fee.--
          (1) In general.--The Secretary shall charge the 
        borrower of a loan made under this part an origination 
        fee of 4.0 percent of the principal amount of loan.
          (2) Subsequent reduction.--Paragraph (1) shall be 
        applied to loans made under this part, other than 
        Federal Direct Consolidation loans and Federal Direct 
        PLUS loans--
                  (A) by substituting ``3.0 percent'' for ``4.0 
                percent'' with respect to loans for which the 
                first disbursement of principal is made on or 
                after the date of enactment of the Higher 
                Education Reconciliation Act of 2005, and 
                before July 1, 2007;
                  (B) by substituting ``2.5 percent'' for ``4.0 
                percent'' with respect to loans for which the 
                first disbursement of principal is made on or 
                after July 1, 2007, and before July 1, 2008;
                  (C) by substituting ``2.0 percent'' for ``4.0 
                percent'' with respect to loans for which the 
                first disbursement of principal is made on or 
                after July 1, 2008, and before July 1, 2009;
                  (D) by substituting ``1.5 percent'' for ``4.0 
                percent'' with respect to loans for which the 
                first disbursement of principal is made on or 
                after July 1, 2009, and before July 1, 2010; 
                and
                  (E) by substituting ``1.0 percent'' for ``4.0 
                percent'' with respect to loans for which the 
                first disbursement of principal is made on or 
                after July 1, 2010.
  (d) Repayment Plans.--
          (1) Design and selection.--Consistent with criteria 
        established by the Secretary, the Secretary shall offer 
        a borrower of a loan made under this part a variety of 
        plans for repayment of such loan, including principal 
        and interest on the loan. The borrower shall be 
        entitled to accelerate, without penalty, repayment on 
        the borrower's loans under this part. The borrower may 
        choose--
                  (A) a standard repayment plan, consistent 
                with subsection (a)(1) of this section and with 
                section 428(b)(9)(A)(i);
                  (B) a graduated repayment plan, consistent 
                with section 428(b)(9)(A)(ii);
                  (C) an extended repayment plan, consistent 
                with section 428(b)(9)(A)(iv), except that the 
                borrower shall annually repay a minimum amount 
                determined by the Secretary in accordance with 
                section 428(b)(1)(L);
                  (D) an income contingent repayment plan, with 
                varying annual repayment amounts based on the 
                income of the borrower, paid over an extended 
                period of time prescribed by the Secretary, not 
                to exceed 25 years, except that the plan 
                described in this subparagraph shall not be 
                available to the borrower of a Federal Direct 
                PLUS loan made on behalf of a dependent 
                student; and
                  (E) beginning on July 1, 2009, an income-
                based repayment plan that enables borrowers who 
                have a partial financial hardship to make a 
                lower monthly payment in accordance with 
                section 493C, except that the plan described in 
                this subparagraph shall not be available to the 
                borrower of a Federal Direct PLUS Loan made on 
                behalf of a dependent student or a Federal 
                Direct Consolidation Loan, if the proceeds of 
                such loan were used to discharge the liability 
                on such Federal Direct PLUS Loan or a loan 
                under section 428B made on behalf of a 
                dependent student.
          (2) Selection by secretary.--If a borrower of a loan 
        made under this part does not select a repayment plan 
        described in paragraph (1), the Secretary may provide 
        the borrower with a repayment plan described in 
        subparagraph (A), (B), or (C) of paragraph (1).
          (3) Changes in selections.--The borrower of a loan 
        made under this part may change the borrower's 
        selection of a repayment plan under paragraph (1), or 
        the Secretary's selection of a plan for the borrower 
        under paragraph (2), as the case may be, under such 
        terms and conditions as may be established by the 
        Secretary.
          (4) Alternative repayment plans.--The Secretary may 
        provide, on a case by case basis, an alternative 
        repayment plan to a borrower of a loan made under this 
        part who demonstrates to the satisfaction of the 
        Secretary that the terms and conditions of the 
        repayment plans available under paragraph (1) are not 
        adequate to accommodate the borrower's exceptional 
        circumstances. In designing such alternative repayment 
        plans, the Secretary shall ensure that such plans do 
        not exceed the cost to the Federal Government, as 
        determined on the basis of the present value of future 
        payments by such borrowers, of loans made using the 
        plans available under paragraph (1).
          (5) Repayment after default.--The Secretary may 
        require any borrower who has defaulted on a loan made 
        under this part to--
                  (A) pay all reasonable collection costs 
                associated with such loan; and
                  (B) repay the loan pursuant to an income 
                contingent repayment plan.
  (e) Income Contingent Repayment.--
          (1) Information and procedures.--The Secretary may 
        obtain such information as is reasonably necessary 
        regarding the income of a borrower (and the borrower's 
        spouse, if applicable) of a loan made under this part 
        that is, or may be, repaid pursuant to income 
        contingent repayment, for the purpose of determining 
        the annual repayment obligation of the borrower. 
        Returns and return information (as defined in section 
        6103 of the Internal Revenue Code of 1986) may be 
        obtained under the preceding sentence only to the 
        extent authorized by section 6103(l)(13) of such Code. 
        The Secretary shall establish procedures for 
        determining the borrower's repayment obligation on that 
        loan for such year, and such other procedures as are 
        necessary to implement effectively income contingent 
        repayment.
          (2) Repayment based on adjusted gross income.--A 
        repayment schedule for a loan made under this part and 
        repaid pursuant to income contingent repayment shall be 
        based on the adjusted gross income (as defined in 
        section 62 of the Internal Revenue Code of 1986) of the 
        borrower or, if the borrower is married and files a 
        Federal income tax return jointly with the borrower's 
        spouse, on the adjusted gross income of the borrower 
        and the borrower's spouse.
          (3) Additional documents.--A borrower who chooses, or 
        is required, to repay a loan made under this part 
        pursuant to income contingent repayment, and for whom 
        adjusted gross income is unavailable or does not 
        reasonably reflect the borrower's current income, shall 
        provide to the Secretary other documentation of income 
        satisfactory to the Secretary, which documentation the 
        Secretary may use to determine an appropriate repayment 
        schedule.
          (4) Repayment schedules.--Income contingent repayment 
        schedules shall be established by regulations 
        promulgated by the Secretary and shall require payments 
        that vary in relation to the appropriate portion of the 
        annual income of the borrower (and the borrower's 
        spouse, if applicable) as determined by the Secretary.
          (5) Calculation of balance due.--The balance due on a 
        loan made under this part that is repaid pursuant to 
        income contingent repayment shall equal the unpaid 
        principal amount of the loan, any accrued interest, and 
        any fees, such as late charges, assessed on such loan. 
        The Secretary may promulgate regulations limiting the 
        amount of interest that may be capitalized on such 
        loan, and the timing of any such capitalization.
          (6) Notification to borrowers.--The Secretary shall 
        establish procedures under which a borrower of a loan 
        made under this part who chooses or is required to 
        repay such loan pursuant to income contingent repayment 
        is notified of the terms and conditions of such plan, 
        including notification of such borrower--
                  (A) that the Internal Revenue Service will 
                disclose to the Secretary tax return 
                information as authorized under section 
                6103(l)(13) of the Internal Revenue Code of 
                1986; and
                  (B) that if a borrower considers that special 
                circumstances, such as a loss of employment by 
                the borrower or the borrower's spouse, warrant 
                an adjustment in the borrower's loan repayment 
                as determined using the information described 
                in subparagraph (A), or the alternative 
                documentation described in paragraph (3), the 
                borrower may contact the Secretary, who shall 
                determine whether such adjustment is 
                appropriate, in accordance with criteria 
                established by the Secretary.
          (7) Maximum repayment period.--In calculating the 
        extended period of time for which an income contingent 
        repayment plan under this subsection may be in effect 
        for a borrower, the Secretary shall include all time 
        periods during which a borrower of loans under part B, 
        part D, or part E--
                  (A) is not in default on any loan that is 
                included in the income contingent repayment 
                plan; and
                  (B)(i) is in deferment due to an economic 
                hardship described in section 435(o);
                  (ii) makes monthly payments under paragraph 
                (1) or (6) of section 493C(b);
                  (iii) makes monthly payments of not less than 
                the monthly amount calculated under section 
                428(b)(9)(A)(i) or subsection (d)(1)(A), based 
                on a 10-year repayment period, when the 
                borrower first made the election described in 
                section 493C(b)(1);
                  (iv) makes payments of not less than the 
                payments required under a standard repayment 
                plan under section 428(b)(9)(A)(i) or 
                subsection (d)(1)(A) with a repayment period of 
                10 years; or
                  (v) makes payments under an income contingent 
                repayment plan under subsection (d)(1)(D).
  (f) Deferment.--
          (1) Effect on principal and interest.--A borrower of 
        a loan made under this part who meets the requirements 
        described in paragraph (2) shall be eligible for a 
        deferment, during which periodic installments of 
        principal need not be paid, and interest--
                  (A) shall not accrue, in the case of a--
                          (i) Federal Direct Stafford Loan; or
                          (ii) a Federal Direct Consolidation 
                        Loan that consolidated only Federal 
                        Direct Stafford Loans, or a combination 
                        of such loans and Federal Stafford 
                        Loans for which the student borrower 
                        received an interest subsidy under 
                        section 428; or
                  (B) shall accrue and be capitalized or paid 
                by the borrower, in the case of a Federal 
                Direct PLUS Loan, a Federal Direct Unsubsidized 
                Stafford Loan, or a Federal Direct 
                Consolidation Loan not described in 
                subparagraph (A)(ii).
          (2) Eligibility.--A borrower of a loan made under 
        this part shall be eligible for a deferment during any 
        period--
                  (A) during which the borrower--
                          (i) is carrying at least one-half the 
                        normal full-time work load for the 
                        course of study that the borrower is 
                        pursuing, as determined by the eligible 
                        institution (as such term is defined in 
                        section 435(a)) the borrower is 
                        attending; or
                          (ii) is pursuing a course of study 
                        pursuant to a graduate fellowship 
                        program approved by the Secretary, or 
                        pursuant to a rehabilitation training 
                        program for individuals with 
                        disabilities approved by the Secretary,
                except that no borrower shall be eligible for a 
                deferment under this subparagraph, or a loan 
                made under this part (other than a Federal 
                Direct PLUS Loan or a Federal Direct 
                Consolidation Loan), while serving in a medical 
                internship or residency program;
                  (B) not in excess of 3 years during which the 
                borrower is seeking and unable to find full-
                time employment;
                  (C) during which the borrower--
                          (i) is serving on active duty during 
                        a war or other military operation or 
                        national emergency; or
                          (ii) is performing qualifying 
                        National Guard duty during a war or 
                        other military operation or national 
                        emergency,
                and for the 180-day period following the 
                demobilization date for the service described 
                in clause (i) or (ii); or
                  (D) not in excess of 3 years during which the 
                Secretary determines, in accordance with 
                regulations prescribed under section 435(o), 
                that the borrower has experienced or will 
                experience an economic hardship.
          (3) Deferment for borrowers receiving cancer 
        treatment.--
                  (A) Effect on principal and interest.--A 
                borrower of a loan made under this part who 
                meets the requirements of subparagraph (B) 
                shall be eligible for a deferment, during which 
                periodic installments of principal need not be 
                paid, and interest shall not accrue.
                  (B) Eligibility.--A borrower of a loan made 
                under this part shall be eligible for a 
                deferment during--
                          (i) any period in which such borrower 
                        is receiving treatment for cancer; and
                          (ii) the 6 months after such period.
                  (C) Applicability.--This paragraph shall 
                apply with respect to loans--
                          (i) made on or after the date of the 
                        enactment of this paragraph; or
                          (ii) in repayment on the date of the 
                        enactment of this paragraph.
          [(3)] (4) Definition of borrower.--For the purpose of 
        this subsection, the term ``borrower'' means an 
        individual who is a new borrower on the date such 
        individual applies for a loan under this part for which 
        the first disbursement is made on or after July 1, 
        1993.
          [(4)] (5) Deferments for previous part b loan 
        borrowers.--A borrower of a loan made under this part, 
        who at the time such individual applies for such loan, 
        has an outstanding balance of principal or interest 
        owing on any loan made, insured, or guaranteed under 
        part B of title IV prior to July 1, 1993, shall be 
        eligible for a deferment under section 427(a)(2)(C) or 
        section 428(b)(1)(M) as such sections were in effect on 
        July 22, 1992.
  (g) Federal Direct Consolidation Loans.--A borrower of a loan 
made under this part may consolidate such loan with the loans 
described in section 428C(a)(4), including any loan made under 
part B and first disbursed before July 1, 2010. To be eligible 
for a consolidation loan under this part, a borrower shall meet 
the eligibility criteria set forth in section 428C(a)(3).
  (h) Borrower Defenses.--Notwithstanding any other provision 
of State or Federal law, the Secretary shall specify in 
regulations which acts or omissions of an institution of higher 
education a borrower may assert as a defense to repayment of a 
loan made under this part, except that in no event may a 
borrower recover from the Secretary, in any action arising from 
or relating to a loan made under this part, an amount in excess 
of the amount such borrower has repaid on such loan.
  (i) Loan Application and Promissory Note.--The common 
financial reporting form required in section 483(a)(1) shall 
constitute the application for loans made under this part 
(other than a Federal Direct PLUS loan). The Secretary shall 
develop, print, and distribute to participating institutions a 
standard promissory note and loan disclosure form.
  (j) Loan Disbursement.--
          (1) In general.--Proceeds of loans to students under 
        this part shall be applied to the student's account for 
        tuition and fees, and, in the case of institutionally 
        owned housing, to room and board. Loan proceeds that 
        remain after the application of the previous sentence 
        shall be delivered to the borrower by check or other 
        means that is payable to and requires the endorsement 
        or other certification by such borrower.
          (2) Payment periods.--The Secretary shall establish 
        periods for the payments described in paragraph (1) in 
        a manner consistent with payment of Federal Pell Grants 
        under subpart 1 of part A of this title.
  (k) Fiscal Control and Fund Accountability.--
          (1) In general.--(A) An institution shall maintain 
        financial records in a manner consistent with records 
        maintained for other programs under this title.
          (B) Except as otherwise required by regulations of 
        the Secretary an institution may maintain loan funds 
        under this part in the same account as other Federal 
        student financial assistance.
          (2) Payments and refunds.--Payments and refunds shall 
        be reconciled in a manner consistent with the manner 
        set forth for the submission of a payment summary 
        report required of institutions participating in the 
        program under subpart 1 of part A, except that nothing 
        in this paragraph shall prevent such reconciliations on 
        a monthly basis.
          (3) Transaction histories.--All transaction histories 
        under this part shall be maintained using the same 
        system designated by the Secretary for the provision of 
        Federal Pell Grants under subpart 1 of part A of this 
        title.
  (l) Armed Forces Student Loan Interest Payment Program.--
          (1) Authority.--Using funds received by transfer to 
        the Secretary under section 2174 of title 10, United 
        States Code, for the payment of interest on a loan made 
        under this part to a member of the Armed Forces, the 
        Secretary shall pay the interest on the loan as due for 
        a period not in excess of 36 consecutive months. The 
        Secretary may not pay interest on such a loan out of 
        any funds other than funds that have been so 
        transferred.
          (2) Forbearance.--During the period in which the 
        Secretary is making payments on a loan under paragraph 
        (1), the Secretary shall grant the borrower 
        forbearance, in the form of a temporary cessation of 
        all payments on the loan other than the payments of 
        interest on the loan that are made under that 
        paragraph.
  (m) Repayment Plan for Public Service Employees.--
          (1) In general.--The Secretary shall cancel the 
        balance of interest and principal due, in accordance 
        with paragraph (2), on any eligible Federal Direct Loan 
        not in default for a borrower who--
                  (A) has made 120 monthly payments on the 
                eligible Federal Direct Loan after October 1, 
                2007, pursuant to any one or a combination of 
                the following--
                          (i) payments under an income-based 
                        repayment plan under section 493C;
                          (ii) payments under a standard 
                        repayment plan under subsection 
                        (d)(1)(A), based on a 10-year repayment 
                        period;
                          (iii) monthly payments under a 
                        repayment plan under subsection (d)(1) 
                        or (g) of not less than the monthly 
                        amount calculated under subsection 
                        (d)(1)(A), based on a 10-year repayment 
                        period; or
                          (iv) payments under an income 
                        contingent repayment plan under 
                        subsection (d)(1)(D); and
                  (B)(i) is employed in a public service job at 
                the time of such forgiveness; and
                  (ii) has been employed in a public service 
                job during the period in which the borrower 
                makes each of the 120 payments described in 
                subparagraph (A).
          (2) Loan cancellation amount.--After the conclusion 
        of the employment period described in paragraph (1), 
        the Secretary shall cancel the obligation to repay the 
        balance of principal and interest due as of the time of 
        such cancellation, on the eligible Federal Direct Loans 
        made to the borrower under this part.
          (3) Definitions.--In this subsection:
                  (A) Eligible federal direct loan.--The term 
                ``eligible Federal Direct Loan'' means a 
                Federal Direct Stafford Loan, Federal Direct 
                PLUS Loan, or Federal Direct Unsubsidized 
                Stafford Loan, or a Federal Direct 
                Consolidation Loan.
                  (B) Public service job.--The term ``public 
                service job'' means--
                          (i) a full-time job in emergency 
                        management, government (excluding time 
                        served as a member of Congress), 
                        military service, public safety, law 
                        enforcement, public health (including 
                        nurses, nurse practitioners, nurses in 
                        a clinical setting, and full-time 
                        professionals engaged in health care 
                        practitioner occupations and health 
                        care support occupations, as such terms 
                        are defined by the Bureau of Labor 
                        Statistics), public education, social 
                        work in a public child or family 
                        service agency, public interest law 
                        services (including prosecution or 
                        public defense or legal advocacy on 
                        behalf of low-income communities at a 
                        nonprofit organization), early 
                        childhood education (including licensed 
                        or regulated childcare, Head Start, and 
                        State funded prekindergarten), public 
                        service for individuals with 
                        disabilities, public service for the 
                        elderly, public library sciences, 
                        school-based library sciences and other 
                        school-based services, or at an 
                        organization that is described in 
                        section 501(c)(3) of the Internal 
                        Revenue Code of 1986 and exempt from 
                        taxation under section 501(a) of such 
                        Code; or
                          (ii) teaching as a full-time faculty 
                        member at a Tribal College or 
                        University as defined in section 316(b) 
                        and other faculty teaching in high-
                        needs subject areas or areas of 
                        shortage (including nurse faculty, 
                        foreign language faculty, and part-time 
                        faculty at community colleges), as 
                        determined by the Secretary.
          (4) Ineligibility for double benefits.--No borrower 
        may, for the same service, receive a reduction of loan 
        obligations under both this subsection and section 
        428J, 428K, 428L, or 460.
  (n) Identity Fraud Protection.--The Secretary shall take such 
steps as may be necessary to ensure that monthly Federal Direct 
Loan statements and other publications of the Department do not 
contain more than four digits of the Social Security number of 
any individual.
  (o) No Accrual of Interest for Active Duty Service Members.--
          (1) In general.--Notwithstanding any other provision 
        of this part and in accordance with paragraphs (2) and 
        (4), interest shall not accrue for an eligible military 
        borrower on a loan made under this part for which the 
        first disbursement is made on or after October 1, 2008.
          (2) Consolidation loans.--In the case of any 
        consolidation loan made under this part that is 
        disbursed on or after October 1, 2008, interest shall 
        not accrue pursuant to this subsection only on such 
        portion of such loan as was used to repay a loan made 
        under this part for which the first disbursement is 
        made on or after October 1, 2008.
          (3) Eligible military borrower.--In this subsection, 
        the term ``eligible military borrower'' means an 
        individual who--
                  (A)(i) is serving on active duty during a war 
                or other military operation or national 
                emergency; or
                  (ii) is performing qualifying National Guard 
                duty during a war or other military operation 
                or national emergency; and
                  (B) is serving in an area of hostilities in 
                which service qualifies for special pay under 
                section 310, or paragraph (1) or (3) of section 
                351(a), of title 37, United States Code.
          (4) Limitation.--An individual who qualifies as an 
        eligible military borrower under this subsection may 
        receive the benefit of this subsection for not more 
        than 60 months.
  (p) Disclosures.--Each institution of higher education with 
which the Secretary has an agreement under section 453, and 
each contractor with which the Secretary has a contract under 
section 456, shall, with respect to loans under this part and 
in accordance with such regulations as the Secretary shall 
prescribe, comply with each of the requirements under section 
433 that apply to a lender with respect to a loan under part B.
  (q) Eligibility For, and Interest Charges On, Federal Direct 
Stafford Loans for New Borrowers on or After July 1, 2013.--
          (1) In general.--Notwithstanding subsection (a) or 
        any other provision of this title, any borrower who was 
        a new borrower on or after July 1, 2013, shall not be 
        eligible for a Federal Direct Stafford Loan if the 
        period of time for which the borrower has received 
        Federal Direct Stafford Loans, in the aggregate, 
        exceeds the period of enrollment described in paragraph 
        (3). Such borrower may still receive any Federal Direct 
        Unsubsidized Stafford Loan for which such borrower is 
        otherwise eligible.
          (2) Accrual of interest on federal direct stafford 
        loans.--Notwithstanding subsection (f)(1)(A) or any 
        other provision of this title and beginning on the date 
        upon which a borrower who is enrolled in a program of 
        education or training (including a course of study or 
        program described in paragraph (3)(B) or (4)(B) of 
        section 484(b)) for which borrowers are otherwise 
        eligible to receive Federal Direct Stafford Loans, 
        becomes ineligible for such loan as a result of 
        paragraph (1), interest on all Federal Direct Stafford 
        Loans that were disbursed to such borrower on or after 
        July 1, 2013, shall accrue. Such interest shall be paid 
        or capitalized in the same manner as interest on a 
        Federal Direct Unsubsidized Stafford Loan is paid or 
        capitalized under section 428H(e)(2).
          (3) Period of enrollment.--
                  (A) In general.--The aggregate period of 
                enrollment referred to in paragraph (1) shall 
                not exceed the lesser of--
                          (i) a period equal to 150 percent of 
                        the published length of the educational 
                        program in which the student is 
                        enrolled; or
                          (ii) in the case of a borrower who 
                        was previously enrolled in one or more 
                        other educational programs that began 
                        on or after July 1, 2013, and subject 
                        to subparagraph (B), a period of time 
                        equal to the difference between--
                                  (I) 150 percent of the 
                                published length of the longest 
                                educational program in which 
                                the borrower was, or is, 
                                enrolled; and
                                  (II) any periods of 
                                enrollment in which the 
                                borrower received a Federal 
                                Direct Stafford Loan.
                  (B) Regulations.--The Secretary shall specify 
                in regulation--
                          (i) how the aggregate period 
                        described in subparagraph (A) shall be 
                        calculated with respect to a borrower 
                        who was or is enrolled on less than a 
                        full-time basis; and
                          (ii) how such aggregate period shall 
                        be calculated to include a course of 
                        study or program described in paragraph 
                        (3)(B) or (4)(B) of section 484(b), 
                        respectively.

           *       *       *       *       *       *       *


SEC. 458. FUNDS FOR ADMINISTRATIVE EXPENSES.

  (a) Administrative Expenses.--
          (1) Mandatory funds for fiscal year 2006.--For fiscal 
        year 2006, there shall be available to the Secretary, 
        from funds not otherwise appropriated, funds to be 
        obligated for--
                  (A) administrative costs under this part and 
                part B, including the costs of the direct 
                student loan programs under this part; and
                  (B) account maintenance fees payable to 
                guaranty agencies under part B and calculated 
                in accordance with subsections (b) and (c),
        not to exceed (from such funds not otherwise 
        appropriated) $820,000,000 in fiscal year 2006.
          (3) Authorization for administrative costs beginning 
        in fiscal years 2007 through 2014.--For each of the 
        fiscal years 2007 through 2014, there are authorized to 
        be appropriated such sums as may be necessary for 
        administrative costs under this part and part B, 
        including the costs of the direct student loan programs 
        under this part.
          (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).
          (5) Account maintenance fees.--Account maintenance 
        fees under paragraph (3) shall be paid quarterly and 
        deposited in the Agency Operating Fund established 
        under section 422B.
          (6) Technical assistance to institutions of higher 
        education.--
                  (A) Provision of assistance.--The Secretary 
                shall provide institutions of higher education 
                participating, or seeking to participate, in 
                the loan programs under this part with 
                technical assistance in establishing and 
                administering such programs.
                  (B) Funds.--There are authorized to be 
                appropriated, and there are appropriated, to 
                carry out this paragraph (in addition to any 
                other amounts appropriated to carry out this 
                paragraph and out of any money in the Treasury 
                not otherwise appropriated), $50,000,000 for 
                fiscal year 2010.
                  (C) Definition.--In this paragraph, the term 
                ``assistance'' means the provision of technical 
                support, training, materials, technical 
                assistance, and financial assistance.
          (7) Additional payments.--
                  (A) Provision of assistance.--The Secretary 
                shall provide payments to loan servicers for 
                retaining jobs at locations in the United 
                States where such servicers were operating 
                under part B on January 1, 2010.
                  (B) Funds.--There are authorized to be 
                appropriated, and there are appropriated, to 
                carry out this paragraph (in addition to any 
                other amounts appropriated to carry out this 
                paragraph and out of any money in the Treasury 
                not otherwise appropriated), $25,000,000 for 
                each of the fiscal years 2010 and 2011.
          (8) Carryover.--The Secretary may carry over funds 
        made available under this section to a subsequent 
        fiscal year.
  (b) Calculation Basis.--Account maintenance fees payable to 
guaranty agencies under subsection (a)(4) shall be calculated 
on the basis of 0.06 percent of the original principal amount 
of outstanding loans on which insurance was issued under part 
B.
  (c) Budget Justification.--No funds may be expended under 
this section unless the Secretary includes in the Department of 
Education's annual budget justification to Congress a detailed 
description of the specific activities for which the funds made 
available by this section have been used in the prior and 
current years (if applicable), the activities and costs planned 
for the budget year, and the projection of activities and costs 
for each remaining year for which administrative expenses under 
this section are made available.

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Part E--Federal Perkins Loans

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SEC. 464. TERMS OF LOANS.

  (a) Terms and Conditions.--(1) Loans from any student loan 
fund established pursuant to an agreement under section 463 to 
any student by any institution shall, subject to such 
conditions, limitations, and requirements as the Secretary 
shall prescribe by regulation, be made on such terms and 
conditions as the institution may determine.
  (2)(A) Except as provided in paragraph (4), the total of 
loans made to a student in any academic year or its equivalent 
by an institution of higher education from a loan fund 
established pursuant to an agreement under this part shall not 
exceed--
          (i) $5,500, in the case of a student who has not 
        successfully completed a program of undergraduate 
        education; or
          (ii) $8,000, in the case of a graduate or 
        professional student (as defined in regulations issued 
        by the Secretary).
  (B) Except as provided in paragraph (4), the aggregate unpaid 
principal amount for all loans made to a student by 
institutions of higher education from loan funds established 
pursuant to agreements under this part may not exceed--
          (i) $60,000, in the case of any graduate or 
        professional student (as defined by regulations issued 
        by the Secretary, and including any loans from such 
        funds made to such person before such person became a 
        graduate or professional student);
          (ii) $27,500, in the case of a student who has 
        successfully completed 2 years of a program of 
        education leading to a bachelor's degree but who has 
        not completed the work necessary for such a degree 
        (determined under regulations issued by the Secretary), 
        and including any loans from such funds made to such 
        person before such person became such a student; and
          (iii) $11,000, in the case of any other student.
  (3) Regulations of the Secretary under paragraph (1) shall be 
designed to prevent the impairment of the capital student loan 
funds to the maximum extent practicable and with a view toward 
the objective of enabling the student to complete his course of 
study.
  (4) In the case of a program of study abroad that is approved 
for credit by the home institution at which a student is 
enrolled and that has reasonable costs in excess of the home 
institution's budget, the annual and aggregate loan limits for 
the student may exceed the amounts described in paragraphs 
(2)(A) and (2)(B) by 20 percent.
  (b) Demonstration of Need and Eligibility Required.--(1) A 
loan from a student loan fund assisted under this part may be 
made only to a student who demonstrates financial need in 
accordance with part F of this title, who meets the 
requirements of section 484, and who provides the institution 
with the student's drivers license number, if any, at the time 
of application for the loan. A student who is in default on a 
loan under this part shall not be eligible for an additional 
loan under this part unless such loan meets one of the 
conditions for exclusion under section 462(g)(1)(E).
  (2) If the institution's capital contribution under section 
462 is directly or indirectly based in part on the financial 
need demonstrated by students who are (A) attending the 
institution less than full time, or (B) independent students, 
then a reasonable portion of the loans made from the 
institution's student loan fund containing the contribution 
shall be made available to such students.
  (c) Contents of Loan Agreement.--(1) Any agreement between an 
institution and a student for a loan from a student loan fund 
assisted under this part--
          (A) shall be evidenced by note or other written 
        instrument which, except as provided in paragraph (2), 
        provides for repayment of the principal amount of the 
        loan, together with interest thereon, in equal 
        installments (or, if the borrower so requests, in 
        graduated periodic installments determined in 
        accordance with such schedules as may be approved by 
        the Secretary) payable quarterly, bimonthly, or 
        monthly, at the option of the institution, over a 
        period beginning nine months after the date on which 
        the student ceases to carry, at an institution of 
        higher education or a comparable institution outside 
        the United States approved for this purpose by the 
        Secretary, at least one-half the normal full-time 
        academic workload, and ending 10 years and 9 months 
        after such date except that such period may begin 
        earlier than 9 months after such date upon the request 
        of the borrower;
          (B) shall include provision for acceleration of 
        repayment of the whole, or any part, of such loan, at 
        the option of the borrower;
          (C)(i) may provide, at the option of the institution, 
        in accordance with regulations of the Secretary, that 
        during the repayment period of the loan, payments of 
        principal and interest by the borrower with respect to 
        all outstanding loans made to the student from a 
        student loan fund assisted under this part shall be at 
        a rate equal to not less than $40 per month, except 
        that the institution may, subject to such regulations, 
        permit a borrower to pay less than $40 per month for a 
        period of not more than one year where necessary to 
        avoid hardship to the borrower, but without extending 
        the 10-year maximum repayment period provided for in 
        subparagraph (A) of this paragraph; and
          (ii) may provide that the total payments by a 
        borrower for a monthly or similar payment period with 
        respect to the aggregate of all loans held by the 
        institution may, when the amount of a monthly or other 
        similar payment is not a multiple of $5, be rounded to 
        the next highest whole dollar amount that is a multiple 
        of $5;
          (D) shall provide that the loan shall bear interest, 
        on the unpaid balance of the loan, at the rate of 5 
        percent per year in the case of any loan made on or 
        after October 1, 1981, except that no interest shall 
        accrue (i) prior to the beginning date of repayment 
        determined under paragraph (2)(A)(i), or (ii) during 
        any period in which repayment is suspended by reason of 
        paragraph (2);
          (E) shall provide that the loan shall be made without 
        security and without endorsement;
          (F) shall provide that the liability to repay the 
        loan shall be cancelled--
                  (i) upon the death of the borrower;
                  (ii) if the borrower becomes permanently and 
                totally disabled as determined in accordance 
                with regulations of the Secretary;
                  (iii) if the borrower is unable to engage in 
                any substantial gainful activity by reason of 
                any medically determinable physical or mental 
                impairment that can be expected to result in 
                death, has lasted for a continuous period of 
                not less than 60 months, or can be expected to 
                last for a continuous period of not less than 
                60 months; or
                  (iv) if the borrower is determined by the 
                Secretary of Veterans Affairs to be 
                unemployable due to a service-connected 
                disability;
          (G) shall provide that no note or evidence of 
        obligation may be assigned by the lender, except upon 
        the transfer of the borrower to another institution 
        participating under this part (or, if not so 
        participating, is eligible to do so and is approved by 
        the Secretary for such purpose), to such institution, 
        and except as necessary to carry out section 463(a)(6);
          (H) pursuant to regulations of the Secretary, shall 
        provide for an assessment of a charge with respect to 
        the loan for failure of the borrower to pay all or part 
        of an installment when due, which shall include the 
        expenses reasonably incurred in attempting collection 
        of the loan, to the extent permitted by the Secretary, 
        except that no charge imposed under this subparagraph 
        shall exceed 20 percent of the amount of the monthly 
        payment of the borrower; and
          (I) shall contain a notice of the system of 
        disclosure of information concerning default on such 
        loan to consumer reporting agencies under section 
        463(c).
  (2)(A) No repayment of principal of, or interest on, any loan 
from a student loan fund assisted under this part shall be 
required during any period--
          (i) during which the borrower--
                  (I) is pursuing at least a half-time course 
                of study as determined by an eligible 
                institution; or
                  (II) is pursuing a course of study pursuant 
                to a graduate fellowship program approved by 
                the Secretary, or pursuant to a rehabilitation 
                training program for disabled individuals 
                approved by the Secretary,
        except that no borrower shall be eligible for a 
        deferment under this clause, or loan made under this 
        part while serving in a medical internship or residency 
        program;
          (ii) not in excess of 3 years during which the 
        borrower is seeking and unable to find full-time 
        employment;
          (iii) during which the borrower--
                  (I) is serving on active duty during a war or 
                other military operation or national emergency; 
                or
                  (II) is performing qualifying National Guard 
                duty during a war or other military operation 
                or national emergency,
        and for the 180-day period following the demobilization 
        date for the service described in subclause (I) or 
        (II);
          (iv) not in excess of 3 years for any reason which 
        the lender determines, in accordance with regulations 
        prescribed by the Secretary under section 435(o), has 
        caused or will cause the borrower to have an economic 
        hardship[; or];
          (v) during which the borrower is engaged in service 
        described in section 465(a)(2); or
                  (vi) during which the borrower is receiving 
                treatment for cancer and the 6 months after 
                such period;
and provides that any such period shall not be included in 
determining the 10-year period described in subparagraph (A) of 
paragraph (1).
  (B) No repayment of principal of, or interest on, any loan 
for any period described in subparagraph (A) shall begin until 
6 months after the completion of such period.
  (C) An individual with an outstanding loan balance who meets 
the eligibility criteria for a deferment described in 
subparagraph (A) as in effect on the date of enactment of this 
subparagraph shall be eligible for deferment under this 
paragraph notwithstanding any contrary provision of the 
promissory note under which the loan or loans were made, and 
notwithstanding any amendment (or effective date provision 
relating to any amendment) to this section made prior to the 
date of such deferment.
  (3)(A) The Secretary is authorized, when good cause is shown, 
to extend, in accordance with regulations, the 10-year maximum 
repayment period provided for in subparagraph (A) of paragraph 
(1) with respect to individual loans.
  (B) Pursuant to uniform criteria established by the 
Secretary, the repayment period for any student borrower who 
during the repayment period is a low-income individual may be 
extended for a period not to exceed 10 years and the repayment 
schedule may be adjusted to reflect the income of that 
individual.
  (4) The repayment period for a loan made under this part 
shall begin on the day immediately following the expiration of 
the period, specified in paragraph (1)(A), after the student 
ceases to carry the required academic workload, unless the 
borrower requests and is granted a repayment schedule that 
provides for repayment to commence at an earlier point in time, 
and shall exclude any period of authorized deferment, 
forbearance, or cancellation.
  (5) The institution may elect--
          (A) to add the amount of any charge imposed under 
        paragraph (1)(H) to the principal amount of the loan as 
        of the first day after the day on which the installment 
        was due and to notify the borrower of the assessment of 
        the charge; or
          (B) to make the amount of the charge payable to the 
        institution not later than the due date of the next 
        installment.
  (6) Requests for deferment of repayment of loans under this 
part by students engaged in graduate or post-graduate 
fellowship-supported study (such as pursuant to a Fulbright 
grant) outside the United States shall be approved until 
completion of the period of the fellowship.
  (7) There shall be excluded from the 9-month period that 
begins on the date on which a student ceases to carry at least 
one-half the normal full-time academic workload (as described 
in paragraph (1)(A)) any period not to exceed 3 years during 
which a borrower who is a member of a reserve component of the 
Armed Forces named in section 10101 of title 10, United States 
Code, is called or ordered to active duty for a period of more 
than 30 days (as defined in section 101(d)(2) of such title). 
Such period of exclusion shall include the period necessary to 
resume enrollment at the borrower's next available regular 
enrollment period.
  (d) Availability of Loan Fund to All Eligible Students.--An 
agreement under this part for payment of Federal capital 
contributions shall include provisions designed to make loans 
from the student loan fund established pursuant to such 
agreement reasonably available (to the extent of the available 
funds in such fund) to all eligible students in such 
institutions in need thereof.
  (e) Forbearance.--(1) The Secretary shall ensure that, as 
documented in accordance with paragraph (2), an institution of 
higher education shall grant a borrower forbearance of 
principal and interest or principal only, renewable at 12-month 
intervals for a period not to exceed 3 years, on such terms as 
are otherwise consistent with the regulations issued by the 
Secretary and agreed upon in writing by the parties to the 
loan, if--
          (A) the borrower's debt burden equals or exceeds 20 
        percent of such borrower's gross income;
          (B) the institution determines that the borrower 
        should qualify for forbearance for other reasons; or
          (C) the borrower is eligible for interest payments to 
        be made on such loan for service in the Armed Forces 
        under section 2174 of title 10, United States Code, 
        and, pursuant to that eligibility, the interest on such 
        loan is being paid under subsection (j), except that 
        the form of a forbearance under this paragraph shall be 
        a temporary cessation of all payments on the loan other 
        than payments of interest on the loan that are made 
        under subsection (j).
  (2) For the purpose of paragraph (1), the terms of 
forbearance agreed to by the parties shall be documented by--
          (A) confirming the agreement of the borrower by 
        notice to the borrower from the institution of higher 
        education; and
          (B) recording the terms in the borrower's file.
  (f) Special Repayment Rule Authority.--(1) Subject to such 
restrictions as the Secretary may prescribe to protect the 
interest of the United States, in order to encourage repayment 
of loans made under this part which are in default, the 
Secretary may, in the agreement entered into under this part, 
authorize an institution of higher education to compromise on 
the repayment of such defaulted loans in accordance with 
paragraph (2). The Federal share of the compromise repayment 
shall bear the same relation to the institution's share of such 
compromise repayment as the Federal capital contribution to the 
institution's loan fund under this part bears to the 
institution's capital contribution to such fund.
  (2) No compromise repayment of a defaulted loan as authorized 
by paragraph (1) may be made unless the student borrower pays--
          (A) 90 percent of the loan under this part;
          (B) the interest due on such loan; and
          (C) any collection fees due on such loan;
in a lump sum payment.
  (g) Discharge.--
          (1) In general.--If a student borrower who received a 
        loan made under this part on or after January 1, 1986, 
        is unable to complete the program in which such student 
        is enrolled due to the closure of the institution, then 
        the Secretary shall discharge the borrower's liability 
        on the loan (including the interest and collection 
        fees) and shall subsequently pursue any claim available 
        to such borrower against the institution and the 
        institution's affiliates and principals, or settle the 
        loan obligation pursuant to the financial 
        responsibility standards described in section 498(c).
          (2) Assignment.--A borrower whose loan has been 
        discharged pursuant to this subsection shall be deemed 
        to have assigned to the United States the right to a 
        loan refund in an amount that does not exceed the 
        amount discharged against the institution and the 
        institution's affiliates and principals.
          (3) Eligibility for additional assistance.--The 
        period during which a student was unable to complete a 
        course of study due to the closing of the institution 
        shall not be considered for purposes of calculating the 
        student's period of eligibility for additional 
        assistance under this title.
          (4) Special rule.--A borrower whose loan has been 
        discharged pursuant to this subsection shall not be 
        precluded, because of that discharge, from receiving 
        additional grant, loan, or work assistance under this 
        title for which the borrower would be otherwise 
        eligible (but for the default on the discharged loan). 
        The amount discharged under this subsection shall be 
        treated as an amount canceled under section 465(a).
          (5) Reporting.--The Secretary or institution, as the 
        case may be, shall report to consumer reporting 
        agencies with respect to loans that have been 
        discharged pursuant to this subsection.
  (h) Rehabilitation of Loans.--
          (1) Rehabilitation.--
                  (A) In general.--If the borrower of a loan 
                made under this part who has defaulted on the 
                loan makes 9 on-time, consecutive, monthly 
                payments of amounts owed on the loan, as 
                determined by the institution, or by the 
                Secretary in the case of a loan held by the 
                Secretary, the loan shall be considered 
                rehabilitated, and the institution that made 
                that loan (or the Secretary, in the case of a 
                loan held by the Secretary) shall request that 
                any consumer reporting agency to which the 
                default was reported remove the default from 
                the borrower's credit history.
                  (B) Comparable conditions.--As long as the 
                borrower continues to make scheduled repayments 
                on a loan rehabilitated under this paragraph, 
                the rehabilitated loan shall be subject to the 
                same terms and conditions, and qualify for the 
                same benefits and privileges, as other loans 
                made under this part.
                  (C) Additional assistance.--The borrower of a 
                rehabilitated loan shall not be precluded by 
                section 484 from receiving additional grant, 
                loan, or work assistance under this title (for 
                which the borrower is otherwise eligible) on 
                the basis of defaulting on the loan prior to 
                such rehabilitation.
                  (D) Limitations.--A borrower only once may 
                obtain the benefit of this paragraph with 
                respect to rehabilitating a loan under this 
                part.
          (2) Restoration of eligibility.--If the borrower of a 
        loan made under this part who has defaulted on that 
        loan makes 6 ontime, consecutive, monthly payments of 
        amounts owed on such loan, the borrower's eligibility 
        for grant, loan, or work assistance under this title 
        shall be restored to the extent that the borrower is 
        otherwise eligible. A borrower only once may obtain the 
        benefit of this paragraph with respect to restored 
        eligibility.
  (i) Incentive Repayment Program.--
          (1) In general.--Each institution of higher education 
        may establish, with the approval of the Secretary, an 
        incentive repayment program designed to reduce default 
        and to replenish student loan funds established under 
        this part. Each such incentive repayment program may--
                  (A) offer a reduction of the interest rate on 
                a loan on which the borrower has made 48 
                consecutive, monthly repayments, but in no 
                event may the rate be reduced by more than 1 
                percent;
                  (B) provide for a discount on the balance 
                owed on a loan on which the borrower pays the 
                principal and interest in full prior to the end 
                of the applicable repayment period, but in no 
                event may the discount exceed 5 percent of the 
                unpaid principal balance due on the loan at the 
                time the early repayment is made; and
                  (C) include such other incentive repayment 
                options as the institution determines will 
                carry out the objectives of this subsection.
          (2) Limitation.--No incentive repayment option under 
        an incentive repayment program authorized by this 
        subsection may be paid for with Federal funds, 
        including any Federal funds from the student loan fund, 
        or with institutional funds from the student loan fund.
  (j) Armed Forces Student Loan Interest Payment Program.--
          (1) Authority.--Using funds received by transfer to 
        the Secretary under section 2174 of title 10, United 
        States Code, for the payment of interest on a loan made 
        under this part to a member of the Armed Forces, the 
        Secretary shall pay the interest on the loan as due for 
        a period not in excess of 36 consecutive months. The 
        Secretary may not pay interest on such a loan out of 
        any funds other than funds that have been so 
        transferred.
          (2) Forbearance.--During the period in which the 
        Secretary is making payments on a loan under paragraph 
        (1), the institution of higher education shall grant 
        the borrower forbearance in accordance with subsection 
        (e)(1)(C).
  (k) The Secretary may develop such additional safeguards as 
the Secretary determines necessary to prevent fraud and abuse 
in the cancellation of liability under subsection (c)(1)(F). 
Notwithstanding subsection (c)(1)(F), the Secretary may 
promulgate regulations to resume collection on loans cancelled 
under subsection (c)(1)(F) in any case in which--
          (1) a borrower received a cancellation of liability 
        under subsection (c)(1)(F) and after the cancellation 
        the borrower--
                  (A) receives a loan made, insured, or 
                guaranteed under this title; or
                  (B) has earned income in excess of the 
                poverty line; or
          (2) the Secretary determines necessary.

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                              ----------                              


                       PUBLIC HEALTH SERVICE ACT



           *       *       *       *       *       *       *
TITLE II--ADMINISTRATION AND MISCELLANEOUS PROVISIONS

           *       *       *       *       *       *       *


Part B--Miscellaneous Provisions

           *       *       *       *       *       *       *


SEC. 245A. PROHIBITING GOVERNMENTAL DISCRIMINATION AGAINST PROVIDERS OF 
                    HEALTH SERVICES THAT ARE NOT INVOLVED IN ABORTION.

  (a) In General.--Notwithstanding any other law, the Federal 
Government, and any State or local government that receives 
Federal financial assistance, may not penalize, retaliate 
against, or otherwise discriminate against a health care 
provider on the basis that the provider does not--
          (1) perform, refer for, pay for, or otherwise 
        participate in abortion;
          (2) provide or sponsor abortion coverage; or
          (3) facilitate or make arrangements for any of the 
        activities specified in this subsection.
  (b) Rule of Construction.--Nothing in this section shall be 
construed--
          (1) to prevent any health care provider from 
        voluntarily electing to participate in abortions or 
        abortion referrals;
          (2) to prevent any health care provider from 
        voluntarily electing to provide or sponsor abortion 
        coverage or health benefits coverage that includes 
        abortion;
          (3) to prevent an accrediting agency, the Federal 
        Government, or a State or local government from 
        establishing standards of medical competency applicable 
        only to those who have knowingly, voluntarily, and 
        specifically elected to perform abortions, or from 
        enforcing contractual obligations applicable only to 
        those who, as part of such contract, knowingly, 
        voluntarily, and specifically elect to provide 
        abortions;
          (4) to affect, or be affected by, section 1867 of the 
        Social Security Act (42 U.S.C. 1395dd, commonly 
        referred to as the ``Emergency Medical Treatment and 
        Active Labor Act''); or
          (5) to supersede any law enacted by any State for the 
        purpose of regulating insurance, except as specified in 
        subsection (a).
  (c) Administration.--The Secretary shall designate the 
Director of the Office for Civil Rights of the Department of 
Health and Human Services--
          (1) to receive complaints alleging a violation of 
        this section, section 245 of this Act, or any of 
        subsections (b) through (e) of section 401 of the 
        Health Programs Extension Act of 1973; and
          (2) to pursue the investigation of such complaints in 
        coordination with the Attorney General.
  (d) Definitions.--For purposes of this section:
          (1) Federal financial assistance.--The term ``Federal 
        financial assistance'' means Federal payments