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

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



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

                 June 28, 2018.--Ordered to be printed

                                _______
                                

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

                                 REPORT

                         [To accompany S. 3158]

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



Amounts to new budget authority

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








                                CONTENTS

                              ----------                              
                                                                   Page

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

                         LIST OF ABBREVIATIONS

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

       SUMMARY OF BUDGET ESTIMATES AND COMMITTEE RECOMMENDATIONS

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

                                OVERVIEW

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

                     NATIONAL INSTITUTES OF HEALTH

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

                         COMBATING OPIOID ABUSE

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

             PROMOTING COLLEGE AFFORDABILITY AND COMPLETION

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

           STRENGTHENING THE WORKFORCE FOR A STRONGER ECONOMY

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

  INCREASING ACCESS TO HIGH-QUALITY EARLY CHILDHOOD CARE AND EDUCATION

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

                             RURAL AMERICA

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

                          ALZHEIMER'S DISEASE

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

                INVESTING IN PUBLIC HEALTH PREPAREDNESS

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

                    IMPROVING FISCAL ACCOUNTABILITY

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

     INCREASING THE EFFICIENCY AND COST EFFECTIVENESS OF GOVERNMENT

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

                          BILL-WIDE DIRECTIVES

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

                      OTHER HIGHLIGHTS OF THE BILL

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

                                TITLE I

                          DEPARTMENT OF LABOR

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

                 Employment and Training Administration

                    TRAINING AND EMPLOYMENT SERVICES

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

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

Grants to States

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

Federally Administered Programs

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

National Activities

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

                               JOB CORPS

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

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

            COMMUNITY SERVICE EMPLOYMENT FOR OLDER AMERICANS

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

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

              FEDERAL UNEMPLOYMENT BENEFITS AND ALLOWANCES

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

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

     STATE UNEMPLOYMENT INSURANCE AND EMPLOYMENT SERVICE OPERATIONS

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

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

        ADVANCES TO THE UNEMPLOYMENT TRUST FUND AND OTHER FUNDS

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

                         PROGRAM ADMINISTRATION

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

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

               Employee Benefits Security Administration


                         SALARIES AND EXPENSES

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

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

                  Pension Benefit Guaranty Corporation

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

                         Wage and Hour Division


                         SALARIES AND EXPENSES

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

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

                  Office of Labor-Management Standards


                         SALARIES AND EXPENSES

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

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

             Office of Federal Contract Compliance Programs


                         SALARIES AND EXPENSES

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

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

                Office of Workers' Compensation Programs


                         SALARIES AND EXPENSES

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

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

                            SPECIAL BENEFITS

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

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

               SPECIAL BENEFITS FOR DISABLED COAL MINERS

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

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

     DIVISION OF ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION

                         SALARIES AND EXPENSES

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

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

                    BLACK LUNG DISABILITY TRUST FUND

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

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

             Occupational Safety and Health Administration


                         SALARIES AND EXPENSES

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

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

                 Mine Safety and Health Administration


                         SALARIES AND EXPENSES

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

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

                       Bureau of Labor Statistics


                         SALARIES AND EXPENSES

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

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

                 Office of Disability Employment Policy

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

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

                        Departmental Management


                         SALARIES AND EXPENSES

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

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

                    VETERANS EMPLOYMENT AND TRAINING

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

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

                  INFORMATION TECHNOLOGY MODERNIZATION

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

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

                    OFFICE OF THE INSPECTOR GENERAL

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

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

                           General Provisions

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

                                TITLE II

                DEPARTMENT OF HEALTH AND HUMAN SERVICES

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

              Health Resources and Services Administration

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

                     BUREAU OF PRIMARY HEALTH CARE

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

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

Community Health Centers

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

Free Clinics Medical Malpractice Coverage

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

                      BUREAU OF HEALTH PROFESSIONS

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

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

National Health Service Corps

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

Training for Diversity

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

Training in Oral Health Care

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

Interdisciplinary, Community-Based Linkages

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

Health Professions Workforce Information and Analysis

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

Public Health Workforce Development

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

Nursing Workforce Development Programs

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

Children's Hospitals Graduate Medical Education

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

National Practitioner Data Bank

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

                       MATERNAL AND CHILD HEALTH

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

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

Sickle Cell Anemia

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

Autism and Other Developmental Disorders

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

Newborn Screening for Heritable Disorders

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

Healthy Start

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

Universal Newborn Hearing Screening and Early Intervention

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

Emergency Medical Services for Children

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

Screening and Treatment for Maternal Depression

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

Pediatric Mental Health Care Access

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

                            HIV/AIDS BUREAU

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

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

Emergency Assistance

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

Comprehensive Care Programs

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

Early Intervention Services

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

Children, Youth, Women, and Families

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

AIDS Dental Services

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

AIDS Education and Training Centers

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

Special Projects of National Significance

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

                          HEALTH CARE SYSTEMS

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

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

Organ Donation and Transplantation

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

National Cord Blood Inventory

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

C.W. Bill Young Cell Transplantation Program

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

Office of Pharmacy Affairs

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

Poison Control Centers

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

National Hansen's Disease Program

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

National Hansen's Disease Program Buildings and Facilities

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

Payment to Hawaii for Hansen's Disease Treatment

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

                              RURAL HEALTH

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

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

Rural Health Outreach

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

Rural Health Research

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

Rural Hospital Flexibility Grants

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

State Offices of Rural Health

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

Black Lung Clinics

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

Radiation and Exposure Screening and Education Program

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

Telehealth

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

                            FAMILY PLANNING

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

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

                           PROGRAM MANAGEMENT

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

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

             VACCINE INJURY COMPENSATION PROGRAM TRUST FUND

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

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

               Centers for Disease Control and Prevention

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

                 IMMUNIZATION AND RESPIRATORY DISEASES

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

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

 
                        [In thousands of dollars]
------------------------------------------------------------------------
                                      Fiscal year 2018      Committee
           Budget activity              appropriation    recommendation
------------------------------------------------------------------------
Section 317 Immunization Program....           610,847           610,847
    National Immunization Survey                12,864            12,864
     (non-add)......................
Influenza Planning and Response.....           187,558           187,558
------------------------------------------------------------------------

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

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

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

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

 
                        [In thousands of dollars]
------------------------------------------------------------------------
                                      Fiscal year 2018      Committee
           Budget activity              appropriation    recommendation
------------------------------------------------------------------------
Domestic HIV/AIDS Prevention and               788,712           788,712
 Research...........................
    HIV Prevention by Health                   397,161           397,161
     Department.....................
    HIV Surveillance................           119,861           119,861
    Activities to Improve Program              103,208           103,208
     Effectiveness..................
    National, Regional, Local,                 135,401           135,401
     Community & Other Organizations
    School Health...................            33,081            33,081
Viral Hepatitis.....................            39,000            39,000
Sexually Transmitted Infections.....           157,310           157,310
Tuberculosis........................           142,256           142,256
Infectious Disease and Opioids......  ................             5,000
------------------------------------------------------------------------

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

               EMERGING AND ZOONOTIC INFECTIOUS DISEASES

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

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

 
                        [In thousands of dollars]
------------------------------------------------------------------------
                                      Fiscal year 2018      Committee
           Budget activity              appropriation    recommendation
------------------------------------------------------------------------
Core Infectious Diseases............           422,000           425,000
    Antibiotic Resistance Initiative           168,000           168,000
    Lab Safety and Quality..........             8,000             8,000
    Vector-borne Diseases...........            38,603            38,603
    Lyme Disease....................            10,700            10,700
    Prion Disease...................             6,000             6,000
    Chronic Fatigue Syndrome........             5,400             5,400
    Emerging Infectious Diseases....           155,457           158,457
    All Other Infectious Diseases...            29,840            29,840
Food Safety.........................            58,000            58,000
National HealthCare Safety Network..            21,000            21,000
Quarantine..........................            31,572            31,572
Advanced Molecular Detection........            30,000            30,000
Epidemiology and Lab Capacity                   40,000            40,000
 Program............................
Healthcare-Associated Infections....            12,000            12,000
------------------------------------------------------------------------

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

            CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION

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

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

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

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

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

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

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

 
                        [In thousands of dollars]
------------------------------------------------------------------------
                                      Fiscal year 2018      Committee
           Budget activity              appropriation    recommendation
------------------------------------------------------------------------
Total Birth Defects.................           140,560           153,560
    Child Health and Development....            65,800            75,800
        Other Birth Defects.........            19,000            19,000
        Fetal Death.................               900               900
        Fetal Alcohol Syndrome......            11,000            11,000
        Folic Acid..................             3,150             3,150
        Infant Health...............             8,650             8,650
        Autism......................            23,100            23,100
        Surveillance for Emerging     ................            10,000
         Threats to Mother and
         Babies.....................
    Health and Development with                 59,660            62,660
     Disabilities...................
        Disability and Health.......            27,000            30,000
        Tourette Syndrome...........             2,000             2,000
        Early Hearing Detection and             10,760            10,760
         Intervention...............
        Muscular Dystrophy..........             6,000             6,000
        Attention Deficit                        1,900             1,900
         Hyperactivity Disorder.....
        Fragile X...................             2,000             2,000
        Spina Bifida................             6,000             6,000
        Congenital Heart Defects....             4,000             4,000
    Public Health Approach to Blood              4,400             4,400
     Disorders......................
    Hemophilia CDC Activities.......             3,500             3,500
    Hemophilia Treatment Centers....             5,100             5,100
    Thalassemia.....................             2,100             2,100
------------------------------------------------------------------------

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

                   PUBLIC HEALTH SCIENTIFIC SERVICES

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

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

 
                        [In thousands of dollars]
------------------------------------------------------------------------
                                      Fiscal year 2018      Committee
           Budget activity              appropriation    recommendation
------------------------------------------------------------------------
Health Statistics...................           160,397           161,397
Surveillance, Epidemiology, and PH             279,000           279,000
 Informatics........................
Public Health Workforce.............            51,000            52,000
------------------------------------------------------------------------

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

                          ENVIRONMENTAL HEALTH

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

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

 
                        [In thousands of dollars]
------------------------------------------------------------------------
                                      Fiscal year 2018      Committee
           Budget activity              appropriation    recommendation
------------------------------------------------------------------------
Environmental Health Laboratory.....            63,150            63,150
    Newborn Screening Quality                   13,400            13,400
     Assurance Program..............
    Newborn Screening for SCID......             1,250             1,250
    Other Environmental Health......            48,500            48,500
Environmental Health Activities.....            44,600            44,600
    Safe Water......................             8,600             8,600
    Amyotrophic Lateral Sclerosis               10,000            10,000
     Registry.......................
    Climate Change..................            10,000            10,000
    All Other Environmental Health..            16,000            16,000
Environmental and Health Outcome                34,000            34,000
 Tracking Network...................
Asthma..............................            29,000            29,000
Childhood Lead Poisoning............            18,000            18,000
Lead Poisoning Prevention...........            17,000            17,000
------------------------------------------------------------------------

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

                     INJURY PREVENTION AND CONTROL

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

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

 
                        [In thousands of dollars]
------------------------------------------------------------------------
                                      Fiscal year 2018      Committee
           Budget activity              appropriation    recommendation
------------------------------------------------------------------------
Intentional Injury..................           102,730           102,730
    Domestic Violence and Sexual                32,700            32,700
     Violence.......................
        Child Maltreatment..........             7,250             7,250
    Youth Violence Prevention.......            15,100            15,100
    Domestic Violence Community                  5,500             5,500
     Projects.......................
    Rape Prevention.................            49,430            49,430
National Violent Death Reporting                23,500            23,500
 System.............................
Unintentional Injury................             8,800             8,800
    Traumatic Brain Injury..........             6,750             6,750
    Elderly Falls...................             2,050             2,050
Injury Prevention Activities........            28,950            28,950
Opioid Overdose Prevention and                 475,579           475,579
 Surviellance.......................
Injury Control Research Centers.....             9,000             9,000
------------------------------------------------------------------------

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

                     OCCUPATIONAL SAFETY AND HEALTH

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

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

 
                        [In thousands of dollars]
------------------------------------------------------------------------
                                      Fiscal year 2018      Committee
           Budget activity              appropriation    recommendation
------------------------------------------------------------------------
Total NIOSH.........................           335,200           335,300
    National Occupational Research             116,000           116,000
     Agenda.........................
        Agriculture, Forestry,                  25,500            25,500
         Fishing (non-add)..........
    Education and Research Centers..            29,000            29,000
    Personal Protective Technology..            20,000            20,000
    Mining Research.................            59,500            59,500
    National Mesothelioma Registry               1,100             1,200
     and Tissue Bank................
    Other Occupational Safety and              109,600           109,600
     Health Research................
------------------------------------------------------------------------

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

         ENERGY EMPLOYEES OCCUPATIONAL INJURY COMPENSATION ACT

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

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

                             GLOBAL HEALTH

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

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

 
                        [In thousands of dollars]
------------------------------------------------------------------------
                                      Fiscal year 2018      Committee
           Budget activity              appropriation    recommendation
------------------------------------------------------------------------
Global HIV/AIDS Program.............           128,421           128,421
Global Immunization Program.........           226,000           226,000
    Polio Eradication...............           176,000           176,000
    Measles and Other Vaccine                   50,000            50,000
     Preventable Diseases...........
Parasitic Diseases and Malaria......            26,000            26,000
Global Public Health Protection.....           108,200           108,200
    Global Disease Detection and                98,400            98,400
     Emergency Response.............
    Global Public Health Capacity                9,800             9,800
     Development....................
------------------------------------------------------------------------

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

                PUBLIC HEALTH PREPAREDNESS AND RESPONSE

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

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

 
                        [In thousands of dollars]
------------------------------------------------------------------------
                                      Fiscal year 2018      Committee
           Budget activity              appropriation    recommendation
------------------------------------------------------------------------
Public Health Emergency Preparedness           670,000           680,000
 Cooperative Agreement..............
Academic Centers for Public Health               8,200             8,200
 Preparedness.......................
BioSense............................            23,000            23,000
All Other CDC Preparedness..........           138,800           148,800
Strategic National Stockpile........           610,000           610,000
------------------------------------------------------------------------

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

                        BUILDINGS AND FACILTIIES

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

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

                          CDC-WIDE ACTIVITIES

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

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

 
                        [In thousands of dollars]
------------------------------------------------------------------------
                                      Fiscal year 2018      Committee
           Budget activity              appropriation    recommendation
------------------------------------------------------------------------
Preventive Health and Health                   160,000           160,000
 Services Block Grant...............
Public Health Leadership and Support           113,570           113,570
------------------------------------------------------------------------

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

                     National Institutes of Health

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

                       NATIONAL CANCER INSTITUTE

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


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

               NATIONAL HEART, LUNG, AND BLOOD INSTITUTE

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

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

         NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL RESEARCH

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

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

    NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES

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

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

        NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE

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

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

         NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES

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

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

             NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES

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

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

  EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN 
                              DEVELOPMENT

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

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

                         NATIONAL EYE INSTITUTE

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

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

          NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES

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

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

                      NATIONAL INSTITUTE ON AGING

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

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

 NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN DISEASES

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

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

    NATIONAL INSTITUTE ON DEAFNESS AND OTHER COMMUNICATION DISORDERS

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

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

                 NATIONAL INSTITUTE OF NURSING RESEARCH

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

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

           NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM

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

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

                    NATIONAL INSTITUTE ON DRUG ABUSE

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

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

                  NATIONAL INSTITUTE OF MENTAL HEALTH

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

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

                NATIONAL HUMAN GENOME RESEARCH INSTITUTE

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

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

      NATIONAL INSTITUTE OF BIOMEDICAL IMAGING AND BIOENGINEERING

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

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

        NATIONAL CENTER FOR COMPLEMENTARY AND INTEGRATIVE HEALTH

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

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

      NATIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH DISPARITIES

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

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

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

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

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

                      NATIONAL LIBRARY OF MEDICINE

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

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

          NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCES

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

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

                         OFFICE OF THE DIRECTOR

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

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

                        BUILDINGS AND FACILITIES

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

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

                   NIH INNOVATION ACCOUNT, CURES ACT

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

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

         NATIONAL INSTITUTE FOR RESEARCH ON SAFETY AND QUALITY

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

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

         NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH

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

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

       NATIONAL INSTITUTE ON DISABILITY, INDEPENDENT LIVING, AND 
                        REHABILITATION RESEARCH

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

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

       Substance Abuse and Mental Health Services Administration

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

                             MENTAL HEALTH

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

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

Programs of Regional and National Significance

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

 
                        [In thousands of dollars]
------------------------------------------------------------------------
                                      Fiscal year 2018      Committee
           Budget activity              appropriation    recommendation
------------------------------------------------------------------------
CAPACITY:
    Seclusion & Restraint...........             1,147             1,147
    Project AWARE State Grants......            71,001            71,001
    Mental Health First Aid.........            19,963            21,963
    Healthy Transitions.............            25,951            25,951
    National Traumatic Stress                   53,887            55,887
     Network........................
    Children and Family Programs....             7,229             7,229
    Consumer and Family Network                  4,954             4,954
     Grants.........................
    MH System Transformation and                 3,779             3,779
     Health Reform..................
    Project LAUNCH..................            23,605            23,605
    Primary and Behavioral Health               49,877            49,877
     Care Integration...............
    National Strategy for Suicide               11,000            11,000
     Prevention.....................
    Suicide Lifeline................             7,198             7,198
    GLS--Youth Suicide Prevention--             35,427            35,427
     States.........................
    GLS--Youth Suicide Prevention--              6,488             6,488
     Campus.........................
    AI/AN Suicide Prevention                     2,931             2,931
     Initiative.....................
    Homelessness Prevention Programs            30,696            30,696
    Tribal Behavioral Grants........            15,000            15,000
    Minority AIDS...................             9,224             9,224
    Criminal and Juvenile Justice                4,269             4,269
     Programs.......................
    Assisted Outpatient Treatment...            15,000            15,000
    Infant and Early Childhood                   5,000             5,000
     Mental Health..................
    Assertive Community Treatment                5,000             5,000
     for Ind. With SMI..............
 
SCIENCE AND SERVICE:
    GLS--Suicide Prevention Resource             5,988             5,988
     Center.........................
    Practice Improvement and                     7,828             7,828
     Training.......................
    Primary and Behavioral Health                1,991             1,991
     Care Integration TA............
    Consumer & Consumer Support TA               1,918             1,918
     Centers........................
    Minority Fellowship Program.....             8,059             8,059
    Disaster Response...............             1,953             1,953
    Homelessness....................             2,296             2,296
------------------------------------------------------------------------

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

Community Mental Health Services Block Grant

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

Children's Mental Health Services

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

Projects for Assistance in Transition From Homelessness

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

Protection and Advocacy for Individuals With Mental Illness

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

                       SUBSTANCE ABUSE TREATMENT

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

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

Programs of Regional and National Significance

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

 
                        [In thousands of dollars]
------------------------------------------------------------------------
                                      Fiscal year 2018      Committee
           Budget activity              appropriation    recommendation
------------------------------------------------------------------------
CAPACITY:
    Opioid Treatment Programs/                   8,724             8,724
     Regulatory Activities..........
    Screening, Brief Intervention,              30,000            30,000
     Referral, & Treatment..........
    Target Capacity Expansion.......            95,192            95,192
        Medicated Assisted Treatment            84,000            84,000
         for Prescription Drug and
         Opioid Addiction (non-add).
    First Responder Grants..........            36,000            36,000
    Grants to Prevent Prescription              12,000            12,000
     Drug/Opioid Overdose...........
    Pregnant & Postpartum Women.....            29,931            29,931
    Recovery Community Services                  2,434             2,434
     Program........................
    Children and Families...........            29,605            29,605
    Treatment Systems for Homeless..            36,386            36,386
    Minority AIDS...................            65,570            65,570
    Criminal Justice Activities.....            89,000            89,000
    Building Communities of Recovery             5,000             5,000
 
SCIENCE AND SERVICE:
    Addiction Technology Transfer                9,046             9,046
     Centers........................
    Minority Fellowship Program.....             4,539             5,039
------------------------------------------------------------------------

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

Substance Abuse Prevention and Treatment Block Grant

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

                       SUBSTANCE ABUSE PREVENTION

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

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

Programs of Regional and National Significance

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

 
                        [In thousands of dollars]
------------------------------------------------------------------------
                                      Fiscal year 2018      Committee
           Budget activity              appropriation    recommendation
------------------------------------------------------------------------
CAPACITY:
    Strategic Prevention Framework/            109,484           109,484
     Partnership for Success........
    Strategic Prevention Framework              10,000            10,000
     Rx.............................
    Improving Access to Overdose                 1,000             1,000
     Treatment......................
    Mandatory Drug Testing..........             4,894             4,894
    Minority AIDS...................            41,205            41,205
    Sober Truth on Preventing                    7,000             7,000
     Underage Drinking (STOP Act)...
    National Adult-Oriented Media                1,000             1,000
     Public Service Campaign........
    Community-based Coalition                    5,000             5,000
     Enhancement Grants.............
    ICCPUD..........................             1,000             1,000
    Tribal Behavioral Health Grants.            15,000            15,000
 
SCIENCE AND SERVICE:
    Center for the Application of                7,493             7,493
     Prevention Technologies........
    Science and Service Program                  4,072             4,072
     Coordination...................
    Minority Fellowship Program.....                71                71
------------------------------------------------------------------------

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

                HEALTH SURVEILLANCE AND PROGRAM SUPPORT

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

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

 
                        [In thousands of dollars]
------------------------------------------------------------------------
                                      Fiscal year 2018      Committee
           Budget activity              appropriation    recommendation
------------------------------------------------------------------------
Health Surveillance.................            57,258            57,258
Program Management..................            79,000            79,000
Performance & Quality Information               10,000            10,000
 Systems............................
Public Awareness and Support........            13,000            13,000
Behavioral Health Workforce Data....             1,000             1,000
------------------------------------------------------------------------

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

               Agency for Healthcare Research and Quality

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

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

                  HEALTH COSTS, QUALITY, AND OUTCOMES

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

 
                        [In thousands of dollars]
------------------------------------------------------------------------
                                      Fiscal year 2018      Committee
           Budget activity              appropriation    recommendation
------------------------------------------------------------------------
Research on Health Costs, Quality,
 and Outcomes:
    Prevention/Care Management......            11,649            11,649
    Health Information Technology...            16,500            16,500
    Patient Safety Research.........            70,276            70,276
    Health Services Research, Data              94,284            94,284
     and Dissemination..............
------------------------------------------------------------------------

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

                   MEDICAL EXPENDITURES PANEL SURVEYS

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

                            PROGRAM SUPPORT

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

               Centers for Medicare and Medicaid Services


                     GRANTS TO STATES FOR MEDICAID

Appropriations, 2018

                                                        $284,798,384,000

Budget estimate, 2019

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

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

                   PAYMENTS TO HEALTHCARE TRUST FUNDS

Appropriations, 2018

                                                        $323,497,300,000

Budget estimate, 2019

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

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

                           PROGRAM MANAGEMENT

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

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

Federal Administration

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

                   HEALTHCARE FRAUD AND ABUSE CONTROL

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

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

                Administration for Children and Families


  PAYMENTS TO STATES FOR CHILD SUPPORT ENFORCEMENT AND FAMILY SUPPORT 
                                PROGRAMS

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

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

               LOW INCOME HOME ENERGY ASSISTANCE PROGRAM

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

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

                     REFUGEE AND ENTRANT ASSISTANCE

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

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

   PAYMENTS TO STATES FOR THE CHILD CARE AND DEVELOPMENT BLOCK GRANT

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

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

                      SOCIAL SERVICES BLOCK GRANT

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

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

                CHILDREN AND FAMILIES SERVICES PROGRAMS

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

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

                   PROMOTING SAFE AND STABLE FAMILIES

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

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

                PAYMENTS FOR FOSTER CARE AND PERMANENCY

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

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

                  Administration for Community Living


                 AGING AND DISABILITY SERVICES PROGRAMS

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

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

Home- and Community-Based Supportive Services

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

Preventive Health Services

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

Protection of Vulnerable Older Americans

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

National Family Caregiver Support Program

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

Native American Caregiver Support Program

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

Congregate and Home-Delivered Nutrition Services

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

Aging Network Support Activities

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

Alzheimer's Disease Program Demonstration Grants to States

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

Lifespan Respite Care

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

Chronic Disease Self-Management Program

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

Elder Falls Prevention

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

Elder Rights Support Activities

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

Aging and Disability Resource Centers

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

State Health Insurance Assistance Program

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

Paralysis Resource Center

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

Limb Loss

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

Traumatic Brain Injury

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

Developmental Disabilities State Councils

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

Developmental Disabilities Protection and Advocacy

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

Voting Access for Individuals With Disabilities

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

Developmental Disabilities Projects of National Significance

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

Independent Living

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

National Institute on Disability, Independent Living, and 
        Rehabilitation Research

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

Assistive Technology

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

Program Administration

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

                        Office of the Secretary


                    GENERAL DEPARTMENTAL MANAGEMENT

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

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

Office of Minority Health

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

Office of Women's Health

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

                OFFICE OF MEDICARE HEARINGS AND APPEALS

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

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

  OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH INFORMATION TECHNOLOGY

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

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

                      OFFICE OF INSPECTOR GENERAL

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

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

                        OFFICE FOR CIVIL RIGHTS

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

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

     RETIREMENT PAY AND MEDICAL BENEFITS FOR COMMISSIONED OFFICERS

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

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

            PUBLIC HEALTH AND SOCIAL SERVICES EMERGENCY FUND

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

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

Office of the Assistant Secretary for Preparedness and Response

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

Biomedical Advanced Research and Development Authority [BARDA]

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

Project BioShield Special Reserve Fund

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

Other Activities

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

Office of the Assistant Secretary for Administration

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

Office of the Assistant Secretary for Health/Medical Reserve Corps

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

Office of the Secretary

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

Pandemic Influenza Preparedness

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

Office of Security and Strategic Information

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

                   PREVENTION AND PUBLIC HEALTH FUND

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

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

                           General Provisions

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

                               TITLE III

                        DEPARTMENT OF EDUCATION

                    Education for the Disadvantaged

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

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

Grants to Local Educational Agencies

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

Comprehensive Literacy State Development Grants

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

Innovative Approaches to Literacy

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

Migrant Education Program

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

Neglected and Delinquent

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

Special Programs for Migrant Students

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

                               Impact Aid

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

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

                      School Improvement Programs

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

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

Supporting Effective Instruction State Grants

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

Supplemental Education Grants

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

21st Century Community Learning Centers

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

State Assessments Grants

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

Education for Homeless Children and Youth

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

Training and Advisory Services

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

Native Hawaiian Education

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

Alaska Native Education

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

Rural Education

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

Comprehensive Centers

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

Student Support and Academic Enrichment Grants

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

                            Indian Education

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

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

Grants to Local Educational Agencies

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

Special Programs for Indian Children

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

National Activities

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

                       Innovation and Improvement

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

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

Education Innovation and Research

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

Charter School Program

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

Magnet Schools Assistance

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

Arts in Education

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

Javits Gifted and Talented Students

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

American History and Civics Education

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

Teacher and School Leader Incentive Grants

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

Ready-To-Learn Television

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

Supporting Effective Educator Development

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

Statewide Family Engagement Centers

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

                 Safe Schools and Citizenship Education

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

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

Promise Neighborhoods

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

School Safety National Activities

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

Full Service Community Schools

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

                      English Language Acquisition

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

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

                           Special Education

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

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

Grants to States

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

Preschool Grants

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

Grants for Infants and Families

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

State Personnel Development

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

Technical Assistance and Dissemination

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

Personnel Preparation

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

Parent Information Centers

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

Technology and Media Services

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

                        Rehabilitation Services

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

Vocational Rehabilitation State Grants

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

Client Assistance State Grants

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

Training

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

Demonstration and Training Programs

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

Protection and Advocacy of Individual Rights

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

Supported Employment State Grants

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

Independent Living Services for Older Individuals Who Are Blind

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

Helen Keller National Center

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

           Special Institutions for Persons With Disabilities


                 AMERICAN PRINTING HOUSE FOR THE BLIND

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

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

               NATIONAL TECHNICAL INSTITUTE FOR THE DEAF

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

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

                          GALLAUDET UNIVERSITY

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

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

                 Career, Technical, and Adult Education

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

Career and Technical Education

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

Adult Education

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

                      Student Financial Assistance

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

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

Federal Pell Grant Program

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

Federal Supplemental Educational Opportunity Grant Program

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

Federal Work-Study Program

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

              Federal Direct Student Loan Program Account

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

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

                       Student Aid Administration

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

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

                            Higher Education

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

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

Aid for Institutional Development

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

International Education and Foreign Language Studies

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

Model Comprehensive Transition and Postsecondary Programs for Students 
        With Intellectual Disabilities

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

Minority Science and Engineering Improvement

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

Tribally Controlled Postsecondary Career and Technical Institutions

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

Federal TRIO Programs

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

Gaining Early Awareness and Readiness for Undergraduate Programs

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

Graduate Assistance in Areas of National Need and Javits Fellowships

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

Teacher Quality Partnership Program

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

Child Care Access Means Parents in Schools

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

Fund for the Improvement of Post-Secondary Education

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

                           Howard University

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

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

         College Housing and Academic Facilities Loans Program

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

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

  Historically Black College and University Capital Financing Program 
                                Account

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

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

                    Institute of Education Sciences

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

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

                RESEARCH, DEVELOPMENT, AND DISSEMINATION

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

                               STATISTICS

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

                   REGIONAL EDUCATIONAL LABORATORIES

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

              RESEARCH AND INNOVATION IN SPECIAL EDUCATION

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

               SPECIAL EDUCATION STUDIES AND EVALUATIONS

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

                         STATEWIDE DATA SYSTEMS

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

                               ASSESSMENT

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

                        Departmental Management

                         PROGRAM ADMINISTRATION

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

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

                        OFFICE FOR CIVIL RIGHTS

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

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

                      office of inspector general

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

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

                           General Provisions

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

                                TITLE IV

                            RELATED AGENCIES

 Committee for Purchase From People Who Are Blind or Severely Disabled

                         SALARIES AND EXPENSES

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

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

             Corporation for National and Community Service

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

                           OPERATING EXPENSES

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

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

Volunteers in Service to America [VISTA]

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

National Senior Volunteer Corps

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

AmeriCorps State and National Grants

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

National Civilian Community Corps [NCCC]

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

Innovation, Demonstration, and Assistance Activities

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

Evaluation

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

State Commission Grants

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

                 PAYMENT TO THE NATIONAL SERVICE TRUST

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

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

                         SALARIES AND EXPENSES

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

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

                      office of inspector general

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

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

                       ADMINISTRATIVE PROVISIONS

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

                  Corporation for Public Broadcasting

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

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

               Federal Mediation and Conciliation Service


                         SALARIES AND EXPENSES

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

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

            Federal Mine Safety and Health Review Commission


                         SALARIES AND EXPENSES

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

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

                Institute of Museum and Library Services


       OFFICE OF MUSEUM AND LIBRARIES: GRANTS AND ADMINISTRATION

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

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

 
                        [In thousands of dollars]
------------------------------------------------------------------------
                                      Fiscal year 2018      Committee
           Budget activity              appropriation    recommendation
------------------------------------------------------------------------
Library Services Technology Act
 [LSTA]:
    Grants to States................       160,803,000       160,803,000
    Native American Library Services         5,063,000         5,063,000
    National Leadership: Libraries..        13,406,000        13,406,000
    Laura Bush 21st Century                 10,000,000        10,000,000
     Librarian......................
                                     -----------------------------------
        Subtotal, LSTA..............       189,272,000       189,272,000
 
Museum Services Act:
    Museums for America.............        22,899,000        22,899,000
    Native American/Hawaiian Museum          1,472,000         1,472,000
     Services.......................
    National Leadership: Museums....         8,113,000         8,113,000
                                     -----------------------------------
        Subtotal, MSA...............        32,484,000        32,484,000
 
African American History and Culture         2,231,000         2,231,000
 Act................................
Administration......................        14,000,000        15,000,000
Research, Analysis and Data                  2,013,000         3,013,000
 Collection.........................
        IMLS, Total.................       240,000,000       242,000,000
------------------------------------------------------------------------

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

            Medicaid and CHIP Payment and Access Commission


                         SALARIES AND EXPENSES

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

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

                  Medicare Payment Advisory Commission


                         SALARIES AND EXPENSES

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

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

                     National Council on Disability


                         SALARIES AND EXPENSES

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

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

                     National Labor Relations Board


                         SALARIES AND EXPENSES

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

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

                       ADMINISTRATIVE PROVISIONS

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

                        National Mediation Board


                         SALARIES AND EXPENSES

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

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

            Occupational Safety and Health Review Commission


                         SALARIES AND EXPENSES

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

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

                       Railroad Retirement Board

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

                     DUAL BENEFITS PAYMENTS ACCOUNT

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

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

          FEDERAL PAYMENTS TO THE RAILROAD RETIREMENT ACCOUNTS

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

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

                      LIMITATION ON ADMINISTRATION

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

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

           limitation on the office of the inspector general

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

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

                     Social Security Administration


                PAYMENTS TO SOCIAL SECURITY TRUST FUNDS

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

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

                  SUPPLEMENTAL SECURITY INCOME PROGRAM

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

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

Federal Benefit Payments

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

Beneficiary Services

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

Research and Demonstration

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

Administrative Expenses

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

                 LIMITATION ON ADMINISTRATIVE EXPENSES

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

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

                      office of inspector general

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

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

                                TITLE V

                           GENERAL PROVISIONS

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

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

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

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

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

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

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

                          TITLE 20--EDUCATION


     CHAPTER 28--HIGHER EDUCATION RESOURCES AND STUDENT ASSISTANCE


                    SUBCHAPTER I--GENERAL PROVISIONS


                 Part B--Additional General Provisions


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

(a) Establishment

           *       *       *       *       *       *       *

(f) Termination

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

           *       *       *       *       *       *       *


                   SUBCHAPTER IV--STUDENT ASSISTANCE


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


                     SUBPART 1--FEDERAL PELL GRANTS

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

(a) Program authority and method of distribution

           *       *       *       *       *       *       *

(b) Purpose and amount of grants

    (1) * * *

    (7) Additional funds.--

            (A) In general.--* * *

                    (i) * * *

           *       *       *       *       *       *       *

                    (iv) to carry out this section--

                            (I) * * *

           *       *       *       *       *       *       *

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

           *       *       *       *       *       *       *


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


Sec. 1087h. Funds for administrative expenses

(a) Program authority and method of distribution

  (1) Mandatory funds for fiscal year 2006

           *       *       *       *       *       *       *

  (4) Continuing mandatory funds for account maintenance fees

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


                        BUDGETARY IMPACT OF BILL


  PREPARED IN CONSULTATION WITH THE CONGRESSIONAL BUDGET OFFICE PURSUANT TO SEC. 308(A), PUBLIC LAW 93-344, AS
                                                     AMENDED
                                            [In millions of dollars]
----------------------------------------------------------------------------------------------------------------
                                                                  Budget authority               Outlays
                                                             ---------------------------------------------------
                                                               Committee    Amount  in   Committee    Amount  in
                                                               allocation      bill      allocation      bill
----------------------------------------------------------------------------------------------------------------
Comparison of amounts in the bill with the subcommittee
 allocation for 2019: Subcommittee on Labor, HHS, Education,
 and Related Agencies:
    Mandatory...............................................      783,118      783,118      782,757   \1\782,757
    Discretionary...........................................      179,289      181,186      184,249   \1\185,822
        Security............................................  ...........  ...........           NA           NA
        Nonsecurity.........................................      179,289      181,186           NA           NA
Projections of outlays associated with the recommendation:
    2019....................................................  ...........  ...........  ...........   \2\859,720
    2020....................................................  ...........  ...........  ...........       81,262
    2021....................................................  ...........  ...........  ...........       22,003
    2022....................................................  ...........  ...........  ...........        3,714
    2023 and future years...................................  ...........  ...........  ...........        1,272
Financial assistance to State and local governments for                NA      482,130           NA   \2\434,966
 P2019......................................................
 
----------------------------------------------------------------------------------------------------------------
\1\Includes outlays from prior-year budget authority.
\2\Excludes outlays from prior-year budget authority.
 
NA: Not applicable.
 
NOTE.--Consistent with the funding recommended in the bill for continuing disability reviews and
  redeterminations, for healthcare fraud and abuse control, and for reemployment services and eligibility
  assessments and in accordance with subparagraphs (B), (C), and (E) of section 251(b)(2) of the BBEDCA of 1985,
  the Committee anticipates that the Budget Committee will provide, at the appropriate time, a 302(a) allocation
  for the Committee on Appropriations reflecting an upward adjustment of $1,897,000,000 in budget authority plus
  associated outlays. Also, pursuant to section 1001(b)(3)(B) of the 21st Century Cures Act (Public Law 114-
  255), $711,000,000 in budget authority and the resulting outlays do not count for the purposes of estimates
  under the Congressional Budget and Impoundment Control Act of 1974 or the Balanced Budget and Emergency
  Deficit Control Act of 1985.


  COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2018 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL FOR FISCAL
                                                                        YEAR 2019
                                                                [In thousands of dollars]
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                        Senate Committee recommendation
                                                                                                                            compared with (+ or -)
                             Item                                     2018         Budget estimate      Committee    -----------------------------------
                                                                  appropriation                      recommendation         2018
                                                                                                                        appropriation    Budget estimate
--------------------------------------------------------------------------------------------------------------------------------------------------------
                 TITLE I--DEPARTMENT OF LABOR
 
            EMPLOYMENT AND TRAINING ADMINISTRATION
 
               Training and Employment Services
 
Grants to States:
    Adult Training, current year..............................          133,556           103,556           133,556   ................          +30,000
        Advance from prior year...............................         (712,000)         (712,000)         (712,000)  ................  ................
        Fiscal year 2020......................................          712,000           712,000           712,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
          Subtotal............................................          845,556           815,556           845,556   ................          +30,000
 
    Youth Training............................................          903,416           873,416           903,416   ................          +30,000
    Dislocated Worker Assistance, current year................          180,860           160,860           180,860   ................          +20,000
        Advance from prior year...............................         (860,000)         (860,000)         (860,000)  ................  ................
        Fiscal year 2020......................................          860,000           860,000           860,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
          Subtotal............................................        1,040,860         1,020,860         1,040,860   ................          +20,000
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Grants to States..............................        2,789,832         2,709,832         2,789,832   ................          +80,000
 
            Current year......................................       (1,217,832)       (1,137,832)       (1,217,832)  ................         (+80,000)
            Fiscal year 2020..................................       (1,572,000)       (1,572,000)       (1,572,000)  ................  ................
 
National Programs:
    Dislocated Worker Assistance National Reserve:
        Current year..........................................           20,859            20,859            20,859   ................  ................
        Advance from prior year...............................         (200,000)         (200,000)         (200,000)  ................  ................
        Fiscal year 2020......................................          200,000           125,000           200,000   ................          +75,000
                                                               -----------------------------------------------------------------------------------------
          Subtotal............................................          220,859           145,859           220,859   ................          +75,000
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Dislocated Worker Assistance..................        1,261,719         1,166,719         1,261,719   ................          +95,000
 
    Native American programs..................................           54,000   ................           54,000   ................          +54,000
    Migrant and Seasonal Farmworker programs..................           87,896   ................           87,896   ................          +87,896
    YouthBuild activities.....................................           89,534            84,534            89,534   ................           +5,000
    Technical assistance......................................  ................            2,000   ................  ................           -2,000
    Reintegration of Ex-Offenders.............................           93,079            78,324            93,079   ................          +14,755
    Workforce Data Quality Initiative.........................            6,000   ................            6,000   ................           +6,000
    Apprenticeship programs...................................          145,000           200,000           160,000           +15,000           -40,000
                                                               -----------------------------------------------------------------------------------------
      Total, National Programs................................          696,368           510,717           711,368           +15,000          +200,651
 
          Current year........................................         (496,368)         (385,717)         (511,368)         (+15,000)        (+125,651)
          Fiscal year 2020....................................         (200,000)         (125,000)         (200,000)  ................         (+75,000)
                                                               =========================================================================================
      Total, Training and Employment Services [TES]...........        3,486,200         3,220,549         3,501,200           +15,000          +280,651
 
          Current year........................................       (1,714,200)       (1,523,549)       (1,729,200)         (+15,000)        (+205,651)
          Fiscal year 2020....................................       (1,772,000)       (1,697,000)       (1,772,000)  ................         (+75,000)
                                                               =========================================================================================
                           Job Corps
 
Operations....................................................        1,603,325         1,189,812         1,603,325   ................         +413,513
Construction, Rehabilitation and Acquisition..................           83,000            75,016            83,000   ................           +7,984
Administration................................................           32,330            32,110            32,330   ................             +220
                                                               -----------------------------------------------------------------------------------------
      Total, Job Corps........................................        1,718,655         1,296,938         1,718,655   ................         +421,717
 
          Current Year........................................       (1,718,655)       (1,296,938)       (1,718,655)  ................        (+421,717)
                                                               =========================================================================================
Community Service Employment For Older Americans..............          400,000   ................          400,000   ................         +400,000
Federal Unemployment Benefits and Allowances (indefinite).....          790,000           790,000           790,000   ................  ................
 
State Unemployment Insurance and Employment Service Operations
 
Unemployment Compensation [UI]:
    State Operations..........................................        2,510,600         2,356,816         2,356,816          -153,784   ................
    Reemployment eligibility assessments--UI integrity........          120,000           130,000           150,000           +30,000           +20,000
    UI Integrity Center of Excellence.........................            9,000             6,000             9,000   ................           +3,000
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Unemployment Compensation.....................        2,639,600         2,492,816         2,515,816          -123,784           +23,000
 
    Federal-State UI National Activities......................           13,897            12,000            12,000            -1,897   ................
 
Employment Service [ES]:
    Grants to States:
        Federal Funds.........................................           21,413            21,413            21,413   ................  ................
        Trust Funds...........................................          645,000           650,000           645,000   ................           -5,000
                                                               -----------------------------------------------------------------------------------------
          Subtotal, Grants to States..........................          666,413           671,413           666,413   ................           -5,000
 
    ES National Activities....................................           19,818            19,683            19,818   ................             +135
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Employment Service............................          686,231           691,096           686,231   ................           -4,865
 
                Federal Funds.................................          (21,413)          (21,413)          (21,413)  ................  ................
                Trust Funds...................................         (664,818)         (669,683)         (664,818)  ................          (-4,865)
 
Foreign Labor Certifications and Related Activities:
    Federal Administration....................................           48,028            47,937            48,028   ................              +91
    Grants to States..........................................           14,282            14,255            14,282   ................              +27
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Foreign Labor Certification...................           62,310            62,192            62,310   ................             +118
 
One-Stop Career Centers/Labor Market Information..............           62,653            67,194            62,653   ................           -4,541
                                                               -----------------------------------------------------------------------------------------
      Total, State UI and ES..................................        3,464,691         3,325,298         3,339,010          -125,681           +13,712
 
          Federal Funds.......................................          (84,066)          (88,607)          (84,066)  ................          (-4,541)
          Trust Funds.........................................       (3,380,625)       (3,236,691)       (3,254,944)        (-125,681)         (+18,253)
                                                               =========================================================================================
                    Program Administration
 
Training and Employment.......................................           62,040            59,744            62,040   ................           +2,296
    Trust Funds...............................................            8,639             8,580             8,639   ................              +59
Employment Security...........................................            3,440             2,184             3,440   ................           +1,256
    Trust Funds...............................................           39,264            38,997            39,264   ................             +267
Apprenticeship Services.......................................           36,160            35,914            36,160   ................             +246
Executive Direction...........................................            7,034             6,781             7,034   ................             +253
    Trust Funds...............................................            2,079             2,065             2,079   ................              +14
                                                               -----------------------------------------------------------------------------------------
      Total, Program Administration...........................          158,656           154,265           158,656   ................           +4,391
 
          Federal Funds.......................................         (108,674)         (104,623)         (108,674)  ................          (+4,051)
          Trust Funds.........................................          (49,982)          (49,642)          (49,982)  ................            (+340)
                                                               =========================================================================================
      Total, Employment and Training Administration...........       10,018,202         8,787,050         9,907,521          -110,681        +1,120,471
 
          Federal Funds.......................................        6,587,595         5,500,717         6,602,595           +15,000        +1,101,878
                Current year..................................       (4,815,595)       (3,803,717)       (4,830,595)         (+15,000)      (+1,026,878)
                Fiscal year 2020..............................       (1,772,000)       (1,697,000)       (1,772,000)  ................         (+75,000)
          Trust Funds.........................................        3,430,607         3,286,333         3,304,926          -125,681           +18,593
                                                               =========================================================================================
       EMPLOYEE BENEFITS SECURITY ADMINISTRATION [EBSA]
 
                     Salaries and Expenses
 
Enforcement and Participant Assistance........................          147,400           154,813           152,900            +5,500            -1,913
Policy and Compliance Assistance..............................           26,901            28,033            26,901   ................           -1,132
Executive Leadership, Program Oversight and Administration....            6,699             6,654             6,699   ................              +45
                                                               -----------------------------------------------------------------------------------------
      Total, EBSA.............................................          181,000           189,500           186,500            +5,500            -3,000
                                                               =========================================================================================
          PENSION BENEFIT GUARANTY CORPORATION (PBGC)
 
           Pension Benefit Guaranty Corporation Fund
 
Consolidated Administrative budget............................         (424,417)         (445,363)         (445,363)         (+20,946)  ................
WAGE AND HOUR DIVISION, Salaries and Expenses.................          227,500           230,068           229,000            +1,500            -1,068
OFFICE OF LABOR-MANAGEMENT STANDARDS, Salaries and Expenses...           40,187            46,634            40,187   ................           -6,447
OFFICE OF FEDERAL CONTRACT COMPLIANCE PROGRAMS, Salaries and            103,476            91,100           103,476   ................          +12,376
 Expenses.....................................................
 
           OFFICE OF WORKERS' COMPENSATION PROGRAMS
 
Salaries and Expenses.........................................          115,424           113,109           115,424   ................           +2,315
    Trust Funds...............................................            2,177             2,173             2,177   ................               +4
                                                               -----------------------------------------------------------------------------------------
      Total, Salaries and Expenses............................          117,601           115,282           117,601   ................           +2,319
 
          Federal Funds.......................................         (115,424)         (113,109)         (115,424)  ................          (+2,315)
          Trust Funds.........................................           (2,177)           (2,173)           (2,177)  ................              (+4)
                                                               =========================================================================================
                       Special Benefits
 
Federal Employees' Compensation Benefits......................          217,000           227,000           227,000           +10,000   ................
Longshore and Harbor Workers' Benefits........................            3,000             3,000             3,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
      Total, Special Benefits.................................          220,000           230,000           230,000           +10,000   ................
                                                               =========================================================================================
           Special Benefits for Disabled Coal Miners
 
Benefit Payments..............................................           65,000            20,000            20,000           -45,000   ................
Administration................................................            5,319             5,319             5,319   ................  ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Fiscal year 2019 program level................           70,319            25,319            25,319           -45,000   ................
 
        Less funds advanced in prior year.....................          -16,000           -15,000           -15,000            +1,000   ................
                                                               -----------------------------------------------------------------------------------------
          Total, Current Year.................................           54,319            10,319            10,319           -44,000   ................
 
            New advances, 1st quarter, fiscal year 2020.......           15,000            14,000            14,000            -1,000   ................
                                                               -----------------------------------------------------------------------------------------
      Total, Special Benefits for Disabled Coal Miners........           69,319            24,319            24,319           -45,000   ................
                                                               =========================================================================================
Administrative Expenses, Energy Employees Occupational Illness
                       Compensation Fund
 
Administrative Expenses.......................................           59,846            59,098            59,098              -748   ................
 
               Black Lung Disability Trust Fund
 
Benefit Payments and Interest on Advances.....................          345,635           257,256           257,256           -88,379   ................
Workers' Compensation Programs, Salaries and Expenses.........           38,246            38,246            38,246   ................  ................
Departmental Management, Salaries and Expenses................           31,994            31,994            31,994   ................  ................
Departmental Management, Inspector General....................              330               330               330   ................  ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Black Lung Disability.........................          416,205           327,826           327,826           -88,379   ................
 
Treasury Department Administrative Costs......................              356               356               356   ................  ................
                                                               -----------------------------------------------------------------------------------------
      Total, Black Lung Disability Trust Fund.................          416,561           328,182           328,182           -88,379   ................
                                                               =========================================================================================
      Total, Workers' Compensation Programs...................          883,327           756,881           759,200          -124,127            +2,319
 
        Federal Funds.........................................          881,150           754,708           757,023          -124,127            +2,315
          Current year........................................         (866,150)         (740,708)         (743,023)        (-123,127)          (+2,315)
          Fiscal year 2020....................................          (15,000)          (14,000)          (14,000)          (-1,000)  ................
      Trust Funds.............................................            2,177             2,173             2,177   ................               +4
                                                               =========================================================================================
     OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION (OSHA)
 
                     Salaries and Expenses
 
Safety and Health Standards...................................           18,000            17,878            18,000   ................             +122
Federal Enforcement...........................................          208,000           212,735           210,000            +2,000            -2,735
Whistleblower enforcement.....................................           17,500            17,381            17,500   ................             +119
State Programs................................................          100,850           100,165           102,850            +2,000            +2,685
Technical Support.............................................           24,469            23,766            24,469   ................             +703
 
Compliance Assistance:
    Federal Assistance........................................           70,981            75,619            70,981   ................           -4,638
    State Consultation Grants.................................           59,500            59,096            59,500   ................             +404
    Training Grants...........................................           10,537   ................           10,537   ................          +10,537
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Compliance Assistance.........................          141,018           134,715           141,018   ................           +6,303
 
Safety and Health Statistics..................................           32,900            32,677            32,900   ................             +223
Executive Direction and Administration........................           10,050             9,716            10,050   ................             +334
                                                               -----------------------------------------------------------------------------------------
      Total, OSHA.............................................          552,787           549,033           556,787            +4,000            +7,754
                                                               =========================================================================================
             MINE SAFETY AND HEALTH ADMINISTRATION
 
                     Salaries and Expenses
 
Coal Enforcement..............................................          160,000           156,136           160,000   ................           +3,864
Metal/Non-Metal Enforcement...................................           94,500            96,975            94,500   ................           -2,475
Standards Development.........................................            4,500             5,345             4,500   ................             -845
Assessments...................................................            6,627             7,394             6,627   ................             -767
Educational Policy and Development............................           39,320            38,297            39,320   ................           +1,023
Technical Support.............................................           35,041            33,848            35,041   ................           +1,193
Program Evaluation and Information Resources [PEIR]...........           17,990            21,953            17,990   ................           -3,963
Program Administration........................................           15,838            15,958            15,838   ................             -120
                                                               -----------------------------------------------------------------------------------------
      Total, Mine Safety and Health Administration............          373,816           375,906           373,816   ................           -2,090
                                                               =========================================================================================
      Total, Worker Protection Agencies.......................        1,596,367         1,597,523         1,607,367           +11,000            +9,844
 
        Federal Funds.........................................       (1,594,190)       (1,595,350)       (1,605,190)         (+11,000)          (+9,840)
        Trust Funds...........................................           (2,177)           (2,173)           (2,177)  ................              (+4)
                                                               =========================================================================================
                  BUREAU OF LABOR STATISTICS
 
                     Salaries and Expenses
 
Employment and Unemployment Statistics........................          209,000           209,398           212,000            +3,000            +2,602
Labor Market Information......................................           65,000            64,559            65,000   ................             +441
Prices and Cost of Living.....................................          209,000           207,235           209,000   ................           +1,765
Compensation and Working Conditions...........................           83,500            80,947            83,500   ................           +2,553
Productivity and Technology...................................           10,500            10,622            10,500   ................             -122
Executive Direction and Staff Services........................           35,000            36,625            35,000   ................           -1,625
                                                               -----------------------------------------------------------------------------------------
      Total, Bureau of Labor Statistics.......................          612,000           609,386           615,000            +3,000            +5,614
 
          Federal Funds.......................................          547,000           544,827           550,000            +3,000            +5,173
          Trust Funds.........................................           65,000            64,559            65,000   ................             +441
                                                               =========================================================================================
            OFFICE OF DISABILITY EMPLOYMENT POLICY
 
Salaries and Expenses.........................................           38,203            27,000            38,203   ................          +11,203
 
                    DEPARTMENTAL MANAGEMENT
 
                     Salaries and Expenses
 
Executive Direction...........................................           30,250            30,045            30,250   ................             +205
Departmental Program Evaluation...............................            8,040             7,985             8,040   ................              +55
Legal Services................................................          123,745           124,644           123,745   ................             -899
    Trust Funds...............................................              308               306               308   ................               +2
International Labor Affairs...................................           86,125            18,500            86,125   ................          +67,625
Administration and Management.................................           23,534            23,808            23,534   ................             -274
Adjudication..................................................           35,000            35,462            35,000   ................             -462
Women's Bureau................................................           13,530             3,525            13,530   ................          +10,005
Civil Rights Activities.......................................            6,880             6,833             6,880   ................              +47
Chief Financial Officer.......................................           10,432             9,927            10,432   ................             +505
                                                               -----------------------------------------------------------------------------------------
      Total, Departmental Management Salaries and expenses....          337,844           261,035           337,844   ................          +76,809
 
          Federal Funds.......................................         (337,536)         (260,729)         (337,536)  ................         (+76,807)
          Trust Funds.........................................             (308)             (306)             (308)  ................              (+2)
                                                               =========================================================================================
               Veterans Employment and Training
 
State Administration, Grants..................................          180,000           173,812           180,000   ................           +6,188
Transition Assistance Program.................................           19,500            16,950            24,500            +5,000            +7,550
Federal Administration........................................           42,127            42,748            42,127   ................             -621
National Veterans' Employment and Training Services Institute.            3,414             3,391             3,414   ................              +23
Homeless Veterans Programs....................................           50,000            44,694            50,000   ................           +5,306
                                                               -----------------------------------------------------------------------------------------
      Total, Veterans Employment and Training.................          295,041           281,595           300,041            +5,000           +18,446
 
          Federal Funds.......................................           50,000            44,694            50,000   ................           +5,306
          Trust Funds.........................................          245,041           236,901           250,041            +5,000           +13,140
                                                               =========================================================================================
                       IT Modernization
 
Departmental support systems..................................            4,889   ................            4,889   ................           +4,889
Infrastructure technology modernization.......................           15,880   ................           15,880   ................          +15,880
                                                               -----------------------------------------------------------------------------------------
      Total, IT Modernization.................................           20,769   ................           20,769   ................          +20,769
                                                               =========================================================================================
                  Office of Inspector General
 
Program Activities............................................           83,487            82,061            83,487   ................           +1,426
    Trust Funds...............................................            5,660             5,660             5,660   ................  ................
                                                               -----------------------------------------------------------------------------------------
      Total, Office of Inspector General......................           89,147            87,721            89,147   ................           +1,426
                                                               =========================================================================================
      Total, Departmental Management..........................          742,801           630,351           747,801            +5,000          +117,450
 
          Federal Funds.......................................          491,792           387,484           491,792   ................         +104,308
            Current year......................................         (491,792)         (387,484)         (491,792)  ................        (+104,308)
          Trust Funds.........................................          251,009           242,867           256,009            +5,000           +13,142
                                                               =========================================================================================
      Total, Workforce Investment Act Programs................        5,204,855         4,517,487         5,219,855           +15,000          +702,368
 
          Current year........................................       (3,432,855)       (2,820,487)       (3,447,855)         (+15,000)        (+627,368)
          Fiscal year 2020....................................       (1,772,000)       (1,697,000)       (1,772,000)  ................         (+75,000)
                                                               =========================================================================================
      Total, Title I, Department of Labor.....................       13,773,299        12,292,909        13,557,491          -215,808        +1,264,582
          Federal Funds.......................................       10,024,506         8,696,977         9,929,379           -95,127        +1,232,402
                Current year..................................       (8,237,506)       (6,985,977)       (8,143,379)         (-94,127)      (+1,157,402)
                Fiscal year 2020..............................       (1,787,000)       (1,711,000)       (1,786,000)          (-1,000)         (+75,000)
          Trust Funds.........................................        3,748,793         3,595,932         3,628,112          -120,681           +32,180
                                                               =========================================================================================
       TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES
 
      HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA)
 
                      Primary Health Care
 
Community Health Centers......................................        1,625,522         4,990,629         1,625,522   ................       -3,365,107
Health CenterTort Claims......................................  ................           99,893   ................  ................          -99,893
Free Clinics Medical Malpractice..............................            1,000             1,000             1,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
      Total, Primary Health Care..............................        1,626,522         5,091,522         1,626,522   ................       -3,465,000
                                                               =========================================================================================
                       Health Workforce
 
National Health Service Corps.................................          105,000           310,000           105,000   ................         -205,000
 
Training for Diversity:
    Centers of Excellence.....................................           23,711   ................           23,711   ................          +23,711
    Health Careers Opportunity Program........................           14,189   ................           14,189   ................          +14,189
    Faculty Loan Repayment....................................            1,190   ................            1,190   ................           +1,190
    Scholarships for Disadvantaged Students...................           48,970   ................           48,970   ................          +48,970
                                                               -----------------------------------------------------------------------------------------
      Total, Training for Diversity...........................           88,060   ................           88,060   ................          +88,060
                                                               =========================================================================================
Primary Care Training and Enhancement.........................           48,924   ................           48,924   ................          +48,924
Oral Health Training..........................................           40,673   ................           40,673   ................          +40,673
 
Interdisciplinary Community-Based Linkages:
    Area Health Education Centers.............................           38,250   ................           40,250            +2,000           +40,250
    Geriatric Programs........................................           40,737   ................           40,737   ................          +40,737
    Mental and Behavorial Health..............................           36,916   ................           36,916   ................          +36,916
    Behavioral Health Workforce Education and Training........           75,000   ................           75,000   ................          +75,000
                                                               -----------------------------------------------------------------------------------------
      Total, Interdisciplinary Community Linkages.............          190,903   ................          192,903            +2,000          +192,903
                                                               =========================================================================================
Workforce Assessment..........................................            5,663             4,663             5,663   ................           +1,000
Public Health and Preventive Medicine programs................           17,000   ................           17,000   ................          +17,000
 
Nursing Programs:
    Advanced Education Nursing................................           74,581   ................           74,581   ................          +74,581
    Nurse Education, Practice, and Retention..................           41,913   ................           41,913   ................          +41,913
    Nursing Workforce Diversity...............................           17,343   ................           17,343   ................          +17,343
    Nursing Corps Scholarship and Loan Repayment Program......           87,135            83,135            87,135   ................           +4,000
    Nursing Faculty Loan Program..............................           28,500   ................           28,500   ................          +28,500
                                                               -----------------------------------------------------------------------------------------
      Total, Nursing programs.................................          249,472            83,135           249,472   ................         +166,337
                                                               =========================================================================================
Children's Hospitals Graduate Medical Education...............          315,000   ................          325,000           +10,000          +325,000
Teaching Health Center, Graduate Medical Education............  ................           60,000   ................  ................          -60,000
National Practitioner Data Bank...............................           18,814            18,814            18,814   ................  ................
    User Fees.................................................          -18,814           -18,814           -18,814   ................  ................
                                                               -----------------------------------------------------------------------------------------
      Total, Health Workforce.................................        1,060,695           457,798         1,072,695           +12,000          +614,897
                                                               =========================================================================================
                   Maternal and Child Health
 
Maternal and Child Health Block Grant.........................          651,700           627,700           677,700           +26,000           +50,000
Sickle Cell Anemia Demonstration Program......................            4,455   ................            4,455   ................           +4,455
Autism and Other Developmental Disabilities...................           49,099   ................           49,099   ................          +49,099
Heritable Disorders in Newborns and Children..................           15,883   ................           15,883   ................          +15,883
Family-to-Family Health Information Centers...................  ................            5,000   ................  ................           -5,000
Maternal, Infant and Early Childhood Home Visiting Program....  ................          400,000   ................  ................         -400,000
Healthy Start.................................................          110,500           103,500           122,500           +12,000           +19,000
Universal Newborn Hearing Screening...........................           17,818   ................           17,818   ................          +17,818
Emergency Medical Services for Children.......................           22,334   ................           22,334   ................          +22,334
Screening and treatment for maternal depression...............            5,000   ................            5,000   ................           +5,000
Pediatric Mental Health Care Access...........................           10,000   ................           10,000   ................          +10,000
                                                               -----------------------------------------------------------------------------------------
      Total, Maternal and Child Health........................          886,789         1,136,200           924,789           +38,000          -211,411
                                                               =========================================================================================
                  Ryan White HIV/AIDS Program
 
Emergency Assistance (Part A).................................          655,876           655,876           655,876   ................  ................
Comprehensive Care Programs (Part B)..........................        1,315,005         1,315,005         1,315,005   ................  ................
    AIDS Drug Assistance Program [ADAP] (NA)..................         (900,313)         (900,313)         (900,313)  ................  ................
Early Intervention Program (Part C)...........................          201,079           201,079           201,079   ................  ................
Children, Youth, Women, and Families (Part D).................           75,088            75,088            75,088   ................  ................
AIDS Dental Services (Part F).................................           13,122            13,122            13,122   ................  ................
Education and Training Centers (Part F).......................           33,611   ................           33,611   ................          +33,611
Special Projects of National Significance.....................           25,000   ................           25,000   ................          +25,000
                                                               -----------------------------------------------------------------------------------------
      Total, Ryan White HIV/AIDS program......................        2,318,781         2,260,170         2,318,781   ................          +58,611
                                                               =========================================================================================
                      Health Care Systems
 
Organ Transplantation.........................................           25,549            23,549            25,549   ................           +2,000
National Cord Blood Inventory.................................           15,266            12,266            15,266   ................           +3,000
C.W. Bill Young Cell Transplantation..........................           24,109            22,109            24,109   ................           +2,000
340B Drug Pricing program/Office of Pharmacy Affairs..........           10,238            26,238            10,238   ................          -16,000
    User Fees.................................................  ................          -16,000   ................  ................          +16,000
Poison Control Centers........................................           20,846            18,846            22,846            +2,000            +4,000
Hansen's Disease Program......................................           13,706            11,653            13,706   ................           +2,053
Hansen's Disease Program--Buildings and Facilities............              122   ................              122   ................             +122
Payment to Hawaii, Treatment of Hansen's......................            1,857             1,857             1,857   ................  ................
                                                               -----------------------------------------------------------------------------------------
      Total, Health Care Systems..............................          111,693           100,518           113,693            +2,000           +13,175
                                                               =========================================================================================
                         Rural Health
 
Rural Outreach Grants.........................................           71,500            50,811            77,500            +6,000           +26,689
Rural Health Research/Policy Development......................            9,351             5,000             9,351   ................           +4,351
Rural Hospital Flexibility Grants.............................           49,609   ................           49,609   ................          +49,609
State Offices of Rural Health.................................           10,000   ................           10,000   ................          +10,000
Black Lung Clinics............................................           10,000             7,266            10,000   ................           +2,734
Radiation Exposure Screening and Education Program............            1,834             1,834             1,834   ................  ................
Telehealth....................................................           23,500            10,000            25,500            +2,000           +15,500
Rural Communities Opioid Response.............................          100,000   ................          120,000           +20,000          +120,000
Rural Residency Program.......................................           15,000   ................           15,000   ................          +15,000
                                                               -----------------------------------------------------------------------------------------
      Total, Rural Health.....................................          290,794            74,911           318,794           +28,000          +243,883
                                                               =========================================================================================
Family Planning...............................................          286,479           286,479           286,479   ................  ................
Program Management............................................          155,000           151,993           155,000   ................           +3,007
 
        Vaccine Injury Compensation Program Trust Fund
 
Post-Fiscal Year 1988 Claims..................................          268,000           308,000           308,000           +40,000   ................
HRSA Administrative expenses..................................            9,200             9,200             9,200   ................  ................
                                                               -----------------------------------------------------------------------------------------
      Total, Vaccine Injury Compensation Trust Fund...........          277,200           317,200           317,200           +40,000   ................
                                                               =========================================================================================
      Total, Health Resources and Services Administration.....        7,013,953         9,876,791         7,133,953          +120,000        -2,742,838
                                                               =========================================================================================
          CENTERS FOR DISEASE CONTROL AND PREVENTION
 
Immunization and Respiratory Diseases.........................          474,055           700,828           474,055   ................         -226,773
    Prevention and Public Health Fund.........................         (324,350)  ................         (324,350)  ................        (+324,350)
                                                               -----------------------------------------------------------------------------------------
      Subtotal................................................         (798,405)         (700,828)         (798,405)  ................         (+97,577)
 
HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and         1,127,278         1,117,278         1,132,278            +5,000           +15,000
 Tuberculosis Prevention......................................
Emerging and Zoonotic Infectious Diseases.....................          562,572           508,328           565,572            +3,000           +57,244
    Prevention and Public Health Fund.........................          (52,000)  ................          (52,000)  ................         (+52,000)
                                                               -----------------------------------------------------------------------------------------
      Subtotal................................................          614,572           508,328           617,572            +3,000          +109,244
 
Chronic Disease Prevention and Health Promotion...............          915,346           939,250           911,821            -3,525           -27,429
    Prevention and Public Health Fund.........................         (247,550)  ................         (254,950)          (+7,400)        (+254,950)
                                                               -----------------------------------------------------------------------------------------
      Subtotal................................................        1,162,896           939,250         1,166,771            +3,875          +227,521
 
Birth Defects, Developmental Disabilities, Disabilities and             140,560           110,000           153,560           +13,000           +43,560
 Health.......................................................
                                                               -----------------------------------------------------------------------------------------
      Subtotal................................................          140,560           110,000           153,560           +13,000           +43,560
 
Public Health Scientific Services.............................          490,397           332,180           492,397            +2,000          +160,217
    Evaluation Tap Funding....................................  ................         (135,820)  ................  ................        (-135,820)
                                                               -----------------------------------------------------------------------------------------
      Subtotal................................................         (490,397)         (468,000)         (492,397)          (+2,000)         (+24,397)
 
Environmental Health..........................................          188,750           157,000           188,750   ................          +31,750
    Prevention and Public Health Fund.........................          (17,000)  ................          (17,000)  ................         (+17,000)
                                                               -----------------------------------------------------------------------------------------
      Subtotal................................................          205,750           157,000           205,750   ................          +48,750
 
Injury Prevention and Control.................................          648,559           266,309           648,559   ................         +382,250
National Institute for Occupational Safety and Health.........          335,200   ................          335,300              +100          +335,300
Energy Employees Occupational Illness Compensation Program....           55,358   ................           55,358   ................          +55,358
Global Health.................................................          488,621           408,762           488,621   ................          +79,859
Public Health Preparedness and Response.......................        1,450,000           800,000         1,470,000           +20,000          +670,000
Buildings and Facilities......................................          270,000            30,000            30,000          -240,000   ................
    Transfers from Nonrecurring Expenses Fund.................         (240,000)  ................  ................        (-240,000)  ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal................................................          510,000            30,000            30,000          -480,000   ................
 
            CDC-Wide Activities and Program Support
 
Prevention and Public Health Fund.............................         (160,000)  ................         (160,000)  ................        (+160,000)
Office of the Director........................................          113,570           155,000           113,570   ................          -41,430
                                                               -----------------------------------------------------------------------------------------
      Subtotal, CDC-Wide Activities...........................         (273,570)         (155,000)         (273,570)  ................        (+118,570)
                                                               -----------------------------------------------------------------------------------------
      Total, Centers for Disease Control......................        7,260,266         5,524,935         7,059,841          -200,425        +1,534,906
 
          Evaluation Tap Funding (NA).........................  ................         (135,820)  ................  ................        (-135,820)
          Prevention and Public Health Fund...................         (800,900)  ................         (808,300)          (+7,400)        (+808,300)
          Transfers from Nonrecurring Expenses Fund...........         (240,000)  ................  ................        (-240,000)  ................
      Total, Centers for Disease Control Program Level........       (8,301,166)       (5,660,755)       (7,868,141)        (-433,025)      (+2,207,386)
                                                               =========================================================================================
                 NATIONAL INSTITUTES OF HEALTH
 
National Cancer Institute (NCI)...............................        5,657,015         5,226,312         5,747,125           +90,110          +520,813
NIH Innovation Account, CURES Act.............................          300,000           400,000           400,000          +100,000   ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, NCI...........................................        5,957,015         5,626,312         6,147,125          +190,110          +520,813
 
National Heart, Lung, and Blood Institute (NHLBI).............        3,382,232         3,112,032         3,490,171          +107,939          +378,139
National Institute of Dental and Craniofacial Research (NIDCR)          447,735           413,196           462,024           +14,289           +48,828
National Institute of Diabetes and Digestive and Kidney               1,968,083         1,965,434         2,030,892           +62,809           +65,458
 Diseases [NIDDK].............................................
    Juvenile Diabetes (mandatory).............................         (150,000)         (150,000)         (150,000)  ................  ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, NIDDK program level...........................        2,118,083         2,115,434         2,180,892           +62,809           +65,458
 
National Institute of Neurological Disorders and Stroke               2,106,482         1,781,056         2,218,080          +111,598          +437,024
 (NINDS)......................................................
NIH Innovation Account, CURES Act.............................           43,000            57,500            57,500           +14,500   ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, NINDS.........................................        2,149,482         1,838,556         2,275,580          +126,098          +437,024
 
National Institute of Allergy and Infectious Diseases (NIAID).        5,280,665         4,761,948         5,506,190          +225,525          +744,242
National Institute of General Medical Sciences (NIGMS)........        1,862,529         1,831,669         1,855,971            -6,558           +24,302
    Evaluation Tap Funding....................................         (922,871)         (741,000)       (1,018,321)         (+95,450)        (+277,321)
                                                               -----------------------------------------------------------------------------------------
      Subtotal, NIGMS program level...........................        2,785,400         2,572,669         2,874,292           +88,892          +301,623
 
Eunice Kennedy Shriver National Institute of Child Health and         1,460,637         1,339,592         1,507,251           +46,614          +167,659
 Human Development (NICHD)....................................
National Eye Institute (NEI)..................................          772,308           711,015           796,955           +24,647           +85,940
National Institute of Environmental Health Sciences (NIEHS)...          751,143           693,199           775,115           +23,972           +81,916
National Institute on Aging (NIA).............................        2,577,550         1,988,200         3,084,809          +507,259        +1,096,609
National Institute of Arthritis and Musculoskeletal and Skin            586,661           545,494           605,383           +18,722           +59,889
 Diseases (NIAMS).............................................
National Institute on Deafness and Other Communication                  459,974           423,992           474,653           +14,679           +50,661
 Disorders (NIDCD)............................................
National Institute of Nursing Research (NINR).................          158,033           145,842           163,076            +5,043           +17,234
National Institute on Alcohol Abuse and Alcoholism (NIAAA)....          509,604           469,109           525,867           +16,263           +56,758
National Institute on Drug Abuse (NIDA).......................        1,376,657         1,137,403         1,420,591           +43,934          +283,188
National Institute of Mental Health (NIMH)....................        1,714,657         1,554,692         1,813,750           +99,093          +259,058
NIH Innovation Account, CURES Act.............................           43,000            57,500            57,500           +14,500   ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, NIMH..........................................        1,757,657         1,612,192         1,871,250          +113,593          +259,058
 
National Human Genome Research Institute (NHGRI)..............          558,072           512,979           575,882           +17,810           +62,903
National Institute of Biomedical Imaging and Bioengineering             377,618           346,550           389,672           +12,054           +43,122
 (NIBIB)......................................................
National Center for Complementary and Integrative Health                142,018           130,717           146,550            +4,532           +15,833
 (NCCIH)......................................................
National Institute on Minority Health and Health Disparities            305,108           280,545           314,845            +9,737           +34,300
 (NIMHD)......................................................
John E. Fogarty International Center (FIC)....................           75,733            70,084            78,150            +2,417            +8,066
National Library of Medicine (NLM)............................          428,553           395,493           442,230           +13,677           +46,737
National Center for Advancing Translational Sciences (NCATS)..          762,454           685,087           806,787           +44,333          +121,700
National Institute for Research on Safety and Quality (NIRSQ).  ................          255,960   ................  ................         -255,960
National Institute for Occupational Safety and Health (NIOSH).  ................          200,000   ................  ................         -200,000
National Institute on Disability, Independent Living, and       ................           95,127   ................  ................          -95,127
 Rehabilitation Research (NIDILRR)............................
Energy Employees Occupational Illness Compensation Program....  ................           55,358   ................  ................          -55,358
Office of the Director........................................        1,802,145         1,795,706         1,910,060          +107,915          +114,354
    Common Fund (non-add).....................................         (588,116)         (586,181)         (606,885)         (+18,769)         (+20,704)
    Gabriella Miller Kids First Research Act (Common Fund add)           12,600            12,600            12,600   ................  ................
NIH Innovation Account, CURES Act.............................          110,000           196,000           196,000           +86,000   ................
Buildings and Facilities......................................          128,863           200,000           200,000           +71,137   ................
                                                               =========================================================================================
      Total, National Institutes of Health (NIH)..............       36,161,129        33,847,391        38,065,679        +1,904,550        +4,218,288
          (Evaluation Tap Funding)............................         (922,871)         (741,000)       (1,018,321)         (+95,450)        (+277,321)
      Total, NIH Program Level................................      (37,084,000)      (34,588,391)      (39,084,000)      (+2,000,000)      (+4,495,609)
                                                               =========================================================================================
   SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION
                           (SAMHSA)
 
                         Mental Health
 
Programs of Regional and National Significance................          426,659           282,544           430,659            +4,000          +148,115
    Prevention and Public Health Fund.........................          (12,000)  ................          (12,000)  ................         (+12,000)
                                                               -----------------------------------------------------------------------------------------
      Subtotal................................................          438,659           282,544           442,659            +4,000          +160,115
 
Mental Health block grant.....................................          701,532           541,532           726,532           +25,000          +185,000
    Evaluation Tap Funding....................................          (21,039)          (21,039)          (21,039)  ................  ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal................................................         (722,571)         (562,571)         (747,571)         (+25,000)        (+185,000)
 
Certified Community Behavioral Health Clinics.................          100,000   ................          150,000           +50,000          +150,000
National Child Traumatic Stress Initiative....................  ................  ................  ................  ................  ................
Children's Mental Health......................................          125,000           119,026           125,000   ................           +5,974
Grants to States for the Homeless (PATH)......................           64,635            64,635            64,635   ................  ................
Protection and Advocacy.......................................           36,146            36,146            36,146   ................  ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Mental Health.................................        1,453,972         1,043,883         1,532,972           +79,000          +489,089
          (Evaluation Tap Funding)............................          (21,039)          (21,039)          (21,039)  ................  ................
      Subtotal, Mental Health program level...................       (1,487,011)       (1,064,922)       (1,566,011)         (+79,000)        (+501,089)
 
                   Substance Abuse Treatment
 
Programs of Regional and National Significance................          403,427           255,318           451,927           +48,500          +196,609
    Evaluation Tap Funding....................................           (2,000)  ................           (2,000)  ................          (+2,000)
                                                               -----------------------------------------------------------------------------------------
      Subtotal................................................         (405,427)         (255,318)         (453,927)         (+48,500)        (+198,609)
 
Substance Abuse block grant...................................        1,778,879         1,778,879         1,778,879   ................  ................
    Evaluation Tap Funding....................................          (79,200)          (79,200)          (79,200)  ................  ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, block grant...................................       (1,858,079)       (1,858,079)       (1,858,079)  ................  ................
 
State Opioid Response grants..................................        1,000,000   ................        1,500,000          +500,000        +1,500,000
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Substance Abuse Treatment.....................        3,182,306         2,034,197         3,730,806          +548,500        +1,696,609
          (Evaluation Tap Funding)............................          (81,200)          (79,200)          (81,200)  ................          (+2,000)
      Subtotal, Program level.................................       (3,263,506)       (2,113,397)       (3,812,006)        (+548,500)      (+1,698,609)
 
                  Substance Abuse Prevention
 
Programs of Regional and National Significance................          248,219           220,885           200,219           -48,000           -20,666
    Evaluation Tap Funding (NA)...............................  ................  ................  ................  ................  ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal................................................          248,219           220,885           200,219           -48,000           -20,666
                                                               -----------------------------------------------------------------------------------------
      Total, Substance Abuse Prevention.......................          248,219           220,885           200,219           -48,000           -20,666
                                                               =========================================================================================
Health Surveillance and Program Support.......................          128,830           126,922           128,830   ................           +1,908
    Evaluation Tap Funding (NA)...............................          (31,428)          (20,426)          (31,428)  ................         (+11,002)
                                                               -----------------------------------------------------------------------------------------
      Subtotal................................................          160,258           147,348           160,258   ................          +12,910
                                                               =========================================================================================
      Total, SAMHSA...........................................        5,013,327         3,425,887         5,592,827          +579,500        +2,166,940
          (Evaluation Tap Funding)............................         (133,667)         (120,665)         (133,667)  ................         (+13,002)
          (Prevention and Public Health Fund )................          (12,000)  ................          (12,000)  ................         (+12,000)
      Total, SAMHSA Program Level.............................       (5,158,994)       (3,546,552)       (5,738,494)        (+579,500)      (+2,191,942)
                                                               =========================================================================================
       AGENCY FOR HEALTHCARE RESEARCH AND QUALITY (AHRQ)
 
                Healthcare Research and Quality
 
Research on Health Costs, Quality, and Outcomes:
    Federal Funds.............................................          197,156   ................          192,709            -4,447          +192,709
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Health Costs, Quality, and Outcomes...........         (197,156)  ................         (192,709)          (-4,447)        (+192,709)
          (Evaluation Tap Funding)............................  ................  ................  ................  ................  ................
 
Medical Expenditures Panel Surveys:
    Federal Funds.............................................           66,000   ................           69,991            +3,991           +69,991
 
Program Support:
    Federal Funds.............................................           70,844   ................           71,300              +456           +71,300
                                                               -----------------------------------------------------------------------------------------
      Total, AHRQ Program Level...............................         (334,000)  ................         (334,000)  ................        (+334,000)
 
          Federal funds.......................................         (334,000)  ................         (334,000)  ................        (+334,000)
      Total, Public Health Service (PHS) appropriation........       55,782,675        52,675,004        58,186,300        +2,403,625        +5,511,296
      Total, Public Health Service Program Level..............      (57,892,113)      (53,672,489)      (60,158,588)      (+2,266,475)      (+6,486,099)
                                                               =========================================================================================
          CENTERS FOR MEDICARE AND MEDICAID SERVICES
 
                 Grants to States for Medicaid
 
Medicaid Current Law Benefits.................................      384,608,394       384,882,625       384,882,625          +274,231   ................
State and Local Administration................................       20,811,084        21,474,885        21,474,885          +663,801   ................
Vaccines for Children.........................................        4,598,358         4,726,461         4,726,461          +128,103   ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Medicaid Program Level........................      410,017,836       411,083,971       411,083,971        +1,066,135   ................
 
          Less funds advanced in prior year...................     -125,219,452      -134,847,759      -134,847,759        -9,628,307   ................
                                                               -----------------------------------------------------------------------------------------
      Total, Grants to States for Medicaid....................      284,798,384       276,236,212       276,236,212        -8,562,172   ................
 
            New advance, 1st quarter, fiscal year 2020........      134,847,759       137,931,797       137,931,797        +3,084,038   ................
                                                               =========================================================================================
              Payments to Health Care Trust Funds
 
Supplemental Medical Insurance................................      245,396,000       284,288,300       284,288,300       +38,892,300   ................
Federal Uninsured Payment.....................................          132,000           127,000           127,000            -5,000   ................
Program Management............................................        1,104,000           898,000           898,000          -206,000   ................
General Revenue for Part D Benefit............................       76,133,000        92,070,000        92,070,000       +15,937,000   ................
General Revenue for Part D Administration.....................          422,000           642,000           642,000          +220,000   ................
HCFAC Reimbursement...........................................          307,000           315,000           315,000            +8,000   ................
State Low-Income Determination for Part D.....................            3,300             3,500             3,500              +200   ................
                                                               -----------------------------------------------------------------------------------------
      Total, Payments to Trust Funds, Program Level...........      323,497,300       378,343,800       378,343,800       +54,846,500   ................
                                                               =========================================================================================
                      Program Management
 
Research, Demonstration, Evaluation...........................           20,054            18,054            20,054   ................           +2,000
Program Operations............................................        2,519,823         2,402,089         2,519,823   ................         +117,734
State Survey and Certification................................          397,334           421,135           397,334   ................          -23,801
Federal Administration........................................          732,533           702,601           732,533   ................          +29,932
                                                               -----------------------------------------------------------------------------------------
      Total, Program management...............................        3,669,744         3,543,879         3,669,744   ................         +125,865
                                                               =========================================================================================
          Health Care Fraud and Abuse Control Account
 
Centers for Medicare and Medicaid Services....................          500,368           609,766           600,464          +100,096            -9,302
HHS Office of Inspector General...............................           84,398            84,398            86,664            +2,266            +2,266
Medicaid/CHIP.................................................           84,398   ................  ................          -84,398   ................
Department of Justice.........................................           75,836            75,836            77,872            +2,036            +2,036
                                                               -----------------------------------------------------------------------------------------
      Total, Health Care Fraud and Abuse Control..............          745,000           770,000           765,000           +20,000            -5,000
                                                               =========================================================================================
      Total, Centers for Medicare and Medicaid Services.......      747,558,187       796,825,688       796,946,553       +49,388,366          +120,865
 
          Federal funds.......................................      743,143,443       792,511,809       792,511,809       +49,368,366   ................
          Current year........................................     (608,295,684)     (654,580,012)     (654,580,012)     (+46,284,328)  ................
          New advance, fiscal year 2020.......................     (134,847,759)     (137,931,797)     (137,931,797)      (+3,084,038)  ................
        Trust Funds...........................................        4,414,744         4,313,879         4,434,744           +20,000          +120,865
                                                               =========================================================================================
        ADMINISTRATION FOR CHILDREN AND FAMILIES (ACF)
 
  Payments to States for Child Support Enforcement and Family
                       Support Programs
 
Payments to Territories.......................................           33,000            33,000            33,000   ................  ................
Repatriation..................................................            1,000             1,000             1,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal................................................           34,000            34,000            34,000   ................  ................
 
Child Support Enforcement:
    State and Local Administration............................        3,763,200         3,689,574         3,689,574           -73,626   ................
    Federal Incentive Payments................................          588,200           588,673           588,673              +473   ................
    Access and Visitation.....................................           10,000            10,000            10,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Child Support Enforcement.....................        4,361,400         4,288,247         4,288,247           -73,153   ................
                                                               -----------------------------------------------------------------------------------------
      Total, Family Support Payments Program Level............        4,395,400         4,322,247         4,322,247           -73,153   ................
 
          Less funds advanced in previous years...............       -1,400,000        -1,400,000        -1,400,000   ................  ................
                                                               =========================================================================================
      Total, Family Support Payments, current year............        2,995,400         2,922,247         2,922,247           -73,153   ................
 
          New advance, 1st quarter, fiscal year 2020..........        1,400,000         1,400,000         1,400,000   ................  ................
                                                               =========================================================================================
          Low Income Home Energy Assistance (LIHEAP)
 
Formula Grants................................................        3,640,304   ................        3,690,304           +50,000        +3,690,304
 
                Refugee and Entrant Assistance
 
Transitional and Medical Services.............................          320,000           354,000           354,000           +34,000   ................
Refugee Support Services......................................          207,201           160,821           207,201   ................          +46,380
Victims of Trafficking........................................           23,755            18,755            26,755            +3,000            +8,000
Unaccompanied Minors..........................................        1,303,245         1,048,000         1,303,245   ................         +255,245
Unaccompanied Minors Contingency Fund.........................  ................          200,000   ................  ................         -200,000
Victims of Torture............................................           10,735            10,735            14,000            +3,265            +3,265
                                                               -----------------------------------------------------------------------------------------
      Total, Refugee and Entrant Assistance...................        1,864,936         1,792,311         1,905,201           +40,265          +112,890
                                                               =========================================================================================
Payments to States for the Child Care and Development Block           5,226,000         3,006,000         5,226,000   ................       +2,220,000
 Grant........................................................
Social Services Block Grant (Title XX)........................        1,700,000         1,700,000         1,700,000   ................  ................
    Discretionary Funds.......................................  ................           85,000   ................  ................          -85,000
                                                               -----------------------------------------------------------------------------------------
      Total, Social Services Block Grant......................        1,700,000         1,785,000         1,700,000   ................          -85,000
 
            Children and Families Services Programs
 
Programs for Children, Youth and Families:
    Head Start, current funded................................        9,863,095         9,275,000        10,113,095          +250,000          +838,095
    Preschool Development Grants..............................          250,000   ................          250,000   ................         +250,000
    Consolidated Runaway, Homeless Youth Program..............          110,280           101,980           110,280   ................           +8,300
    Prevention Grants to Reduce Abuse of Runaway Youth........           17,141            17,141            17,141   ................  ................
    Child Abuse State Grants..................................           85,310            25,310            85,310   ................          +60,000
    Child Abuse Discretionary Activities......................           33,000            33,000            33,000   ................  ................
    Community Based Child Abuse Prevention....................           39,764            39,764            39,764   ................  ................
    Child Welfare Services....................................          268,735           268,735           268,735   ................  ................
    Child Welfare Training, Research, or Demonstration                   17,984            17,984            17,984   ................  ................
     projects.................................................
    Adoption Opportunities....................................           39,100            39,100            39,100   ................  ................
    Adoption Incentive grants.................................           75,000            37,943            75,000   ................          +37,057
Social Services and Income Maintenance Research...............            6,512             6,512             6,512   ................  ................
Native American Programs......................................           54,050            52,050            54,050   ................           +2,000
 
Community Services:
    Community Services Block Grant Act programs:
        Grants to States for Community Services...............          715,000   ................          725,000           +10,000          +725,000
        Economic Development..................................           19,883   ................           19,883   ................          +19,883
        Rural Community Facilities............................            8,000   ................            8,000   ................           +8,000
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Community Services............................          742,883   ................          752,883           +10,000          +752,883
 
Domestic Violence Hotline.....................................            9,250             8,250            10,250            +1,000            +2,000
Family Violence/Battered Women's Shelters.....................          160,000           151,000           165,000            +5,000           +14,000
Chafee Education and Training Vouchers........................           43,257            43,257            43,257   ................  ................
Disaster Human Services Case Management.......................            1,864             1,864             1,864   ................  ................
Program Direction.............................................          205,000           205,000           205,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
      Total, Children and Families Services Programs..........       12,022,225        10,323,890        12,288,225          +266,000        +1,964,335
                                                               =========================================================================================
Promoting Safe and Stable Families............................          345,000           325,000           345,000   ................          +20,000
    Discretionary Funds.......................................           99,765           209,765            99,765   ................         -110,000
                                                               -----------------------------------------------------------------------------------------
      Total, Promoting Safe and Stable Families...............          444,765           534,765           444,765   ................          -90,000
                                                               =========================================================================================
            Payments for Foster Care and Permanency
 
Foster Care...................................................        5,537,000         5,329,000         5,329,000          -208,000   ................
Adoption Assistance...........................................        2,867,000         3,063,000         3,063,000          +196,000   ................
Guardianship..................................................          181,000           203,000           203,000           +22,000   ................
Independent Living............................................          140,000           140,000           140,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
      Total, Payments to States...............................        8,725,000         8,735,000         8,735,000           +10,000   ................
 
          Less Advances from Prior Year.......................       -2,500,000        -2,700,000        -2,700,000          -200,000   ................
                                                               -----------------------------------------------------------------------------------------
            Total, payments, current year.....................        6,225,000         6,035,000         6,035,000          -190,000   ................
 
            New Advance, 1st quarter, fiscal year 2020........        2,700,000         2,800,000         2,800,000          +100,000   ................
                                                               =========================================================================================
      Total, ACF..............................................       38,218,630        30,599,213        38,411,742          +193,112        +7,812,529
 
          Current year........................................      (34,118,630)      (26,399,213)      (34,211,742)         (+93,112)      (+7,812,529)
          Fiscal year 2020....................................       (4,100,000)       (4,200,000)       (4,200,000)        (+100,000)  ................
                                                               -----------------------------------------------------------------------------------------
            Total, ACF Program Level..........................       38,218,630        30,599,213        38,411,742          +193,112        +7,812,529
                                                               =========================================================================================
              ADMINISTRATION FOR COMMUNITY LIVING
 
            Aging and Disability Services Programs
 
Grants to States:
    Home and Community-based Supportive Services..............          385,074           350,224           385,074   ................          +34,850
    Preventive Health.........................................           24,848            24,848            24,848   ................  ................
    Protection of Vulnerable Older Americans-Title VII........           21,658            20,628            21,658   ................           +1,030
                                                               -----------------------------------------------------------------------------------------
      Subtotal................................................          431,580           395,700           431,580   ................          +35,880
 
    Family Caregivers.........................................          180,586           150,586           180,886              +300           +30,300
    Native American Caregivers Support........................            9,556             7,556             9,556   ................           +2,000
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Caregivers....................................          190,142           158,142           190,442              +300           +32,300
 
    Nutrition:
        Congregate Meals......................................          490,342           450,342           490,342   ................          +40,000
        Home Delivered Meals..................................          246,342           227,342           246,342   ................          +19,000
        Nutrition Services Incentive Program..................          160,069           160,069           160,069   ................  ................
                                                               -----------------------------------------------------------------------------------------
          Subtotal............................................          896,753           837,753           896,753   ................          +59,000
                                                               -----------------------------------------------------------------------------------------
          Subtotal, Grants to States..........................        1,518,475         1,391,595         1,518,775              +300          +127,180
 
Grants for Native Americans...................................           33,208            31,208            33,208   ................           +2,000
Aging Network Support Activities..............................           12,461             8,998            12,461   ................           +3,463
Alzheimer's Disease Program...................................            8,800            19,490             8,800   ................          -10,690
    Prevention and Public Health Fund.........................          (14,700)  ................          (14,700)  ................         (+14,700)
Lifespan Respite Care.........................................            4,110             3,360             4,110   ................             +750
Chronic Disease Self-Management Program.......................  ................  ................  ................  ................  ................
    Prevention and Public Health Fund.........................           (8,000)  ................           (8,000)  ................          (+8,000)
Elder Falls Prevention........................................  ................  ................  ................  ................  ................
    Prevention and Public Health Fund.........................           (5,000)  ................           (5,000)  ................          (+5,000)
Elder Rights Support Activities...............................           15,874            11,874            15,874   ................           +4,000
Aging and Disability Resources................................            8,119             6,119             8,119   ................           +2,000
State Health Insurance Program................................           49,115   ................           49,115   ................          +49,115
Paralysis Resource Center.....................................            7,700   ................            8,700            +1,000            +8,700
Limb loss.....................................................            3,500   ................            3,500   ................           +3,500
Traumatic Brain Injury........................................           11,321             9,321            11,321   ................           +2,000
 
Developmental Disabilities Programs:
    State Councils............................................           76,000            56,000            76,000   ................          +20,000
    Protection and Advocacy...................................           40,734            38,734            40,734   ................           +2,000
    Voting Access for Individuals with Disabilities...........            6,963             4,963             6,963   ................           +2,000
    Developmental Disabilities Projects of National                      12,000             1,050            12,000   ................          +10,950
     Significance.............................................
    University Centers for Excellence in Developmental                   40,619            32,546            40,619   ................           +8,073
     Disabilities.............................................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Developmental Disabilities Programs...........          176,316           133,293           176,316   ................          +43,023
 
Workforce Innovation and Opportunity Act
    Independent Living........................................          113,183            95,997           113,183   ................          +17,186
    National Institute on Disability, Independent Living, and           104,970   ................          108,970            +4,000          +108,970
     Rehabilitation Research..................................
    Assistive Technology......................................           36,000            31,939            36,000   ................           +4,061
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Workforce Innovation and Opportunity Act......          254,153           127,936           258,153            +4,000          +130,217
 
Aging and Disability Services Programs
    Area Agencies on Aging....................................  ................            7,500   ................  ................           -7,500
    National Center for Benefits Outreach and Enrollment......  ................           12,000   ................  ................          -12,000
    State Health Insurance Assistance.........................  ................           13,000   ................  ................          -13,000
    Aging and Disability Resource Centers.....................  ................            5,000   ................  ................           -5,000
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Aging and Disability Services Programs........  ................           37,500   ................  ................          -37,500
 
Program Administration........................................           41,063            37,987            41,063   ................           +3,076
                                                               =========================================================================================
      Total, Administration for Community Living (ACL)........        2,144,215         1,818,681         2,149,515            +5,300          +330,834
 
          Federal funds.......................................       (2,095,100)       (1,781,181)       (2,100,400)          (+5,300)        (+319,219)
          Trust Funds.........................................          (49,115)          (37,500)          (49,115)  ................         (+11,615)
          (Prevention and Public Health Fund )................          (27,700)  ................          (27,700)  ................         (+27,700)
      Total, ACL program level................................        2,171,915         1,818,681         2,177,215            +5,300          +358,534
                                                               =========================================================================================
                    OFFICE OF THE SECRETARY
 
                General Departmental Management
 
General Departmental Management, Federal Funds................          200,919           206,135           200,919   ................           -5,216
Teen Pregnancy Prevention Community Grants....................          101,000   ................          101,000   ................         +101,000
    Evaluation Tap Funding....................................           (6,800)  ................           (6,800)  ................          (+6,800)
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Grants........................................         (107,800)  ................         (107,800)  ................        (+107,800)
 
Sexual Risk Avoidance.........................................           25,000   ................           35,000           +10,000           +35,000
Office of Minority Health.....................................           56,670            53,956            56,670   ................           +2,714
Office on Women's Health......................................           32,140            28,454            32,140   ................           +3,686
Minority HIV/AIDS prevention and treatment....................           53,900   ................           53,900   ................          +53,900
Embryo Adoption Awareness Campaign............................            1,000             1,000             1,000   ................  ................
Planning and Evaluation, Evaluation Tap Funding...............          (58,028)          (53,445)          (58,028)  ................          (+4,583)
                                                               -----------------------------------------------------------------------------------------
      Subtotal, General Departmental Management...............          470,629           289,545           480,629           +10,000          +191,084
                                                               -----------------------------------------------------------------------------------------
      Total, General Departmental Management..................          470,629           289,545           480,629           +10,000          +191,084
 
          Federal Funds.......................................         (470,629)         (289,545)         (480,629)         (+10,000)        (+191,084)
          (Evaluation Tap Funding)............................          (64,828)          (53,445)          (64,828)  ................         (+11,383)
      Total, General Departmental Management Program..........          535,457           342,990           545,457           +10,000          +202,467
                                                               =========================================================================================
Account for the State Response to the Opioid Abuse Crisis,              500,000   ................  ................         -500,000   ................
 CURES Act....................................................
Office of Medicare Hearings and Appeals.......................          182,381           112,381           182,381   ................          +70,000
 
Office of Medicare Hearings and Appeals and Departmental        ................           10,000   ................  ................          -10,000
 Appeals Board Recovery Audit Contractor (RAC) appeals related
 expenses.....................................................
Office of the National Coordinator for Health Information                60,367            38,381            60,367   ................          +21,986
 Technology...................................................
Combatting Opioids Abuse and Misuse and Addressing Mental       ................       10,000,000   ................  ................      -10,000,000
 Illness......................................................
 
                  Office of Inspector General
 
Inspector General Federal Funds...............................           80,000            80,000            80,000   ................  ................
    HCFAC funding (NA)........................................         (334,097)         (334,097)         (334,097)  ................  ................
                                                               -----------------------------------------------------------------------------------------
      Total, Inspector General Program Level..................         (414,097)         (414,097)         (414,097)  ................  ................
                                                               =========================================================================================
                    Office for Civil Rights
 
Federal Funds.................................................           38,798            30,904            38,798   ................           +7,894
 
 Retirement Pay and Medical Benefits for Commissioned Officers
 
Retirement Payments...........................................          456,266           469,246           469,246           +12,980   ................
Survivors Benefits............................................           31,583            31,756            31,756              +173   ................
Dependents' Medical Care......................................          130,840           128,207           128,207            -2,633   ................
                                                               -----------------------------------------------------------------------------------------
      Total, Benefits for Commissioned Officers...............          618,689           629,209           629,209           +10,520   ................
                                                               =========================================================================================
   Public Health and Social Services Emergency Fund (PHSSEF)
 
       Assistant Secretary for Preparedness and Response
 
Operations....................................................           30,938            30,879            30,938   ................              +59
Preparedness and Emergency Operations.........................           24,654            26,596            24,654   ................           -1,942
National Disaster Medical System..............................           57,404            49,809            57,404   ................           +7,595
 
Hospital Preparedness Cooperative Agreement Grants:
    Formula Grants............................................          264,555           254,555           264,555   ................          +10,000
Biomedical Advanced Research and Development Authority (BARDA)          536,700           511,700           561,700           +25,000           +50,000
Policy and Planning...........................................           14,877            14,849            14,877   ................              +28
Project BioShield.............................................          710,000           510,000           735,000           +25,000          +225,000
Strategic National Stockpile..................................  ................          575,000   ................  ................         -575,000
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Preparedness and Response.....................        1,639,128         1,973,388         1,689,128           +50,000          -284,260
 
            Assistant Secretary for Administration
 
Assistant Secretary for Administration, Cybersecurity.........           50,860            68,093            58,860            +8,000            -9,233
Office of Security and Strategic Information..................            7,470             8,496             7,470   ................           -1,026
 
                   Public Health and Science
 
Medical Reserve Corps.........................................            6,000             3,900             6,000   ................           +2,100
Pandemic Influenza Preparedness...............................          250,000           250,000           285,000           +35,000           +35,000
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Non-pandemic flu/BioShield/Parklawn/Other               993,458         1,543,877         1,026,458           +33,000          -517,419
       construction...........................................
                                                               -----------------------------------------------------------------------------------------
      Total, PHSSEF...........................................        1,953,458         2,303,877         2,046,458           +93,000          -257,419
                                                               =========================================================================================
      Total, Office of the Secretary..........................        3,904,322        13,494,297         3,517,842          -386,480        -9,976,455
 
          Federal Funds.......................................        3,721,941        13,381,916         3,335,461          -386,480       -10,046,455
          Trust Funds.........................................          182,381           112,381           182,381   ................          +70,000
            (Evaluation Tap Funding)..........................          (64,828)          (53,445)          (64,828)  ................         (+11,383)
      Total, Office of the Secretary Program Level............        3,969,150        13,547,742         3,582,670          -386,480        -9,965,072
                                                               =========================================================================================
      Total, Title II, Health and Human Services..............      847,608,029       895,412,883       899,211,952       +51,603,923        +3,799,069
          Federal Funds.......................................      842,952,589       890,939,923       894,536,512       +51,583,923        +3,596,589
                Current year..................................     (704,004,830)     (748,808,126)     (752,404,715)     (+48,399,885)      (+3,596,589)
                Fiscal year 2020..............................     (138,947,759)     (142,131,797)     (142,131,797)      (+3,184,038)  ................
          Trust Funds.........................................        4,655,440         4,472,960         4,675,440           +20,000          +202,480
      Total, CURES Act........................................         (996,000)         (711,000)         (711,000)        (-285,000)  ................
      Total, Prevention and Public Health Fund................         (840,600)  ................         (848,000)          (+7,400)        (+848,000)
      Total, Transfers from Nonrecurring Expenses Fund........         (240,000)  ................  ................        (-240,000)  ................
                                                               =========================================================================================
              TITLE III--DEPARTMENT OF EDUCATION
 
                EDUCATION FOR THE DISADVANTAGED
 
Grants to Local Educational Agencies (LEAs)
    Basic Grants:
        Advance from prior year...............................       (1,840,776)       (1,540,776)       (1,540,776)        (-300,000)  ................
        Forward funded........................................        4,913,625         3,777,904         5,038,625          +125,000        +1,260,721
        Current funded........................................            5,000   ................            5,000   ................           +5,000
                                                               -----------------------------------------------------------------------------------------
          Subtotal, Basic grants current year approp..........        4,918,625         3,777,904         5,043,625          +125,000        +1,265,721
          Subtotal, Basic grants total funds available........       (6,759,401)       (5,318,680)       (6,584,401)        (-175,000)      (+1,265,721)
 
    Basic Grants Fiscal Year 2020 Advance.....................        1,540,776         2,681,497         1,415,776          -125,000        -1,265,721
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Basic grants, program level...................        6,459,401         6,459,401         6,459,401   ................  ................
 
    Concentration Grants:
        Advance from prior year...............................       (1,362,301)       (1,362,301)       (1,362,301)  ................  ................
        Fiscal year 2020 Advance..............................        1,362,301         1,362,301         1,362,301   ................  ................
                                                               -----------------------------------------------------------------------------------------
          Subtotal............................................        1,362,301         1,362,301         1,362,301   ................  ................
 
    Targeted Grants:
        Advance from prior year...............................       (3,819,050)       (3,969,050)       (3,969,050)        (+150,000)  ................
        Fiscal year 2020 Advance..............................        3,969,050         3,819,050         4,031,550           +62,500          +212,500
                                                               -----------------------------------------------------------------------------------------
          Subtotal............................................        3,969,050         3,819,050         4,031,550           +62,500          +212,500
 
    Education Finance Incentive Grants:
        Advance from prior year...............................       (3,819,050)       (3,969,050)       (3,969,050)        (+150,000)  ................
        Fiscal year 2020 Advance..............................        3,969,050         3,819,050         4,031,550           +62,500          +212,500
                                                               -----------------------------------------------------------------------------------------
          Subtotal............................................        3,969,050         3,819,050         4,031,550           +62,500          +212,500
                                                               =========================================================================================
      Subtotal, Grants to LEAs, program level.................       15,759,802        15,459,802        15,884,802          +125,000          +425,000
 
Innovative Approaches to Literacy.............................           27,000   ................           27,000   ................          +27,000
Comprehensive literacy development grants.....................          190,000   ................          190,000   ................         +190,000
 
State Agency Programs:
    Migrant...................................................          374,751           374,751           374,751   ................  ................
    Neglected and Delinquent/High Risk Youth..................           47,614            47,614            47,614   ................  ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, State Agency programs.........................          422,365           422,365           422,365   ................  ................
 
Special Programs for Migrant Students.........................           44,623            44,623            44,623   ................  ................
                                                               -----------------------------------------------------------------------------------------
      Total, Education for the disadvantaged..................       16,443,790        15,926,790        16,568,790          +125,000          +642,000
 
          Current year........................................       (5,602,613)       (4,244,892)       (5,727,613)        (+125,000)      (+1,482,721)
          Fiscal year 2020....................................      (10,841,177)      (11,681,898)      (10,841,177)  ................        (-840,721)
      Subtotal, Forward Funded................................       (5,525,990)       (4,200,269)       (5,650,990)        (+125,000)      (+1,450,721)
                                                               =========================================================================================
                          IMPACT AID
 
Basic Support Payments........................................        1,270,242         1,189,233         1,294,242           +24,000          +105,009
Payments for Children with Disabilities.......................           48,316            48,316            48,316   ................  ................
Facilities Maintenance (Sec. 8008)............................            4,835             4,835             4,835   ................  ................
Construction (Sec. 8007)......................................           17,406            17,406            17,406   ................  ................
Payments for Federal Property (Sec. 8002).....................           73,313   ................           74,313            +1,000           +74,313
                                                               -----------------------------------------------------------------------------------------
      Total, Impact aid.......................................        1,414,112         1,259,790         1,439,112           +25,000          +179,322
                                                               =========================================================================================
                  SCHOOL IMPROVEMENT PROGRAMS
 
Supporting Effective Instruction State Grants.................          374,389   ................          374,389   ................         +374,389
    Advance from prior year...................................       (1,681,441)       (1,681,441)       (1,681,441)  ................  ................
    Fiscal year 2020..........................................        1,681,441   ................        1,681,441   ................       +1,681,441
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Supporting Effective Instruction State Grants,        2,055,830   ................        2,055,830   ................       +2,055,830
       program level..........................................
 
Supplemental Education Grants.................................           16,699            16,699            16,699   ................  ................
21st Century Community Learning Centers.......................        1,211,673   ................        1,211,673   ................       +1,211,673
State Assessments.............................................          378,000           369,100           378,000   ................           +8,900
Education for Homeless Children and Youth.....................           85,000            77,000            93,500            +8,500           +16,500
Training and Advisory Services (Civil Rights).................            6,575             6,575             6,575   ................  ................
Education for Native Hawaiians................................           36,397   ................           36,397   ................          +36,397
Alaska Native Education Equity................................           35,453   ................           35,453   ................          +35,453
Rural Education...............................................          180,840           175,840           180,840   ................           +5,000
Comprehensive Centers.........................................           52,000   ................           52,000   ................          +52,000
Student Support and Academic Enrichment grants................        1,100,000   ................        1,225,000          +125,000        +1,225,000
                                                               -----------------------------------------------------------------------------------------
      Total, School Improvement Programs......................        5,158,467           645,214         5,291,967          +133,500        +4,646,753
 
          Current year........................................       (3,477,026)         (645,214)       (3,610,526)        (+133,500)      (+2,965,312)
          Fiscal year 2020....................................       (1,681,441)  ................       (1,681,441)  ................      (+1,681,441)
      Subtotal, Forward Funded................................       (3,329,902)         (621,940)       (3,463,402)        (+133,500)      (+2,841,462)
                                                               =========================================================================================
                       INDIAN EDUCATION
 
Grants to Local Educational Agencies..........................          105,381           100,381           105,381   ................           +5,000
 
Federal Programs:
    Special Programs for Indian Children......................           67,993            57,993            67,993   ................          +10,000
    National Activities.......................................            6,865             6,565             6,865   ................             +300
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Federal Programs..............................           74,858            64,558            74,858   ................          +10,300
                                                               -----------------------------------------------------------------------------------------
      Total, Indian Education.................................          180,239           164,939           180,239   ................          +15,300
                                                               =========================================================================================
                  INNOVATION AND IMPROVEMENT
 
Opportunity Grants............................................  ................        1,000,000   ................  ................       -1,000,000
Education Innovation and Research.............................          120,000           180,000           135,000           +15,000           -45,000
American History and Civics Academies.........................            1,815   ................            1,815   ................           +1,815
American History and Civics National Activities...............            1,700   ................            1,700   ................           +1,700
Charter Schools Grants........................................          400,000           500,000           445,000           +45,000           -55,000
Magnet Schools Assistance.....................................          105,000            97,647           105,000   ................           +7,353
Teacher and School Leader Incentive Grants....................          200,000   ................          200,000   ................         +200,000
Ready-to-Learn Television.....................................           27,741   ................           27,741   ................          +27,741
Supporting Effective Educator Development (SEED)..............           75,000   ................           75,000   ................          +75,000
Arts in Education.............................................           29,000   ................           29,000   ................          +29,000
Javits Gifted and Talented Students...........................           12,000   ................           12,000   ................          +12,000
Statewide Family Engagement Centers...........................           10,000   ................           10,000   ................          +10,000
                                                               -----------------------------------------------------------------------------------------
      Total, Innovation and Improvement.......................          982,256         1,777,647         1,042,256           +60,000          -735,391
 
          Current Year........................................         (982,256)       (1,777,647)       (1,042,256)         (+60,000)        (-735,391)
                                                               -----------------------------------------------------------------------------------------
            SAFE SCHOOLS AND CITIZENSHIP EDUCATION
 
Promise Neighborhoods.........................................           78,254   ................           78,254   ................          +78,254
School Safety National Activities.............................           90,000            43,000            95,000            +5,000           +52,000
Full-Service Community Schools................................           17,500   ................           17,500   ................          +17,500
                                                               -----------------------------------------------------------------------------------------
      Total, Safe Schools and Citizenship Education...........          185,754            43,000           190,754            +5,000          +147,754
                                                               =========================================================================================
                 ENGLISH LANGUAGE ACQUISITION
 
Current funded................................................           47,931            47,931            47,931   ................  ................
Forward funded................................................          689,469           689,469           689,469   ................  ................
                                                               -----------------------------------------------------------------------------------------
      Total, English Language Acquisition.....................          737,400           737,400           737,400   ................  ................
                                                               =========================================================================================
                       SPECIAL EDUCATION
 
State Grants:
    Grants to States Part B current year......................        2,994,465         1,878,745         3,119,465          +125,000        +1,240,720
        Part B advance from prior year........................       (9,283,383)       (9,283,383)       (9,283,383)  ................  ................
    Grants to States Part B (fiscal year 2020)................        9,283,383        10,124,103         9,283,383   ................         -840,720
                                                               -----------------------------------------------------------------------------------------
      Subtotal, program level.................................       12,277,848        12,002,848        12,402,848          +125,000          +400,000
 
    Preschool Grants..........................................          381,120           368,238           381,120   ................          +12,882
    Grants for Infants and Families...........................          470,000           458,556           470,000   ................          +11,444
                                                               -----------------------------------------------------------------------------------------
      Subtotal, program level.................................       13,128,968        12,829,642        13,253,968          +125,000          +424,326
 
IDEA National Activities (current funded):
    State Personnel Development...............................           38,630            38,630            38,630   ................  ................
    Technical Assistance and Dissemination (including Special            59,428            44,345            61,928            +2,500           +17,583
     Olympics Education)......................................
    Personnel Preparation.....................................           83,700            83,700            83,700   ................  ................
    Parent Information Centers................................           27,411            27,411            27,411   ................  ................
Educational Technology, Media, and Materials..................           28,047            28,047            28,047   ................  ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, IDEA National Activities......................          237,216           222,133           239,716            +2,500           +17,583
 
Adjustment to match official bill language....................  ................                1   ................  ................               -1
                                                               -----------------------------------------------------------------------------------------
      Total, Special education................................       13,366,184        13,051,776        13,493,684          +127,500          +441,908
 
          Current year........................................       (4,082,801)       (2,927,673)       (4,210,301)        (+127,500)      (+1,282,628)
          Fiscal year 2020....................................       (9,283,383)      (10,124,103)       (9,283,383)  ................        (-840,720)
      Total, Forward Funded...................................       (3,845,585)       (2,705,539)       (3,970,585)        (+125,000)      (+1,265,046)
                                                               =========================================================================================
                    REHABILITATION SERVICES
 
Vocational Rehabilitation State Grants........................        3,452,931         3,521,990         3,521,990           +69,059   ................
Client Assistance State grants................................           13,000            13,000            13,000   ................  ................
Training......................................................           29,388            29,388            29,388   ................  ................
Demonstration and Training programs...........................            5,796             9,296             5,796   ................           -3,500
Protection and Advocacy of Individual Rights [PAIR]...........           17,650            17,650            17,650   ................  ................
Supported Employment State grants.............................           22,548   ................           22,548   ................          +22,548
 
Independent Living:
    Services for Older Blind Individuals......................           33,317            33,317            33,317   ................  ................
Helen Keller National Center for Deaf/Blind Youth and Adults..           12,500            10,336            12,500   ................           +2,164
                                                               -----------------------------------------------------------------------------------------
      Total, Rehabilitation services..........................        3,587,130         3,634,977         3,656,189           +69,059           +21,212
                                                               =========================================================================================
      SPECIAL INSTITUTIONS FOR PERSONS WITH DISABILITIES
 
American Printing House for the Blind.........................           27,431            25,431            30,431            +3,000            +5,000
 
National Technical Institute for the Deaf [NTID]:
    Operations................................................           73,000            70,016            76,500            +3,500            +6,484
 
Gallaudet University:
    Operations................................................          128,000           121,275           133,000            +5,000           +11,725
                                                               -----------------------------------------------------------------------------------------
      Total, Gallaudet University.............................          128,000           121,275           133,000            +5,000           +11,725
                                                               -----------------------------------------------------------------------------------------
      Total, Special Institutions for Persons with                      228,431           216,722           239,931           +11,500           +23,209
       Disabilities...........................................
                                                               =========================================================================================
            CAREER, TECHNICAL, AND ADULT EDUCATION
 
Career Education:
    Basic State Grants/Secondary & Technical Education State            401,598           326,598           401,598   ................          +75,000
     Grants, current funded...................................
        Advance from prior year...............................         (791,000)         (791,000)         (791,000)  ................  ................
        Fiscal year 2020......................................          791,000           791,000           791,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
          Subtotal, Basic State Grants, program level.........        1,192,598         1,117,598         1,192,598   ................          +75,000
 
    National Programs.........................................            7,421            20,000             7,421   ................          -12,579
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Career Education..............................        1,200,019         1,137,598         1,200,019   ................          +62,421
 
Adult Education:
    State Grants/Adult Basic and Literacy Education:
        State Grants, current funded..........................          616,955           485,849           641,955           +25,000          +156,106
National Leadership Activities................................           13,712            13,712            13,712   ................  ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Adult education...............................          630,667           499,561           655,667           +25,000          +156,106
                                                               -----------------------------------------------------------------------------------------
      Total, Career, Technical, and Adult Education...........        1,830,686         1,637,159         1,855,686           +25,000          +218,527
 
          Current year........................................       (1,039,686)         (846,159)       (1,064,686)         (+25,000)        (+218,527)
          Fiscal year 2020....................................         (791,000)         (791,000)         (791,000)  ................  ................
      Total, Forward Funded...................................       (1,039,686)         (846,159)       (1,064,686)         (+25,000)        (+218,527)
                                                               =========================================================================================
                 STUDENT FINANCIAL ASSISTANCE
 
Pell Grants--maximum grant (NA)...............................           (5,035)           (4,860)           (5,135)            (+100)            (+275)
Pell Grants...................................................       22,475,352        22,475,352        22,475,352   ................  ................
Federal Supplemental Educational Opportunity Grants...........          840,000   ................          840,000   ................         +840,000
Federal Work Study............................................        1,130,000           500,000         1,130,000   ................         +630,000
                                                               -----------------------------------------------------------------------------------------
      Total, Student Financial Assistance [SFA]...............       24,445,352        22,975,352        24,445,352   ................       +1,470,000
                                                               =========================================================================================
FEDERAL DIRECT STUDENT LOAN PROGRAM ACCOUNT...................          350,000   ................          350,000   ................         +350,000
 
                  STUDENT AID ADMINISTRATION
 
Salaries and Expenses.........................................          698,943           762,000           698,943   ................          -63,057
Servicing Activities..........................................          980,000         1,010,000           980,000   ................          -30,000
                                                               -----------------------------------------------------------------------------------------
      Total, Student Aid Administration.......................        1,678,943         1,772,000         1,678,943   ................          -93,057
                                                               =========================================================================================
                       HIGHER EDUCATION
 
Aid for Institutional Development:
    Strengthening Institutions................................           98,886   ................          101,067            +2,181          +101,067
    Hispanic Serving Institutions.............................          123,183   ................          125,898            +2,715          +125,898
    Promoting Post-Baccalaureate Opportunities for Hispanic              11,052   ................           11,296              +244           +11,296
     Americans................................................
    Strengthening Historically Black Colleges (HBCUs).........          279,624           244,694           285,788            +6,164           +41,094
    Strengthening Historically Black Graduate Institutions....           72,314            63,281            73,908            +1,594           +10,627
    Strengthening Predominantly Black Institutions............           11,361   ................           11,611              +250           +11,611
    Asian American Pacific Islander...........................            3,826   ................            3,910               +84            +3,910
    Strengthening Alaska Native and Native Hawaiian-Serving              15