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116th Congress  }                                     {   Report
                        HOUSE OF REPRESENTATIVES        
2d Session      }                                     {   116-450
_______________________________________________________________________

                                     

                                     

  DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND 
               RELATED AGENCIES APPROPRIATIONS BILL, 2021

                               ----------                              

                              R E P O R T

                                 of the

                       COMMITTEE ON APPROPRIATION
                        HOUSE OF REPRESENTATIVES

                                   on

                               H.R. 7614

                             together with

                             MINORITY VIEWS




 July 15, 2020.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed
              
              
              
              

  DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND 
               RELATED AGENCIES APPROPRIATIONS BILL, 2021
               
               
               
               
               
               
116th Congress }                                              {   Report
                          HOUSE OF REPRESENTATIVES                 
2d Session     }                                              {  116-450
_______________________________________________________________________

                                     

                                     

  DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND 
               RELATED AGENCIES APPROPRIATIONS BILL, 2021

                               __________

                              R E P O R T

                                 of the

                      COMMITTEE ON APPROPRIATIONS

                        HOUSE OF REPRESENTATIVES

                                   on

                               H.R. 7614

                             together with

                             MINORITY VIEWS
                             







 July 15, 2020.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed
              
              
              
              
                             ______

              U.S. GOVERNMENT PUBLISHING OFFICE 
 40-837                WASHINGTON : 2020 
              
              
              
              





116th Congress   }                                            {    Report
                        HOUSE OF REPRESENTATIVES
 2d Session      }                                            {   116-450

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



 
  DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND 
               RELATED AGENCIES APPROPRIATIONS BILL, 2021

                                _______
                                

 July 15, 2020.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

   Ms. DeLauro, from the Committee on Appropriations, submitted the 
                               following

                              R E P O R T

                             together with

                             MINORITY VIEWS

                        [To accompany H.R. 7614]

    The Committee on Appropriations submits the following 
report in explanation of the accompanying bill making 
appropriations for the Departments of Labor, Health and Human 
Services (except the Food and Drug Administration, the Agency 
for Toxic Substances and Disease Registry and the Indian Health 
Service), and Education, and the Committee for Purchase from 
People Who Are Blind or Severely Disabled, Corporation for 
National and Community Service, Corporation for Public 
Broadcasting, Federal Mediation and Conciliation Service, 
Federal Mine Safety and Health Review Commission, Institute of 
Museum and Library Services, Medicaid and CHIP Payment and 
Access Commission, Medicare Payment Advisory Commission, 
National Council on Disability, National Labor Relations Board, 
National Mediation Board, Occupational Safety and Health Review 
Commission, Railroad Retirement Board, and Social Security 
Administration for the fiscal year ending September 30, 2021, 
and for other purposes.

                        INDEX TO BILL AND REPORT

_______________________________________________________________________


                                                            Page number

                                                            Bill Report
Summary of Estimates and Appropriations....................
                                                                      3
General Summary of the Bill................................
                                                                      3
Title I--Department of Labor:
        Employment and Training Administration.............     2
                                                                     12
        Employee Benefits Security Administration..........    20
                                                                     24
        Pension Benefit Guaranty Corporation...............    21
                                                                     24
        Wage and Hour Division.............................    22
                                                                     24
        Office of Labor-Management Standards...............    22
                                                                     26
        Office of Federal Contract Compliance Programs.....    23
                                                                     26
        Office of Workers' Compensation Programs...........    23
                                                                     27
        Occupational Safety and Health Administration......    27
                                                                     29
        Mine Safety and Health Administration..............    28
                                                                     30
        Bureau of Labor Statistics.........................    30
                                                                     31
        Office of Disability Employment Policy.............    31
                                                                     33
        Departmental Management............................    31
                                                                     33
        General Provisions.................................    36
                                                                     39
Title II--Department of Health and Human Services:
        Health Resources and Services Administration.......    46
                                                                     40
        Centers for Disease Control and Prevention.........    56
                                                                     61
        National Institutes of Health......................    63
                                                                     92
        Substance Abuse and Mental Health Services 
            Administration.................................    72
                                                                    152
        Agency for Healthcare Research and Quality.........    77
                                                                    157
        Centers for Medicare & Medicaid Services...........    78
                                                                    159
        Administration for Children and Families...........    83
                                                                    176
        Administration for Community Living................    93
                                                                    197
        Office of the Secretary............................    96
                                                                    205
        Public Health and Social Services Emergency Fund...   100
                                                                    221
        General Provisions.................................   102
                                                                    228
Title III--Department of Education:
        Education for the Disadvantaged....................   126
                                                                    232
        Impact Aid.........................................   127
                                                                    235
        School Improvement Programs........................   128
                                                                    236
        Indian Education...................................   130
                                                                    241
        Innovation and Improvement.........................   130
                                                                    242
        Safe Schools and Citizenship Education.............   131
                                                                    248
        English Language Acquisition.......................   131
                                                                    250
        Special Education..................................   132
                                                                    251
        Rehabilitation Services............................   136
                                                                    253
        Special Institutions for Persons with Disabilities.   138
                                                                    255
        Career, Technical and Adult Education..............   138
                                                                    257
        Student Financial Assistance.......................   139
                                                                    259
        Federal Direct Student Loan Program Account........
                                                                    262
        Student Aid Administration.........................   139
                                                                    263
        Higher Education...................................   143
                                                                    266
        Howard University..................................   144
                                                                    276
        College Housing and Academic Facilities Loans......   144
                                                                    276
        Historically Black College and University Capital 
            Financing Program Account......................   144
                                                                    276
        Institute of Education Sciences....................   146
                                                                    277
        Departmental Management............................   147
                                                                    279
        General Provisions.................................   148
                                                                    288
Title IV--Related Agencies:
        Committee for the Purchase from People Who Are 
            Blind or Severely Disabled.....................   162
                                                                    289
        Corporation for National and Community Service.....   163
                                                                    290
        Corporation for Public Broadcasting................   168
                                                                    293
        Federal Mediation and Conciliation Service.........   169
                                                                    294
        Federal Mine Safety and Health Review Commission...   170
                                                                    295
        Institute of Museum and Library Services...........   170
                                                                    295
        Medicaid and CHIP Payment and Access Commission....   170
                                                                    296
        Medicare Payment Advisory Commission...............   171
                                                                    296
        National Council on Disability.....................   171
                                                                    296
        National Labor Relations Board.....................   171
                                                                    297
        National Mediation Board...........................   173
                                                                    299
        Occupational Safety and Health Review Commission...   173
                                                                    300
        Railroad Retirement Board..........................   173
                                                                    300
        Social Security Administration.....................   175
                                                                    301
Title V--General Provisions:
Title VI--Emergency Funding:
House of Representatives Report Requirements


                Summary of Estimates and Appropriations

    The following table compares on a summary basis the 
appropriations, including trust funds for fiscal year 2021, the 
budget request for fiscal year 2021, and the Committee 
recommendation for fiscal year 2021 in the accompanying bill.

                                         2021 LABOR, HHS, EDUCATION BILL
                                 [Discretionary funding in thousands of dollars]
----------------------------------------------------------------------------------------------------------------
                                                   Fiscal Year--                   2021 Committee compared to--
         Budget Activity         -------------------------------------------------------------------------------
                                   2020 Enacted     2021 Budget   2021 Committee   2020 Enacted     2021 Budget
----------------------------------------------------------------------------------------------------------------
Department of Labor.............     $12,413,848     $11,174,499     $12,667,501        +253,653      +1,493,002
Department of Health and Human       $94,901,177     $85,267,729     $96,357,874      +1,456,797     +11,090,145
 Services.......................
Department of Education.........     $72,751,214     $66,560,692     $73,467,154        +715,940      +6,906,462
Related Agencies................     $15,346,861     $14,146,294     $15,507,471        +160,610      +1,361,177
----------------------------------------------------------------------------------------------------------------

                      General Summary of the Bill

    For fiscal year 2021, the Committee recommends a total of 
$182,914,000,000 in current year discretionary funding--the 
302(b) allocation--and $196,546,000,000 in overall programmatic 
funding, including offsets and adjustments. The fiscal year 
2021 recommendation is an increase of $2,399,000,000 above the 
fiscal year 2020 enacted level.

                           COVID-19 PANDEMIC

    The United States and the international community continue 
to respond to the deadly COVID-19 pandemic--the worst public 
health crisis of the last century.
    According to the Centers for Disease Control and Prevention 
(CDC), between February 29 and June 30, the U.S. recorded more 
than 2.6 million cases of coronavirus and 127,000 deaths due to 
COVID-19. Moreover, those figures likely under count the true 
toll of the pandemic, due to a shortage of diagnostic testing 
since the virus began spreading across our communities in early 
2020.
    Unfortunately, the Administration's response to the 
coronavirus pandemic has been inconsistent and incoherent.
    In a public health emergency, historically, the Federal 
response should be led by the CDC, the nation's foremost public 
health agency, based on science and public health expertise. 
The Trump Administration, however, has sidelined the CDC and 
downplayed the recommendations of the world's foremost public 
health experts.
    In their place, the Administration has elevated non-expert 
views of political appointees in the White House. As a result, 
the Administration did not develop a coordinated Federal 
strategy to contain the coronavirus, which has resulted in the 
worst response to the pandemic of any of the world's 
economically-advanced industrialized nations.
    Other nations, from Germany to South Korea, applied 
rigorous public health guidelines to successfully contain the 
coronavirus. The U.S., on the other hand, deferred to political 
operatives and business leaders to focus on reopening economic 
activity without regard to public health. As a result, while 
nations such as New Zealand and Japan have contained the 
coronavirus, the U.S. has suffered approximately one-quarter of 
COVID-19 deaths across the globe, despite having less than five 
percent of the global population.
    Congress demanded a national strategy for diagnostic 
testing and contact tracing to contain the virus and enable 
Americans to return to economic and social activities--but the 
Administration deferred to States to take action. Despite the 
urgent need for federal leadership, the Administration 
announced that States should develop their own testing plans 
and the federal government should be considered ``the supplier 
of last resort.''
    In response to the COVID-19 pandemic, the President 
abdicated all federal responsibility. As a result, the 
Administration's failed response cannot be defended from a 
public health perspective.
    But it did not have to be this way.

Timeline

    In January, China confirmed its first known death caused by 
the novel coronavirus. Shortly thereafter, cases were 
identified in Japan, South Korea, Thailand, and the United 
States. By January 23, China closed down Wuhan, a city of 11 
million people and the epicenter of the outbreak.
    On January 25, HHS Secretary Alex Azar notified the 
Committee that the CDC would begin to access funds in the 
Infectious Diseases Rapid Response Reserve Fund, which was 
first established in the fiscal year 2019 Labor-HHS Education 
Appropriations Act, to support public health preparedness and 
response activities.
    On January 30, the World Health Organization declared a 
``public health emergency of international concern.'' The 
following day, the Administration imposed travel restrictions 
to prevent foreign nationals who had recently traveled to China 
from entering the United States.
    The evidence was becoming clear--the U.S. needed to prepare 
for a serious public health crisis.
    On February 4, House Appropriations Committee Chairwoman 
Nita Lowey and LHHS Subcommittee Chair Rosa DeLauro sent a 
letter to HHS Secretary Alex Azar, urging him to submit a 
request for emergency supplemental appropriations to prepare 
for this public health threat. Chairwoman Lowey and Chair 
DeLauro noted: ``It is clear, however, that further resources 
will be necessary to support an aggressive and comprehensive 
government-wide response to the 2019 novel Coronavirus, both 
domestically and internationally.''
    The Chairwomen urged the Secretary to submit an emergency 
supplemental request no later than February 10, including 
sufficient resources to support ``surveillance, epidemiology, 
and laboratory capacity; enhanced screening at ports of entry; 
repatriation of U.S. nationals; mandatory quarantine of 
travelers; research, advanced development, and procurement of 
medical countermeasures, including vaccines, therapeutics, and 
diagnostics; communications and public awareness; direct 
assistance to state and local public health departments, 
including through the Public Health Emergency Preparedness 
Cooperative Agreement and the Hospital Preparedness Program; 
and other activities to prevent, prepare for, or respond to the 
2019 novel Coronavirus.''
    In response, the Administration noted ``[it] is still early 
on in the response effort for the 2019-nCOV and we cannot 
predict with accuracy when [the Infectious Diseases Rapid 
Response Reserve Fund] will run out of funding, nor how the 
outbreak and our response needs will evolve.'' The 
Administration did not submit a request for emergency 
supplemental appropriations until February 24--at which point, 
the request was limited to $1,250,000,000 in new emergency 
funding, repurposing of $535,000,000 in emergency funding for 
Ebola, and transfers from other existing health programs.
    On February 25, Dr. Nancy Messonnier, Director of the CDC's 
National Center for Immunization and Respiratory Diseases, held 
a media briefing and presciently warned the country of the 
severity of the coronavirus outbreak. According to Dr. 
Messonnier, ``Ultimately, we expect we will see community 
spread in the United States. It's not a question of if this 
will happen, but when this will happen and how many people in 
this country will have severe illnesses.'' She further noted, 
``disruptions to everyday life may be severe'' and advised that 
Americans should begin to plan accordingly.
    According to credible media accounts, President Trump did 
not heed the warning of the CDC's foremost expert on 
respiratory diseases. Instead, the President was angry at Dr. 
Messonnier for upsetting the stock market.
    On February 25, in response to the CDC's warnings, Larry 
Kudlow, Director of the National Economic Council, told 
reporters, ``We have contained this. I won't say airtight, but 
pretty close to airtight.'' The following day, the President 
said, ``It's going to disappear. One day, it's like a miracle, 
it's going to disappear.''
    Two weeks later, on March 11, the World Health Organization 
declared the coronavirus outbreak a pandemic. On March 13, the 
President declared a state of national emergency under the 
Stafford Act and four days later, on March 17, the President 
encouraged Americans to work from home, postpone unnecessary 
travel, and avoid gatherings of more than 10 people.
    At the time, in mid-March, there were fewer than 100 
confirmed or presumed cases of COVID-19 in the United States. 
The country heeded the advice of public health experts to 
mitigate the spread of COVID-19 and to flatten the curve of the 
outbreak--thereby reducing the peak number of hospitalizations, 
easing the strain on the health care system, and saving 
hundreds of thousands of American lives.
    But the Trump Administration quickly reverted to its 
inconsistent and incoherent response.
    By April and May, the Administration had essentially given 
up any attempt to mitigate or contain the COVID-19 pandemic. As 
more than 1,300 Americans died every day of COVID-19, and more 
than 23,000 Americans tested positive every day, the 
Administration inexplicably shifted its attention to re-
starting economic and social activities. The White House urged 
States to reopen businesses and the President urged Governors 
to dismantle public health measures.
    Public health leaders continued to express deep concerns 
about re-starting economic and social activities without 
sufficient testing, contact tracing, or quarantine 
capabilities.
    The CDC published guidance for schools, child care, 
employers with workers at high risk, restaurants and bars, and 
mass transit. The CDC advised against crowded indoor 
gatherings.
    Not a single State met the CDC's recommended thresholds for 
widespread reopening of activities. But the Administration 
urged States to reopen anyway.
    In the span of only two months--April and May--100,000 
Americans died of COVID-19.
    In June, as States relaxed stay-at-home orders and reopened 
businesses, coronavirus cases in the U.S. surged by nearly 50 
percent. The surge of new cases was led by States that reopened 
their economies most rapidly and aggressively. By the end of 
June, the U.S. reported a total of more than 125,000 deaths due 
to COVID-19.
    On July 1, States reported more than 52,000 new cases, the 
highest single-day total since the beginning of the pandemic. 
The new single-day peak lasted for 24 hours. On July 2, States 
reported more than 55,000 new cases. On July 3, States reported 
more than 57,000 new cases.

Emergency Supplemental Appropriations

    Despite the Administration's inconsistent and incoherent 
response to the coronavirus pandemic, the Appropriations 
Committee has worked on a bipartisan basis since the beginning 
of the outbreak. Since March 6, Congress has passed four 
emergency supplemental appropriations packages, including more 
than $2,000,000,000,000 in emergency relief through the CARES 
Act. In addition, the House of Representatives passed the 
Heroes Act on May 15 to provide further emergency relief--
however, the Senate has thus far failed to vote on the bill.
    On March 4, the House of Representatives passed the first 
emergency supplemental appropriations bill, the Coronavirus 
Preparedness and Response Supplemental Appropriations Act (P.L. 
116-123). The bill included a total of $8,300,000,000, 
including $6,100,000,000 through the Labor-HHS Education 
subcommittee--

           $2,200,000,000 for the CDC to support State 
        and local public health departments, including for 
        surveillance, laboratory testing, contact tracing, 
        infection control; and mitigation; as well as global 
        disease detection and emergency response;

           More than $3,000,000,000 for NIH and BARDA 
        to support research and development of vaccines, 
        therapeutics, and diagnostics; and

           Nearly $1,000,000 for procurement of masks, 
        personal protective equipment, pharmaceuticals, and 
        other medical supplies, as well as funding for 
        Community Health Centers.

    On March 14, the House of Representatives passed the second 
emergency supplemental appropriations bill, the Families First 
Coronavirus Response Act (P.L. 116-127). The bill included a 
total of $192,000,000,000, including $21,000,000,000 for 
Supplemental Nutrition Assistance Program benefits and 
$50,000,000,000 to increase the Federal share of expenditures 
in the Medicaid and CHIP programs, as well as $1.25 billion 
through the Labor-HHS Education subcommittee--

           $250,000,000 for home-delivered and 
        prepackaged meals for low-income seniors; and

           $1,000,000,000 to cover diagnostic testing 
        for the uninsured.

    On March 27, the House of Representatives passed the third 
emergency supplemental appropriations bill, the Coronavirus 
Aid, Relief, and Emergency Security Act (CARES Act) (P.L. 116-
136). The bill included more than $2,000,000,000,000 in 
emergency relief, including direct payments to households, 
enhanced unemployment compensation, and emergency assistance 
for state and local governments, small businesses, and 
corporation. The CARES Act included $172,000,000,000 in 
emergency supplemental appropriations through the Labor-HHS 
Education subcommittee--

           $100,000,000,000 for health care providers 
        to cover health care expenses or lost revenues 
        attributable to the coronavirus;

           $27,000,000,000 for the Assistant Secretary 
        for Preparedness and Response, including 
        $16,000,000,000 for the Strategic National Stockpile 
        and at least $3,500,000,000 for additional advanced 
        research and development of vaccines and therapeutics;

           $4,300,000,000 for the CDC to support State 
        and local public health departments, including for 
        surveillance, laboratory testing, contact tracing, 
        infection control; and mitigation; as well as global 
        disease detection and emergency response;

           $945,000,000 for NIH to expand research on 
        COVID-19;

           $425,000,000 for mental health and substance 
        abuse prevention and treatment activities at the 
        Substance Abuse and Mental Health Services 
        Administration (SAMHSA);

           $200,000,000 for CMS to assist nursing homes 
        with infection control and support States' efforts to 
        prevent the spread of coronavirus in nursing homes;

           $6,300,000,000 for the Administration for 
        Children and Families (ACF), supporting child care for 
        essential workers including healthcare workers and 
        first responders, Head Start, and grants to States for 
        community and social services, home energy assistance, 
        child welfare services, runaway and homeless youth, and 
        family violence prevention services;

           $955,000,000 for the Administration for 
        Community Living (ACL) to support nutrition programs, 
        home- and community-based services, support for family 
        caregivers, and expand oversight and protections for 
        seniors and individuals with disabilities;

           $275,000,000 for the Health Resources and 
        Services Administration, including funding for rural 
        hospitals, expansion of telehealth services, and Ryan 
        White HIV/AIDS programs;

           $30,900,000,000 for the Department of 
        Education to assist students, school districts, 
        institutions of higher education and States with 
        immediate needs related to the coronavirus;

           $360,000,000 for the Department of Labor, 
        including $345,000,000 for States and communities to 
        respond to workforce impacts and layoffs resulting from 
        the coronavirus through the Dislocated Worker National 
        Reserve;

           $338,000,000 for the Social Security 
        Administration to support essential telework, 
        communication needs, and salaries and benefits of 
        Federal employees impacted by office closures, and for 
        the purposes of issuing emergency assistance Economic 
        Impact Payments;

           $75,000,000 for stabilization grants through 
        the Corporation for Public Broadcasting to maintain 
        programming services and to preserve small and rural 
        public telecommunication stations;

           $50,000,000 for digital access and technical 
        support services through the Institute for Museum and 
        Library Services; and

           $5,000,000 for the Railroad Retirement Board 
        to support telework and administer the Railroad 
        Unemployment Insurance Act.

    On April 23, the House of Representatives passed the fourth 
emergency supplemental appropriations bill, the Paycheck 
Protection Program and Health Care Enhancement Act (P.L. 116-
139). The bill included nearly $500,000,000,000 in emergency 
relief, including $100,000,000,000 through the Labor-HHS 
Education subcommittee--

           $75,000,000,000 for the Health Care Provider 
        Relief Fund; and

           $25,000,000,000 to support increased 
        diagnostic testing and contact tracing across the 
        United States.

    On May 15, the House of Representatives passed the Heroes 
Act (H.R. 6800). The bill includes more than $3,000,000,000,000 
in emergency relief for American families, workers, and 
businesses, as well as ongoing emergency response activities, 
including nearly $200,000,000,000 through the Labor-HHS 
Education subcommittee--

           $100,000,000,000 for the Health Care 
        Provider Relief Fund;

           $75,000,000,000 to support increased 
        diagnostic testing and contact tracing;

           $7,600,000,000 for Community Health Centers;

           $2,100,000,000 for the CDC to support State 
        and local public health agencies;

           $4,700,000,000 for NIH to expand research on 
        COVID-19, as well as support research projects 
        interrupted by the pandemic;

           $4,500,000,000 for BARDA for additional 
        advanced research and development of vaccines and 
        therapeutics;

           $10,100,000,000 for the Administration for 
        Children and Families (ACF), including $7,000,000,000 
        in Child Care and Development Block Grant (CCDBG) 
        funding to States, $3,000,000,000 in home energy and 
        water bill assistance to low income households, and 
        additional funding for family violence and child abuse 
        prevention services;

           $100,000,000,000 to provide direct services 
        such as home-delivered and pre-packaged meals, and 
        supportive services for seniors and disabled 
        individuals and their caregivers through the 
        Administration for Community Living (ACL);

           $100,200,000,000 to support the educational 
        needs of students, school districts, institutions of 
        higher education and States in response to the 
        coronavirus, including $90,000,000,000 through a State 
        Fiscal Stabilization Fund to support statewide and 
        local funding for elementary and secondary schools and 
        public postsecondary institutions and $10,200,000,000 
        for private colleges and Minority Serving Institutions;

           $2,000,000,000 through the Department of 
        Labor to support workforce training, including through 
        remote access, and providing emergency supportive 
        services for migrant and seasonal workers;

           $940,000,000,000 to support the Unemployment 
        Insurance system, including funds to speed the payment 
        of benefits and assist States in processing claims;

           $107,000,000 for worker protection 
        activities, including additional enforcement of 
        standards and directives at slaughterhouses, poultry 
        processing plants, and agricultural workplaces, and 
        outreach to workers to make them aware of their rights 
        to paid family and medical leave and paid sick leave;

           $5,000,000 to support libraries and museums 
        with costs and expenses associated with the 
        coronavirus; and

           $5,000,000 for the Railroad Retirement Board 
        to support the processing of unemployment benefits 
        under the Railroad Unemployment Insurance Act.

    In March and April, the Labor-HHS Education subcommittee 
provided a total of $279,500,000,000 in emergency 
appropriations to protect the health and safety of Americans 
and to help Americans families and businesses to recover.

Oversight of the Administration's Response to COVID-19

    Since the beginning of February, the Labor-HHS Education 
subcommittee has held nine subcommittee hearings or bipartisan 
briefings on the topic of COVID-19, including hearings and 
briefings with senior HHS officials as well as hearings and 
briefings with non-governmental public health experts. The 
Subcommittee intends to hold additional oversight hearings 
through the rest of this Congress.
    On February 12, the Subcommittee held a bipartisan briefing 
to examine HHS's response to the coronavirus. The briefing was 
led by Dr. Nancy Messonnier, Director of CDC's National Center 
for Immunization and Respiratory Diseases; Dr. Anthony Fauci, 
Director of NIH's National Institute of Allergy and Infectious 
Diseases; and Dr. Robert Kadlec, Assistant Secretary for 
Preparedness and Response. These HHS officials outlined the 
Department's preparedness and response activities, including 
efforts to assist in repatriating U.S. nationals from China, as 
well as screening and quarantine operations at ports of entry. 
Dr. Fauci and Dr. Kadlec also provided an overview of early 
efforts to develop medical countermeasures for the coronavirus, 
including vaccines and therapeutics.
    On March 10, the Subcommittee held a hearing with the CDC 
to examine the agency's 2021 budget request. Witnesses included 
Dr. Robert Redfield, Director of the CDC; Dr. Ileana Arias, 
Associate Deputy Director for Public Health Science and 
Surveillance; Dr. Debra Houry, Director of the National Center 
for Injury Prevention and Control; and Ms. Sherri Berger, Chief 
Strategy Officer and Chief Operating Officer. The Subcommittee 
held the hearing one week after Congress passed the first 
emergency supplemental appropriations package, including $2.2 
billion for the CDC, and focused on CDC's COVID-19 response 
activities, including the delay in producing diagnostic test 
kits, as well as the recent transition from a strategy of 
containment of the coronavirus to a strategy of mitigation 
(including social distancing).
    On April 15, the Subcommittee held a bipartisan briefing 
for full committee members with HHS Secretary Alex Azar to 
examine the Department of Health and Human Services' plans to 
allocate $100,000,000,000 in emergency relief--enacted in the 
CARES Act on March 27--to hospitals, health care providers, and 
other entities for their health-related expenses and lost 
revenues due to the coronavirus. The briefing focused on how 
the Department would disseminate emergency funding quickly to 
health care providers, including to hospitals and other 
providers in areas most directly affected by the COVID-19 
pandemic.
    On April 16, the Subcommittee held a bipartisan briefing 
for full committee members to examine the Department of 
Education's implementation of CARES Act funding. The briefing 
was led by James Blew, Assistant Secretary for Planning, 
Evaluation and Policy Development; Robert King, Assistant 
Secretary for Postsecondary Education; Frank Brogan, Assistant 
Secretary for Elementary and Secondary Education; and, Diane 
Jones, Principal Deputy Under Secretary, Delegated the Duties 
of the Under Secretary. In the winter and spring of 2020, 
school buildings, campuses and libraries physically closed, and 
social and economic services that students and their families 
rely upon were disrupted or ceased entirely. In response, 
Congress passed the CARES Act to provide vital resources to 
assist students whose educations have been disrupted. During 
the briefing, members had an opportunity to ask questions of 
Department officials about the Secretary's timeline for 
distributing aid. Unfortunately, details regarding the 
Secretary's implementation of key provisions of the law that 
are in contravention of both the plain reading of the statute 
and the intent of Congress were omitted during the briefing. 
And to date, the Department has issued conflicting and 
confusing guidance, which has resulted in the delay of 
assistance to students, families and institutions in need. As 
such, the Heroes Act takes steps to provide further relief and 
reassert Congressional intent.
    On May 1, the Subcommittee held a bipartisan briefing for 
full committee members with Dr. Scott Gottlieb, former FDA 
Commissioner, to discuss recommendations for the conditions 
that would be necessary to re-start economic and social 
activities during the pandemic. Dr. Gottlieb outlined 
recommendations in a recent report by the American Enterprise 
Institute, A Road Map to Reopening, that he co-authored with 
Dr. Caitlin Rivers, Dr. Mark McClellan, Lauren Silvis, and Dr. 
Crystal Watson. The briefing focused on improvements in state 
and local capacity that would be necessary to slow community 
transition of COVID-19 before local communities could safely 
reopen.
    On May 6, the Subcommittee held a hearing with two public 
health experts, Dr. Tom Frieden and Dr. Caitlin Rivers, to 
examine the necessary public health measures to respond to 
COVID-19, including surveillance, diagnostic testing, contact 
tracing, quarantine, social distancing, production and 
distribution of personal protective equipment, medical surge 
and health care resiliency, development of vaccines and 
therapeutics, and long-term investments in public health 
preparedness and response activities--including state and local 
health departments, public health laboratories, public health 
data modernization, public health workforce, and global disease 
detection and response.
    On June 4, the Subcommittee held a hearing with Dr. Robert 
Redfield, Director of the CDC, to examine the Administration's 
inconsistent and incoherent response to the COVID-19 pandemic. 
While the CDC had issued guidance for re-starting economic and 
social activities, many States were already moving forward with 
activities despite failing to meet the CDC's recommended 
criteria. The hearing focused on the Administration's efforts 
to sideline the CDC, the nation's foremost public health 
agency, in favor of non-expert guidance from political 
appointees in the White House.
    On June 11, the Subcommittee held a bipartisan briefing for 
full committee members with Dr. Ashish Jha, Professor of Global 
Health at the Harvard T.H. Chan School of Public Health and 
Director of the Harvard Global Health Institute, to examine the 
ongoing Federal response to the COVID-19 pandemic, particularly 
as the number of cases were increasing in many States and the 
U.S. continued to record as many as 800-1,000 deaths on a daily 
basis. The briefing focused on the projected course of the 
pandemic over subsequent months, including a likely worsening 
of the outbreak in the Fall and Winter months until a 
successful therapeutic or vaccine is widely available, as well 
as the need for the Administration to take a leadership role in 
responding to the pandemic.
    On June 22, the Subcommittee held a bipartisan briefing 
with Randi Weingarten, President of the American Federation of 
Teachers to discuss reopening schools safely, preventing State 
and local layoffs, and addressing learning loss among our most 
at-risk students. In particular, Members discussed the effects 
of ongoing trauma and mental health issues, how adverse 
childhood experiences impede and even prevent learning and the 
importance of trauma-informed care and services. The briefing 
also included a discussion on the importance of appropriate 
personal protective equipment for students and employees, 
including the availability of and training on how to 
effectively use it.

                      TITLE I--DEPARTMENT OF LABOR


                 Employment and Training Administration


 
 
 
Appropriation, fiscal year 2020.......................    $9,973,160,000
Budget request, fiscal year 2021......................     8,676,681,000
Committee Recommendation..............................    10,160,630,000
    Change from enacted level.........................      +187,470,000
    Change from budget request........................    +1,483,949,000
 

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

                    TRAINING AND EMPLOYMENT SERVICES

 
 
 
Appropriation, fiscal year 2020.......................    $3,611,200,000
Budget request, fiscal year 2021......................     3,358,304,000
Committee Recommendation..............................     3,696,700,000
    Change from enacted level.........................       +85,500,000
    Change from budget request........................      +338,396,000
 

    Training and Employment Services provides funding for 
Federal job training programs authorized primarily by the 
Workforce Innovation and Opportunity Act of 2014 (WIOA).
    The Committee recommendation includes new bill language 
allowing the Secretary to waive certain requirements to permit 
the outlying areas to submit a single application for a 
consolidated grant.
    Adult Employment and Training Activities.--For Adult 
Employment and Training Activities, the Committee recommends 
$864,649,000, which is $10,000,000 more than the fiscal year 
2020 enacted level and the fiscal year 2021 budget request.
    Youth Employment and Training Activities.--For Youth 
Employment and Training Activities, the Committee recommends 
$925,130,000, which is $12,000,000 more than the fiscal year 
2020 enacted level and the fiscal year 2021 budget request.
    The Committee is concerned that many 16-24 year-olds 
seeking employment are unable to find jobs due to limited 
access to resources and networks. This inability is worsened by 
racial disparities, especially in urban areas. The Committee 
directs the Secretary to include an update in the fiscal year 
2022 Congressional Budget Justification on youth unemployment, 
including the number of unemployed youth ages 16-24, 
disaggregated by race, socioeconomic status, and age, as well 
as the disparities such youth face in seeking and obtaining 
employment. This update must also include information on youth 
unemployment by industry and sector, including Science, 
Technology, Engineering, and Math (STEM), as well as 
entrepreneurship. In addition, the Committee directs the 
Secretary to include recommendations on actions Congress can 
take to ensure that youth unemployment decreases.
    In addition to the challenges posed by youth unemployment, 
the Committee recognizes that participation in work-based 
learning during high school can have a positive impact on 
students that may lead to sustained employment and higher-
quality jobs. Therefore, the Committee urges the Department to 
encourage local secondary educational authorities with 
expertise in work-based learning to be included as part of the 
required education and training organization representatives on 
local workforce development boards to provide guidance on work 
experience, including summer employment opportunities for 
youth.
    Dislocated Worker Employment and Training Activities.--For 
Dislocated Worker Employment and Training Activities, the 
Committee recommends $1,080,053,000, which is $28,000,000 more 
than the fiscal year 2020 enacted level and the fiscal year 
2021 budget request.
    Dislocated Worker Assistance National Reserve.--The 
Committee recommends $280,859,000 for the Dislocated Workers 
National Reserve, an increase of $10,000,000 over the fiscal 
year 2020 enacted level and $120,000,000 over the fiscal year 
2021 budget request.
    In addition, the Coronavirus Aid, Relief, and Economic 
Security Act (CARES Act) (P.L. 116-136) included $345,000,000 
for the Dislocated Worker National Reserve for States and 
communities to help address workforce-related impacts of COVID-
19.
    The Committee recommendation includes $50,000,000, an 
increase of $10,000,000 over the fiscal year 2020 enacted 
level, for Strengthening Community College Training Grants to 
support a new grant competition. This funding will continue to 
help better align workforce development efforts with 
postsecondary education and build off lessons learned from the 
Trade Adjustment Assistance Community College and Career 
Training Grant program. The fiscal year 2021 budget request did 
not include funding for this program.
    The Committee is deeply troubled by the Department's 
failure to follow the requirements for this program as laid out 
in the Department of Labor Appropriations Act, 2020. This 
legislation included language requiring the Department to 
``follow the requirements for the program in House Report 116-
62,'' which included a requirement that the solicitation for 
grant applications (SGA) be issued within 120 days of enactment 
of that Act. As such, this requirement was incorporated by 
reference into the appropriations measure and had the same 
legal effect as the legislation itself. The Department issued 
an SGA more than 200 days after enactment, thereby failing to 
follow the requirements for this program. Coupled with the 
ETA's misuse of registered apprenticeship funds, the Committee 
notices a concerning trend within ETA regarding proper 
execution of the law and is disappointed ETA continues to 
disregard Congressional intent. The Committee recommendation 
continues to direct the Department to follow the program 
requirements as laid out in House Report 116-62 and includes 
new bill language requiring ETA to issue an SGA within 120 days 
of enactment of this Act. The Committee recommendation includes 
new bill language reducing the Department's Executive Direction 
budget by $100,000 for each day the SGA is not issued beyond 
the 120 day requirement.
    The Committee includes $10,000,000, the same as the fiscal 
year 2020 enacted level, for grants to support national out-of-
school time organizations that serve youth and teens and place 
an emphasis on age-appropriate workforce readiness programming 
to expand job training and workforce pathways for youth and 
disconnected youth, including soft skill development, career 
exploration, job readiness and certification, summer jobs, 
year-round job opportunities, and registered apprenticeships. 
Funding will also support partnerships between workforce 
investment boards and youth serving organizations. The fiscal 
year 2021 budget request did not include funding for this 
initiative.
    Native Americans.--For the Indian and Native American 
programs, the Committee recommends $55,500,000, which is 
$500,000 more than the fiscal year 2020 enacted level. The 
fiscal year 2021 budget request proposes to eliminate this 
program.
    Migrant and Seasonal Farmworkers.--For the National 
Farmworker Jobs program, the Committee recommends $95,896,000, 
which is $4,000,000 more than the fiscal year 2020 enacted 
level. The fiscal year 2021 budget request proposes to 
eliminate this program.
    The Committee recognizes that grantee performance may 
suffer as a result of the coronavirus, leading to lower 
performance measures in the future. Accordingly, the Committee 
encourages the Secretary to take into account the effects of 
the coronavirus outbreak on performance. Moreover, the 
recommendation includes new bill language adjusting the 
definition of ``low-income'' for purposes of this program.
    YouthBuild.--For the YouthBuild program, the Committee 
recommends $100,534,000, which is $6,000,000 more than the 
fiscal year 2020 enacted level and $16,000,000 more than the 
fiscal year 2021 budget request.
    Reintegration of Ex-Offenders.--The Committee recommends 
$103,079,000 for training and reintegration activities for 
individuals with criminal records or who have been justice 
system-involved, which is $5,000,000 more than the fiscal year 
2020 enacted level and $10,000,000 more than the fiscal year 
2021 budget request. The Committee directs the Department to 
ensure grantees establish formal partnerships with employers 
and that program participants receive industry recognized 
credentials and training in fields that prepare them for 
successful reintegration, including ensuring participants 
receive training and credentials in fields where their record 
is not a barrier to entry or continued employment. The 
Committee also directs the Department to consider the needs of 
communities that have recently experienced significant unrest.
    The Committee also continues the set-aside of $25,000,000 
for competitive grants to national and regional intermediaries 
for activities that prepare for employment young adults with 
criminal records or who have been justice system-involved or 
who have dropped out of school or other educational programs, 
with a priority for projects serving high-crime, high-poverty 
areas. The Committee directs the Department to consult data 
from the Department of Education and prioritize grants in 
communities where students of color have disproportionate rates 
of expulsions and suspensions.
    The Committee is aware that recent re-entry programs are an 
excellent way to help address workforce challenges, including 
those in the advanced manufacturing sector. The Committee 
directs the Department to provide an update in the fiscal year 
2022 Congressional Budget Justification on information from the 
last three fiscal years on pathways and relationships built 
with employers, including data on formerly incarcerated 
individuals who have utilized the program, rates of increased 
credentials, and placement in higher paying positions. The 
Committee also directs the Department to provide a briefing to 
the Committees on Appropriations within 180 days of enactment 
of this Act on such information.
    Workforce Data Quality Initiative.--The Committee 
recommends $6,000,000 for the Workforce Data Quality 
Initiative, which is the same as the fiscal year 2020 enacted 
level. The fiscal year 2021 budget request proposes to 
eliminate this program. The Committee supports the work of 
States in using these funds to create and utilize data to align 
preschool through workforce systems.
    Apprenticeship Grants.--The Committee recommends 
$185,000,000 for the apprenticeship grants program, which is 
$10,000,000 more than the fiscal year 2020 enacted level and 
$15,000,000 below the fiscal year 2021 budget request. The 
Committee established this program in 2016 to expand work-based 
learning programs in in-demand industries through registered 
apprenticeships. Registered apprenticeships are a proven 
strategy for meeting the needs of our nation's workforce and 
industry simultaneously.
    The Committee continues to invest in expanding 
opportunities relating to Registered Apprenticeship programs 
registered only under the National Apprenticeship Act, to be 
available to the Secretary to carry out activities through 
grants, cooperative agreements, contracts and other 
arrangements with States and other appropriate entities. As 
part of these opportunities, the Committee directs the 
Secretary to continue funding for national and local 
apprenticeship intermediaries, business and labor industry 
partner intermediaries, and equity intermediaries. The 
Committee also directs the Department to ensure that these 
intermediaries are given opportunities to apply for competitive 
grants, cooperative agreements, contracts, and other funding 
opportunities. The Committee urges the Secretary to ensure that 
States engage both business and labor as part of any State 
funding opportunities associated with this program. In 
addition, the Committee continues to support the funding and 
development of industry or sector partnerships as a means to 
expand work-based learning programs and registered 
apprenticeships in in-demand industries.
    The Committee directs the Secretary to submit a report to 
the Committees on Appropriations providing details on entities 
awarded funding, selection criteria used, and the funding 
amount for each grant or contract awarded at the time such 
awards are made. Not later than 90 days after enactment of this 
Act, the Department shall provide the Committees on 
Appropriations a detailed spend plan of anticipated uses of 
funds made available, including administrative costs.
    The Committee is deeply concerned by the Industry 
Recognized Apprenticeship Program (IRAP) final rule as 
published in the Federal Register on March 11, 2020 (85 Fed. 
Reg. 14,294), entitled ``Apprenticeship Programs, Labor 
Standards for Registration, Amendment of Regulations.'' The 
Committee maintains that IRAPs are a duplicative apprenticeship 
model that wastes not only taxpayer dollars, but Federal 
resources and staff capacity at the Department. Therefore, the 
Committee includes a new bill-wide provision defining 
``apprenticeship'' and ``apprenticeship program'' as an 
apprenticeship program registered under the National 
Apprenticeship Act, including any requirement, standard, or 
rule promulgated under such Act as was in effect on December 
30, 2019. The Committee directs the Secretary to submit a 
report, not later than 90 days after the enactment of this Act, 
to the Committees on Appropriations on the implementation of 
the rule and any impact on Registered Apprenticeship programs. 
Such a report shall include, but not be limited to: a list of 
all entities awarded funding through grants or contracts 
related to the development or execution of IRAPs during fiscal 
years 2018, 2019, and 2020, including the funding amounts from 
Program Administration, H-1B fees, and all other sources 
derived; a list of all entities recognized or under 
consideration for recognition as Standards and Recognition 
Entities (SREs); a list of all IRAPs approved or seeking 
approval and the SREs for those programs recognized under the 
rule; an analysis of the starting wages and expected pay 
increases for apprentices in IRAPs and the portability of the 
credentials offered by the programs; the number of Departmental 
full-time equivalent employees dedicated solely to the 
Registered Apprenticeship program, and a list of any 
applications submitted under the rule. The report shall also 
include an accounting of all funds used for implementing or 
supporting IRAPs or awarded through grants or contracts under 
this rule since the date of the Executive Order issued on June 
15, 2017, entitled Expanding Apprenticeships in America, 
through the end of fiscal year 2020, including any funds used 
from Program Administration, any grant programs under ETA, or 
H1-B fees.
    The Committee also directs the Department to provide a 
detailed report within 90 days of enactment of this Act, 
outlining specific steps the Department will take towards 
effective oversight of the IRAP system, including monitoring 
conflicts of interests between SREs and program operators, the 
finances of SREs and any fees charged to program operators for 
recognition by the SRE, and any violations of civil rights laws 
or non-compliance with Equal Employment Opportunity regulations 
and guidelines.
    The Committee strongly supports efforts to expand 
Registered Apprenticeships to traditionally underrepresented 
communities and encourages the Department to explore the 
feasibility and expansion of Registered Apprenticeship programs 
within the arts, theater, film, and television industries. 
Specifically, the Committee requests that the Department 
explore expanding the Registered Apprenticeship model to create 
career training strategies for all roles in the entertainment 
industry such as creative, production, technical, marketing and 
public relations roles.
    In addition, the Committee notes that apprenticeships are 
an important path to the middle-class, with those completing a 
program earning an average annual income of $70,000. However, 
women are largely underrepresented in apprenticeship programs, 
and women who do participate make far less than men. Therefore, 
the Committee directs the Department to accelerate efforts to 
recruit and retain women as part of these programs and to 
ensure equal compensation.
    The Committee is concerned about shortages nationwide of 
qualified drinking water and wastewater operation 
professionals, especially in rural areas, and encourages the 
Secretary to make funding available to address these 
challenges.
    The Committee also supports the use of apprenticeship 
grants that provide worker education based on public-private 
partnerships in in-demand fields, including first responder, 
utility (water), as well as in goods movement sectors such as 
global logistics, rail and other freight-related employment.
    The Committee encourages the Department to support 
apprenticeship programs that increase the number of trained 
workers in cybersecurity.

                               JOB CORPS

 
 
 
Appropriation, fiscal year 2020.......................    $1,743,655,000
Budget request, fiscal year 2021......................     1,015,897,000
Committee Recommendation..............................     1,755,655,000
    Change from enacted level.........................       +12,000,000
    Change from budget request........................      +739,758,000
 

    Job Corps is the nation's largest residential employment 
and workforce development program for youth, helping prepare 
thousands of young people ages 16 through 24 for jobs in in-
demand occupations with good wages each year.
    Operations.--For Job Corps Operations, the Committee 
recommends $1,603,325,000, which is the same as the fiscal year 
2020 enacted level and $719,991,000 more than the fiscal year 
2021 budget request.
    Construction, Rehabilitation, and Acquisition.--The 
Committee recommends $120,000,000 for construction, 
rehabilitation, and acquisition activities of Job Corps 
centers, which is $12,000,000 more than the fiscal year 2020 
enacted level and $19,984,000 more than the fiscal year 2021 
budget request.
    Administration.--The Committee recommends $32,330,000 for 
the administrative expenses of the Job Corps program, which is 
the same as the fiscal year 2020 enacted level and $217,000 
less than the fiscal year 2021 budget request.
    For over 50 years, Job Corps has successfully educated and 
trained millions of young adults for jobs in high demand 
industries and trades. Job Corps has campuses across all 50 
States and Puerto Rico and provides a safe living, learning and 
disciplined residential setting that allows disconnected and 
opportunity youth to gain the employment and skills that U.S. 
employers seek. The Committee recommendation includes funding 
for Job Corps to meet capacity and ensure a safe learning 
environment for all students and staff, including to train 
youth for employment in industry sectors facing critical 
shortages of skilled workers, such as construction, healthcare, 
manufacturing, transportation, and cyber technologies. Job 
Corps centers are capable of serving approximately 50,000 out-
of-work and out-of-school youth each year, and the Committee 
encourages the Department to use such funding accordingly.
    In addition, the Committee is concerned with the 
administration of the Job Corps program, including the 
underutilization of centers relative to on-board strength, 
industry-standard training, and performance incentives. The 
Committee directs the Department to submit a report, within 90 
days of enactment of this Act, on obligations, outlays, and 
unobligated funds for the current fiscal year and the most 
recent fiscal year to the Committees on Appropriations. To 
better utilize Job Corps centers, the Committee directs the 
Department to include an update in the fiscal year 2022 
Congressional Budget Justification on specific outreach and 
admissions efforts, the most recent geographic assignment plan 
required by Sec. 145(c) of the WIOA, and an analysis of Job 
Corps application and enrollment data to evaluate the relative 
efficacy of different investments in producing Job Corps-
eligible applicants, arrivals, and their families, including 
social media, national television or radio buys, and local 
outreach efforts targeted at eligible youth, guardians, and 
influencers. The Committee encourages the Department to hire 
additional Outreach and Admissions staff to increase 
recruitment efforts targeted at disconnected youth in large 
cities and rural areas. The Committee directs the Department to 
provide a briefing to the Committee on Appropriations within 
120 days of enactment of this Act on efforts to responsibly 
increase onboard strength and training slot capacity. Moreover, 
the Committee urges the Department to suspend plans to 
eliminate programs based upon the 85-90 percent On-Board 
Strength/Career Technical Training range.
    The Committee supports the Department's intention to make 
investments in Job Corps facilities to ``support high-quality 
training that meets existing industry standards.'' Therefore, 
the Committee requests additional information in the fiscal 
year 2022 Congressional Budget Justification on the cost of 
modernizing Job Corps centers' trade offerings, curricula, and 
equipment to meet existing industry standards. This information 
is of particular interest given the realignment of Job Corps 
center recruitment and placement with local workforce 
development areas through the National Enrollee Assignment 
Plan.
    The Department states that Job Corps' existing model 
incentivizes continuous performance improvement while the 
transition to fixed price contracts is expected to yield cost 
savings. The Committee is concerned that the current 
implementation of this transition may shift Job Corps' focus 
from student outcomes to cost savings. Within 90 days of 
enactment of this Act, the Committee requests detailed 
information regarding how the Department will assess which Job 
Corps proposals will provide the best value, specifically with 
respect to student outcomes. In addition, the Committee 
requests information on options for incorporating performance-
based incentives into Job Corps' fixed price contracts in order 
to ensure student outcomes are the highest priority, including 
a timeline for implementation, in its fiscal year 2022 
Congressional Budget Justification.

            COMMUNITY SERVICE EMPLOYMENT FOR OLDER AMERICANS

 
 
 
Appropriation, fiscal year 2020.......................      $405,000,000
Budget request, fiscal year 2021......................             - - -
Committee Recommendation..............................       410,000,000
    Change from enacted level.........................        +5,000,000
    Change from budget request........................      +410,000,000
 

    The Community Service Employment for Older Americans 
program provides grants to public and private non-profit 
organizations that subsidize part-time work in community 
service activities for unemployed persons aged 55 and older 
whose family income is below 125 percent of the poverty level.
    The Committee recommends $410,000,000 for the Community 
Service Employment for Older Americans program, which is 
$5,000,000 more than the fiscal year 2020 enacted level. The 
fiscal year 2021 budget request proposes to eliminate this 
program.

              FEDERAL UNEMPLOYMENT BENEFITS AND ALLOWANCES

 
 
 
Appropriation, fiscal year 2020.......................      $680,000,000
Budget request, fiscal year 2021......................       633,600,000
Committee Recommendation..............................       633,600,000
    Change from enacted level.........................       -46,400,000
    Change from budget request........................             - - -
 

    The Trade Adjustment Assistance program (TAA) provides 
assistance to workers adversely affected by international 
trade. TAA provides training, income support, wage subsidies 
for older workers, job search and relocation allowances to 
groups of workers who file a petition and are certified as 
eligible to apply for such benefits due to job losses resulting 
from increases in imports or foreign trade.
    The mandatory funding provided for this program is 
dependent upon the Administration's economic assumptions, and 
the Committee's recommendation for fiscal year 2021 is lower 
than the fiscal year 2020 enacted level for this reason.

     STATE UNEMPLOYMENT INSURANCE AND EMPLOYMENT SERVICE OPERATIONS

 
 
 
Appropriation, fiscal year 2020.......................    $3,374,649,000
Budget request, fiscal year 2021......................     3,497,280,000
Committee Recommendation..............................     3,506,019,000
    Change from enacted level.........................      +131,370,000
    Change from budget request........................        +8,739,000
 

    The total includes $3,421,953,000 from the Employment 
Security Administration Account from the Unemployment Trust 
Fund and $84,066,000 from the General Fund of the Treasury. 
These funds are used to support the administration of Federal 
and State unemployment compensation laws.
    Unemployment Insurance Compensation.--For Unemployment 
Insurance (UI) Compensation, the Committee recommends 
$2,649,686,000, which is $108,870,000 more than the fiscal year 
2020 enacted level and $3,000,000 more than the fiscal year 
2021 budget request. The recommendation provides additional 
resources for States to increase staffing capacity and to 
accommodate sustained increases in workload.
    In addition, the recommendation provides contingency 
funding for increased workloads that States may face in the 
administration of UI. The Committee recommendation includes 
bill language so that, during fiscal year 2021, for every 
100,000 increase in the total average weekly insured 
unemployment (AWIU) above 1,728,000, an additional $28,600,000 
shall be made available to States from the Unemployment Trust 
Fund. Under current economic conditions, the Congressional 
Budget Office estimates that this will result in an additional 
$925,000,000 to flow to States.
    In the event that additional funds are provided to States 
under the AWIU contingency authority, the Department is 
directed to provide notification to the Committees on 
Appropriations of the current projected AWIU level for the 
fiscal year, when funds were provided to States, and how much 
additional funding was provided in total and to each State 
within 15 days of funding being provided. In the event that 
additional funds are provided on a quarterly basis, the 
Department shall provide this information on a quarterly basis.
    The Committee includes $117,000,000 for the Reemployment 
Services and Eligibility Assessments program, and an additional 
$83,000,000 is made available pursuant to the Bipartisan Budget 
Act of 2018 (P.L. 115-123), which is $25,000,000 more than the 
fiscal year 2020 enacted level and equal to the fiscal year 
2021 budget request.
    Unemployment Compensation National Activities.--The 
Committee recommends $18,000,000 for National Activities, which 
is $6,000,000 more than the fiscal year 2020 enacted level and 
the same as the fiscal year 2021 budget request. This increase 
in funding is intended to help modernize the UI Interstate 
Connection Network (ICON) hub and support States in 
administering the UI program.
    Employment Service.--The Committee recommends $673,052,000 
for the Employment Service allotment to States, which is 
$5,000,000 more than the fiscal year 2020 enacted level and the 
fiscal year 2021 budget request.
    The Committee also recommends $24,818,000 for Employment 
Service National Activities, which is $2,500,000 more than the 
fiscal year 2020 enacted level and $5,000,000 more than the 
fiscal year 2021 budget request. The increase in funds is 
intended to reduce the processing backlog for the work 
opportunity tax credit program and for assisting States in 
adopting or modernizing information technology for processing 
of certification requests, which may include training and 
technical assistance to States.
    The Employment Service offers vital services such as 
referrals for job openings, career counseling, and job searches 
for individuals seeking employment, including veterans and 
people with disabilities. Since 1933, this Federal-State 
partnership has facilitated the connection between employers in 
need of workers and individuals seeking employment. Given the 
nature of this exchange, the Department has historically 
required that the Employment Service system rely on State 
merit-staff employees to ensure that these services are 
rendered in the public interest and not solely to meet private 
interests. However, the Department's recent final rule marks a 
dangerous departure from this operation. This final rule could 
upend vital public services provided to vulnerable populations 
by privatizing job search functions and other forms of 
assistance. Although the Department received comments from the 
public outlining these concerns, the Department has chosen to 
ignore this counsel. As such, in an effort to preserve the 
Employment Service system, the recommendation includes new bill 
language preventing the implementation of the final rule, 
entitled ``Wagner-Peyser Act Staffing Flexibility'' (85 Fed. 
Reg. 592).
    Foreign Labor Certification.--The Committee recommends 
$77,810,000 for the Foreign Labor Certification (FLC) program, 
which is $9,000,000 more than the fiscal year 2020 enacted 
level and $2,088,000 below the fiscal year 2021 budget request. 
The recommendation includes $57,528,000 for Federal 
administration, an increase of $3,000,000 over the fiscal year 
2020 enacted level and $5,088,000 below the fiscal year 2021 
budget request, that is intended to be used to ensure effective 
oversight and enforcement of employer regulations, and 
$20,282,000 for grants to States, an increase of $6,000,000 
over the fiscal year 2020 enacted level and $3,000,000 more 
than the fiscal year 2021 budget request.
    H-2A Program.--The Committee notes there are increases in 
the number of H-2A applications requested and that States have 
requested additional support for the proper reviewing and 
oversight of processing of H-2A applications, recruitment of 
potential domestic agricultural workers, and oversight of 
contract terms.
    Within 120 days of enactment of this Act, the Committee 
directs the Secretary to submit a report to the Committees on 
Appropriations on the number of H-2A visa applications, trends 
in H-2A requests, and the distribution of funding according to 
the needs of States. The report shall detail how the agency 
considers costs associated with administrative and oversight 
requirements for both the H-2A and H-2B visa programs when 
determining the allocation. The Committee encourages the 
Department to continue to monitor the number and scope of 
requests from the previous year along with projected use in the 
coming year when determining State funding allocations.
    H-2B violations.--The Committee directs the Department to 
submit a report to the Committees on Appropriations within 120 
days of enactment of this Act on the recent history of 
sanctions and remedies that the Department has issued in each 
of the last three fiscal years against employers who violate H-
2B provisions, including violations listed in 29 CFR 
Sec. 503.19(a). The update should contain, but should not be 
limited to: a list of the employers that were cited and for 
what violation; how many workers in total have been impacted by 
violations; what impact the violations had on the domestic 
workforce; what industries the violations occurred in; how many 
employers have been debarred from the H-2B program; the 
methodology used in the decision to debar; and a justification 
for why repeat offenders continue to receive visas. The 
Department is also directed to include in such a report the 
distribution of visas granted by industry and sector through 
the H-2B program and contain a tabulation of the percentage of 
overall visas provided to the top 15 employers.
    Schedule A Occupational Classification.--The Committee is 
aware that the Schedule A occupational classification list 
currently includes only two broad occupational classifications 
and a narrow subset of other applicants. The Committee 
encourages the Secretary to consider rulemaking to improve the 
experience of employers and to effectively allocate Department 
resources with the goal of protecting U.S. workers from undue 
foreign competition through the labor certification process.
    One-Stop Career Centers/Labor Market Information.--The 
Committee recommends $62,653,000 for One-Stop Career Centers 
and Labor Market Information, which is the same as the fiscal 
year 2020 enacted level and $2,173,000 less than the fiscal 
year 2021 budget request.

        ADVANCES TO THE UNEMPLOYMENT TRUST FUND AND OTHER FUNDS

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

                         PROGRAM ADMINISTRATION

 
 
 
Appropriation, fiscal year 2020.......................      $158,656,000
Budget request, fiscal year 2021......................       171,600,000
Committee Recommendation..............................       158,656,000
    Change from enacted level.........................             - - -
    Change from budget request........................             - - -
 

    The recommendation includes $108,674,000 from the General 
Fund of the Treasury and $49,982,000 from the Employment 
Security Administration Account in the Unemployment Trust Fund.
    The Committee includes new bill language ensuring Office of 
Apprenticeship resources support Registered Apprenticeships and 
adequate staffing in the Office of Apprenticeship and State 
offices.
    Outreach.--The Committee encourages the Department to 
support student support services, academic advisement and 
professional development for faculty and staff at educational 
institutions that offer accredited registered apprenticeship 
programs. Additionally, the Committee encourages the Department 
to support such institutions and in their outreach to local 
elementary and secondary education schools, businesses, 
workforce boards, and other local leaders in order to most 
effectively serve current students and increase program 
awareness for future students and their communities.
    Prize Competition.--The Committee encourages the 
Department, in coordination with the Office of Science and 
Technology Policy, to establish a prize competition consistent 
with the requirements of section 24 of the Stevenson-Wydler 
Technology Innovation Act of 1980, to support eligible programs 
designed to prepare high school students to enter and succeed 
in an in-demand industry sector or occupation.
    GAO Study on Automation.--The Committee directs the 
Government Accountability Office (GAO) to conduct a study that 
should explore: (1) the barriers to, and opportunities for, 
retraining workers in industries that have a high likelihood of 
being impacted by automation; (2) availability of data and 
strategies to improve collection, with respect to the workforce 
in in-demand industry sectors and occupations in the United 
States, such as advanced manufacturing, information technology, 
and health care, including how this data may be used to 
identify skills and jobs available for retrained workers or 
those displaced by automation; (3) the impact of the 
geographical location of workers and their access to 
transportation on the ability of the workers to access job 
training and related high-skilled positions; (4) what are the 
lessons learned from existing training programs and what more 
could be done to respond to changes in the labor market, 
including evolving technologies. Not later than one year after 
enactment of this Act, GAO should provide to the Committee a 
briefing on preliminary findings.
    Advanced Manufacturing.--The Committee encourages the 
Department to support programs that facilitate partnerships 
between local educational entities (e.g., technical colleges, 
community colleges, or entities that assist educationally 
underserved communities) and manufacturers that employ 
individuals who have advanced manufacturing skills. These 
programs should (1) develop skills and competencies in 
communities with expected growth in advanced manufacturing; (2) 
provide education and training for available and anticipated 
jobs in advanced manufacturing; (3) educate individuals about 
career advancement opportunities within advanced manufacturing; 
and (4) give priority to low-income incumbent workers, 
dislocated workers, and unemployed individuals.
    Artificial Intelligence.--The Committee notes that it is 
not yet fully understood the extent of the disruption 
Artificial Intelligence will cause and how it will impact the 
workforce. Therefore, the Committee emphasizes the importance 
of anticipating changes in the workforce, investing in worker 
retraining programs, and providing adequate funding for 
registered apprenticeship programs.
    Long-term Unemployed.--The Committee notes the economic 
challenges millions of individuals now face due to the 
coronavirus pandemic and high-unemployment. Within a matter of 
months, a nine-year period of sustained economic recovery and 
growth was swept away by a wave of pathogen, shuttering 
businesses and creating economic uncertainty. The Committee 
also notes that the economic prospects for many individuals 
unemployed prior to the start of the national emergency were 
worsened as a result of COVID-19. Prior to the pandemic, these 
individuals faced significant barriers to employment, having 
been unemployed for 27 weeks or more. While it is essential 
that the Department supports policies and practices that put 
Americans back to work in a safe and sustainable way, the 
Department must also ensure that the long-term unemployed do 
not fall through the cracks of our economic recovery. To 
advance this effort, the Committee encourages the Department to 
support reemployment programs targeting long-term unemployed 
workers.
    Open Data Reporting.--The Committee notes that Congress has 
made a significant investment in our workforce development, 
postsecondary, and career and technical education systems. As a 
result of this investment, the number of credentials in the 
U.S. continues to rise. However, the Committee is aware that 
many workers and students may face challenges in navigating an 
intricate network of diplomas, licenses, certifications, and 
badges. Therefore, the recommendation includes new bill 
language requiring the Department to publicly disclose 
information on credentials and competencies earned through 
Registered Apprenticeships and information related to 
occupational and professional licenses and certifications in an 
open-source format. The Committee believes that this 
requirement will lead to the development of useful comparison 
tools and other resources that will improve the delivery of 
workforce development and postsecondary education programs, as 
well as enable workers and students to make more informed 
choices in their educational and job-training journeys. The 
Committee directs the Department to ensure that such 
information is also provided in a consumer-tested and user-
friendly manner to ensure that workers and students are able to 
utilize this information about potential credentials 
effectively.
    Remote Learning.--The Committee encourages the Secretary to 
consider the various ways the delivery of training may need to 
be altered in response to COVID-19, including through remote 
access.
    National Guard Job ChalleNGe.--Committee appreciates the 
value and success of the National Guard's Youth ChalleNGe 
Program, and the benefits the Department of Labor's 
collaboration through Job ChalleNGe provides to the youth 
served through the experience. The occupational skills 
training, individualized career and academic counseling, work-
based learning opportunities, and leadership development 
activities provided through the Job ChalleNGe are even more 
vital services during the economic fallout of the current COVID 
pandemic.

               Employee Benefits Security Administration


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2020.......................      $181,000,000
Budget request, fiscal year 2021......................       192,738,000
Committee Recommendation..............................       181,000,000
    Change from enacted level.........................             - - -
    Change from budget request........................       -11,738,000
 

    The Employee Benefits Security Administration (EBSA) 
assures the security of retirement, health and other workplace-
related benefits of working Americans.
    The Committee recommends $181,000,000 for EBSA, which is 
the same as the fiscal year 2020 enacted level and $11,738,000 
less than the fiscal year 2021 budget request.
    The Committee continues to encourage EBSA to prioritize 
audit resources to review the Thrift Savings Plan's (TSP) 
Information Technology operating environment, including the 
adequacy of controls at contractor sites and TSP's progress in 
remediating previously identified issues from past EBSA audits.

                  Pension Benefit Guaranty Corporation


 
 
 
Appropriation, fiscal year 2020.......................      $452,858,000
Budget request, fiscal year 2021......................       465,289,000
Committee Recommendation..............................       465,289,000
    Change from enacted level.........................       +12,431,000
    Change from budget request........................             - - -
 

    Congress established the Pension Benefit Guaranty 
Corporation to insure the defined-benefit pension plans of 
working Americans.

                         Wage and Hour Division


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2020.......................      $242,000,000
Budget request, fiscal year 2021......................       244,283,000
Committee Recommendation..............................       246,283,000
    Change from enacted level.........................        +4,283,000
    Change from budget request........................        +2,000,000
 

    The Wage and Hour Division (WHD) enforces Federal minimum 
wage, overtime pay, recordkeeping, and child labor requirements 
of the Fair Labor Standards Act (FLSA). WHD also has 
enforcement and other administrative responsibilities related 
to the Migrant and Seasonal Agricultural Worker Protection Act, 
the Employee Polygraph Protection Act, the Family and Medical 
Leave Act, the Davis Bacon Act, and the Service Contract Act.
    The Committee recommends $246,283,000 for WHD, which is 
$4,283,000 above the fiscal year 2020 enacted level and 
$2,000,000 above the fiscal year 2021 budget request. This 
increase will support WHD's role in implementing the Labor 
Value Content provision to the Rules of Origin Chapter within 
the United States-Mexico-Canada Agreement. The increase will 
also support additional investigators to combat wage theft and 
protect workers. The Committee urges WHD to explore and expand 
strategic enforcement approaches to the agency's work to make 
the most of this increase.
    In the fiscal year 2022 Congressional Budget Justification, 
WHD is directed to continue providing annual and historical 
information on the Payroll Audit Independent Determination 
(PAID) program, including administrative expenditures on PAID, 
amounts recovered through PAID, and the number of businesses 
participating in PAID.
    On January 16, 2020, the WHD finalized its interpretative 
regulation narrowing joint employment liability under the FLSA, 
effective March 16, 2020. The Committee is concerned that the 
Department acted beyond its authority by issuing an 
interpretive rule that conflicts with the law and congressional 
intent by so narrowly restricting its interpretation of joint 
employment liability to a question of control and rejecting the 
economic dependence inquiry. As an interpretive regulation, 
this rule does not have the force of law, but will dictate how 
and if the Department will continue to hold employers 
accountable when they are jointly liable for FLSA violations. 
This could leave workers in low-wage, high-violation industries 
vulnerable.
    In response to concerns about the Department's overreach 
and negative impact on workers, the Committee includes new bill 
language to prohibit the use of funds to implement or enforce 
the final interpretative regulation. Further, the Committee 
directs the Department to submit a report no later than 90 days 
of enactment of this Act to the Committees on Appropriations, 
the House Committee on Education and Labor, and the Senate 
Committee on Health, Education, Labor, and Pensions detailing 
the impact of the final interpretive rule on the WHD's 
enforcement actions involving joint employment liability under 
the FLSA. Such report shall include the number of findings of 
joint employment liability under the FLSA the WHD made in 
fiscal years 2017, 2018, and 2019, disaggregated by industry; 
the number of investigations and the number of cases in 
Department-initiated litigation involving joint employment 
liability, disaggregated by industry, that were ongoing as of 
March 16, 2020; how the Department has proceeded with such 
cases and investigations between March 16, 2020 and the date of 
enactment of this Act; and the number of investigations and the 
number of cases in Department-initiated litigation involving 
joint employment liability, disaggregated by industry, that 
commenced on or after March 16, 2020 through the date of 
enactment of this Act. This report will provide transparency to 
the Committee to understand the extent to which WHD no longer 
pursued joint employment cases that it otherwise would have 
under the previous interpretation, leaving workers worse off.
    The Committee is deeply concerned by WHD Field Bulletin No. 
2020-2, which scales back the agency's use of liquidated 
damages to compensate workers who have been denied their earned 
wages. Victims of wage theft deserve to not only be compensated 
for the wages they were denied, but for the cost of not having 
access to their pay over time. Further, WHD's decision to scale 
back its use of enforcement tools sends a strong signal to 
businesses that they can expect a slight slap on the wrist if 
any wrongdoing occurs. That approach is unacceptable, and it 
undermines WHD's core mission of protecting workers from wage 
theft. The Committee strongly urges WHD to adjust course and 
abandon Field Bulletin No. 2020-2 so that workers can be 
appropriately compensated for their losses and so employers 
understand there are meaningful consequences for flagrant, 
repeated violations of the FLSA.

                  Office of Labor Management Standards


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2020.......................       $43,187,000
Budget request, fiscal year 2021......................        50,410,000
Committee Recommendation..............................        42,187,000
    Change from enacted level.........................        -1,000,000
    Change from budget request........................        -8,223,000
 

    The Office of Labor Management Standards (OLMS) administers 
the Labor-Management Reporting and Disclosure Act (LMRDA), 
which establishes safeguards for union democracy and union 
financial integrity, and requires public disclosure reporting 
by unions, union officers, employees of unions, labor relations 
consultants, employers, and surety companies.
    The Committee is concerned about OLMS' administration of 
the LMRDA, specifically efforts to utilize reporting and 
transparency requirements as tools to undermine, rather than 
strengthen, union democracy and integrity. The Department is 
encouraged to partner in good faith with those entities covered 
by the LMRDA to ensure compliance.

             Office of Federal Contract Compliance Programs


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2020.......................      $105,976,000
Budget request, fiscal year 2021......................       106,412,000
Committee Recommendation..............................       105,976,000
    Change from enacted level.........................             - - -
    Change from budget request........................          -436,000
 

    The Office of Federal Contract Compliance Programs (OFCCP) 
ensures equal employment opportunity in the Federal contracting 
community through enforcement, regulatory work, outreach and 
education to workers and their advocates.
    OFCCP is responsible, per Executive Order 11246 (EO 11246), 
for ensuring Federal contractors and subcontractors take 
affirmative action to ensure that all individuals have an equal 
opportunity for employment, without regard to race, color, 
religion, sex, or national origin. The Committee supports 
OFCCP's efforts to make sure contractors and subcontractors are 
adhering fully to EO 11246.
    In the fiscal year 2022 Congressional Budget Justification, 
OFCCP is directed to detail the agency's compliance and 
enforcement efforts with regard to promoting equal 
opportunities for employment by contractors and subcontractors 
to the Federal government, including technology contractors and 
subcontractors.
    The Committee strongly opposes OFCCP's proposed rule on 
Implementing Legal Requirements Regarding the Equal Opportunity 
Clause's Religious Exemption, (RIN 1250-AA09), which would give 
taxpayer funded contractors, including for-profit corporations, 
the extraordinary power to hire and fire employees based on 
religion and the employer's understanding of religious tenets 
and beliefs. In response to these concerns, new bill language 
is included to prohibit funds from being used to implement, 
enforce, or give effect to this proposed rule.

                Office of Workers' Compensation Programs


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2020.......................      $117,601,000
Budget request, fiscal year 2021......................       119,312,000
Committee Recommendation..............................       117,601,000
    Change from enacted level.........................             - - -
    Change from budget request........................        -1,711,000
 

    The Office of Workers' Compensation Programs (OWCP) 
administers the Federal Employees' Compensation Act, the 
Longshore and Harbor Workers' Compensation Act, the Energy 
Employees Occupational Illness Compensation Program Act, and 
the Black Lung Benefits Act. These programs provide eligible 
injured and disabled workers and their survivors with 
compensation, medical benefits, and services including 
rehabilitation, supervision of medical care, and technical and 
advisory counseling.
    The Committee recommendation includes $115,424,000 in 
General Funds from the Treasury, which is the same as the 
fiscal year 2020 enacted level and $462,000 above the fiscal 
year 2021 request, and $2,177,000 from the Special Fund 
established by the Longshore and Harbor Workers' Compensation 
Act.

                            SPECIAL BENEFITS

 
 
 
Appropriation, fiscal year 2020.......................      $234,600,000
Budget request, fiscal year 2021......................       239,000,000
Committee Recommendation..............................       239,000,000
    Change from enacted level.........................        +4,400,000
    Change from budget request........................             - - -
 

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

               SPECIAL BENEFITS FOR DISABLED COAL MINERS

 
 
 
Appropriation, fiscal year 2020.......................       $34,970,000
Budget request, fiscal year 2021......................        54,970,000
Committee Recommendation..............................        54,970,000
    Change from enacted level.........................       +20,000,000
    Change from budget request........................             - - -
 

    These funds provide mandatory benefits to coal miners 
disabled by black lung disease, to their survivors and eligible 
dependents, and for necessary administrative costs.
    The Committee recommends a mandatory appropriation of 
$40,970,000 in fiscal year 2021 for special benefits for 
disabled coal miners. This is in addition to the $14,000,000 
appropriated last year as an advance for the first quarter of 
fiscal year 2021, for a total program level of $54,970,000 in 
fiscal year 2021.
    The Committee recommendation also provides $14,000,000 as 
an advance appropriation for the first quarter of fiscal year 
2022. These funds ensure uninterrupted payments to 
beneficiaries.

    ADMINISTRATIVE EXPENSES, ENERGY EMPLOYEES OCCUPATIONAL ILLNESS 
                           COMPENSATION FUND

 
 
 
Appropriation, fiscal year 2020.......................       $59,846,000
Budget request, fiscal year 2021......................        62,507,000
Committee Recommendation..............................        62,507,000
    Change from enacted level.........................        +2,661,000
    Change from budget request........................             - - -
 

    These funds provide mandatory benefits to eligible 
employees or survivors of employees of the Department of Energy 
(DOE); its contractors and subcontractors; companies that 
provided beryllium to DOE; atomic weapons employees who suffer 
from a radiation-related cancer, beryllium-related disease, or 
chronic silicosis as a result of their work in producing or 
testing nuclear weapons; and uranium workers covered under the 
Radiation Exposure Compensation Act.
    The Committee recognizes the vital role the Energy 
Employees Occupational Illness Compensation Program Act 
(EEOICPA) plays in the lives of former DOE employees and 
contractors and prioritizes policies that ensure efficient and 
effective medical care for these individuals. The Committee 
requests the Department submit a report to the Committees 
within 180 days of enactment of this Act on the policy changes 
the Department made to the program in fiscal years 2018, 2019 
and 2020, and the overall impact these changes have had on 
program beneficiaries and medical providers. The report shall 
include information on how these policy changes have impacted 
the quality of care for program beneficiaries and how the 
policy changes have impacted operational efficiencies for 
medical providers.
    The Department shall ensure the Advisory Board on Toxic 
Substances and Worker Health has sufficient funding and 
staffing to meet its obligations.

                    BLACK LUNG DISABILITY TRUST FUND

 
 
 
Appropriation, fiscal year 2020.......................      $365,240,000
Budget request, fiscal year 2021......................       382,991,000
Committee Recommendation..............................       382,991,000
    Change from enacted level.........................       +17,751,000
    Change from budget request........................             - - -
 

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

             Occupational Safety and Health Administration


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2020.......................      $581,787,000
Budget request, fiscal year 2021......................       576,813,000
Committee Recommendation..............................       593,787,000
    Change from enacted level.........................       +12,000,000
    Change from budget request........................       +16,974,000
 

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

------------------------------------------------------------------------
                   Budget Activity                     FY 2021 Committee
------------------------------------------------------------------------
Safety and Health Standards..........................        $18,000,000
Federal Enforcement..................................        231,711,000
Whistleblower Programs...............................         18,564,000
State Programs.......................................        108,575,000
Technical Support....................................         24,469,000
Federal Compliance Assistance........................         74,481,000
State Consultation Grants............................         61,500,000
Training Grants......................................         13,537,000
Safety and Health Statistics.........................         32,900,000
Executive Direction and Administration...............         10,050,000
------------------------------------------------------------------------

    The Committee directs OSHA to publish Funding Opportunity 
Notices for the Susan Harwood Training Grant program no later 
than June 30, 2021. Further, the Committee directs OSHA to 
provide technical assistance, guidance, and support for 
applicants in order to reduce the proportion of applicants that 
did not meet eligibility and program requirements included in 
Funding Opportunity Notices in previous fiscal years.
    The Committee encourages the Department to include hazards 
facing domestic workers as a topic for training in its 
announcements for Susan Harwood Training Grants.
    In the fiscal year 2022 Congressional Budget Justification, 
OSHA is directed to include annual expenditures on the 
Voluntary Protection Program for each year since fiscal year 
2015 as well as planned expenditures in fiscal year 2022.
    The Committee recognizes the risks posed by the COVID-19 
pandemic to our nation's essential farm workforce as they 
continue to ensure the availability of the food supply. OSHA 
must use all available resources provided by this Committee to 
fully protect workers from getting sick. That should start with 
issuing an Emergency Temporary Infectious Disease Standard. 
Clear, effective, comprehensive requirements from OSHA is the 
only way to guarantee that all workers, including farmworkers, 
receive the protections from COVID-19 that will keep them safe. 
Fortunately, much work has been done over the past decade on an 
infectious disease rulemaking that can be used to issue the 
Emergency Temporary Infectious Disease Standard. In the 
interim, to protect workers from coronavirus infection, OSHA 
should be fully enforcing all applicable standards and 
directives, including the Personal Protective Equipment 
standard (29 CFR 1910.132), the Respiratory Protection standard 
(29 CFR 1910.134), the General Duty Clause (Section 5(a)(1) of 
the Occupational Safety and Health Act of 1970), and the 
Bloodborne Pathogens standard (29 CFR 1910.1030). Particular 
emphasis should be placed on workplaces where workers are 
deemed essential and also face a higher risk of infection, such 
as slaughterhouses, poultry processing plants, and agricultural 
workplaces.
    To minimize the risk of a future COVID-19 outbreak and 
mitigate the impacts of having to shut down operations and 
decontaminate a worksite if a case of COVID-19 is detected 
among their workforce, the Committee urges OSHA to create clear 
requirements and guidance for manufacturers and other employers 
on best practices for protecting workers from infectious 
diseases.
    The Committee recognizes the challenge of ensuring adequate 
enforcement in remote geographical areas, such as the Pacific 
territories, and that there have been worker fatalities and 
injuries in areas where there is no permanent enforcement 
presence. The Committee encourages OSHA to ensure compliance 
safety and health officers are adequately serving these 
territories and to provide an assessment of need for areas with 
no permanent enforcement presence in its fiscal year 2022 
Congressional Budget Justification.
    The Committee is deeply concerned that OSHA is failing to 
move forward to develop and issue needed standards on major 
safety and health problems. One issue of particular concern is 
workplace violence, a serious and growing problem that has 
reached epidemic levels. Workplace violence is now the third 
leading cause of death and is responsible for nearly 30,000 
serious injuries every year. Nurses, medical assistants, 
emergency responders and social workers face some of the 
greatest threats, suffering more than 70 percent of all 
workplace assaults. Workers who are women are at particular 
risk, suffering two out of every three serious workplace 
violence injuries. In January 2017, OSHA committed to 
developing and issuing a workplace violence standard, but the 
agency has not yet completed a required small business review, 
and there is no estimated date for the issuance of a proposed 
or final rule. The Committee believes issuing a workplace 
violence standard to protect workers in health care and social 
services should be a top priority for the Department. In order 
to monitor the agency's progress on this important rule, the 
Committee directs OSHA to brief the Committees on 
Appropriations, within 90 days of enactment of this Act, on a 
schedule for moving this rule to completion, including the 
dates on which a proposed rule and final rule will be issued.

                 Mine Safety and Health Administration


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2020.......................      $379,816,000
Budget request, fiscal year 2021......................       381,587,000
Committee Recommendation..............................       379,816,000
    Change from enacted level.........................             - - -
    Change from budget request........................        -1,771,000
 

    The Mine Safety and Health Administration (MSHA) enforces 
the Federal Mine Safety and Health Act in underground and 
surface coalmines and metal/non-metal mines.
    MSHA is directed to include in the fiscal year 2022 
Congressional Budget Justification and all future Congressional 
Budget Justifications historical and budget year information on 
enforcement activities and outcomes, distinguishing between 
coal and metal/non-metal mines. To promote transparency in 
agency spending on its enforcement activities, MSHA shall 
continue to separately present annual spending on coal and 
metal/non-metal mines as it has in past Congressional Budget 
Justifications.

                       Bureau of Labor Statistics


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2020.......................      $655,000,000
Budget request, fiscal year 2021......................       658,318,000
Committee Recommendation..............................       655,000,000
    Change from enacted level.........................             - - -
    Change from budget request........................        -3,318,000
 

    The Bureau of Labor Statistics (BLS) is an independent 
national statistical agency that collects, processes, analyzes, 
and disseminates essential economic data to the Congress, 
Federal agencies, State and local governments, businesses, and 
the public. Its principal surveys include the Consumer Price 
Index and the monthly unemployment series.
    The Committee recommendation includes $587,000,000 from the 
General Fund of the Treasury and $68,000,000 from the 
Employment Security Administration Account in the Unemployment 
Trust Fund.
    Within the total for BLS, the Committee provides the 
following amounts:

------------------------------------------------------------------------
                                                            FY 2021
                   Budget Activity                         Committee
------------------------------------------------------------------------
Employment and Unemployment Statistics...............       $221,000,000
Labor Market Information.............................         68,000,000
Prices and Cost of Living............................        210,000,000
Compensation and Working Conditions..................         83,500,000
Productivity and Technology..........................         10,500,000
Executive Direction and Staff Services...............         62,000,000
------------------------------------------------------------------------

    The Committee is supportive of BLS' workplan for 
implementing investments included in the explanatory statement 
accompanying the Department of Labor Appropriations Act, 2020, 
which includes:

           An annual supplement to the Current 
        Population Survey to allow for collection of data on 
        contingent and alternative work arrangements every two 
        years and data on other topics related to the labor 
        force in alternate years, including an occasional 
        veterans supplement;

           Restoration of the production and 
        publication of employment, unemployment, and labor 
        force data under the Local Area Unemployment Statistics 
        program for New England Minor Civil Divisions with 
        populations less than 1,000; and,

           Investment into the planning, development, 
        and implementation of a new National Longitudinal 
        Survey of Youth (NLSY) cohort.

    BLS shall brief the Committees on Appropriations with 
updated estimates for the annual costs and five-year plan for 
implementing the new NLSY cohort within 90 days of enactment of 
this Act. The Committee is supportive of BLS' interest in 
improving the Job Openings and Labor Turnover Survey (JOLTS) 
and Consumer Expenditure (CE) program poverty measurement; 
however, BLS must ensure it has adequate resources for the 
planning, development, and implementation of the new NLSY 
cohort before moving to new investments for JOLTS and CE.
    When implementing these investments, BLS shall not reduce 
or eliminate existing statistical work. Further, BLS shall not 
reduce the number of full-time equivalent positions beyond the 
apportioned fiscal year 2020 full-time equivalent ceiling.
    Within the total amount for BLS, the Committee includes 
$13,000,000 to continue the relocation of the BLS headquarters, 
which was initiated in fiscal year 2020. BLS is strongly urged 
to consider the needs of its employees throughout this 
transition and to work with the General Services Administration 
(GSA) to address any outstanding safety concerns and office 
space considerations for the development of sensitive economic 
indicators. In addition, BLS, in coordination with the 
Administrator of GSA, shall follow appropriate CDC guidance and 
take such actions as are necessary to mitigate and reduce the 
potential for airborne transmission of COVID-19 through air 
conditioning, heating, ventilating, water systems, and floor 
plans in facilities owned or leased by the GSA and occupied by 
BLS, to ensure safe and healthy indoor environments for BLS 
employees. Such plans should include consideration of worker 
health and safety during the move to the Suitland Federal 
Center. Within 120 days of enactment of this Act, the GSA shall 
provide a report to the Committees on Appropriations on all 
plans to mitigate the spread of COVID-19 in all facilities 
controlled by the GSA and occupied by BLS.
    The Committee encourages BLS to consider expanding the 
Contingent Worker and Alternative Work Arrangement Supplement 
(CWS) to the Current Population Survey (CPS) to measure both 
workers engaged in alternative work as a primary form of 
occupation as well as workers who engage in alternative work in 
a supplementary or informal capacity. This could include, but 
is not limited to, traditional employees who engage in 
alternative work, including as independent contractors, in 
addition to their primary occupations. The Committee is aware 
that BLS forecasts labor-market trends using historical data 
and is supportive of any efforts that would incorporate a wider 
and more forward-looking range of inputs to better project how 
rapidly changing technology and automation will impact the 
workforce of the future. In the fiscal year 2022 Congressional 
Budget Justification, the Committee requests that BLS include 
its views on the merits of developing more forward-looking 
estimates.
    Furthermore, the Committee is aware of the development of 
artificial intelligence and encourages BLS to examine this 
trend's impact on the economy.

                 Office of Disability Employment Policy


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2020.......................       $38,500,000
Budget request, fiscal year 2021......................        27,100,000
Committee Recommendation..............................        38,500,000
    Change from enacted level.........................             - - -
    Change from budget request........................       +11,400,000
 

    The Office of Disability Employment Policy (ODEP) provides 
policy guidance and leadership to eliminate employment barriers 
to people with disabilities.
    The Committee recommendation is the same as the fiscal year 
2020 enacted level and $11,400,000 above the fiscal year 2021 
budget request.
    Given the high number of young adults with disabilities who 
experience significant challenges to live independently and 
achieve gainful employment, the Committee encourages ODEP to 
quantify and evaluate the efficacy of experiential learning 
work-life programs that serve young adults with developmental 
disabilities, including those with Autism Spectrum Disorder 
(ASD), which is the fastest growing developmental disability in 
the U.S. with approximately 1 in 59 children diagnosed each 
year, and more than 50,000 young adults with ASD turning 18 in 
the next fiscal year. Further, the Committee encourages ODEP to 
evaluate barriers to both attaining and sustaining employment 
and career development within this population, and the 
financial impact that long-term gainful employment will have on 
increasing the number of young adults with developmental 
disabilities who are able to achieve economic self-sufficiency.

                        Departmental Management


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2020.......................      $348,364,000
Budget request, fiscal year 2021......................       271,952,000
Committee Recommendation..............................       349,364,000
    Change from enacted level.........................        +1,000,000
    Change from budget request........................       +77,412,000
 

    The Departmental Management appropriation provides funds 
for the staff responsible for Departmental operations, 
management, and policy development.
    The Committee recommendation includes $349,056,000 from the 
General Fund of the Treasury, $1,000,000 above the fiscal year 
2020 enacted level and $77,412,000 above the fiscal year 2021 
budget request, and $308,000 from the Employment Security 
Administration Account in the Unemployment Trust Fund.
    In addition, the CARES Act (P.L. 116-136) included 
$15,000,000 for Departmental Management to prevent, prepare 
for, and respond to the coronavirus, including to implement 
paid family and medical leave, paid sick leave, worker 
protection and Unemployment Insurance stabilization activities.
    Within the total for Departmental Management, the Committee 
provides the following amounts:

------------------------------------------------------------------------
                                                            FY 2021
                   Budget Activity                         Committee
------------------------------------------------------------------------
Program Direction and Support........................        $30,250,000
Departmental Evaluation..............................          8,040,000
Legal Services.......................................        124,053,000
International Labor Affairs..........................         96,125,000
Administration and Management........................         28,450,000
Adjudication.........................................         35,000,000
Women's Bureau.......................................         15,050,000
Civil Rights Activities..............................          6,880,000
Chief Financial Officer..............................          5,516,000
------------------------------------------------------------------------

    Of the $96,125,000 recommended for the International Labor 
Affairs Bureau (ILAB), the Committee directs the Secretary to 
allocate not less than $13,500,000 in grants to build the 
capacity of countries to enforce labor rights to promote a more 
level playing field for workers in the U.S. while maintaining 
critical funding for combatting child labor. ILAB is directed 
to continue its work on three key reports, including: DOL's 
Findings on the Worst Forms of Child Labor; the List of Goods 
Produced by Child Labor or Forced Labor; and, the List of 
Products Produced by Forced or Indentured Child Labor.
    In fiscal year 2020, the Committee provided additional 
resources to the Office of Trade and Labor Affairs to bolster 
monitoring and enforcement activities around the world and to 
hire additional labor attaches in critical U.S. Embassies to 
increase field-based and international monitoring. ILAB is in 
urgent need of attaches in Bangladesh, Vietnam, and Geneva, 
Switzerland for engagement with the International Labor 
Organization (ILO).
    The Committee is very supportive of ILAB's efforts to hire 
additional attaches in Mexico to support the U.S.'s enforcement 
of the United States-Mexico-Canada Agreement (USMCA); however, 
those expenses should be supported by resources this Committee 
provided in Title IX of the USMCA Implementation Act (P.L. 116-
113), which included $210,000,000 for ILAB. Resources provided 
in this Act should support ILAB's efforts to add additional 
attaches in other areas of strategic importance, such as 
Bangladesh, Vietnam, and ILO engagement in Geneva, Switzerland.
    Finally, the Committee urges ILAB to use USMCA 
Implementation Act funding to directly support workers' rights 
and capacity to organize independent unions in Mexico. These 
activities must be central to ILAB's monitoring, enforcement, 
and capacity-building roles in USMCA implementation. ILAB can 
also advance this critical work through technical assistance 
that strengthens the capacity of independent unions in USMCA 
priority sectors. Further, ILAB can fund research and legal 
teams, including through academic institutions, to develop 
sustainable programs that train and support labor lawyers and 
researchers in priority sectors. Finally, ILAB can support key 
USMCA objectives by funding innovative supply chain monitoring 
and accountability mechanisms, focused on ensuring the 
effective recognition of workers' rights to organize and 
collective bargaining in USMCA priority sectors. Such efforts 
to develop necessary research, legal assistance and monitoring 
mechanisms will collectively supplement and strengthen core 
ILAB program to directly educate and train workers to build 
independent unions.
    In the fiscal year 2022 Congressional Budget Justification, 
ILAB is directed to include spending plans for resources 
provided in the USMCA Implementation Act for fiscal years 2020, 
2021, and 2022. Spending plans should include descriptions and 
amounts for projects and staffing.
    The Committee directs the Department to notify and brief 
the Committees on Appropriations, the House Committee on Ways 
and Means, and the Senate Committee on Finance, no later than 
seven days in advance of any action to transfer funds provided 
in the USMCA Implementation Act.
    Of the $15,050,000 appropriated to the Women's Bureau, the 
Committee provides no less than $1,794,000 for the Women in 
Apprenticeship and Nontraditional Occupations (WANTO) program, 
which is $500,000 above the fiscal year 2020 enacted level. The 
Committee once again rejects the fiscal year 2021 budget 
request's proposal to eliminate WANTO. This program helps 
employers and labor unions recruit, train, and retain women for 
nontraditional employment opportunities. These resources are 
essential in helping women overcome traditional barriers to 
entry and supporting women's full participation in the labor 
force.
    The Committee directs the Department to submit its annual 
Operating Plan to the Committees on Appropriations within the 
45-day statutory deadline.
    The Committee understands that, as the largest advertiser 
in the U.S., the Federal Government should work to ensure fair 
access to its advertising contracts for small disadvantaged 
businesses and businesses owned by minorities and women. The 
Committee directs the Department to include the following 
information in its fiscal year 2022 Congressional Budget 
Justification: Expenditures for fiscal year 2020 and expected 
expenditures for fiscal years 2021 and 2022, respectively, for 
(1) all contracts for advertising services; and, (2) contracts 
for the advertising services of (I) socially and economically 
disadvantaged small business concerns (as defined in section 
8(a)(4) of the Small Business Act (15 U.S.C. 637(a)(4)); and 
(II) women- and minority-owned businesses.
    The Committee directs the Department to provide 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.
    The Committee directs the Department to provide a report to 
the Committees on Appropriations within 120 days of enactment 
of this Act on the number of full-time equivalent employees and 
funds obligated for personnel, training, equipment and travel 
to provide security for the Secretary and others covered under 
applicable security detail provisions within this Act for 
fiscal years 2019 and 2020. In addition, the Department shall 
include projected costs for fiscal years 2021 and 2022 in the 
fiscal year 2022 Congressional Budget Justification.
    The Committee supports targeted investments in impoverished 
areas, particularly in persistent poverty counties and in other 
high poverty census tracts. To understand how programs funded 
through the Department are serving these particular areas, the 
Committee directs the Department to submit a report to the 
Committees on Appropriations on the percentage of funds 
allocated by all competitive grant programs and other anti-
poverty programs in fiscal years 2018, 2019 and 2020 and 
estimates for fiscal year 2021 to serve individuals living in 
persistent poverty counties, as defined as a county that has 
had 20 percent or more of its population living in poverty over 
the past 30 years, as measured by the 1990 and 2000 decennial 
censuses and the most recent Small Area Income and Poverty 
estimates, or any territory or possession of the U.S., and 
high-poverty areas, as defined as any census tract with a 
poverty rate of at least 20 percent as measured by the 2014-
2018 5-year data series available from the American Community 
Survey of the Census Bureau. The Department shall report this 
information to the Committees within 90 days of such data being 
available and provide a briefing to the Committees not later 
than 180 days of enactment of this Act on how the Department is 
carrying out this directive. In the case of any program for 
which at least 10 percent of the funds allocated in fiscal year 
2020 were not allocated to persistent poverty counties or for 
which the percentage allocated to high-poverty areas in fiscal 
year 2020 was less than the average percentage of Federal 
assistance allocated to high-poverty areas awarded under the 
program in fiscal years 2017, 2018, and 2019, such report and 
briefing shall explain why such a benchmark is unable to be 
met.
    The Committee is supportive of efforts by the Department to 
consider evidence of effectiveness in grant competitions and 
requests an update in the fiscal year 2022 Congressional Budget 
Justification on implementation of the Foundations for 
Evidence-based Policymaking Act (P.L. 115-435) and 
implementation plans for the coming year. The Committee 
encourages the Secretary to develop guidance to ensure relevant 
participants and grantees are involved in the Department-wide 
process of prioritizing evidence needs, including participating 
in Department led evaluations. Consistent with program 
statutes, the Committee encourages the Secretary to ensure that 
evidence of effectiveness is a consideration in grant 
opportunities.
    The Committee directs the Department to comply with title 
31 of the United States Code, including the development of 
organizational priority goals and outcomes such as performance 
outcome measures, output measures, efficiency measures, and 
customer service measures. The Committee further directs the 
Department to include an update on the progress of these 
efforts in the fiscal year 2022 Congressional Budget 
Justification.
    The Committee continues to support efforts to improve 
customer service in accordance with Executive Order 13571--
Streamlining Service Delivery and Improving Customer Service. 
The Committee directs the Secretary to develop standards to 
improve customer service and incorporate the standards into the 
performance plans required under 31 U.S.C. 1115. The Committee 
further directs the Department to include an update on the 
progress of these efforts in the fiscal year 2022 Congressional 
Budget Justification.
    The Committee is concerned by the Department's 
implementation of Executive Orders 13836, 13837, and 13839 and 
eagerness to bring disputes with employee bargaining units 
before the Federal Service Impasses Panel. The Committee urges 
the Department to negotiate in good faith with Department's 
employees and cease efforts that curtail their ability to 
collectively bargain and organize.
    The Committee is concerned by reports of widespread 
workplace harassment and mistreatment of vulnerable workers, 
including domestic workers. To address these concerns, the 
Committee directs GAO to study and recommend improvements to 
Federal support programs for survivors of workplace harassment 
in low-wage, vulnerable, and marginalized sectors like domestic 
work. This would include recommendations to ensure that 
domestic workers can safely access housing, health care, mental 
health, and counseling service supports; as well as workers 
compensation, unemployment insurance, disability benefits, 
transportation stipends, and other support. The Committee 
recognizes that menstrual hygiene products are basic health 
necessities and supports efforts by employers to provide 
menstrual hygiene products free of charge for employees.
    The Committee is deeply concerned about the 11.9 million 
children, including 7.5 million Black and Latino children, 
living in poverty as of 2018. Now, millions more are projected 
to live in poverty due to the COVID-19 pandemic. Without robust 
Federal support, a Columbia University study estimates that 
child poverty could balloon from an already shameful 13.6 
percent to nearly 21 percent, with Black and Latino children 
bearing a disproportionate risk of falling into or deeper into 
poverty. More than 50 percent of low-income households report 
they or someone in their household has experienced job loss or 
a pay cut, and more nearly 40 million Americans have lost their 
jobs to date. During the pandemic, families are stretched 
thinner than ever and far too many families, especially in 
communities of color, are struggling to pay the bills and keep 
the lights on. The Committee recognizes that resources provided 
for the Department are critical now more than ever to reducing 
child poverty and racial disparities. However, there is concern 
that especially with tight budget caps for fiscal year 2021, 
funding for programs to help children in poverty is not enough. 
Deep inequities remain for children of color who are often more 
segregated by neighborhood, lower socioeconomic status, and in 
K-12 schooling. The Committee requests that the Department 
looks for opportunities to target resources to communities with 
the highest child poverty rates to help reduce child poverty 
and racial disparities, especially in the context of COVID-19, 
and as the pandemic threatens to increase child poverty for 
years to come.
    The Committee encourages the Department to consider using 
local media in their advertising, including local television, 
radio broadcast stations, and newspapers to the greatest extent 
possible. The Committee directs the Department to include in 
its fiscal year 2022 Congressional Budget Justification details 
on expenditures on local media advertising for the prior two 
fiscal years.
    The Committee directs the Department's Division of 
Protective Operations, to the extent it has not already done 
so, to submit its use of force data to the Federal Bureau of 
Investigation's National Use of Force Data Collection database. 
The Committee further directs, within 90 days of enactment of 
this Act, the Department to brief the Committees on 
Appropriations on its current efforts to tabulate and submit 
its use of force data to the FBI.

                    VETERANS EMPLOYMENT AND TRAINING

 
 
 
Appropriation, fiscal year 2020.......................      $311,341,000
Budget request, fiscal year 2021......................       312,000,000
Committee Recommendation..............................       313,841,000
    Change from enacted level.........................        +2,500,000
    Change from budget request........................        +1,841,000
 

    The recommendation includes $57,500,000 from the General 
Fund of the Treasury and $256,341,000 from the Employment 
Security Administration Account in the Unemployment Trust Fund.
    The Veterans Employment and Training (VETS) program serves 
America's veterans and separating service members by preparing 
them for meaningful careers, providing employment resources and 
expertise, and protecting their employment rights.
    Within the total for VETS, the Committee provides the 
following amounts:

------------------------------------------------------------------------
                                                            FY 2021
                   Budget Activity                         Committee
------------------------------------------------------------------------
State Administration Grants..........................       $180,000,000
Transition Assistance Program........................         29,379,000
Federal Administration...............................         43,548,000
Veterans Employment and Training Institute...........          3,414,000
Homeless Veterans Reintegration Program..............         57,500,000
------------------------------------------------------------------------

    The Committee recommendation includes $29,379,000 for the 
Transition Assistance Program, which is the same as the fiscal 
year 2020 enacted level and the fiscal year 2021 budget 
request. This funding will enhance the quality of employment 
support services for transitioning service members and allow 
VETS to develop and implement a course curriculum to help 
military spouses overcome the challenges they face related to 
employment and career development.
    The Committee includes $57,500,000 for the Homeless 
Veterans Reintegration Program, which is $2,500,000 more than 
the fiscal year 2020 enacted level and the fiscal year 2021 
budget request. Funds will be used to further support the needs 
of veterans experiencing homelessness.
    The Committee includes $500,000, which is the same as the 
fiscal year 2020 enacted level and the fiscal year 2021 budget 
request, to support the HIRE Vets Medallion Program authorized 
by the Honoring Investments in Recruiting and Employing 
American Military Veterans Act of 2017.
    The Committee recommendation includes $300,000 within 
Federal Administration, which is the same as the fiscal year 
2020 enacted level and the fiscal year 2021 budget request, to 
continue the operation of the Disabled Veteran Program (DVP), 
which was initiated by the Committee last year. The DVP 
addresses the high unemployment and low labor force 
participation rate of veterans with service-connected and non-
service-connected disabilities. The DVP helps increase 
employment and advancement opportunities for veterans with 
disabilities by working with Federal, State, and private 
partners to promote the hiring of veterans with disabilities, 
improve coordination of available employment services and 
supports, and to identify and share employment best practices 
for hiring, retaining, and advancing veterans with disabilities 
in the workforce.
    Equity and Access for Homeless Veterans.--The Committee 
directs the Department to include an update on racial equity 
and access to programs at the Department providing services to 
homeless veterans in its fiscal year 2022 Congressional Budget 
Justification. The update shall also track departmental 
expenditures within the Homeless Veteran Programs, specifically 
with regard to minority, female, and LGBTQ populations. Where 
available, the Department shall disaggregate data by ethnicity, 
age, gender identity, and discharge status.

                  INFORMATION TECHNOLOGY MODERNIZATION

 
 
 
Appropriation, fiscal year 2020.......................       $25,269,000
Budget request, fiscal year 2021......................        37,000,000
Committee Recommendation..............................        25,269,000
    Change from enacted level.........................             - - -
    Change from budget request........................       -11,731,000
 

    Information Technology (IT) Modernization provides a 
dedicated source of funding for Department-wide IT 
modernization projects together with funding through the 
Department's Working Capital Fund.

                      OFFICE OF INSPECTOR GENERAL

 
 
 
Appropriation, fiscal year 2020.......................       $90,847,000
Budget request, fiscal year 2021......................        93,493,000
Committee Recommendation..............................        91,847,000
    Change from enacted level.........................        +1,000,000
    Change from budget request........................        -1,646,000
 

    The Office of Inspector General (OIG) conducts audits of 
Department programs and operations in order to determine that 
they comply with the applicable laws and regulations, that they 
use resources effectively, and that they are achieving their 
intended results.
    The recommendation includes $85,187,000 from the General 
Fund of the Treasury, which is $1,000,000 more than the fiscal 
year 2020 enacted level and $1,646,000 below the fiscal year 
2021 budget request, and $5,660,000 from the Employment 
Security Administration Account in the Unemployment Trust Fund.
    The CARES Act (P.L.116-136) included $26 million, including 
$1,000,000 in discretionary funding, for the OIG to conduct 
oversight of activities supported with funds appropriated to 
the Department to prevent, prepare for, and respond to COVID-
19.

                           General Provisions

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

                          (TRANSFER OF FUNDS)

    Sec. 102. The Committee modifies a provision regarding 
transfer authority.
    Sec. 103. The Committee continues a prohibition on use of 
funds to purchase goods that are in any part produced by 
indentured children.
    Sec. 104. The Committee continues a provision related to 
grants made from funds available to the Department under the 
American Competitiveness and Workforce Improvement Act.
    Sec. 105. The Committee continues a provision to prohibit 
recipients of funds provided to the Employment and Training 
Administration from using such funds for the compensation of 
any individual at a rate in excess of Executive Level II.

                          (TRANSFER OF FUNDS)

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

                          (TRANSFER OF FUNDS)

    Sec. 107. The Committee continues a provision allowing up 
to 0.75 percent of discretionary appropriations provided in 
this Act for specific Department of Labor agencies to be used 
by the Office of the Chief Evaluation Officer for evaluation 
purposes consistent with the terms and conditions in this Act 
applicable to such office.
    Sec. 108. The Committee continues a provision relating to 
surplus property and apprenticeship programs.
    Sec. 109. The Committee modifies a provision relating to 
the Secretary's security detail.
    Sec. 110. The Committee continues a provision relating to 
the Treasure Island Job Corps Center.

                              (RESCISSION)

    Sec. 111. The Committee modifies a provision relating to H-
1B fees.
    Sec. 112. The Committee continues a provision relating to 
Job Corps.
    Sec. 113. The Committee includes a new provision relating 
to the Joint Employer Status regulation.
    Sec. 114. The Committee includes a new provision relating 
to the Implementing Legal Requirements Regarding the Equal 
Opportunity Clause's Religious Exemption regulation.
    Sec. 115. The Committee includes a new provision related to 
the Wagner-Peyser Act Staffing Flexibility regulation.

           TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES


              Health Resources and Services Administration


 
 
 
Appropriation, fiscal year 2020.......................    $7,037,259,000
Budget request, fiscal year 2021......................     6,289,085,000
Committee Recommendation..............................     7,195,758,000
    Change from enacted level.........................      +158,499,000
    Change from budget request........................      +906,673,000
 

    The Health Resources and Services Administration (HRSA) 
supports programs that provide health services to 
disadvantaged, medically underserved, and special populations; 
decrease infant mortality rates; assist in the education of 
health professionals; and provide technical assistance 
regarding the utilization of health resources and facilities.
    The Committee recommendation for HRSA includes 
$7,195,758,000 in discretionary budget authority, and 
$265,600,000 in mandatory funding and $10,200,000 in trust fund 
appropriations for the Vaccine Injury Compensation Program 
Trust Fund.
    In addition, the Coronavirus Preparedness and Response 
Supplemental Appropriations Act (P.L. 116-123) included 
$100,000,000 and the CARES Act (P.L. 116-136) included 
$275,000,000 in discretionary appropriations and $1,320,000,000 
in mandatory funding to support health centers, Ryan White HIV/
AIDS clinics, and hospitals respond to the COVID-19 pandemic.

                          PRIMARY HEALTH CARE

 
 
 
Appropriation, fiscal year 2020.......................    $1,626,522,000
Budget request, fiscal year 2021......................     1,728,522,000
Committee Recommendation..............................     1,651,522,000
    Change from enacted level.........................        25,000,000
    Change from budget request........................       -77,000,000
 

Health Centers

    The Committee recommends $1,650,522,000 for the Health 
Centers program, $25,000,000 above the fiscal year 2020 enacted 
level and $77,000,000 below the fiscal year 2021 budget 
request.
    In addition, the Coronavirus Preparedness and Response 
Supplemental Appropriations Act included $100,000,000 and the 
CARES Act included $1,320,000,000 in mandatory funding to 
support COVID-19 testing and treatment as well as maintain 
other critical services at Health Centers.
    The Committee includes bill language providing up to 
$120,000,000 for the Federal Tort Claims Act program, the same 
as the fiscal year 2020 enacted level and the fiscal year 2021 
budget request.
    Ending the HIV Epidemic Initiative.--The Committee provides 
$65,000,000 within the Health Centers program for the Ending 
the HIV Epidemic (EHE) Initiative, $15,000,000 above the fiscal 
year 2020 enacted level and $72,000,000 below the fiscal year 
2021 budget request. This investment builds on an increase of 
$50,000,000 included in fiscal year 2020, bringing the two-year 
investment in Health Centers for their role in the EHE 
Initiative to a total of $115,000,000. This initiative provides 
funding to Health Centers in high-need jurisdictions to 
increase the use of pre-exposure prophylaxis (PrEP) among 
people at high risk for HIV transmission.
    Native Hawaiian Health Care Program.--The Committee 
provides $19,000,000 within the total for Health Centers for 
the Native Hawaiian Health Care Program, the same as the fiscal 
year 2020 enacted level and the fiscal year 2021 budget 
request. The Native Hawaiian Healthcare Systems help improve 
the health status of Native Hawaiians by making health 
education, health promotion, disease prevention, and Native 
Hawaiian traditional healing services available.
    Health Care for the Homeless.--Recognizing the complex and 
serious health challenges homeless individuals face, the 
Committee urges HRSA to prioritize access to expanded 
behavioral health services, including mental health services 
and substance use disorder treatment services.
    Health Center Guidelines for Hepatitis B (HBV) and 
Hepatitis C (HCV).--Funded health centers are expected to 
follow the USPSTF Guidelines for testing of HBV and HCV, 
vaccination against Hepatitis A (HAV) and HBV, and offering 
appropriate care and treatment for those clients who test 
positive for these viruses. The Committee requests that HRSA 
submit a status report within 180 days of enactment of Act on 
the number of annual viral hepatitis tests conducted and adult 
vaccinations administered by Community Health Centers, and the 
number of clients treated for HBV and cured of HCV. The 
Committee requests that HRSA provide guidance to Federally-
Qualified Health Centers (FQHCs) outlining how primary care 
doctors ought to manage and treat HCV.
    Health Centers and Home Visiting Programs.--The Committee 
supports HRSA's continued promotion of expanded partnerships 
between Health Centers and evidence-based home visiting 
programs to improve maternal and child health outcomes in high-
need communities. Home visiting programs can also provide cost-
effective benefits such as care coordination and service 
referral that help Health Centers achieve community health 
goals. As such, the Committee directs the Bureau to issue 
written guidance on how these partnerships fit within Health 
Centers' scope of practice.
    Health Centers as Primary Dental Homes.--The Committee 
recognizes the importance of Health Centers in providing 
integrated care to the nation's underserved communities. Health 
Centers serve as a primary dental home for many who would 
otherwise face barriers to dental care. The Committee is aware 
that some Health Centers have partnered with Community Dental 
Health Coordinators (CDHCs) to provide patients with greater 
access to dental care. CDHCs provide community-based 
prevention, care coordination, and patient navigation to 
underserved populations in rural, urban, and Native American 
communities. The Committee encourages HRSA to work with Health 
Centers to expand their work in this area.
    HRSA Strategy to Address Intimate Partner Violence and 
Project Catalyst.--The Committee includes no less than 
$1,500,000 for the HRSA Strategy to Address Intimate Partner 
Violence, an increase of $500,000 over the fiscal year 2020 
enacted level. The Committee particularly supports training, 
technical assistance, and resource development to assist public 
health and health care professionals to better serve 
individuals and communities impacted by intimate partner 
violence.
    School-Based Health Centers.--The Committee includes an 
increase of $10,000,000 within the total for Health Centers to 
increase the number of and services provided at SBHCs. SBHCs 
provide a convenient access point to high-quality, 
comprehensive primary health care, mental health services, 
preventive care, social services, and youth development to 
primarily children and adolescents from low-income families.

Free Clinics Medical Malpractice

    The Committee recommends $1,000,000 for carrying out 
responsibilities under the Federal Tort Claims Act, the same as 
the fiscal year 2020 enacted level and the fiscal year 2021 
budget request. The program provides medical malpractice 
coverage to individuals involved in the operation of free 
clinics to expand access to health care services to low-income 
individuals in medically underserved areas.

                            HEALTH WORKFORCE

 
 
 
Appropriation, fiscal year 2020.......................    $1,194,506,000
Budget request, fiscal year 2021......................       370,425,000
Committee Recommendation..............................     1,242,505,000
    Change from enacted level.........................       +47,999,000
    Change from budget request........................      +872,080,000
 

    The Bureau of Health Workforce strengthens the health care 
workforce by providing grants, scholarships, and loan repayment 
programs to help communities recruit and retain health care 
providers where they are most needed.
    Rural Health Workforce.--The Committee encourages HRSA to 
explore opportunities for collaboration and partnership with 
schools and programs that offer rural residencies, rural health 
certificates, or otherwise recognized rural curriculum in order 
to increase the placement of health care providers and 
professionals with rural health training in HRSA Health 
Workforce Programs. The agency shall report to the Committees 
on these efforts within 60 days of enactment of this Act.

Health Professions

    The Committee recommends $847,505,000 for the Health 
Professions programs, $42,999,000 above the fiscal year 2020 
enacted level and $477,080,000 above the fiscal year 2021 
budget request. The Health Professions programs support grants 
for the development of the health workforce in fields 
challenged by a high need and insufficient supply of health 
professionals. Given that colleges and universities serve the 
dual role of training students and carrying out a majority of 
Federally-funded biomedical research, the Committee believes 
these institutions serve as an ideal setting to expose future 
clinicians to the evidence base that underlies their intended 
profession.
    Within the total for Health Professions, the Committee 
recommends the following amounts:

------------------------------------------------------------------------
                                                            FY 2021
                   Budget Activity                         Committee
------------------------------------------------------------------------
National Health Service Corps........................       $120,000,000
Health Professions Training for Diversity
    Centers of Excellence............................         23,711,000
    Health Careers Opportunity Program...............         15,000,000
    Faculty Loan Repayment...........................          1,190,000
    Scholarships for Disadvantaged Students..........         51,470,000
Primary Care Training and Enhancement................         48,924,000
Oral Health Training Programs........................         40,673,000
Interdisciplinary, Community-Based Linkages
    Area Health Education Centers....................         43,249,000
    Geriatric Programs...............................         42,737,000
    Mental and Behavioral Health.....................         38,916,000
    Behavioral Health Workforce Education and                127,000,000
     Training........................................
Workforce Information and Analysis...................          5,663,000
Public Health and Preventive Medicine Programs.......         19,000,000
Nursing Programs
    Advanced Education Nursing.......................         78,581,000
    Nurse Education, Practice, and Retention.........         45,913,000
    Nurse Practitioner Optional Fellowship Program...          5,000,000
    Nursing Workforce Diversity......................         20,343,000
    NURSE Corps Scholarship and Loan Repayment.......         91,635,000
    Nursing Faculty Loan Program.....................         28,500,000
------------------------------------------------------------------------

    Attracting Health Care Providers to the Non-Contiguous 
States.--Non-contiguous States are continually challenged by a 
shortage of health care providers. Due to the geographic 
challenges of these two States, including large rural areas, 
areas of sparse population, fragmentation, duplication due to 
roadless areas (including ocean geography), and higher costs 
due to the volume of patients served, non-contiguous areas have 
geographic challenges that make it difficult to provide access 
to quality health care. The Committee requests a report, not 
later than 180 days of enactment of this Act, on best practices 
and strategies to attract health care practitioners to non-
contiguous States, especially in the areas with health care 
professional shortages.
    Health Professionals Staffing Shortages Report.--The 
Committee recognizes the current and growing shortage of 
primary care physicians, psychiatrists, behavioral health 
specialists, and geriatric medical professionals. The Committee 
looks forward to receiving the Health Professional Staffing 
Shortages report requested in House Report 116-62, which was 
due by June 20, 2020.
    HRSA Diversity Programs.--The Committee supports programs 
that improve the diversity of the healthcare workforce. HRSA's 
diversity pipeline programs, including the Health Careers 
Opportunity Program, Centers for Excellence, Faculty Loan 
Repayment, Nursing Workforce Diversity, and Scholarships for 
Disadvantaged Students help advance patient care and ensure 
opportunity for all healthcare providers. The Committee 
requests a report within 180 days of enactment of this Act on 
how these programs can be further strengthened to address 
mental health disparities.
    Pediatric Nephrology Workforce.--The Committee is concerned 
about the growing shortage of pediatric nephrologists, 
particularly in rural parts of the country. If these trends 
continue, there will not be enough pediatric nephrologists to 
treat children with kidney disease. The Committee requests a 
report within 120 days of enactment of this Act on ways HRSA 
can support efforts to recruit, train, and support pediatric 
nephrologists, including existing workforce training 
opportunities and recommendations to address health 
professional staffing shortages.
    Rural Medical Provider Shortages.--The Committee is 
concerned with the large medical provider shortage in rural 
areas around the country. The Committee directs HRSA to submit 
a report to the Committee and the Committee on Ways and Means 
within 180 days of enactment of this Act detailing specific 
strategies and the associated costs that could be used to 
eliminate medical provider shortages in rural communities, 
including but not limited to expanding the National Health 
Service Corps. This report should place an emphasis on both 
recruitment and retention of medical providers in rural 
communities.

National Health Service Corps

    The Committee directs HRSA to examine the application 
processes and eligibility requirements for both NHSC recruits 
and provider locations, including the HPSA qualification and 
scoring. The Committee looks forward to receiving the report, 
as directed in House Report 116-62, with recommendations on how 
the NHSC program, including the HPSA application and scoring 
process, may be modified to increase recruitment and field 
strength as well as diversify provider sites on the roles of 
Department agencies in addressing gaps in maternal mental 
health, within 60 days of enactment of this Act.

Centers of Excellence (COEs)

    The Committee notes that COEs disproportionately educate 
health professionals from minority and underserved backgrounds 
and address the need for a diverse and culturally competent 
American healthcare workforce. The Committee looks forward to 
receiving the report requested in House Report 116-32 on 
achievements and challenges faced by COEs and the contribution 
COEs make to workforce development.

Health Careers Opportunity Program (HCOP)

    The Committee notes that HCOPs assist students from 
minority and economically disadvantaged backgrounds navigate 
careers into the health professions. Given the volume of HCOP 
scholars that return or remain in medically underserved 
communities, the Committee encourages HRSA's Bureau of Health 
Workforce to continue its improvement of the diversity and 
distribution of needed health care professionals through 
National Health Career Opportunity Program Academies and urges 
HRSA to report updates on HCOP pipeline activity back to 
Congress within 120 days of the enactment of this Act.

Scholarships for Disadvantaged Students

    Within the total funding for Scholarships for Disadvantaged 
Students, the Committee directs $2,500,000, the same as the 
fiscal year 2020 enacted level, to be set aside to educate 
midwives to address the national shortage of maternity care 
providers and the lack of diversity in the maternity care 
workforce.

Oral Health Training

    Oral Health Training and Dental Faculty Loan Repayment 
Program.--Within the total for Oral Health Training, the 
Committee includes not less than $12,000,000 for General 
Dentistry Programs and not less than $12,000,000 for Pediatric 
Dentistry Programs. The Committee directs HRSA to provide 
continuation funding for section 748 Dental Faculty Loan 
Program (DFLRP) grants initially awarded in fiscal years 2016, 
2017, and 2018. The Committee continues to support DFLRP awards 
with a 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 affiliate sites.

Area Health Education Centers (AHEC)

    AHEC Oral Health Projects.--The Committee encourages HRSA 
to support AHEC oral health projects that establish primary 
points of service and address the need to help patients find 
treatment outside of hospital emergency rooms. The Committee 
encourages HRSA to work with programs that have already been 
initiated by some State dental associations to refer emergency 
room patients to dental networks.

Mental and Behavioral Health Education Training (MBHET) Programs

    Graduate Psychology Education.--Within the total for MBHET, 
the Committee recommendation includes $20,000,000, $2,000,000 
above the fiscal year 2020 enacted level and the fiscal year 
2021 budget request, for the interprofessional Graduate 
Psychology Education (GPE) Program to support health service 
psychologists trained to provide integrated services to high-
need, underserved populations in rural and urban communities. 
In addressing the opioid epidemic, the Committee recognizes the 
growing need for highly trained mental and behavioral health 
professionals to deliver evidence-based behavioral 
interventions for pain management. The Committee encourages 
HRSA to help integrate health service psychology trainees at 
FQHCs.

Behavioral Health Workforce Education and Training (BHWET)

    The Committee includes $127,000,000 for the BHWET Program, 
$25,000,000 above the fiscal year 2020 enacted level and the 
fiscal year 2021 budget request. This program establishes and 
expands internships or field placement programs in behavioral 
health serving populations in rural and medically underserved 
areas.
    BHWET Support in Rural Settings.--The Committee is 
concerned about the utilization of BHWET programs by rural 
residents and in rural areas. In the 2017-2018 academic year, 
only 27 percent of BHWET trainees were from rural areas, 25 
percent of BHWET clinical sites were located in rural settings, 
and 20 percent of BHWET trainees were receiving training in 
rural areas. The Committee encourages HRSA to increase the 
number of trainees from rural areas, clinical sites located in 
rural areas, and trainees receiving training in rural areas. 
The Committee directs HRSA to update the Committee on such 
efforts within 180 days of enactment of this Act.
    Peer Support Specialists in the Opioid Use Disorder 
Workforce.--Within the total for BHWET, the Committee includes 
$15,000,000, an increase of $5,000,000 above the fiscal year 
2020 enacted level and $15,000,000 above the fiscal year 2021 
budget request, to fund training, internships, and national 
certification for mental health and substance abuse peer 
support specialists to create an advanced peer workforce 
prepared to work in clinical settings. The Committee further 
recommends that consideration should be given to community-
based experiential training for students focusing on veterans, 
first responders, or marginalized populations.
    Loan Repayment Program for Substance Use Disorder Treatment 
Workforce.--The Committee includes $17,000,000 for the Loan 
Repayment Program for Substance Use Disorder Treatment 
Workforce, $5,000,000 above the fiscal year 2020 enacted level 
and the fiscal year 2021 budget request. This program addresses 
shortages in the substance use disorder (SUD) workforce by 
providing for the repayment of education loans for individuals 
working in a full-time SUD treatment job that involves direct 
patient care in either a Mental Health Professional Shortage 
Area or a county where the overdose death rate exceeds the 
national average. This program contributes to increasing the 
ranks of a well-trained SUD workforce in communities across 
America and helps save lives by equipping the frontline 
professionals who prevent and treat addiction, provide recovery 
support, and help reduce the negative consequences associated 
with substance use.
    Mental and Substance Use Disorder Workforce Training 
Demonstration.--The Committee includes $41,700,000 for the 
Mental and Substance Use Disorder Workforce Training 
Demonstration program, $15,000,000 above the fiscal year 2020 
enacted level and $12,000,000 above the fiscal year 2021 budget 
request. This program makes grants to institutions, including 
but not limited to medical schools and FQHCs, to support 
training for medical residents and fellows in psychiatry and 
addiction medicine, as well as nurse practitioners, physician 
assistants, and others, to provide SUD treatment in underserved 
communities. Within the total, the Committee includes an 
additional $15,000,000 for new grants to expand the number of 
nurse practitioners, physician assistants, health service 
psychologists, and social workers trained to provide mental and 
substance use disorder services in underserved community-based 
settings that integrate primary care and mental and substance 
use disorder services, which may include establishing, 
maintaining, or improving academic units or programs to support 
those activities, as authorized under section 760 of the PHS 
Act.
    The Committee remains concerned by the lack of pediatric 
and adolescent addiction medicine and addiction psychiatry 
expertise. Currently, there are insufficient opportunities to 
effectively train a robust mental health and substance use 
disorder workforce. Only 75 of the nation's 179 accredited 
medical schools offer addiction medicine fellowships, and only 
one program focuses on fellowship opportunities for pediatric 
and adolescent addiction medicine and addiction psychiatry. 
This gap is even more troubling given that the onset of mental 
health disorders and substance use disorders are most likely to 
occur at a young age. Substance use disorders prevent children 
and adolescents from reaching their full potential and are 
antecedent to addiction in adulthood, and it is evident that 
our nation is not equipped to support this population. 
Therefore, the Committee strongly encourages HRSA to include an 
adequate number of funding awards to fellowship programs 
focused on increasing the number of board-certified pediatric 
and adolescent addiction medicine and addiction psychiatry 
subspecialists.

Public Health And Preventive Medicine Programs

    The Committee includes $19,000,000 for Public Health and 
Preventive Medicine Training Grant Programs, $2,000,000 above 
the fiscal year 2020 enacted level and $19,000,000 above the 
fiscal year 2021 budget request. Within this total, the 
Committee provides an increase of $1,000,000 for the Preventive 
Medicine Residency Training Program and an increase of 
$1,000,000 for Public Health Training Centers.

Nurse Practitioner Optional Fellowship Program

    The Committee provides $5,000,000, the same as the fiscal 
year 2020 enacted level and $5,000,000 above the fiscal year 
2021 budget request, to make grants to establish or expand 
optional community-based nurse practitioner fellowship programs 
that are accredited for practicing postgraduate nurse 
practitioners (NPs) in primary care or behavioral health. The 
Committee directs HRSA to give preference to FQHCs, as defined 
by section 1861(aa)(4) of the Social Security Act. The 
Committee is concerned the nation is unprepared for healthcare 
provider shortages and recognizes that optional postgraduate 
programs with this focus, integrating primary care and 
behavioral health, will help to address this problem. Patients 
need expert primary care and behavioral health providers 
prepared to manage the social and clinical complexities 
experienced in FQHCs. A key focus of the program will be 
training and professional development in the integration of 
primary care and behavioral health. The program will provide 
original fellowships for transitioning to an integrated model 
of care consistent with the current high standards of NP 
education and practice meeting the needs of our nation's most 
vulnerable populations.

Nursing Education, Practice, Quality, and Retention (NEPQR)

    Experiential Learning Opportunities.--Within the total for 
NEPQR, the Committee includes not less than $2,000,000, the 
same as the fiscal year 2020 enacted level and $2,000,000 above 
the fiscal year 2021 budget request, for competitive grants to 
enhance nurse education and strengthen the nursing workforce 
through the expansion of experiential learning opportunities. 
The Committee encourages HRSA to support qualifying nurse 
education training programs at community colleges throughout 
the country. The Committee directs HRSA to ensure that these 
grants include as an allowable use the purchase of simulation 
training equipment. The Committee also directs HRSA to give 
priority to grantees located in a health professional shortage 
area in a State with an age-adjusted high burden of stroke, 
heart disease, and obesity, and to prioritize submissions that 
support high poverty rate communities.

Children's Hospitals Graduate Medical Education

    The Committee recommends $340,000,000 for the Children's 
Hospitals Graduate Medical Education (CHGME) Payment program, 
the same as the fiscal year 2020 enacted level and $340,000,000 
above the fiscal year 2021 budget request. The CHGME Payment 
program helps eligible hospitals maintain graduate medical 
education programs, which support the training of residents to 
care for the pediatric population and enhance the supply of 
primary care and pediatric medical and surgical subspecialties.

Medical Student Education

    The Committee recommends $55,000,000, $5,000,000 above the 
fiscal year 2020 enacted level and $55,000,000 above the fiscal 
year 2021 budget request, to support colleges of medicine at 
public universities located in the top quintile of States 
projected to have a primary care provider shortage. The 
Committee directs HRSA to give priority to applications from 
universities located in States with the greatest number of 
Federally-recognized Tribes. The Committee also directs HRSA to 
give priority to applications from public universities with a 
demonstrated public-private partnership.

National Practitioner Data Bank (NPDB)

    The Committee recommendation includes $18,814,000 for the 
NPDB, the same as the fiscal year 2020 enacted level and the 
fiscal year 2021 budget request. The NPDB is a workforce tool 
that collects and discloses information to authorized entities 
on past adverse actions of health care practitioners, 
providers, and suppliers to reduce fraud and abuse and improve 
health care quality.

                       MATERNAL AND CHILD HEALTH

 
 
 
Appropriation, fiscal year 2020.......................      $943,784,000
Budget request, fiscal year 2021......................       919,018,000
Committee Recommendation..............................       980,784,000
    Change from enacted level.........................       +37,000,000
    Change from budget request........................       +61,766,000
 

    The mission of the Maternal and Child Health Bureau is to 
improve the physical and mental health, safety, and well-being 
of the Nation's women, infants, children, adolescents, and 
their families.
    Hereditary Hemorrhagic Telangiectasia (HHT).--In fiscal 
years 2017 and 2018, the committee provided $200,000 to CDC to 
support a collaborative pilot model that enables up to three 
existing Federally-funded Hemophilia Treatment Centers (HTC) to 
serve as specialty centers for the evaluation and management of 
HHT. If proven effective, these joint HTC-HHT Centers have the 
potential to provide critical diagnostic and treatment services 
to both hemophilia and HHT populations. The Committee 
encourages HRSA to work closely with CDC and stakeholder 
organizations to track the progress of this pilot initiative 
for potential replication.

Maternal and Child Health (MCH) Block Grant

    The Committee recommends $712,700,000 for the MCH Block 
Grant, $25,000,000 above the fiscal year 2020 enacted level and 
$48,000,000 below the fiscal year 2021 budget request. States 
use the MCH Block Grant to improve access to care for mothers, 
children, and their families; reduce infant mortality; provide 
pre- and post-natal care; support screening and health 
assessments for children; and provide systems of care for 
children with special health care needs.
    Maternal, Infant, and Early Childhood Home Visiting 
Program.--The Committee recognizes that good oral health is an 
important component for improving the health and well-being of 
children and families. The Committee encourages HRSA to explore 
opportunities to integrate oral health in the agency's Home 
Visiting Program and provide the home visitors with the 
training to become a Community Dental Health Coordinator. The 
Committee also encourages HRSA to work with oral health 
initiatives such as Community Dental Health Coordinators that 
have already been initiated by dental organizations to provide 
dental education, community-based prevention, care 
coordination, and patient navigation to children and vulnerable 
families.

Special Projects of Regional and National Significance

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

------------------------------------------------------------------------
                   Budget Activity                     FY 2021 Committee
------------------------------------------------------------------------
Set-aside for Oral Health............................         $5,250,000
Set-aside for Epilepsy...............................          3,642,000
Set-aside for Sickle Cell Disease....................          5,000,000
Set-aside for Fetal Alcohol Syndrome.................          1,000,000
------------------------------------------------------------------------

    State Oral Health Programs.--The Committee continues to 
include $250,000 to continue demonstration projects to increase 
the implementation of integrating oral health and primary care 
practice. The projects should model the core clinical oral 
health competencies for non-dental providers that HRSA 
published and initially tested in its 2014 report Integration 
of Oral Health and Primary Care Practice. The Committee 
encourages the Chief Dental Officer to continue to direct the 
design, monitoring, oversight, and implementation of these 
projects.
    Fetal Alcohol Syndrome (FAS) Set-Aside.--Recognizing that 
as many as one in 20 school-age children are affected by fetal 
alcohol spectrum disorders (FASD), yet few have access to 
essential diagnostic and multidisciplinary services, the 
Committee includes no less than the fiscal year 2020 level for 
HRSA to continue activities funded by the FAS set-aside. The 
Committee also encourages HRSA to consider support for an 
established FASD-specific national network to improve the well-
being of children and families with FASD.
    Adverse Childhood Experiences.--The Committee is aware that 
childhood trauma and toxic stress have been linked to negative 
health outcomes through adulthood, including higher rates of 
diabetes, stroke, depression, lapses in cognitive abilities, 
and developmental delays, suicide, and substance misuse, among 
others. The Committee recognizes that promoting awareness to 
parents and health care providers around the impact of trauma 
on the developing brain and the importance of encouraging 
supportive and responsive relationships with caring adults as 
two promising strategies. The Committee supports efforts to 
improve child health by developing screening protocols and 
evidence-based interventions to individuals suffering from 
adverse childhood experiences (ACEs) such as child abuse and 
neglect, witnessing interpersonal violence, family substance 
abuse, family separation, parental divorce, parental loss, and 
mental illness, to promote developmental resiliency. The end 
goal of such efforts should be to yield a model for integrating 
ACEs screening and trauma-informed onsite services into primary 
care settings.
    The Committee includes $1,000,000 within SPRANS to fund a 
study focused on improving child health by implementing 
screening protocols and evidence-based interventions to 
individuals who have experienced adverse childhood experiences 
(ACEs) such as child abuse and neglect, witnessing 
interpersonal violence, family substance abuse, family 
separation, parental divorce, parental loss, and mental 
illness, to promote developmental resiliency. The end goal of 
the study should be to yield a model for integrating ACEs 
screening and trauma-informed strength based care into primary 
care settings. The Committee directs HRSA to submit a report 
with the results of this study to the Committee within three 
years of enactment of this Act.
    Alliance for Maternal Health Safety Bundles.--The Committee 
includes $7,000,000, an increase of $2,000,000 above the fiscal 
year 2020 enacted level and $8,000,000 below the fiscal year 
2021 budget request, to expand implementation of the Alliance 
for Innovation on Maternal Health program's maternal safety 
bundles to all U.S. States, the District of Columbia, U.S. 
territories, and tribal entities. Maternal safety bundles are a 
set of targeted and evidence-based best practices that, when 
implemented, improve patient outcomes and reduce maternal 
mortality and severe maternal morbidity.
    Children's Health and Development.--The Committee continues 
to provide $3,500,000 to continue studies focused on 
identifying interventions that could result in systemic change 
that would positively impact the policy of child-health-related 
institutions and systems in States with the highest levels of 
childhood poverty.
    Hemophilia Treatment Centers.--The Committee provides 
$4,800,000 for Hemophilia Treatment Centers, the same as the 
fiscal year 2020 enacted level. The Regional Hemophilia Network 
Program uses a regional infrastructure of hemophilia treatment 
centers to promote and improve the comprehensive care of 
individuals with hemophilia and related bleeding disorders or 
clotting disorders.
    Infant-Toddler Court Teams.--The Committee includes 
$10,000,000, the same as the fiscal year 2020 enacted level, 
for the fourth year of a cooperative agreement to support 
research-based infant-toddler court teams to change child 
welfare practices to improve well-being for infants, toddlers, 
and their families. The Committee encourages HRSA to use these 
funds to: (1) build upon the work of sites established or 
currently supported through the Infant-Toddler Court Program, 
including by providing training, technical assistance, and 
additional support for such court teams' efforts across the 
country; and (2) plan and support additional infant-toddler 
court teams.
    Maternal Mental Health Hotline.--The U.S. suffers from one 
of the highest maternal death rates in the developed world. 
Suicide and overdose have been identified as the leading causes 
of death during the first year postpartum and depression is the 
most common complication of pregnancy in the first year 
postpartum. To help address these issues, the Committee 
includes $3,000,000 to contract with a qualified entity to 
establish and maintain a maternal mental health hotline to be 
staffed by qualified counselors, 24 hours a day. Funding may 
also be used for outreach to raise awareness about maternal 
mental health issues and the hotline.
    State Maternal Health Innovation Grants.--The Committee 
includes $23,000,000, the same as the fiscal year 2019 enacted 
level, for State Maternal Health Innovation Grants that will 
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.

Maternal and Child Health Programs

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

------------------------------------------------------------------------
                   Budget Activity                     FY 2021 Committee
------------------------------------------------------------------------
Sickle Cell Anemia Program...........................         $7,205,000
Autism and Other Developmental Disorders.............         53,344,000
Heritable Disorders..................................         21,883,000
Healthy Start........................................        130,500,000
Universal Newborn Hearing............................         17,818,000
Emergency Medical Services for Children..............         22,334,000
Screening and Treatment for Maternal Depression......          5,000,000
Pediatric Mental Health Access.......................         10,000,000
------------------------------------------------------------------------

Autism and Other Developmental Disorders

    The Committee recommends $53,344,000 for Autism and Other 
Developmental Disorders, $1,000,000 above the fiscal year 2020 
enacted level and $53,344,000 above the fiscal year 2021 budget 
request. These programs seek to improve the health and well-
being of children and adolescents with autism spectrum disorder 
and other developmental disabilities and to advance best 
practices for the early identification and treatment of autism 
and related developmental disabilities.
    Leadership Education in Neurodevelopmental and Related 
Disabilities (LEND).--The Committee provides $36,245,000, 
$1,000,000 above the fiscal year 2020 enacted level, for the 
LEND program to allow the existing 52 LEND sites to maintain 
their capacity to train interdisciplinary professionals to 
screen, diagnose, and provide evidence-based interventions to 
individuals with autism spectrum disorder and other 
developmental disabilities. (ASD/DD) as authorized by the 
Autism CARES Act. This funding will enable the LEND network to 
fulfill its expanded statutory mandate to train 
interdisciplinary providers who will serve individuals across 
the lifespan, addressing a critical shortage of health care 
professionals for adults with autism and other developmental 
disabilities. This funding will also enable the LEND network to 
assist in ongoing developmental monitoring, especially for 
children impacted by pressing public health crises, such as 
opioids, lead and other environmental toxins, the Zika virus, 
COVID-19, and other new or emerging issues, with resulting 
complications. The LENDs are a strong community link to 
services and supports for these newest members of the 
disability community and their families. This funding is 
critical to the LEND's role in providing direct clinical 
assessment and evidence-based interventions. In addition, the 
funding will allow these programs to develop innovative 
strategies to integrate and enhance existing investments, 
including translating research findings on interventions, 
guidelines, tools, and systems management approaches to 
interdisciplinary training settings, to communities, and into 
practice, and promote life-course considerations--from 
developmental screening in early childhood to transition to 
adulthood issues.

Heritable Disorders

    The Committee provides $21,883,000 for the Heritable 
Disorders program, $4,000,000 above the fiscal year 2020 
enacted level and $21,883,000 above the fiscal year 2021 budget 
request. This program supports activities that strengthen the 
newborn screening system to ensure infants born in every State 
receive rapid identification, early intervention, and 
potentially life-saving treatment.
    Severe Combined Immune Deficiency (SCID).--Within the total 
amount for Heritable Disorders, the Committee provides 
$3,000,000, the same as the fiscal year 2020 enacted level, to 
support wider implementation, education, and awareness of 
newborn screening and follow-up for SCID and other newborn 
screening disorders. The Committee applauds HRSA's ongoing work 
to ensure screening of all newborns for Severe Combined Immune 
Deficiency (SCID), including through initiatives that help 
parents of newborns diagnosed with SCID understand the disease 
and treatment options and to navigate the path forward. The 
Committee encourages HRSA to support efforts to develop 
telehealth approaches to link families in rural and underserved 
communities with support and resources, engage providers in 
education or training related to SCID, and establish mechanisms 
to obtain long-term outcomes information on infants with SCID 
through newborn screening.

Healthy Start

    The Committee recommends $130,500,000 for the Healthy Start 
program, $5,000,000 above the fiscal year 2020 enacted level 
and the fiscal year 2021 budget request. The program provides 
grants to communities with high rates of infant mortality to 
support primary and preventive health care services for mothers 
and their infants.
    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 continues to provide no less than 
$15,000,000, the same as the fiscal year 2020 enacted level and 
the fiscal year 2021 budget request, for 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.

                      RYAN WHITE HIV/AIDS PROGRAM

 
 
 
Appropriation, fiscal year 2020.......................    $2,388,781,000
Budget request, fiscal year 2021......................     2,483,781,000
Committee Recommendation..............................     2,413,781,000
    Change from enacted level.........................       +25,000,000
    Change from budget request........................       -70,000,000
 

    In addition to the funds above, the CARES Act included 
$90,000,000 for the Ryan White HIV/AIDS program to prevent and 
respond to coronavirus and maintain care for patients.
    The Ryan White Human Immunodeficiency Virus/Acquired 
Immunodeficiency Syndrome (HIV/AIDS) program funds activities 
to address the care and treatment of persons living with HIV/
AIDS who are either uninsured or underinsured and need 
assistance to obtain treatment. The program provides grants to 
States and eligible metropolitan areas to improve the quality, 
availability, and coordination of health care and support 
services to include access to HIV-related medications; grants 
to service providers for early intervention outpatient 
services; grants to organizations to provide care to HIV 
infected women, infants, children, and youth; and grants to 
organizations to support the education and training of health 
care providers.
    Within the total for the Ryan White HIV/AIDS program, the 
Committee provides the following amounts:

------------------------------------------------------------------------
                   Budget Activity                     FY 2021 Committee
------------------------------------------------------------------------
Emergency Assistance.................................       $655,876,000
Comprehensive Care Programs..........................      1,315,005,000
    AIDS Drug Assistance Program.....................        900,313,000
Early Intervention Program...........................        201,079,000
Children, Youth, Women, and Families.................         75,088,000
AIDS Dental Services.................................         13,122,000
Education and Training Centers.......................         33,611,000
Special Projects of National Significance............         25,000,000
Domestic HIV Initiative..............................         95,000,000
------------------------------------------------------------------------

    Ending the HIV Epidemic Initiative.--The Committee includes 
$95,000,000 within the Ryan White HIV/AIDS Program for the EHE 
Initiative, an increase of $25,000,000 above the fiscal year 
2020 enacted level and $70,000,000 below the fiscal year 2021 
budget request. This investment builds on an increase of 
$70,000,000 included in fiscal year 2020, bringing the two-year 
investment in Ryan White for the EHE Initiative to a total of 
$165,000,000. Funds are distributed to high-need jurisdictions 
to increase linkage, engagement, and retention in care with the 
goal of increasing viral suppression among people living with 
HIV.

                          HEALTH CARE SYSTEMS

 
 
 
Appropriation, fiscal year 2020.......................      $123,593,000
Budget request, fiscal year 2021......................       115,418,000
Committee Recommendation..............................       131,093,000
    Change from enacted level.........................        +7,500,000
    Change from budget request........................        +5,060,000
 

    In addition to the funds above, the CARES Act included 
$5,000,000 to support increased demand for services from Poison 
Control Centers.
    The Health Care Systems Bureau supports national activities 
that enhance health care delivery in the U.S., including 
maintaining a national system to allocate and distribute donor 
organs to individuals awaiting transplant; building an 
inventory of cord blood units; maintaining a national system 
for the recruitment of bone marrow donors; operating the 340B 
drug discount program; and operating a national toll-free 
poison control hotline.
    Within the total for Health Care Systems, the Committee 
provides the following amounts:

------------------------------------------------------------------------
                   Budget Activity                     FY 2021 Committee
------------------------------------------------------------------------
Organ Transplantation................................        $33,049,000
National Cord Blood Inventory........................         17,266,000
C.W. Bill Young Cell Transplantation Program.........         30,009,000
Office of Pharmacy Affairs...........................         10,238,000
Poison Control Centers...............................         24,846,000
Hansen's Disease Program.............................         13,706,000
Hansen's Disease Buildings and Facilities............            122,000
Hansen's Payment to Hawaii...........................          1,857,000
------------------------------------------------------------------------

Organ Transplantation

    The Committee includes $33,049,000 for the Organ 
Transplantation program, $5,500,000 above the fiscal year 2020 
enacted level and $2,500,000 above the fiscal year 2021 budget 
request.
    Maximizing Deceased Donor Organ Recovery, Acceptance, and 
Utilization.--The Committee supports the goal of significantly 
increasing kidney transplants, established by the President's 
Executive Order on Advancing American Kidney Health, and 
supports efforts to establish objective outcome measures for 
Organ Procurement Organizations (OPO) as well as efforts to 
decertify underperforming OPOs at the conclusion of the current 
contract cycles. The Committee encourages HHS and HRSA to 
monitor transplant center listing and acceptance practices as 
recorded with the Organ and Procurement and Transplantation 
Network (OPTN), and to make publicly available its findings 
based on one calendar year of data. The listed screening 
criteria for each patient receiving an organ offer should be 
compared to center refusals codes for those organs not accepted 
for transplant by the patient's transplant center. Further, the 
utilization rates by center should be reported for all organ 
offers and for both the brain dead and donation after 
circulatory death subcategories. The Committee supports HHS's 
Request for Information for the technology system over which 
these organ offers are facilitated and encourages HHS to 
promote competition for this contract.
    Reimbursement of Travel and Subsistence Expenses Toward 
Living Organ Donation Program.--The Committee includes 
$10,000,000, an increase of $5,500,000 above the fiscal year 
2020 enacted level and $500,000 above the fiscal year 2021 
budget request, for expansion of the program administered via 
the National Living Donor Assistance Center to reimburse a 
comprehensive range of living donor expenses for the greatest 
possible number of donors, including lost wages, childcare, 
eldercare, similar expenses for donor caretakers, and removing 
other disincentives to donation. The Committee supports 
significant expansion of income eligibility for the program to 
allow as many donors as possible to qualify and to ensure that 
financial reimbursement and monetary exchange take place 
outside of the organ donor-organ recipient relationship to the 
greatest extent possible.

Office of Pharmacy Affairs

    The Committee includes $10,238,000 for the Office of 
Pharmacy Affairs, the same as the fiscal year 2020 enacted 
level and the fiscal year 2021 budget request. The Committee 
recognizes 340B remains important and allows providers to 
stretch scarce Federal resources to reach more eligible 
patients and provide comprehensive services. The 340B drug 
pricing program was designed to help safety net providers 
maintain, improve, and expand patient access to healthcare 
services. The 340B program has lowered the cost of outpatient 
drugs to health clinics and nonprofit and public hospitals that 
serve a disproportionate share of low-income and rural 
patients. These entities provide additional services and 
benefits to their communities with the savings realized.
    The Committee acknowledges the request for additional 
regulatory authority and notes that HRSA already has existing 
oversight authority that allows the agency to conduct audits of 
stakeholders who participate in the program to ensure 
compliance. The Committee recognizes that HRSA has used this 
authority to conduct 1,300 audits of covered entities, but only 
20 audits of manufacturers. The Committee is concerned that 
HRSA is not using their existing oversight authority to pursue 
balanced oversight of both providers and drug manufacturers. We 
encourage HRSA to use its existing oversight authority to 
pursue more balanced oversight of both providers and 
manufacturers to ensure compliance and integrity of the 340B 
program.

Poison Control Centers

    In addition to the amounts provided in this bill, the CARES 
Act included $5,000,000 for Poison Control Centers to 
accommodate increased demand due to the COVID-19 pandemic.
    The Committee recommends $24,846,000 for Poison Control 
Centers, which is $2,000,000 above the fiscal year 2020 enacted 
level and the fiscal year 2021 budget request. This program 
funds poison centers, supports a national emergency poison 
toll-free number (800-222-1222), and implements public 
education and outreach programs to educate and serve the public 
and health care providers. The Committee notes the impact of 
COVID-19, and significant State and hospital revenue loss, to 
the poison control program nationally. Poison centers are 
experiencing dramatic increases in intentional suspected 
suicides among youth, the misuse of household cleaners, bleach, 
and rubbing alcohol, and COV1D-19 related anxiety, isolation, 
and depression, which is leading to increased use of substances 
and risk of self-harm and suicide.

                              RURAL HEALTH

 
 
 
Appropriation, fiscal year 2020.......................      $318,294,000
Budget request, fiscal year 2021......................       246,834,000
Committee Recommendation..............................       334,294,000
    Change from enacted level.........................       +16,000,000
    Change from budget request........................       +87,460,000
 

    In addition to the funds above, the CARES Act included 
$180,000,000 for Rural Health programs to expand telehealth and 
support rural hospitals amid the COVID-19 pandemic.
    The Federal Office of Rural Health Policy's programs 
provide funding to improve access, quality, and coordination of 
care in rural communities; for research on rural health issues; 
for technical assistance and recruitment of health care 
providers; for screening activities for individuals affected by 
the mining, transport, and processing of uranium; for the 
outreach and treatment of coal miners and others with 
occupation-related respiratory and pulmonary impairments; and 
for the expansion of telehealth services.
    Within the total for Rural Health activities, the Committee 
provides the following amounts:

------------------------------------------------------------------------
                   Budget Activity                     FY 2021 Committee
------------------------------------------------------------------------
Rural Outreach Programs..............................        $79,500,000
Rural Health Research................................         10,351,000
Rural Hospital Flexibility Grants....................         55,609,000
State Offices of Rural Health........................         12,500,000
Black Lung Clinics...................................         11,500,000
Radiation Exposure Screening and Education...........          1,834,000
Telehealth...........................................         42,000,000
Rural Communities Opioid Response....................        110,000,000
Rural Health Residency Program.......................         11,000,000
------------------------------------------------------------------------

    Rural Health Liaison.--The Committee directs HRSA to submit 
a report to the Committee describing how HRSA is coordinating 
with the Department of Agriculture Rural Health Liaison within 
180 days of enactment of this Act.
    GAO Study on Obstetrics (OB) Closures.--According to the 
Rural Health Research Gateway, between 2004 and 2014, 179 rural 
counties lost hospital-based OB services. The Committee directs 
the Government Accountability Office (GAO) to submit a report 
on ways to improve access to obstetrics care in rural areas and 
prevent OB unit hospital closures in rural areas.

Rural Health Outreach Programs

    Community Health Workers.--The Committee recognizes the 
importance of community health workers, particularly in rural 
and underserved areas, to help address persistent health issues 
tied to social determinants of health. The Committee is aware 
that many States would like to better incorporate community 
health workers into their systems, but there is currently a 
lack of a unified training and certification resource available 
to them. The Committee encourages HRSA to consider supporting a 
national center, based at an academic medical center with 
expertise in integrating community health workers into health 
systems, to assist States and providers through workshops, 
consultations, certifications and continuing education credits.
    Southwest States Rural Development Network Grant Program.--
The Committee encourages HRSA to consider funding a new 
Southwest States Rural Development Network Grant Program, 
within the Southwest Border Region as defined by 40 U.S.C. 
Sec. 15732, to promote the development of integrated health 
care networks in order to: (1) achieve efficiencies; (2) expand 
access to, coordinate, and improve the quality of essential 
health care services; and (3) strengthen the rural health care 
system as a whole. The Committee also encourages HRSA to 
consider a pilot program to help underserved rural communities 
in the region identify and better address their health care 
needs and to help small rural hospitals improve their financial 
and operational performance.
    Rural Health Research and Policy Development Telementoring 
Training Center.--The Committee continues to include $1,000,000 
within the total for Rural Health Research and Policy 
Development to support a telementoring training center to train 
academic medical centers and other centers of excellence in the 
creation of technology-enabled telementoring learning programs 
that facilitate the dissemination of best practice specialty 
care to primary care providers and care teams across the 
country.

Rural Health Flexibility Grants

    The Committee includes $55,609,000 for Rural Health 
Flexibility Grants, $2,000,000 above the fiscal year 2020 
enacted level and $55,609,000 above the fiscal year 2021 budget 
request.
    Small Rural Hospital Improvement Program (SHIP).--The 
Committee recommendation includes $21,942,000 for SHIP, an 
increase of $2,000,000 over the fiscal year 2020 enacted level 
and $21,942,000 above the fiscal year 2021 budget request.

Radiation Exposure Screening and Education

    The Committee commends the work of the Radiation Exposure 
Screening and Education Program, which supports States most 
affected by the mining, transport, and processing of uranium 
and the testing of nuclear weapons for the Nation's weapons 
arsenal.

Telehealth

    The Committee includes $42,000,000 for Telehealth, 
$13,000,000 above the fiscal year 2020 enacted level and the 
fiscal year 2021 budget request.
    In addition to the amounts provided in this bill, the CARES 
Act included $15,000,000 for the Telehealth program to expand 
services amid the COVID-19 pandemic.
    Rural Telemedicine Projects.--The Committee strongly 
supports expanded use of effective and secure telemedicine 
platforms and remote capabilities to provide expanded health 
care and related behavior health monitoring and surveillance 
services in areas that have been hard hit by the opioid 
epidemic and related substance use disorders. Such technology 
is needed to augment care and provide access to high quality 
medical services and monitoring capabilities that decrease 
geographic barriers and reduce the cost of care, especially for 
individuals at risk for incarceration and recidivism. To 
bolster current efforts and address current and anticipated 
needs surrounding infections disease outbreaks such as the 
novel coronavirus of 2019, as well as other medication-assisted 
treatments and related mental health monitoring services, the 
Committee supports efforts that use telemedicine platforms to 
expand access to rural regions and communities 
disproportionately impacted by the lack of much needed health 
care delivery services.
    Technology-Enabled Collaborative Learning Capacity Building 
Models Grants.--The Committee includes $10,000,000 within the 
total for Telehealth to support grants to connect specialists 
at academic medical centers with primary care providers in 
rural and underserved areas, providing evidence-based training 
and support to help them treat patients with complex conditions 
in their communities.
    Telehealth Centers of Excellence.--The Committee 
recommendation includes $7,000,000, an increase of $1,000,000 
over the fiscal year 2020 enacted level, to support the 
continued development of Telehealth Centers of Excellence. 
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 in order 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 Centers of Excellence serve to promote the adoption of 
telehealth programs across the country by validating 
technology, establishing training protocols, and by providing a 
comprehensive template for States to integrate telehealth into 
their State health provider network. Additional funding for the 
Centers of Excellence will serve to promote the adoption of 
telehealth services nation-wide and thus address the access to 
care issue faced by rural America.

Rural Health Residency Program

    The Committee includes $11,000,000 for Rural Health 
Residency Program, $1,000,000 above the fiscal year 2020 
enacted level and $11,000,000 above the fiscal year 2021 budget 
request.
    Rural Residency Planning and Development Program.--The 
Committee commends the Office of Rural Health Policy for its 
efforts to expand the physician workforce in rural areas and 
supports continuation and expansion of the program to develop 
new rural residency programs, or Rural Training Tracks (RTTs). 
The Committee encourages HRSA to expand the current program to 
include RTTs in obstetrics and gynecology. Women in rural 
communities are more likely to begin prenatal care late and are 
more likely to experience maternal mortality and severe 
maternal morbidity. The expansion of this program would align 
with the agency's goals of improving maternal health outcomes 
and eliminating preventable maternal mortality.

                            FAMILY PLANNING

 
 
 
Appropriation, fiscal year 2020.......................      $286,479,000
Budget request, fiscal year 2021......................       286,479,000
Committee Recommendation..............................       286,479,000
    Change from enacted level.........................             - - -
    Change from budget request........................             - - -
 

    The Committee includes $286,479,000 for the Family Planning 
program, the same as the fiscal year 2020 enacted level and the 
2021 budget request. The Family Planning program administers 
Title X of the Public Health Service Act. This program plays a 
vital role not only in ensuring access to affordable 
contraceptive education, services, and supplies, but also in 
STD prevention, screening, and treatment; cervical and breast 
cancer screenings; first-line infertility services; and other 
community and health care services.
    The bill includes language directing the Secretary to carry 
out the Title X Family Planning program in accordance with the 
regulations that were in place on January 18, 2017 and provide 
new grants to grantees whose awards were relinquished or 
terminated before the planned end of the performance period in 
fiscal year 2019. The Committee directs the Secretary to ensure 
that grantees certify that they: (1) provide medically accurate 
and complete counseling, including referral as requested, on 
all matters; (2) shall not condition the receipt of Title X-
supported services on patients remaining sexually abstinent 
until marriage; and (3) will not make any appointments or 
referrals for patients that are contrary to the patient's 
wishes.

                           PROGRAM MANAGEMENT

 
 
 
Appropriation, fiscal year 2020.......................      $155,300,000
Budget request, fiscal year 2021......................       151,993,000
Committee Recommendation..............................       155,300,000
    Change from enacted level.........................             - - -
    Change from budget request........................        +3,307,000
 

    Program management supports the cost of Federal staff and 
related activities to coordinate, direct, and manage the 
programs of HRSA.
    Chief Dental Officer.--The Committee is pleased that HRSA 
has restored the position of Chief Dental Officer (CDO) and 
looks forward to learning how the agency has ensured that the 
CDO is functioning at an executive level authority with 
resources and staff to oversee and lead all oral health 
programs and initiatives across HRSA. The Committee requests an 
update by February 2021 on how the CDO is serving as the agency 
representative with executive level authority on oral health 
issues to international, national, State and/or local 
government agencies, universities, and oral health stakeholder 
organizations.
    Investments in Impoverished Areas.--The Committee supports 
targeted investments in impoverished areas, particularly in 
persistent poverty counties and in other high-poverty census 
tracts. To understand how programs funded through HRSA are 
serving these particular areas, the Committee directs HRSA to 
submit a report to the Committee on the percentage of funds 
allocated by all competitive grant programs and other anti-
poverty programs in fiscal years 2018, 2019 and 2020 and 
estimates for fiscal year 2021 to serve individuals living in 
persistent poverty counties, as defined as a county that has 
had 20 percent or more of its population living in poverty over 
the past 30 years, as measured by the 1990 and 2000 decennial 
censuses and the most recent Small Area Income and Poverty 
estimates, or any territory or possession of the U.S., and 
high-poverty areas, as defined as any census tract with a 
poverty rate of at least 20 percent as measured by the 2014-
2018 5-year data series available from the American Community 
Survey of the Census Bureau. HRSA shall report this information 
to the Committee within 90 days of such data being available 
and provide a briefing to the Committee not later than 180 days 
of enactment of this Act on how HRSA is carrying out this 
directive. In the case of any program for which at least 10 
percent of the funds allocated in fiscal year 2020 were not 
allocated to persistent poverty counties or for which the 
percentage allocated to high-poverty areas in fiscal year 2020 
was less than the average percentage of Federal assistance 
allocated to high-poverty areas awarded under the program in 
fiscal years 2017, 2018, and 2019, such report and briefing 
shall explain why such a benchmark is unable to be met.
    Oral Health Literacy.--The Committee includes $300,000 to 
continue the development of an oral health awareness and 
education campaign across relevant HRSA divisions, including 
the Health Centers Program, Oral Health Workforce, Maternal and 
Child Health, Ryan White HIV/AIDS Program, and Rural Health. 
The Committee directs HRSA to identify oral health literacy 
strategies that are evidence-based and focused on oral 
healthcare prevention and education, including prevention of 
oral disease such as early childhood and other caries, 
periodontal disease, and oral cancer. The Committee encourages 
the Chief Dental Officer to play a key role in the design, 
monitoring, oversight, and implementation of this project.

               Centers for Disease Control and Prevention


 
 
 
Appropriation, fiscal year 2020.......................    $7,749,554,000
Budget request, fiscal year 2021......................     7,056,264,000
Committee Recommendation..............................     7,981,654,000
    Change from enacted level.........................      +232,100,000
    Change from budget request........................      +925,390,000
 

    The Committee recommendation for the Centers for Disease 
Control and Prevention (CDC) program level includes 
$7,070,146,000 in discretionary budget authority, $55,358,000 
in mandatory funds under the terms of the Energy Employees 
Occupational Illness Compensation Program Act, and $856,150,000 
in transfers from the Prevention and Public Health (PPH) Fund.
    In addition, the Committee includes $9,000,000,000 in 
emergency appropriations for CDC programs and activities, 
including emergency appropriations for State and local health 
departments, State and local public health laboratories, global 
health and global disease detection, vaccination campaigns, 
public health data modernization, public health workforce 
development, and the Infectious Diseases Rapid Response Reserve 
Fund. The emergency appropriation is further described under 
Title VI of this committee report.
    Further, the Coronavirus Preparedness and Response 
Supplemental Appropriations Act (P.L. 116-123) included 
$2,200,000,000; the CARES Act (P.L. 116-136) included 
$4,300,000,000; and the Paycheck Protection Program and Health 
Care Enhancement Act (P.L. 116-139) included $1,000,000,000 for 
CDC to support public health and emergency response activities, 
domestically and internationally, in response to the COVID-19 
pandemic.
    CDC's mission is to protect Americans from health, safety, 
and security threats, which it accomplishes by supporting core 
public health functions at State, local, and Tribal health 
departments, detecting and responding to new and emerging 
health threats, promoting health and safety, and providing 
leadership in the public health workforce.
    CDC Guidance for COVID-19.--The Committee recognizes that 
CDC does not have independent regulatory authority. However, 
the Committee strongly urges CDC to work closely with State and 
local health departments, as well as the Occupational Safety 
and Health Administration, to ensure that State and local 
health regulations are aligned with CDC guidance for mask 
wearing, schools and day camps, child care programs, employers 
with workers at high risk, restaurants and bars, mass transit, 
crowded public events, and any other CDC guidance intended to 
mitigate the spread of COVID-19.

                 IMMUNIZATION AND RESPIRATORY DISEASES

 
 
 
Appropriation, fiscal year 2020.......................      $790,005,000
Budget request, fiscal year 2021......................       830,005,000
Committee Recommendation..............................       840,005,000
    Change from enacted level.........................       +50,000,000
    Change from budget request........................       +10,000,000
 

    The Committee recommendation includes $469,705,000 in 
discretionary budget authority and $370,300,000 in transfers 
from the PPH Fund.
    Immunization cooperative agreements are awarded to State 
and local public health departments for planning, developing, 
and conducting childhood, adolescent, and adult immunization 
programs, including enhancement of the vaccine delivery 
infrastructure. CDC directly maintains a stockpile of vaccines, 
supports consolidated purchase of vaccines for State and local 
health agencies, and conducts surveillance, investigations, and 
research into the safety and efficacy of new and presently used 
vaccines.
    Within the total for Immunization and Respiratory Diseases, 
the Committee recommends the following amounts:

------------------------------------------------------------------------
                   Budget Activity                     FY 2021 Committee
------------------------------------------------------------------------
Section 317 Immunization Program.....................       $613,647,000
    National Immunization Survey.....................         12,864,000
Acute Flaccid Myelitis...............................         10,000,000
Influenza Planning and Response......................        216,358,000
------------------------------------------------------------------------

    Acute Flaccid Myelitis.--The Committee includes $10,000,000 
to identify the cause, prevention, and treatment of acute 
flaccid myelitis, a rare but serious condition that affects the 
nervous system.
    Cost Estimates.--The Committee looks forward to reviewing 
the fiscal year 2022 report on estimated funding needs of the 
Section 317 Immunization Program and urges that the report be 
updated and submitted not later than February 1, 2021. The 
updated report should include an estimate of optimum State and 
local operations funding, as well as a discussion of the role 
of the 317 Program, as coverage for vaccination under public 
and private resources continues to evolve. The fiscal year 2022 
report should include specific information on the estimated 
cost to fully address evidence-based public health strategies 
that could be funded through CDC to improve coverage for human 
papillomavirus and influenza.
    Immunization Rates.--As communities follow stay-at-home 
orders to reduce transmission of the coronavirus, there have 
been reductions in vaccination coverage that leave young 
children and communities vulnerable to vaccine-preventable 
diseases. The Committee is concerned that areas where 
immunization rates have fallen below the threshold necessary to 
prevent future outbreaks put the public health at risk. The 
Committee believes that it is important to public health to 
increase the rate at which people in the U.S. choose to 
vaccinate themselves and their children. Within the funding 
provided, the Committee supports CDC's efforts to understand 
and address obstacles to vaccination including access, 
hesitancy and misinformation.
    Influenza Planning and Response.--The Committee includes an 
increase of $40,000,000 to enhance CDC's influenza activities, 
including expanding vaccine effectiveness monitoring and 
evaluation, and increasing influenza vaccine acceptance by 
removing barriers to vaccination and promoting vaccination 
coverage. The Committee is very concerned about the 2020-2021 
influenza season and the impact of the double wave of influenza 
and COVID-19.
    Influenza Vaccine.--The Committee encourages CDC to 
consider including vaccines produced through recombinant DNA 
technology in addition to traditionally-produced vaccines in 
future solicitations to facilitate the competitive process for 
all vaccine manufacturers.
    Measles Immunization.--The Committee recognizes the growing 
risk with measles and its impact on the Pacific Region. The 
Committee urges CDC to work through emergency responders, 
Centers of Excellence, Community Health Centers, and other 
applicable providers to provide education and training on 
proper protocols to prevent and treat measles, including 
immunization.
    Respiratory Syncytial Virus.--The Committee applauds the 
ongoing development of passive and active immunization 
candidates for the prevention of respiratory syncytial virus 
(RSV) which is the leading cause of infant hospitalization, a 
major cause of outpatient and emergency medical visits in the 
U.S. and for which there is no current preventive measure 
available for use in infants, except for high risk. As new 
vaccines and immunoprophylaxis products are in the late stages 
of development, it is important to have robust information on 
the existing burden of RSV to properly evaluate the benefit to 
patients and the healthcare system. Therefore, the Committee 
encourages CDC to continue to explore surveillance approaches 
with the Council of State and Territorial Epidemiologists.
    Section 317 Immunization Program.--The Committee views the 
317 Immunization Program, including the Vaccines for Children 
Program, as a pivotal part of the U.S. public health 
infrastructure. The Committee is aware that public health 
experts expect SARS-CoV-2, the novel coronavirus that causes 
COVID-19, to continue to circulate in the U.S. during the fall 
2020 and winter 2020-2021. While the timing of availability of 
a vaccine to prevent COVID-19 remains unclear, one strategy to 
decrease stress on the healthcare system is to increase 
vaccination coverage with seasonal influenza vaccine beginning 
in early fall 2020. Although the impact of increased coverage 
varies season-to-season, higher influenza vaccine coverage 
would be expected to result in decreases in doctor visits and 
hospitalizations during the influenza season, making more 
capacity available for persons with COVID-19. In order to 
reduce health care utilization for influenza and protect 
populations vulnerable to severe COVID-19 outcomes, CDC should 
launch an enhanced influenza campaign in time for the 2020-21 
season, including messages targeting those at higher risk for 
COVID-19. In addition, in order to prepare for a national SARS-
CoV-2 vaccination program, the Committee urges CDC to initiate 
planning and expansion of vaccination infrastructure in 
coordination with State, local, territorial and tribal public 
health authorities.
    Shared Clinical Decision Making.--The Committee encourages 
CDC to work with Advisory Committee on Immunization Practices 
and the National Vaccine Advisory Committee (NVAC) to provide 
further explanation and guidelines around the recommendation of 
shared clinical decision-making in the context of immunizing 
older adult populations, and develop and disseminate guidance 
and resources to help to ensure that medical professionals and 
patients continue to have a clear understanding of and 
continued access to the immunizations they should receive 
across the lifespan. The Committee further encourages the 
Assistant Secretary for Health to consider appointing Geriatric 
specialists to the NVAC so that vaccine recommendations will be 
informed by providers with a history of caring for senior 
populations.

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

 
 
 
Appropriation, fiscal year 2020.......................    $1,273,556,000
Budget request, fiscal year 2021......................     1,552,556,000
Committee Recommendation..............................     1,287,556,000
    Change from enacted level.........................       +14,000,000
    Change from budget request........................      -265,000,000
 

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

------------------------------------------------------------------------
                                                            FY 2021
                   Budget Activity                         Committee
------------------------------------------------------------------------
Domestic HIV/AIDS Prevention and Research............       $940,712,000
    HIV Initiative...................................        150,000,000
    School Health-HIV................................         35,081,000
Viral Hepatitis......................................         39,000,000
Sexually Transmitted Diseases........................        162,810,000
Tuberculosis.........................................        135,034,000
Infectious Diseases & the Opioid Epidemic............         10,000,000
------------------------------------------------------------------------

    Community-Based Organizations.--The Committee recognizes 
that community-based organizations play a crucial role because 
of their capacity to reach communities highly impacted by HIV. 
The Committee directs CDC to ensure that Ending the HIV 
Epidemic advisory groups or committees reflect their local 
epidemic by including community-based organizations and people 
living with HIV. The Committee further requests CDC's progress 
of engaging such communities be included in the fiscal year 
2022 Congressional Budget Justification.
    Congenital Syphilis.--The Committee is concerned that the 
cases of congenital syphilis (CS) are at the highest rate in 20 
years. The Committee urges CDC to work with State and local 
authorities to design an initiative that will strengthen 
prenatal outreach programs. The Committee further urges CDC to 
increase awareness of CS through community organizations and 
STD and drug addiction clinics of the importance of multi-
testing throughout pregnancy.
    Emphasis on Comprehensive Services.--In recent fiscal 
years, the Committee has provided historic resources to combat 
the opioid epidemic, with a particular focus on expanding 
access to treatment, and treating and preventing comorbidities 
that can be associated with injection drug use. At the 
Committee's urging, the Department has rightfully prioritized 
efforts that increase access to treatment and recovery 
services. For all programs not focused exclusively on 
prevention of substance abuse, the Committee directs the 
Department to continue its emphasis on evidence-based medical 
interventions, and to ensure that all such interventions, 
including programs that focus on harm reduction, provide 
referral to treatment and recovery services.
    HIV/AIDS Data Sharing Platform.--The Committee encourages 
CDC to enhance the Collaborative Advanced Analytics and Data 
Sharing system to lower overall operating costs and reduce 
reporting burdens on Federal and State health departments.
    HIV Initiative.--The Committee includes an increase of 
$10,000,000. This investment builds on an increase of 
$140,000,000 included in fiscal year 2020, bringing the two-
year investment in CDC's role in the Eliminating HIV/AIDS 
Initiative to a total of $290,000,000. CDC will focus on areas 
of the country that constitute the majority of new HIV 
infections annually to diagnose people with HIV as early as 
possible after infection, link people to effective treatment 
and prevention strategies, and respond rapidly to clusters and 
outbreaks of new HIV infections. By working with State and 
local health departments, along with community-based 
organizations, there will be intensive testing and rapid 
referral to care and treatment. The initiative will develop and 
deploy innovative data management solutions, increase access to 
Pre-Exposure Prophylaxis (PrEP), and improve detection and 
response to HIV clusters. The Committee recognizes that 
sexually transmitted diseases are associated with increased 
risk of HIV acquisition. The Committee urges CDC to include an 
expansion of sexually transmitted infections programs and 
initiatives designed to increase HIV testing; PrEP and condom 
availability at STD clinics; increase the number of Disease 
Intervention Specialists to prevent the spread of STIs and HIV; 
and implement HIV and STI education and prevention programs in 
schools.
    Historically Black Colleges and Universities.--The 
Committee encourages increased engagement with Historically 
Black Colleges and Universities.
    Infectious Diseases and the Opioid Epidemic.--The Committee 
includes funding to strengthen efforts to conduct surveillance 
to improve knowledge of the full scope of the burden of 
infectious diseases (including viral, bacterial and fungal 
pathogens) associated with substance use disorders, and in 
collaboration with state and local health departments, health 
care facilities, and providers, deploy existing authorities to 
prevent and detect infectious diseases associated with 
substance use disorder and strengthen linkages to addiction, 
mental health and infectious diseases treatment. The Committee 
urges CDC to support the development and evaluation of 
innovative interventions to enable hospitals to link people 
with opioid-use related infections to community-based treatment 
and harm reduction services.
    School Health.--The Committee includes an increase of 
$2,000,000 to bolster school capacity for sexual health 
education, and access to sexual health services and safe and 
supportive environments.
    Sexually Transmitted Infections.--The Committee includes an 
increase of $2,000,000 in recognition that the number of 
combined cases of syphilis, gonorrhea, and chlamydia have 
reached an all-time high in the U.S. The Committee is concerned 
by the adverse consequences that a rise in STDs has on women, 
especially during pregnancy. According to CDC, undiagnosed STDs 
cause infertility in more than 24,000 women each year. Among 
newborns, Syphilis cases increased by 40 percent, to more than 
1,300 cases across the country. The Committee commends CDC for 
providing resources to state and local health departments for 
STD prevention and surveillance.
    Sexually Transmitted Diseases Program Administration.--The 
Committee is concerned regarding CDC's practice of diverting an 
increasing percentage of STD program dollars away from State 
and local health departments. While the Committee understands 
the need to cover basic administrative costs, the percentage 
being diverted has continued to rise over the past several 
years, leaving State and local authorities and the Division of 
STD Prevention at CDC with fewer resources to address the STI 
epidemic.
    Tuberculosis.--The Committee is concerned that there is a 
lack of resources to reach, test, and treat the millions of 
people in the U.S. who have longstanding latent tuberculosis 
infection (LTBI). The Committee urges CDC to provide additional 
resources that will enable CDC, along with State and local 
entities, to expand testing and preventive treatment of 
individuals with LTBI.
    Viral Hepatitis and Opioids.--The Committee is concerned 
that as a result of the opioid crisis, infections of viral 
hepatitis have spiked at alarming rates in many parts of the 
nation. The Committee urges CDC to develop a plan for a 
national chronic hepatitis B (HBV) and hepatitis C (HCV) 
surveillance infrastructure and increase grant funding to 
States for viral hepatitis surveillance, testing, linkage to 
care, and hepatitis A (HAV) and HBV vaccination among all 
populations at risk for infection. The Committee also urges CDC 
to incorporate infectious disease prevention, testing, and 
linkage to care into the agency's response to the opioid 
crisis. Given that HBV and HCV are the most common drivers of 
liver cancer in the U.S., the incidence and mortality of which 
are increasing more rapidly than any other cancers, the 
Committee urges that CDC raise awareness of and encourage 
awardees to address this link. The Committee requests that CDC 
submit a status report of the above efforts in the fiscal year 
2022 Congressional Justification.
    The Committee is concerned about invasive mycological or 
fungal infections. These infections are a major cause of 
morbidity and mortality worldwide. leading to approximately 
500.000 deaths annually. The overall disease burden is over 180 
million people worldwide, and in the US. approximately one 
million new infections occur annually in a variety of 
immtmocompetent and immunocompromised individuals.
    Viral Hepatitis Vaccination.--The Committee is concerned 
that despite the availability of an effective hepatitis B (HBV) 
vaccine, less than 25 percent of adults age 19 and older are 
vaccinated. According to CDC's most recent survey of 
Vaccination Coverage Among Adults, this poor vaccination rate 
remains flat and has not improved in several years. The 
Committee recognizes that CDC is evaluating new universal HBV 
vaccination recommendations including a comprehensive plan to 
increase adult HBV vaccinations. CDC is further urged to 
promote awareness about the importance of HBV vaccination among 
medical and health professionals, communities at high risk, and 
the general public and to improve collaboration and 
coordination across CDC to achieve this goal. Furthermore, the 
Committee recognizes that viral hepatitis can cause serious 
health consequences for people living with HIV and that 25 
percent of people living with HIV are also living with 
hepatitis C virus (HCV), and about 10 percent of people living 
with HIV are also living with hepatitis B virus (HBV). The 
Committee directs CDC to submit a report on the plan to 
increase the rate of HBV adult vaccination to the levels 
necessary to eliminate new infections of HBV in the U.S. in the 
fiscal year 2022 Congressional Justification.

               EMERGING AND ZOONOTIC INFECTIOUS DISEASES

 
 
 
Appropriation, fiscal year 2020.......................      $635,772,000
Budget request, fiscal year 2021......................       550,464,000
Committee Recommendation..............................       645,972,000
    Change from enacted level.........................       +10,200,000
    Change from budget request........................       +95,508,000
 

    The Committee recommendation includes $593,972,000 in 
discretionary appropriations and $52,000,000 in transfers from 
the PPH Fund. Programs funded under Emerging and Zoonotic 
Infectious Diseases (EZID) support the prevention and control 
of infectious diseases through surveillance, outbreak 
investigation and response, research, and prevention.
    Within the total for EZID, the Committee recommends the 
following amounts:

------------------------------------------------------------------------
                                                            FY 2021
                   Budget Activity                         Committee
------------------------------------------------------------------------
Antibiotic Resistance Initiative.....................       $175,000,000
Vector-borne Diseases................................         38,603,000
Lyme Disease.........................................         16,000,000
Prion Disease........................................          7,000,000
Chronic Fatigue Syndrome.............................          5,400,000
Food Safety..........................................         65,000,000
Emerging Infectious Diseases.........................        191,197,000
National Health Care Safety Network..................         21,000,000
Quarantine...........................................         42,772,000
Advanced Molecular Detection.........................         30,000,000
Epidemiology and Laboratory Capacity.................         40,000,000
Healthcare-Associated Infections.....................         12,000,000
Harmful Algal Blooms.................................          2,000,000
------------------------------------------------------------------------

    Advanced Molecular Detection.--The Committee recognizes 
that the Advanced Molecular Detection (AMD) Initiative provides 
critical funding for rapid technological innovation, such as 
genomic sequencing of pathogens, to allow for better prevention 
and control of infectious diseases and more rapid 
identification and characterization of antibiotic resistant 
infections. In addition, AMD is helping CDC to understand, 
characterize, and control antibiotic resistance and develop and 
target prevention measures, including vaccines. Technology 
being developed in the AMD program will ultimately make it 
possible for state public health officials to take the DNA 
fingerprint of foodborne bacteria like Salmonella and E coli, 
understand whether they are antibiotic-resistant, and identify 
related strains to solve outbreaks, all without relying on the 
slow and expensive process of clinical culture.
    Antibiotic Resistance.--The Committee includes an increase 
of $5,000,000. The Committee recognizes the importance of 
effectively combatting antibiotic resistant bacteria as part of 
CDC's broader efforts to mitigate the clinical and public 
health impacts of the COVID-19 outbreak. Furthermore, the 
Committee recognizes the importance of the addressing the 
problem of antibiotic-resistant bacteria through a ``One 
Health'' approach and by tracking resistance through local, 
regional, national, and global surveillance. The Committee 
encourages CDC to competitively award research activities that 
address aspects of antibiotic resistance related to ``One 
Health,'' including global surveillance and research and 
development for new tools to counter antibiotic resistance 
among entities, including public academic medical centers, 
veterinary schools with agriculture extension services, and 
public health departments whose proposals are in line with 
CDC's strategy for addressing antibiotic resistant bacteria.
    Emerging Infectious Diseases.--The Committee recognizes the 
significant threat that emerging infectious diseases pose for 
both military and civilian populations and operations. The 
Committee urges CDC to sustain and optimize infrastructure at 
existing academic centers for emerging infectious diseases in 
States with high tourism and vital military assets to ensure 
preparedness and response measures for the diagnosis, treatment 
and prevention of emerging infectious diseases.
    Harmful Algal Blooms.--The Committee includes funding to 
support monitoring and health reporting concerns related to 
harmful algal blooms (HABs). The Committee urges CDC to 
continue work on affected waters, with a focus on freshwater 
and the related dangers to drinking water supplies. CDC has a 
unique role in better understanding the intersection of public 
health and environmental impacts of HABs to: (1) Increase 
outreach efforts to States and local public health officials to 
use these monitoring and reporting systems; (2) work with a 
variety of agencies that currently collaborate on HABs such as 
the HABARCA Task-Force and the Great Lakes Restoration 
Initiative. The scope of future research may expand to include 
improving laboratory methods for HAB-related toxins in 
biological specimens and clinical diagnostic methods to 
identify HAB-related symptoms and illnesses, optimizing 
emergency response capacities, and identifying and addressing 
the impacts of harmful algal toxins to humans. There is an 
important nexus between freshwater and health through drinking 
water and recreation, and CDC is encouraged to expand their 
work regionally to understand HABs impact on our nation's 
largest fresh bodies of water.
    Food Safety.--The Committee includes an increase of 
$2,000,000 to help address the critical unmet needs in the 
nation's food safety system, in part through programs that 
enhance state and local public health capacity to support vital 
national surveillance, improve foodborne outbreak detection and 
investigations, enhance food safety prevention efforts, and 
maintain vigilance for emerging threats to our nation's food 
supply.
    Lyme Disease.--The Committee includes an increase of 
$2,000,000 to support CDC's efforts to develop improved 
diagnostics and surveillance networks so that disease burden 
can be more accurately determined, and bolster critical 
prevention and provider and public awareness efforts.
    Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.--The 
Committee commends CDC for its recent progress in myalgic 
encephalomyelitis/chronic fatigue syndrome (ME/CFS) medical 
education and in the Multisite Clinical Assessment of ME/CFS 
(MCAM) study, including the expansion of this study into 
pediatric research. The Committee is concerned that there is a 
lack of information about ME/CFS onset and requests an update 
in the fiscal year 2022 Congressional Justification.
    Mycotic Diseases.--The Committee is concerned about 
invasive mycological or fungal infections. These infections are 
a major cause of morbidity and mortality worldwide, leading to 
approximately 500,000 deaths annually. The overall disease 
burden is over 100 million people worldwide, and in the US, 
approximately one million new infections occur annually in a 
variety of immunocompetent and immunocompromised individuals. 
The Committee provides an additional $200,000 in Emerging 
Infectious Diseases for mycotic diseases, including, but not 
limited to, surveillance and prevention, building capacity in 
the State and local health departments, cooperative agreements, 
education of the public and healthcare providers, and 
laboratory support. The Committee requests an update in the 
fiscal year 2022 Congressional Justification on how this 
funding is being utilized.
    National One Health Framework.--As the coronavirus pandemic 
has proven, zoonotic diseases pose a significant threat and the 
Committee recognizes the need to improve the nation's response 
capacity. The Committee directs CDC to develop a national one-
health framework to combat the threat of zoonotic diseases and 
advance emergency preparedness. The Committee directs the 
Secretary of Health and Human Services and the Secretary of 
Agriculture in coordination with the Environmental Protection 
Agency, the Department of Homeland Security, the Department of 
the Interior, the Department of Defense, the Department of 
Commerce, and other departments and agencies as appropriate, to 
develop, publish, and shall report to the Committee no later 
than 180 days after enactment of this Act on a national One 
Health Framework for coordinated Federal Activities.
    One Health Federal Interagency Coordination Committee.--The 
Committee directs CDC to work with the Department of 
Agriculture and Department of Interior to develop a One Health 
coordination mechanism at the federal level. This mechanism 
will be used to strengthen One Health collaboration related to 
prevention, detection, control, and response for the 
prioritized zoonotic diseases and related One Health work 
across the federal government. HHS shall report to the 
Committee no later than 180 days after enactment of this Act on 
the National One Health Framework and the One Health 
Coordination Mechanism regarding the steps being taken to 
implement the recommendations detailed in the U.S. One Health 
Zoonotic Disease Prioritization Workshop summary, entitled 
Prioritizing Zoonotic Diseases for Multisectoral, One Health 
Collaboration in the U.S.
    Prion.--The Committee includes an increase of $1,000,000 to 
advance efforts on prion diseases, which occur in both humans 
and animals, primarily affecting the central nervous system. 
This group of degenerative neurological disorders is currently 
incurable and invariably fatal. CDC supports the only Federally 
provided resources to monitor human prion diseases in the U.S. 
The Committee supports these efforts and recognizes the 
critical work of the National Prion Disease Pathology 
Surveillance Center. The workload related to chronic wasting 
disease (CWD) in deer and elk populations in the U.S. is in 
addition to the Center's ongoing efforts related to human prion 
diseases that includes research, surveillance, tissue banking, 
and technical and supportive assistance to providers to 
families. Accordingly, the Committee provides increased funding 
to support this work.
    Sepsis.--The Committee is concerned that sepsis continues 
to be a leading public health threat that is responsible for 
the death of approximately 270,000 adults and 7,000 children 
annually in U.S. The Committee encourages CDC to increase 
coordination within the Department of Health and Human 
Services, with the Department of Education, and with the 
Department of Labor to increase the dissemination of and the 
utilization of sepsis educational materials, including the Get 
Ahead of Sepsis Campaign. Coordination should focus on 
increasing utilization of the campaign by school nurses, 
company nurses and health care providers. The Committee also 
encourages enhanced outreach to health departments, academic 
partners, healthcare providers and systems, professional and 
quality improvement organizations, and patient representatives 
to increase utilization of sepsis educational materials, 
including the Get Ahead of Sepsis Campaign. In addition, the 
Committee encourages CDC to enhance outreach to national, 
state, and local hospital associations to increase usage of the 
Get Ahead of Sepsis Campaign and the CDC Sepsis Prevention 
Toolkit by medical staff. The Committee directs CDC to report 
to the House and Senate Committees on Appropriations on 
coordination efforts, utilization rates, and the results of 
enhanced outreach efforts 180 days after the enactment of this 
Act.
    Vector-Borne Disease Centers of Excellence.--The Committee 
is concerned about the Pacific Northwest being an underserved 
region for funding and representation in the Regional Centers 
of Excellence in Vector-Borne Diseases network. The ecology, 
disease transmission dynamics, and resources for vector-borne 
disease training, surveillance, and control in the Northwest 
differ significantly from those in the five regional centers 
currently funded. The Committee encourages CDC to examine 
options to provide greater coverage of the Northwest region for 
vector-borne disease resources.

            CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION

 
 
 
Appropriation, fiscal year 2020.......................    $1,239,914,000
Budget request, fiscal year 2021......................       813,250,000
Committee Recommendation..............................     1,306,414,000
    Change from enacted level.........................       +66,500,000
    Change from budget request........................      +493,164,000
 

    The Committee recommendation includes $1,049,564,000 in 
discretionary appropriations and $256,850,000 in transfers from 
the PPH Fund. Programs supported within Chronic Disease 
Prevention and Health Promotion (CDPHP) provide national 
leadership and support for State, Tribal, and community efforts 
to promote health and well-being through the prevention and 
control of chronic diseases.
    The recommendation for CDPHP maintains the existing program 
line items as they were funded in fiscal year 2020 and does not 
provide funding for the America's Health Block Grant proposed 
again in the fiscal year 2021 budget request. The Committee 
supports evidence-based strategies to address public health 
priorities through proven State-based grant programs, utilizing 
related national organizations for technical assistance, and 
encourages CDC to continue and expand these successful 
approaches. Within the total provided, the Committee recommends 
the following amounts:

------------------------------------------------------------------------
                                                            FY 2021
                   Budget Activity                         Committee
------------------------------------------------------------------------
Tobacco..............................................       $240,000,000
Nutrition, Physical Activity, and Obesity............         56,920,000
    High Obesity Rate Counties.......................         15,000,000
School Health........................................         15,400,000
Health Promotion.....................................         36,600,000
    Glaucoma.........................................          4,000,000
    Vision and Eye Health............................          1,000,000
    Alzheimer's Disease..............................         20,000,000
    Inflammatory Bowel Diseases......................          1,000,000
    Interstitial Cystitis............................          1,100,000
    Excessive Alcohol Use............................          4,000,000
    Chronic Kidney Disease...........................          2,500,000
    Chronic Disease Education & Awareness............          3,000,000
Prevention Research Centers..........................         26,461,000
Heart Disease and Stroke.............................        145,105,000
Diabetes.............................................        148,129,000
National Diabetes Prevention Program.................         30,300,000
Cancer Prevention and Control........................        386,049,000
    Breast and Cervical Cancer.......................        225,000,000
        WISEWOMAN....................................         28,120,000
    Breast Cancer Awareness for Young Women..........          4,960,000
    Cancer Registries................................         51,440,000
    Colorectal Cancer................................         44,294,000
    Comprehensive Cancer.............................         19,675,000
    Johanna's Law....................................         10,000,000
    Ovarian Cancer...................................         12,000,000
    Prostate Cancer..................................         14,205,000
    Skin Cancer......................................          4,000,000
    Cancer Survivorship Resource Center..............            475,000
Oral Health..........................................         19,500,000
Safe Motherhood/Infant Health........................         68,000,000
    Maternal Mortality Review Committees.............         22,000,000
    Preterm Birth....................................          2,000,000
Other Chronic Diseases...............................         30,000,000
    Arthritis........................................         11,000,000
    Epilepsy.........................................         10,500,000
    National Lupus Patient Registry..................          8,500,000
Racial and Ethnic Approaches to Community Health.....         66,950,000
    Good Health and Wellness in Indian Country.......         23,000,000
Social Determinants of Health........................         10,000,000
Healthy Aging........................................         10,000,000
Million Hearts.......................................          4,000,000
National Early Child Care Collaboratives.............          4,000,000
Hospitals Promoting Breastfeeding....................          9,000,000
------------------------------------------------------------------------

    Alzheimer's Disease.--The Committee includes an increase of 
$4,500,000 to support provisions enacted in the Building Our 
Largest Dementia (BOLD) Infrastructure for Alzheimer's Act 
(P.L. 115-406), including establishing Centers of Excellence 
and building a robust Alzheimer's and other dementias public 
health infrastructure across the country.
    Arthritis.--The Committee recognizes the serious issue of 
arthritis in communities across the country, which affects one 
in four Americans and is the number one cause of disability in 
the U.S. The Committee commends the ongoing work of the CDC 
Arthritis Program to provide existing investments in data and 
intervention and prevention research. The Committee urges CDC 
to support robust investment to expand the number of state-
based arthritis programs, provide access to proven arthritis 
self-management and physical activity programs, and improve 
data collection and surveillance. The Committee requests a 
report on the resources necessary to fully scale the Arthritis 
Program and identify gaps in arthritis public health research 
and data collection in the fiscal year 2022 Congressional 
Justification.
    Breast and Cervical Cancer.--The National Breast and 
Cervical Cancer Early Detection Program provides, critical, 
lifesaving breast cancer screening and diagnostic services to 
low-income, uninsured and underinsured women, providing exams 
to more than 5.6 million women since its creation in 1991, 
diagnosing nearly 5,000 invasive cervical cancers and 215,000 
premalignant cervical lesions, and almost 70,000 invasive 
breast cancers. Previous funding levels allowed 15 percent of 
women eligible for breast cancers screening and approximately 7 
percent of women eligible for cervical cancer screening to be 
served. The Committee encourages CDC to work with States and 
stakeholders to implement strategies to maximize the number of 
women in the program.
    Chronic Disease Education and Awareness.--The Committee 
recognizes CDC's work with stakeholders to expand public health 
education and awareness activities that help to improve 
surveillance, diagnosis, and proper treatment for chronic 
diseases. The Committee includes $3,000,000 to establish a 
Chronic Disease Education and Awareness competitive grant 
program to expand and advance CDC's work with stakeholders on 
education, outreach, and public awareness activities for a 
variety of chronic diseases for which there is a clear 
disparity in public and professional awareness that are not 
already specified under CDC in this report. This approach would 
utilize a competitive grant process to strengthen the science 
base for prevention, education, and public health awareness for 
a variety of chronic diseases, such as lymphatic diseases, that 
do not currently have dedicated resources that would lead to 
meaningful patient outcomes.
    Chronic Obstructive Pulmonary Disease.--The Committee urges 
CDC to do more to address Chronic Obstructive Pulmonary Disease 
(COPD), the nation's fourth leading cause of death, including 
fully engaging with the timely implementation of the COPD 
National Action Plan, developed by the National Heart, Lung, 
Blood Institute in coordination with CDC, such as fully 
integrating COPD surveillance, research, prevention, and 
management strategies into existing chronic disease efforts. 
The Committee requests a written report on the updates to the 
COPD Action Plan no later than 180 days after enactment of this 
Act.
    Chronic Pain.--The Committee previously encouraged CDC to 
analyze data collected from the chronic pain questions included 
in the 2017 National Health Interview Survey and to clarify the 
incidence and prevalence of various pain syndromes 
differentiated by patient age, comorbidities, socioeconomic 
status, race and gender. The Committee also encouraged CDC to 
collect data on direct and indirect costs of pain treatment and 
the effectiveness of evidence-based treatment approaches (S. 
Rept. 115-150--Departments of Labor, Health and Human Services, 
and Education, and Related Agencies Appropriation Bill, 2018). 
In light of the issuance of the HHS Pain Management Best 
Practices Task Force report identifying gaps in access to care, 
and the importance of utilizing interventional procedures such 
as nerve blocks, injections and surgical devices; behavioral 
health approaches such as cognitive behavioral therapy; and 
complementary and integrative health therapies such as massage 
therapy and acupuncture to address pain, the Committee again 
encourages CDC to collect this needed data and publish it 
annually. Furthermore, the Committee directs CDC to provide an 
update on pain statistics in the fiscal year 2022 Congressional 
Justification.
    Colorectal Cancer.--The Committee includes an increase of 
$1,000,000 for colorectal cancer. The Committee is concerned 
with the increasing rate of colorectal cancer among younger 
adults. The Committee urges CDC to identify risk factors that 
may be associated with this increase among younger adults and 
further identify trends of increase by race and socioeconomic 
status.
    Diabetes.--The Committee includes funding to prevent 
diabetes, its complications, and to reduce inequities through 
prevention strategies, translational research, and education. 
The Committee also includes an increase of $3,000,000 for the 
Diabetes Prevention Program to expand efforts of this public-
private partnership that provides diabetes prevention for 
people with prediabetes. The Committee encourages CDC to 
support diabetes screening programs located in hospital 
settings.
    E-Cigarette or Vaping Product Use--Associated Lung 
Injury.--The Committee remains concerned about the impacts of 
utilizing e-cigarettes or vaping products that lead to 
hospitalizations and deaths across the country. The Committee 
requests an update of CDC's findings relating to this topic in 
the fiscal year 2022 Congressional Justification.
    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 
includes funding for the National Early Child Care 
Collaboratives Program to support direct provider-level 
training in implementation of comprehensive programming to 
support healthy eating and physical activity best practices and 
technical assistance to States for integrating such best 
practices into existing State and local systems for early care 
and education.
    Eating Disorders.--The Committee encourages CDC to assist 
States in collecting data by including standard questions on 
unhealthy weight control practices for eating disorders, 
including binge eating, through the Youth Risk Behavior 
Surveillance System and the Behavioral Risk Factor Surveillance 
System.
    Epilepsy.--The Committee includes an increase of $1,000,000 
to support epidemiologic studies, national dissemination of 
evidence-based programs to improve access of care and expand 
provider education and public awareness campaigns to reduce 
stigma.
    Food and Health.--The Committee understands that many 
chronic medical conditions, such as diabetes, asthma, arthritis 
and inflammatory diseases, and maternal health and child 
development, can be managed cost effectively by improved 
nutrition. The Committee supports efforts to provide 
information on how culturally appropriate, food-based solutions 
integrated into the healthcare system, using the latest 
knowledge in nutrition, can improve medical effectiveness 
resulting in cost savings.
    Healthy Aging.--The Committee includes $10,000,000 for CDC 
to expand its healthy aging work to include coordinating 
healthy aging efforts across the agency, funding applied 
research and translation for public health practice, and 
awarding cooperative agreements to build capacity in state, 
tribal and territorial public health departments to promote the 
health of older adults within an age-friendly public health 
system. The Committee recognizes the role of public health in 
promoting healthy aging. As the nation's population rapidly 
ages, the U.S. public health system must adapt accordingly. 
Isolation and loneliness, financial struggles, multiple chronic 
conditions, including loss of bone density, hearing, decline in 
vision, and access to transportation, healthy food, and 
affordable housing are challenges many older people face. 
Social isolation alone increases the risk of heart disease, 
infections, depression, cognitive decline and death among older 
people. The impact of social isolation is particularly 
important to consider as the U.S. responds to the outbreak of 
COVID-19. Age-friendly public health interventions can optimize 
the health and well-being of adults 65 and over, prolong their 
independence, and reduce their use of expensive healthcare 
services.
    Heart Disease and Stroke.--The Committee includes an 
increase of $3,000,000 to support, strengthen, and expand 
evidence-based initiatives, given that almost half of the U.S. 
population has some form of cardiovascular disease.
    Inflammatory Bowel Diseases.--The Committee commends CDC 
for continuing to support research on the incidence and 
prevalence of inflammatory bowel diseases (IBD) in the U.S., 
including on disparities in patterns of care within minority 
populations. The Committee encourages CDC to begin planning an 
educational campaign to increase awareness among healthcare 
providers and patients in order to reduce disparate health 
outcomes among minority populations with IBD.
    Interstitial Cystitis.--The Committee requests an update on 
education, outreach, and public awareness activities in the 
fiscal year 2022 Congressional Justification.
    Johanna's Law.--The Committee includes an increase of 
$1,000,000 for CDC's Inside Knowledge Campaign that raises 
awareness of the five main types of gynecological cancer: 
cervical, ovarian, uterine, vaginal, and vulvar. This campaign 
educates women of all ages, races, and ethnic groups, and 
healthcare providers.
    Kidney Disease.--The Committee is deeply troubled by the 
significant and growing burden of chronic kidney disease (CKD), 
which affects an estimated 37 million Americans. Unfortunately, 
90 percent of individuals with CKD are unaware they have the 
illness, only learning of it when there is a need for dialysis 
or kidney transplantation. With timely awareness, diagnosis, 
and treatment, the progression of kidney disease and its 
comorbidities can be slowed.
    Lung Cancer.--The Committee remains concerned about the 
high morbidity and mortality of lung cancer. Early detection 
and treatment of lung cancer translates into higher survival 
rates, but only 16 percent of lung cancer cases are diagnosed 
early when the disease is most treatable. The Committee urges 
CDC to promote lung cancer screening awareness as part of its 
tobacco prevention and control activities.
    Nutrition, Physical Activity and Obesity.--The Committee 
supports CDC's efforts to protect the health of Americans at 
every stage of life by encouraging regular physical activity, 
good nutrition, and preventing adult and childhood obesity. The 
Committee is concerned that the eligibility for the High 
Obesity Program is limited to communities with high obesity 
rates solely among adults, without taking into account 
childhood obesity rates. This exclusion represents a missed 
opportunity to address the important public health problem of 
childhood obesity, which can lead to high blood pressure, sleep 
apnea, high cholesterol, fatty liver disease, psychological 
problems and more. In addition, by focusing only on obesity 
rates at the county level, the program misses high-risk 
communities within healthier counties. The Committee encourages 
that CDC consider including high childhood obesity rates in its 
eligibility criteria for the High Obesity Program, as well as 
consider opening eligibility to program sites in census tracts 
with high obesity rates.
    Oral Health.--The Committee is aware that there are some 
Community Dental Health Coordinators (CDHCs) that serve in 
school-based settings where they provide oral health education, 
screenings, cleanings and dental sealants. The Committee 
encourages CDC to engage federal partners, external 
stakeholders, including current and former grantees of the 
program, to determine how CDHCs can be used to continually 
educate and provide preventative care in school-based settings.
    Ovarian Cancer.--The Committee includes an increase of 
$1,000,000 for ovarian cancer, which causes more deaths each 
year than any other gynecological cancer in the U.S., to 
advance ovarian cancer prevention, early detection, risk 
assessment, and access to the standard of care.
    Prostate Cancer.--The Committee support's CDC's efforts to 
increase the public's awareness of prostate cancer risks, 
screening and treatment, and improve surveillance of this 
disease, which is the most commonly diagnosed cancer in men and 
the second leading cause of cancer deaths among men in the U.S. 
The Committee encourages CDC to increase outreach and education 
among high-risk men, especially African-American men.
    Pregnancy Risk Assessment Monitoring System for Fathers 
Pilot.--The Committee is aware of the pilot Pregnancy Risk 
Assessment Monitoring System (PRAMS) for Fathers with state and 
local public health agencies. Building on the successful PRAMS 
surveillance system that provides data from women during 
pregnancy and the first few months after birth, the pilot 
program extending this surveillance to fathers has provided 
paternal data with immense value for public health 
interventions.
    Prevention Research Centers.--The Committee includes 
funding for the national network committed to conducting 
prevention research and translating research results into 
policy and public health practice that address local public 
health needs.
    Racial and Ethnic Approaches to Community Health.--The 
Committee includes an increase of $7,000,000 for the only 
Federal program addressing the nation's racial and ethnic 
health disparities. The Committee recommends that all racial 
and ethnic target populations are represented. The Committee's 
recommended level includes an increase of $2,000,000 for Good 
Health and Wellness in Indian Country.
    Safe Motherhood and Infant Health.--The Committee includes 
an increase of $10,000,000 and recognizes CDC's ongoing efforts 
to address the pressing public health issue of rising maternal 
mortality rate in the U.S. Black, American Indian and Alaska 
Native women are two to three times more likely to die from 
pregnancy-related causes than white women, and this disparity 
increases with age. The Committee encourages CDC to work with 
States to establish and continue Maternal Mortality Review 
Committees, and to provide assistance for all Committees to 
collect, analyze, and report data collected through the 
Maternal Mortality Review Information Application (MMRIA) 
System. CDC is encouraged to analyze the MMRIA data from all 
States, to the extent possible, issue a report of findings, and 
provide follow up technical assistance to support States to 
develop and implement strategies to improve data collection and 
analysis and to reduce maternal mortality. The Committee 
requests a report in the fiscal year 2022 Congressional 
Justification, analyzing the necessary costs and resources 
needed to enable State or regional databases to institute a 
policy nation-wide of monitoring death records 365 days after a 
birth record is issued for an individual's newborn. 
Furthermore, the Committee commends CDC for funding State-based 
Perinatal Quality Collaboratives (PQCs) that focus on improving 
maternal and neonatal outcomes using known prevention 
strategies such as reducing early elective deliveries. CDC is 
encouraged to continue support for PQCs particularly due to the 
rise in maternal mortality rates and neonatal abstinence 
syndrome (NAS) as a result of the opioid crisis. To maintain 
the notable work of the PREEMIE CDC-funded state-based PQCs 
around the country, the Committee urges CDC to expand their 
work in States disproportionately affected by the opioid crisis 
and focus efforts in the top five States affected by opioid 
misuse.
    Social Determinants of Health Pilot Program.--The Committee 
recognizes the role of public health in working across sectors 
on social determinants of health. The Committee includes 
$10,000,000 for CDC to establish a Social Determinants of 
Health pilot program to award competitive grants to State, 
local, Territorial, or Tribal jurisdictions to support the 
development of Social Determinants of Health Accelerator Plans. 
Such plans should include a description of the health and 
social outcome objectives of the Social Determinants 
Accelerator Plan; identify target populations that would 
benefit from implementation of the plan; and identify non-
governmental public health organizations and community 
organizations that would participate in the development of the 
plan. Grantees may use a portion of grant funding to convene 
government entities and stakeholders and to engage qualified 
research experts in developing Social Determinants Accelerator 
Plans. The Committee directs CDC to submit a report within 120 
days of enactment of this Act on how such grants will be 
administered.
    Sudden Unexpected Infant Death and Sudden Unexplained Death 
in Childhood.--The Committee is aware that currently, there is 
no known way to prevent sudden unexpected infant death syndrome 
(SIDS), but there are ways to reduce the risk. Several factors 
present during pregnancy, at birth, and throughout the first 
year after birth can impact SIDS risk. The Committee urges CDC 
to improve data and prevention strategies, including by 
revising standardized death investigation forms, incorporating 
scene investigation and doll-reenactments.
    Tobacco.--The Committee is deeply troubled by the dramatic 
increase in e-cigarette use among youth and concurs with the 
Surgeon General that youth use of e-cigarettes has reached 
epidemic levels. The Committee is also concerned that certain 
populations and regions of the country continue to experience 
high rates of tobacco use and are disproportionately burdened 
by tobacco-related disease and premature death. The Committee 
urges CDC to continue its efforts to reduce this and other 
disparities in tobacco use prevalence. Accordingly, the 
Committee includes an increase of $10,000,000 so that CDC and 
States can use evidence-based strategies to respond to the 
public health risk caused by the dramatic increase of youth use 
of e-cigarettes, including school-based interventions as part 
of a comprehensive strategy, enhance efforts to reduce tobacco 
use among certain populations and in areas with high tobacco 
use rates and tobacco-related mortality, as well as expand its 
highly effective Tips from Former Smokers campaign.
    Tobacco and COVID-19.--The Committee is aware that smoking 
and use of e-cigarettes harm the lungs, and that researchers 
and public health officials are increasingly concerned that 
users of such products may be at increased risk for poorer 
health outcomes related to COVID-19. The Committee urges CDC to 
improve the collection of data on whether individuals who have 
tested positive for the novel coronavirus are current smokers, 
former smokers, or e-cigarette users, and to assess whether 
smokers and e-cigarette users are at higher risk for developing 
severe illness and death from COVID-19 than non-users. The 
Committee urges CDC to begin tracking this information within 
90 days of enactment and to make such data and assessments 
publicly available.
    Vision and Eye Health.--The Committee includes funding to 
enhance programs that prevent blindness and preserve sight. The 
Committee is aware that vision impairments and eye disease 
contribute to or complicate many other serious and costly 
chronic health conditions, including diabetes, cardiovascular 
disease, injuries and death related to falling, depression, and 
cognitive decline. State and community-level intervention are 
vital, as 75 percent of incidents of vision loss are 
preventable through early detection and treatment.
    WISEWOMAN.--The Committee recognizes the vital importance 
of addressing cardiovascular disease among women by raising 
awareness of rising cardiovascular mortality among women, 
particularly women of color, and including an increase of 
$2,000,000 to support a comprehensive public awareness 
initiative that establishes best practices for identifying and 
treating cardiovascular incidents in women. The Committee 
further recognizes that the resulting costs to the health care 
system of unrecognized symptoms in the treatment of women can 
be substantially reduced with appropriate public policy and 
prevention efforts.

   BIRTH DEFECTS, DEVELOPMENTAL DISABILITIES, DISABILITIES AND HEALTH

 
 
 
Appropriation, fiscal year 2020.......................      $160,810,000
Budget request, fiscal year 2021......................       112,250,000
Committee Recommendation..............................       162,810,000
    Change from enacted level.........................        +2,000,000
    Change from budget request........................       +50,560,000
 

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

------------------------------------------------------------------------
                                                            FY 2021
                   Budget Activity                         Committee
------------------------------------------------------------------------
Child Health and Development.........................        $65,800,000
    Birth Defects....................................         19,000,000
    Fetal Death......................................            900,000
    Fetal Alcohol Syndrome...........................         11,000,000
    Folic Acid.......................................          3,150,000
    Infant Health....................................          8,650,000
    Autism...........................................         23,100,000
Health and Development for People with Disabilities..         69,660,000
    Disability & Health incl. Child Development......         35,000,000
    Tourette Syndrome................................          2,000,000
    Early Hearing Detection and Intervention.........         10,760,000
    Muscular Dystrophy...............................          6,000,000
    Attention Deficit Hyperactivity Disorder.........          1,900,000
    Fragile X........................................          2,000,000
    Spina Bifida ....................................          6,000,000
    Congenital Heart.................................          6,000,000
Public Health Approach to Blood Disorders............          4,400,000
Hemophilia Activities................................          3,500,000
Hemophilia Treatment Centers.........................          5,100,000
Thalassemia..........................................          2,100,000
Neonatal Abstinence Syndrome.........................          2,250,000
Surveillance for Emerging Threats to Mothers and              10,000,000
 Babies..............................................
------------------------------------------------------------------------

    Congenital Heart Defects.--The Committee includes funding 
for grants or cooperative agreements to provide technical 
assistance to State and local agencies to complement intramural 
programs and to conduct applied research related to screening, 
evaluation, diagnosis, results reporting, data collection, 
surveillance, intervention programs, systems, and follow-up of 
children identified through Critical Congenital Heart Defects 
(CCHD) screening to better understand the long-term outcomes 
and needs of this population.
    Duchenne Muscular Dystrophy.--The Committee is aware of the 
development and dissemination of the Duchenne Muscular 
Dystrophy Care Considerations. In order to understand their 
impact, the Committee urges CDC to consider how widely the Care 
Considerations have been adopted across the country and whether 
this has led to changes in practice or an improvement in 
patient outcomes, particularly in rural and underserved areas, 
and the presence of a Certified Duchenne Care Center.
    Fetal Alcohol Spectrum Disorders.--The Committee is 
concerned about the rising trend of prenatal alcohol 
consumption and increased rates of fetal alcohol spectrum 
disorders (FASD) and urges CDC to increase support to: expand 
prevention efforts to heighten awareness of FASD and the risks 
associated with prenatal alcohol exposure; and strengthen 
existing national community-based and professional FASD 
networks to expand access to diagnostic, treatment, 
intervention, and other essential services.
    Improving the Health of People with Intellectual 
Disabilities.--The Committee includes an increase of $2,000,000 
for the expanded provision of year-round, grassroots activities 
in communities to create opportunities for health screenings 
and access to quality healthcare, and health and wellness 
programming for people with intellectual disabilities. These 
efforts enhance the lives of individuals while eliminating 
stigmas and stereotypes.
    Infant and Maternal Health Surveillance.--The Committee 
directs, within 90 days of enactment of this Act, an update on 
adaptions that have been made to the Surveillance for Emerging 
Threats to Mothers and Babies Program, Pregnancy Risk 
Assessment Monitoring System, and other infant and maternal 
health surveillance efforts to evaluate the risks for and 
effects of COVID-19 on infants and pregnant and lactating 
individuals.
    Pregnancy-Status COVID-19 Data Collection and Reporting.--
The Committee directs, within 90 days of enactment of this Act, 
a report be submitted describing the specific steps taken to 
ensure that pregnancy status be included in COVID-19 data 
collection, documentation, and reporting from health care 
providers to public health agencies, particularly at the time 
of the initial or first report.
    Sickle Cell Disease.--The Committee urges the Division of 
Blood Disorders plan to establish a population-based 
surveillance system to collect and analyze longitudinal data on 
people living in the U.S. with sickle cell disease and 
established a separate budget account for sickle cell disease.
    Spina Bifida.--The Committee is aware of a growing 
incidence of sudden death in the adult spina bifida population, 
and understands that there is a significant need to study this 
issue and to develop medical interventions that lead to optimal 
outcomes and to address the transitional and adult care needs 
of the growing, aging Spina Bifida community. Therefore, the 
Committee encourages CDC to use funding for the National Spina 
Bifida Program (NSBP) to be used to support the continuation of 
the Spina Bifida Clinical Care Monitoring and Tracking Program 
which works with the National Spina Bifida Registry to guide 
the health care community in best treatment options for people 
living with Spina Bifida.

                   PUBLIC HEALTH SCIENTIFIC SERVICES

 
 
 
Appropriation, fiscal year 2020.......................      $578,497,000
Budget request, fiscal year 2021......................       521,000,000
Committee Recommendation..............................       593,497,000
    Change from enacted level.........................       +15,000,000
    Change from budget request........................       +72,497,000
 

    This account supports programs that provide leadership and 
training for the public health workforce, support 
infrastructure to modernize public health surveillance, promote 
and facilitate science standards and policies, and improve 
access to information on disease outbreaks and other threats.
    In addition, the CARES Act (P.L. 116-136) included 
$500,000,000 for the public health data modernization 
initiative.
    Within the total, the Committee recommends the following 
amounts:

------------------------------------------------------------------------
                                                            FY 2021
                   Budget Activity                         Committee
------------------------------------------------------------------------
Health Statistics....................................       $174,397,000
Surveillance, Epidemiology, and Informatics..........        363,100,000
Public Health Workforce..............................         56,000,000
------------------------------------------------------------------------

    Birth Settings.--The Committee notes that the 2020 
Consensus Study Report ``Birth Settings in America: Outcomes, 
Quality, Access, and Choice'' conducted by the National 
Academies of Sciences, Engineering and Medicine found that 
``Modifications to the birth certificate that allow inquiry 
into birth settings based on models indicating intended setting 
of birth, including planned attended and planned unassisted 
home births in the U.S. and intended birth attendants are 
needed to better understand and assess outcomes by birth 
settings.'' The Committee urges the National Center for Health 
Statistics to explore ways to collect more detailed records on 
birth settings as part of its collection of vital statistics.
    Familial Hypercholesterolemia.--The Committee includes 
$100,000 to support efforts focused on this inherited genetic 
disorder that causes early, aggressive, heart disease. The 
Committee is concerned that more than 85 percent of those in 
the U.S. who are affected with familial hypercholesterolemia 
(FH) are completely unaware of their condition. The Committee 
supports CDC addressing FH as a public health concern in order 
to improve diagnosis and care delivery and prevent heart 
disease.
    Forecasting.--The Committee encourages CDC to identify a 
research institution capable of developing a Center of 
Excellence that can model public health response, preparation, 
and planning of a coronavirus outbreak, and has experience 
participating in or hosting an influenza forecasting center of 
excellence. The Committee encourages CDC to work in 
collaboration with leading research institutions that provide 
national leadership in creating methodologies and technologies 
to produce safe, effective AI systems that are fair, 
accountable, transparent, and protect individual privacy.
    National Neurological Conditions Surveillance System.--The 
Committee includes $5,000,000 within Surveillance, 
Epidemiology, and Informatics to continue efforts on the two 
initial conditions.
    Primary Immunodeficiencies.--The Committee includes funding 
at the fiscal year 2020 level to continue the existing program 
of education and awareness related to primary 
immunodeficiencies. This program has proven effective in 
identifying undiagnosed patients and linking them to centers of 
care. With NIH estimating that one to two percent of the U.S. 
population is affected by these disorders, a greater commitment 
is required to maximize the benefits of this effort.
    Public Health Data Modernization Initiative.--The 
Coronavirus Pandemic and the outbreak of lung injury associated 
with the use of e-cigarette, or vaping, products brought to 
national attention that more needs to be done to ensure that 
CDC can develop and deploy world-class data and analytics that 
scale rapidly in emergencies, provide predictive capacity to 
identify emerging threats, reduce burden on public health 
partners who are reporting data and ensure bidirectional 
information flows. In addition, public health professionals are 
faced with rapid advances in data science and evolving 
cybersecurity threats that require the necessary skills to 
securely integrate health data. The Committee initiated the 
funding for this effort in fiscal year 2020 and provided 
significant, multi-year resources in the CARES Act (P.L. 116-
136); the Committee directs these funds to be thoughtfully 
planned and invested for a comprehensive, crosscutting effort 
to advance CDC's capabilities to respond to all public health 
threats not limited to COVID-19. This is the opportunity for 
there to be significant improvement in public health data and 
analytics. The Committee includes $50,000,000 to continue to 
modernize systems, and recruit and retain skilled data 
scientists to improve public health data including at the 
National Center for Health Statistics, and State, local, tribal 
and territorial partners. Furthermore, the Committee encourages 
CDC to consider the acceleration of predictive modeling and use 
of artificial intelligence to more rapidly transform how CDC 
collects and uses data to understand various situations in real 
time.
    Public Health Workforce.--The bill includes an increase of 
$5,000,000 to support workforce and training programs, 
including the Epidemic Intelligence Service, that provide HHS, 
and State and local health departments with skilled staff, 
technical assistance, and education services. The Committee 
recognizes that a robust and well-trained public health 
workforce is critical to maintaining a highly-effective public 
health system.
    Strengthening Public Health Infrastructure.--The Committee 
includes an increase of $10,000,000 for CDC to assist States 
and eligible local public health agencies by strengthening 
basic epidemiologic and laboratory capacity.

                          ENVIRONMENTAL HEALTH

 
 
 
Appropriation, fiscal year 2020.......................      $213,850,000
Budget request, fiscal year 2021......................       182,000,000
Committee Recommendation..............................       236,850,000
    Change from enacted level.........................       +23,000,000
    Change from budget request........................       +54,850,000
 

    The Committee recommendation includes $219,850,000 in 
discretionary appropriations and $17,000,000 in transfers from 
the PPH Fund.
    Programs supported within Environmental Health conduct 
surveillance and data collection to detect and address emerging 
pathogens and environmental toxins that pose significant 
challenges to public health, as well as determine whether and 
at what level of exposure these substances are harmful to 
humans.
    Within the total, the Committee recommends the following 
amounts:

------------------------------------------------------------------------
                                                            FY 2021
                   Budget Activity                         Committee
------------------------------------------------------------------------
Environmental Health Laboratory......................        $68,750,000
    Newborn Screening Quality Assurance Program......         19,000,000
    Newborn Screening /Severe Combined                         1,250,000
     Immunodeficiency Diseases.......................
Environmental Health Activities......................         16,000,000
Safe Water...........................................          8,600,000
Amyotrophic Lateral Sclerosis (ALS) Registry.........         10,000,000
Climate and Health...................................         15,000,000
Environmental and Health Outcome Tracking Network....         34,000,000
Asthma...............................................         33,000,000
Trevor's Law.........................................          1,500,000
Childhood Lead Poisoning.............................         40,000,000
Lead Exposure Registry...............................         10,000,000
------------------------------------------------------------------------

    Asthma.--The Committee includes an increase of $3,000,000 
for the National Asthma Control Program. The Committee 
recognizes that millions of people in the U.S. suffer from 
asthma, and that it disproportionately affects African American 
children.
    Childhood Lead Poisoning.--The Committee includes an 
increase of $3,000,000 to strengthen blood lead surveillance by 
supporting state and local program to improve blood lead 
screening test rates, identify high-risk populations, and 
ensure effective follow-up for children with elevated blood 
lead levels. The Committee encourages CDC to require that 
States receiving funding for lead prevention report all blood 
tests in a standardized format through the Nationally 
Notifiable Noninfectious Diseases and Conditions reporting 
system. The Committee directs the Lead Exposure and Prevention 
Advisory Committee to produce a report about the prevalence and 
impact of leaded paint manufacturing plants. The report should 
identify the leaded paint manufacturers, public health hazards 
posed by the plants (including but not limited to the 
environmental hazards), and how the leaded paint is being 
circulated. The report shall be included in the fiscal year 
2022 Congressional Justification.
    Climate and Health.--The Committee recognizes that 
communities are on the front line of responding to climate-
related health effects, including health threats from increased 
spread of vector-borne diseases, higher levels of air 
pollution, hotter temperatures, extreme weather events and 
longer allergy seasons. The Committee includes an increase of 
$5,000,000 to expand investments to a larger number of States, 
cities, or tribes to plan for public health threats caused by 
climate change, and to conduct an analysis of grantee programs 
to allow for broad sharing of best practices and strategies 
that best protect public health.
    Lead Exposure Registry.--The Committee supports CDC's 
implementation of the Flint, Michigan Lead Exposure Registry 
and directs $10,000,000 for the continuation of the Registry 
beyond fiscal year 2021.
    Newborn Screening.--The Committee includes an increase of 
$2,000,000 to further support newborn screening efforts so that 
affected newborns can receive early and often life-saving 
treatment through the timely implementation for all Recommended 
Uniform Screening Panel conditions. The Committee is aware that 
State laboratories need specialized support to begin screening 
for additional newborn conditions and recognizes CDC's 
expertise in working with laboratories to implement accurate 
newborn screening tests. The Committee supports the Newborn 
Screening Quality Assurance Program to support State 
laboratories as they implement screening for new disorders. 
This funding will support evaluation of testing methods for new 
conditions, expansion of CDC's quality assurance materials, and 
critical infrastructure and development of tests for rare 
conditions.

                     INJURY PREVENTION AND CONTROL

 
 
 
Appropriation, fiscal year 2020.......................      $677,379,000
Budget request, fiscal year 2021......................       730,159,000
Committee Recommendation..............................       694,879,000
    Change from enacted level.........................       +17,500,000
    Change from budget request........................       -35,280,000
 

    Programs supported within Injury Prevention and Control 
provide national leadership on violence and injury prevention, 
conduct research and surveillance, and promote evidence-based 
strategies to inform real-world solutions to prevent premature 
death and disability and to reduce human suffering and medical 
costs caused by injury and violence.
    The Committee does not accept the proposal to include 
$100,000,000 for the Drug-Free Communities program in the 
Injury Prevention and Control appropriation. The Committee 
directs the program to remain in the Office of National Drug 
Control Policy.
    Within the total, the Committee recommends the following 
amounts:

------------------------------------------------------------------------
                                                            FY 2021
                   Budget Activity                         Committee
------------------------------------------------------------------------
Domestic Violence and Sexual Violence................         34,700,000
    Child Maltreatment...............................          7,250,000
    Child Sexual Abuse Prevention....................          2,000,000
Youth Violence Prevention............................         15,100,000
Domestic Violence Community Projects.................          7,500,000
Rape Prevention......................................         52,750,000
Suicide Prevention...................................         10,000,000
Adverse Childhood Experiences........................          4,000,000
National Violent Death Reporting System..............         23,500,000
Traumatic Brain Injury...............................          6,750,000
Elderly Falls........................................          2,050,000
Injury Prevention Activities.........................         28,950,000
Opioid Overdose Prevention and Surveillance..........        475,579,000
Injury Control Research Centers......................          9,000,000
Firearm Injury and Mortality Prevention Research.....         25,000,000
------------------------------------------------------------------------

    Adverse Childhood Experiences.--The Committee encourages 
CDC to prioritize the collection and reporting of data on 
adverse childhood experiences (ACEs), including exposure to 
violence, neglect, and living in a home with mental health or 
substance use problems, and to use these data to support the 
implementation of comprehensive ACEs prevention strategies at 
the State, territorial, tribal and local levels. The Committee 
also encourages CDC to report on the prevalence of adverse 
childhood experiences across geography, race and ethnicity, 
disability and socioeconomic status.
    Child Sexual Abuse Prevention.--The Committee includes an 
increase of $1,000,000 and recognizes the severe and often 
life-long physical, cognitive and emotional impact of child 
sexual abuse and appreciates CDC's report outlining the gaps in 
current child sexual abuse prevention research. These 
opportunities include the need to improve surveillance systems 
and data collection, increase the understanding of risk and 
protective factors, and develop and disseminate effective 
prevention efforts.
    Domestic Violence and Sexual Violence.--The Committee 
encourages CDC to prioritize the collection and reporting of 
data on domestic violence and sexual violence. The Committee 
also encourages CDC to work with State and local governments, 
as well as nonprofit organizations, to implement the necessary 
mechanism for sharing data as well as provide technical 
assistance when needed to ensure that the data is properly 
understood and utilized correctly.
    Domestic Violence Prevention.--The Committee includes an 
increase of $2,000,000 for the Domestic Violence Prevention 
Enhancements and Leadership Through Alliances (DELTA) program 
to expand efforts. DELTA is the only dedicated federal funding 
source for the primary prevention of domestic violence.
    Drowning Prevention.--About one in five people who die from 
drowning are children aged 14 and younger. For every child who 
dies from drowning, another five receive emergency department 
care for nonfatal submersion injuries. The Committee strongly 
supports efforts by CDC to educate families and youth serving 
organizations on the best practices to avoid injuries related 
to drowning, and to support State drowning surveillance efforts 
and a national plan on water safety.
    Firearm Injury and Mortality Prevention Research.--The 
Committee includes an increase of $12,500,000 for research on 
firearm injury and mortality through a public health approach 
that focuses on data to understand its causes and to inform 
prevention strategies. The Committee directs CDC to focus on 
activities that will have the greatest potential public health 
impact. Furthermore, the Committee recognizes that community 
gun violence, such as gang violence, constitutes a significant 
portion of gun homicides in the U.S. There is a 
disproportionate impact of community gun violence on low-income 
communities of color, which is not often reflected in the 
national narrative surrounding gun violence. The Committee 
encourages CDC to support research on community gun violence 
and to select grantees that reflect the diversity of the 
victims of gun violence and that work in or near the impacted 
communities.
    National Violent Death Reporting System.--The Committee 
includes funding for the only State-based surveillance system 
that pools information together from multiple sources into a 
usable, anonymous database of all types of violent deaths so 
that prevention efforts can be informed and progress monitored.
    Opioid Abuse and Overdose Prevention.--The Committee 
commends CDC for its leadership on combating opioid drug 
overdoses. The Committee encourages the Director to continue to 
implement these activities based on population-adjusted burden 
of disease criteria, including mortality data (age adjusted 
rate), as significant criteria when distributing funds for 
overdose prevention activities. The Committee recognizes that 
the substance misuse epidemic is shifting, with an increase in 
overdoses resulting from stimulants and other substances. The 
Committee urges for CDC to monitor, prevent, and reduce harms 
associated with drug use, misuse, and overdose, including 
opioids, stimulants, cannabis, and other emerging risks. The 
Committee appreciates efforts by CDC to ensure that funding for 
opioid abuse and overdose prevention reaches local communities 
to advance local understanding of the opioid overdose epidemic 
and to scale-up prevention and response activities as intended 
by Congress.
    Public Health Approach to Violence.--The Committee 
recognizes all forms of violence as a health crisis that is in 
desperate need of increased data collection and funding to 
support effective prevention and intervention efforts grounded 
in public health approaches. There is increasing evidence of 
the profound negative effects of violence and the exposure to 
violence on child development, the long-term mental and 
physical health of affected populations, and the economic 
development of communities, especially communities of color. In 
order to support calls for greater investment in these 
approaches, the Committee directs CDC within 180 days of 
enactment of this Act to submit a comprehensive report 
detailing the scope and intersection of all forms of violence 
in the U.S., the cost of violence, and identify areas where 
more data and intervention are needed.
    Rape Prevention.--The Committee includes an increase of 
$2,000,000 to amplify funding to States and Territories to 
support essential rape prevention and education programs.
    Suicide.--The Committee recognizes that suicide is 
devastating communities across the U.S., as evidenced by more 
than 48,000 deaths in 2018, and is the tenth leading cause of 
death in America. While depression and other mental health 
conditions are a significant risk factor for suicide, less than 
half of the people who die by suicide have a known mental 
health condition.

         NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH

 
 
 
Appropriation, fiscal year 2020.......................      $342,800,000
Budget request, fiscal year 2021......................       190,000,000
Committee Recommendation..............................       344,700,000
    Change from enacted level.........................        +1,900,000
  Change from budget request..........................      +154,700,000
 

    The National Institute for Occupational Safety and Health 
(NIOSH) conducts applied research, develops criteria for 
occupational safety and health standards, and provides 
technical services to government, labor, and industry, 
including training for the prevention of work-related diseases 
and injuries. This appropriation supports surveillance, health 
hazard evaluations, intramural and extramural research, 
instrument and methods development, dissemination, and training 
grants.
    Within the total for NIOSH, the Committee recommends the 
following amounts:

------------------------------------------------------------------------
                   Budget Activity                     FY 2021 Committee
------------------------------------------------------------------------
National Occupational Research Agenda................       $117,000,000
    Agricultural, Forestry, and Fishing..............         26,500,000
Education and Research Centers.......................         30,000,000
Personal Protective Technology.......................         20,000,000
Mining Research......................................         60,500,000
National Mesothelioma Registry and Tissue Bank.......          1,600,000
Firefighter Cancer Registry..........................          2,500,000
Other Occupational Safety and Health Research........        113,100,000
------------------------------------------------------------------------

    Agricultural, Forestry, and Fishing.--The Committee 
includes funding to support efforts to protect workers in this 
sector by providing leadership in applied research, disease and 
injury surveillance, education and prevention.
    Education and Research Centers.--The Committee includes 
funding to support efforts to reduce work-related injuries and 
illnesses by prevention research, and implementing programs to 
improve occupational health and safety.
    Mesothelioma.--The Committee recognizes that CDC undertook 
a feasibility study for a mesothelioma patient registry in 
fiscal year 2019 to evaluate case finding methodologies to 
determine incidence and prevalence, demographics and risk 
factors. The Committee includes an increase of $400,000 to take 
the next step toward establishment of a national mesothelioma 
patient registry through collecting data on individuals 
suffering from the disease and identify gaps in treatment in 
order for researchers to develop new treatments and a cure for 
this disease, which is among the deadliest and most painful 
cancers. The Committee encourages CDC to establish priorities 
for successful outcomes; develop and revise standards of care 
and treatment best practices; share evidence-based information 
between physicians across the country; and implement benchmarks 
to improve care for mesothelioma patients.
    Total Worker Health.--The Committee includes an increase of 
$1,500,000 for the Total Worker Health (TWH) program, which 
supports centers of excellence that advance the overall safety, 
health, and well-being of U.S. workers. The Committee notes 
that millions of American workers and businesses are 
confronting the mental health effects of the COVID-19 pandemic; 
these include isolation, economic insecurity, concerns about 
physical health and the challenges of working remotely and 
reintegrating back into the workplace. In addition, mental 
health conditions represent a leading cause of worker 
disability, rising medical costs and lost productivity. 
Therefore, the Committee directs NIOSH to use the additional 
funding to create a new TWH center of excellence for workplace 
mental health. This center will support companies across all 
sizes and industries in the study and implementation of best 
practices to improve workplace mental health and worker well-
being nationwide. NIOSH should award the center to an academic 
research institution in partnership with a national nonprofit 
organization. Priority should be given to applicants with 
expertise in mental illness from the worker/workplace 
perspective, a strong track record of data collection and 
analysis, experience in sustaining a positive culture/climate 
in U.S. workplaces, and evaluating workplace policies and 
practices with employers of varying sizes. The center should 
also have the capacity to translate data and science into 
interventions, disseminate best practices across the country 
and collect national data on employers and the mental health 
and well-being of their workers.

       ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION PROGRAM

 
 
 
Appropriation, fiscal year 2020.......................       $55,358,000
Budget request, fiscal year 2021......................        55,358,000
Committee Recommendation..............................        55,358,000
    Change from enacted level.........................             - - -
    Change from budget request........................             - - -
 

    The Energy Employees Occupational Illness Compensation 
Program (EEOICPA) provides compensation to employees and 
survivors of employees of Department of Energy facilities and 
private contractors who have been diagnosed with a radiation-
related cancer, beryllium-related disease, or chronic silicosis 
as a result of their work. NIOSH estimates occupational 
radiation exposure for cancer cases, considers and issues 
determinations for adding classes of workers to the Special 
Exposure Cohort, and provides administrative support to the 
Advisory Board on Radiation and Worker Health.

                             GLOBAL HEALTH

 
 
 
Appropriation, fiscal year 2020.......................      $570,843,000
Budget request, fiscal year 2021......................       532,222,000
Committee Recommendation..............................       572,843,000
    Change from enacted level.........................        +2,000,000
    Change from budget request........................       +40,621,000
 

    Through its Global Health activities, CDC coordinates, 
cooperates, participates with, and provides consultation to 
other nations, Federal agencies, and international 
organizations to prevent and contain diseases and environmental 
health problems and to develop and apply health promotion 
activities. In cooperation with ministries of health and other 
appropriate organizations, CDC tracks and assesses evolving 
global health issues and identifies and develops activities to 
apply CDC's technical expertise.
    In addition, the Coronavirus Preparedness and Response 
Supplemental Appropriations Act (P.L. 116-123) included 
$300,000,000 and the CARES Act (P.L. 116-136) included 
$500,000,000 for global disease detection and emergency 
response.
    Within the total, the Committee recommends the following 
amounts:

------------------------------------------------------------------------
                   Budget Activity                     FY 2021 Committee
------------------------------------------------------------------------
Global AIDS Program..................................       $128,421,000
Global Tuberculosis..................................          9,222,000
Global Immunization Program..........................        226,000,000
    Polio Eradication................................        176,000,000
    Other Global/Measles.............................         50,000,000
Parasitic Diseases and Malaria.......................         26,000,000
Global Public Health Protection......................        183,200,000
------------------------------------------------------------------------

    Global Health Security.--The Committee provided additional, 
multi-year funding through coronavirus supplemental 
appropriations to further CDC's work to protect global health 
security through the Center for Global Health, the National 
Center for Emerging and Zoonotic Infectious Diseases, and other 
programs that detect, prevent, and respond to infectious 
diseases and other health threats. CDC's global health security 
work focuses on the core foundation for strong public health 
systems: surveillance, laboratory, workforce, and emergency 
operations. As emerging infectious diseases like COVID-19, 
Ebola and Zika represent profound challenges for our health 
system, the Committee supports continued work supporting the 
core public health system foundations for Ministries of Health 
and enhanced work in research and development aimed at creating 
new tools to respond to health threats at home and abroad. The 
Committee urges CDC to ensure that the importance of research 
and development to global health security is appropriately 
reflected in their international engagements. The Committee 
also supports CDC's core activities in developing and 
validating innovative tools for use by U.S. bilateral and 
multilateral global health programs and laboratory efforts to 
monitor and combat drug and insecticide resistance, a function 
essential to ensuring that global health programs are 
responsive, efficient, and tailored for maximum impact. The 
Committee notes the urgent need for new disease detection and 
diagnostic tools to accurately measure progress towards the 
U.S. government's disease control and elimination goals and 
supports CDC's leadership role in the development of those 
tools and in the application of next-generation approaches to 
disease sequencing and diagnosis.
    Global Public Health Protection.--In addition to the 
funding provided in this bill, the Committee provided 
significant, multi-year funding in the CARES Act (P.L. 116-136) 
to support and enhance CDC's mission to protect the health of 
our nation, including by working across the globe. The 
Committee supports CDC's global efforts to detect epidemic 
threats earlier, respond more effectively, and prevent 
avoidable crises, including by providing support of program 
implementation and scientific and technical experts in Atlanta 
and in the field with concentrated efforts on countries, 
populations, and programs where resources will have the 
greatest public health impact.
    Global Tuberculosis.--The Committee includes an increase of 
$2,000,000 to advance CDC's global tuberculosis priorities to 
find, cure, prevent, and sustain.
    Global Water Strategy.--The Committee recognizes CDC's work 
to provide sustainable Water, Sanitation, & Hygiene (WASH) in 
healthcare facilities, aligned with the 2017 US Global Water 
Strategy, and to support WASH efforts to contribute to the 
elimination of cholera as a public health threat as outlined by 
Ending Cholera--A Global Roadmap to 2030. The Committee urges 
CDC to increase its WASH efforts in areas where Neglected 
Tropical Diseases are endemic.
    Malaria.--The Committee is concerned with the exponentially 
growing need of severe malaria treatment with no commercially 
available options following the withdrawal of the only FDA-
approved drug for severe malaria (quinidine) from the U.S. 
market. The severe malaria treatment preferred by the World 
Health Organization is IV artesunate which is not FDA-approved 
due to a lack of commercial interest. CDC is able to stock its 
network of Quarantine Stations with IV artesunate by relying on 
imports from China as well as unused reserves from the 
Department of Defense. Artesunate releases from CDC's 
Quarantine Stations have increased almost 1,100 percent from 
2018 to 2019. To address the need for rapid access, CDC is 
encouraged to support additional staff support at Quarantine 
Stations and headquarters to provide technical support, coupled 
with an expanded distribution model. Distributing artesunate 
from Quarantine Stations, select health departments, and 
positioning at select hospitals is the most effective and cost-
efficient method for preventing morbidity in high burden areas. 
This hybrid model would put artesunate within 100 miles of 88 
percent of the places that severe cases have historically 
reported to. Additional work to promote utilization of malaria 
prophylaxis for travelers could help reduce malaria cases.
    Parasitic Disease and Malaria.--The Committee recognizes 
the important role the Center plays in the fight against 
malaria and parasitic disease, and protecting Americans through 
global health security through its efforts to detect, prevent, 
and respond to infectious diseases and other health threats. 
The Center also provides crucial monitoring and surveillance of 
transmission, evaluation of interventions for effectiveness and 
impact, development of key diagnostics, and testing of tools in 
a real work setting that are critical to ensuring that our 
global health investments are smarter, better, and not 
wasteful. Therefore, the Committee encourages CDC to continue 
to research, monitor, and evaluate efforts for malaria and 
parasitic disease in collaboration with other divisions and 
agencies.
    Population-based Surveillance Platforms.--The Committee 
directs at least $3,000,000 to be used to support existing 
longitudinal population-based infectious disease surveillance 
platforms that enable comparative analysis between urban and 
rural populations in the developing world.
    Soil Transmitted Helminth and Related Diseases of 
Poverty.--The Committee includes $1,500,000 to extend the 
currently funded CDC projects aimed at surveillance, source 
remediation and clinical care to reduce soil transmitted 
helminth infection.
    World Health Organization.--The Committee strongly opposes 
the President's proposed ban on U.S. support and funding for 
the World Health Organization (WHO). This action would have a 
damaging impact on global public health efforts affecting 
billions of people across the globe, including the current 
response to the COVID-19 pandemic, global health security, 
emergency preparedness and response, and programs to reduce 
chronic disease. For example, a ban on support for the WHO 
would have a terrible impact on the global polio eradication 
campaign, in which WHO-coordinated surveillance is critical to 
tracking polio outbreaks, targeting resources to those 
outbreaks, and ultimately, certifying regions to be polio free. 
The Committee urges CDC to continue to engage with the WHO to 
address global health issues, including COVID-19, and to 
continue to use its resources to support essential WHO global 
health activities.

                PUBLIC HEALTH PREPAREDNESS AND RESPONSE

 
 
 
Appropriation, fiscal year 2020.......................      $827,200,000
Budget request, fiscal year 2021......................       802,000,000
Committee Recommendation..............................       852,200,000
    Change from enacted level.........................       +25,000,000
    Change from budget request........................       +50,200,000
 

    The Public Health Preparedness and Response (PHPR) account 
supports programs that build and strengthen national 
preparedness for public health emergencies, both naturally-
occurring and intentional. PHPR supports needs assessments, 
response planning, training, epidemiology and surveillance, and 
upgrades for laboratory capacity and communications systems.
    In addition, the Coronavirus Preparedness and Response 
Supplemental Appropriations Act (P.L. 116-123) included 
$950,000,000; the CARES Act (P.L. 116-136) included 
$1,500,000,000 for State, local, Tribal, and Territorial health 
departments. Moreover, the Paycheck Protection Program and 
Health Care Enhancement Act (P.L. 116-139) included 
$10,250,000,000 for diagnostic testing of COVID-19 that was 
distributed to State, local, and Territorial recipients through 
the public health emergency preparedness cooperative agreement.
    Within the total, the Committee recommends the following 
amounts:

------------------------------------------------------------------------
                   Budget Activity                     FY 2021 Committee
------------------------------------------------------------------------
Public Health Emergency Preparedness Cooperative            $700,000,000
 Agreement...........................................
Academic Centers for Public Health Preparedness......          8,200,000
CDC Preparedness and Response........................        144,000,000
------------------------------------------------------------------------

    Agricultural Farmworkers and COVID-19.--The Committee 
recognizes the risks posed by the COVID-19 pandemic to our 
nation's essential farm workforce as they continue to ensure 
the availability of the food supply. The Committee urges the 
CDC to provide technical assistance to State and local health 
departments to ensure that farmworkers are included in any 
category of the workforce that receives priority for COVID-19 
diagnostic testing.
    Public Health Preparedness Cooperative Agreements.--The 
Committee includes an increase of $25,000,000 to enhance 
support to State and local health departments in developing and 
maintaining capable, flexible, and adaptable public health 
systems to rapidly respond in an emergency. The Committee 
encourages CDC to apply a risk-based approach using population 
or other risks when allocating funds to PHEP in order to 
reflect the potential magnitude of illness and death that may 
be anticipated. The Committee recognizes the challenges of 
ensuring adequate response in remote geographical areas, such 
as the Pacific territories, during potential outbreaks and 
encourages CDC improve laboratory capacity in such areas. 
Furthermore, the Committee directs the incorporation of Limited 
English Proficient (LEP) Individuals in emergency planning. The 
Committee requests a report on the steps taken to ensure that 
recipients are conducting outreach to LEP communities in the 
fiscal year 2022 Congressional Justification.
    Strategic National Stockpile.--The Committee recognizes the 
reorganization of the Strategic National Stockpile (SNS) to the 
Office of the Assistant Secretary for Preparedness and 
Response. The Committee expects that CDC will continue its 
significant role in providing scientific expertise in decision-
making related to procurement of countermeasures, and 
maintaining strong relationships with State and local public 
health departments to facilitate efficient deployment of 
countermeasures in public health emergencies.

                        BUILDINGS AND FACILITIES

 
 
 
Appropriation, fiscal year 2020.......................       $25,000,000
Budget request, fiscal year 2021......................        30,000,000
Committee Recommendation..............................        30,000,000
    Change from enacted level.........................        +5,000,000
    Change from budget request........................             - - -
 

    The Committee recommendation includes $30,000,000, an 
increase of $5,000,000, in discretionary budget authority.
    This account supports capital projects as well as repairs 
and improvements to restore, maintain, and improve CDC's assets 
at facilities in seven States and San Juan, Puerto Rico.
    The Committee continues language to allow CDC to retain 
unobligated funds in the Individual Learning Accounts from 
departed employees to support the replacement of the 
underground and surface coal mine safety and health research 
facility.

                CDC-WIDE ACTIVITIES AND PROGRAM SUPPORT

 
 
 
Appropriation, fiscal year 2020.......................      $358,570,000
Budget request, fiscal year 2021......................       155,000,000
Committee Recommendation..............................       358,570,000
    Change from enacted level.........................             - - -
    Change from budget request........................      +203,570,000
 

    The Committee recommendation includes $198,570,000 in 
discretionary funds and $160,000,000 in transfers from the PPH 
Fund.
    This account supports public health leadership and support 
activities at CDC.
    Within the total, the Committee recommends the following 
amounts:

------------------------------------------------------------------------
                   Budget Activity                     FY 2021 Committee
------------------------------------------------------------------------
Preventive Health and Health Services Block Grant....       $160,000,000
Public Health Leadership and Support.................        113,570,000
Infectious Diseases Rapid Response Reserve Fund......         85,000,000
------------------------------------------------------------------------

    Infectious Diseases Rapid Response Reserve Fund.--The 
Committee includes funding within this account for the 
Infectious Diseases Rapid Response Reserve Fund. This funding 
is in addition to the resources provided in the Coronavirus 
Preparedness and Response Supplemental Appropriations Act (P.L. 
116-123) and the CARES Act (P.L. 116-136). As utilized during 
the initial response to COVID-19, the Reserve Fund will provide 
an immediate source of funding to quickly respond to an 
imminent infectious disease crisis that endangers American 
lives. Funds are available until expended.
    Management-Worker Relations.--The Committee urges CDC to 
continue a robust program to support the morale and engagement 
of staff, including addressing management-worker relations and 
ensuring fair, equitable treatment that complies with Federal 
civil rights statutes and standards.
    Prevention and Public Health Fund.--The Committee 
encourages the Prevention and Public Health fund be used for 
programs it was intended to assist, such as cardiovascular/
stroke prevention through Million Hearts.
    Preventive Health and Health Services Block Grant.--The 
Committee continues to support the Preventive Health and Health 
Services Block grant, of which at least $7,000,000 is to 
support direct services to victims of sexual assault and to 
prevent rape.
    Undergraduate Public Health Scholars Program.--The 
Committee encourages CDC to continue engagement of Historically 
Black Colleges and Universities in the CDC Undergraduate Public 
Health Scholars (CUPS) Program.

                     National Institutes of Health


 
 
 
Appropriation, fiscal year 2020.......................   $41,684,000,000
Budget request, fiscal year 2021......................    38,371,491,000
Committee Recommendation..............................    46,959,000,000
    Change from enacted level.........................    +5,275,000,000
    Change from budget request........................    +8,587,509,000
 

    The Committee recommendation for the National Institutes of 
Health (NIH) program level includes $40,617,687,000 in 
discretionary appropriations and $1,341,313,000 in Public 
Health Service Act section 241 evaluation set-aside transfers. 
Within the total appropriation, the Committee recommendation 
includes $404,000,000 in budget authority authorized in the 
21st Century Cures Act (P.L. 114-255). The bill includes an 
increase in discretionary, non-emergency budget authority of 
588,000,000 above the fiscal year 2020 enacted level, which is 
necessary to maintain an overall increase of $500,000,000 while 
compensating for a reduction of $88,000,000 in funding made 
available by the Cures Act.
    In addition, Title VI of this Act includes $5,000,000,000 
in emergency appropriations to NIH, of which not less than 
$2,500,000,000 must be transferred to Institutes and Centers in 
proportion to their share of appropriations in fiscal year 
2020. Each Institute and Center will receive an increase of at 
least 7 percent over the 2020 enacted level. The emergency 
appropriation is further described under Title VI.
    Further, the Coronavirus Preparedness and Response 
Supplemental Appropriations Act included $826,000,000; the 
CARES Act included $945,400,000; and the Paycheck Protection 
Program and Health Care Enhancement Act included $1,806,000,000 
for NIH to support and conduct research on diagnostics, 
therapeutics, and vaccines for COVID-19.
    The mission of NIH is to seek fundamental knowledge about 
the nature and behavior of living systems and the application 
of that knowledge to enhance health, lengthen life, and reduce 
illness and disability. NIH conducts and supports research to 
understand the basic biology of human health and disease; apply 
this understanding towards designing new approaches for 
preventing, diagnosing, and treating disease and disability; 
and ensure that these approaches are widely available.
    The recommendation includes funding for initiatives 
established in the 21st Century Cures Act, including a total of 
$195,000,000 for the Cancer Moonshot Initiative; $500,000,000 
for the ``All of Us'' precision medicine initiative (including 
$109,000,000 from the Cures Act); and $500,000,000 for the 
Brain Research through Application of Innovative 
Neurotechnologies (BRAIN) Initiative (including $100,000,000 
from the Cures Act).
    The Committee includes specific funding allocations for a 
number of initiatives and activities detailed in the Institute- 
and Center-specific sections below.

                    NATIONAL CANCER INSTITUTE (NCI)

 
 
 
Appropriation, fiscal year 2020.......................    $6,440,442,000
Budget request, fiscal year 2021......................     5,881,173,000
Committee Recommendation..............................     6,494,155,000
    Change from enacted level.........................       +53,713,000
    Change from budget request........................      +612,982,000
Committee Recommendation (including Title VI).........     6,908,600,000
    Change from enacted level.........................      +468,158,000
    Change from budget request........................    +1,027,427,000
 

    In addition, the Paycheck Protection Program and Health 
Care Enhancement Act included $306,000,000 for NCI to support 
research related to the COVID-19 pandemic.
    Mission.--NCI leads, conducts, and supports cancer research 
across the nation to advance scientific knowledge and help all 
people live longer, healthier lives.
    Cancer Bioengineering.--The Committee is concerned about 
the high cost of new cancer therapies. A major driver for the 
high cost is that 95 percent of cancer therapies that begin 
Phase I clinical trials fail to secure FDA approval. The 
Committee is encouraged by the scientific advances in cancer 
research generated by the Physical Sciences Oncology Network 
(PSON) and the Cancer Systems Biology Consortium (CSBC) where 
math, physics, and bioengineering approaches have revealed 
novel strategies that may reduce the clinical trial failure 
rate and lower the cost of new cancer therapies. The Committee 
encourages NCI to build upon the success of the PSON and CSBC 
by funding research focused on bioengineering and quantitative 
approaches to basic science and translational oncology.
    Cancer Clinical Trials.--The Committee is concerned that 
only a small percent of patients participate in cancer clinical 
trials, even though most express an interest in clinical 
research; and that ultimately, about one in five cancer 
clinical trials fail because of lack of patient enrollment. 
Groups that are generally underrepresented in clinical trials 
include racial and ethnic minorities and older and lower-income 
individuals as well as those from rural communities. As such, 
the Committee directs the GAO to conduct a review of what 
actions Federal agencies have taken to help to address barriers 
to participate in Federally-funded cancer clinical trials by 
populations that have been traditionally underrepresented in 
such trials, and identify challenges, if any, in implementing 
such actions. In addition, this GAO review should identify 
additional actions that can be taken by Federal agencies to 
address barriers to participation in Federally-funded cancer 
clinical trials by populations that have been traditionally 
underrepresented in such trials and make recommendations on 
potential changes in practices and policies to improve 
participation in such trials by such populations.
    Cancer Immunotherapy.--The Committee recognizes that cancer 
immunotherapies hold enormous promise to cure a number of 
cancers. Patients with certain hematologic malignancies have 
already benefited from the development of chimeric antigen 
receptor T-cell (CAR-T), an immunotherapy. Additional 
innovative and life-saving therapies for different types of 
cancers, some with few treatment options, will only be 
available from additional research in this field. The Committee 
is encouraged by the research NCI has already supported in this 
field, but urges the Institute to continue to prioritize 
research on new immunotherapies. The Committee requests that 
NCI provide an update in the fiscal year 2022 Congressional 
Justification on progress being made in this area and the gaps 
in research that remain.
    Cancer Moonshot.--The Committee directs NIH to transfer 
$195,000,000 from the NIH Innovation Account to NCI to support 
the Cancer Moonshot initiative. These funds were authorized in 
the 21st Century Cures Act (P.L. 114-255).
    Childhood Cancer Data Initiative (CCDI).--The Committee 
includes $50,000,000 for the second year of the CCDI, as 
proposed in the fiscal year 2021 budget request. The 
development of new therapies is important to finding a cure for 
childhood cancers, many of which have not seen new therapies in 
decades.
    Childhood Cancer Survival Metrics.--A recent study 
determined that childhood cancer diagnoses are on the rise by 
approximately 0.8 percent per year. Worldwide, there are 
400,000 new childhood cancer diagnoses annually. However, 
childhood cancer death rates are described as being on the 
decline. The Committee is concerned that the current metric 
used to determine mortality and survival statistics for 
childhood cancer does not fully capture the long-term morbidity 
and mortality of these diseases. Currently, a child or adult 
that lives five years from the date of diagnosis is considered 
a survivor. Yet, children are not small adults and their 
potential life span after diagnosis is much longer than an 
adult. Using the five-year survival metric does not capture 
children who die prematurely as a result of their cancer or its 
treatment when they are past the five-year point. The Committee 
directs NCI to establish a task force composed of childhood 
cancer researchers and advocates to determine the most 
appropriate survivorship metric for childhood cancer. In 
addition, the Committee recognizes a critical goal of the CCDI 
is to collect comprehensive data about every child diagnosed 
with cancer in the U.S., including data on survival and 
mortality, such as death due to late effects of cancer and its 
treatment. The Committee requests an update from NCI in the 
fiscal year 2022 Congressional Justification focusing on how 
CCDI efforts will address this need to more accurately capture 
childhood cancer mortality beyond the current five-year 
survival metric.
    Deadliest Cancers.--The Committee looks forward to seeing 
NCI's update on developing scientific frameworks for stomach 
and esophageal cancers as well as ways in which it is 
supporting research into all recalcitrant cancers, as directed 
in House Report 116-62. Further, the Committee notes that the 
Recalcitrant Cancer Research Act of 2012 directed NCI to 
develop a scientific framework for at least two cancer types 
that meet the definition of recalcitrant cancers as defined in 
the Act. The Committee directs NCI to outline other specific 
steps the NCI is taking to support research that aims to reduce 
the burden of disease from pancreatic, non-small cell lung, 
stomach, and esophageal cancers in the fiscal year 2022 
Congressional Justification.
    Endometrial Cancer.--The Committee is concerned that both 
the incidence and mortality rates for endometrial cancer are 
rising, with a survival disparity for Black women. The 
Committee believes that a renewed emphasis by NCI on 
endometrial cancer research is needed to facilitate early 
detection and optimal treatments and outcomes for all women, 
including minority populations. The Committee urges NCI to 
study endometrial cancer disparities, including biologic 
differences in tumor type, molecular mechanisms, pathogenesis, 
and tumor microenvironment, and to conduct clinical trials to 
better define appropriate therapy for a precision medicine 
approach to endometrial cancer. The Committee requests an 
update on NCI's activities regarding endometrial cancer in the 
fiscal year 2022 Congressional Justification, including 
progress made in incidence and survival rates by ethnicity.
    Glioblastoma (GBM).--The Committee recognizes that GBM is 
the most common, most deadly, and most difficult form of brain 
cancer to treat in adults. For the thousands of Americans 
facing this disease, the lack of progress is a devastating 
reality that trails behind the impressive progress made in 
research of other forms of cancer. The Committee strongly 
encourages NIH to support additional research on glioblastoma 
treatment.
    HPV Associated Cancers.--The Committee encourages NCI to 
expand research related to HPV-associated cancers.
    Kidney Cancer.--The Committee is concerned with the growing 
number of kidney cancer diagnoses and lack of early detection 
of the disease. The Committee encourages NCI to continue to 
prioritize meritorious research that could assist in developing 
diagnostic tests and early detection techniques.
    Liver Cancer.--The Committee notes that liver cancer is a 
devastating disease, with a five-year survival rate of only 20 
percent. The Committee commends NCI for the creation of a 
Specialized Center of Research Excellence (SPORE) focused on 
liver cancer and encourages other new program projects, 
research, and contract opportunities for investigators that 
focus on a better understanding of the biology of liver cancer 
and new therapeutic targets. In addition, the Committee 
commends NCI for its support of the inter-institute effort to 
develop the NIH Strategic Plan to Cure Hepatitis B and 
encourages continued close collaboration with the National 
Institute of Allergy and Infectious Diseases (NIAID) and the 
National Institute of Diabetes and Digestive and Kidney 
Diseases (NIDDK) and active participation in the Director's 
Trans-NIH Hepatitis B Working Group. The Committee requests an 
update on NCI's activities in these areas in the fiscal year 
2022 Congressional Justification.
    Melanoma.--The Committee encourages NCI to continue its 
support of research on melanoma, including the development of 
experimental models to identify mechanisms and associated 
biomarkers, new technologies such as artificial intelligence 
systems for detection and classification, and clinical trials 
that provide population-based evidence for public health 
guidelines for screening and sun protection practices. In 
addition, the Committee encourages research on therapies for 
metastatic melanoma, including CNS, LMD, uveal, mucosal and 
pediatric melanomas; neoadjuvant therapies in trials designed 
to test for clinical benefit; and risk factors for recurrence. 
The Committee also urges NCI to continue to evaluate clinical 
trial eligibility criteria so that patients with brain 
metastases can also be included in trials whenever clinically 
appropriate and urges inclusion of melanoma in enhancements to 
the SEER registry. Finally, in the U.S., there are now more 
than 1.3 million survivors of melanoma. The Committee 
encourages further research into survivorship care for melanoma 
patients. The Committee requests an update on these requests in 
the fiscal year 2022 Congressional Justification.
    Pancreatic Cancer.--The Committee appreciates NCI's recent 
submissions of the five-year review and update reports required 
by the Recalcitrant Cancer Research Act of 2012. This year, the 
Committee looks forward to the report on the effectiveness of 
the framework, including an update on research efforts in 
pancreatic cancer prevention, detection, diagnosis, and 
treatment. While progress has been made, the Committee 
encourages NCI to continue to support research efforts to 
advance discoveries and improve treatment options for patients 
diagnosed with pancreatic cancer.
    Partnerships to Advance Cancer Health Equity (PACHE) 
Program.--The Committee encourages NCI to expand support for 
the PACHE program, which aims to create stable, comprehensive, 
and long-term partnerships between institutions serving 
underserved health disparity populations and underrepresented 
students (ISUPS) and NCI-designated Cancer Centers (CCs) in the 
areas of cancer research, cancer research education, and cancer 
outreach. The Committee encourages NCI to prioritize funding to 
States and territories in the Pacific Region, where, according 
to the National Center for Biotechnology Information, 
sociocultural, geographic, and biologic factors contribute to 
cancer health disparities in indigenous Pacific peoples (IPPs) 
in Guam, Hawaii, and the U.S. Associated Pacific Islands 
(USAPI), and IPPs experience a greater burden of cancer health 
disparities that are associated with late-stage diagnosis and 
poor survival outcomes compared with majority populations in 
the U.S.
    Pediatric Brain Cancer.--The Committee recognizes that 
brain cancer remains the most fatal of all pediatric cancers. 
Despite progress in other diseases, pediatric brain cancer 
survival rates have not improved for decades and have lagged 
behind the strides made in other cancers. The majority of 
children who survive may experience lifelong impairments and 
disabilities that result from high levels of toxicity 
associated with treatment. The Committee strongly encourages 
NIH to expand funding on research on pediatric brain cancer, 
including but not limited to drug delivery methods and new 
therapies with reduced levels of toxicity and long-term 
complications.
    Prostate Cancer.--The Committee remains concerned that 
prostate cancer lacks treatments for men with advanced disease 
as well as adequate diagnostic and imaging methodologies. To 
ensure Federal resources are leveraged to the greatest extent 
possible, the Committee encourages NCI to coordinate, when 
appropriate, its research efforts with other Federal agencies, 
including the Department of Defense, as well as private 
research foundations and advocacy groups.
    Rare Cancers Therapeutics Research and Development.-- Rare 
cancers, defined at those cancers that have fewer than six new 
cases per 100,000 Americans per year, represent over 30 percent 
of all cancers. Rare cancers present a unique research 
challenges for many reasons, including the difficulty in 
accruing enough patients to participate in clinical trials, the 
lack of industry focus on these cancers due to the relatively 
small number of patients diagnosed with each cancer, the lack 
of rare cancer tumor models and cell lines, and the difficulty 
of patients receiving accurate and precise diagnoses due in 
part to the lack of clinician familiarity with rare cancers. 
The Committee commends NCI's investment in the Rare Tumor 
Patient Engagement Networks, including NCI CONNECT and MyPART, 
and in particular the NCI Experimental Therapeutics Program, 
with a focus on supporting the most promising new drug 
discovery and development projects. The Committee encourages 
NCI to expand these initiatives to include additional rare 
cancers not covered in prior and existing efforts and to issue 
a report on this progress and an update on the DART study in 
the fiscal year 2022 Congressional Justification.
    Reducing Native American Cancer Disparities.--The Committee 
encourages NCI to expand research efforts to reduce Native 
American cancer disparities, including through NCI's continued 
participation in the trans-NIH Intervention Research to Improve 
Native American Health (IRINAH) program. The Committee notes 
that the Native American population experiences an overall 
cancer incidence and mortality rates which are much higher than 
non-Native populations. The goal of intensifying research in 
this area is to develop durable capacity for tribally-engaged 
cancer disparities research through an integrated program of 
research, education, outreach, and clinical access.
    Surveillance, Epidemiology, and End Results (SEER) Program 
Registry.-- The SEER Program is an authoritative source of 
information on cancer incidence and survival in the U.S. SEER 
currently collects and publishes cancer incidence and survival 
data from population-based cancer registries covering 
approximately 34.6 percent of the U.S. population. The 
Committee encourages NCI to continue to advance efforts to 
modernize the SEER Registry and better capture key data points, 
such as metastatic recurrence and cancer migration. The 
Committee requests an update on plans to cover more of the U.S. 
population in the fiscal year 2022 Congressional Justification.
    Specialized Programs of Research Excellence (SPOREs).--The 
SPORE program is a key component of NCI's efforts to translate 
basic research into the prevention, early detection, diagnosis, 
and treatment of cancer. The Committee commends NCI for its 
recent funding opportunity announcement regarding the 
development of SPOREs that are focused on cancer health 
disparities, and it encourages additional research in this 
area. The Committee urges NCI to prioritize the use of multi-
center SPOREs, which allow greater opportunities for 
collaborative, interdisciplinary research.
    STAR Act.--The Committee includes no less than $25,000,000, 
the same as the fiscal year 2020 enacted level, for continued 
implementation of sections of the Childhood Cancer 
Survivorship, Treatment, Access, and Research (STAR) Act to 
expand existing biorepositories for childhood cancer patients 
enrolled in NCI-sponsored clinical trials to collect and 
maintain relevant clinical, biological, and demographic 
information on children, adolescents, and young adults, with an 
emphasis on selected cancer subtypes (and their recurrences) 
for which current treatments are least effective. Funding 
provided this year will allow NCI to continue to conduct and 
support childhood cancer survivorship research as authorized in 
the STAR Act.
    Women and Lung Cancer.--The Committee notes that lung 
cancer has a disparate impact on women, particularly younger 
women who have never smoked. Additional research strategies are 
needed to explore the differences in women with respect to lung 
cancer risk factors, incidence, and histology. The Committee 
urges NCI to accelerate research into treatments and 
implementation of lung cancer preventive services for women. 
The Committee requests an update on these activities in fiscal 
year 2022 Congressional Justification.

           NATIONAL HEART, LUNG, AND BLOOD INSTITUTE (NHLBI)

 
 
 
Appropriation, fiscal year 2020.......................    $3,624,258,000
Budget request, fiscal year 2021......................     3,298,004,000
Committee Recommendation..............................     3,655,428,000
    Change from enacted level.........................       +31,170,000
    Change from budget request........................      +357,424,000
Committee Recommendation (including Title VI).........     3,888,652,000
    Change from enacted level.........................      +264,394,000
    Change from budget request........................      +590,648,000
 

    In addition, the CARES Act included $103,400,000 for NHLBI 
to support and conduct research related to the COVID-19 
pandemic.
    Mission.--NHLBI provides global leadership for a research, 
training, and education program to promote the prevention and 
treatment of heart, lung, and blood disorders and enhance the 
health of all individuals so that they can live longer and more 
fulfilling lives.
    Blood Donor Questionnaire Education Materials.--The 
Committee is concerned that certain FDA guidance in the 
educational materials provided in the blood donor questionnaire 
is inappropriate and misguided. The recommendations for 
deferral should not mention someone's sexual orientation, and 
rather should focus on risk factors that might expose a 
potential donor to blood-borne illness. The Committee strongly 
recommends that NHLBI work with the FDA and remove or replace 
the recommended deferment of blood for men who have had sex 
with men in the last 12 months.
    Cardiovascular Disease.--The Committee remains concerned 
about the prevalence of cardiovascular disease among Americans 
and encourages ongoing support for basic research programs to 
evaluate the damaging effects of smoking. Such research could 
help mitigate the risk of heart attack and stroke related to 
smoking and should also include better infrastructure to gather 
data on damaged endothelial cells in order to identify 
abnormalities caused by smoking, biomarkers of early disease, 
and personalized therapies to promote blood vessel healing. The 
Committee encourages NIH to support research to be conducted 
across the disciplines of medicine, immunology, imaging, 
chemistry, biomedical engineering, physics, statistics, 
mathematics, and entrepreneurship to design new therapies and 
therapy delivery systems and strategies that are safer and more 
effective and improve patient compliance, while seeking to move 
technologies from bench to bedside with private partners and 
local health care and community organizations.
    Familial Hypercholesterolemia (FH).--The Committee 
recognizes the value that well-characterized, longitudinal, 
population-based cohort studies provide in bringing to light 
more information about cardiovascular disease progression in 
FH. By studying participants over time, much can be learned 
about the development of cardiovascular disease that will help 
scientists understand the role of environmental and genetic 
factors in disease development and progression. The Committee 
urges NHLBI to fund efforts to continue the study into the 
development and progression of cardiovascular disease caused by 
FH, the effect of treatment on patient outcomes, and effective 
ways to identify individuals with FH and their affected family 
members early in life.
    G Protein-Coupled Receptors (GPCRs).--The Committee 
recognizes that recent developments in multiple basic sciences 
(structural biology, molecular modeling, receptor biology, and 
pharmacology) have greatly accelerated the rate of discovery of 
drugs that GPCRs, the largest and most readily and frequently 
targeted protein family in the human genome. The rate of 
discovery now strains the ability of academic laboratories to 
test, in a timely manner, the efficacy of these drugs in 
physiologically and disease-relevant systems. Cardiovascular, 
lung, and blood diseases remain among the most important and 
costly diseases that would benefit from a new generation of 
drugs. The Committee encourages NHLBI to develop additional 
funding mechanisms enabling academic laboratories, as both 
singular and networked or collaborative entities, to accelerate 
the pace of pre-clinical development of GPCR-targeting drugs.
    Heart Disease.--Heart disease continues to be the leading 
cause of death in the U.S., claiming hundreds of thousands of 
lives and costing billions of dollars every year. The Committee 
is concerned that this largely preventable disease 
disproportionately affects racial and ethnic minorities and 
those living in rural communities and supports ongoing 
population studies that seek to address these disparities. The 
Committee is concerned that heart disease is the leading cause 
of death of pregnant women and that one in five American women 
experience some type of cardiovascular complication during 
pregnancy. The Committee supports the NHLBI's Strategic Vision 
Objective to address maternal health and reduce the risk of 
cardiovascular disease for women before, during, and after 
pregnancy. The Committee also supports continued research 
addressing congenital heart disease, the acceleration of 
research in regenerative medicine, further investments in data 
science that will help facilitate precision medicine, and 
continued genetic research related to heart disease, including 
heart failure and atrial fibrillation (AFib). The Committee 
also commends the Institute for initiating research that seeks 
to address the health-related effects of e-cigarette use and 
vaping.
    Lymphedema (LE).--LE is a chronic, debilitating, and 
incurable swelling that can be a result of damage to the 
lymphatic system due to surgery, cancer treatment, or injury, 
and that can also be inherited. An estimated 10 million 
Americans suffer from lymphedema. Additional research is 
necessary to improve our understanding of this condition and 
expand the treatment options available. The Committee strongly 
encourages NHLBI to expand support for research on LE and 
requests a report within 120 days of enactment of this Act 
describing NHLBI's current and planned research related to LE.
    National Center on Sleep Disorders Research (NCSDR).--The 
Committee commends the ongoing work of NCSDR to reinvigorate 
sleep, circadian, and sleep disorders research activities 
across the government, and notes impactful new projects through 
the HEAL Initiative and studying the relationship between sleep 
and stroke. The Committee encourages NCSDR to continue to build 
meaningful partnerships across Federal agencies and further 
coordinate research in this area.
    National Chronic Obstructive Pulmonary Disease (COPD) 
Action Plan.--The Committee notes NHLBI's role in crafting the 
National COPD Action Plan and encourages NHLBI to continue this 
important work by supporting additional research activities and 
collaborating with other Public Health Service agencies to 
facilitate implementation of the plan's recommendations.
    Postural Orthostatic Tachycardia Syndrome (POTS).--The 
Committee is disappointed in NIH's disregard for Congressional 
direction in the recent NIH report Postural Orthostatic 
Tachycardia Syndrome (POTS): State of the Science, Clinical 
Care, and Research, which was requested in Senate Report 115-
289 and submitted to the Committee on January 31, 2020. NIH 
appears to have ignored the symposium participants' 
recommendations and failed to provide the requested estimate of 
the level of funding needed annually to achieve the objectives 
specified in Senate Report 115-289. The Committee directs NIH 
to: (1) update the January 31, 2020 report with recommendations 
from the POTS experts and submit a revised report to the 
Committee within 30 days of enactment of this Act, (2) 
implement the research priorities described in the January 31, 
2020 report supplemented with recommendations from the POTS 
experts, including a funding estimate, and (3) provide a 
progress update to the Committee within 90 days of enactment of 
this Act documenting progress towards identifying priority 
areas of focus for future POTS research.
    Pulmonary Fibrosis (PF).--The Committee recognizes that PF 
is a family of more than 200 different lung diseases that all 
look very much alike despite having a variety of causes. This 
heterogeneity presents significant challenges for diagnosis and 
treatment. The Committee commends NHLBI for its recent efforts 
to apply the principles of precision medicine to PF research, 
especially by funding a major new study that will evaluate a 
promising treatment for a subset of patients with a particular 
gene variant. This study, known as PRECISIONS, also aims to 
identify genetic variants that play a role in certain forms of 
PF. The Committee urges NHLBI to prioritize basic research on 
PF, particularly to better understand the causes and process of 
scarring and the varying impacts on patients.
    Sickle Cell Disease (SCD).--The Committee commends NIH for 
its ongoing support of clinical research for SCD, which imposes 
major morbidity on an estimated 90,000 to 100,000 individuals 
in the U.S., with three million Americans carrying the sickle 
cell trait. The Committee encourages NIH to support clinical 
trials for prenatal and postnatal treatment of SCD, which 
includes multiple promising approaches to eradicate this 
disease, save lives, and dramatically reduce the substantial 
health care costs associated with SCD for children and adults. 
The Committee encourages NIH to consider programs both 
domestically and globally to evaluate the effectiveness of 
screening technologies for infants and children with the sickle 
cell trait and disease. Further, while the Committee is aware 
that NHLBI is funding very promising areas of innovation 
related to curative gene therapies, the Committee strongly 
encourages NHLBI to increase its focus as well on disease-
modifying therapies that could improve day-to-day care for the 
vast majority of patients and address issues such as organ 
damage and pain management. Lastly, the Committee encourages 
NHLBI to fund the training of more sickle cell disease 
clinicians and researchers in order to maintain this essential 
workforce pipeline and to make advances on the transition from 
childhood medical care to adult.
    Thalassemia.--Recent studies have shown that the length of 
time between when blood is donated and transfused does not 
impact outcomes for patients in need of an emergency blood 
transfusion. However, these studies do not determine the impact 
on chronically-transfused patients, such as those with 
thalassemia, in which an administration of older red cells may 
exacerbate iron loading and contribute to worse outcomes. The 
Committee urges NHLBI to review the scientific literature on 
this issue and provide an update in the fiscal year 2022 
Congressional Justification on the best way to address this 
public health issue.
    The Heart Truth Program.--For over a decade, The Heart 
Truth program has worked to raise awareness about women's risk 
of heart disease. The program's goals are to increase awareness 
that heart disease is the leading cause of death among women 
and to increase the conversations between women and their 
healthcare providers. The Committee encourages NHLBI to 
continue robust support for The Heart Truth program.

     NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL RESEARCH (NIDCR)

 
 
 
Appropriation, fiscal year 2020.......................      $477,429,000
Budget request, fiscal year 2021......................       434,559,000
Committee Recommendation..............................       481,535,000
    Change from enacted level.........................        +4,106,000
    Change from budget request........................       +46,976,000
Committee Recommendation (including Title VI).........       512,258,000
    Change from enacted level.........................       +34,829,000
    Change from budget request........................       +77,699,000
 

    Mission.--The mission of NIDCR is to improve dental, oral, 
and craniofacial health through research, research training, 
and the dissemination of health information.
    Oral Microbiome.--The Committee appreciates NIDCR's 
leadership in microbiome research, including its support of the 
Human Oral Microbiome Database. The Committee encourages NIDCR 
to build upon its microbiome research to discover and better 
understand the microbiome's connection to overall health, 
including its influence on preventing and treating illness and 
disease.
    Regenerative Medicine.--The Committee appreciates NIDCR's 
contributions to the field of regenerative medicine and 
recognizes the promise this field holds for people across the 
country, including but not limited to members of the military. 
The Committee urges NIDCR to continue supporting its already 
robust regenerative medicine research portfolio and dedicate 
resources into promising research in this space, including 
autotherapies research.
    Surgeon General's Report on Oral Health.--The Committee 
greatly appreciates NIDCR's contributions to the U.S. Surgeon 
General's 2020 Report on Oral Health. The Committee encourages 
NIDCR to utilize the findings of the 2020 Report to identify 
research gaps across dental, oral, and craniofacial research 
and pursue research opportunities to fill those gaps.

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

 
 
 
Appropriation, fiscal year 2020.......................    $2,114,314,000
Budget request, fiscal year 2021......................     1,924,211,000
Committee Recommendation..............................     2,132,498,000
    Change from enacted level.........................       +18,184,000
    Change from budget request........................      +208,287,000
Committee Recommendation (including Title VI).........     2,268,556,000
    Change from enacted level.........................      +154,242,000
    Change from budget request........................      +344,345,000
 

    Mission.--The NIDDK mission is to conduct and support 
medical research and research training and disseminate science-
based information on diabetes and other endocrine and metabolic 
diseases; digestive diseases, nutritional disorders, and 
obesity; and kidney, urologic, and hematologic diseases, to 
improve people's health and quality of life.
    End-Stage Renal Disease (ESRD).--The Committee notes the 
work in supporting critical kidney research that NIDDK has 
accomplished, including research on ESRD. This research has led 
to new developments for possible treatments and the Committee 
continues to encourage NIDDK to work with stakeholders to 
facilitate new opportunities for research.
    Functional Gastrointestinal Disorders.--The Committee 
encourages NIH to continue to invest in research on functional 
gastrointestinal disorders, including to expand, intensify, and 
coordinate the activities of NIH with respect to functional 
gastrointestinal and motility disorders in line with the 
recommendations of the National Commission on Digestive 
Diseases relating to functional gastrointestinal and motility 
disorders (FGIMDs). Further, the Committee urges NIH to enhance 
innovative basic, translational, and clinical research focused 
on FGIMDs.
    Gastroesophageal Reflux Disease (GERD).--The Committee 
recognizes that GERD is the most common gastrointestinal (GI) 
diagnosis and can lead to a variety of other GI diseases. The 
Committee is concerned about risks associated with 
pharmacological treatments of GERD while surgical approaches 
remain too invasive to most patients. The Committee directs 
NIDDK to submit a report to the Committee within 120 days of 
enactment of this Act on the current research done on non-
pharmacological, non-surgical treatments for GERD, such as 
injectable bulking agents. The Committee encourages NIDDK to 
prioritize the bulking agents that were FDA-approved for non-GI 
indications and show promise in the treatment of GERD.
    Glomerular Diseases.--The Committee continues to support 
the important work that the Cure Glomeruloneuropathy (CureGN) 
initiative has accomplished that has led to breakthroughs for 
critical clinical trials. The Committee encourages NIDDK to 
continue supporting research that has proven to lead to new 
therapies.
    Inflammatory Bowel Diseases (IBD).--The Committee 
recognizes NIDDK's leadership in supporting research into 
Crohn's disease and ulcerative colitis. The Committee also 
recognizes the importance of patient-centered, bedside-to-bench 
approaches to understand complex, chronic diseases such as IBD, 
and the need to better understand the impact of diet on IBD. 
The Committee directs NIDDK to pursue research on the 
interactions among food, the gut, and the brain/nervous system 
in people with IBD and other chronic gastrointestinal diseases. 
The Committee notes that this bedside-to-bench approach has 
been successful in other disease areas, including type 2 
diabetes and oncology, and we encourage NIDDK to use a similar 
approach focused on IBD.
    Pediatric Nephrology.--The Committee recognizes the 
importance of research funded by NIDDK to develop the 
infrastructure required to enhance biomedical research focused 
on advancing innovations in kidney care, including research on 
pediatric kidney injury and disease. The Committee has raised 
concerns about the lack of clinical trials in pediatric 
nephrology. One way to address this problem is to ensure there 
is a robust training pipeline for the pediatric nephrology 
biomedical research workforce. The Committee encourages NIDDK 
to prioritize mechanisms to incentivize researchers to enter 
this field. The Committee requests that NIDDK report back in 
the fiscal year 2022 Congressional Justification on the 
progress made to bolster this biomedical workforce, including 
opportunities so that young investigators may be further 
encouraged to explore research in this space.
    Polycystic Kidney Disease.--The Committee commends NIDDK 
for its continued commitment to Polycystic Kidney Disease 
Research and Translation Centers and the Pediatric Centers of 
Excellence in Nephrology, which improve our understanding of 
the causes of autosomal dominant polycystic kidney disease and 
autosomal recessive polycystic kidney disease. The Committee 
continues to encourage NIDDK to work with stakeholders to 
facilitate new opportunities for research and promote the 
development of new therapeutic strategies.

    NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE (NINDS)

 
 
 
Appropriation, fiscal year 2020.......................    $2,444,687,000
Budget request, fiscal year 2021......................     2,245,110,000
Committee Recommendation..............................     2,465,110,000
    Change from enacted level.........................       +40,423,000
    Change from budget request........................      +220,000,000
Committee Recommendation (including Title VI).........     2,622,427,000
    Change from enacted level.........................      +177,740,000
    Change from budget request........................      +377,317,000
 

    Mission.--The NINDS mission is to seek fundamental 
knowledge about the brain and nervous system and use that 
knowledge to reduce the burden of neurological disease.
    Amyotrophic Lateral Sclerosis (ALS).--To leverage the work 
done thus far in a meaningful way and make measurable progress 
towards a cure for ALS patients, the Committee encourages NIH 
to bring together researchers to capitalize on recent 
advancements, augment existing efforts by bringing into the 
fight against ALS leading researchers from other, more 
developed disciplines, and expedite the drive towards a cure 
for ALS. The Committee encourages NIH to incentivize the 
continued exploration of novel therapeutic pathways and support 
additional clinical trials, increasing the likelihood that the 
progress of the last decade can germinate into cures with the 
next decade.
    Brain Aneurysm.--The Committee continues to be concerned 
that an estimated one out of 50 individuals in the U.S. has a 
brain aneurysm, and an estimated 30,000 Americans suffer from a 
brain aneurysm rupture each year. The Committee is concerned 
that not enough research is focused on prevention of brain 
aneurysm ruptures and urges NINDS to increase research on 
preventing brain aneurysm ruptures.
    BRAIN Initiative.--The Committee directs NIH to transfer 
$50,000,000 from the NIH Innovation Account to NINDS to support 
the BRAIN Initiative. These funds were authorized in the 21st 
Century Cures Act (P.L. 114-255). This collaborative effort is 
revolutionizing the understanding of how neural components and 
their dynamic interactions result in complex behaviors, 
cognition, and disease, while accelerating the development of 
transformative tools to explore the brain in unprecedented 
ways, making information previously beyond reach accessible. To 
achieve this goal, two specific projects outlined in a recent 
BRAIN 2.0 Initiative Advisory Committee report stand out for 
their importance to human health and technical viability: the 
Human Brain Cell Atlas and the Human Brain Projectome. Both 
projects are separate transformative projects that will 
culminate in a body of data that will provide the clearest view 
possible of the human brain. To be successful, these projects 
will require a focused, large-scale effort with 
multidisciplinary teams with open platforms for dissemination 
of the tools and knowledge realized. The Committee requests an 
update on this effort in the fiscal year 2022 Congressional 
Justification.
    Chronic Fatigue Syndrome (ME/CFS).--The Committee commends 
NIH on its ongoing ME/CFS efforts, including the unanimous 
adoption of the National Advisory Neurological Disorders and 
Stroke (NANDS) Council Working Group by the full NANDS Council, 
the Thinking the Future: A Workshop for Young/Early Career ME/
CFS Investigators workshop, and the continued investment in the 
Collaborative Research Centers (CRC) Consortium. The Committee 
remains concerned that these initiatives are not making 
progress fast enough to meet the urgent needs of millions of 
American adults and children suffering with ME/CFS today. The 
Committee encourages NIH to accelerate and expand efforts for 
ME/CFS; such as: (1) accelerating the progress of the NIH ME/
CFS Intramural Study by publishing and sharing data, (2) 
issuing new ME/CFS disease specific funding announcements, (3) 
coordinating an initiative to develop an interagency consensus 
on the selection criteria for study participants involved in 
ME/CFS research, and (4) implementing mechanisms to incentivize 
new and early career researchers to enter and contribute data 
to the ME/CFS scientific field.
    Duchenne Muscular Dystrophy.--Duchenne muscular dystrophy 
is a severe type of muscular dystrophy for which there is no 
cure and for which the average life expectancy is in the second 
decade. The Committee strongly encourages NIH to significantly 
expand its support for research on Duchenne muscular dystrophy, 
particularly accelerating and optimizing the clinical trial 
process through novel and innovative trial designs, such as 
platform trials, which might serve as a model for other rare 
diseases communities. The Committee also urges NIH to support 
methodological research on challenges, such as redosing, 
manufacturing supply, and potential immune response, associated 
with the advent of gene therapies for rare diseases such as 
Duchenne.
    Dystonia.--The Committee notes the recommendations from the 
conference on dystonia held by NINDS to revitalize the dystonia 
research portfolio were recently released. The Committee 
requests an update in the fiscal year 2022 Congressional 
Justification on the release of the recommendations and new 
research and therapeutic needs that the conference identified. 
The Committee encourages NINDS to work with other dystonia 
research related Institutes such as the National Institute on 
Deafness and Other Communication Disorders (NIDCD) and the 
National Eye Institute (NEI) on research that will lead to a 
better understanding of dystonia etiology and evaluation of the 
current status of translational research that may lead to more 
treatment options for those affected by dystonia.
    Expanded Access for ALS Treatment.--The Committee supports 
efforts to expand access for neurodegenerative diseases with no 
disease modifying treatments. The Committee encourages NINDS to 
collaborate with stakeholders to expand access for patients 
through clinical trials.
    Headache Disorders.--The Committee strongly urges NINDS to 
consider funding applications on fundamental, translational, 
and clinical research on headache disorders, including 
migraine, post-traumatic headache, the trigeminal autonomic 
cephalalgias, and intracranial hypo/hypertension, that align 
with the HEAL Initiative's goal to achieve rapid and long-
lasting solutions to the opioid crisis.
    Multiple Sclerosis (MS).--The Committee encourages NINDS to 
prioritize studies that develop the medical understanding of 
the progression of MS and advance research on prevention 
strategies, treatments, and cures for MS.
    Muscular Dystrophy.--The Committee is aware of the Eunice 
Kennedy Shriver National Institute of Child Health and Human 
Development's (NICHD's) Data and Specimen Hub (DASH) project to 
create a centralized resource to store and access de-identified 
data from NICHD-supported studies. The Committee encourages 
NINDS to work with NICHD to explore utilizing the DASH site for 
NINDS studies.
    Myotonic Dystrophy.--The Committee recognizes there are 
significant opportunities to advance the science regarding the 
causes of myotonic dystrophy, a serious degenerative genetic 
condition, and support current efforts to develop the first 
ever FDA-approved treatment for this inherited genetic 
disorder. The Committee directs NIH to prioritize the 
recruitment of young researchers to this field to grow the 
number of high-quality research proposals submitted for peer 
review as these efforts hold significant promise for major 
advances across many neurodegenerative diseases, particularly 
other triplet repeat expansion diseases. The Committee requests 
an update on these activities in the fiscal year 2022 
Congressional Justification.
    Opioids.--The Committee continues to support the HEAL 
(Helping to End Addiction Long-Term) Initiative, a trans-NIH 
effort to speed scientific solutions to stem the national 
opioid public health crisis. This initiative builds on 
extensive, well-established NIH research, including basic 
science of the complex neurological pathways involved in pain 
and addiction, implementation of science to develop and test 
treatment models, and research to integrate behavioral 
interventions with medication-assisted treatment for opioid use 
disorder. The Committee includes no less than the fiscal year 
2020 enacted level of $266,300,000 within NINDS for this 
research.
    Peripheral Neuropathies.--The Committee notes the continued 
progress of ongoing research into Guillain-Barre syndrome 
(GBS), chronic inflammatory demyelinating polyneuropathy 
(CIDP), and related conditions. The Committee encourages NINDS 
to continue its work with NIAID and stakeholders on a state of 
the science conference on evolving research and scientific 
mechanisms.
    Sleep Disorders.--The Committee notes the leadership of 
NINDS in advancing research into under-represented sleep 
disorders, such as narcolepsy and restless leg syndrome, and 
encourages NINDS to bolster these activities and pursue 
initiatives that advance scientific understanding of specific 
sleep disorders impacting patients.
    Stroke.--Despite remarkable progress to reduce the stroke 
mortality rate, it is still the most common cause of severe 
long-term disability. The Committee supports continued research 
to improve the scientific understanding of stroke and clinical 
trials that are developing new treatments and improved 
approaches to stroke recovery and rehabilitation through the 
NIH-funded clinical trials network StrokeNet. The Committee 
supports continued stroke-related research conducted through 
the BRAIN Initiative that seeks to discover how brain circuits 
rewire themselves to repair damage that occurs during a stroke 
and that may lead to effective treatments to mitigate this 
damage in the future. Understanding that stroke is a largely 
preventable disorder, the Committee supports ongoing population 
studies that seek to reveal the reasons for stroke disparities 
found in communities, especially in rural States in the stroke 
belt. The Committee further supports additional research 
exploring how, and the extent to which, the accumulation of 
white matter lesions in the brain are related to stroke and 
dementia and urges continued collaborative research among NIH 
Institutes related to vascular dementia.
    Traumatic Brain Injury (TBI) Mitigation.--The Committee 
understands that research on regenerative medicine and 
neuroplasticity, including the use of adult stem cells and 
neuroplasticity, may play an important role in developing 
treatments and identifying therapeutic targets for 
neuroprotection pre/post TBI. The Committee urges NINDS to work 
with all relevant Institutes and Centers, including NIA, to 
support a robust and coordinated portfolio of TBI research that 
explores all promising avenues to facilitate functional repair 
of damaged circuitry in TBI. Such analysis should include 
research on regenerative medicine and neuroplasticity, 
inclusive to preventative approaches in reducing risk or to 
eliminate vulnerabilities from a TBI. A potential mitigation 
approach is to develop interventions that protect from the 
delayed effects of TBI and associated pathology before they 
occur. The Committee directs NINDS to provide an update 
regarding these specific areas of TBI research in the fiscal 
year 2022 Congressional Justification.

     NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES (NIAID)

 
 
 
Appropriation, fiscal year 2020.......................    $5,885,470,000
Budget request, fiscal year 2021......................     5,445,886,000
Committee Recommendation..............................     6,013,087,000
    Change from enacted level.........................      +127,617,000
    Change from budget request........................      +567,201,000
Committee Recommendation (including Title VI).........     6,391,821,000
    Change from enacted level.........................      +506,351,000
    Change from budget request........................      +945,935,000
 

    In addition, the Coronavirus Preparedness and Response 
Supplemental Appropriations Act included $826,000,000 and the 
CARES Act included $706,000,000 for NIAID to conduct and 
support research to develop diagnostics, therapeutics, and 
vaccines for COVID-19.
    Mission.--The NIAID mission is to conduct and support basic 
and applied research to better understand, treat, and 
ultimately prevent infectious, immunologic, and allergic 
diseases.
    Autoimmune Neuropathies.--The Committee is pleased at the 
progress between NIAID and NINDS on a state-of-the-science 
conference on autoimmune neuropathies research into conditions 
like Guillain-Barre syndrome and chronic inflammatory 
demyelinating polyneuropathy. The Committee continues to 
encourage both Institutes to continue their work with patient 
stakeholders on this important conference.
    Biodefense and Emerging Infectious Diseases.--The Committee 
recognizes the threat of emerging infectious diseases from bats 
and urges NIAID to fund research into the immunological basis 
for persistence and clearance of emerging infections; defining 
common features that underlie emerging infectious disease 
syndromes, such as viral hemorrhagic fever and severe acute 
respiratory distress; and clarifying mechanisms that facilitate 
transmission of zoonotic pathogens from reservoir hosts (e.g. 
bats) to humans. The Committee supports the ongoing work of the 
National Biocontainment Laboratories (NBLs) as a national 
resource. Given the ongoing threat of emerging infectious 
diseases, such as the 2019 novel coronavirus that causes the 
disease COVID-19, the Committee encourages NIAID to expand its 
research infrastructure and facilities to include additional 
existing BSL 4 labs to conduct research that will facilitate 
the development of next generation therapeutics, diagnostics 
and vaccines for infectious diseases.
    Celiac Disease.--The Committee supports NIH research on 
celiac disease, including the autoimmune causation underpinning 
the affliction. Today, the only known treatment for this 
disease is a gluten-free diet, but recent research reveals that 
this strategy is insufficient for many who suffer from celiac 
disease. The Committee urges NIAID to support new research and 
to better coordinate existing research with NIDDK and the other 
Institutes and Centers. The Committee requests that NIAID 
report back in the fiscal year 2022 Congressional Justification 
on the progress made towards promoting, recruiting, and 
supporting additional celiac-focused research.
    Centers for AIDS Research.--As part of the Ending the HIV 
Epidemic initiative, the Committee includes $61,000,000 for the 
Centers for AIDS Research, an increase of $10,000,000 above the 
estimated fiscal year 2020 enacted level and the same as the 
fiscal year 2021 budget request. These Centers offer evidence-
based practices on prevention and treatment to initiative 
partners and support for evaluating the initiative.
    Combating Antibiotic-Resistant Bacteria.--The Committee 
maintains funding for NIAID research related to combating 
antibiotic-resistant bacteria. These funds enable NIAID to 
support research on antimicrobial (drug) resistance, including 
basic research on how microbes develop resistance, new and 
faster diagnostics, and clinical trials designed to find new 
vaccines and treatments effective against drug-resistant 
microbes.
    Food Allergies.--The Committee recognizes the serious issue 
of food allergies which affect approximately eight percent of 
children and ten percent of adults in the U.S. The Committee 
commends the ongoing work of NIAID in supporting a total of 17 
clinical sites for this critical research, including seven 
sites as part of the Consortium of Food Allergy Research 
(CoFAR). The Committee strongly encourages NIAID to expand 
support for the CoFAR.
    Gonorrhea.--The Committee continues to be concerned about 
the prevalence of gonorrhea, the 75 percent increase in the 
incidence of this disease over the past eleven years, and the 
drug resistance to multiple classes of antibiotics. The 
Committee commends NIAID for its efforts in developing new 
antibiotics to combat the bacterium that causes this disease 
and encourages NIAID to continue its work toward better 
diagnosis, treatments, and cures for this STI.
    Hepatitis B (HBV).--The Committee commends NIAID for its 
leadership to develop the Trans-NIH Strategic Plan to Cure 
Hepatitis B and urges NIAID to issue targeted calls for 
research to implement and fund the Strategic Plan. The 
Committee notes that infection with HBV is a serious public 
health threat. One in 20 Americans have been infected with HBV, 
and more than two million Americans are chronically infected, 
increasing by 70,000 a year. In addition, HBV results in over 
780,000 worldwide deaths each year. To implement the Strategic 
Plan, the Committee encourages NIAID to use contracts, program 
announcements, and research resources initiatives to stimulate 
new research applications and facilitate ongoing work. The 
Committee requests that NIAID submit, within 90 days of 
enactment of this Act, an update to the HBV Strategic plan 
focused on a cure for HBV in coordination with the Trans-NIH 
Hepatitis B Working Group.
    Hereditary Angioedema (HAE).--The Committee notes NIAID's 
meaningful progress in advancing research and diagnosis for 
patients who suffer from HAE caused by C1 inhibitor deficiency 
and encourages NIAID to facilitate basic and clinical genetic 
and biochemical research focused on understanding swelling in 
patients with normal C1 inhibitor.
    Inflammatory Disorders.--The Committee supports expanded 
research into the treatment of inflammation. Inflammation is 
one of the body's major defense mechanisms in response to 
infection or injury, but when it is uncontrolled, it causes 
inflammatory diseases such as COPD, asthma, rheumatoid 
arthritis, inflammatory bowel disease, otitis media, and 
cancer.
    Lyme Disease Vaccine Development.--With an estimated 
300,000 new cases of Lyme disease reported each year, the 
Committee encourages NIAID to expand its research on tick-borne 
disease, including prevention, diagnosis, and treatment. The 
Committee commends the NIAID's strategic plan for combating 
tick-borne illnesses to include vaccine development and 
encourages NIAID to focus its attention on supporting the most 
promising Lyme disease vaccine candidate clinical trials.
    Microbicides.--The Committee recognizes that with NIH and 
USAID leadership, research has shown the potential for 
antiretroviral (ARV) drugs to prevent HIV infection in women. 
The Committee encourages NIAID to continue coordination with 
USAID, the State Department, and others to advance ARV-based 
microbicide development efforts with the goal of enabling 
regulatory approval of the first safe and effective microbicide 
for women and supporting an active ARV-based microbicide 
pipeline to produce additional solutions to prevent HIV and 
help end the epidemic.
    Pandemic Influenza.--T cell-mediated immunity plays a 
central role in controlling viral infections. To create a 
universal influenza vaccine, the Committee encourages NIAID to 
prioritize research to facilitate the application of vaccines 
that induce strong cross-reactive T cell responses as a 
complementary or alternative approach to vaccines primarily 
designed to elicit an antibody response.
    Syphilis.--The Committee continues to be concerned about 
the increased cases of syphilis, the rise in congenital 
syphilis, and the link between syphilis and transmitting HIV. 
The Committee commends the NIAID for their work in this area 
and encourages acceleration in the development of screening 
tests, vaccines for prevention, and new treatment options, for 
both adults and newborns, to provide a fasts and efficient way 
to diagnose and define the stages of this infection.
    Tuberculosis.--The Committee encourages NIAID to continue 
to support research on tuberculosis.
    Universal Influenza Vaccine.--The Committee directs NIAID 
to allocate at least $240,000,000, an increase of $40,000,000 
over the fiscal year 2020 level, to support basic, 
translational, and clinical research to develop a universal 
influenza vaccine that provides robust, long-lasting protection 
against multiple subtypes of flu, rather than a select few. 
Such a vaccine would eliminate the need to update and 
administer the seasonal flu vaccine each year and could provide 
protection against newly emerging flu strains, potentially 
including those that could cause a flu pandemic. The Committee 
directs NIAID to allocate the increase in funding to clinical 
research. The Committee requests an update on these efforts 
within 60 days of enactment of this Act.

         NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES (NIGMS)

 
 
 
Appropriation, fiscal year 2020.......................    $2,937,218,000
Budget request, fiscal year 2021......................     2,672,074,000
Committee Recommendation..............................     2,972,479,000
    Change from enacted level.........................       +35,261,000
    Change from budget request........................      +300,405,000
Committee Recommendation (including Title VI).........     3,161,491,000
    Change from enacted level.........................      +224,273,000
    Change from budget request........................      +489,417,000
 

    Mission.--NIGMS supports basic research that increases our 
understanding of biological processes and lays the foundation 
for advances in disease diagnosis, treatment, and prevention.
    Forecasting and Modeling Partnerships for Countering 
Infectious Diseases.--The Committee believes that emerging 
viral threats such as COVID-19 highlight the need for 
innovative and real-time forecasting and modeling techniques to 
ensure the U.S. is best positioned to respond to emerging 
public health threats. The Committee encourages NIGMS and the 
Fogarty International Center (FIC) to continue to support 
emerging infectious disease forecasting and modeling methods 
and monitoring data developed by university and private 
partners. The Committee encourages NIGMS and FIC to prioritize 
funding and explore partnerships to improve our ability to 
respond to public health and national security threats through 
emerging infectious disease modeling and forecasting.
    Institutional Development Awards (IDeA).--The Committee 
provides $396,573,000 for IDeA, $10,000,000 above the fiscal 
year 2020 enacted level. IDeA supports high-quality research 
and investigators throughout the country in States in which the 
success rate for NIH grants has been historically low.
    Minority Access to Research Careers (MARC).--The Committee 
includes continued support for the MARC Program, which provides 
research training opportunities for underrepresented minority 
students and faculty in biomedical and behavioral sciences 
relevant to biomedicine, including mathematics and engineering.
    Science Education Partnership Awards (SEPA).--The Committee 
continues to support the SEPA program, which supports 
educational activities and workforce training for teachers to 
expand opportunities for students from underserved communities 
to consider careers in basic or clinical research.
    Small Business Technology Transfer (STTR) Regional 
Accelerator Hubs.--The Committee remains concerned with the 
lower levels of STTR funding in IDeA States compared to non-
IDeA States. In response to this discrepancy, NIGMS funded four 
STTR Regional Accelerator Hubs to help build entrepreneurial 
cultures in IDeA States through developing technology transfer 
networks, providing entrepreneurial training, and leveraging 
resources. The Committee continues to support this program and 
encourages NIGMS to provided funding at a lever sufficient for 
initial awards to be renewed.

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

 
 
 
Appropriation, fiscal year 2020.......................    $1,556,879,000
Budget request, fiscal year 2021......................     1,416,366,000
Committee Recommendation..............................     1,570,269,000
    Change from enacted level.........................       +13,390,000
    Change from budget request........................      +153,903,000
Committee Recommendation (including Title VI).........     1,670,455,000
    Change from enacted level.........................      +113,576,000
    Change from budget request........................      +254,089,000
 

    Mission.--NICHD investigates human development throughout 
the entire life process, with a focus on understanding 
disabilities and important events that occur during pregnancy.
    Addressing Maternal Mortality Disparities.--The Committee 
encourages NICHD to continue its support of research into the 
leading causes of maternal morbidity and mortality. As Black 
women experience maternal mortality at nearly four times the 
rate of white women, the Committee strongly urges NICHD to 
support research that investigates factors contributing to this 
disparity, and test evidence-based interventions to address 
this disparity. The Committee also encourages NICHD to 
collaborate with the National Institute for Minority Health and 
Health Disparities (NIMHD) as appropriate to develop targeted 
funding opportunities.
    Congenital Syphilis (CS).--The Committee continues to be 
concerned about the rise of congenital syphilis and the 
lifelong health effects the disease can have on children. The 
Committee encourages NICHD to prioritize research in this area 
and to work with NIAID on new testing, diagnosis, and treatment 
efforts.
    Endometriosis.--Endometriosis affects one in ten women, can 
cause intense pain, and is a leading cause of infertility. 
Despite its prevalence and health impact, there has been little 
investment in research to better understand this condition. 
Such research could lead to better health outcomes for millions 
of women. The Committee strongly encourages NICHD to 
significantly increase funding to expand basic, clinical, and 
translational research into the mechanics of endometriosis, 
identify early diagnostic markers, and develop new treatment 
methods.
    Human Microbiome.--The Committee appreciates the NICHD 2020 
strategic plan's key research themes, including: (1) promoting 
gynecologic, andrologic, and reproductive health, and (2) 
setting the foundation for healthy pregnancies and lifelong 
wellness. The Committee commends NICHD's partnership with the 
Office of the Director on the Human Microbiome Project, which 
has led to valuable scientific discoveries related to women's 
reproductive health and pregnancy. The Committee urges 
continued focus on the human microbiome and expanded 
investigation into the impact of the microbiome of the female 
reproductive tract on women's health and pregnancy outcomes, 
including larger collaborative and interdisciplinary multi-omic 
projects cognizant of health disparities among racial and 
ethnic populations.
    Human Milk Research.--The Committee encourages NICHD to 
expand its research on human milk, including by expanding the 
research pipeline by supporting graduate and postdoctoral 
fellowships in this area. In addition, the Committee encourages 
NICHD to establish a research center network for human milk 
research to facilitate support for shared resources and 
infrastructure for human milk research.
    Learning Disabilities Research.--The Committee is concerned 
with the decline in achievement for students with disabilities 
and recognizes the need for continued research and improved 
interventions. The Committee recognizes the importance of 
NICHD's funding of Learning Disabilities Research Centers and 
Learning Disabilities Innovation Hubs, which are the only 
source of Federal funding available to researchers interested 
in exploring child development and learning disabilities to 
conduct randomized control trials and explore the relationships 
between different variables at work. While learning 
disabilities affect an individual's education and academic 
achievement, these disorders are brain-based, and clinical 
research using the latest technology and advances in 
neuroscience is essential. The Committee encourages NICHD to 
continue its robust research into language, reading 
development, learning disabilities, and disorders that 
adversely affect the development of listening, speaking, 
reading, writing, and mathematics abilities. The Committee also 
encourages NICHD to increase its investment in its Learning 
Disabilities Research Centers and Learning Disabilities 
Innovation Hubs.
    Male Reproductive Health.--The Committee urges NICHD to 
support research on male mechanisms of infertility. In fiscal 
year 2020, the Committee encouraged NICHD to support research 
on male infertility and requests a report on progress in this 
area in the fiscal year 2022 Congressional Justification. Due 
to the gap in knowledge of how to diagnose and treat male 
infertility and abnormal embryo development, the Committee 
reiterates its priority interest. The Committee requests a 
report within 90 days of enactment of this Act detailing 
NICHD's existing collaborations and research to identify new 
proteins and sperm structures that are necessary for normal 
sperm foundation and, consequently, for fertility and embryo 
development.
    Maternal-Fetal Medicine Units (MFMU) Network.--The 
Committee supports the critical work of the MFMU Network in 
improving health outcomes for pregnant women and their babies. 
Leveraging existing infrastructure to address maternal 
mortality and severe maternal morbidity in the U.S. is 
critical. The Committee understands that NICHD is considering 
several models of infrastructure for its networks and 
encourages NICHD to maintain the features that made the MFMU 
Network successful and cost-effective, including the renewal 
process that maximizes efficiency and ability to conduct 
multiple large trials with long term follow up over many years. 
Such an infrastructure is essential for maintaining a 
collective repository of knowledge and skills as well as a 
stable foundation for data sharing and workforce development. 
The Committee looks forward to reports about the process for 
restructuring and final outcomes once a final decision has been 
made with respect to the new infrastructure.
    Maternal-Fetal Transmission of Lyme Disease.--The HHS Tick-
Borne Disease Working Group's Clinical Aspects of Lyme Disease 
Subcommittee January 2020 report includes ``further evaluate 
potential maternal-fetal transmission of Lyme disease and of 
congenital Lyme disease'' as a recommended priority. The 
Committee urges NIH to evaluate potential maternal-fetal 
transmission of Lyme disease and congenital Lyme disease and 
issue requests for proposals and funding opportunity 
announcements to stimulate researcher interest in these areas. 
Within 180 days of enactment of this Act, the Committee 
requests a report on NIH plans to address the need for research 
on maternal-fetal transmission of B. burgdorferi, congenital 
Lyme disease, and adverse outcomes in infants and children from 
maternal transmission.
    Maternal Mortality Research.--The Committee supports NIH 
efforts to establish the Implementing a Maternal Health and 
Pregnancy Outcomes Vision for Everyone (IMPROVE) Initiative. 
The initiative will use an integrated approach to understand 
biological, behavioral, sociocultural, and structural factors 
that affect severe maternal mortality and maternal mortality 
(SMM/MM) by building an evidence base for improved care and 
outcomes in specific regions of the country. IMPROVE will 
target health disparities associated with SMM/MM by (1) 
implementing and evaluating community-based interventions for 
disproportionately affected women (e.g., African American, 
American Indian/Alaska Native, advanced maternal age, low 
socioeconomic status, and rural populations), and (2) 
identifying risk factors and the underlying biological 
mechanisms associated with leading causes of SMM/MM, including 
cardiovascular disease, infection and immunity, and mental 
health.
    Participation of Pregnant and Lactating Individuals in 
COVID-19 Research.--The Committee directs NICHD, within 90 days 
of enactment of this Act, to submit a report to the Committee 
describing the specific steps being taken to ensure racially, 
ethnically, and geographically diverse participation in studies 
conducted to understand the effects of COVID-19 on pregnant and 
lactating individuals.
    Polycystic Ovary Syndrome (PCOS).--PCOS affects up to 15 
percent of women and has metabolic, reproductive, mental, and 
maternal/child health manifestations. PCOS is the most common 
endocrine disorder in women and is a significant risk factor 
for high blood pressure, sleep disorders, heart disease, 
pregnancy-induced hypertension, preeclampsia, cholesterol 
disorders, and other disorders that impact cardiovascular and 
metabolic health. The Committee encourages NICHD to partner 
with NHLBI to promote research in PCOS, particularly with a 
focus on comorbidities associated with PCOS that impact heart, 
blood, lung, sleep, and maternal/fetal health as they 
contribute to negative health outcomes. The Committee also 
encourages NHLBI to report on research that has been conducted 
on PCOS and its impact on cardiovascular health to date in the 
fiscal year 2022 Congressional Justification.
    Population Research.--The Committee recognizes NICHD for 
supporting innovative population research and research training 
programs, longitudinal surveys, and research on the social 
determinants of health and on the development of low-cost data 
archiving, data curation, and data sharing strategies that both 
protect survey participants and provide unparalleled access for 
researchers. The Committee encourages NICHD to highlight these 
strategies as it works with NIH leadership to implement its 
data sharing and management policy. Further, the Committee 
urges NICHD to continue supporting large-scale data collection 
activities, especially prospective, population-representative 
longitudinal studies, and to continue its leadership in 
supporting research on the social determinants of health, 
morbidity, and mortality across the lifespan, including 
maternal and infant health.
    Premature Birth Research.--The Committee supports NIH's 
efforts to expand neonatal research to improve the treatment 
and health outcomes of premature babies and explore ways to 
support multi-site clinical trials in pregnancy and lactation, 
which will lay the foundation for optimal clinical care for 
these infants.
    Research in Pregnant and Lactating Women.--The Committee is 
pleased with the progress being made by the Task Force on 
Research Specific to Pregnant Women and Lactating Women in 
identifying and developing strategies to address gaps in 
knowledge and research on safe and effective therapies for 
pregnant and lactating women to carry out the recommendations 
in its 2018 report. The Committee directs NICHD to provide the 
Task Force's recommendations to the Committee within 60 days of 
enactment of this Act. The Committee also directs NICHD, along 
with other relevant NIH Institutes and Centers, CDC, FDA, and 
other relevant agencies, to prepare to implement these 
recommendations to the extent appropriate and feasible under 
the legal authorities available to the Secretary. Finally, the 
Committee directs NICHD, in conjunction with the Secretary, to 
report back to the Committee on the feasibility of implementing 
these policies and any additional authorizations or 
appropriations required in the fiscal year 2022 Congressional 
Justification.
    Strategic Plan.--The Committee has reviewed NICHD's 2020 
Strategic Plan and believes that there is insufficient focus on 
behavioral health, cognition, development of young children, 
language, learning differences, and school readiness. NICHD has 
long history of funding critical and meritorious work in these 
areas. The Committee encourages NICHD to consider otherwise 
qualified grants in these areas on the same basis as any other 
areas of focus as it works to implement its strategic plan.

                      NATIONAL EYE INSTITUTE (NEI)

 
 
 
Appropriation, fiscal year 2020.......................      $824,090,000
Budget request, fiscal year 2021......................       749,003,000
Committee Recommendation..............................       831,177,000
    Change from enacted level.........................        +7,087,000
    Change from budget request........................       +82,174,000
Committee Recommendation (including Title VI).........       884,208,000
    Change from enacted level.........................       +60,118,000
    Change from budget request........................      +135,205,000
 

    Mission.--NEI conducts and supports basic and clinical 
research, research training, and other programs with respect to 
blinding eye diseases, visual disorders, and mechanisms of 
visual function, preservation of sight, and the special health 
problems and needs of individuals who are visually-impaired or 
blind.
    Academic and Non-Profit Institutional Research Using Human 
Ocular Tissue from Not-for-Profit Eye Banks.--Macular 
degeneration is the leading cause of blindness and impacts some 
15 million people in the U.S., with an estimated 200,000 new 
cases annually. The Committee is aware that, due to the high 
cost of human ocular tissue, many academic researchers resort 
to using animal tissue when studying diseases and conditions of 
the eye. This is problematic as animal tissue is not a perfect 
equivalent to human tissue, and certain diseases, such as 
macular degeneration, are not present in animal tissue. The 
Committee encourages NEI to consider establishing an ocular 
tissue program to achieve cost savings and facilitate critical 
ocular research utilizing tissue provided by non-profit 
organizations to academic and other not-for-profit research 
entities. Such a program could facilitate critical research to 
eradicate the debilitating impact of macular degeneration and 
other ocular disorders.
    Blepharospasm.--The Committee continues to encourage NEI to 
pursue collaboration with stakeholders on cross-cutting 
research opportunities that affect all forms of dystonia, 
including blepharospasm. The Committee notes the opportunity to 
collaborate with NINDS and NIDCD from the 2018 dystonia 
conference and encourages all three Institutes to work together 
to advance critical research.
    Eye Bonds.--The Committee recognizes the monumental strides 
being made in medical research, but is also concerned about the 
growing need to fund translational research in what is known as 
the valley of death, that area between basic science and the 
development of a patient-ready product. Eye disease in America 
is one such challenge with significant human and economic 
consequences. In America, 4.24 million adults are blind or have 
vision impairment, and among working-age blind adults, 70.5 
percent are not employed full-time. The economic burden of eye 
diseases is estimated to be $138 billion a year. The Committee 
encourages NEI to work with other Institutes and Centers, other 
agencies within HHS, and stakeholder organizations to examine 
novel methods to fund translational research and bridge the 
valley of death.
    Macular Degeneration.--The Committee is concerned with 
advanced age-related macular degeneration as the leading cause 
of irreversible blindness and vision impairment globally. At 
least 11 million people in the U.S. have some form of macular 
degeneration and that number is expected to double to 22 
million by 2050. The Committee encourages NIH to fund research 
that will stem the growth of macular degeneration and requests 
an update on current research and future initiatives in the 
fiscal year 2022 Congressional Justification.
    Vision Research.--The number of Americans with visual 
impairment or blindness is expected to double to more than 8 
million by 2050. The Committee recognizes NEI's research to 
advance the understanding of the causes of these afflictions 
and potential treatments and encourages NEI to expand these 
research activities.

      NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES (NIEHS)

 
 
 
Appropriation, fiscal year 2020.......................      $802,598,000
Budget request, fiscal year 2021......................       730,147,000
Committee Recommendation..............................       809,501,000
    Change from enacted level.........................        +6,903,000
    Change from budget request........................       +79,354,000
Committee Recommendation (including Title VI).........       861,149,000
    Change from enacted level.........................       +58,551,000
    Change from budget request........................      +131,002,000
 

    Mission.--NIEHS's mission is to discover how the 
environment affects people in order to promote healthier lives.
    Air Pollution and Asthma.--The Committee notes with concern 
the evidence suggesting a causal link between air pollution and 
the development of asthma. The Committee urges NIEHS to explore 
this potential causal link and any interventions necessary to 
prevent the development of asthma.
    Harmful Algal Blooms Human Health Effects Research.--The 
Committee recognizes the value of the NIEHS mission and the 
NIEHS-NSF jointly-funded Oceans and Human Health Program as a 
means to increase scientific knowledge about short-term and 
long-term human health effects associated with acute and 
chronic exposures to toxins produced by harmful algal blooms 
(HABs). The Committee recognizes the increasing relevance of 
this scientific research to communities directly affected by 
HABs, including in Florida, where one of the longest documented 
HABs in the State's history occurred from late 2017 through 
early 2019. The Committee encourages NIEHS to continue 
investing in this research area using its competitive, peer-
reviewed grantmaking processes. In particular, the Committee 
notes growing scientific interest in further investigating 
respiratory irritation and illness associated with inhalation 
of aerosolized HAB toxins and neurotoxic shellfish poisoning 
arising from ingestion of contaminated seafood. The Committee 
commends NIEHS for its collaborations with other agencies, 
including the National Science Foundation (NSF), National 
Oceanic and Atmospheric Administration (NOAA), Environmental 
Protection Agency (EPA), and CDC, to advance research about 
HABs and translate key research findings for clinical and 
public health benefits.
    Polyfluoroalkyl Substances (PFAS) Research.--The Committee 
appreciates NIEHS's support for research into understanding the 
toxic properties of PFAS chemicals and the potential adverse 
health effects of PFAS exposure. Research to date has revealed 
an association between PFAS exposures and adverse health 
outcomes, including the potential for effects on children's 
cognitive and behavioral development, immune system 
dysfunction, endocrine disruption, obesity, diabetes, and 
cancer. More research is necessary to fully understand the 
impact of PFAS exposure on health. The Committee strongly 
encourages NIEHS to continue to support research on human 
exposure to PFAS chemicals.

                   NATIONAL INSTITUTE ON AGING (NIA)

 
 
 
Appropriation, fiscal year 2020.......................    $3,543,673,000
Budget request, fiscal year 2021......................     3,225,782,000
Committee Recommendation..............................     3,609,150,000
    Change from enacted level.........................       +65,477,000
    Change from budget request........................      +383,368,000
Committee Recommendation (including Title VI).........     3,837,188,000
    Change from enacted level.........................      +293,515,000
    Change from budget request........................      +611,406,000
 

    Mission.--NIA's mission is to understand the nature of 
aging and the aging process, and diseases and conditions 
associated with growing older, in order to extend the healthy, 
active years of life.
    Alzheimer's Disease.--In recognition that Alzheimer's 
disease poses a serious threat to the nation's long-term health 
and economic stability, the Committee recommends a total of no 
less than $2,853,000,000 for Alzheimer's disease and related 
dementias research, $35,000,000 above the estimated fiscal year 
2020 level. The Committee encourages NIA to continue to address 
the research goals set forth in the National Plan to Address 
Alzheimer's disease, as well as the recommendations from the 
Alzheimer's Disease Research Summits in 2015 and 2018, the 
Alzheimer's Disease Related Dementias Research Summits in 2017 
and 2020, and the Dementia Care and Services Research Summit in 
2017. In addition, the Committee is concerned about the racial 
and ethnic disparities that exist in Alzheimer's disease 
diagnoses and encourages NIA to support research exploring the 
disproportionate impact Alzheimer's disease has on people of 
color, particularly African-Americans, who are two times more 
likely to develop late-onset Alzheimer's disease than whites.
    Population Research.--The Committee recognizes the NIA 
National Advisory Council on Aging (NACA) for conducting a 
recent review of NIA's Division of Behavioral and Social 
Research. The review reinforced the value of NIA's investment 
in an array of population aging research activities, including 
large-scale, longitudinal studies such as the Health and 
Retirement Study, which is the nation's leading source of 
combined data on health and socioeconomic circumstances of 
Americans over age 50, and its center programs, such as the 
Centers on the Demography and Economics of Aging, which are 
conducting research on the demographic, economic, social, and 
health consequences of U.S. and global aging at 11 universities 
and organizations nationwide. The Committee urges NIA to 
sustain its investment in these activities in fiscal year 2021 
and to consider, as the NACA review recommended, expanding 
research opportunities that will advance our understanding of 
the factors throughout the life course that contribute to the 
poor overall health of older people in America and the growing 
disparities in some parts of the country as well as the 
disparities between the US and other countries.
    Thalassemia.--Thanks to significant advances in medical 
science, thalassemia patients and others dealing with chronic 
diseases are now living well into adulthood, some even into 
their 60s. While this is a tremendous victory for research, it 
has opened new questions. Among these are female and male 
reproductive issues, the impact of non-disease related 
medicines, the relationship to diseases of aging such as 
Alzheimer's disease and other dementias, Parkinson's, 
arthritis, osteoporosis, and more. The Committee requests that 
NIA review these issues and report back on the steps that will 
be taken to address them in the fiscal year 2022 Congressional 
Justification.
    Update NIH Alzheimer's Disease and Dementia Screening 
Tools.--The Committee remains very interested in opportunities 
to detect cognitive impairment that may be caused by 
Alzheimer's disease and related dementias as early as possible. 
The Committee directs NIH to update its analysis of validated 
screening tools, including digital screening tools, that are 
able to reliably detect mild cognitive impairment (MCI). This 
review should focus on identifying tools that have been 
developed in the time since the last assessment was conducted 
and on providing information to assist healthcare providers in 
regularly using such tools to assess the cognitive health of 
their patients.

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

 
 
 
Appropriation, fiscal year 2020.......................      $624,889,000
Budget request, fiscal year 2021......................       568,480,000
Committee Recommendation..............................       630,263,000
    Change from enacted level.........................        +5,374,000
    Change from budget request........................       +61,783,000
Committee Recommendation (including Title VI).........       670,475,000
    Change from enacted level.........................       +45,586,000
    Change from budget request........................      +101,995,000
 

    Mission.--NIAMS's mission is to support research into the 
causes, treatment, and prevention of arthritis and 
musculoskeletal and skin diseases; the training of basic and 
clinical scientists to carry out this research; and the 
dissemination of information on research progress in these 
diseases.
    Alopecia.--Alopecia affects 6.8 million Americans, 
including children, and disproportionately impacts women of 
color. The Committee encourages NIAMS to work with relevant 
Institutes and Centers, including NIMHD, to develop possible 
collaborative efforts to increase research into this disparity, 
specifically among Black and Hispanic women, and pursue 
collaborative opportunities that will lead to new research 
discoveries.
    Musculoskeletal Research.--The NIH has made significant 
progress in terms of diversity in musculoskeletal research and 
has included it as a priority in its 2020-2024 strategic plan. 
The Committee encourages NIAMS to support additional focused 
research into sexual dimorphism, race/ethnicity, and socio-
economic status and how these factors relate to injury 
prevention, levels of disease activity and functional status, 
access, and quality of care across the lifespan. Specifically, 
we recommend that NIAMS issue Request for Applications (RFA) or 
Participatory Action Research (PAR) grant programs on 
disparities similar to those of the NIMHD or NCI. In addition, 
the Committee encourages NIAMS to support further research on 
rural inequities in musculoskeletal care in terms of addressing 
occupational injury types and resulting complications due to 
limited specialty care access.

   NATIONAL INSTITUTE ON DEAFNESS AND OTHER COMMUNICATION DISORDERS 
                                (NIDCD)

 
 
 
Appropriation, fiscal year 2020.......................      $490,692,000
Budget request, fiscal year 2021......................       446,397,000
Committee Recommendation..............................       494,912,000
    Change from enacted level.........................        +4,220,000
    Change from budget request........................       +48,515,000
Committee Recommendation (including Title VI).........       526,488,000
    Change from enacted level.........................       +35,796,000
    Change from budget request........................       +80,091,000
 

    Mission.--NIDCD conducts and supports biomedical and 
behavioral research and research training in the normal and 
disordered processes of hearing, balance, taste, smell, voice, 
speech, and language. NIDCD also conducts and supports research 
and research training related to disease prevention and health 
promotion; addresses special biomedical and behavioral problems 
associated with people who have communication impairments or 
disorders; and supports efforts to create devices which 
substitute for lost and impaired sensory and communication 
function.
    Spasmodic Dysphonia.--The Committee notes the work that 
NIDCD has done in conducting research on spasmodic dysphonia 
and encourages NIDCD to work with stakeholders to advance 
critical research resulting from the 2018 dystonia conference.

             NATIONAL INSTITUTE OF NURSING RESEARCH (NINR)

 
 
 
Appropriation, fiscal year 2020.......................      $169,113,000
Budget request, fiscal year 2021......................       156,804,000
Committee Recommendation..............................       170,567,000
    Change from enacted level.........................        +1,454,000
    Change from budget request........................       +13,763,000
Committee Recommendation (including Title VI).........       181,450,000
    Change from enacted level.........................       +12,337,000
    Change from budget request........................       +24,646,000
 

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

       NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM (NIAAA)

 
 
 
Appropriation, fiscal year 2020.......................      $545,373,000
Budget request, fiscal year 2021......................       497,346,000
Committee Recommendation..............................       550,063,000
    Change from enacted level.........................        +4,690,000
    Change from budget request........................       +52,717,000
Committee Recommendation (including Title VI).........       585,158,000
    Change from enacted level.........................       +39,785,000
    Change from budget request........................       +87,812,000
 

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

                NATIONAL INSTITUTE ON DRUG ABUSE (NIDA)

 
 
 
Appropriation, fiscal year 2020.......................    $1,462,016,000
Budget request, fiscal year 2021......................     1,431,770,000
Committee Recommendation..............................     1,474,590,000
    Change from enacted level.........................       +12,574,000
    Change from budget request........................       +42,820,000
Committee Recommendation (including Title VI).........     1,568,672,000
    Change from enacted level.........................      +106,656,000
    Change from budget request........................      +136,902,000
 

    Mission.--NIDA's mission is to advance science on the 
causes and consequences of drug use and addiction and to apply 
that knowledge to improve individual and public health.
    Cannabis Research.--NIH currently supports a diverse 
portfolio of research on cannabinoids and the endocannabinoid 
system, yet this research support typically relies on narrowly 
tailored program announcements and grants rather than a 
multipronged strategy wherein basic and clinical scientists and 
public health specialists work together to address the 
opportunities and challenges of cannabis in a comprehensive 
manner. The Committee encourages NIDA to continue supporting a 
full range of research on the health effects of marijuana and 
its components, including research to understand how marijuana 
policies affect public health, to help inform marijuana 
policymaking in States.
    Determination of Synthetic Drug Ingestion.--The Committee 
encourages NIDA to support research to develop a process for 
rapid determination of synthetic drug ingestion. Such research 
should include the development of metabolite profiles of 
opioids and their synthetic derivatives using pooled human 
liver microsomes and a cytochrome mixture; development of 
analytical methodology for rapid detection of metabolites in 
urine samples; development of a program that utilizes the 
metabolite profile that provides an output of class and drug; 
and validation of the methodology with simulated and/or real 
world samples.
    Electronic Cigarettes.--The Committee understands that 
electronic cigarettes (e-cigarettes) and other vaporizing 
equipment are increasingly popular among adolescents, and 
encourages NIDA to support research on the use and consequences 
of these devices. The Committee also supports the Population 
Assessment of Tobacco and Health (PATH) Study, a collaboration 
between NIDA and the FDA Center for Tobacco Products to help 
scientists learn how and why people start using tobacco 
products, quit using them, and start using them again after 
they have quit, as well as how different tobacco products 
affect health outcomes over time.
    Kratom.--The Committee encourages NIDA to expand research 
on all health impacts of kratom, including its constituent 
compounds, mitragynine and 7-hydroxymitragynine. The Committee 
is aware of the potential promise of kratom-derived compounds 
for acute and chronic pain patients who seek safer alternatives 
to sometimes dangerously addictive and potentially deadly 
prescription opioids.
    Methamphetamines and Other Stimulants.--The Committee is 
concerned that the number of deaths from the drug categories 
that include methamphetamine and cocaine more than doubled from 
2015-2018, leading some to refer to stimulant overdoses as the 
``fourth wave'' of the current drug addiction crisis in America 
following the rise of opioid-related deaths involving 
prescription opioids, heroin, and fentanyl-related substances. 
Methamphetamine is highly addictive and there are no FDA-
approved treatments for methamphetamine and other stimulant use 
disorders. The Committee continues to support NIDA's efforts to 
address the opioid crisis, has provided continued funding for 
the HEAL Initiative, and supports NIDA's efforts to combat the 
growing problem of methamphetamine and other stimulant use and 
related deaths.
    Opioids.--The Committee continues to be extremely concerned 
about the epidemic of prescription opioids, heroin, and illicit 
synthetic opioid use, addiction and overdose in the U.S. In 
2018, approximately 185 people died each day in this country 
from drug overdose (128 of those deaths are directly from 
opioids), making it one of the most common causes of non-
disease-related deaths for adolescents and young adults. This 
crisis has been exacerbated by the availability of illicit 
fentanyl and its analogs in many communities. The Committee 
appreciates the important role that research plays in the 
various Federal initiatives aimed at this crisis. To combat 
this crisis, the bill includes no less than the fiscal year 
2020 funding level of $266,300,000 for research related to 
preventing and treating opioid misuse and addiction. NIDA's 
opioid specific allocation should be targeted for the following 
areas: development of safe and effective medications and new 
formulations and combinations to treat opioid use disorders and 
to prevent and reverse overdose; conduct implementation 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; test interventions in justice system settings to 
expand the uptake of medication for addiction treatment and 
methods to scale up these interventions for population-based 
impact; and develop evidence-based strategies to integrate 
screening and treatment for opioid use disorders in emergency 
department and primary care settings.
    Overdose Prevention Centers.--The Committee recognizes that 
Overdose Prevention Centers, or Supervised Consumption Sites, 
are part of a larger effort of harm reduction interventions 
intended to reduce the risk of drug overdose death and reduce 
the spread of infectious disease. The Committee directs NIDA, 
in consultation with the CDC Division of Injury Prevention and 
Control, to provide a report to the Committee and post 
publicly, no later than 180 days after the enactment of this 
Act providing an updated literature review and evaluation of 
the potential public health impact of Overdose Prevention 
Centers in the U.S.
    Pain Therapeutics and Opioid Addiction Centers of 
Excellence.--Addictions are a chronic problem in the U.S. and 
are inadequately addressed in U.S. medical schools and 
residency training programs. The Committee strongly encourages 
NIDA to create regional Centers of Excellence in opioid 
research and training to assist States in educating and 
implementing best practices in opioid prescribing, pain 
management, screening and linkage to care for individuals with 
opioid use disorders and addictions. The Centers should develop 
training materials for health care providers and trainees in 
opioid use and other addictive disorders.
    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 
(e.g., internal medicine, family practice, and pediatrics). The 
Committee encourages NIDA to continue its efforts in this 
space, providing physicians and other medical professionals 
with the tools and skills needed to incorporate substance use 
and misuse screening and treatment into their clinical 
practices.
    The HEALthy Brain and Child Development (BCD) Study.--The 
Committee recognizes and supports the NIH HEALthy Brain and 
Child Development Study, which will establish a large cohort of 
pregnant women from regions of the country significantly 
affected by the opioid crisis and follow them and their 
children for at least 10 years. This knowledge will be critical 
to help predict and prevent some of the known impacts of pre- 
and postnatal exposure to drugs or adverse environments, 
including risk for future substance use, mental disorders, and 
other behavioral and developmental problems. The Committee 
recognizes that the BCD Study is supported in part by the NIH 
HEAL Initiative, and encourages other NIH Institutes, such as 
NICHD, NIMH, NHLBI, NCI, NIAAA, NIMH, NINR, as well as the 
Office of the Director to support this important study.
    Tobacco Regulatory Science Program.--The Committee supports 
the Tobacco Regulatory Science Program and encourages increased 
research to inform the FDA in regulation of the manufacture, 
marketing, and distribution of tobacco products to reduce the 
public health toll from tobacco product use in the U.S. The 
Committee encourages NIH to support research into the 
understanding of nicotine addiction and to spur the development 
of better prevention and treatment strategies. Of particular 
importance for funding are research for effective interventions 
to help youth and young adults to quit vaping, and to 
understand the interrelationship between the vaping of tobacco 
and marijuana.
    Youth Tobacco Cessation.--The Committee is concerned about 
the increase in youth e-cigarette addiction and the significant 
lack of research to inform effective therapies to help youth 
quit. The U.S. Preventive Services Task Force has determined 
that there is not sufficient evidence to recommend adolescent 
use of existing pharmacological tobacco cessation treatments 
that are currently approved for adults. There is great need for 
additional clinical trials and other research to determine if 
new or existing pharmacological treatments, behavioral 
interventions, or combination therapies have the potential to 
benefit adolescents in quitting cigarettes and other forms of 
tobacco, including e-cigarettes.

               NATIONAL INSTITUTE OF MENTAL HEALTH (NIMH)

 
 
 
Appropriation, fiscal year 2020.......................    $2,038,374,000
Budget request, fiscal year 2021......................     1,844,865,000
Committee Recommendation..............................     2,055,303,000
    Change from enacted level.........................       +36,929,000
    Change from budget request........................      +210,438,000
Committee Recommendation (including Title VI).........     2,186,474,000
    Change from enacted level.........................      +148,100,000
    Change from budget request........................      +341,609,000
 

    Mission.--NIMH's mission is to transform the understanding 
and treatment of mental illnesses through basic and clinical 
research, paving the way for prevention, recovery, and cure.
    Addressing Youth Mental Health Disparities.--The Committee 
is encouraged by the work of NIMH to support research on issues 
related to youth mental health, including suicide among youth. 
The Committee is further encouraged by NIMH efforts to address 
mental health disparities among underrepresented and undeserved 
youth. To guide this continuing work, the Committee requests 
within 180 days of enactment of this Act, a 10-year strategic 
plan with long-term plan with short-term goals from NIMH with a 
goal of eliminating racial mental health disparities in youth 
by 2030.
    This plan should include, but is not limited to: (1) 
convening a consensus conference, which could be used to guide 
strategic plan development; (2) identifying and/or creating 
funding mechanisms that actively support the development of 
evidence-based practices for racial mental health disparities 
populations; (3) developing targeted funding opportunities for 
projects in communities with disparities starting in fiscal 
year 2021; and (4) developing structures to solicit wide-
ranging community input on barriers to addressing mental health 
disparities. This may include quarterly workshops to solicit 
community input. The Committee requests an update in the fiscal 
year 2022 Congressional Justification on progress towards 
achieving goals in this strategic plan.
    The Committee further encourages the Institute to convene a 
consensus conference that includes: leading extramural experts 
on health disparities; representatives from other relevant NIH 
Institutes and Centers like the HHS Office of Minority Health, 
NICHD, NIMHD; and public stakeholders to discuss research 
opportunities and gaps, as well as evidence-based solutions and 
therapeutic interventions. At the conclusion of the conference, 
the Committee requests a report which should include priority 
areas for additional study to advance research in addressing 
mental health disparities in youth.
    Autism.--The Committee encourages NIH to support greater 
investment in research and collaborations focused on addressing 
gaps in the Strategic Plan developed by the lnteragency Autism 
Coordinating Committee, including efforts to understand the 
intersection of biology, behavior, and the environment.
    BRAIN Initiative.--The Committee directs NIH to transfer 
$50,000,000 from the NIH Innovation Account to NIMH to support 
the BRAIN Initiative. These funds are authorized by the 21st 
Century Cures Act (P.L. 114-255). This collaborative effort is 
revolutionizing our understanding of how neural components and 
their dynamic interactions result in complex behaviors, 
cognition, and disease, while accelerating the development of 
transformative tools to explore the brain in unprecedented ways 
making information previously beyond reach accessible.
    Pediatric Lyme Disease.--The Committee is concerned about 
reports that Lyme disease poses special risks for children in 
terms of neurodevelopmental disorders and psychiatric 
comorbidities and encourages NIMH to conduct studies on the 
neuropsychiatric manifestations of pediatric Lyme disease.
    Suicide Prevention.--The Committee continues to be alarmed 
with the growing rates of suicide across the country, with the 
CDC reporting a 30 percent increase since 1999. Suicide is 
currently the tenth leading cause of death for all ages and the 
second leading cause of death for young people aged 10 to 34. 
To address and combat this crisis, the Committee encourages 
NIMH to prioritize its suicide screening and prevention 
research efforts, with special emphasis on producing models 
that are interpretable, scalable, and practical for clinical 
implementation, including healthcare, education, and criminal 
justice systems that serve populations at risk. In addition, 
the Committee believes increased collaboration between NIMH and 
other Institutes holds immense value. The Committee strongly 
encourages NIMH to partner with NIDA and NIAAA to examine the 
multifaceted relationship between suicide and substance use 
disorder (SUD), including opioid abuse. Enhanced research into 
these relationships will provide critical knowledge regarding 
common risk factors, and preventive and intervention efforts 
that reduce morbidity associated with suicide risk. The 
Committee directs NIMH to provide an update on these efforts in 
the fiscal year 2022 Congressional Justification.

            NATIONAL HUMAN GENOME RESEARCH INSTITUTE (NHGRI)

 
 
 
Appropriation, fiscal year 2020.......................      $606,349,000
Budget request, fiscal year 2021......................       550,116,000
Committee Recommendation..............................       611,564,000
    Change from enacted level.........................        +5,215,000
    Change from budget request........................       +61,448,000
Committee Recommendation (including Title VI).........       650,583,000
    Change from enacted level.........................       +44,234,000
    Change from budget request........................      +100,467,000
 

    Mission.--NHGRI's mission is to accelerate scientific and 
medical breakthroughs that improve human health by driving 
cutting-edge research, developing new technologies, and 
studying the impact of genomics on society.
    Emerging Centers of Excellence in Genomic Sciences.--The 
Committee provides no less than $15,000,000, the same as the 
fiscal year 2020 enacted level, to sustain and grow the 
Emerging Centers of Excellence in Genomic Sciences competitive 
grant program. The Committee maintains prior direction that 
present awardees of the Centers for Excellence in Genomic 
Sciences program shall not be eligible to receive these grants. 
The Committee again urges NHGRI to include plans for 
sustainment of this capacity-building mechanism in its 2020 
vision report.

  NATIONAL INSTITUTE OF BIOMEDICAL IMAGING AND BIOENGINEERING (NIBIB)

 
 
 
Appropriation, fiscal year 2020.......................      $403,638,000
Budget request, fiscal year 2021......................       368,111,000
Committee Recommendation..............................       407,109,000
    Change from enacted level.........................        +3,471,000
    Change from budget request........................       +38,998,000
Committee Recommendation (including Title VI).........       433,083,000
    Change from enacted level.........................       +29,445,000
    Change from budget request........................       +64,972,000
 

    In addition, the CARES Act included $60,000,000 and the 
Paycheck Protection Program and Health Care Enhancement Act 
included $500,000,000 for NIBIB to conduct and support research 
related to COVID-19.
    Mission.--The NIBIB mission is to improve health by leading 
the development and accelerating the application of biomedical 
technologies.
    Integrated Medical Engineering.--Many recent advancements 
in health innovation are the result of the convergence of 
medicine and engineering. In the coming years, this trend holds 
increasing promise. The Committee believes that NIH would be 
well suited to help develop the next generation of health 
innovation by investing in such programs and strongly 
encourages NIH to support academic medical centers which award 
joint degrees of Doctor of Medicine and master's degrees in 
engineering.

  NATIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH DISPARITIES (NIMHD)

 
 
 
Appropriation, fiscal year 2020.......................      $335,812,000
Budget request, fiscal year 2021......................       305,498,000
Committee Recommendation..............................       343,700,000
    Change from enacted level.........................        +7,888,000
    Change from budget request........................       +38,202,000
Committee Recommendation (including Title VI).........       365,310,000
    Change from enacted level.........................       +29,498,000
    Change from budget request........................       +59,812,000
 

    Mission.--NIMHD's mission is to lead scientific research to 
improve minority health and reduce health disparities.
    The Committee strongly supports the mission of NIMHD to 
lead scientific research to improve minority health and reduce 
health disparities. Persistent racial and ethnic health 
disparities can be largely attributed to poor social and 
physical determinants of health in communities of color. 
Advancing health equity requires a multifactorial response to 
address issues such as high unemployment, unstable housing, 
lack of quality education, and inability to access health care. 
Reducing health disparities also requires solutions that are 
informed by and tailored to the specific racial, ethnic, 
socioeconomic, and geographic communities at which they are 
aimed. The Committee urges NIMHD to maximize funding 
opportunities that emphasize community-based, multidisciplinary 
research focused on identifying root causes of health 
disparities while also informing regional health and social 
policy to strategically reduce health inequity across 
communities.
    Focal Segmental Glomerulosclerosis (FSGS).--The Committee 
notes the continued commitment of NIMHD in researching health 
disparities. The Committee continues to encourage collaboration 
with other Institutes and Centers and stakeholders to expand 
research opportunities on the APOL1 gene that causes African-
Americans and Latinos to be disproportionately affected by 
FSGS.
    Research Centers in Minority Institutions (RCMIs).--The 
Committee recognizes the important role of the RCMI program in 
developing the infrastructure required to enhance biomedical 
research conducted at historically minority serving 
institutions. This infrastructure is critical to supporting the 
development of new investigators and sustaining an established 
workforce conducting world-class biomedical research that 
emphasizes the advancement of minority health and the reduction 
of health disparities through basic research in disease areas 
impacting minority communities at abnormally high rates as well 
as behavioral and clinical research in these same areas. The 
Committee includes $80,000,000, an increase of $5,000,000 above 
the fiscal year 2020 level, for RCMIs to ensure that critical 
infrastructure development in historically minority graduate 
and health professional schools continue to be enhanced to meet 
these critical needs. The Committee also recognizes the 
importance of the RCMI Translational Research Network in 
ensuring that collectively, institutions can engage in multi-
site collaborative research.
    The Committee notes that the RCMI program was created to 
provide equitable means for health professions institutions 
with historical missions and precedence of serving minorities, 
such as Historically Black Graduate Institutions in the health 
professions, the wherewithal in research infrastructure to 
train minority biomedical researchers and explore research 
discovery. The Committee encourages the NIMHD to continue 
following Congressional intent for the RCMI program and follow 
the spirit of the original instructions provided to NIH by 
Congress.
    Research Endowment Program (REP).--The Committee is 
concerned by NIMHD's lack of engagement with stakeholders and 
the broader community regarding REP eligibility. The Committee 
urges NIMHD to move forward with the recommendations made by 
the Advisory Council workgroup to restore endowment eligibility 
for REP to the original Congressional intent. The Committee 
requests that NIMHD report to the Committee on progress made to 
implement these recommendations prior to issuing its next FOA 
for REP.
    Unregulated Cosmetics.--The Committee is concerned about 
the prevalence of cosmetics containing dangerous levels of 
mercury made available through online sales and increased 
global travel. Evidence suggests that these harmful unregulated 
cosmetics, such as skin lightening creams, are 
disproportionately used by women of color. The Committee 
encourages NIMHD to collaborate with FDA to identify research 
gaps in the understanding of the health effects of these 
products and provide a report to the Committee summarizing the 
state of science and describing NIMHD's collaboration with FDA 
within 180 days of enactment of this Act.
    Women's Health Centers of Excellence.--The Committee 
recognizes that health disparities persist for women in both 
urban and rural communities across the country. The Committee 
encourages NIMHD to establish three urban and two rural 
academic-affiliated Centers of Excellence focused on health 
disparities that disproportionately affect underserved and 
minority women.

    NATIONAL CENTER FOR COMPLEMENTARY AND INTEGRATIVE HEALTH (NCCIH)

 
 
 
Appropriation, fiscal year 2020.......................      $151,740,000
Budget request, fiscal year 2021......................       138,167,000
Committee Recommendation..............................       153,045,000
    Change from enacted level.........................        +1,305,000
    Change from budget request........................       +14,878,000
Committee Recommendation (including Title VI).........       162,810,000
    Change from enacted level.........................       +11,070,000
    Change from budget request........................       +24,643,000
 

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

      NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCES (NCATS)

 
 
 
Appropriation, fiscal year 2020.......................      $832,888,000
Budget request, fiscal year 2021......................       787,703,000
Committee Recommendation..............................       840,051,000
    Change from enacted level.........................        +7,163,000
    Change from budget request........................       +52,348,000
Committee Recommendation (including Title VI).........       893,648,000
    Change from enacted level.........................       +60,760,000
    Change from budget request........................      +105,945,000
 

    In addition, the CARES Act included $36,000,000 for NCATS 
to conduct and support research related to COVID-19.
    Mission.--NCATS was established to transform the 
translational process so that new treatments and cures for 
disease can be delivered to patients faster.
    Clinical and Translational Science Awards (CTSA).--The 
Committee directs NIH to fund the CTSA program at not less than 
the level provided in fiscal year 2020. The Committee 
reiterates its support for the CTSA program and notes the 
recent contributions of this critical infrastructure program 
towards community engagement and addressing health disparities. 
Because CTSAs are uniquely positioned to help address physician 
workforce shortage issues, NCATS is encouraged to bolster the 
role of CTSAs in workforce development activities with an 
emphasis on training and career development opportunities.
    Collaboration with Business Incubators.--The Committee 
urges NCATS to explore potential collaborations or funding 
opportunities with business incubators that host small to mid-
size science, research, and pharmaceutical companies that use 
services-based approaches to nurture and guide the member 
companies to success. The Committee believes that such 
collaborations offer an effective way to advance translational 
science and meet the NCATS mission to deliver more treatment to 
more people quickly. Priority consideration should be given to 
nonprofit life science incubators with a track record of 
success in new drug discovery, biomarker discovery, and 
translational biotechnology in common research themes.
    Gene Vector Initiative.--The Committee encourages NCATS to 
pursue the initiative described in the fiscal year 2021 budget 
request to create a consortium for innovation in large-scale 
gene vector production. There is currently a bottleneck in the 
production of the vector therapies necessary to deliver gene 
therapies to patients. This initiative would improve the 
capacity to produce vectors and accelerate gene therapy 
clinical trials.
    Rare Cancers Therapeutics Research and Development.-- Rare 
cancers, defined at those cancers that have fewer than six new 
cases per 100,000 Americans per year, represent over 30 percent 
of all cancers. Rare cancers present a unique research 
challenges for many reasons, including the difficulty in 
accruing enough patients to participate in clinical trials, the 
lack of industry focus on these cancers due to the relatively 
small number of patients diagnosed with each cancer, the lack 
of rare cancer tumor models and cell lines, and the difficulty 
of patients receiving accurate and precise diagnoses due in 
part to the lack of clinician familiarity with rare cancers. 
Knowing that targeted cancer therapies frequently work more 
effectively and with fewer side effects than traditional 
chemotherapy and radiation, the Committee supports efforts to 
accelerate therapies for rare cancers and to support broader 
sharing of omic-related rare cancer data to accelerate research 
and drug development for these cancers. The NCATS novel 
scientific model has proven successful in addressing other rare 
diseases and would benefit rare cancer therapeutic development. 
Therefore, the Committee encourages NIH to establish a joint 
NCATS-NCI rare cancer translational medicine initiative to 
accelerate the study of commonalities across rare cancers and 
the development of platform treatments for rare cancers to help 
patients who often have no other options.

               JOHN E. FOGARTY INTERNATIONAL CENTER (FIC)

 
 
 
Appropriation, fiscal year 2020.......................       $80,760,000
Budget request, fiscal year 2021......................        73,531,000
Committee Recommendation..............................        86,455,000
    Change from enacted level.........................        +5,695,000
    Change from budget request........................       +12,924,000
Committee Recommendation (including Title VI).........        91,652,000
    Change from enacted level.........................       +10,892,000
    Change from budget request........................       +18,121,000
 

    Mission.--FIC's mission is to support and facilitate global 
health research conducted by U.S. and international 
investigators, building partnerships between health research 
institutions in the U.S. and abroad, and training the next 
generation of scientists to address global health needs.
    The Committee includes additional funding for FIC to 
support its mission of advancing research on and training the 
future biomedical research workforce in global health. The 
current COVID-19 pandemic illustrates the importance of FIC's 
efforts to build country capacity to enable cutting edge 
research at the origin of outbreaks, improving the likelihood 
that emerging diseases can be addressed at their source. 
Expanded resources will allow FIC-supported researchers to 
continue monitoring disease outbreaks and increase preparedness 
for future epidemics.
    Global Infectious Diseases.--Recent outbreaks of COVID-19, 
Ebola, Zika, and dengue have shown the importance of FIC's 
essential role in global infectious disease health research 
training and health system strengthening to assist developing 
countries in advancing their own research and health solutions 
and tools. The FIC has developed important partnerships in 
countries, including countries unfriendly to the U.S., to not 
only fight malaria, neglected tropical diseases, and other 
infectious diseases, but also to build their capabilities to 
detect and treat infectious diseases that are not endemic to 
the U.S. prior to spreading to the U.S., 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 capacity on the ground, helping to detect, 
prevent, and treat infectious diseases while strengthening 
bonds of trust with the U.S. though health diplomacy in their 
countries.

                   NATIONAL LIBRARY OF MEDICINE (NLM)

 
 
 
Appropriation, fiscal year 2020.......................      $456,911,000
Budget request, fiscal year 2021......................       415,665,000
Committee Recommendation..............................       460,841,000
    Change from enacted level.........................        +3,930,000
    Change from budget request........................       +45,176,000
Committee Recommendation (including Title VI).........       490,244,000
    Change from enacted level.........................       +33,333,000
    Change from budget request........................       +74,579,000
 

    In addition, the CARES Act included $10,000,000 for NLM to 
support research activities related to the COVID-19 pandemic.
    Mission.--The NLM collects and organizes information 
important to biomedicine; serves as a national information 
resource for medical education, research, and health service 
activities; enhances access to biomedical literature through 
electronic services; serves the public by providing electronic 
access to reliable health information for consumers; supports 
and directs the national network of libraries of medicine; 
provides grants for research in biomedical communications, 
medical library development, and training health information 
specialists; conducts and supports research in biomedical 
informatics and computational biology; and creates information 
resources for genomics, molecular biology, toxicology, medical 
images, environmental health, emergency preparedness and 
response, and health services research.

                      OFFICE OF THE DIRECTOR (OD)

 
 
 
Appropriation, fiscal year 2020.......................    $2,239,787,000
Budget request, fiscal year 2021......................     2,086,463,000
Committee Recommendation..............................     2,324,548,000
    Change from enacted level.........................       +84,761,000
    Change from budget request........................      +238,085,000
Committee Recommendation (including Title VI).........     4,599,548,000
    Change from enacted level.........................    +2,359,761,000
    Change from budget request........................    +2,513,085,000
 

    In addition, the CARES Act included $30,000,000 and the 
Paycheck Protection Program and Health Care Enhancement Act 
included $1,000,000,000 for OD to support and conduct research 
and related activities related to the COVID-19 pandemic.
    Mission.--The OD provides leadership to NIH research 
enterprise and coordinates and directs initiatives that 
crosscut NIH. OD is responsible for the development and 
management of intramural and extramural research and research 
training policy, the review of program quality and 
effectiveness, the coordination of selected NIH-wide program 
activities, and the administration of centralized support 
activities essential to the operations of NIH.
    The items below include issues and programs specific to the 
Office of the Director as well as those that involve multiple 
Institutes and Centers.
    Adult Cellular Therapies/Regenerative Medicine.--The 
Committee encourages NIH, in coordination with FDA and HRSA, to 
explore the feasibility and utility of an outcomes database for 
adult cellular therapies that are either FDA-approved or are 
being administered under FDA Investigational New Drug or 
Investigational Device Exemption protocols. The Committee also 
encourages engagement of experts and stakeholders to define 
data types and standards necessary for such a database.
    All of Us Program.--The Committee provides a total of 
$500,000,000 for the All of Us precision medicine initiative, 
the same as the fiscal year 2020 enacted level and $62,041,000 
above the fiscal year 2021 budget request. The total includes 
$109,000,000 authorized in the 21st Century Cures Act (P.L. 
114-255) to be transferred from the NIH Innovation Account.
    Amyloidosis.--The Committee encourages NIH to continue its 
expansion of research efforts in 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. Average survival without treatment is in months. 
The Committee directs NIH to inform the Committee on the steps 
NIH has taken to understand the causes of amyloidosis and the 
measures taken to improve the diagnosis and treatment of this 
devastating group of diseases in the fiscal year 2022 
Congressional Justification.
    Amyotrophic Lateral Sclerosis (ALS).--The Committee 
strongly supports the Transformative Research Award program for 
ALS and directs the Director to continue to fund this critical 
initiative in fiscal year 2021.
    Animal Use in Research.--The Committee is aware that in 
September 2019, GAO issued a report entitled ``Animal Use in 
Research: Federal Agencies Should Assess and Report on Their 
Efforts to Develop and Promote Alternatives.'' The Committee 
understands that this report found that the Interagency 
Coordinating Committee on the Validation of Alternative Methods 
(ICCVAM) and its member agencies have not routinely developed 
or reported metrics to demonstrate how their efforts to 
encourage the use of alternative methods affect animal use in 
research. The Committee acknowledges NIEHS for having helped 
establish a workgroup of ICCVAM member agencies to identify 
potential quantitative and qualitative metrics that could 
provide data for comprehensively assessing progress of agencies 
toward reducing, refining, and replacing animal use in 
research. The Committee is aware that the Environmental 
Protection Agency (EPA) has committed to eliminate its requests 
for, and funding of, whole and live animal studies by 2035. The 
Committee therefore directs this workgroup to actively 
collaborate with EPA to determine where replacement 
alternatives to animal testing are lacking, to ensure any gaps 
in currently available methods to replace animal testing are 
filled before 2035. The Committee directs that interagency 
workgroup to report its findings to the Committee by 2022 and 
use these metrics to assess progress in using alternative 
methods at EPA, and other agencies that are part of ICCVAM, in 
ICCVAM's required biennial report to be issued in 2024.
    Artificial Intelligence.--The Committee supports NIH's 
efforts in research using artificial intelligence. Merging the 
biological and computer sciences, artificial intelligence can 
accelerate the analysis of large, complex datasets to better 
understand disease and improve care.
    Behavioral Research.--The Committee believes that a more 
robust and focused NIH commitment to behavioral science 
research and training would yield significant improvements to 
the nation's health due to the important connections between 
behavior and health. Most of the leading public health issues 
facing our nation--including cancer, addiction, heart disease, 
mental illness, diabetes, violence, and AIDS--are rooted in 
individual and social behavior, yet behavioral science is 
decentralized across NIH's Institutes and Centers, and the NIH 
commitment to manage and directly fund this important research 
is limited. The Committee directs the Director to convene a 
special advisory panel of behavioral scientists and other 
community experts to complete an assessment providing 
recommendations on how to better integrate and realize the 
benefits to overall health from behavioral research at NIH. The 
Committee requests that this assessment be finalized before the 
end of fiscal year 2021 and that a report be submitted to the 
Committee at that time.
    Biomedical Research Facilities.--The bill provides 
$50,000,000, the same as the fiscal year 2020 enacted level and 
$50,000,000 above the fiscal year 2021 budget request, for 
grants to public and/or 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, as well as applicants that 
demonstrate innovative solutions and cost savings to meet 
safety and scientific requirements of facilities for basic, 
translational, and clinical research. The Committee also 
directs NIH to allocate no less than 25 percent of funding for 
this program to institutions that serve underrepresented and 
underprivileged populations and to institutions in the 
geographical areas with deficits in research resources, access 
to advanced technologies, and health-related services to ensure 
geographic and institutional diversity.
    Black Men in Medicine and Science.--The Committee supports 
the efforts of the National Academies Roundtable on Black Men 
and Black Women in Medicine to explore the factors that 
contribute to the low participation of Black men in the medical 
profession. The Committee directs the Director to allocate 
increased resources through the Common Fund to address the 
increasing underrepresentation of Black men in medical schools 
and in the biomedical research profession. In addition, the 
Committee recognizes the need to increase the number of 
biomedical research professionals as leaders in critical areas 
of national need. The Committee directs NIH to establish a 
scholarship program that encourages African American students 
to pursue a career in medicine, science, and biomedical 
research to combat the persistent decline of Black male 
physicians over the last decade.
    Biorepository Catalog.--The Committee is encouraged by 
efforts within the biomedical research community to better 
understand chronic diseases through biorepositories which store 
medical tissues and associated information for scientific 
research. Increasing awareness and utilization of these 
biorepositories by the wider medical community would be highly 
useful to science, medicine, and national security. The 
Committee encourages NIH to partner with one or more research 
institutions to implement innovative approaches for improving 
the discoverability and utility of biorepositories for tissues 
and associated data for cardiovascular diseases, 
neurodegenerative diseases, cancer and diabetes. The Committee 
encourages NIH, along with the sponsoring research institution 
or institutions, to establish protocols for the release of 
tissues and associated data from such biorepositories.
    Brain and Body Health.--The Committee encourages 
partnership and collaboration with entities able to explore the 
similarities in the brains and comorbid conditions of those 
with Alzheimer's disease, dementia, and autism, to facilitate 
studies related to brain and body health, including studies 
designed to improve and empirically validate a variety of 
supports for complex conditions.
    Centers for Polysubstance Use Research.--The Committee is 
pleased that NIH supports research on alcohol/polysubstance use 
and encourages the Director to increase research in this area 
through additional comprehensive centers across the U.S. Given 
the increasing prevalence of polysubstance deaths, particularly 
among rural and minority communities, the Committee also 
encourages the Director to focus one or more centers on rural 
and minority communities with high rates of alcohol and 
polysubstance use mortality.
    Childhood Post-Infectious Autoimmune Disorders.--The 
Committee continues to be concerned that children, following 
streptococcal and other infections, are experiencing the onset 
of neuropsychiatric and behavioral disorders. These auto-
inflammatory encephalopathic conditions, including Pediatric 
Autoimmune Neuropsychiatric Disorders Associated with 
Streptococcal Infections (PANDAS) and Pediatric Acute-onset 
Neuropsychiatric Syndrome (PANS), are often misdiagnosed. 
Delays in diagnosis and lack of developed avenues of treatment 
result in a devastating escalation of mental health symptoms 
and associated costs. The Committee encourages NIH to explore 
cross-disciplinary research in this area, including 
neurobiology, neurology, immunology, infectious disease, and 
mental health, and report to the Committee in the fiscal year 
2022 Congressional Justification on the understanding of the 
incidence, causes, diagnostic criteria, and treatment of these 
conditions.
    Clinical Trials During the COVID-19 Pandemic.--The 
Committee appreciates the accommodations NIH has made for 
clinical trial sites so that institutions can continue to 
safely conduct clinical trials during the COVID-19 pandemic. 
The Committee encourages the Director to make investments in 
research at trial sites to study the impacts of these 
flexibilities on trial participants, providers, and the overall 
integrity of the research, and to determine similar adaptations 
that could be made to improve accessibility of trials, 
especially for those with historically low participation rates 
(e.g., racial and ethnic minorities, rural residents, 
adolescent and young adults, and older adults).
    Common Fund.--The Committee recommends $631,899,000 for the 
Common Fund (CF), and an additional $12,600,000 provided to 
support the Gabriella Miller Kids First Research Act for the 
seventh year of the ten-year Pediatric Research Initiative. 
This is $5,388,000 above the fiscal year 2020 enacted level and 
$48,032,000 above the fiscal year 2021 budget request.
    Community-Based Participation Initiative for Tick-Borne 
Diseases.--The Committee recognizes that community-based 
physicians, advocates, and patients are potential resources who 
can add value to a broad range of NIH's tick-borne disease 
(TBD) activities as they are in other diseases, such as HIV. 
The Committee encourages NIH to establish a Community-Based 
Participation (CBP) initiative for TBD and to identify 
community-based resources--data and people--to evaluate how 
community-based perspectives can add significant value to and 
be incorporated into the broad range of TBD activities, such as 
strategic planning, research portfolio design, programs, 
special Initiatives, grant proposals and peer review.
    Diversity at NIH Working Group and Strategic Plan.--While 
the Committee is encouraged by the NIH's demonstrated 
commitment to diversity, the Committee remains concerned about 
the continued lack of diversity at NIH among staff and 
grantees. Accordingly, the Committee requests, within 180 days 
of enactment of this Act, a strategic plan with long-term and 
short-term goals to address the racial, ethnic, and gender 
disparities at NIH. Given recent research in funding gaps at 
NIH, the Committee requests that this strategic plan identifies 
barriers in access to NIH funding by investigators researching 
health disparities, as well as corrective solutions that can be 
implemented at NIH. The Committee encourages NIH to establish a 
working group to support development and implementation of this 
plan, which should be comprised of, but is not limited to, the 
NIH Office of Equity, Diversity, and Inclusion; Institute and 
Center Directors and their designees; extramural grantees; 
experts working in diversity and inclusion; and other community 
stakeholders.
    The Committee requests a report from the NIH within 90 days 
of enactment of this Act that includes detailed information 
about the composition of the NIH workforce, advisory 
committees, and grantees over the last five fiscal years. The 
data should include disaggregated race and ethnicity data, 
gender, disability status, and veteran status. For grantees and 
advisory committee members, the data should also include data 
on the institution of terminal degree and undergraduate 
institution.
    Diversity in Alzheimer's Disease Clinical Trials.--The 
Committee appreciates NIH taking actions to address under-
representation of minority populations in Alzheimer's disease 
and dementia clinical trials. To build upon this work, the 
Committee directs the Director, in concert with NIA and NIMHD, 
to examine the language accessibility of its Alzheimer's 
disease clinical trials and report back on opportunities to 
strengthen access to clinical research for volunteers who are 
not fluent in English. Further, the Committee directs NIH to 
enhance the functionality of ClincalTrials.gov to include ways 
to more easily identify trials that accept participants in 
different languages. The Committee requests a project plan and 
timeline for implementing these changes within 180 days of 
enactment of this Act.
    Duchenne Muscular Dystrophy Research Models.--In recent 
years, more Duchenne drug trials have failed than succeeded 
despite promising results from pre-clinical animal models. 
These results lead to years of inefficient drug development and 
few approved treatments. The Committee urges NIH to convene a 
multi-stakeholder workshop to evaluate pre-clinical animal 
models used frequently in muscular dystrophy treatment 
research, including Duchenne muscular dystrophy, and to 
consider whether alternative models or strategies may improve 
therapy development outcomes.
    Eating Disorder Research.--The Committee commends NIH for 
supporting multi-Institute research on the chronic, fatal, and 
serious mental illnesses encompassing eating disorders that 
affect 30 million Americans during their lifetimes, and its 
association with other conditions such as diabetes, 
infertility, heart disease, PTSD, substance use, co-morbid 
mental illnesses, and tooth decay. The Committee recognizes 
that eating disorders are a deadly bio-psycho-social illness 
and that multiple research topics must be explored to 
understand, prevent, and treat eating disorders, including 
psychosocial issues; health disparities and food insecurity; 
environmental factors such as weight stigma; the complex 
interplay of metabolic processes; and maternal health. The 
Committee encourages NIH to increase support for eating 
disorders research and explore these and other research 
questions through multiple Institutes and Centers, including 
NIMH, NIDDK, NIMHD, and NIDA. The Committee directs NIH to 
inform the Committee on the steps taken to increase support for 
eating disorders and measures taken to improve prevention, 
diagnosis, and treatment of eating disorders in the fiscal year 
2022 Congressional Justification.
    E-Cigarette Research.--The Committee encourages NIH to 
prioritize research into the understanding of the biological 
changes that occur due to use of electronic nicotine delivery 
systems (ENDS) among adolescents.
    Ehlers-Danlos Syndrome.--The Committee encourages NIH to 
support research and activities with respect to Ehlers-Danlos 
Syndrome and related connective tissue disorders.
    Environmental Influences on Child Health Outcomes (ECHO).--
The Committee includes no less than the fiscal year 2020 
enacted level for the ECHO Project, which has the potential to 
greatly increase understanding of these critical determinants 
of health across the lifespan, through its observational 
cohorts and the IDeA States Pediatric Clinical Trials Network. 
The Committee encourages continued communication about the 
program's progress toward goals, milestones, and projected 
funding estimates with both external stakeholders and Congress.
    Federal Advisory Committees Transparency Initiative.--The 
Committee recognizes that Federal advisory committees 
established as part NIH pursuant to 42 U.S.C. 282(b)(6) fill an 
important role in advising NIH on major decisions on plans and 
policies. However, to guarantee due process, it is vital that 
all NIH Federal advisory committees operate in a transparent 
way. As such, the Committee directs all NIH Federal advisory 
committees, including in particular the Literature Selection 
Technical Review Committee (LSTRC), to make public their 
standards of review, decision-making methodologies, and 
processes by which to appeal a recommendation. Moreover, the 
LSTRC and all other NIH Federal advisory committees shall 
ensure that they are operating in accordance with the 
provisions of the Federal Advisory Committee Act, as amended (5 
U.S.C., Appendix 2).
    Firearm Injury and Mortality Prevention Research.--The 
Committee includes $25,000,000 to support research on the 
prevention of gun violence, $12,500,000 above the fiscal year 
2020 enacted level and $25,000,000 above the fiscal year 2021 
budget request. Research should focus on biological, 
behavioral, and environmental mechanisms that underlie 
aggression, as well as prevention of self-directed violence.
    The Committee recognizes that community gun violence, such 
as gang violence, constitutes a significant portion of gun 
homicides in the U.S. There is a disproportionate impact of 
community gun violence on low-income communities of color, 
which is not often reflected in the national narrative 
surrounding gun violence. The Committee encourages NIH to 
support research on community gun violence and to select 
grantees that reflect the diversity of the victims of gun 
violence and that work in or near the impacted communities.
    Fostering Department of Energy (DOE)-NIH Partnership for 
Radiopharmaceutical Production and Use.--The Committee 
encourages NIH to explore novel applications for 
radiopharmaceuticals and leverage next-generation advanced 
manufacturing techniques for isotope production being made by 
DOE-funded research universities and National Laboratories.
    Fragile X (FX).--The Committee encourages NIH to expand the 
base of researchers and clinicians who are familiar with and 
trained in the Fragile X-associated disorders and promoting 
collaboration between basic scientists and clinicians to enable 
researchers to better understand phenotypes, document 
variations in how the disorder presents itself, identify 
potential biomarkers and outcome measures, and develop new 
interventions.
    Gene-Environment Interactions in Neurodegenerative 
Disorders in Diverse Populations of African Americans and 
Latinos.--In the context of NIH's robust neurological disease 
research portfolio, the Committee commends the leadership of 
NIH in advancing the relevant objectives of the 21st Century 
Cures Act and the BRAIN Initiative. The Committee is concerned 
and recognizes the need to better understand the interactions 
between genetics and environmental factors, in particular with 
regard to elderly and diverse populations of African Americans 
and Latinos. The Committee encourages NIH to accelerate 
collaborative research across relevant Institutes and Centers 
and the research community to address the goal of determining 
the role of the interaction between environmental exposures to 
toxic chemicals, other environmental stressors, and genetics 
and their impact on neurodegenerative disorders in diverse 
populations of African Americans and Latinos, to allow for 
earlier diagnosis and subsequent treatment to arrest the 
progression of these devastating neurodegenerative disorders.
    Harassment Policies.--The Committee commends NIH for its 
ongoing work focused on changing the culture of sexual 
harassment that is pervasive throughout its biomedical research 
laboratories. However, the Committee believes NIH must do more 
to play an active role in addressing sexual harassment and 
gender discrimination, particularly in extramural research 
settings. For this reason, in the statement of managers 
accompanying the Consolidated Appropriations Act, 2020, the 
conferees directed ``NIH ``to require institutions to notify 
the agency when key personnel named on an NIH grant award are 
removed because of sexual harassment concerns''. NIH took a 
major step toward implementing this direction in its June 11, 
2020 clarification of its ``Guidance Regarding Change of 
Status, Including Absence of PD/PI and Other Key Personnel 
Named in the Notice of Award'' (NOT-OD-20-124), but then fell 
short by not requiring its grantees to notify it when key 
personnel are removed for concerns of harassment. The Committee 
directs NIH to revise this guidance within 30 days of enactment 
of this Act to make clear that grantees must identify any 
changes to key personnel on an award that are related to 
concerns about harassment. These new terms and conditions must 
also require the awardee to notify NIH if the Principal 
Investigator (PI) or co-PI is placed on administrative leave or 
if the awardee has imposed any administrative action on the PI 
or any co-PI relating to any finding, determination or 
infraction regarding codes of conduct, statutes, regulations, 
or executive orders related to sexual harassment, other forms 
of harassment, or sexual assault within ten business days from 
the date of the finding or determination or the date of the 
placement of a PI or co-PI by the awardee on administrative 
leave or the imposition of an administrative action. The 
Committee directs NIH, in coordination with the HHS Office for 
Civil Rights, to assess the feasibility of creating a pathway 
of communication and reporting for individuals to report 
concerns of sex discrimination occurring in NIH-funded 
extramural laboratories outside of the Title IX complaint 
process. The Committee directs NIH to develop written guidance 
specifying the types of reporting considered to be informal and 
possible ways information regarding concerns of sex 
discrimination, including sexual harassment, may be used. The 
Committee directs NIH to submit to the Committee, within 90 
days of enactment of this Act, goals and a plan outlining the 
potential for this pathway and guidance and assessing the 
agency's sexual harassment prevention and intervention efforts 
for grantees, including methods to regularly monitor and 
evaluate sexual harassment prevention and intervention policies 
and communication mechanisms. Finally, the NIH Director is 
directed to provide semiannual reports to the Committee 
detailing progress made toward these activities.
    Human Microbiome Project.--The Committee is pleased with 
the developments made by the NIH's Human Microbiome Project and 
encourages relevant Institutes and Centers to spearhead new 
cross-disciplinary efforts in microbiome sciences. The 
Committee also encourages collaborations with academia to 
develop knowledge and tools required to predict and control 
behavior of diverse microbiomes through multidisciplinary 
approaches.
    Humane Research Alternatives.--Recognizing that humane, 
cost-effective, and scientifically suitable non-animal methods 
are available but underutilized, the Committee requests that 
NIH assemble a panel to investigate and make recommendations 
regarding incentives for more quickly and effectively moving 
NIH intramural and external research away from methods that 
rely on animals to methods that rely on non-animal 
alternatives. The panel should review and recommend means of 
encouraging greater reliance on existing humane and 
scientifically satisfactory non-animal methods. Panel 
membership should include individuals with proven knowledge of/
experience with non-animal research methods; with expertise in 
evaluating the adequacy of searches for non-animal methods 
described in research proposals; and with knowledge of the 
welfare concerns and scientific limitations of animal-based 
studies. The Committee asks that NIH provide a report of the 
panel's findings by June 2022.
    Impact of Racism on Public Health.--Many local officials 
and health departments are declaring racism as a public health 
emergency. National organizations such as the American Medical 
Association, the American College of Physicians, and the 
American Academy of Pediatrics have made similar statements 
decrying the impact of racism on health. Many studies have 
shown that racism--as expressed through implicit and explicit 
biases, institutional structures, and interpersonal 
relationships--has a negative impact on the health of impacted 
communities. The Committee directs NIH to provide a report to 
the Committee within 90 days of enactment of this Act 
summarizing NIH's current portfolio of research on racism as a 
social determinant of health and outlining how NIH plans to 
expand and build upon this work.
    Increasing Diversity in Health Disparities Research.--The 
Committee recognizes that there is an urgent need to increase 
the representation of Hispanic patients, caregivers, clinicians 
and researchers in biomedical research, particularly in health 
disparities research. The Committee encourages NIH to develop a 
Junior Faculty Research Accelerator program to support efforts 
related to scientific workforce diversity and help ensure 
better health outcomes and reduce health care disparities 
affecting the underrepresented communities, including the 
Hispanic community. Such a program should recruit junior 
researchers from medicine and public health from across the 
nation and match them with senior researchers experienced with 
health disparities research. Participants should receive one-
on-one mentoring, onsite educational meetings at NIH, and 
access to other assistance and resources that place them on a 
research track relevant to underserved communities, public 
health, prevention, and social determinants of health.
    Induced Pluripotent Stem Cell (iPSC) Technology.--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 
immense therapeutic value and potential for curing human 
diseases. The Committee recognizes that basic science leads to 
pre-clinical trials, cures, diagnostics, and treatments and 
encourages NIH to further explore additional basic science 
opportunities. In addition, the Committee understands that 
collaborative consortiums such as the Southeast Stem Cell 
Consortium (SESCC) leverages research capabilities to further 
advance scientific knowledge in the area of iPSC basic 
research. The Committee requests an update in the fiscal year 
2022 Congressional Justification on NIH efforts to expand iPSC 
technology basic research through collaborative consortiums.
    Inflammatory Bowel Diseases (IBD).--The Committee commends 
NIH for leading cross-Institute initiatives focused on 
nutrition, including a Strategic Plan for Nutrition Research 
and a precision nutrition initiative within the NIH Common 
Fund. To advance these efforts with a focus on IBD and related 
chronic inflammatory autoimmune diseases, the Committee 
encourages NIH to work with multiple Institutes and Centers on 
current and emerging IBD disease research priorities including 
the interactions among food, the gut, and the brain/nervous 
system in people with IBD and other chronic gastrointestinal 
diseases.
    Intramural Primate Research.--The Committee remains 
concerned about NIH's intramural use of nonhuman primates in 
biomedical research and continues to urge NIH to accelerate 
efforts to identify more efficient and effective alternatives 
to nonhuman primate research. The Committee directs NIH to 
provide a report to the Committee no later than one year after 
enactment that outlines a plan to implement more efficient and 
effective alternatives to nonhuman primate research activities, 
describes how these alternatives have reduced intramural 
research using nonhuman primates by December 31, 2025, and 
outlines a plan for retirement of primates no longer needed in 
intramural research.
    Lyme and Other Tick-Borne Diseases.--The Committee strongly 
encourages NIH to hold, within one year of enactment of this 
Act, a workshop on the numerous molecular and functional 
mechanisms that Borrelia burgdorferi (Bb) employs to evade and 
subvert the immune system of the human host and the immune 
responses and consequences and also how these mechanisms and 
responses can subvert the effectiveness of antibiotics. The 
Committee supports inclusion of other TBD pathogens to consider 
shared and unique characteristics of the pathogens as NIH 
determines practical for the workshop, with participation by 
researchers who have published peer-reviewed articles 
describing such mechanisms and immune cell responses, 
particularly for Bb. Multiple, well-documented, defense 
mechanisms of Bb should be evaluated and recognized as 
understanding these mechanisms and their significance underpins 
the ability to develop effective diagnostics and treatments. 
The Committee encourages NIH to continue research on early 
diagnosis and treatment of Lyme and other TBD to prevent the 
development of late stage disease and more serious and longer-
term disability, but also intensify research on diagnosis and 
treatment of late stage and chronic disease. Priority should be 
based on disease burden and should be given to Lyme disease, 
which has a high public health burden in the U.S. and has a 
significant patient population who are not diagnosed until late 
stage when treatment is more difficult.
    Microbiome Research.--The last decade has seen an explosion 
in microbiome data. The microbiome is now considered an 
unrealized source for drug targets and precision medicine, yet 
the nontraditional collaborations between leaders in microbial 
ecology, engineering, and medicine required for translation and 
innovation are currently lacking. Support for a centralized 
venue for experts from universities and the public and private 
sectors to partner, share and analyze data, and support bench-
to-bedside-to-bench research is critical to enhancing our 
understanding of microbial relationships to human health and 
accelerate discovery.
    Mitochondrial Disorder Research and Coordination.--The 
Committee is aware that NIH has spearheaded a number of 
initiatives to identify new mitochondrial disorders, discover 
the linkages between mitochondrial disorders, and translate 
advances in mitochondrial research to treatments, cures, and 
other medical interventions for mitochondrial disorders and 
their secondary diseases, such as Alzheimer's disease, 
Parkinson's disease, and cancer. The Committee is supportive of 
NIH's efforts through the formation of the North American 
Mitochondrial Disease Consortium (NAMDC) and its associated 
registry as well as coordination among Institutes and Centers 
to support the Mitochondrial Disease Sequence Data Resource 
Consortium (MSeqDR), which serves as a robust central 
repository for genomic sequencing data for mitochondrial 
disorders.
    Mucopolysaccharidosis (MPS).--MPS diseases are inherited, 
with death occurring for many in early childhood. This 
systematic disease causes progressive damage to the bones, 
heart, respiratory system, and brain. The Committee continues 
to urge NIH, particularly NCATS and NINDS, to put a high 
priority on better understanding and treating MPS and 
mucolipidosis diseases. The Committee also 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, inflammatory, cardiovascular, and skeletal 
manifestations of MPS, with an emphasis on gene therapy. The 
Committee thanks NINDS, NIDDK, and ORDR for again funding the 
Lysosomal Disease Network (LDN) through the Rare Disease 
Clinical Research Network (RDCRN) and for funding lysosomal 
research meetings. The Committee encourages the NIH to 
incentivize MPS research. Understanding the manifestations and 
treatments of both the skeletal and neurological disease 
continues to be the greatest areas of unmet needs.
    National Commission on Lymphatic Diseases.--The Committee 
encourages NIH to work with relevant stakeholders to advance 
the establishment of a National Commission on Lymphatic 
Diseases that will make critical recommendations on 
coordinating NIH-wide lymphatic disease research. The Committee 
requests an update no later than 90 days after the enactment of 
this bill about specific next steps to establish the 
Commission. In addition, the Committee is concerned that not 
enough research is focused on lymphedema and requests a report 
within 120 days of enactment of this Act regarding the annual 
support level for lymphatic research funding over the past five 
years, including the types of grants supported in the last five 
fiscal years.
    National Laboratories.--NIH funding supports investments 
which are collaborative with the ongoing work of the DOE. The 
Committee directs NIH to update the committee on the work to 
coordinate its efforts with DOE and the National Laboratories, 
and in more strategic ways to leverage NIH's research needs in 
the next generation of cancer research, brain mapping, drug 
development or other emerging ideas in biomedical research that 
requires DOE's instrumentation, materials, modeling simulation, 
and data science. In 2015, the Secretary of Energy established 
the Energy Advisory Board (SEAB) to evaluate the prospects for 
increased collaboration between DOE researchers and biomedical 
scientists supported by other agencies, especially NIH. 
Increased and more effective coordination could be instrumental 
to assist in the development of the Nation's health, security, 
novel biomedical technologies, and in the development of more 
strategic enabling technologies. The Committee supports NIH's 
collaboration with DOE and the National Laboratories in an 
effort to maximize utilization of DOE's capabilities, 
particularly for NIH's rapidly growing data and computational 
challenges.
    National Research Service Award (NRSA) Program.--The 
Committee encourages NIH to continue support for the Minority 
Biomedical Research Support (MBRS), the Graduate Research 
Training Initiative for Student Enhancement (G-RISE), and the 
Undergraduate Research Training Initiative for Student 
Enhancement (U-RISE) programs under the NRSA program. These 
programs aim to increase the participation of, and broaden 
opportunities for, underrepresented minority faculty, 
investigators, and students engaged in biomedical and 
behavioral research.
    Neurofibromatosis (NF).--The Committee supports efforts to 
increase funding and resources for NF research and treatment at 
multiple Institutes, including NCI, NINDS, NIDCD, NHLBI, NICHD, 
NIMH, NCATS, and NEI. Children and adults with NF are at 
elevated risk for the development of many forms of cancer, as 
well as deafness, blindness, developmental delays and autism; 
the Committee encourages NCI to increase its NF research 
portfolio in fundamental laboratory science, patient-directed 
research, and clinical trials focused on NF-associated benign 
and malignant cancers. The Committee also encourages NCI to 
support clinical and preclinical trials consortia. Because NF 
can cause blindness, pain, and hearing loss, the Committee 
urges NINDS, NEI, and NIDCD to continue to aggressively fund 
fundamental basic science research on NF relevant to restoring 
normal nerve function. 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 increase their investments in laboratory-
based and patient-directed research 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-related research. NF can cause 
vision loss due to optic gliomas. The Committee encourages NEI 
to expand its investment in NF1-focused research on optic 
gliomas and vision restoration.
    NIH Chimp Retirements to Chimp Haven.--The Committee is 
aware that NIH has a statutory duty under the CHIMP Act (42 
U.S.C. 283m) to retire all surplus chimpanzees to the national 
sanctuary system, and NIH's stated plan to now keep the 
chimpanzees at Alamogordo Primate Facility (APF) instead of 
moving them to Chimp Haven goes against the intent of Congress. 
While NIH cites the health condition of the chimpanzees as a 
reason to warehouse them at APF, it is because of their health 
and long history of laboratory use that makes it urgent they be 
provided an opportunity to live the remainder of their lives in 
sanctuary, even if for a short period. This is not only a 
concern about chimp welfare, but also taxpayer spending. 
According to the most recent APF contract, it costs 
approximately $133 per day per chimpanzee to keep them at APF 
compared to $42 per chimpanzee per day at Chimp Haven. The APF 
costs will continue to increase as the population declines 
while Chimp Haven costs will decline as their population 
increases. Therefore, recognizing the best interests of both 
the chimps and taxpayer costs, the Committee strongly 
encourages the NIH to resume transport of all APF chimpanzees 
to Chimp Haven no later than November 1, 2020 and complete by 
May 15, 2021. Movement of government-owned and supported chimps 
from Southwest National Primate Research Center (SNPRC) and 
Keeling Center for Comparative Medicine and Research (KCCMR) 
should immediately follow transport of the APF chimpanzees to 
Chimp Haven and conclude no later than November 1, 2022. The 
Committee also directs NIH to provide updates to the Committee 
each quarter, beginning no later than December 31, 2020 that 
shall include: (1) the number of chimpanzees transported to the 
national sanctuary over the last quarter; (2) a census of all 
government-owned and supported chimpanzees remaining, if any, 
at APF, SNPRC or KCCMR; and (3) a list of any chimpanzee deaths 
that have occurred at any time after January 1, 2020 at either 
APF, SNPRC or KCCMR.
    NIH Division of Police.--The Committee directs the NIH 
Division of Police, to the extent it has not already done so, 
to submit their use of force data to the Federal Bureau of 
Investigation's National Use of Force Data Collection database. 
The Committee further directs, within 90 days of enactment of 
this Act, the Director to brief the Committee on its current 
efforts to tabulate and submit its use of force data to the 
FBI.
    Office of AIDS Research.--The Committee includes no less 
than $3,107,000,000 for HIV/AIDS research, an increase of 
$37,000,000 above the estimated fiscal year 2020 level. This 
investment builds on an increase of $31,000,000 included in 
fiscal year 2020, bringing the two-year increase for NIH's HIV/
AIDS research to a total of $99 million.
    Office of Behavioral and Social Sciences Research 
(OBSSR).--OBSSR was established to coordinate and promote 
basic, clinical, and translational research in the behavioral 
and social sciences in support of the NIH mission. The 
Committee supports OBSSR's activities aimed at strengthening 
these sciences by enhancing trans-NIH investments in 
longitudinal datasets, technology in support of behavior 
change, innovative research methodologies, and promoting the 
inclusion of behavioral and social sciences in initiatives at 
the NIH Institutes and Centers. In partnership with other 
Institutes and Centers, OBSSR co-funds highly rated grants that 
these Institutions and Centers cannot fund alone, and 
coordinates NIH's high-priority program on gun violence 
prevention research.
    Office of Research on Women's Health (ORWH).--The Committee 
commends the ORWH on its efforts to ensure that NIH-supported 
research addresses issues that affect women, promote the 
inclusion of women in clinical research, and develop and expand 
opportunities for women throughout the biomedical research 
career pipeline. The Committee is disappointed that funding for 
ORWH has lagged behind the total funding for NIH over the past 
several years. The Committee includes no less than $43,925,000, 
an increase of $5,000,000 above the estimated fiscal year 2020 
funding level, for ORWH to expand its work in fiscal year 2021.
    Osteopathic Medical Schools.--Osteopathic medical schools 
serve an important role in treating our nation's rural, 
underserved, and socioeconomically challenged populations. 
Doctor of Osteopathic Medicine, usually primary care 
clinicians, currently make up 11 percent of the active 
clinician workforce, and their numbers are projected to grow to 
20 percent by 2030. In addition, currently 34 of America's 185 
medical schools (18 percent) are Doctor of Osteopathic Medicine 
schools, and 26 percent of students entering medical school are 
osteopathic medical students. Historically, this group lacks 
access to research funding and is disproportionately 
underrepresented in NIH review panels. Currently, Doctor of 
Osteopathic Medicine receive only 0.1 percent of NIH grants. Of 
the 3,233 grant reviewers on the 173 NIH standing study 
sections established to provide grant review for calendar year 
2018, zero had Doctor of Osteopathic Medicine credentials. The 
Committee supports efforts to ensure the full range of medical 
professionals are included in grant awards and grant review 
panels.
    Pediatric Research.--The Committee requests an update from 
the Director within 120 days of enactment of this Act on how 
NIH will focus on the unique needs of children in its NIH-wide 
initiatives that span multiple Institutes and Centers, as well 
as its highest priority initiatives, including but not limited 
to the All of Us Research Program and the Cancer Moonshot. The 
Committee asks that with respect to these major NIH 
initiatives, this update describe the inclusion of pediatric 
subjects, research relevant to pediatrics, specific funding 
allocations, support for pediatric physician scientists, and a 
strategy to more proportionally target funds within these 
initiatives to pediatric research. The Committee commends NIH 
for the establishment of the Trans-NIH Pediatric Research 
Consortium to help coordinate pediatric research at NIH. The 
Committee also requests an update in the fiscal year 2022 
Congressional Justification on the activities of the Consortium 
and its plans to better coordinate pediatric research across 
the institutes, including identifying gaps and opportunities 
for collaboration.
    Pelvic Floor Disorders.--The Committee recognizes that 
pelvic floor disorders, including such conditions as urinary 
incontinence, accidental bowel leakage, and pelvic organ 
prolapse, have a large financial impact on individuals and 
society, and significant negative quality of life impact for 
more than 25 million women annually, in the U.S. alone. The 
Committee urges NICHD, NIDDK, and NIA to collaborate, on the 
development of universally accepted disorder specific data sets 
for the purpose of research studies on patient outcomes of 
current and future therapies used to treat pelvic floor 
disorders and the pathogenesis of these conditions. The 
Committee requests that NICHD, NIDDK and NIA provide a report 
on current research and future initiatives to address pelvic 
floor disorders in the fiscal year 2022 Congressional 
Justification and provide timely updates to the Committee on 
advances being made with respect to prevention, treatment and 
understanding the mechanisms of these conditions.
    Polycystic Ovary Syndrome (PCOS).--The Committee recognizes 
the significant health burden of PCOS, the most common cause of 
female infertility. About 10 million women have PCOS, which has 
affected their reproductive, mental, and metabolic health and 
wellness. The Committee commends NICHD for its continued 
leadership in PCOS research. Over 70 percent of NIH's 
investment in PCOS research has focused on symptoms and 
comorbidities that impact women's reproductive health. Pregnant 
women with PCOS are more likely to develop preeclampsia 
(pregnancy-related hypertension) and have emergency C-sections. 
Given that the majority of NIH research on PCOS has focused on 
reproductive implications of the syndrome, critical gaps still 
exist in understanding the connections between these severe 
comorbidities and PCOS. The Committee encourages NIH to expand 
its PCOS research activities and programs to include research 
on comorbidities associated with PCOS, including liver disease, 
uterine cancer, heart disease, stroke, diabetes, anxiety, 
depression, sleep disorders, and suicide. Therefore, the 
Committee requests an update in the fiscal year 2022 
Congressional Justification on current PCOS research activities 
on related comorbidities and existing research gaps, as well as 
opportunities for trans-NIH research efforts to address PCOS 
and related diseases. The Committee urges NIH to prioritize 
PCOS research funding for New and Early Stage Investigator 
Awards, and to encourage experienced biomedical and public 
health researchers to study PCOS and collaborate with patients 
to identify more effective treatments and a possible cure for 
PCOS.
    Post-Research Adoption of Animals in Extramural Research.--
The Committee commends NIH and other agencies for instituting 
policies and procedures to facilitate the placement of animals 
no longer needed for research with families or nonprofit 
shelters or sanctuaries. This is a far more humane and less 
wasteful practice than euthanizing otherwise healthy animals. 
The Committee notes, however, that the NIH policy covers only 
NIH intramural research. Animals used in NIH funded extramural 
research also should not be needlessly euthanized at the end of 
the experiment if they are determined to be healthy enough to 
be adopted or retired. The Committee encourages NIH to require 
grantees receiving extramural funds from NIH for research using 
animals to implement post research adoption policies that are 
at least as comprehensive as the NIH intramural policy. The 
committee requests that NIH provide a written update on this 
effort within one year of enactment of this Act.
    Prematurity and Maternal Mortality.-- Preterm birth and its 
complications continue to be the leading cause of death for 
infants in the U.S. and around the world. The Committee is 
aware that the PREEMIE Reauthorization Act of 2018 (P.L. 115-
328) enables the Secretary to establish an interagency working 
group to improve coordination of programs and activities within 
the Department to prevent preterm birth, infant mortality, and 
related adverse birth outcomes. The Committee requests a report 
within 60 days of enactment of this Act regarding NIH's 
activities to create the interagency workgroup and its 
activities to-date to accomplish the duties outlined in the 
PREEMIE Act. In addition, the Committee recognizes the 
disparities in outcomes by race, ethnicity, geography and 
income related to maternal mortality and prematurity and 
appreciates the work of many agencies in addressing these 
disparities. The Committee directs the Interagency Workgroup to 
develop a coordinated Department-wide strategy and 
implementation plan to share learnings and identify and address 
factors that lead to maternal mortality and prematurity, 
including those socio-economic and racial-ethnic factors 
contributing to disparities in outcomes and inequities in 
health care. Within one year of the enactment of this Act, the 
Committee directs NIH to submit a report to the Committee on 
the aforementioned strategy and a plan for implementation.
    Rare Disease Research.--The Committee is aware that nearly 
one in ten individuals in the U.S. is affected by a rare 
disease, and that rare diseases frequently are genetic or have 
a genetic component. The Committee urges NIH to expand research 
on rare genetic and chromosomal abnormalities, such as 7q11.23 
Duplication Syndrome and Hereditary Spastic Paraparesis 49 
(TECPR2).
    SARS-CoV-2 Pediatric Research Agenda.--The Committee is 
concerned with the impact of SARS-CoV-2 infection in children, 
including Multisystem Inflammatory Syndrome in Children (MIS-C) 
and impacts for children with underlying medical conditions. 
Therefore, the Committee directs NIH to establish a 
comprehensive SARS-CoV-2 pediatric research agenda and report 
to the Committee within 120 days of enactment of this Act on 
this program. The Committee asks NIH to consider identification 
of research needs focused on the novel coronavirus impacts on 
children and adolescents, how pediatric patients have been 
included in current NIH SARS-CoV-2 research and clinical 
trials, any disparities that have emerged in how children of 
different communities have been affected, the risk and 
protective factors children may produce against COVID-19 
antigens, longer-term impacts of SARS-CoV-2 on child health, 
research focused on treatments and prevention methods for SARS-
CoV-2 focused on children and adolescents when creating this 
agenda.
    Sex Differences and the COVID-19 Pandemic.--Successfully 
confronting and mitigating the ongoing coronavirus pandemic 
requires scientific rigor and reproducibility in studies that 
benefit both women and men. Extensive prior research has 
revealed significant differences in the immune systems of women 
and men that affect health outcomes. This knowledge, coupled 
with evidence that men are likely to suffer more severe cases 
and die of COVID-19 than women, has led to research uncovering 
that immune responses to SARS-CoV-2 differ between women and 
men, and the nature of the response seen more frequently in men 
is what is likely to account for heightened disease 
susceptibility. The Committee strongly encourages NIH to 
consider sex differences in its research on COVID-19 to ensure 
that the benefits of this research will be applicable to men 
and women.
    Spina Bifida.--The Committee encourages NIA, NIDDK, NICHD, 
and NINDS to study the causes and care of neurogenic bladder 
and kidney disease 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 
sudden death in the adult spina bifida population; 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; and to 
provide an update on research findings related to spina bifida 
in the fiscal year 2022 Congressional Justification. The 
Committee supports the specific efforts of NICHD to understand 
early human development; set the foundation for healthy 
pregnancy, and lifelong wellness of women and children; and 
promote the gynecological, andrological and reproductive health 
for people with spina bifida. In addition, the Committee 
encourages NICHD to identify sensitive time periods to optimize 
health interventions; improve health during transition from 
adolescence to adulthood; and ensure safe and effective 
therapeutics and devices for adults as well as children.
    Strengthening Maternal Health Coordination.--The Committee 
is concerned with the rising rate of maternal mortality and 
morbidity in the U.S., especially in communities of color. The 
Committee supports the activities of the trans-NIH Maternal 
Health Working Group, and its new Implementing a Maternal 
Health and Pregnancy Outcomes Vision for Everyone (IMPROVE) 
Initiative. The Committee urges the working group to share 
results from IMPROVE, including the research, knowledge, and 
best practices to State and local governments, health 
organizations, and private entities, to assist with efforts to 
combat the growing trend. The Committee directs the working 
group to submit a report outlining actions taken within one 
year of enactment of this Act.
    Timely Evaluation of Promising Biomedical Research 
Proposals.--The Committee is concerned that the review process 
for certain research proposals is delaying promising biomedical 
research. The Committee directs NIH to ensure that any research 
proposal reviewed by an Ethics Advisory Board described by 42 
U.S.C. Sec. 289a-1 is evaluated within the same timeframe as 
research proposals not subject to review by an Ethics Advisory 
Board.
    Tobacco Regulatory Science Program.--The Committee supports 
the Tobacco Regulatory Science Program and encourages increased 
research to inform the FDA in regulation of the manufacture, 
marketing, and distribution of tobacco products to reduce the 
public health toll from tobacco product use in the U.S. The 
Committee encourages NIH to increase support for research into 
the understanding of nicotine addiction and to spur the 
development of better prevention and treatment strategies. Of 
particular importance are funding for research for effective 
interventions to help youth and young adults to quit vaping, 
and the interrelationship between the vaping of tobacco and 
marijuana.
    Trisomy 21.--The Committee commends NIH for its continuing 
support of the Investigating Co-Occurring Conditions Across the 
Lifespan to Understand Down Syndrome (INCLUDE) Initiative. The 
Committee includes no less than $65,000,000, an increase of 
$5,000,000 above the fiscal year 2020 level, within the Office 
of the Director for the INCLUDE Initiative. The Committee 
expects that this multi-year, trans-NIH research initiative may 
advance scientific discoveries that will dramatically improve 
the health and quality of life of individuals with Down 
syndrome as well as millions of typical individuals. The 
Committee requests the Director provide a plan within 60 days 
of enactment of this Act that includes a timeline description 
of potential grant opportunities and deadlines for all expected 
funding opportunities so that young investigators and new 
research institutions may be further encouraged to explore 
research in this space. This plan should also incorporate and 
increase pipeline research initiatives specific to Down 
syndrome.
    Undiagnosed Diseases Network (UDN).--The Committee urges 
the UDN to continue efforts to enhance access to patients, 
caregivers, and other stakeholders as well as make information 
obtained through the UDN available to Federal agencies and 
health-related agencies.
    Use of Human Fetal Tissue in Research.--The Committee 
directs NIH to submit a report to the Committee within 180 days 
of enactment of this Act on the number and type of research 
proposals on cancer, eye diseases and disorders, HIV/AIDS, 
infectious diseases, neurological diseases and disorders, birth 
defects and developmental conditions, and other research topics 
that have been halted or delayed as a result of the new policy 
on research using human fetal tissue, as well as the goals and 
potential significance of the proposed research.
    Women's Health Research Priorities.--The Committee is 
concerned that funding for women's health research specifically 
related to gynecology and obstetrics remains disproportionately 
lower than other areas of research at NIH. The Committee 
believes that more focus on this research would help to address 
the rising maternal morbidity and mortality rates; rising rates 
of chronic debilitating conditions in women; and stagnant 
cervical cancer survival rates. The Committee encourages NIH to 
convene a consensus conference within six months of enactment 
of this Act to include representatives from the Office of 
Research on Women's Health, NICHD, NCI, NHLBI, and NIDDK, as 
well as any other relevant NIH Institutes and Centers, and 
researchers, clinicians, women s health advocates and other 
relevant public stakeholders, to evaluate research currently 
underway related to women's health. As part of the consensus 
conference, the Committee directs NIH to provide an update in 
the fiscal year 2022 Congressional Justification that 
identifies priority areas for additional study to advance 
women's health research, including reproductive sciences.

                        BUILDINGS AND FACILITIES

 
 
 
Appropriation, fiscal year 2020.......................      $200,000,000
Budget request, fiscal year 2021......................       300,000,000
Committee Recommendation..............................       200,000,000
    Change from enacted level.........................             - - -
    Change from budget request........................             - - -
Committee Recommendation (including Title VI).........       425,000,000
    Change from enacted level.........................      +225,000,000
    Change from budget request........................      +125,000,000
 

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

                         NIH INNOVATION ACCOUNT

    This account supports NIH programs authorized in the 21st 
Century Cures Act (P.L. 114-255).

       Substance Abuse and Mental Health Services Administration


 
 
 
Appropriation, fiscal year 2020.......................    $5,882,496,000
Budget request, fiscal year 2021......................     5,740,343,000
Committee Recommendation..............................     5,978,496,000
    Change from enacted level.........................       +96,000,000
    Change from budget request........................      +238,153,000
 

    The Committee recommendation for the Substance Abuse and 
Mental Health Services Administration (SAMHSA) program level 
includes $5,832,829,000 in discretionary budget authority, 
$133,667,000 in PHS Evaluation Tap Funding, and $12,000,000 in 
transfers from the Prevention and Public Health (PPH) Fund.
    In addition, the CARES Act (P.L. 116-136) included 
$425,000,000 for SAMHSA to support mental health and substance 
use disorders during the COVID-19 pandemic.
    The Substance Abuse and Mental Health Services 
Administration (SAMHSA) is the agency within the U.S. 
Department of Health and Human Services that leads public 
health efforts to advance the behavioral health of the nation. 
SAMHSA's mission is to reduce the impact of substance abuse and 
mental illness on America's communities.
    The Committee continues to include bill language that 
exempts the Mental Health Block Grant and the Substance Abuse 
Prevention and Treatment Block Grant as a source for the Public 
Health Service Act section 241 evaluation set-aside in fiscal 
year 2021.

                             MENTAL HEALTH

 
 
 
Appropriation, fiscal year 2020.......................    $1,678,013,000
Budget request, fiscal year 2021......................     1,696,145,000
Committee Recommendation..............................     1,761,013,000
    Change from enacted level.........................       +83,000,000
    Change from budget request........................       +64,868,000
 

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

------------------------------------------------------------------------
                   Budget Activity                     FY 2021 Committee
------------------------------------------------------------------------
Capacity:
    Seclusion and Restraint..........................         $1,147,000
    Project AWARE....................................        107,001,000
    Mental Health Awareness Training.................         22,963,000
    Healthy Transitions..............................         28,951,000
    Infant and Early Childhood Mental Health.........          7,000,000
    Children and Family Programs.....................          7,229,000
    Consumer and Family Network Grants...............          4,954,000
    Project LAUNCH...................................         23,605,000
    Mental Health System Transformation..............          3,779,000
    Primary and Behavioral Health Care Integration...         54,877,000
    National Strategy for Suicide Prevention.........         23,200,000
        Zero Suicide.................................         21,200,000
            American Indian and Alaska Native Set-             2,200,000
             Aside...................................
    Suicide Lifeline.................................         21,000,000
    Garrett Lee Smith-Youth Suicide Prevention.......
        State Grants.................................         35,427,000
        Campus Grants................................          6,488,000
    American Indian and Alaska Native Suicide                  2,931,000
     Prevention......................................
    Tribal Behavioral Health Grants..................         22,000,000
    Homeless Prevention Programs.....................         30,696,000
    Minority AIDS....................................          9,224,000
    Criminal and Juvenile Justice Programs...........          6,269,000
    Assisted Outpatient Treatment....................         19,000,000
    Assertive Community Treatment for Individuals              7,000,000
     with Serious Mental Illness.....................
    Comprehensive Opioid Recovery Centers............          2,000,000
Science and Service:
    Garrett Lee Smith-Suicide Prevention Resource              7,988,000
     Center..........................................
    Practice Improvement and Training................          7,828,000
    Consumer and Consumer Support Technical                    1,918,000
     Assistance Centers..............................
    Primary and Behavioral Health Care Integration             1,991,000
     Technical Assistance............................
    Minority Fellowship Program......................         10,059,000
    Disaster Response................................          1,953,000
    Homelessness.....................................          2,296,000
------------------------------------------------------------------------

    Comprehensive Opioid Recovery Centers.--The Committee 
includes funding to provide grants, as authorized by section 
7121 of the SUPPORT Act (P.L. 115-271), to help ensure that 
people with substance use disorders can access proper 
treatment. The Committee recognizes that there is a tremendous 
need for increasing access to coordinated, comprehensive care 
services that utilize the full range of FDA-approved 
medications and evidence-based treatments. These long-term care 
and support services dramatically improve outcomes for 
individuals and generate meaningful outcomes data to contribute 
to best practices for substance use disorders. The Committee 
directs SAMHSA to make the funding opportunity available to all 
eligible entities, as defined in section 7121, that meet this 
criterion.
    Criminal and Juvenile Justice Programs.--The Committee 
includes funding to address some of the unmet need for 
effective behavioral health services and supports that are 
accessible before, during, and after incarceration and continue 
in the community for those with a mental disorder. The 
Committee recognizes the importance of providing comprehensive 
services to those who suffer from severe mental health issues. 
The Committee is aware that there can be a correlation between 
mental health disturbances and repeat criminal offenders. 
Therefore, the Committee strongly encourages SAMHSA's Criminal 
Justice Activities to prioritize funding for centers that 
provide assistance to those with severe mental health needs who 
are at risk of recidivism. These mental health centers can 
provide, but are not limited to, the following services: crisis 
care, residential treatment, outpatient mental health and 
primary care services, and community re-entry supports. The 
Committee strongly encourages SAMHSA to prioritize applications 
from areas with high rates of uninsured individuals, poverty, 
and substance use disorders.
    Infant and Early Childhood Mental Health.--The Committee 
supports access to a range of evidence-based and culturally-
appropriate infant and early childhood mental health services, 
and to aid in addressing the national shortage of mental health 
professionals with infant and early childhood expertise. The 
Committee recognizes the importance of building mental health 
services for children under age six. 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.
    Minority Fellowship Program.--The Committee includes an 
increase of $1,000,000 in order to improve prevention, 
wellness, and treatment across the lifespan. As Congress seeks 
to better address substance abuse and mental health disorders 
across all populations, the Committee recognizes the critical 
importance of supporting a diverse behavioral health workforce 
and its effectiveness in addressing substance use disorders and 
mental health issues impacting minority and underserved 
populations.
    Now is the Time.--To increase access to mental health 
services, as set out by the 2013 ``Now is the Time'' plan, the 
Committee includes an increase of $5,000,000 for Project AWARE, 
which is designed to identify children and youth in need of 
mental health services, to increase access to mental health 
treatment, and promote mental health literacy among teachers 
and school personnel. The Committee encourages SAMHSA to 
sustain and strengthen its grant and other programs that 
support school-based and campus-based services aimed at 
preventing and treating mental health challenges experienced by 
younger Americans. The Committee is concerned that some States 
were notified that they would not be receiving already approved 
funding due to a new requirement, and urges SAMHSA to not 
change requirements mid-award cycle. In addition, the Committee 
supports the Healthy Transitions program, which provides grants 
to states and tribes to improve access to mental disorder 
treatment and related support services for young people aged 16 
to 25 who either have, or at risk of developing a serious 
mental health condition.
    Primary and Behavioral Health Care Integration.--The 
Committee includes an increase of $5,000,000 to fund a learning 
collaborative for interested health care systems on effective 
integration of nationally certified peer support specialists, 
with an emphasis on health care systems in alternative payment 
models.
    PTSD in First Responders.--The Committee is aware of 
research indicating that individuals working in the civilian 
first responder disciplines of law enforcement, fire services, 
and emergency medical services are at greater risk for full or 
partial post-traumatic stress disorder (PTSD) than most other 
occupations because their responsibilities routinely entail 
confrontation with traumatic stressors. The Committee 
encourages SAMHSA to examine PTSD among this population, 
including prevalence rate, risk factors, symptom presentation, 
course, comorbidities, and rates of suicidal thoughts and 
actions.
    Suicide Prevention.--The Committee recognizes the rising 
rate of suicide and notes that family and friends are often in 
the best position to recognize the warning signs of suicide and 
to help an at-risk individual get treatment. The Committee 
urges SAMHSA to develop and disseminate programs to provide 
specialized training and resources on identifying and 
responding to people at risk of suicide for families and 
friends of at-risk individuals. The Committee includes an 
increase of $5,000,000 for the implementation the Zero Suicide 
model, a comprehensive, multi-setting approach to suicide 
prevention in health care systems. The Committee includes an 
increase of $2,000,000 and recognizes the importance of the 
Suicide Lifeline to provide rapid access at any time of the day 
or night to crisis intervention, and when needed, emergency 
response. The Committee is concerned by recent data from CDC 
and the National Survey on Drug Use and Health indicating a 
significant rise in youth suicide reported over the last 
decade. The Committee encourages that SAMHSA, in consultation 
with the U.S. Department of Education, to develop a standard 
for providing all school-based teachers and nurses with suicide 
prevention training to treat mental health challenges 
experienced by younger Americans. In House Report 116-62, the 
Committee urged SAMHSA to provide specific training programs 
for Suicide Lifeline counselors to increase competency in 
serving LGBTQ youth through the utilization of existing 
specialized resources. The Committee also urged SAMHSA to 
consider the diversion of calls to specialty partners who are 
best situated to serve the LGBTQ community. As the Lifeline 
continues to anticipate higher call volume, both due to mental 
health stresses caused by COVID-19 and the potential transition 
to a three digit code, it is now more important than ever that 
SAMHSA work to implement LGBTQ competency training for 
counselors and an Integrated Voice Response option for LGBTQ 
youth callers.
    Teacher and Educator Mental Health.--The Committee finds 
there has been a lack of specific resources designed to address 
teacher and educator mental health. The Committee finds our 
educators and teachers need additional resources to address 
mental health issues that arise due to their work. Educators 
are dealing with larger classrooms, fewer student resources, 
challenging social and societal problems, all of which have 
negative impacts on mental health, job satisfaction, family and 
home life, and ability to continue to teach effectively.
    Tribal Behavioral Grants.--The Committee includes an 
increase of $2,000,000 to expand efforts to address the high 
incidence of substance abuse and suicide among American Indian/
Alaska Native populations.

Mental Health Block Grant

    The Committee includes a total of $757,571,000, an increase 
of $35,000,000, for the Mental Health Block Grant. The block 
grant provides funds to States to support mental illness 
prevention, treatment, and rehabilitation services. Funds are 
allocated according to a statutory formula among the States 
that have submitted approved annual plans.
    The Committee continues the ten percent set-aside within 
the Mental Health Block Grant total for evidence-based programs 
that address the needs of individuals with early serious mental 
illness, including psychotic disorders. The Committee expects 
SAMHSA to continue its collaboration with the National 
Institute of Mental Health to encourage States to use this 
block grant funding to support programs that demonstrate strong 
evidence of effectiveness.
    Furthermore, the Committee directs a new five percent set-
aside of the total for evidence-based crisis care programs 
addressing the needs of individuals with serious mental 
illnesses and children with serious mental and emotional 
disturbances. The Committee directs SAMHSA to use the set-aside 
to fund, at the discretion of eligible States and Territories, 
some or all of a set of core crisis care elements including: 
centrally deployed 24/7 mobile crisis units, short-term 
residential crisis stabilization beds, evidence-based protocols 
for delivering services to individuals with suicide risk, and 
regional or State-wide crisis call centers coordinating in real 
time.
    Health Care Disparities.--The Committee believes that 
addressing health care disparities experienced by racial and 
ethnic minorities should be a priority in programs funded by 
Federal agencies, including programs funded in whole or part by 
the Community Mental Health Services Block Grant authorized 
under 42 U.S.C. 300x-1. The Committee directs SAMHSA to 
require, in the reporting mandated of states receiving the 
Mental Health Block Grant under 42 U.S.C. 300x-1, that State 
Mental Health Agencies report on services provided to 
individuals from racial and ethnic minorities, including the 
extent to which those services are provided to individuals from 
racial and ethnic minorities and the outcomes experienced by 
individuals from racial and ethnic minorities as a result of 
those services being provided. SAMHSA shall direct that impact 
and outcomes be reported for racial and ethnic minority adults 
with serious mental illness and racial and ethnic minority 
children with serious emotional disturbance in reports of data 
submitted relating to systems of care, diversions from 
hospitalization and criminal justice system involvement, 
treatment for first episode psychosis, reductions in suicide 
and treatment for suicidal ideation, response through crisis 
services, and treatment of homeless individuals and individuals 
residing in rural communities. State Mental Health Agencies 
shall also report on outreach to, and the hiring of, racial and 
ethnic minority providers of mental health services.

National Child Traumatic Stress Initiative

    The Committee includes $71,887,000 for the National Child 
Traumatic Stress Initiative. The Committee strongly supports 
the National Child Traumatic Stress Network for building, 
evaluating, disseminating, and delivering evidence-based 
services and best practices, including through universities, 
hospitals, and front-line providers, to prevent and mitigate 
the impact of exposure to trauma among children and families. 
For the new grant cycle, the Committee provides an additional 
$3,000,000 for awards to promote the collaboration between 
academic researchers, mental health clinicians, and front-line 
service providers. Of the total amount, $8,000,000 is 
designated for the National Center for Child Traumatic Stress 
coordinating center cooperative agreement. The Committee also 
directs SAMHSA to ensure that the network maintains its focus 
on collaboration, data collection, and the provision of direct 
services and that new grants should not be awarded as training 
only.
    Child Victims of Disaster.--The Committee recognizes the 
ongoing threat to mental health posed to our nation's children 
and families as a result of increasing frequency and intensity 
of natural and manmade technological disasters. Children who 
experience traumatic stress may struggle with a wide range of 
childhood developmental capabilities, including social and 
educational functioning, and are at higher risk of later 
adverse physical, mental, and behavioral health outcomes if not 
recognized and addressed at an early stage. For this reason, 
the Committee strongly encourages that funding for the National 
Child Traumatic Stress Network be used to address child trauma 
as a result of natural and technological manmade disasters.

Children's Mental Health

    The Committee includes $125,000,000 for the Children's 
Mental Health program. This program supports grants and 
technical assistance for community-based services for children 
and adolescents with serious emotional, behavioral, or mental 
disorders, and assists States and local jurisdictions in 
developing integrated systems of community care.

Projects for Assistance in Transition from Homelessness

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

Protection and Advocacy for Individuals with Mental Illness

    The Committee includes $36,146,000 for the Protection and 
Advocacy for Individuals with Mental Illness program. This 
program serves to ensure that the rights of mentally ill 
individuals are protected while they are patients in all public 
and private facilities or while they are living in the 
community. Funds are allocated to States according to a formula 
based on population and relative per capita incomes.

Certified Community Behavioral Health Clinics

    The Committee includes $225,000,000, an increase of 
$25,000,000 to provide grants to continue the improvement of 
mental disorder treatment, services, and interventions for 
children and adults, including the use of long-acting 
injectable medications approved for the treatment of serious 
mental illness and assistance to those with severe mental 
health needs who are at risk of recidivism. These mental health 
centers can provide, but are not limited to, the following 
services: crisis care, residential treatment, outpatient mental 
health and primary care services, and community re-entry 
supports.
    In addition, the CARES Act included $250,000,000 to support 
Certified Community Behavioral Health Clinics.
    Certified Community Behavioral Health Clinics Expansion.--
The Committee is pleased that the Certified Community 
Behavioral Health Clinics (CCBHC) program is expanding access 
to mental health and addiction treatment services and 
significantly reducing hospital emergency room utilization 
while assisting local law enforcement agencies nationwide.
    Certified Community Behavioral Health Clinics.--The 
Committee directs SAMHSA to prioritize resources to entities 
within States that are part of section 223(a) of the Protecting 
Access to Medicare Act of 2014 (P.L. 113-93) demonstration and 
to entities within States that were awarded planning grants.

                       SUBSTANCE ABUSE TREATMENT

 
 
 
Appropriation, fiscal year 2020.......................    $3,837,756,000
Budget request, fiscal year 2021......................     3,807,756,000
Committee Recommendation..............................     3,847,756,000
    Change from enacted level.........................       +10,000,000
    Change from budget request........................       +40,000,000
 

State Opioid Response Grants

    The Committee includes $1,500,000,000 for the State Opioid 
Response Grants (SOR).
    Area Health Education Centers.--The Committee recognizes 
the effectiveness of Area Health Education Centers (AHEC) 
statewide networks and commends their interdisciplinary 
traineeship of health professionals who will treat opioid use 
disorder (OUD). Given the reach of the AHEC network to 85 
percent of all counties in the U.S., including the District of 
Columbia, SOR grantees may choose to work collaboratively with 
AHECs for the development and implementation of statewide OUD 
continuing education, training, and response activities.
    State Opioid Response Grants.--The Committee is concerned 
longstanding guidance to the Department to avoid a significant 
cliff between States with similar mortality rates was 
overlooked in the award of fiscal year 2020 funds. For future 
awards, the Committee directs the Assistant Secretary to award 
funds to address funding cliffs between States with similar 
mortality rates.

Substance Abuse Prevention and Treatment Block Grant

    The Committee includes a program level of $1,858,079,000 
for the Substance Abuse Prevention and Treatment Block Grant 
provide funding to States to support alcohol and drug abuse 
prevention, treatment, and rehabilitation services. The 
Committee recognizes the critical role the block grant plays in 
State systems across the country.
    Within the total provided for Programs of Regional and 
National Significance, the Committee recommends the following 
amounts:

------------------------------------------------------------------------
                   Budget Activity                     FY 2021 Committee
------------------------------------------------------------------------
Capacity:
    Opioid Treatment Programs and Regulatory                  $8,724,000
     Activities......................................
    Screening, Brief Intervention, Referral to                30,000,000
     Treatment.......................................
        PHS Evaluation Funds.........................          2,000,000
    Targeted Capacity Expansion-General..............        102,192,000
        Medication-Assisted Treatment................         91,000,000
        Tribal Set-aside.............................         12,000,000
    Grants to Prevent Prescription Drug/Opioid                12,000,000
     Overdose........................................
    First Responder Training.........................         41,000,000
        Rural Focus..................................         23,000,000
    Pregnant and Postpartum Women....................         31,931,000
    Recovery Community Services Program..............          2,434,000
    Children and Families............................         29,605,000
    Treatment Systems for Homeless...................         36,386,000
    Minority AIDS....................................         65,570,000
    Criminal Justice Activities......................         89,000,000
        Drug Courts..................................         70,000,000
    Improving Access to Overdose Treatment...........          1,000,000
    Building Communities of Recovery.................         10,000,000
    Peer Support Technical Assistance Center.........          1,000,000
    Emergency Department Alternatives to Opioids.....          5,000,000
    Treatment, Recovery, and Workforce Support.......          4,000,000
    Opioid Response Grants...........................          3,000,000
Science and Service:
    Addiction Technology Transfer Centers............          9,046,000
    Minority Fellowship Program......................          5,789,000
------------------------------------------------------------------------

    Building Communities of Recovery.--The Committee includes 
an increase of $2,000,000 for enhanced long-term recovery 
support principally governed by people in recovery from 
substance use disorders. Such support reflects the community 
being served and encourages the role of recovery coaches. 
SAMHSA is encouraged to ensure that grants employing peers 
comply with the highest standards within their respective 
States.
    Criminal Justice Activities.--The Committee provides 
$89,000,000 for the Criminal Justice Activities program. Of 
this amount, the Committee directs that not less than 
$70,000,000 will be used exclusively for Drug Court activities. 
The Committee continues to direct SAMHSA to ensure that all 
funding appropriated for Drug Treatment Courts is allocated to 
serve people diagnosed with a substance use disorder as their 
primary condition. The Committee directs SAMHSA to ensure that 
all drug treatment court grant recipients work directly with 
the corresponding State substance abuse agency in the planning, 
implementation, and evaluation of the grant. The Committee 
further directs SAMHSA to expand training and technical 
assistance to drug treatment court grant recipients to ensure 
evidence-based practices are fully implemented.
    Emphasis on Comprehensive Services.--In recent fiscal 
years, the Committee has provided historic resources to combat 
the opioid epidemic, with a particular focus on expanding 
access to treatment, and treating and preventing comorbidities 
that can be associated with injection drug use. At the 
Committee's urging, the Department has rightfully prioritized 
efforts that increase access to treatment and recovery 
services. For all programs not focused exclusively on 
prevention of substance abuse, the Committee directs the 
Department to continue its emphasis on evidence-based medical 
interventions, and to ensure that all such interventions, 
including programs that focus on harm reduction, provide 
referral to treatment and recovery services.
    Grants to Prevent Prescription Drug/Opioid Overdose and 
First Responder Training.--The Committee notes strong concerns 
about the increasing number of unintentional overdose deaths 
attributable to prescription and nonprescription opioids. 
SAMHSA is urged to take steps to encourage and support the use 
of Substance Abuse and Prevention Block Grant funds for opioid 
safety education and training, including initiatives that 
improve access for licensed healthcare professionals, including 
paramedics, to emergency devices used to rapidly reverse the 
effects of opioid overdoses. Such initiatives should 
incorporate robust evidence-based intervention training and 
facilitate linkage to treatment and recovery services.
    Minority Fellowship Program.--The Committee includes an 
increase of $1,000,000 in order to improve prevention, 
wellness, and treatment across the lifespan. As Congress seeks 
to better address substance abuse and mental health disorders 
across all populations, the Committee recognizes the critical 
importance of supporting a diverse behavioral health workforce 
and its effectiveness in addressing substance use disorders and 
mental health issues impacting minority and underserved 
populations.
    Opioid Response Grants.--The Committee includes $3,000,000 
for supplemental grants to States whose award from the State 
Opioid Response formula grant declined by more than 40 percent 
in fiscal year 2020 in comparison to fiscal year 2019. The 
Committee directs SAMHSA to allocate the funds to eligible 
States within 30 days of enactment of this Act.
    Pregnant and Postpartum Women.--The Committee recognizes 
SAMHSA for its work managing the Pregnant and Postpartum Women 
program which utilizes a family-centered approach to provide 
comprehensive residential substance use disorder treatment 
services for pregnant and postpartum women, their minor 
children and for other family members. A provision in the 
Comprehensive Addiction and Recovery Act (CARA) authorized 
SAMHSA to allocate a portion of these resources for a pilot 
program to State alcohol and drug agencies to support 
outpatient, intensive outpatient and related services in a 
family-centered approach. The Committee encourages SAMHSA to 
fund an additional cohort of States above and beyond those 
pilots already funded.
    Screening, Brief Intervention, and Referral to Treatment.-- 
The Committee understands that substance use disorders, 
including opioid use, typically begin in adolescence, and that 
preventing underage drinking and other early substance use is a 
cost-effective strategy in preventing costly problems later in 
life. The Committee is also aware that Screening, Brief 
Intervention and Referral to Treatment (SBIRT) has been shown 
to be a cost-effective model for reducing and preventing 
underage drinking and other substance abuse, but that many 
health providers, especially pediatricians, have not been 
trained to use the method effectively. Therefore, the Committee 
directs $2,000,000 for implementing grants to pediatric health 
care providers in accordance with the specifications outlined 
in Section 9016 of P.L. 114-255, Sober Truth in Preventing 
Underage Drinking Reauthorization. Training grants should focus 
on screening for underage drinking, opioid use, and other drug 
use, and be managed by CSAT within the existing SBIRT program.
    Targeted Capacity Expansion.--The Committee includes an 
increase of $2,000,000 for grants to Indian tribes, tribal 
organizations, or consortia. The Center for Substance Abuse 
Treatment is directed to include as an allowable use 
medication-assisted treatment and other clinically appropriate 
services to achieve and maintain abstinence from all opioids 
and heroin and prioritize treatment regimens that are less 
susceptible to diversion for illicit purposes.

Center for Substance Abuse Treatment

    Family Support Services for Addiction.--The Committee 
recognizes the devastating impact the opioid epidemic has had 
on communities across the country. The Committee is also aware 
of the impact nonprofit family community organizations have had 
in providing support for families of individuals struggling 
with substance use disorder, as well as their ability to 
mobilize resources within and outside of communities to provide 
a support network and peer to peer education. As many resources 
have been disbursed to state and local agencies, the Committee 
urges SAMHSA, in accordance with the Public Health Service Act, 
to ensure these family community organizations also have access 
to these funds to develop, expand, and enhance their services 
for families of those struggling with substance use disorder.
    High Risk of Homelessness.--The Committee encourages the 
prioritization of developing evidence-based programs and 
treatments specifically tailored for those with alcohol, 
illicit drugs, and prescription medications abuse and that are 
at high risk of becoming homeless. The science should inform 
local, state, and federal public health officials on successful 
treatment actions with low rates of recidivism.
    Medication-Supported Therapy.--The Committee is concerned 
that relapse following opioid detoxification is a contributing 
factor to the overdose crisis. The Committee appreciates 
SAMHSA's efforts to address this within the federal grant 
population by emphasizing that opioid detoxification should be 
followed by medication to prevent relapse to opioid dependence 
and encourages SAMHSA to disseminate and implement this policy 
in all settings where detoxification is offered, including 
rehabilitation and criminal justice settings.
    Neonatal Abstinence Syndrome.--The Committee recognizes the 
increase in maternal substance abuse and Neonatal Abstinence 
Syndrome (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 is aware of existing pilot 
programs that have effectively addressed the maternal and 
neonatal health needs of this population while lowering medical 
costs.
    Overdose Cases.--The Committee is concerned that the rise 
in opioid overdoses among African American communities, 
especially urban cities, is not reflected enough in data 
summarizing opioid-related deaths and overdoses. The Committee 
is aware of the growing demographic changes of opioid deaths 
and encourages efforts to reverse this trend.
    Overdose Deaths Involving Stimulants.--The Committee 
recognizes an increase in the rate of drug overdose deaths 
involving stimulants, including methamphetamine. The Committee 
is aware of proven existing pilot programs that have developed 
policies for effective drug prevention, treatment, and harm 
reduction. SAMHSA is encouraged to determine if such programs 
can be scaled to address this important issue.
    Point of Use Testing.--The Committee encourages SAMHSA to 
allow eligible grantees to purchase and distribute point of use 
fentanyl testing strips and other testing methods in community 
settings.
    Prescription Opioids.--The encourages SAMHSA, as part of 
its opioid prevention efforts, to provide clinicians with 
resources to adopt protocols to reduce the number of opioids 
prescribed to treat acute and urgent pain in this country.

                       SUBSTANCE ABUSE PREVENTION

 
 
 
Appropriation, fiscal year 2020.......................      $206,469,000
Budget request, fiscal year 2020......................        96,985,000
Committee Recommendation..............................       209,469,000
    Change from enacted level.........................        +3,000,000
    Change from budget request........................      +112,484,000
 

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

------------------------------------------------------------------------
                                                            FY 2021
                   Budget Activity                         Committee
------------------------------------------------------------------------
Capacity:
    Strategic Prevention Framework...................       $119,484,000
        Strategic Prevention Framework Rx............         10,000,000
    Federal Drug-Free Workplace......................          4,894,000
    Minority AIDS Initiative.........................         41,205,000
    Sober Truth on Preventing Underage Drinking......         10,000,000
        National Adult-Oriented Media Public Service           2,000,000
         Campaign....................................
        Community Based Coalition Enhancement Grants.          7,000,000
        Interagency Coordinating Committee to Prevent          1,000,000
         Underage Drinking...........................
    Tribal Behavioral Health Grants..................         22,000,000
Science and Service:
    Center for the Application of Prevention                   7,493,000
     Technologies....................................
    Science and Service Program Coordination.........          4,072,000
    Minority Fellowship Program......................            321,000
------------------------------------------------------------------------

    Sober Truth on Preventing Underage Drinking Act (STOP 
Act).--The Committee includes an increase of $1,000,000 for the 
public health service campaign to strengthen efforts to reduce 
and prevent underage drinking.
    Tribal Behavioral Grants.--The Committee includes an 
increase of $2,000,000 to expand efforts to address the high 
incidence of substance abuse and suicide among American Indian/
Alaska Native populations.

                HEALTH SURVEILLANCE AND PROGRAM SUPPORT

 
 
 
Appropriation, fiscal year 2020.......................      $160,258,000
Budget request, fiscal year 2021......................       139,457,000
Committee Recommendation..............................       160,258,000
    Change from enacted level.........................             - - -
    Change from budget request........................       +20,801,000
 

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

------------------------------------------------------------------------
                                                            FY 2021
                   Budget Activity                         Committee
------------------------------------------------------------------------
Health Surveillance..................................        $47,258,000
    PHS Evaluation Funds.............................         30,428,000
Program Support......................................         79,000,000
Public Awareness and Support.........................         13,000,000
Performance and Quality Information Systems..........         10,000,000
Drug Abuse Warning Network...........................         10,000,000
Behavioral Health Workforce..........................          1,000,000
    PHS Evaluation Funds.............................          1,000,000
------------------------------------------------------------------------

    Clinical Training.--The Committee recognizes the importance 
of clinical training experiences as a means of mitigating 
stigma towards patients with substance use disorders and 
encouraging students to specialize in behavioral health 
following graduation. The Committee directs SAMHSA to examine 
methods of facilitating increased clinical training 
opportunities for physician assistant and other graduate level 
health professions students, including through Certified 
Community Behavioral Health Clinics and the agency's other 
existing grant opportunities.
    Collaboration with HUD.--In the Fiscal Year 2020 
Transportation, and Housing and Urban Development Report 116-
106, the Committee directed the Department of Housing and Urban 
Development to conduct a feasibility study with SAMHSA to 
understand how Section 8 vouchers could provide housing 
opportunities to those who seek SAMHSA supported services. The 
Committee is concerned over the slow effort to engage on this 
request. The Committee expects this effort to proceed 
expeditiously and expects an update within 30 days of enactment 
of this Act.
    Data on Drug and Substance Abuse in the U.S. Territories.--
The Committee is concerned about the limited availability of 
data regarding drug and substance abuse in Puerto Rico and the 
rest of the U.S. territories. In particular, the Committee is 
concerned that the National Survey on Drug Use and Health 
(NSDUH) does not include statistics from these jurisdictions. 
The Committee encourages SAMHSA to take all reasonable steps to 
include Puerto Rico and the rest of the territories in the 
NSDUH, in the same manner that data is collected and published 
for the 50 States and the District of Columbia.

               Agency for Healthcare Research and Quality


                    HEALTHCARE RESEARCH AND QUALITY

 
 
 
Appropriation, fiscal year 2020.......................      $338,000,000
Budget request, fiscal year 2021......................             - - -
Committee Recommendation..............................       343,000,000
  Change from enacted level...........................        +5,000,000
  Change from budget request..........................      +343,000,000
 

    The Committee includes $343,000,000 in program level 
funding for the Agency for Healthcare Research and Quality 
(AHRQ). The total includes $143,091,000 in discretionary budget 
authority and $199,909,000 in PHS Act section 241 evaluation 
set-aside transfers.
    AHRQ's mission is to produce evidence to make health care 
safer, higher quality, more accessible, equitable, and 
affordable, and to work within HHS and with other partners to 
make sure that the evidence is understood and used. AHRQ 
conducts, supports, and disseminates scientific and policy-
relevant research on topics such as promoting high-quality 
care, eliminating healthcare disparities, using information 
technology, and evaluating the effectiveness of clinical 
services.
    Within the total for AHRQ, the House includes the following 
amounts:

------------------------------------------------------------------------
                                                            FY 2021
                   Budget Activity                         Committee
------------------------------------------------------------------------
Prevention/Care Management...........................         11,649,000
Health Information Technology (IT)...................         16,500,000
Patient Safety Research..............................         74,276,000
Health Services Research, Data, and Dissemination....         97,484,000
Medical Expenditure Panel Survey.....................         71,791,000
Program Management...................................         71,300,000
------------------------------------------------------------------------

    Antimicrobial Resistance.--The Committee continues to 
provide no less than $10,000,000 for combating antibiotic-
resistant bacteria.
    Cardiovascular Clinical Outcomes.--Heart disease is the 
leading cause of death for Americans. Understanding how to 
reduce the rate of cardiac events and to control the metabolic 
processes that lead to such events is needed. The Committee 
encourages AHRQ to conduct a study that assesses the current 
evidence for lipid control and cardiovascular event reduction 
and quality measures for the improvement of clinical outcomes 
(e.g. coronary heart disease death, myocardial infarction, 
ischemic stroke, or urgent coronary revascularization 
procedure) and to report findings back to the Committee no 
later than 180 days after the enactment of this Act. AHRQ is 
also encouraged to develop and disseminate education resources 
and materials about improving cardiovascular clinical outcomes.
    Center for Primary Care Research.--The Committee encourages 
AHRQ to consider establishing a Center for Primary Care 
Research to support clinical primary care research. The areas 
of focus could include strategies to improve primary care 
delivery, including through the use of clinical pharmacists and 
interprofessional; team based care; advancing the development 
of primary care researchers; expanding research on persons with 
multiple co-morbid conditions; and improving primary care in 
rural and underserved areas, especially in remote and non-
contiguous States.
    Infectious Disease Research.--The Committee encourages AHRQ 
to fund diagnostics outcomes studies for infectious diseases, 
including those assessing patient outcomes, lengths of stay, 
changes in antibiotic use, rates of antibiotic use for certain 
patient populations, and costs of care. The Committee 
encourages AHRQ to develop metrics to measure and track the 
effectiveness and outcomes of diagnostic interventions to 
improve clinical uptake, enhance stewardship efforts, and 
reduce the healthcare and economic burden of antimicrobial 
resistance in the U.S. as recommended by the Presidential 
Advisory Council on Combating Antibiotic-Resistant Bacteria.
    Minimizing Racial Bias in Health Technology.--The Committee 
is concerned that recent studies have demonstrated health 
technologies exacerbated inequitable delivery of health 
services. Accordingly, the Committee encourages ARHQ to examine 
how racism and bias is built into algorithms, machine learning, 
and clinical decision support tools that impact patient 
outcomes and lead to disparities. The Committee requests a 
report within 120 days of the date of enactment of this Act 
from ARHQ that covers the extent of such bias in public health 
systems, as well as best practices health systems and public 
health stakeholders can take to address and minimize these 
biases in the use of algorithms, machine learning, and clinical 
decision support tools.
    Partners Enabling Diagnostic Excellence.--Within the 
Patient Safety portfolio, the Committee includes no less than 
$3,000,000, an increase of $1,000,000 above the fiscal year 
2020 enacted level, to support improving diagnosis in medicine. 
The Committee encourages AHRQ to include a multiyear 
competitive grant program to address diagnostic errors, which 
may include the establishment of Research Centers of Diagnostic 
Excellence to develop systems, measures, and new technology 
solutions to improve diagnostic safety and quality.
    Prenatal Care for Pregnant Individuals.--The Committee 
recognizes the Department's ongoing efforts to address the 
pressing public health issue of rising maternal mortality. 
Research shows prenatal care is a critical component of 
preventative care for pregnant individuals. The Committee 
includes no less than $500,000 for research that examines the 
potential cost-savings to the public health system of providing 
a special enrollment period for pregnant individuals, as well 
as the impact of a special enrollment period on the private 
insurance market.
    Kratom.--The Committee notes that little research has been 
done to date on natural products that are used by many to treat 
pain in place of opioids. These natural plants and substances 
include kratom and cannabidiol (CBD). Given the wide 
availability and increased use of these substances, it is 
imperative to know more about potential risks or benefits, and 
whether or not they can have a role in finding new and 
effective non-opioid methods to treat pain. The Committee 
recommends $1,000,000 for this research, an increase of 
$500,000 above the fiscal year 2020 enacted level, and 
encourages AHRQ to make center-based grants to address research 
which will lead to clinical trials in geographic regions which 
are among the hardest hit by the opioid crisis.
    Trafficking Awareness Training for Health Care.--The 
Committee encourages AHRQ to support activities authorized in 
the Trafficking Awareness Training for Health Care Act, 
including a pilot program for the creation, distribution, and 
evaluation of best practices for medical professionals to 
identify and respond to victims of human trafficking.

                Centers For Medicare & Medicaid Services


                     GRANTS TO STATES FOR MEDICAID

 
 
 
Appropriation, fiscal year 2020...................      $273,188,478,000
Budget request, fiscal year 2021..................       313,904,099,000
Committee Recommendation..........................       313,904,099,000
    Change from enacted level.....................       +40,715,621,000
    Change from budget request....................                 - - -
 

    Medicaid provides health coverage to eligible populations, 
including eligible low-income adults, children, pregnant women, 
elderly adults, and people with disabilities. Medicaid is 
administered by States, according to Federal requirements. The 
program is funded jointly by States and the Federal government.
    This amount does not include $139,903,075,000, which was 
provided as advance funding for the first quarter of fiscal 
year 2021. In addition, the Committee recommends an advance 
appropriation of $148,732,315,000 for program costs in the 
first quarter of fiscal year 2022.
    The Committee continues bill language providing indefinite 
budget authority for unanticipated costs in fiscal year 2021. 
Federal Medicaid grants reimburse States for a portion of their 
expenditures in providing health care for individuals whose 
income and resources fall below specified levels. Subject to 
certain minimum requirements, States are provided certain 
limited authority within the law to set eligibility, coverage, 
and payment levels.

                PAYMENTS TO THE HEALTH CARE TRUST FUNDS

 
 
 
Appropriation, fiscal year 2020...................      $410,796,100,000
Budget request, fiscal year 2021..................       439,514,000,000
Committee Recommendation..........................       439,514,000,000
    Change from enacted level.....................       +28,717,900,000
    Change from budget request....................                 - - -
 

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

                           PROGRAM MANAGEMENT

 
 
 
Appropriation, fiscal year 2020...................        $3,669,744,000
Budget request, fiscal year 2021..................         3,693,548,000
Committee Recommendation..........................         3,984,744,000
    Change from enacted level.....................          +315,000,000
    Change from budget request....................          +291,196,000
 

Research, Demonstration, and Evaluation

    The Committee includes $20,054,000 for Research, 
Demonstration, and Evaluation, which is the same as the fiscal 
year 2020 enacted level and $20,054,000 more than the fiscal 
year 2021 budget request.

Program Operations

    The Committee includes $2,824,823,000 for Program 
Operations, which is $305,000,000 more than the fiscal year 
2020 enacted level and $346,000,000 more than the fiscal year 
2020 budget request. This office administers the programs under 
the Centers for Medicare & Medicaid Services (CMS), funds 
beneficiary outreach and education, maintains information 
technology infrastructure needed to support various claims 
processing systems, and supports other programmatic 
improvements.
    In addition, the CARES Act (P.L. 116-136) included 
$200,000,000 for CMS activities, including not less than 
$100,000,000 for the survey and certification program, 
prioritizing nursing home facilities in localities with 
community transmission of coronavirus.
    Access to Rare Disease Treatments.--The Committee 
understands that 1 in 10 Americans is impacted by a rare 
disease and that the Orphan Drug Act incentivizes the discovery 
of diagnostics and treatments that confirm prognosis, prolong 
life, and realize health system savings. Despite progress, 
treatments exist for only five percent of rare diseases. The 
Committee urges CMS to support access to biologic and gene 
therapies to address rare diseases.
    Addressing Obesity and Related Comorbidities.--The 
Committee encourages CMS to provide access to the full 
continuum of care for obesity, including access to FDA-approved 
anti-obesity medications under Medicare Part D, if determined 
as clinically appropriate by the patient's physician, 
consistent with CMS's approach to pharmacotherapy agents used 
for weight gain to treat AIDS wasting and cachexia.
    Advanced Primary Care Model.--The Committee encourages CMS 
to utilize data garnered from CMMI models in which pharmacists 
manage chronic diseases and medications and play an important 
role in comprehensive medication management and transitions of 
care. The Committee recommends CMS test a model that 
incentivizes pharmacist involvement across relevant Medicare 
service lines, including in value-based models such as the 
Comprehensive Primary Care Plus (CPC+) primary care model. This 
advanced primary care model integrates pharmacists as part of 
the care team to provide medication management services, that 
include evaluating medication regimens, providing medication 
self-management support for patients to help them adhere to 
their prescribed therapies, and promoting clinically-sound, 
cost-effective medication therapies.
    Adverse Childhood Experiences.--The Committee is aware that 
childhood trauma and toxic stress have been linked to negative 
health outcomes through adulthood, including higher rates of 
diabetes, stroke, depression, lapses in cognitive abilities, 
and developmental delays, suicide, and substance misuse, among 
others. Low-income children are particularly vulnerable to the 
impacts of adverse childhood experiences (ACEs). The Committee 
directs CMS to work with the National Child Traumatic Stress 
Network and CDC to provide a report no later than one year 
after the enactment of this act that evaluates how Medicaid 
could be leveraged to screen, diagnose, and provide evidence-
based interventions to children ages 0-21 suffering from 
adverse childhood experiences.
    Ambulatory Surgical Centers.--The Committee requests CMS 
submit a report within 180 days of enactment of this Act on the 
migration of procedures to ambulatory surgical centers (ASCs). 
The report should evaluate volume changes in hospital 
outpatient departments and ASCs for procedures that have been 
added to the ambulatory surgical center payable list since 
2008.
    Annual Wellness Exam.--The Committee understands that many 
Medicare beneficiaries are not utilizing the Annual Wellness 
Exam benefit and urges CMS to continue outreach to providers to 
emphasize the value of this service and to better understand 
barriers to higher participation.
    Biosimilar Utilization.--The Committee is concerned about 
the underutilization of lower cost biosimilars, particularly 
those in Medicare Part B, and encourages CMS to support 
development and implementation of new policies that may help 
increase biosimilar uptake when clinically appropriate, such as 
reducing patient co-pays or other mechanisms.
    Blue Button.--The Committee is concerned about low 
beneficiary participation rates in the Blue Button program due 
to their lack of awareness about Blue Button, how to access it, 
and how to use it. The Committee directs CMS to submit a report 
within 90 days of enactment of this Act on the active 
participant levels in Blue Button since its inception and 
detailed information about what the agency is doing to promote 
participation in this program and educate beneficiaries about 
its benefits.
    Breakthrough Pathway.--The Committee notes that FDA's 
accelerated approval pathways, like the Breakthrough pathway, 
play an important role in expediting review of products that 
address significant unmet need and have compelling clinical 
data. After FDA approval, however, patients are often still 
unable to access these therapies if the disease does not yet 
have an appropriate ICD-10 diagnosis code. To ensure timely 
access to Breakthrough products, the Committee urges CMS to use 
its existing authority to review ICD-10 CM codes in an 
expedited manner.
    Breast Prosthetics.--The Committee is encouraged by the 
deployment of new technologies related to prosthesis. The 
Committee urges CMS to ensure Medicare recipients recovering 
from breast cancer are given the opportunity, under the care of 
a medical professional, to select custom breast prosthetics.
    Chief Dental Officer.--The Committee is concerned that the 
Chief Dental Officer position at CMS has been vacant since 
October 2017, leaving a significant gap of clinical oral health 
expertise within CMS. Medicaid provides oral health services to 
millions of people across the country, including vulnerable 
populations such as children, pregnant women, and disabled 
adults. A licensed dentist clinician is an invaluable resource 
to CMS's growing oral health strategy to expand access to care. 
The Committee urges CMS to move forward with filling this 
vacancy.
    CMMI Strong Start Initiative.--The Committee continues to 
be concerned that the U.S. spends significantly more per capita 
on childbirth than any other industrialized nation--with costs 
estimated over $50 billion annually--but continues to rank 
behind almost all other developed countries in birth outcomes 
for both mothers and babies, including high rates of preterm 
birth, low birth weight, and high maternal and infant 
mortality. The Committee is aware that the CMMI Strong Start 
Initiative, as well as other research studies, have shown that 
models of care utilizing Certified Nurse Midwives, birth 
centers and licensed doulas are associated with higher patient 
satisfaction and improved outcomes for mothers and infants. The 
Committee looks forward to the report, requested in House 
Report 116-62, that would build on the CMMI Strong Start 
Initiative to develop a proposal for CMS to increase access to 
birth centers and midwives in all state Medicaid programs, and 
incentivize this model of care for low-risk women.
    Comprehensive Dental Care.--The Committee notes that States 
have flexibility to determine dental benefits for adult 
Medicaid enrollees and, while most states provide at least 
emergency dental services for adults, less than half of States 
currently provide comprehensive dental care. The Committee 
urges CMS to study the benefit of comprehensive dental coverage 
for adults and submit recommendations to Congress within 180 
days of the date of enactment of this Act regarding policies to 
increase coverage of, and access to, comprehensive dental 
benefits for adults in State Medicaid programs.
    Co-Prescribing of Overdose Reversal Drugs.--The Committee 
encourages CMS to issue policy guidance to any State that 
receives federal Medicaid funds to refer to the CDC Guidelines 
for the co-prescribing of overdose reversal drugs for all 
individuals who are at risk of overdose, as defined by the CDC 
Opioid Prescribing Guidelines.
    Coverage for Naloxone.--The Committee encourages CMS to 
issue policy guidance to any State that receives federal 
Medicaid funds to provide coverage for naloxone currently 
available as a nasal spray, an auto-injector, or both, if 
approved by the FDA for community use.
    Critical Access Hospitals.--The Committee supports the 
unique role played by critical access hospitals (CAH) in rural 
areas and supports policy considerations that incorporate the 
important role played by CAHs.
    Critical Access Hospitals.--Mental and Behavioral Health.--
The Committee requests the GAO conduct a review of the cost of 
emergency mental and behavioral health services provided at 
Critical Access Hospitals (CAHs), including an analysis of 
potential cost-savings if CAHs expanded access to preventive 
mental health services and opioid use disorder treatment in 
rural areas and currently underserved areas.
    Diabetes.--Diabetes remains a growing disease area which 
costs roughly $327 billion dollars to the U.S. healthcare 
system annually. Individuals living with diabetes very often 
have a multitude of chronic conditions, including 
cardiovascular disease. In recent years, a specific class of 
diabetes medications known as sodium-glucose transport protein 
2 inhibitors (SGLT2) have acquired clinical data that 
illustrates a significant decline in cardiovascular risk and 
mortality. As a result, existing American Diabetes Association 
guidelines as well as the American College of Cardiology 
recommend SGLT2 inhibitors as the most clinically appropriate 
first line branded option. The Committee supports robust 
evaluation of policy options to address the prevalence of 
diabetes.
    Diabetes Technologies.--The Committee is concerned about 
access to new technologies to treat diabetes. The Committee 
requests a report within 120 days of enactment of this Act 
outlining coverage and payment policies for new technologies 
for individuals with diabetes, including hybrid-closed loop 
technologies.
    Diabetic Retinopathy.--The Committee notes that diabetic 
retinopathy remains a major national health challenge. 
According to the National Eye Institute, early detection and 
treatment of diabetic retinopathy can reduce the risk of 
blindness by 95 percent. The Committee urges CMS to update its 
policy to promote earlier diagnosis of diabetic retinopathy.
    Direct and Indirect Remuneration Penalties.--The Committee 
is concerned that direct and indirect remuneration penalties 
(DIR penalties) have skyrocketed by 1600% in the last five 
years, totaling $8.5 billion since 2013.These fees are often 
imposed as clawbacks, recouped months--even a year--after a 
drug is dispensed. DIR penalties are ostensibly based on 
metrics designed for health plans, but these metrics often 
don't apply to pharmacies or are set at unattainable 
thresholds. In short, these excessive DIR penalties pose an 
existential threat to many independent and specialty 
pharmacies. The Committee directs CMS to review the amount of 
DIR penalties collected from pharmacies in Medicare Part D 
networks and assess the impact of these penalties on 
independent and specialty pharmacies--including the impact on 
340B safety net providers like Ryan White clinics and Federally 
Qualified Health Centers. The Committee requests a report on 
the results of this review within 180 days of enactment of this 
Act.
    Disproportionate Share Hospitals.--The Committee instructs 
CMS to compile publicly available information on hospitals that 
receive payments under Medicaid as disproportionate share 
hospitals. Such information shall include the Medicaid 
inpatient utilization rate and low-income utilization rate. 
Within each category, CMS should further identify such 
hospitals by rural or urban status; number of beds, and; status 
as a major teaching hospital.
    Drug Quality.--The Committee is deeply concerned about the 
discovery of dangerous levels of carcinogens in frequently 
prescribed medications, including angiotensin II receptor 
blockers (ARBs) like losartan and valsartan, ranitidine, and 
metformin. As two of the country's largest payers for 
prescription medication, Medicare and Medicaid have a 
responsibility to help ensure the safety and quality of 
prescribed therapies. The Committee requests a report within 
180 days of enactment on the amount of money that the Medicare 
and Medicaid programs spent on medication in the previous three 
fiscal years that was subsequently recalled by manufacturers 
due to the detection of contaminants (including NDMA), adverse 
event reports, and sterility concerns.
    Enhancing Tools to Detect Cognitive Impairment.--The 
Committee remains concerned about the underutilization of the 
cognitive impairment detection component of the Medicare Annual 
Wellness Visit and is aware of multiple efforts to address this 
challenge. To support this effort, the Committee directs CMS to 
update educational materials for Medicare beneficiaries as to 
the availability of this benefit and the importance of regular 
assessments of cognitive health, including the value of 
establishing cognitive health baselines. The Committee also 
directs CMS to develop similarly updated materials for 
healthcare providers including information on the importance of 
baseline and regular assessments as well as tools available to 
conduct such assessments.
    Evaluation and Management Services.--The Committee applauds 
CMS for finalizing significant changes to outpatient evaluation 
and management (E/M) services in the Calendar Year 2020 
Medicare Physician Fee Schedule (MPFS) scheduled to take effect 
January 1, 2021. This policy represents important first steps 
toward improving the documentation and valuation of these 
services and the Committee is eager to see if these changes 
begin to address workforce shortages in a number of cognitive 
physician specialties that affect Medicare beneficiaries' 
access to care. Despite revisions to the outpatient E/M codes, 
the Committee is concerned that their valuation still does not 
accurately reflect the resources required to deliver them and 
will therefore be insufficient to sustain the workforce in many 
cognitive specialties.
    Extravasations.--The Committee is aware of evidence 
demonstrating the prevalence of extravasations in nuclear 
medicine procedures. Extravasations of diagnostic 
radiopharmaceuticals negatively affect the sensitivity and 
quantification of nuclear medicine scans and can affect disease 
staging and treatment assessment, result in unnecessary 
invasive procedures and additional radiation exposure, and lead 
to higher costs for patients and payers. The Committee is 
pleased CMS is engaging with outside stakeholders to consider 
using a variety of levers to encourage providers to engage in 
nuclear medicine injection quality control and assurance. The 
Committee requests an update on this issue in the fiscal year 
2022 Congressional Budget Justification.
    Financial Impacts of Rulemaking.--The Committee urges CMS 
to evaluate the financial impacts on rural hospitals and 
Critical Access Hospitals in all rulemaking relating to payment 
rates, including all pending rules relating to CMS's outpatient 
prospective payment system (OPPS) and the Medicare ambulatory 
surgical center (ASC) payment system.
    Fire Safety and Health Care Facilities.--The Committee is 
concerned that CMS does not adopt on a regular basis the most 
recent edition of the National Fire Protection Association's 
Life Safety Code (NFPA 101), which by reference includes the 
Health Care Facilities Code (NFPA 99). The NFPA code is updated 
every three years to ensure the latest advances in safety and 
technology are incorporated into the code. In July of 2016, CMS 
adopted the 2012 Life Safety Code. The most current revision is 
2018. Thus far CMS has not expressed a timeframe to adopt the 
2018 revision and is currently working from a code that was 
established by NFPA over seven years ago. The Committee is 
aware that CMS previously permitted the use of ``categorical 
waivers,'' including allowances for healthcare organizations to 
comply with specific sections of the 2012 Life Safety Code 
before the entire code document was adopted. Critically, these 
``categorical waivers'' did not require a healthcare 
organization to make a formal request to CMS to utilize these 
waivers, nor did they need to wait until being cited for a 
deficiency. Instead, a healthcare organization could 
proactively document its election to use one of the available 
waivers. The Committee urges CMS to reinstate the ``categorical 
waivers'' it previously permitted in order to ensure hospitals 
have access to products that provide the highest level of 
safety to their facilities, employees, and patients.
    GAO Report on Anesthesia Services.--The Committee 
recognizes the important and unique role of anesthesia services 
and the lack of data on payment rates across markets. The 
Committee looks forward to the report requested under this 
heading in House Report 116-62.
    Geographic Practice Cost Index.--The Committee encourages 
CMS to create a more transparent process for the development of 
Geographic Practice Cost Index so that the various inputs can 
be better understood.
    Health Data Dashboard.--In order to improve health outcomes 
of Medicaid beneficiaries and improve efficiency of Medicaid 
payment models, the Committee encourages CMS, in coordination 
with CDC, to establish a pilot program to facilitate the 
integration of population health and social and economic 
determinants of health into a health care data platform. Such a 
platform should be able to create perfomiance indicators for 
State Medicaid programs.
    Health Inequalities.--The Committee recognizes the 
importance of understanding and addressing the needs of health 
inequalities amongst minority populations. To ensure these 
populations are better served by programs and offices within 
HHS, the Committee directs the Secretary to maintain the 
collection of data pertaining to health inequalities, as 
defined by Healthy People 2020, on surveys administered with 
funding from this Act.
    Home Health Payment Systems.--The Committee urges CMS to 
avoid home health payment systems that would risk patient 
access to home health providers in rural areas. The Committee 
requests a report within 90 days of enactment of this Act 
regarding the impact of implementation of home health payment 
systems on the delivery of home health services.
    Homelessness.--The Committee recognizes that homelessness 
can unnecessarily drive up Medicaid costs through excessive use 
of emergency room care, and that providing housing and resident 
services to this population can reduce such costs. The 
Committee directs HHS to report on the extent and types of 
waivers that exist to allow Medicaid funds to be used for 
affordable housing and resident services, in order to reduce 
Medicaid costs for families and individuals with 
disproportionate levels of health care expenditures. Such 
report shall include any efforts HHS has made or plans to make 
that would encourage such use through guidance to states or use 
of demonstration projects.
    Hospital Acquired Conditions.--The Committee continues its 
desire for CMS to take action to prevent hospital-acquired 
pressure ulcers and pressure injuries (HAPUIs) that impact 
about 2.5 million patients each year and kill more than 60,000 
hospital patients per year. Most HAPUIs are preventable with 
the application of evidence-based protocols. In November 2019, 
the International Pressure Injury Prevention and Treatment 
Clinical Practice Guidelines were released, which includes the 
Standardized Pressure Injury Prevention Protocol (SPIPP), a 
checklist that simplifies the guidelines into actionable steps. 
The Committee expects CMS to take specific steps to promote and 
incentivize the use of the SPIPP, especially in hospitals that 
care for Medicare patients. The Committee requests an update in 
the fiscal year 2022 Budget Request with a timeline and steps 
taken and planned to promote the use of the SPIPP to reduce the 
number of HAPUI's among Medicare beneficiaries.
    Hospitals in the U.S. Virgin Islands.--The Committee is 
concerned that Medicare payments for hospitals in the United 
States Virgin Islands are calculated using out-of-date payment 
data and formulas under the Tax Equity and Fiscal 
Responsibility Act of 1982 (TEFRA). The two hospitals in the 
United States Virgin Islands are reimbursed based on 1982 and 
1996 costs, respectively. As a result, patients are forced to 
travel outside the territory for necessary services, including 
total joint replacements and chemotherapy, often at great 
expense and personal hardship. The Committee encourages CMS to 
update the TEFRA base period for these hospitals to more 
accurately reflect current conditions and costs.
    Hospital Outpatient Prospective Payment.--The Committee 
directs CMS to comply with the Federal Court ruling issued on 
October 21, 2019 (Civil Action No. 18-2841-RMC, Document 38) 
ordering CMS to reverse payment cuts outlined in the 2018 Rule 
titled ``Changes to Hospital Outpatient Prospective Payment and 
Ambulatory Surgical Center Payment Systems and Quality 
Reporting Programs'' (84-FR-53603) and provide backpay to 
hospitals within 30 days of enactment of this Act for 
reimbursements paid out during the time that this rule was in 
effect. CMS is directed to submit an update to the Committee 
within 30 days of enactment of this Act on the status of 
compliance with this Federal court ruling and the status of 
backpay.
    Intravenous Immunoglobulin.--The Committee is aware of an 
ongoing demonstration program evaluating a bundled payment 
covering items and services needed to administer intravenous 
immunoglobulin (IVIG) in the home to beneficiaries with primary 
immunodeficiency diseases (PI), which is currently set to 
expire December 31, 2020. The Committee notes that 
beneficiaries enrolled in the demonstration may face a gap in 
these services between the expiration of the demonstration 
program including future extensions and the implementation of 
updated payment models based on report findings. The Committee 
encourages CMS to conduct an interim evaluation of the current 
project to be completed prior to the end of the project to 
accelerate evidence generation and remove any potential gap in 
services.
    Limited Wraparound Coverage.--The Committee is deeply 
concerned that the Administration did not extend the limited 
wraparound coverage pilot program or make the program 
permanent. This failure has caused significant uncertainty for 
patients who depended on this program for several years. The 
Committee directs CMS to submit a report within 90 days of 
enactment of this Act outlining a plan to ensure that 
participants impacted by the expiration of the pilot program 
will receive benefits equivalent to those of the limited 
wraparound coverage program. This report should include an 
analysis of the outcomes of the pilot program and an 
explanation for CMS's decision not to extend it.
    Liquid Oxygen.--The Committee notes with continued concern 
beneficiary problems in accessing liquid oxygen. The Committee 
directs CMS to report within 60 days of enactment of this Act 
on current access to liquid oxygen, including data on recent 
trends in liquid oxygen use during the period 2010 2019 by 
Medicare beneficiaries, and to work with stakeholders to 
implement appropriate monitoring plans to ensure continued 
access to all appropriate oxygen therapy when the competitive 
bidding program resumes in 2021.
    Malnutrition and Seniors.--Malnutrition in older adults 
remains a serious health problem in the United States. In 
particular, cancer and cancer care increase the risk of 
malnutrition, and older patients with cancer are one of the 
patient populations most underdiagnosed with malnutrition. 
However, CMS has still not included malnutrition quality 
measurements in the hospital Inpatient Quality Reporting 
Program (IQRP). The Committee remains concerned that, by 
failing to include such measures, the U.S. health care system 
is not taking advantage of the clinical and financial benefits 
of quality malnutrition care. The Committee again strongly 
urges CMS to include malnutrition quality measurements in the 
hospital IQRP as well as evaluate other potential policy 
levers, such as integrating malnutrition into CMS Innovation 
Center Pilots, Advanced Payment Models, Population Health 
Initiatives, and the Oncology Care Model, to address 
malnutrition in the Medicare population.
    Measuring Incidence and Prevalence of Mild Cognitive 
Impairment and Alzheimer's Disease.--The Committee remains 
interested in better understanding the impact of Mild Cognitive 
Impairment (MCI), Alzheimer's disease, and other related 
dementias on Medicare beneficiaries to ensure the Medicare 
program is able to address current and future needs. To gather 
such information, the Committee directs CMS to develop and 
incorporate within the Medicare Current Beneficiary Survey a 
module of questions pertaining to MCI, Alzheimer's disease, and 
other related dementias including if beneficiaries have 
received a diagnosis of either condition and how long it took 
for them to receive such a diagnosis; if their providers have 
used the cognitive detection component of the Annual Wellness 
Visit; and if the beneficiaries have been advised about 
Alzheimer's and dementia care planning services that are 
covered under Medicare.
    Medicaid Dental Audits.--The Committee raised concerns in 
House Report 116-62 that failure to use professional guidelines 
or established state Medicaid manual parameters in the auditing 
process can result in inaccurate and unreasonable Medicaid 
dental audits, negatively impacting dentist participation in 
the program and patient access to care. While State Medicaid 
agencies (SMA) have significant responsibility in managing 
provider audits, the Committee believes that as part of CMS 
oversight of the Medicaid program it is appropriate to issue 
guidance to SMAs concerning best practices in dental audits and 
offer training in such practices. The Committee urges CMS to 
develop such guidance for SMAs, in collaboration with the 
American Academy of Pediatric Dentistry and American Dental 
Association, and report to the Committee within 90 days of 
enactment of this Act on steps taken to develop such guidance.
    Medicaid Reimbursement for Birthing Centers.--The Committee 
urges CMS to provide technical assistance and expedited review 
for States submitting Medicaid state plan amendments 
implementing Medicaid reimbursement for birthing centers, 
midwives, and doulas in order to reduce maternal mortality, 
especially among African American and other high-risk 
populations.
    Medically Tailored Meals.--The Committee is aware of peer-
reviewed research showing that medically tailored meals can 
improve health outcomes and reduce health care utilization, and 
further understands that some Medicare Advantage plans have 
partnered with community-based organizations to incorporate 
medically tailored meals as a covered benefit. The Committee 
requests a report within 120 days of enactment of this Act 
outlining how Medicare Advantage and state Medicaid plans are 
using medically tailored meals and related nutrition 
interventions within their coverage plans.
    Medicare Accelerated and Advanced Payments Program.--The 
Secretary of Health and Human Services shall submit a report 
within 30 days of enactment of this Act, and every 90 days 
thereafter until the public health emergency declared by the 
Secretary on January 27, 2020, with respect to the 2019 Novel 
Coronavirus, is no longer in effect, to the Committees on 
Appropriations, Ways and Means, and Energy and Commerce of the 
House of Representatives and the Committees on Appropriations 
and Finance of the Senate, providing a full accounting, 
including methodology, of federal loans provided in fiscal 
years 2020 and 2021 through the Medicare Accelerated and 
Advanced Payments Program. For distributions occurring on or 
after the date of enactment of this Act, the Secretary shall 
require any provider or supplier receiving distributions to 
attest to whether such provider or supplier is owned and 
controlled by a private-equity entity. Such information shall 
be included in the HHS quarterly report, and shall include an 
accounting of the number of private equity owned and controlled 
providers (by provider category) and the amount of funding such 
providers in each category received, by individual provider 
number. The Committee requests that future distributions of 
funds account for a provider or supplier's reserve accounts as 
well as patients treated for COVID-19. As a condition of 
funding for private-equity backed hospitals and health systems, 
the Secretary should consider requiring that no providers face 
furloughs or cuts to pay or benefits. The Committee requests 
that the Secretary of Treasury require any reporting person who 
holds interest in a specified medical care provider, controls 
such provider, and is engaged in any trade or business in which 
such provider is directly or indirectly an expanded specified 
asset or receives any service from any person engaged in an 
applicable trade or business, electronically file a separate 
annual return with respect to each medical care provider that 
contains information relating to gross receipts, real estate 
ownership, and other payments to related persons.
    Medicare Promotion.--The Committee directs CMS to avoid 
taking any action that actively promotes one form of Medicare 
coverage over another, particularly with respect to the choice 
between traditional Medicare and Medicare Advantage. The 
Committee further directs CMS to maintain its online coverage 
options tool in a manner that provides complete and unbiased 
information, particularly the redesigned Medicare Plan Finder. 
Furthermore, CMS should remain objective and neutral in its 
education and outreach materials concerning options that 
beneficiaries have during the open enrollment period and at any 
other time.
    Medicare-reimbursable Expenses.--The Committee is concerned 
that CMS is considering regulations or guidance that would 
regulate the allocation of funds from a liability or no-fault 
related settlement, judgment, award, or other payment to pay 
for an individual's future medical or future prescription drug 
treatment expenses that would otherwise be reimbursable by 
Medicare. The Committee urges the agency not to promulgate a 
mandatory or voluntary regulation, which would be likely to 
harm Medicare beneficiaries, as well as the liability primary 
plan providers such as automobile, li-ability or no-fault 
insurers including those who self-insure.
    Medicare Reimbursement for Virtual Health Services.--The 
Committee requests CMS submit a report within 180 days of 
enactment of this Act outlining Medicare's current policy for 
payment of virtual health services (including digital health 
tools and ancillary services) for chronic conditions. This 
report should include data and other pertinent information on 
current utilization of such services by Medicare beneficiaries 
using the most currently available data. The report should 
assess opportunities to expand access to services for 
chronically ill Medicare beneficiaries under current authority, 
which beneficiaries would benefit most from access to such 
services, and gaps or limitations on HHS's authority to expand 
access to these beneficiaries.
    Mental Health Parity.--The Committee recognizes the 
important role Mental Health parity laws have in ensuring 
access to medical care and treatment. The Mental Health Parity 
and Addiction Equality Act (MHPAEA) requires insurers to cover 
care for mental health and substance use disorders at the same 
level as other medical and surgical care services. However, 
without proper oversight and compliance, patients are left 
fighting for coverage of benefits. The Committee is concerned 
there is still a lack of compliance among insurance companies 
not adequately covering mental and behavioral health services 
and providers more than 11 years after MHPAEA passed. The 
Committee urges the Administrator of CMS to create guidelines, 
in which all States or, where appropriate, Medicaid Managed 
Care Organizations are required to submit a public compliance 
report, with the application of nonquantitative treatment 
limitations while ensuring that any proprietary, personal, or 
confidential consumer information is protected. The Committee 
urges CMS to issue a public compliance report based on CMS's 
2017 Parity Compliance Toolkit Applying Mental Health and 
Substance Use Disorder Parity Requirements to Medicaid and 
Children s Health Insurance Programs. The Committee further 
urges the Administrator of CMS to annually report any auditing 
and enforcement of such plans.
    New Medical Residency Training Programs.--Given the growing 
physician workforce shortage, the Committee strongly encourages 
CMS to utilize its discretion to extend the time period 
described in section 413.79(e) of title 42, Code of Federal 
Regulations, for new residency programs in areas facing 
physician shortages before a full-time equivalent resident cap 
is applied, as authorized in P.L. 105 33. The Committee looks 
forward to receiving CMS's report on these efforts within 60 
days of the enactment of that Act, as directed in House Report 
116-62.
    New Technologies.--The Committee encourages CMS to provide 
adequate time for adaptation of new technologies, from a 
procedural and an administrative perspective, before adjusting 
payment based on claims data.
    Non-Emergency Medical Transportation.--The Committee 
includes a prohibition against the Department publishing a 
proposed regulation relating to Medicaid non-emergency medical 
transportation (NEMT) benefits. The fiscal year 2020 
Appropriations Act for the Department of Health and Human 
Services included $300,000 for MACPAC to examine the benefits 
of NEMT from State Medicaid programs on Medicaid beneficiaries, 
including benefits with chronic diseases such as end stage 
renal disease, substance use disorders, pregnant mothers, and 
patients living in remote, rural areas, and to examine the 
benefits of improving local coordination of NEMT with public 
transportation and other Federally-assisted transportation 
services. The Joint Explanatory Statement accompanying the Act 
directed HHS to take no regulatory action on the availability 
of NEMT services until the study has been completed.
    Non-Group Health Plans.--The Committee directs CMS to 
submit a report within 60 days of enactment of this Act with 
options for modifying existing processes so that Non-Group 
Health Plans may receive query responses that include the name 
and address of any Medicare Advantage or Part D plan in which 
the queried individual currently is enrolled, or, within the 
last three years, has been enrolled.
    Non-Opioid Pain Management.--The Committee believes that 
providing affordable non-opioid pain management to patients 
covered by Medicare and Medicaid is critical to combating drug 
addiction and the opioid crisis. The Committee looks forward to 
receiving CMS's upcoming report on non-opioid pain management, 
as required by section 6086 of the SUPPORT Act.
    Nursing Home Quality.--The Committee includes $1,500,000 
for the National Academies of Sciences, Engineering, and 
Medicine (NASEM) to conduct a study of how the United States 
delivers, regulates, and measures the quality of nursing home 
care. In 1986, the Institute of Medicine (IOM, now NASEM) 
completed an evidence-based examination of nursing home quality 
and issued the landmark report, Improving the Quality of Care 
in Nursing Homes. In 1987, Congress enacted the Nursing Home 
Reform Act as part of the Omnibus Reconciliation Act of 1987, 
after which the Health Care Finance Administration (now CMS) 
issued comprehensive regulations and survey processes to 
``ensure that residents of nursing homes receive quality care 
that will result in their highest practicable physical, mental 
and social well-being.'' These regulations for the most part 
are still in effect, most recently reissued as the 2016 
Requirements of Participation. Over the past 30 years, the 
population served by nursing homes has changed significantly 
and the ability to understand and measure quality in long-term 
care settings has advanced significantly--however, there has 
been no systematic review and analysis of the body of evidence 
regarding quality practices and measurement and how the 
evidence links to the regulations and enforcement system. 
Congress finds that such a study is in the public interest to 
enhance the quality of life and care experienced by residents 
of nursing homes now and in the future, and that NASEM should 
examine the current regulatory structure and how it links to 
care outcomes; consistency and effectiveness of oversight, 
enforcement, and penalties; evidence about which interventions 
produce high quality care in nursing homes; workforce and 
competencies needed to deliver high-quality care in nursing 
homes; current Medicare and Medicaid nursing home payment 
models and whether they support delivery of high-quality care 
and regulatory compliance; what consumers and family members 
seek and value in nursing home care; and alternative 
structures, policies, and care models to promote care 
innovation and assure quality.
    Nutrition Education.--The Committee encourages CMS to 
coordinate with HRSA to promote expanded nutrition education in 
medical school and graduate medical education curricula.
    Pharmacists and Patient Care Services.--The Committee is 
aware that certain Medicare Part B services and care frameworks 
have provisions to include pharmacists and their patient care 
services. However, CMS has few, if any, mechanisms to identify 
and evaluate pharmacists' contributions to patient care and 
outcomes or to identify barriers within current service 
requirements that prevent scalable involvement of pharmacists. 
The Committee urges CMS to create a mechanism to provide 
greater visibility into the scope and outcomes of the Medicare 
services currently provided by pharmacists. In addition, CMS 
should consider testing such system in a CMMI model to assess 
barriers to pharmacist participation in current Medicare 
services and to evaluate the contributions of pharmacists to 
team-based care and better health outcomes in Medicare 
beneficiaries.
    Program Integrity.--The Committee applauds the efforts of 
CMS to recover significant funding due to potential waste, 
fraud, and abuse in the Medicare and Medicaid programs. The 
Committee requests an update within 180 days of enactment of 
this Act on the Recovery Audit Validation Contractor program, 
National Correcting Coding Initiative, and related integrity 
programs, data reporting standards around these programs, and 
the feasibility or challenges of expanding these programs to 
other public payer programs. These or any enhanced recovery 
efforts must be implemented carefully so as not to 
inadvertently curb beneficiary access to care should health 
care providers come to fear retribution for minor billing 
errors or honest mistakes.
    Program of All-Inclusive Care.--The Committee acknowledges 
the important role of the Program of All-Inclusive Care (PACE) 
in the lives of over 52,000 participants, by allowing these 
highly medically complex Medicare or Medicaid beneficiaries to 
live at home, instead of in a nursing facility. The Committee 
urges CMS to move forward expeditiously on PACE-specific 
pilots, authorized by the PACE Innovation Act of 2015, 
specifically testing the innovative, comprehensive, integrated, 
and fully risk-bearing PACE model of care with new Medicare or 
Medicaid beneficiaries.
    Provider Shortages in Non-Contiguous States.--The Committee 
requests a report within 180 days of enactment of this Act on 
provider shortages in non-contiguous States. The report should 
include an analysis of existing payment rates and provide 
recommendations to address provider shortages in both primary 
care and specialty fields.
    Radiation Oncology Model.--The Committee is concerned that 
the Radiation Oncology (RO) Model as currently proposed could 
potentially reduce access to certain types of radiation therapy 
and negatively affect patient outcomes. The Committee requests 
CMS submit a report within 90 days of enactment of this Act on 
the impact of the RO Model on patient access and outcomes and 
the impact on therapy providers.
    Regulatory and Payment Reforms.--The Committee directs CMS 
to work with hospitals and community-based organizations to 
identify substantive regulatory delivery and payment reforms 
that, among other things, integrate behavioral health in 
primary care; create new and evaluates existing delivery models 
to improve spending efficiency and value-based care, and; 
incentivize the health care workforce to meet the unmet care 
needs of Medicare beneficiaries in underserved areas. The 
Committee also directs CMS to work with stakeholders, including 
Medicare beneficiaries and providers, to consider these goals.
    Regulatory Requirements Impacting Advanced Practice 
Registered Nurses and Physician Assistants.--The Committee 
requests that CMS submit a report within 120 days of enactment 
of this Act on regulatory requirements that impact Advanced 
Practice Registered Nurses and Physician Assistants, including 
potential modifications that would reduce these requirements.
    Robotic Stereotactic Radiosurgery.--The Committee continues 
to support robotic stereotactic radiosurgery (SRS) and robotic 
stereotactic body radiation therapy (SBRT). The Committee urges 
CMS to maintain sufficient payment for SRS and SBRT to ensure 
viability in both the hospital and freestanding center setting.
    Sepsis.--The Committee is pleased that CMS and the National 
Quality Forum plan to update the SEP 1 measure. A CMS study 
published in February reported an alarming 40 percent increase 
in the number of Medicare patients hospitalized with sepsis 
over the past seven years. Medicare spent more than $41.5 
billion on sepsis care in 2018. The Committee supports this 
effort and encourages CMS to issue a Request for Information as 
part of this review to collect broad stakeholder input to help 
ensure the new SEP 1 measure improves health outcomes. The 
Committee requests an update on these activities in the fiscal 
year 2022 Budget Justification.
    Social Determinants of Health.--The Committee is aware that 
social determinants of health are critical drivers of health 
outcomes and health care costs and that early childhood 
development is affected by social factors. The Committee 
encourages CMS to clarify and disseminate the strategies that 
States can implement under current Medicaid and CHIP authority, 
or through waivers, to address social determinants of health in 
the provision of health care, including strategies specifically 
targeting the pediatric population. This should include 
guidance on how States can encourage and incentivize managed 
care organizations to address social determinants of health 
through contracts. In addition, academic medical centers can be 
leaders in addressing social determinants of health. The 
Committee encourages CMS to identify opportunities to partner 
with academic medical centers to find innovative approaches to 
addressing social determinants of health, especially at 
academic medical centers that have expertise in addressing 
health disparities and are affiliated with Historically Black 
Colleges and Universities, Hispanic-Serving Institutions, or 
other Minority-Serving Institutions.
    STD Screening and Treatment Initiative.--The Committee 
continues to be concerned about high rates of STDs, especially 
among pregnant women and young adults. To help curb the spread 
of these diseases and address this public health problem, and 
to reach at-risk and vulnerable populations at every 
opportunity, the Committee urges CMS to collaborate with the 
CDC's Division of STD Prevention to develop a screening and 
treatment initiative under its Medicaid Program.
    Technology and Mail Management Modernization.--The 
Committee supports efforts by CMS to modernize its information 
technology and mail management systems. Ensuring that 
beneficiaries receive prompt and accurate written communication 
regarding Medicare, Medicare, and the Affordable Care Act is 
especially important during the ongoing coronavirus pandemic. 
These investments can improve service to beneficiaries, 
increase efficiency, and decrease costs by giving CMS greater 
control over outgoing mail, being able to track and identify 
bad addresses, and improving tracking and accountability. The 
Committee encourages CMS to continue to innovate and modernize 
its mail management systems.
    Telehealth.-- Recent legislative expansions of telehealth 
have provided safe and reliable access to healthcare for 
millions of Americans. In response to the global outbreak of 
COVID-19, these efforts have rapidly changed how medical 
providers deliver efficient services, which are especially 
critical in rural America. Therefore, the Committee strongly 
encourages CMS through its rulemaking to maximize access to 
healthcare through telehealth with equitable payment and 
reimbursement policies.
    Vaccine Cost-Sharing.--The Committee notes that addressing 
cost-sharing and reimbursement issues with Medicare Part D 
vaccines is critical to ensuring that Medicare beneficiaries 
have access to vaccines that have the potential to prevent 
serious disease. To address low vaccination rates, the 
Committee urges CMS to identify options for patients to have 
no-cost access to Part D vaccines, similar to coverage of Part 
B vaccines.
    Vaccine Preventable Illnesses.--The Committee is concerned 
about the underutilization of vaccinations for adults and, in 
particular, high-risk adults where rates do not exceed 20 
percent for certain recommended immunizations. The Committee 
urges CMS to work toward achievement of the Healthy People 2030 
goals aimed at reducing the incidence of vaccine preventable 
illnesses, such as invasive pneumococcal infections, and 
increase the percentage of adults (aged 65 or older) who are 
vaccinated against pneumococcal disease. CMS is encouraged to 
support development and implementation of electronic health 
records and other technologies, such as reminder recall 
programs, to identify Medicare beneficiaries who have not 
received the full course of recommended vaccinations and 
provide information to those beneficiaries and their providers 
of the risks of vaccine preventable conditions and emphasize 
the importance of adherence to the recommendations.
    Violence Against Health Care Providers.--The Committee 
recognizes that preventable violence against health care and 
social service employees such as nurses, physicians, emergency 
responders, medical assistants, and social workers, has been 
and remains on the rise, resulting in not only serious harm to 
these providers and their ability to provide quality care, but 
also to those they serve. Given the prevalence of violent 
incidences across health care and social services settings, the 
Committee requests CMS (in coordination with the National 
Institute for Occupational Safety and Health) submit a report 
within 180 days of enactment of this Act on the degree and 
extent to which health care facilities and social services 
settings have adopted and implemented the practices and 
controls recommended by the Occupational Safety and Health 
Administration's (OSHA) Guidelines for the Prevention of 
Violence for Health Care and Social Service Workers; whether 
the Joint Commission has fully assessed compliance by health 
care facilities with its recommended practices issued in April 
2018; and whether there are gaps in the adoption and full 
implementation of OSHA Guidelines and Joint Commission 
recommendations. Such strategies should be a core consideration 
in ongoing CMS initiatives to safeguard patient and worker 
safety, improve quality and care, and reward high-performing 
providers.

State Survey and Certification

    The Committee provides $407,334,000 for State Survey and 
Certification activities, which is $10,000,000 above the fiscal 
year 2020 enacted level and $34,858,000 less than the fiscal 
year 2021 budget request. State Survey and Certification 
supports certifications of Medicare and Medicaid certified 
health care facilities to ensure that beneficiaries receive 
care at facilities that meet health, safety, and quality 
standards required by CMS.
    In addition, the CARES Act (P.L. 116-136) included not less 
than $100,000,000 for State Survey and Certification activities 
to increase inspections of nursing home facilities in 
localities with community transmission of coronavirus.
    The Committee urges CMS to coordinate with the Department 
of Veterans Affairs on oversight of long-term care facilities 
under the Department of Veterans Affairs, including surveys of 
such facilities.
    The Committee is concerned about the Administration's 
efforts to prevent and respond to the disproportionate impact 
of COVID-19 on our nation's nursing home residents and staff. 
According to data collected by the New York Times, as of June 
26, ``at least 54,000 residents and workers have died from the 
coronavirus at nursing homes and other long-term care 
facilities for older adults in the United States.'' Nursing 
homes and long-term facilities for older adults account for 
approximately 43 percent of all deaths in the U.S. due to 
COVID-19.
    As evidence mounted last April that the approximately 
15,500 nursing homes nationwide are especially vulnerable to 
the coronavirus, CMS was slow to provide clear guidance, 
oversight, and resources to state agencies on the frontlines. 
The CARES Act provided CMS an additional $200,000,000 to 
prevent, prepare for, and respond to coronavirus, with the 
requirement that at least $100,000,000 of the total be used to 
support increased State and Federal oversight of nursing homes. 
Congress expected CMS to use these funds to ensure nursing 
homes were adhering to standards for quality of care, infection 
control, and maintaining sufficient staffing to minimize the 
spread of the virus and protect patients and staff. However, as 
of June 1, CMS had allocated approximately $1,500,000 of this 
emergency supplemental funding to a handful of State oversight 
agencies. The Committee remains troubled that very little of 
this funding has been allocated and directs CMS to release 
funding to States and territories in need through an expedited 
process.

Federal Administration

    The Committee provides $732,533,000 for Federal 
Administration activities related to the Medicare and Medicaid 
programs, which is the same as the fiscal year 2020 enacted 
level and $40,000,000 below the fiscalyear2021 budget request. 
The Federal Administration funding supports CMS staff, along 
with operating and administrative expenses for information 
technology, communication, utilities, rent and space 
requirements, as well as administrative contracts.
    Quality Improvement Organizations.--The Committee does not 
support the Administration`s proposal to shift personnel costs 
to the Federal Administration account that have previously been 
funded by a mandatory appropriation.

              HEALTH CARE FRAUD AND ABUSE CONTROL ACCOUNT

 
 
 
Appropriation, fiscal year 2020.......................      $786,000,000
Budget request, fiscal year 2021......................       813,000,000
Committee Recommendation..............................       807,000,000
    Change from enacted level.........................       +21,000,000
    Change from budget request........................        -6,000,000
 

    This includes a base amount of $311,000,000 and an 
additional $496,000,000 through a discretionary budget cap 
adjustment authorized under section 251(b) of the Balanced 
Budget and Emergency Deficit Control Act of 1985. The Health 
Care Fraud and Abuse Control Account (HCFAC) funds support 
activities conducted by CMS, the HHS Office of Inspector 
General, and the Department of Justice. This level is 
$21,000,000 above the fiscal year 2020 enacted level and 
$6,000,000 below the fiscal year 2021 budget request.
    This funding is in addition to other mandatory funding 
provided through authorizing legislation. The funding will 
provide resources to continue efforts for Medicaid program 
integrity activities, for safeguarding the Medicare 
prescription drug benefit and the Medicare Advantage program, 
and for program integrity efforts related to these programs 
carried out by the Department of Justice.
    The Committee modifies bill language to enable the 
Secretary to fund the Senior Medicare Patrol Program 
administered by the Administration for Community Living from 
either discretionary or mandatory funds provided to this 
account.

                Administration for Children and Families


  PAYMENTS TO STATES FOR CHILD SUPPORT ENFORCEMENT AND FAMILY SUPPORT 
                                PROGRAMS

 
 
 
Appropriation, fiscal year 2020.......................    $2,890,000,000
Budget request, fiscal year 2021......................     3,039,000,000
Committee Recommendation..............................     3,039,000,000
    Change from enacted level.........................      +149,000,000
    Change from budget request........................             - - -
 

    The Committee also recommends $1,400,000,000 in advance 
funding, as requested, for the first quarter of fiscal year 
2022 to ensure timely payments for Child Support Enforcement 
programs. These programs support State-administered programs of 
financial assistance and services for low-income families to 
promote their economic security and self-sufficiency.

                   LOW INCOME HOME ENERGY ASSISTANCE

 
 
 
Appropriation, fiscal year 2020.......................    $3,740,304,000
Budget request, fiscal year 2021......................             - - -
Committee Recommendation..............................     3,765,304,000
    Change from enacted level.........................       +25,000,000
    Change from budget request........................    +3,765,304,000
 

    The Committee recommends $3,765,304,000 for the Low Income 
Home Energy Assistance program, which is $25,000,000 above the 
fiscal year 2020 enacted level and $3,765,304,000 above the 
fiscal year 2021 budget request. The Low Income Home Energy 
Assistance Program (LIHEAP) supports eligible families and 
households through programs providing assistance with energy 
costs. The Committee strongly opposes the Administration's 
proposal to eliminate this important program that serves almost 
six million low-income households each year.
    In addition, the CARES Act (P.L. 116-136) included 
$900,000,000 in emergency supplemental appropriations to help 
eligible families with energy costs.
    Hold Harmless.--While the Committee recognizes the fiscal 
year 2020 bill made progress to limit annual decreases in State 
allocations to no more than three percent of what a State 
received in the previous year, the Committee believes that all 
States have unmet needs and that all States benefit from the 
consistency of annual appropriations when the overall account 
is unchanged or increased. To correct this volatility and hold 
States, territories, and Tribes (funded through the States) 
harmless from annual reductions, the bill includes language 
directing the Administration for Children and Families (ACF) to 
distribute, at a minimum, the same amount of funding to States, 
territories, and Tribes as the fiscal year 2020 appropriation.
    LIHEAP Report.--The Committee directs the program to submit 
a report within 180 days of enactment of this Act on 
recommendations for reducing the volatility in annual State 
allocations as a result of the statutory formula. The report 
should identify the method by which each State's share of the 
new formula was based for FY 2016-FY 2020, as well as show each 
State's share of low income home energy expenditures and each 
State's share of the total funding for that year. The report 
should identify what drove major changes for each State for 
each of these fiscal years. This analysis should also include a 
chart showing hypothetical total funding amounts that would 
trigger a State's new formula share to be based on its new 
formula percentage. As part of the report, the program should 
include a chart of revised State allocations for the past five 
years with the formula recalculated to take into account a 
changing (moving) prior three-year average of low income home 
energy expenditures, e.g. for FY 2016 it would be based on FY 
2012, 2013, 2014 data, compared to a three-year average that is 
updated every third year. In addition, the report should 
include the extent to which it is feasible to project State 
allocations no less than six months prior to a new fiscal year, 
including whether it is possible to use energy cost 
projections, instead of currently used energy price data. While 
the Committee understands the complexity of the LIHEAP 
statutory framework as it exists today, it would be preferable 
to add predictability to the LIHEAP formulation process and 
annual State allocations.

                     REFUGEE AND ENTRANT ASSISTANCE

 
 
 
Appropriation, fiscal year 2020.......................    $1,908,201,000
Budget request, fiscal year 2021......................     2,456,380,000
Committee Recommendation..............................     1,911,201,000
    Change from enacted level.........................        +3,000,000
    Change from budget request........................      -545,179,000
 

    The Office of Refugee Resettlement (ORR) programs are 
designed to help refugees, asylees, Cuban and Haitian entrants, 
and trafficking victims become employed and self-sufficient. 
These programs also provide for care of unaccompanied alien 
children in Federal custody and victims of torture.
    Funding for several of the programs within this account is 
highly dependent on estimates and as such, it is critical that 
ORR communicate changes to estimated numbers of arrivals and 
costs as they become available. The Committee directs ORR to 
provide monthly updates of arrivals each month by category, 
including refugees, asylees, Cuban and Haitian entrants, 
Special Immigrant Visas, and unaccompanied alien children, to 
include any updates in estimated funding needs as a result of 
changes in trends in those categories. In addition, the 
Committee directs ORR to submit a report on efforts ORR is 
taking to ensure programming remains funded and prioritized to 
serve populations within ORR's mandate. This report shall be 
made publicly available and include how ORR intends to ensure 
that no additional barriers are put in place impacting an 
individual's ability to seek protection and receive necessary 
ORR services.
    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 other populations of 
concern who remain statutorily eligible for integration 
services, and to ensure that there is capacity for future 
arrivals to be adequately served.
    In addition, the Committee recognizes the importance of 
meeting the immediate needs of recently arrived refugees and 
other populations receiving resettlement services due to the 
public health and economic crisis as a result of the COVID-19 
pandemic. The Committee expects ORR to continue to engage with 
and approve State requests for additional flexibilities, 
including additional months of cash and medical assistance for 
refugees and other qualified arrivals, and for additional 
services available through the Refugee Support Services 
program.
    Within the total, the Committee includes the following:

------------------------------------------------------------------------
                   Budget Activity                     FY 2021 Committee
------------------------------------------------------------------------
Transitional and Medical Services....................       $354,000,000
Victims of Trafficking...............................         29,755,000
Refugee Support Services.............................        207,201,000
Unaccompanied Children...............................      1,303,245,000
Victims of Torture...................................         17,000,000
------------------------------------------------------------------------

Transitional and Medical Services

    The Committee includes $354,000,000, which is equal to the 
fiscal year 2020 enacted level and $75,441,000 above the fiscal 
year 2021 budget request. The Transitional and Medical Services 
(TAMS) program provides grants to States and nonprofit 
organizations to provide refugees and other eligible 
populations with up to eight months of cash and medical 
assistance.

Victims of Trafficking

    The Committee includes $29,755,000 for the Victims of 
Trafficking program, which is $2,000,000 above the fiscal year 
2020 enacted level and the fiscal year 2021 budget request. The 
recommendation includes $4,500,000 for the National Human 
Trafficking Hotline.
    Health Care for Victims of Trafficking.--The Committee 
supports efforts to build, expand, and sustain the capacity of 
Federally Qualified Health Centers to deliver trauma-informed, 
strength-based, and person-centered services to victims of 
human trafficking and their immediate family members. The 
Committee encourages ACF to work with university health 
centers, allied health professions programs, and medical 
schools to provide health care and mental health services to 
treat the immediate and long-term health needs of victims of 
human trafficking and include human trafficking training in 
health professions academic programs to prepare students to 
recognize victims and intervene on their behalf.
    Human Trafficking in Rural Communities.--The Committee 
supports efforts to address combatting human trafficking in 
rural areas. The isolated geographies and transportation routes 
that facilitate rapid, invisible movement of victims make these 
communities uniquely vulnerable, and the opioid epidemic has 
compounded the issue. These factors also complicate the ability 
for social services and health care providers to provide 
prevention and care to survivors. Many rural areas do not have 
the resources they need to address this crisis. The Committee 
encourages the Office on Trafficking in Persons to recognize 
this issue.

Refugee Support Services

    The recommendation includes $207,201,000, which is equal to 
the fiscal year 2020 enacted level and $56,380,000 above the 
fiscal year 2021 budget request. The Refugee Support Services 
(RSS) program provides formula and competitive grants to States 
and nonprofit organizations to address barriers to employment 
and help refugees become self-sufficient.

Unaccompanied Children

    The recommendation includes $1,303,245,000 for the 
Unaccompanied Alien Children (UAC) Program, which is equal to 
the fiscal year 2020 enacted level. The Committee believes this 
funding, in addition to funding still available from the 
Emergency Supplemental Appropriations for Humanitarian 
Assistance and Security at the Southern Border Act, 2019 (P.L. 
116-26) and the Further Consolidated Appropriations Act, 2020 
(P.L. 116-94), to be sufficient to ensure the UAC program 
fulfills its mission to care for children in ORR's custody, and 
to place them with sponsors as expeditiously as possible.
    The Committee notes the sharp rise of unaccompanied 
children in ORR custody in 2018 and 2019--and the corresponding 
need to open expensive, unlicensed influx facilities--was a 
direct result of the Administration's misguided Memorandum of 
Agreement (MOA) and immoral Family Separation policy. The 
Committee further notes that the drastic reduction in the 
number of children referred to ORR in late 2019 through the 
Spring of 2020 are a result of the Administration's inhumane 
immigration policies, including Migrant Protection Protocols 
(MPP) and the COVID-19-related border closings, which the 
Committee believes to be illegal denials of an immigrant's 
right to seek asylum in the United States under the Trafficking 
Victims Protection Reauthorization Act (TVPRA).
    The Committee strongly opposes the Administration's 
disingenuous use of authorities under the Public Health Service 
Act to evade its legal responsibilities under the TVPRA and to 
pursue its long-term goals of dismantling the Flores Agreement, 
which has been put in place to protect minors who cross the 
border without a parent or guardian.
    The Committee, once again, emphasizes that ORR is not an 
immigration enforcement agency--it is a social services agency 
whose purpose is to provide care for children in its custody 
and to place those children with sponsors as expeditiously as 
possible. To protect ORR's core mission, the bill includes 
directive language and limitations on funding to minimize the 
adverse impacts of this Administration's inhumane policy agenda 
and to protect the safety and health of unaccompanied children 
in the agency's custody.
    The recommendation includes not less than $190,000,000 for 
legal services, post-release services, and child advocates. The 
Committee directs ORR to provide quarterly reports to the 
Committee on the number of children receiving services from 
legal service providers, the number receiving post-release 
services, and the number who are appointed child advocates. The 
report should also include the number of children on the 
waitlist for any of these services, if any, and what steps are 
being taken to ensure all children in custody receive the 
services they need.
    The Committee supports the continued expansion of legal 
services for unaccompanied children and notes that services 
provided by qualified and independent legal counsel to 
unaccompanied children can increase the efficiency and 
effectiveness of immigration proceedings, significantly reduce 
the failure-to-appear rate of children who are released from 
HHS custody, and help relieve the immigration court backlog. 
The recommendation includes funding and direction for ORR to 
ensure in-person ``Know Your Rights'' and legal screenings for 
every child in custody, and includes no less than $30,000,000 
to be spent in fiscal year 2021 for direct representation 
services to children released from HHS custody, as well as to 
additional high-release communities that are not currently 
being served. Post-release direct representation shall be made 
available to children up to funded capacity, without 
restrictions related to: age while in ORR care; release date; 
estimated time to conclude a case; or other characteristics, 
provided the representation is initiated while the individual 
is still a minor. In addition, the Committee strongly 
encourages ORR to work with legal service providers to develop 
a strategy to minimize the risks of any child having to go to 
immigration court without independent legal counsel. The 
recommendation includes an additional $5,500,000 for legal 
service providers to recruit and train additional attorneys for 
the purposes of building the capacity necessary to provide 
independent representation to unaccompanied children with 
pending immigration cases.
    The Committee strongly urges ORR to ensure that each new 
residential care facility has a corresponding independent legal 
services provider (LSP) secured prior to placement of children 
at such facility. The Committee directs ORR to ensure that 
shelters provide appropriate and confidential space for LSPs to 
meet with children, but strongly urges ORR be responsive to LSP 
requests for children to meet with LSPs offsite if that is more 
appropriate for the child. In addition, the Committee believes 
it is critical that children maintain access to legal services 
throughout the COVID-19 pandemic. Should limits on in-person 
meetings due to shelter or provider constraints shift 
communication with the child's attorney to telephonic or video 
means, these measures must be temporary, when done at the 
request of the child or their counsel, and should not be used 
as replacements for in-person legal access when the active 
public health emergency is sufficiently mitigated to allow for 
safe resumption of in-person legal access.
    The recommendation includes funding for ORR to expand Child 
Advocate services, and directs an additional $1,250,000 be used 
to offset matching requirements. The Committee expects ORR to 
ensure the child advocates are appointed to particularly 
vulnerable children, including victims of abuse or trafficking, 
children 12 years old and younger, children in residential 
treatment centers, and to children who are expected to remain 
in ORR custody for prolonged periods of time. The Committee 
directs ORR to ensure the continued independence of the Child 
Advocate program from other contracted service providers to 
avoid any conflicts of interest.
    To ensure that child advocates have the visibility and 
capacity to be appointed to the most pressing cases in ORR 
custody, the Committee strongly urges ORR to proactively share 
census data from each facility with child advocates on a 
consistent basis. Such census should list the names, ages, 
countries of origins, languages and lengths of stay of each 
child in the program, which will help child advocates identify 
the children in greatest need. In addition, within 30 days of 
enactment of this Act, ORR shall provide to child advocates 
information for any category 4 children in custody with stays 
of over 120 days.
    The Committee recognizes ORR's efforts to provide 
additional post-release services to more children following 
release from ORR's care, and recommends additional funding to 
support sponsors prior to a child's release, to mitigate the 
risk for family breakdown, facilitate children's integration 
into their communities, and assist with children's ability to 
comply with their immigration court proceedings. In addition to 
children already designated under law or policy to receive such 
services, the Committee encourages ORR to ensure that all 
pregnant or parenting teens, children whose primary language is 
neither English nor Spanish, as well as children who faced 
separation from a parent or legal guardian at the U.S./Mexico 
border, are referred for post-release services. ORR should 
arrange for such services to be provided by non-governmental 
organizations with experience and expertise in working with 
these children. Further, in determining additional groups of 
children who should be categorically referred for home studies 
and post-release services, the Committee directs ORR to 
formally engage with current family reunification service 
providers to help evaluate and identify new and additional risk 
factors for children.
    Age-Outs.--The Committee is concerned about reports that 
most unaccompanied children turning 18 years old while in the 
care and custody of ORR are transferred directly to the custody 
of Immigration and Customs Enforcement (ICE). The Committee 
directs ORR to develop a tangible post-18 plan for every 17-
year-old unaccompanied child in ORR care at least two weeks in 
advance of his or her 18th birthday. Each post-18 plan should 
at a minimum identify an appropriate non-secure placement for 
the child and identify any necessary social support services 
for the child. The Committee requests a briefing within 60 days 
of enactment of this Act on compliance with the directive 
included under this heading in House Report 116-62, and with 
any improvements made or resources necessary to ensure 
caseworkers have the capacity to complete these plans and 
document such plans in a consistent manner in ORR's electronic 
case management system.
    Children in Prolonged Detention.--The Committee directs ORR 
to submit a report every six months on the number of children 
who have been in ORR custody longer than a year. Such report 
should include how long each child has been in ORR custody and 
a status update on their case, including the type of facility 
or placement where the child is currently being held; whether 
the child has any family or other potential sponsor(s) in the 
United States; and a summary of ORR's efforts to either unify 
the child with a sponsor or place the child into an ORR long-
term foster care setting. The Committee directs ORR to ensure 
that a care provider is taking all steps necessary to place 
every child in a home as expeditiously as possible and that no 
child is unaccounted for, resulting in prolonged detention.
    The Committee appreciates that as part of ORR's Discharge 
Rate Improvement Plan, ORR committed to creating a national UAC 
stakeholder group to discuss and incorporate stakeholder 
feedback on ORR policies and procedures that impact UAC 
operations and improvement discharge rates and procedures. The 
Committee understands that part of the plan and stakeholder 
discussion will be focused on the growing population of 
children in ORR's care that have no identified sponsor, i.e. 
``Category 4'' children. The Committee understands that many 
stakeholders strongly believe that family foster home care 
should be the priority placement option for all children in 
Category 4 cases. The Committee expects ORR to give serious 
consideration to stakeholder recommendations, and strongly 
urges ORR to reconsider the requirement that children in 
Category 4 cases demonstrate their potential eligibility for 
legal relief prior to placement in long-term foster care.
    Communicating with Congress.--The Committee directs the 
Department to notify the Committee prior to making any 
administrative or policy changes expected to impact: the number 
of children in ORR custody; shelter operations; the placement 
of children with sponsors; or any post-release services.
    Community-Based Facilities.--The Committee directs ORR to 
prioritize new grant or contract funding to small-scale, 
community-based residential care placements. As ORR adds State-
licensed capacity to its network, the Committee expects that no 
less than 50% of beds added to the network be in small-scale 
shelters, transitional foster care, small group homes, or long-
term foster care. The Committee directs ORR to ensure there is 
an adequate supply of long-term foster care beds in the network 
to minimize the time it takes for a child to be moved to this 
least restrictive placement. ORR should work closely with its 
long-term foster care providers to expand its pool of foster 
families, particularly those experienced with caring for 
children with mental health and other specialized needs. The 
Committee directs ORR to notify the Committee prior to all new 
funding opportunity announcements, grant or contract awards, or 
plans to release or acquire property.
    Facility Oversight.--The Committee expects ORR to maintain 
strict oversight of all ORR-funded care provider facilities and 
correct violations of Federal, State or local codes related to 
the standards of childcare or the well-being of children, as 
well as violations of ORR policies and procedures, or any 
requirements as listed in the Flores Settlement Agreement, 
regardless of the status of the underlying agreement. Within 90 
days of enactment of this Act, ORR is directed to submit an 
updated version of the report submitted to the Committee 
pursuant to House Report 115 862. The updated report should 
include new or updated information on facility violations, and 
any systematic trends in noncompliance, along with efforts to 
remedy noncompliance across the provider facility network.
    The Committee expects ORR to improve its oversight of State 
licensed shelters by implementing the recommendations included 
in the Office of the Inspector General's reports dated June 17, 
2020. These improvements include collecting information that 
allows ORR to better track and show trends of serious safety 
incidents, addressing staffing shortages, and ensuring shelters 
maintain comprehensive checklists to ensure the physical safety 
of sites housing unaccompanied children. The Committee directs 
the Department to provide a report to the Committee within six 
months of enactment detailing ORR's progress in implementing 
the recommendations contained in the Inspector General's 
reports.
    In addition, the Committee directs ORR to conduct annual 
comprehensive monitoring visits to each provider facility. 
Within 30 days of ORR and a facility finalizing a response from 
a provider facility to a monitoring visit report, ORR is 
directed to submit a copy of that response to the Committee 
along with any remedies that have been taken to address 
concerns observed during the monitoring visit.
    Within 180 days of enactment of this Act, ORR is directed 
to submit to the Committee a report that: (1) describes the 
frequency of ORR's comprehensive monitoring visits to each ORR 
facility within the past five fiscal years; (2) assesses the 
comprehensiveness, uniformity, and effectiveness of ORR's 
monitoring protocols and processes, and identifies actions 
needed to improve those protocols and processes; (3) 
specifically assesses the extent to which ORR's monitoring 
protocols and processes address children's access to legal 
providers and the facilitation of timely release of children 
from care and placement; and (4) identifies actions needed to 
improve such access and facilitation.
    Fingerprinting of Unaccompanied Children.--The Committee 
directs ORR to issue guidance to its care providers requiring 
each provider to provide advance notification to legal services 
providers and to coordinate with such legal service providers 
to ensure that attorneys may be present whenever the Department 
of Homeland Security fingerprints, questions, or interviews an 
unaccompanied child in ORR custody.
    Influx Shelters.--The Committee believes the need for 
influx shelters in fiscal years 2018 and 2019 was due largely 
to the Administration's misguided and willfully harmful 
policies toward unaccompanied children--in particular, the 
Memorandum of Agreement with the Department of Homeland 
Security and the Administration's immoral policy of family 
separation. The Committee strongly supports the medical, 
psychological, and child welfare advocacy communities in their 
compelling arguments against, and well-founded reasons to 
limit, the use of influx shelters, especially large capacity 
shelters where a substantial number of children reside in the 
same room. To eliminate reliance on influx shelters absent such 
unforeseen circumstances, the Committee directs ORR to ensure 
sufficient bed capacity for unaccompanied children in 
permanent, small, State-licensed shelters and shall in no way 
delay or otherwise hinder the expeditious placement of 
unaccompanied children with qualified sponsors.
    Information Sharing with EOIR.--The Committee is concerned 
that ORR is sharing unnecessary case-level information, 
including biographic data, of individual children with the 
Executive Office for Immigration Review (EOIR) and with DHS, in 
ways that may dissuade children from seeking legal relief 
through due process with their independent legal service 
providers or may bias the court and unfairly influence issuance 
and length of continuances. The Committee reminds ORR that they 
are not qualified to assess a child's eligibility for legal 
relief and directs ORR to issue guidance to its employees and 
care providers within 30 days of enactment of this Act 
prohibiting them from sharing non-essential information 
concerning a child's prospects for family reunification with a 
court (including, but not limited to personal records 
pertaining to the child's stay in ORR custody, including 
medical or mental health records and behavioral reports; 
assessments of a child's eligibility for immigration relief; or 
information concerning a potential sponsor's immigration status 
of viability) unless ORR or that care provider is appearing as 
a party or counsel in a proceeding of record.
    In-Kind Donations.--The bill continues to include a general 
provision to allow in-kind donations from the private sector, 
non-governmental organizations and other groups to support 
children in ORR's care. The Committee requests ORR include in 
future Congressional Budget Justifications, information on the 
use of this provision, including examples of donations that are 
offered, donations that are accepted, and donations that care 
providers believe they cannot accept.
    Legal Services.--The Committee understands that ORR is 
preparing a solicitation for a new contract, commencing in 
fiscal year 2021, to provide legal services to unaccompanied 
children. The Committee has significant concerns that some of 
the requirements under this solicitation run contrary to basic 
and well-established legal principles and practices, including 
attorney/client confidentiality, ethical standards, and 
continuity of representation. The Committee directs ORR to 
ensure that the terms of the next legal services arrangement 
strictly adhere to these principles and practices. 
Specifically, the terms shall not require that legal services 
providers share records or case information, including case 
assessments of legal eligibility determinations, with HHS or 
any other Federal agency. Further, consistent with a client's 
right to have ongoing and uninterrupted legal counsel through 
the completion of legal proceedings, the terms shall not 
include a requirement that representation be terminated upon a 
child reaching age 18. Such a requirement would be particularly 
troublesome given the extended length of time currently 
required for children's proceedings and given the existing 
USCIS and immigration court backlog. The terms shall not 
include any requirement that an organization or individual 
involved in providing legal services sign a non-disclosure 
agreement. This would interfere with counsel's ability to 
advocate for their client's interests to the best of their 
ability and in the strongest possible terms, as they are 
compelled to do under ethical standards. Finally, funds shall 
be distributed to organizations providing legal services and 
advocacy services in a manner that allows for continuity of 
staffing and services regardless of fluctuations in the number 
of children in the UAC program over time.
    Memorandum of Agreement.--The Committee notes that there is 
clear evidence that the April 13, 2018 Memorandum of Agreement 
(MOA) between ORR and DHS serves as a deterrent to individuals 
and families willing to sponsor an unaccompanied child. After 
ORR implemented a series of operational directives to override 
elements of the MOA, the placement rate improved dramatically, 
and thousands of children were placed with qualified sponsors. 
Despite these directives, the Committee understands that 
potential sponsors still withdraw from the sponsorship process 
citing a fear of immigration enforcement. The continuation of 
the MOA results in longer stays in custody and further 
traumatizes unaccompanied children. The Committee strongly 
believes that sponsors will come forward faster if the MOA is 
terminated.
    Mental Health Services.--The Committee directs ORR to 
expand mental health services for children in its custody, 
including contracting with governmental and non-governmental 
entities while instituting policies that prevent disclosure of 
this information to immigration enforcement officials. The 
Committee encourages ORR to continue collaborating with the 
National Child Traumatic Stress Network in support of trauma-
informed care initiatives, including screenings, services, and 
therapies to children and staff, competency trainings for 
staff, identifying or improving trauma informed practices in 
ORR; and training for sponsors prior to release of children. 
ORR is directed to keep the Committee informed of additional 
resources necessary to support children and their families, as 
well as staff, who may need additional access to these 
services, including requests for additional resources from care 
providers and staff. The Committee requests ORR include in its 
fiscal year 2022 Congressional Budget Justification information 
on HHS's and grantees' coordination of health and mental health 
services, including training requirements for staff providing 
those services and any challenges to providing adequate care 
for children and the Department's progress implementing the 
recommendations in the September 2019 HHS Office of the 
Inspector General report titled ``Care Provider Facilities 
Described Challenges Addressing Mental Health Needs of Children 
in HHS Custody.''
    Mental Health Services--Confidentiality.--The Committee 
notes the critical importance of mental health services and 
support for unaccompanied children, many of whom have fled 
persecution, abuse, abandonment, and neglect. The Committee is 
deeply concerned about reports that information provided by 
children during ORR counseling sessions has been shared with 
the Department of Homeland Security for use in immigration 
enforcement. In addition, there are reports that ORR is sharing 
mental health information with immigration courts for master 
calendar hearings, where the court is not making decisions 
about a child's custody. ORR is directed to refrain from 
sharing any information with immigration courts for master 
calendar hearings, where the court is not making any decisions 
about the child's custody. The Committee further directs ORR to 
develop policies and protocols to ensure the confidentiality of 
counseling and mental health services provided to unaccompanied 
children, and of all related documentation, including case 
notes and records of therapists and other clinicians, and to 
incorporate these policies into the ORR policy guide within 90 
days of enactment of this Act.
    Migrant Protection Protocols (MPP).--The Committee strongly 
rejects ICE's decision to remove unaccompanied children from 
ORR custody while they are pursuing relief under the TVPRA, 
based on removal orders issued in absentia in connection with 
prior processing under MPP. Once designated unaccompanied, 
children should be granted all the protections afforded to them 
under the TVPRA. The Committee further reiterates its call for 
the Migrant Protection Protocols to be terminated. The 
Committee directs ORR to release children to approved sponsors 
as quickly as possible so they can pursue claims for protection 
regardless of whether a child, pursuant to his or her prior 
processing under MPP, has an order of removal. The Committee 
directs ORR to promptly notify a child's legal service provider 
(LSP) upon learning that the child may have been previously 
processed under MPP, and to provide to the LSP any information 
regarding court proceedings arising from prior processing under 
MPP. Further, the Committee directs ORR to facilitate routine 
communication between any such separated children in ORR 
custody and family members in the U.S. and in Mexico and, where 
available, to provide the children's attorneys with information 
pertaining to family members, including their location and 
contact information.
    Within 30 days of enactment of this Act, and monthly 
thereafter, the Committee directs ORR to include in its monthly 
separation report to the Committee, and make publicly available 
in such report online, the number of children separated from 
parents, legal guardians, or other family members in connection 
with the MPP program, and the number of children who were 
previously subject to the MPP policy with their families and 
subsequently re-entered the U.S. alone and were transferred to 
ORR as unaccompanied children. In addition, the Committee 
directs ACF to conduct an investigation of those unaccompanied 
children removed by ICE on the basis of removal orders issued 
while the children were in MPP and to provide the Committee 
with a report which includes the number of children removed and 
all steps taken to ensure their safety in home country.
    Ongoing Separations.--The bill includes a requirement that 
the Secretary update the Committee, and make publicly available 
online, the number of children referred to ORR's care who have 
been designated by DHS, or subsequently by HHS case managers, 
as having been separated (under any circumstances) from the 
parent or legal guardian with whom they were in DHS custody. 
The Committee considers the timely reporting of this 
information to be critical to oversight efforts to make sure 
that family separation does not occur again.
    The Committee expects ORR to invest in information 
technology that will improve the data tracking issues ORR has 
experienced in recent years, including the functionality 
necessary to track children who have been separated from 
families. The Committee requests a briefing within 30 days of 
enactment of this Act on the status of tools being developed 
and the protections in place to safeguard sensitive UAC and UAC 
sponsor data.
    Operational Directives.--The bill includes a general 
provision prohibiting HHS from reversing several operational 
directives that improved the sponsor suitability determination 
process and reduced the length of time children spend in ORR's 
custody. The Committee expects HHS to continue to improve child 
welfare outcomes by reducing time in care and to consider any 
additional operational directives that can be implemented to 
release children to suitable sponsors as safely and 
expeditiously as possible.
    Protection & Advocacy for Disabled Children.--The Committee 
believes there must be more robust monitoring of care and 
treatment for unaccompanied alien children with disabilities in 
ORR funded care provider facilities and encourages ORR to 
partner with the nationwide network of Protection & Advocacy 
agencies to ensure adherence to Federal, State and local codes 
related to the standards of childcare or the well-being of 
children with disabilities.
    Protection of DNA.--The Committee continues to prohibit any 
governmental agency or private entity from accessing, using, or 
storing any genetic material, data, or information collected in 
this reunification effort, including for the purpose of 
criminal or immigration enforcement. Any genetic material, 
data, or information obtained should be destroyed after testing 
and the probability of a genetic relationship is calculated. 
The entities conducting DNA testing shall obtain the consent of 
any individual over age 18 prior to testing, and shall make 
every effort to obtain the consent of a guardian prior to 
testing anyone under age 18. The Committee requests ORR 
continue to include in its annual Congressional Budget 
Justification the steps it is taking to protect the privacy and 
genetic material and data of individuals who are being tested 
as part of reunification efforts.
    Residential Treatment Centers.--Within 120 days of 
enactment of this Act, and every six months thereafter, ORR 
should submit to the Committee a report with the following 
information: (1) the number of children in residential 
treatment centers; (2) the length of stay for each child in 
residential treatment centers and their total length of care; 
(3) the number of children transferred from other settings to 
residential treatment; and (4) the documented reasons for 
transfer to residential treatment centers, as documented in a 
child's ORR file. In addition, not later than 60 days after the 
date of enactment of this Act, ORR shall submit a report to the 
Committee, and make publicly available in its policy guide, the 
due process safeguards for children in residential treatment 
centers.
    Spend Plan.--The bill includes a general provision 
requiring the Secretary of HHS to continue to submit a 
comprehensive spend plan to the Committee every 60 days. The 
Committee expects the plan to incorporate all funding provided 
in this Act and in previous Appropriations Acts, including 
funds provided in the Emergency Supplemental Appropriations for 
Humanitarian Assistance and Security at the Southern Border 
Act, 2019 (P.L. 116-26) and in the Further Consolidated 
Appropriations Act, 2020 (P.L. 116-94). The plan should 
continue to include a report on facilities, by facility type, 
including facility-specific data including number of licensed 
beds; operating status (open or not yet open); whether a 
facility is operated by a for-profit or non-profit company; and 
the availability of such facilities to legal, medical and 
social service resources.
    Tender Age Children.--In response to a growing number of 
tender age children in ORR facilities, the Committee expects 
ORR to expand the use of interventions and lessons learned from 
context-focused specialists providing early childhood mental 
health, child trauma, and immigration trauma training to ORR 
contracted staff. The Committee expects ORR staff, as well as 
staff in contracted facilities to receive in-person continuing 
education on these topics at least twice per year. Further, the 
Committee directs ORR to work with residential care service 
providers, child welfare experts, and other stakeholders with 
relevant expertise, to develop policy guidelines specifically 
for residential care of tender age children. The Committee 
directs ORR to include in the fiscal year 2022 Congressional 
Budget Justification information on these efforts, which should 
include details and metrics on the types of training offered to 
staff to ensure developmentally appropriate care is available 
for tender age children. The justification should detail how 
placement options and services are tailored for tender age 
children, as well as an assessment of the circumstances under 
which very young children are referred to ORR.
    Video-Teleconferencing Hearings.--The Committee is 
concerned that video teleconference (VTC) hearings for children 
have become more frequent during the COVID-19 crisis. The use 
of VTC for substantive hearings of children is a new practice, 
one often plagued with technical difficulties and inefficient 
use of government resources. Further, the expedited nature of 
these dockets for newly-arrived children pending release from 
ORR custody diverts ORR resources from critical services for 
unaccompanied children, as they require transporting children 
to court on multiple occasions within the space of weeks. These 
practices alienate children from their legal proceedings and 
undermine their ability to comprehend the court process and 
meaningfully participate in their legal defense. The Committee 
strongly urges ORR to allocate sufficient resources to ensure 
that legal services providers can mitigate the adverse impact 
that VTC practices have on children, including having a legal 
services provider presence both in courts and in the child's 
location for VTC proceedings.

Victims of Torture

    The Committee includes $17,000,000 for the Victims of 
Torture program, which is $1,000,000 above the fiscal year 2020 
enacted level and the fiscal year 2021 budget request. The 
program funds non-profit organizations providing healing and 
support services to refugees, asylees and asylum seekers, who 
need help overcoming the effects of torture.

   PAYMENTS TO STATES FOR THE CHILD CARE AND DEVELOPMENT BLOCK GRANT

 
 
 
Appropriation, fiscal year 2020.......................    $5,826,000,000
Budget request, fiscal year 2021......................     5,826,000,000
Committee Recommendation..............................     5,926,000,000
    Change from enacted level.........................      +100,000,000
    Change from budget request........................      +100,000,000
 

    The Committee recommends $5,926,000,000 for the Child Care 
and Development Block Grant (CCDBG) program, which is 
$100,000,000 above the fiscal year 2020 enacted level and the 
fiscal year 2021 budget request. The CCDBG provides funds 
according to a formula to States, territories, and Tribes to 
provide financial assistance to help low-income working 
families and families engaged in training or education 
activities access child care and to improve the quality of 
child care for all children.
    In addition, the CARES Act (P.L. 116-136) included 
$3,500,000,000 to support child care programs, including child 
care for health care workers and other essential workers.
    The Committee encourages States to prioritize increasing 
reimbursement rates to quality providers and increase the 
recruitment of quality providers offering care during non-
traditional hours.
    Child Care Facilities Needs Assessment.--The Committee is 
concerned with the learning environment and deterioration of 
many early child care facilities across the nation, and 
believes that additional investments may be necessary to 
address suboptimal health and early learning conditions. The 
Committee directs ACF to dedicate a portion of Federal CCDBG 
research funding (42 U.S.C. 9858m) towards a feasibility study 
to determine how a needs assessment of child care facilities 
could best be conducted by States and compiled by ACF to 
produce a national estimate of facility remediation needs and 
costs. The Committee requests that the fiscal year 2022 
Congressional Budget Justification include an explanation for 
how such a facilities needs assessment could be conducted, and 
the estimated costs for such an assessment.

                      SOCIAL SERVICES BLOCK GRANT

 
 
 
Appropriation, fiscal year 2020.......................    $1,700,000,000
Budget request, fiscal year 2021......................             - - -
Committee Recommendation..............................     1,700,000,000
    Change from enacted level.........................             - - -
    Change from budget request........................    +1,700,000,000
 

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

                CHILDREN AND FAMILIES SERVICES PROGRAMS

 
 
 
Appropriation, fiscal year 2020.......................   $12,876,652,000
Budget request, fiscal year 2021......................    11,856,130,000
Committee Recommendation..............................    13,098,181,000
    Change from enacted level.........................      +221,529,000
    Change from budget request........................    +1,242,051,000
 

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

------------------------------------------------------------------------
                                                            FY 2021
                   Budget Activity                         Committee
------------------------------------------------------------------------
Programs for Children, Youth, and Families:
    Head Start.......................................    $10,763,095,000
    Preschool Development Grants.....................        300,000,000
    Runaway/Homeless Youth...........................        120,000,000
    Abuse of Runaway Youth Prevention................         20,000,000
    State Child Abuse Prevention.....................         92,591,000
    Discretionary Child Abuse Prevention.............         37,500,000
    Community-based Child Abuse Prevention...........         63,160,000
    Child Welfare Services...........................        268,735,000
    Child Welfare Training...........................         17,984,000
    Adoption Opportunities...........................         42,100,000
    Adoption Incentives..............................         75,000,000
    Social Services/Income Maintenance Research......          7,512,000
    Native American Programs.........................         60,000,000
Community Services:
    Community Services Block Grant...................        750,000,000
    Community Economic Development...................         20,383,000
    Rural Community Facilities.......................         10,000,000
Domestic Violence Hotline............................         14,000,000
Family Violence/Battered Women's Shelters............        185,000,000
Independent Living Training Vouchers.................         43,257,000
Disaster Human Services Case Management..............          1,864,000
Program Direction....................................        206,000,000
------------------------------------------------------------------------

Head Start

    The Committee recommends $10,763,095,000 for the Head Start 
program, which is $150,000,000 above the fiscal year 2020 
enacted level and the fiscal year 2021 budget request. Head 
Start and Early Head Start promote school readiness of children 
under 5 from low-income families through education, health, 
social and other services.
    In addition, the CARES Act (P.L. 116-136) included 
$750,000,000 to supplement grants to all Head Start programs, 
to help them respond to COVID-19 related needs of children and 
families.
    Cost of Living Adjustment.--The Committee includes 
$135,000,000 for a cost-of-living adjustment.
    Tribal Colleges and Universities--Head Start Partnership 
Program.--The Committee recommends $4,000,000 for the recently 
re-established Tribal Colleges and Universities (TCU)--Head 
Start Partnership Program.
    Early Head Start (EHS) Expansion and Early Head Start--
Child Care (EHS-CC) Partnerships.--The Committee continues to 
strongly support EHS Expansion and EHS-CC Partnerships. The 
Committee directs ACF to continue to prioritize equally EHS 
Expansion and EHS-CC Partnerships, as determined by the needs 
of local communities, and expects that any funds used for EHS 
Expansion and EHS-CC Partnership grants that are recompeted 
continue to be used for such purposes. The Committee continues 
to direct ACF to include in the fiscal year 2022 Congressional 
Budget Justification and each Congressional Budget 
Justification thereafter, the actual and estimated number of 
funded slots for each of the following: Head Start, EHS, and 
EHS-CC Partnerships.
    Impact of the Federal Poverty Guideline.--The Committee 
recognizes emerging challenges in Head Start's ability to 
fulfill its purpose of serving low-income children and their 
families as a result of an antiquated federal poverty line. The 
federal poverty line has not kept pace with the cost of basic 
living necessities in communities across the country, and as a 
result an increasing number of families whose income exceeds 
the federal poverty line experience financial hardship. Many 
such families would benefit from the services Head Start 
programs provide but are currently ineligible. The Committee 
requests a report within 180 days of enactment of this Act, 
examining how changes in incomes and poverty have impacted Head 
Start eligibility and enrollment among families facing 
financial hardship given the federal poverty line eligibility 
requirement.
    Migrant and Seasonal Head Start.--The Committee understands 
that Migrant and Seasonal Head Start (MSHS) is facing unique 
challenges due to factors outside of the MSHS community's 
control, and that shifts in funding to accommodate new slots 
elsewhere in the MSHS network are resulting in individual 
programs losing funding that is still critically necessary to 
ensure farmworker families receive quality services in that 
program or region. In an effort to address these MSHS program 
needs without losing opportunities to add slots for MSHS 
eligible children in parts of the country where such new slots 
are needed, the bill includes an additional $15,000,000 to 
supplement funding otherwise available to MSHS programs, which 
shall be provided with flexibility for the program to address 
needs for quality improvement.
    MSHS Eligibility Requirements.--The Committee recognizes 
that a child's eligibility for MSHS is contingent upon a family 
living below the federal poverty line and a requirement that 
more than 50 percent of the family's income be derived from 
agricultural work. In spite of the fact that MSHS parents are 
working and making significant contributions to the nation's 
agricultural industry and economy, many farmworker families 
struggle to meet basic needs even if their incomes are at or 
above the federal poverty line. As part of the Impact of the 
Federal Poverty Guideline report requested above, the Committee 
requests ACF include a separate section examining how 
enrollment and eligibility requirements for the MSHS program 
may act as barriers for low-income farmworker families seeking 
MSHS services and possible solutions to expanding access to 
such families.

Preschool Development Grants

    The Committee recommends $300,000,000 for Preschool 
Development Grants, which is $25,000,000 above the fiscal year 
2020 enacted level and $300,000,000 above the fiscal year 2021 
budget request. This program provides grants to States to build 
State and local capacity to provide preschool for 4-year-olds 
from low-and moderate-income families.

Runaway and Homeless Youth

    The Committee recommends $140,000,000 for the Runaway and 
Homeless Youth (RHY) program, which is $7,579,000 above the 
fiscal year 2020 enacted level and the fiscal year 2021 budget 
request.
    In addition, the CARES Act (P.L. 116-136) included 
$25,000,000 for services for runaway and homeless youth.
    The Committee supports the ability of grantees to provide 
prevention services, such as counseling and case management, 
regardless of enrollment in residential services. The program 
is encouraged to notify applicants if grant applications were 
successful at least 30 days before the grant is to begin, or no 
less than 30 days before an existing grant is set to end.
    The Committee strongly urges the program to ensure that 
service delivery and staff training comprehensively address the 
individual strengths and needs of youth, as well as be language 
appropriate, gender appropriate (interventions that are 
sensitive to the diverse experiences of male, female, and 
transgender youth and consistent with the gender identity of 
participating youth), and culturally sensitive and respectful 
of the complex social identities of youth (i.e., race, 
ethnicity, nationality, age, religion/spirituality, gender 
identity/expression, sexual orientation, socioeconomic status, 
physical or cognitive ability, language, beliefs, values, 
behavior patterns, or customs). The Committee strongly believes 
that no runaway youth or homeless youth should be excluded from 
participation in, be denied the benefits of, or be subject to 
discrimination under, any program or activity funded in whole 
or in part under the Runaway and Homeless Youth Act, based on 
any of the conditions outlined in this paragraph.

State Child Abuse Prevention

    The Committee recommends $92,591,000 for Child Abuse 
Prevention and Treatment Act (CAPTA) State Grants, which is 
$2,500,000 above the fiscal year 2020 enacted level and the 
fiscal year 2021 budget request.
    The Committee is aware that States have failed to respond 
to requests for public disclosure of information, or provided 
incomplete information in response to such requests, regarding 
cases of child abuse or neglect which result in a child 
fatality or near fatality as required by Section 
106(b)(2)(B)(x) of CAPTA. The Committee directs the Children's 
Bureau to remind States that they must comply with Section 
106(b)(2)(B)(x) of CAPTA to be eligible for the CAPTA State 
Grant program. The Committee directs the Children's Bureau to 
review plans submitted by the states to comply with Section 
106(b)(2)(B)(x). The Committee directs the Children's Bureau to 
establish a uniform standard for tracking and reporting child 
fatalities and near fatalities related to child maltreatment 
and to take steps to create an electronic system for States to 
track and report such data as required. The Children's Bureau 
shall report back to the Committee within 180 days of enactment 
of this Act on the Bureau's plan to develop a uniform standard 
and to implement an electronic reporting system, how the Bureau 
will ensure compliance in the future, and recommendations for 
the Committee to facilitate compliance.

Child Abuse Discretionary Activities

    The Committee recommends $37,500,000 for Child Abuse 
Discretionary Activities, which is $2,500,000 above the fiscal 
year 2020 enacted level.
    Child Abuse Hotline.--The Committee includes $1,000,000 to 
support an additional year of the National Child Abuse Hotline 
innovation grant to develop and research text- and online chat-
based intervention and education services through a national 
child abuse hotline. The Committee encourages ACF to continue 
evaluating and sharing text and chat best practices in 
appropriate communication, identity verification, privacy 
protection, and resource sharing with the other national 
hotlines.
    Crisis Nurseries.--The Committee believes that crisis 
nurseries can provide a vital family preservation service, 
effectively supporting children and families by providing 
emergency shelter and direct care services for children, and 
providing critical support for parents treating their own 
substance use, mental, and physical health issues. The 
Committee urges ACF to engage with existing crisis nurseries, 
as well as interested parties who want to open nurseries, to 
coordinate a conversation on national standards for quality 
care and potential best practices.
    National Child Abuse and Neglect Data System (NCANDS).--The 
Committee notes the National Child Abuse and Neglect Data 
System (NCANDS) was established in response to the Child Abuse 
Prevention and Treatment Act of 1988. NCANDS is a voluntary 
data collection system that gathers information from all 50 
states, the District of Columbia, and Puerto Rico about reports 
of child abuse and neglect. In light of the acknowledged close 
relationship between child maltreatment and animal abuse, and 
with exposure to animal abuse considered an Adverse Childhood 
Event (ACE), the Committee encourages HHS to explore the 
feasibility of including a category of animal abuse to 
caregiver characteristics and environmental factors that may 
place the child at risk for maltreatment.
    Trauma-Informed Interventions.--The Committee includes 
$2,500,000 for a demonstration project related to the 
implementation of a new and innovative approach to serving 
children providing trauma-informed interventions. Eligible 
applicants should be nonprofit organizations with a 
demonstrated experience working with children who have 
experienced severe trauma caused by abuse or neglect. 
Applicants are expected to partner with a regional children's 
hospital and shall include Institutional Review Board-approved 
research supported by content area and epidemiological experts. 
The project should report regularly on findings, outcomes, and 
retention rates, including recommendations regarding 
sustainable funding and replicable components.

Community-Based Child Abuse Prevention

    The Committee recommends $63,160,000 for Community-Based 
Child Abuse Prevention, which is $7,500,000 above the fiscal 
year 2020 enacted level and the fiscal year 2021 budget 
request. These formula grants support community-based 
approaches to child abuse and neglect prevention.

Social Services Research and Demonstration

    The Committee recommends $7,512,000 for Social Services and 
Income Maintenance Research, which is $500,000 above the fiscal 
year 2020 enacted level and $1,000,000 above the fiscal year 
2021 budget request.
    Child Welfare Intergenerational Poverty Study.--The 
Committee directs $1,000,000 for the Secretary to enter into an 
agreement with the National Academy of Sciences to provide an 
evidence-based analysis of and recommendations for policies and 
programs to reduce intergenerational poverty and improve child 
welfare. This study should include, but not be limited to: the 
correlates and causes of the perpetuation of poverty from 
childhood into adulthood; the racial disparities and structural 
factors that contribute to this cycle; the effects of major 
assistance, intervention, and education programs on 
intergenerational poverty; identify policies and programs that 
have the potential to significantly reduce the effects of 
intergenerational poverty; and identify key, high-priority gaps 
in the research needed to help develop effective policies for 
reducing intergenerational poverty in the United States.

Native American Programs

    The Committee recommends $60,000,000 for Native American 
Programs, which is $3,950,000 above fiscal year 2020 enacted 
level and $2,725,000 above the fiscal year 2021 budget request. 
These programs assist Tribal and village governments and Native 
American institutions and organizations in their efforts to 
support and develop stable, diversified local economies. Tribes 
and non-profit organizations use funds to develop and implement 
sustainable community-based social and economic programs and 
services to improve the well-being of Native people.
    The Committee recommends an additional $2,450,000 over the 
fiscal year 2020 enacted level for Social and Economic 
Development Strategies (SEDS) grants. These competitive 
financial assistance grants support locally determined projects 
designed to reduce or eliminate community problems and achieve 
community goals.
    Within the total, the recommendation includes no less than 
$15,000,000 for Native American language preservation 
activities, including not less than $6,000,000 for language 
immersion programs as authorized by section 803C(b)(7)(A)-(C) 
of the Native American Programs Act, as amended by the Esther 
Martinez Native American Language Preservation Act of 2006.

Community Services Programs

    Community Services Block Grant.--The Committee recommends 
$750,000,000 for the Community Services Block Grant (CSBG), 
which is $10,000,000 more than the fiscal year 2020 enacted 
level and $750,000,000 above the fiscal year 2021 budget 
request. The CSBG provides funds to alleviate the causes and 
conditions of poverty in communities. In addition, the CARES 
Act (P.L. 116-136) included $1,000,000,000 for supplemental 
community services in response to the coronavirus pandemic.
    The Committee is concerned by reports that States may not 
be disbursing CSBG funding to local grantees in a timely 
manner, and requests the program brief the Committee within 90 
days of enactment of this Act, on any States that are unable to 
distribute CSBG funding to local entities within 30 days of 
receiving funding.
    Community Economic Development.--The Committee recommends 
$20,383,000 for Community Economic Development, which is equal 
to the fiscal year 2020 enacted level and $20,383,000 above the 
fiscal year 2021 budget request. Community Economic Development 
is a grant program, which funds Community Development 
Corporations seeking to address the economic needs of low-
income individuals and families through the creation of 
sustainable business development and employment opportunities.
    The Committee is concerned that the program may be 
considering changes to procedures regarding the disposition of 
intangible assets and program income acquired with, and program 
income derived from, CED grants. The Committee urges the 
program to consider the impact any such changes would have on 
the possibility of leveraging other financing sources in the 
future, and to brief the Committee prior to making any changes 
being considered.
    Rural Community Facilities Development.--The Committee 
recommends $10,000,000 for the Rural Community Facilities 
Development program, which is equal to the fiscal year 2020 
enacted level, and $10,000,000 above the fiscal year 2021 
budget request. Rural Community Development is a grant program 
that works with regional and Tribal organizations to manage 
safe water systems in rural communities.
    Within 120 days of enactment of this Act, the Committee 
requests a report of Rural Community Facilities Development 
projects supported by Rural Community Development (RCD) grants 
in fiscal year 2019 and 2020. The report should identify which 
projects are in persistent poverty areas, which shall be 
defined as any county that has had 20 percent or more of its 
population living in poverty over the past 30 years, as 
measured by the 1990 and 2000 decennial censuses and the most 
recent Small Area Income and Poverty Estimates published by the 
Census Bureau. In addition, the report should identify which 
projects are in high-poverty areas, where the term high-poverty 
area should mean any county or Tribal census tract with a 
poverty rate of at least 20 percent as measured by the 2014-
2018 5-year data series available from the American Community 
Survey of the Census Bureau. The Committee requests the RCD 
program, as part of its fiscal year 2021 grant continuation 
application process, instruct grantees to collect and report 
time and costs associated with work supporting projects in 
persistent and high-poverty areas.

Domestic Violence Hotline

    The Committee recommends $14,000,000 for the Domestic 
Violence Hotline, which is $2,000,000 above the fiscal year 
2020 enacted level and the fiscal year 2021 budget request. The 
Hotline provides 24-hour, toll-free and confidential services 
immediately connecting callers to local service providers.
    In addition, the CARES Act (P.L. 116-136) included 
$2,000,000 to expand the hotline's capacity during the 
coronavirus pandemic.

Family Violence Prevention and Battered Women's Shelters

    The Committee recommends $185,000,000 for the Family 
Violence Prevention and Battered Women's Shelters programs, 
which is $10,000,000 above the fiscal year 2020 enacted level 
and the fiscal year 2021 budget request. The Family Violence 
Prevention and Services Act programs provide funding to support 
the prevention of incidents of family violence, domestic 
violence, and dating violence, and provide the immediate 
shelter and supportive services for adult and youth victims 
(and their dependents).
    In addition, the CARES Act (P.L. 116-136) included 
$45,000,000 for the program to expand capacity to provide 
temporary housing and assistance to victims of family, 
domestic, and dating violence.
    The Committee strongly supports the expertise, training, 
and support that Domestic Violence Resource Network resource 
centers provide to survivors of partner violence across the 
country and recognizes that LGBTQ communities face many unique 
barriers to accessing culturally competent support. The 
Committee understands funding for several resource centers may 
be expiring at the end of this fiscal year. The Committee 
includes funding to continue contracts for resource centers 
that support underserved populations and directs ACF to 
maintain funding to support resource centers serving the LGBTQ 
community at no less than the level provided in fiscal year 
2020.

Program Direction

    The Committee recommends $206,000,000 for Program 
Direction, which is equal to the fiscal year 2020 enacted 
level.
    Member of Congress Letters of Support.--The Committee 
requests a report within 90 days of enactment of this Act 
discussing the process by which ACF evaluates a letter of 
support by a Member of Congress in competitive grant 
applications.
    Status of Funds.--The Committee requests ACF provide the 
quarterly status of balances report, as required in Section 524 
of the bill, at the account and program level of detail 
displayed in the table at the end of this report.

                   PROMOTING SAFE AND STABLE FAMILIES

 
 
 
Appropriation, fiscal year 2020.......................      $437,515,000
Budget request, fiscal year 2021......................       404,765,000
Committee Recommendation..............................       404,765,000
    Change from enacted level.........................       -32,750,000
    Change from budget request........................             - - -
 

    The Committee recommends $345,000,000 in mandatory funds 
and $59,765,000 in discretionary funds for the Promoting Safe 
and Stable Families program. This program enables each State to 
operate a coordinated program of family preservation services, 
community-based family support services, time-limited 
reunification services, and adoption promotion and support 
services. States receive funds based on their share of children 
in all States receiving food stamp benefits.

                PAYMENTS FOR FOSTER CARE AND PERMANENCY

 
 
 
Appropriation, fiscal year 2020.......................    $5,744,000,000
Budget request, fiscal year 2021......................     7,011,538,000
Committee Recommendation..............................     7,011,538,000
    Change from enacted level.........................    +1,267,538,000
    Change from budget request........................             - - -
 

    The Committee also recommends an advance appropriation of 
$3,000,000,000 for the first quarter of fiscal year 2022 to 
ensure timely completion of first quarter grant awards.
    Adoption and Foster Care Analysis and Reporting System 
(AFCARS) Data Elements.--The Committee is very disappointed 
that HHS finalized rulemaking removing LGBTQ and Indian Child 
Welfare Act (ICWA) data from AFCARS. Abandoning data collection 
on LGBTQ foster youth, parents, and guardians is a clear sign 
that HHS is abdicating its statutory responsibilities to 
promote the well-being, safety, and permanency of LGBTQ foster 
youth by limiting the ability to track and improve these 
outcomes for LGBTQ foster youth, as well as to track 
recruitment of LGBTQ foster and adoptive parents in an effort 
to provide diverse family placements for diverse foster youth. 
Similarly, removing many ICWA data elements is a sign that HHS 
is abdicating its statutory and federal trust responsibilities 
to protect the best interests of tribal children, to promote 
the stability and security of Indian tribes and families, and 
to monitor State implementation of the ICWA in order to budget, 
plan, and target needed training and technical assistance to 
support states to meet federal law. LGBTQ and ICWA data 
elements are especially critical for tracking and improving 
outcomes for foster youth and families living at the 
intersections of race, sexual orientation, gender, and tribal 
affiliation, particularly LGBTQ tribal foster youth and 
families.

                  Administration for Community Living


                 AGING AND DISABILITY SERVICES PROGRAMS

 
 
 
Appropriation, fiscal year 2020.......................    $2,171,000,000
Budget request, fiscal year 2021......................     2,072,092,000
Committee Recommendation..............................     2,225,390,000
    Change from enacted level.........................       +54,390,000
    Change from budget request........................      +153,298,000
 

    Created in 2012, the Administration for Community Living 
(ACL) brings together the efforts and achievements of the 
Administration on Aging, the Administration on Intellectual and 
Developmental Disabilities, and the HHS Office on Disability to 
serve as the Federal agency responsible for increasing access 
to community supports, while focusing attention and resources 
on the unique needs of older Americans and people with 
disabilities across the lifespan.
    In addition, the Families First Coronavirus Response Act 
(P.L. 116-127) included $250,000,000 and the CARES Act (P.L. 
116-136) included $955,000,000 to provide millions of 
additional home-delivered and prepackaged meals, supplemental 
home and community-based supportive services, support for the 
long-term care ombudsman, and supplemental family caregiver 
support services; to expand capacity at Aging and Disability 
Resource Centers; and to expand capacity at Centers for 
Independent Living.
    The Committee continues to fund the Senior Medicare Patrol 
Program through the Health Care Fraud and Abuse Control 
Account.

Home and Community-Based Supportive Services

    The Committee recommends $400,074,000 for Home and 
Community-Based Supportive Services, which is $10,000,000 above 
the fiscal year 2020 enacted level and the fiscal year 2021 
budget request. This program provides formula grants to States 
and territories to fund a wide range of social services that 
enable seniors to remain independent in their homes for as long 
as possible.
    In addition, the CARES Act (P.L. 116-136) included 
$200,000,000 to provide supplemental home and community-based 
supportive services during the coronavirus pandemic.

Preventive Health Services

    The Committee recommends $24,848,000 for Preventive Health 
Services, which is the same as the fiscal year 2020 enacted 
level and the fiscal year 2021 budget request. This program 
funds activities that help seniors remain healthy and avoid 
chronic diseases.

Protection of Vulnerable Older Americans

    The Committee recommends $24,658,000 for activities to 
protect vulnerable older Americans, which is $2,000,000 above 
the fiscal year 2020 enacted level and $4,030,000 above the 
fiscal year 2021 budget request. These programs provide grants 
to States for protection of vulnerable older Americans through 
the Long-Term Care Ombudsman and Prevention of Elder Abuse and 
Neglect programs. The recommendation directs an additional 
$2,000,000 to State Long-Term Care Ombudsman Programs.
    In addition, the CARES Act (P.L. 116-136) included 
$20,000,000 for the long-term care ombudsman program, during 
the coronavirus pandemic.

Family Caregiver Support Services

    The Committee recommends $193,936,000 for the National 
Caregiver Support program, which is $8,000,000 above the fiscal 
year 2020 enacted level and $43,350,000 above the fiscal year 
2021 budget request. This program offers a range of support 
services to family caregivers, including assistance in 
accessing services such as respite care, counseling, support 
groups, and caregiver training.
    In addition, the CARES Act (P.L. 116-136) included 
$100,000,000 to provide supplemental caregiver support services 
during the coronavirus pandemic.
    Youth Caregivers.--The Committee recognizes the significant 
barriers and lack of support youth caregivers face, and urges 
ACL and its Family Caregiving Advisory Council to consider the 
needs of youth caregivers in the development and execution of 
its national family caregiving strategy.

Native American Caregiver Support Services

    The Committee recommends $12,306,000 for the Native 
American Caregiver Support program, which is $2,000,000 above 
the fiscal year 2020 enacted level and the fiscal year 2021 
budget request. This program provides grants to Tribes for the 
support of American Indian, Alaskan Native, and Native Hawaiian 
families caring for older relatives with chronic illness or 
disabilities.

Congregate and Home-Delivered Nutrition Services

    The Committee recommends a total of $956,753,000 for senior 
nutrition. The recommendation includes: $520,342,000 for 
Congregate Nutrition Services, which is $10,000,000 above the 
fiscal year 2020 enacted level and the fiscal year 2021 budget 
request; $276,342,000 for Home-Delivered Meal Services, which 
is $10,000,000 above the fiscal year 2020 enacted level and the 
fiscal year 2021 budget request; and $160,069,000 for the 
Nutrition Services Incentives program, which is equal to the 
fiscal year 2020 enacted level and the fiscal year 2021 budget 
request.
    In addition, the Families First Coronavirus Response Act 
(P.L. 116-127) and the CARES Act (P.L. 116-136) included 
$240,000,000 and $480,000,000, respectively, to provide 
millions of additional home-delivered and prepackaged meals, as 
well as related services, during the coronavirus pandemic. 
These programs help older Americans remain healthy and 
independent in their communities by providing meals and related 
services in a variety of settings (including congregate 
facilities such as senior centers) and via home-delivery to 
older adults who are homebound due to illness, disability, or 
geographic isolation.
    Malnutrition.--The Committee is concerned that older adults 
homebound during the COVID-19 pandemic may not have regular 
access to food, putting them at increased risk of malnutrition. 
The Committee understands that malnutrition screening was 
included as a defined disease prevention and health promotion 
service in the recent Older Americans Act (OAA) 
reauthorization, and expects programs to ensure that they are 
using proper nutrition risk screening tools that capture people 
at risk for, or that have malnutrition, as part of regular 
nutrition screening.
    Nutrition Guidelines for Older Adults.--The Committee is 
concerned that GAO's December 2019 report on ``Nutrition 
Assistance Programs: Agencies Could Do More to Help Address the 
Nutritional Needs of Older Adults'' found Federal nutrition 
guidelines do not focus on the needs of many older adults, such 
as those with common health conditions and those over age 70. 
The Committee expects the Administrator of ACL to continue 
working with other relevant HHS officials and to document a 
plan to focus on the specific nutritional needs of older adults 
in the 2025-2030 update of the Dietary Guidelines for 
Americans. The Committee recommends ACL take steps to ensure 
States demonstrate that they are monitoring providers to ensure 
meal consistency with Federal nutrition requirements for meals 
served in congregate and home-delivered meal programs. Finally, 
the Committee directs ACL to centralize and make publicly 
available information on promising approaches for making meal 
accommodations to meet the nutritional needs of older adult 
participants in the congregate and home-delivered meal 
programs.

Native American Nutrition and Supportive Services

    The Committee recommends $37,208,000 for Native American 
Nutrition and Supportive Services, which is $2,500,000 above 
the fiscal year 2020 enacted level and the fiscal year 2021 
budget request. This program provides grants to Tribes to 
promote the delivery of nutrition and home and community-based 
supportive services to Native American, Alaskan Native, and 
Native Hawaiian elders.
    In addition, the Families First Coronavirus Response Act 
(P.L. 116-127) and the CARES Act (P.L. 116-136) included 
$10,000,000 and $20,000,000, respectively, to provide 
additional home-delivered and prepackaged meals, as well as 
related services, during the coronavirus pandemic.

Aging Network Support Activities

    The Committee recommends $12,461,000 for Aging Network 
Support Activities, which is equal to the fiscal year 2020 
enacted level and $958,000 above the fiscal year 2021 budget 
request. This program supports activities that expand public 
understanding of aging and the aging process.
    Holocaust Survivor's Assistance.--The Committee continues 
to provide not less than $5,000,000 for the Holocaust 
Survivor's Assistance program. This program provides supportive 
services for aging Holocaust survivors living in the U.S.
    Care Corps.--The Committee recognizes the growing demand 
for services and supports to help seniors and individuals with 
disabilities live independently in their homes, and the need to 
support family caregivers who facilitate that independence. 
Within 120 days of enactment of this Act, the Committee 
requests ACL provide a briefing on the status and benefits of 
the Care Corps grant program, which places volunteers in 
communities to assist family caregivers and/or assist seniors 
and individuals with disabilities in maintaining independence 
by providing non-medical care.
    Data Collection on Needs of LGBT Older Adults.--The 
Committee understands that while the definition of ``greatest 
social need'' under the Older Americans Act of 1965 includes 
isolation caused by racial or ethnic status, it notes that the 
definition is not intended to exclude the targeting of other 
populations that experience cultural, social, or geographic 
isolation due to other factors. The Committee supports ACL's 
recognition that such isolation may be caused by minority 
religious affiliation, sexual orientation, or gender identity, 
which may restrict a person's ability to perform normal daily 
tasks or live independently. The Committee directs ACL to 
ensure that the needs of such populations are being met by the 
aging services network through targeted outreach and 
programming. Specifically, and within 120 days of enactment of 
this Act, the Committee directs ACL to collect and publish data 
from the aging services network on how the needs of such 
populations are being met, including: (1) the unique needs of 
lesbian, gay, bisexual, and transgender (LGBT) older adults; 
(2) how the aging service network is meeting these needs; and 
(3) what gaps exist in the provision of aging services to this 
population.
    National Technical Assistance Center on Grandfamilies.--The 
Committee recognizes that more than 2.5 million children are 
being raised in grandfamilies without the child's parents in 
the home, with the vast majority of these families raising 
children outside of the formal foster care system and lacking 
access to needed information, services or supports to help them 
care for the children. The Committee encourages ACL to work 
with the Advisory Council to Support Grandparents Raising 
Grandchildren and with ACF, to coordinate the establishment of 
a Technical Assistance Center on Grandfamilies to provide 
information, resources and individualized technical assistance 
and support to help State, tribal, and local agencies and non-
profit organizations use model practices and programs for 
serving children, parents and caregivers in grandfamilies, 
including those impacted by parental substance use.

Alzheimer's Disease Program

    The Committee recommends $26,500,000 for the Alzheimer's 
disease program, which is equal to the fiscal year 2020 enacted 
level and the fiscal year 2021 budget request. This program 
provides competitive matching grants to a limited number of 
States to encourage program innovation and coordination of 
public and private services for people with Alzheimer's disease 
and their families. The Committee continues to support efforts 
to increase respite care services for family members and 
caregivers supporting individuals living with Alzheimer's 
Disease and Related Dementias.

Respite Care

    The Committee recommends $10,000,000 for Respite Care, 
which is $3,890,000 above the fiscal year 2020 enacted level 
and $6,640,000 above the fiscal year 2021 budget request. The 
program focuses on easing the burdens of caregiving by 
providing grants to eligible State organizations to improve the 
quality of, and access to, respite care for family caregivers.

Falls Prevention

    The Committee recommends $5,000,000 to be transferred from 
the PPH Fund to ACL for the Falls Prevention program, which is 
equal to the fiscal year 2020 enacted level and $5,000,000 
above the fiscal year 2021 budget request. Falls prevention 
grants support the promotion and dissemination of prevention 
tools delivered in community settings.

Chronic Disease Self-Management Program

    The Committee recommends $8,000,000 to be transferred from 
the PPH Fund to ACL for the Chronic Disease Self-Management 
program, which is equal to the fiscal year 2020 enacted level 
and $8,000,000 above the fiscal year 2021 budget request. This 
program supports grants to States for low-cost, evidence-based 
prevention models that use state-of-the-art techniques to help 
those with chronic conditions address issues related to the 
management of their disease.

Elder Rights Support Activities

    The Committee recommends $17,874,000 for Elder Rights 
Support Activities, which is $2,000,000 above the fiscal year 
2020 enacted level and equal to the fiscal year 2021 budget 
request. This program supports efforts that provide 
information, training, and technical assistance to legal and 
aging services organizations working to prevent and detect 
elder abuse and neglect.
    The Committee encourages ACL to lead efforts to develop a 
coordinated and consistent approach to Adult Protective 
Services (APS) through development of an APS National Data 
System. The Committee recognizes that the opioid crisis is 
affecting adult protective services, but believes this work 
should be done as part of increased screening efforts, which 
should be prioritized in order to reduce elder abuse, neglect 
and exploitation.
    Guardianship Systems.--The recommendation includes 
$2,000,000 for grants to address problems in State guardianship 
laws and procedures that lead to the unnecessary loss of rights 
and incidence of abuse as authorized under Section 2042(c)(3) 
of the Social Security Act. Grant awards should be provided for 
at least a 5-year award period. The Committee encourages ACL to 
support State efforts to examine their guardianship systems 
through nationally coordinated initiatives such as WINGS 
(Working Interdisciplinary Networks of Guardianship 
Stakeholders), which have been particularly valuable. 
Additional national coordination efforts should include: 
facilitating information sharing between State WINGS via in 
person convenings, remote access, and dissemination of 
materials; technical assistance to State WINGS or similar 
groups; and support for data collection and analysis.

Aging and Disability Resource Centers

    The Committee recommends $8,119,000 for Aging and 
Disability Resource Centers (ADRCs), which is the same as the 
fiscal year 2020 enacted level and $2,000,000 above the fiscal 
year 2021 budget request. These centers provide information, 
counseling and access for individuals to learn about the 
services and support options available to seniors and the 
disabled so they may retain their independence.
    In addition, the CARES Act (P.L. 116-136) included 
$50,000,000 to expand capacity at Aging and Disability Resource 
Centers during the coronavirus pandemic.
    Integrated Wellness in Supportive Housing.--The Committee 
supports the continued collaboration between HHS and the 
Department of Housing and Urban Development (HUD) on research 
initiatives to inform the design of the Supportive Services 
Demonstration for Elderly Households in HUD Assisted 
Multifamily Housing. The Committee recognizes that ADRCs 
support efforts to develop more efficient, cost-effective, and 
consumer-responsive systems, and believes that they can play an 
important role in evaluating the Integrated Wellness in 
Supportive Housing (IWISH) demonstration. The Committee 
strongly urges the ADRCs to continue to collaborate with HUD to 
evaluate the effectiveness of the IWISH project, including its 
potential for expansion and its cost-savings implications for 
the healthcare system.

State Health Insurance Assistance Program

    The Committee recommends $54,115,000 for the State Health 
Insurance Assistance Program, which is $2,000,000 above the 
fiscal year 2020 enacted level and $18,000,000 above the fiscal 
year 2021 budget request. The State Health Insurance Assistance 
Program provides Medicare beneficiaries with information, 
counseling, and enrollment assistance.

Paralysis Resource Center

    The Committee recommends $9,700,000 for the Paralysis 
Resource Center (PRC), and directs not less than $8,700,000 to 
the National PRC. The Paralysis Resource Center offers 
activities and services aimed at increasing independent living 
for people with paralysis and related mobility impairments, and 
supporting integration into the physical and cultural 
communities in which they live.
    The Committee is concerned that PRC State Pilot Programs 
may be duplicative of similar grantmaking efforts at the 
federal level. Within 120 days of enactment of this Act, the 
Committee requests an assessment of the effectiveness of the 
State Pilot Programs in meeting funding or programmatic needs 
not already met by the National PRC.

Limb Loss Resource Center

    The Committee recommends $4,000,000 for the Limb Loss 
Resource Center, which is equal to the fiscal year 2020 enacted 
level and the fiscal year 2021 budget request. The Limb Loss 
Resource Center supports a variety of programs and services for 
those living with limb loss, including a national peer support 
program, educational events, training for consumers and 
healthcare professionals, and information and referral 
services. In addition, the Center supports our Veterans and 
Wounded Warriors through VA and DOD partnerships and volunteer 
programs, and disseminates over 20,000 patient education 
materials created by the program to promote recovery and 
reintegration, improve health and enhance well-being and 
rehabilitation through a national network of professionals and 
support groups.

Traumatic Brain Injury

    The Committee recommends $11,321,000 for the Traumatic 
Brain Injury program, which is equal to the fiscal year 2020 
enacted level and the fiscal year 2021 budget request. The 
program provides grants to States for the development of a 
comprehensive, coordinated family and person-centered service 
system at the State and community level for individuals who 
sustain a traumatic brain injury. The Committee encourages ACL 
to expand efforts to better understand the impacts of TBI on 
young people.

Developmental Disabilities State Councils

    The Committee recommends $80,000,000 for State Councils on 
Developmental Disabilities, which is $2,000,000 above the 
fiscal year 2020 enacted level and $24,000,000 above the fiscal 
year 2021 budget request. The Developmental Disabilities State 
Councils work to develop, improve and expand the system of 
services and supports for people with developmental 
disabilities. The Committee recommends not less than $700,000 
for technical assistance and training for the State Councils on 
Developmental Disabilities, and requests that ACL report back 
to the Committee within 90 days of enactment of this Act on 
implementation of this language.

Developmental Disabilities Protection and Advocacy

    The Committee recommends $41,784,000 for Developmental 
Disabilities Protection and Advocacy, which is $1,000,000 above 
the fiscal year 2020 enacted level and $3,050,000 above the 
fiscal year 2021 budget request. This formula grant program 
provides funding to States to establish and maintain protection 
and advocacy systems to protect the legal rights of persons 
with developmental disabilities.
    The Committee notes that the Supreme Court decision in 
Olmstead v. L.C. (1999) held that the Americans with 
Disabilities Act (ADA) does not require removing individuals 
from institutional settings when they are unable to handle or 
benefit from a community-based setting and that the ADA does 
not require community-based treatment on patients who do not 
desire it. The Committee supports efforts that ensure programs 
properly account for the needs and desires of patients, their 
families, and caregivers and the importance of affording 
patients the proper setting for their care.

Voting Access for Individuals with Disabilities

    The Committee recommends $8,463,000 for Voting Access for 
Individuals with Disabilities program, which is $1,000,000 
above the fiscal year 2020 enacted level and the fiscal year 
2021 budget request. The Voting Access for Individuals with 
Disabilities program authorized by the Help America Vote Act 
provides formula grants to ensure full participation in the 
electoral process for individuals with disabilities, including 
registering to vote, accessing polling places, and casting a 
vote.

Developmental Disabilities Projects of National Significance

    The Committee recommends $12,250,000 for Developmental 
Disabilities Projects of National Significance, which is equal 
to the fiscal year 2020 enacted level and $11,200,000 above the 
fiscal year 2021 budget request. This program funds grants and 
contracts that develop new technologies and demonstrate 
innovative methods to support the independence, productivity, 
and integration of those living with a disability into the 
community.

University Centers for Excellence in Developmental Disabilities

    The Committee recommends $41,619,000 for University Centers 
for Excellence in Developmental Disabilities, which is equal to 
the fiscal year 2020 enacted level and $9,073,000 above the 
fiscal year 2021 budget request. The University Centers for 
Excellence in Developmental Disabilities Education, Research, 
and Service are a nationwide network of independent but 
interlinked centers, representing a national resource for 
addressing issues, finding solutions, and advancing research 
related to the needs of individuals with developmental 
disabilities and their families.

Independent Living

    The Committee recommends $116,183,000 for the Independent 
Living program, of which $25,378,000 is for the Independent 
Living State Grants program and $90,805,000 is for the Centers 
for Independent Living program. This funding level is equal to 
the fiscal year 2020 enacted level and $2,537,000 above the 
fiscal year 2021 budget request. Independent Living programs 
maximize the leadership, empowerment, independence, and 
productivity of individuals with disabilities.
    In addition, the CARES Act (P.L. 116-136) included 
$85,000,000 to expand capacity at Centers for Independent 
Living during the coronavirus pandemic.

National Institute on Disability, Independent Living, and 
        Rehabilitation Research

    The Committee recommends $111,970,000 for the National 
Institute on Disability, Independent Living, and Rehabilitation 
Research (NIDILRR), which is equal to the fiscal year 2020 
enacted level and $21,599,000 above the fiscal year 2021 budget 
request. NIDILRR generates knowledge and promotes its effective 
use to enhance the abilities of people with disabilities to 
perform activities of their choice in the community and to 
expand society's capacity to provide full opportunities for its 
citizens with disabilities.

Assistive Technology

    The Committee recommends $37,000,000 for Assistive 
Technology, which is equal to the fiscal year 2020 enacted 
level and $5,061,000 above the fiscal year 2021 budget request. 
Assistive Technology (AT) supports programs providing grants to 
States for addressing assistive technology needs of individuals 
with disabilities. The goal is to increase awareness of and 
access to assistive technology devices and services that may 
help with education, employment, daily activities, and 
inclusion of people with disabilities in their communities.
    The Committee continues to provide $2,000,000 for 
competitive grants to support existing and new alternative 
financing programs that provide for the purchase of AT devices.

Program Administration

    The Committee recommends $41,063,000 for Program 
Administration, which is the same as the fiscal year 2020 
enacted level. This funding supports Federal administrative 
costs associated with administering ACL's programs.
    Telehealth Training and Education for Medicare 
Beneficiaries.--The Committee recognizes the potential for 
telehealth, remote monitoring, and digital health technologies 
to help meet the needs of patients and families across the 
country. In response to the COVID-19 pandemic, Congress 
expanded access to telehealth services by providing the 
Secretary with the authority to waive longstanding restrictions 
on Medicare telehealth services for the duration of the public 
health emergency. The Committee is aware that as healthcare 
providers have sought to deliver virtual care at scale, some 
beneficiaries and caregivers are in need of training and 
education on how to interact with providers prior to a 
telehealth visit. To address this issue, the Committee directs 
ACL to work with CMS and other stakeholders to develop 
education and training resources that account for age-related 
differences in how beneficiaries interact with technology. The 
Committee directs ACL to submit a report within 60 days of 
enactment of this Act, evaluating current telehealth training 
and education programs, and provide additional recommendations 
on how to improve beneficiary utilization and access to 
synchronous and asynchronous Medicare telehealth services.

                        Office of the Secretary


                     MEDICARE HEARINGS AND APPEALS

 
 
 
Appropriation, fiscal year 2020.......................      $191,881,000
Budget request, fiscal year 2021......................       196,381,000
Committee Recommendation..............................       191,881,000
Change from enacted level.............................             - - -
    Change from budget request........................        -4,500,000
 

    This activity supports hearings at the administrative law 
judge level, the third level of Medicare claims appeals.
    Medicare Appeals Backlog.--The Committee continues bill 
language included in fiscal year 2020 to provide flexibility 
for the Department to address backlogs of appeals hearings, as 
well as retain and recruit Administrative Law Judges.

                    GENERAL DEPARTMENTAL MANAGEMENT

 
 
 
Appropriation, fiscal year 2020.......................      $544,457,000
Budget request, fiscal year 2021......................       420,945,000
Committee Recommendation..............................       522,787,000
    Change from enacted level.........................       -21,670,000
    Change from budget request........................      +101,842,000
 

    Of the funds provided, $64,828,000 shall be derived from 
evaluation set-aside funds available under section 241 of the 
Public Health Service Act, which is the same as the fiscal year 
2020 enacted level and $9,012,000 below the fiscal year 2021 
budget request.
    This appropriation supports activities that are associated 
with the Secretary's roles as policy officer and general 
manager of the Department of Health and Human Services. The 
Office of the Secretary also implements administration and 
Congressional directives, and provides assistance, direction 
and coordination to the headquarters, regions, and field 
organizations of the department. In addition, this funding 
supports the Office of the Surgeon General and several other 
health promotion and disease prevention activities that are 
centrally administered.
    Advertising Contracts.--The Committee understands that, as 
the largest advertiser in the United States, the federal 
government should work to ensure fair access to its advertising 
contracts for small disadvantaged businesses and businesses 
owned by minorities and women. The Committee directs each 
department and agency to include the following information in 
its fiscal year 2022 budget justification: Expenditures for 
fiscal year 2020 and expected expenditures for fiscal year 2021 
and 2022, respectively, for (1) all contracts for advertising 
services; and (2) contracts for the advertising services of (I) 
socially and economically disadvantaged small businesses 
concerns (as defined in section 8(a)(4) of the Small Business 
Act (15 U.S.C. 637 (a)(4)); and (II) women-and minority-owned 
businesses.
    In addition, the Committee encourages the Department to 
consider using local media in their advertising, including 
local television, radio broadcast stations, and newspapers to 
the greatest extent possible. The Committee directs the 
Department to include in its fiscal year 2022 Congressional 
Budget Justification details on expenditures on local media 
advertising for the prior two fiscal years.
    Awareness of Sickle Cell Trait.--The Committee supports the 
efforts to provide Americans with screening for sickle cell 
trait, a known health disparity among African Americans and 
Hispanic/Latino Americans. The Committee urges the Secretary of 
Health and Human Services, in collaboration with NIH and CDC, 
to submit an action plan within 180 days of enactment of this 
Act to address the lack of awareness of sickle cell trait and 
the prevalence of testing for sickle cell trait.
    Bereavement Care.--The Committee is aware of research 
indicating that individuals and families suffer severe health, 
social, and economic declines following the death of a loved 
one--be it a child, sibling, spouse, or parent. The Committee 
encourages CMS, SAMHSA, HRSA, IHS, CDC, NIH, ACF, OMH and OWH 
to examine their involvement in activities to advance 
bereavement care for families, including documenting and 
investigating the policies or programs that help or hinder 
functional coping or adaptive processing and the prevalence and 
outcome of bereavement events (what relationships are impacted, 
how the loved one died and their age, risk factors and 
associated health events or outcomes, and biological or 
physiological changes in well-being.).
    Blood Banks.--The Committee supports the Secretary's 
decision to allow blood banks to provide blood donors with 
COVID-19 antibody testing, and thus directs HHS to continue to 
allow this activity which benefits blood donors and provides 
state and local governmental entities with valuable data.
    Chronic Fatigue Syndrome Advisory Committee.--The Committee 
looks forward to reviewing HHS's plan regarding myalgic 
encephalomyelitis/chronic fatigue syndrome (ME/CFS) as 
requested in House Report 116-62. In the interim, the Committee 
encourages HHS to foster interagency and stakeholder 
collaboration in addressing the crisis in ME/CFS clinical care 
and accelerating drug development for ME/CFS.
    Chronic Pain.--The Committee remains concerned about the 
public health epidemic of acute and chronic pain, including its 
interrelationship with the opioid crisis. The Committee is 
pleased with the release of the HHS Pain Management Best 
Practices Inter-Agency Task Force Report in May 2019, but 
remains concerned over delayed dissemination and implementation 
of the Report's recommendations. A strategic plan to 
disseminate the report and implement recommendations is needed, 
and the Committee strongly encourages the Department to widely 
disseminate the Report to health care providers and other 
public health stakeholders, and to update relevant pain 
management policies and educational tools to reflect Task Force 
recommended best practices across all relevant HHS agencies, 
including the CDC, CMS, SAMHSA and other relevant agencies. The 
Committee also urges the Department to coordinate with the 
Department of Defense and Veterans Affairs to launch a public 
awareness campaign to educate Americans about acute and chronic 
pain and the evidence based non-opioid treatment options that 
are available, including non-opioid medications; interventional 
procedures such as nerve blocks, injections and surgical 
devices; behavioral health approaches such as cognitive 
behavioral therapy; and complementary and integrative health 
therapies such as massage therapy and acupuncture.
    Coordination of Vector-Borne Disease Control.--The 
Committee urges the Secretary to establish a coordinating 
office to facilitate and expedite the government's response to 
vector-borne disease threats, including combating the spread of 
disease through innovative vector control technologies, as well 
as provide a valuable resource to scientific investigators, 
health professionals and the general public. The coordinating 
office should improve communication, collaboration, and 
transparency across numerous agencies engaged in various facets 
of vector-borne disease research and control, including the 
CDC, FDA, NIH, and BARDA. The coordinating office should also 
establish communication, collaboration, and transparency with 
non-HHS agencies, including USDA, USAID, DoD, Homeland 
Security, and Veterans Affairs.
    County Level Data.--Committee encourages agencies, when 
feasible, to collect and report county-level data for programs 
funded through Federal formula grants to States.
    Customer Service.--The Committee continues to support 
efforts to improve customer service in accordance with 
Executive Order 13571--Streamlining Service Delivery and 
Improving Customer Service. The Committee directs the Secretary 
to develop standards to improve customer service and 
incorporate the standards into the performance plans required 
under 31 U.S.C. 1115. The Committee further directs the 
Department to include an update on the progress of these 
efforts in the fiscal year 2022 Congressional Budget 
Justification.
    Dataset of Payments from the Provider Relief Fund.--The 
Secretary shall continue to maintain the online reporting 
dataset of all payments from the Provider Relief Fund. The 
dataset, which is hosted by CDC with data provided by HRSA, 
shall remain publicly available in a searchable, electronic 
format, through fiscal year 2021.
    Data Science.--The Committee supports the use of operations 
research and analytics to inform decision-making and enable 
agencies to improve the development and execution of federal 
programs, more accurately assess their implementation, and 
reduce waste, fraud and abuse. The Committee requests a report 
within 120 days outlining how the Department utilizes data 
scientists and operations research analysts, including how many 
personnel are employed in these positions and the roles they 
fill in the Department.
    Dietary Guidelines for Americans Advisory Committee.--The 
Committee encourages the Dietary Guidelines for Americans 
Advisory Committee to take into account sound scientific 
evidence while developing the Dietary Guidelines for Americans.
    Diverse Participation in COVID-19 Vaccine Development.--The 
Committee is concerned that demographic data on COVID-19 
vaccine clinical trial participants are not being collected and 
reported, which could impede efforts to ensure that eventual 
COVID-19 vaccines are safe and effective for the entire U.S. 
population. The Committee directs the Secretary to require the 
collection and reporting of all relevant demographic data on 
COVID-19 vaccine clinical trial participants, including data on 
age, sex, race, and ethnicity. The Committee directs the 
Secretary, in consultation with relevant agencies within HHS--
including FDA, NIH, the Office of the Assistant Secretary for 
Preparedness and Response, Office of Minority Health, and 
Office on Women's Health--to submit a report to the Committee 
within 90 days of enactment of this Act on the specific steps 
the Department is taking to ensure that ongoing and upcoming 
COVID-19 vaccine clinical trials have diverse and 
representative participation of historically underrepresented 
subgroups, including by age, sex, race, ethnicity, and women 
who are pregnant or lactating.
    Evidence-based Grants and Policy.--The Committee requests 
an update in the fiscal year 2022 Congressional Budget 
Justification on implementation of the Foundations for 
Evidence-based Policymaking Act (P.L. 115-435) and 
implementation plans for the coming year. The Committee 
encourages the Secretary to develop guidance to ensure relevant 
participants and grantees are involved in the Department-wide 
process of prioritizing evidence needs, including participating 
in Department-led evaluations. Consistent with program 
statutes, the Committee encourages the Secretary to ensure that 
evidence of effectiveness is a consideration in grant 
opportunities.
    Geriatric Centers of Excellence.--The Committee is 
concerned about demographic challenges driven by an aging 
population. The Committee directs the Secretary to submit a 
report within 180 days of enactment of this Act about how to 
create the most effective and efficient models for ``geriatric 
centers of excellence.'' which would serve as hubs to provide 
integrated and holistic supportive care for the aging 
population while monitoring and managing performance of the 
community's eldercare arrangements. The report should address 
issues of how these centers will engage in clinical care, as 
well as provide an array of services and supports to make 
community living a possibility for more elders. The report 
should address how a cohort of local geriatric centers of 
excellence could be used to test and disseminate best 
practices. Moreover, the report should examine the benefits of 
establishing geriatric centers of excellence in a variety of 
settings, including urban, suburban, or rural areas.
    Global Health Research.--The Committee requests an update 
in the fiscal year 2022 congressional budget justification 
outlining how CDC, FDA, BARDA, and NIH, including the Fogarty 
International Center, jointly coordinate global health research 
activities with specific measurable metrics used to track 
progress and collaboration toward agreed upon health goals.
    Grants Policy.--The Committee understands Departmental 
grant guidance makes clear that directives contained in a 
House, Senate, or Conference report or explanatory statement 
accompanying an appropriations act should be incorporated into 
funding opportunity announcements as appropriate. However, the 
Committee is aware of instances of funding announcements in the 
past fiscal year failing to address language applicable in a 
fiscal year 2020 report or statement. The Committee requests a 
briefing from the Office of Grants within 90 days of enactment 
of this Act on the process for addressing report or statement 
language.
    Health Impact Assessments.--The Committee believes there is 
an opportunity to use health impact assessments and other 
related approaches in the federal government to raise awareness 
of the potential health consequences of proposed policies 
outside the health domain. The Committee strongly encourages 
the Department to study the benefits of incorporating 
assessments of health effects into the federal policymaking 
process with the intention to solve fundamental challenges of 
population health by better addressing the full range of 
factors that influence overall health and well-being (e.g., 
education, safe environments, housing, transportation, economic 
development, access to healthy foods).
    Hospital Infrastructure.--The Committee is concerned about 
the state of hospital infrastructure in the United States. The 
Committee directs the Secretary of Health and Human Services, 
in consultation with State departments of health and other 
public health entities, to submit a report to the Committee 
within one year of the date of enactment of this Act. The 
report should assess barriers to accessing capital for 
infrastructure at hospitals serving vulnerable populations, 
including disproportionate share hospitals, sole community 
hospitals, critical access hospitals, and public hospitals. The 
report should include an analysis of the impact of such 
barriers, including with respect to life-safety issues and 
emergency preparedness. Further, the report should include 
recommendations for addressing such barriers.
    Lyme Disease.--The Committee encourages the Office of the 
Secretary to sponsor initiatives to spur innovation leading to 
the development of more effective diagnostics for all stages of 
Lyme disease and for the development of novel treatments that 
will return patients to health and eradicate the disease, 
including innovation in tools and resources data, technology 
and scientist collaborations. The Committee is appreciative of 
the role of the Office of the Chief Technology Officer in 
promoting innovation to strengthen agency programs and foster 
public health solutions. The Committee urges the Secretary to 
coordinate and collaborate with the Operating Divisions, 
including NIH, CDC, and FDA, to apply data, technology, and 
human resources to overcome obstacles and develop solutions to 
effectively manage and eradicate Lyme disease. The Committee 
requests the Secretary submit within 180 days of enactment of 
this Act a multi-year plan outlining an initiative to conquer 
Lyme disease.
    Maternal Mental Health.--The Committee looks forward to 
receiving a report, as directed in House Report 116-62, on the 
roles of Department agencies in addressing gaps in maternal 
mental health.
    Mental Health Parity.--The Committee recognizes the 
important role Mental Health parity laws have in ensuring 
access to medical care and treatment. The Mental Health Parity 
and Addiction Equality Act (MHPAEA) requires insurers to cover 
care for mental health and substance use disorders at the same 
level as other medical and surgical care services. However, 
without proper oversight and compliance, patients are left 
fighting for coverage of benefits. The Committee is concerned 
there is still a lack of compliance among insurance companies 
not adequately covering mental and behavioral health services 
and providers more than 11 years after MHPAEA passed. In FY 
2017, the Department of Labor (DOL) conducted 187 
investigations and found 92 insurers were noncompliant. 
Furthermore, in December 2019, the Government Accountability 
Office reported that this lack of compliance extends beyond the 
DOL and includes Health and Human Services (HHS) employer-
sponsored health plans. The Committee directs the Secretary of 
HHS to coordinate with the Secretary of Labor and the Secretary 
of the Treasury to create guidelines, within 90 days of 
enactment, in which all employer-sponsored health plans are 
required to submit an annual public compliance report, with the 
application of nonquantitative treatment limitations while 
ensuring that any proprietary, personal, or confidential 
consumer information is protected. The public compliance report 
shall be based on the Department of Labor's Self-Compliance 
Tool for the MHPAEA. The Secretary of HHS shall also annually 
report any auditing and enforcement of all plans.
    National Health Care Workforce Commission.--The Committee 
includes $3,000,000 to establish the National Health Care 
Workforce Commission, as authorized by the Affordable Care Act. 
The Commission is intended to serve as a resource on health 
care workforce policy for Congress, the Administration, States, 
and localities and is tasked with evaluating healthcare 
workforce needs, assessing education and training activities, 
identifying barriers to improved coordination at the Federal, 
State, and local levels and recommending changes to address 
those barriers.
    Nutritional Education.--The Committee recognizes the value 
of proper nutrition and food's impact on health. Research shows 
modest weight loss, as little as five percent of total body 
weight, can help to improve Type 2 diabetes in patients who are 
overweight. The Committee encourages the Secretary to establish 
an interagency collaboration with the Department of Education 
and Department of Agriculture to enhance nutritional education 
in K-12 schools. The Committee urges the Secretary to be 
proactive in promoting wellness, healthy exercising habits and 
disease prevention by providing evidence-based nutritional 
services, information on existing agency best practices, as 
well as a plan to expand nutritional education and means to 
increase access to nutritional foods for students.
    Patient Perspective on Ethics Advisory Boards.--The 
Committee directs the Secretary to appoint no fewer than three 
patient advocates to any advisory board established under 42 
U.S.C. Sec. 289a 1(b) with personal experience, either as a 
patient, or as a family member of a patient with eye disease, 
congenital birth conditions, diabetes, HIV/AIDS, Parkinson's 
disease, cancer, or other serious or life threatening 
conditions. The Secretary is further directed to ensure patient 
advocates are afforded the same responsibilities and weight of 
opinion as the other members of the ethics advisory board.
    Performance Measures.--The Committee directs the Department 
to comply with title 31 of the United States Code, including 
the development of organizational priority goals and outcomes 
such as performance outcome measures, output measures, 
efficiency measures, and customer service measures. The 
Committee further directs the Department to include an update 
on the progress of these efforts in the fiscal year 2022 
Congressional Budget Justification.
    Persistent Poverty Counties.--The Committee supports 
targeted investments in impoverished areas, particularly in 
persistent poverty counties and in other high-poverty census 
tracts. To understand how programs funded through the 
Department are serving these particular areas, the Committee 
directs the Department to submit a report to the Committees on 
Appropriations on the percentage of funds allocated by all 
competitive grant programs and other anti-poverty programs in 
fiscal years 2018, 2019 and 2020 and estimates for fiscal year 
2021 to serve individuals living in persistent poverty 
counties, as defined as a county that has had 20 percent or 
more of its population living in poverty over the past 30 
years, as measured by the 1990 and 2000 decennial censuses and 
the most recent Small Area Income and Poverty estimates, or any 
territory or possession of the United States, and high-poverty 
areas, as defined as any census tract with a poverty rate of at 
least 20 percent as measured by the 2014 2018 five-year data 
series available from the American Community Survey of the 
Census Bureau. The Department shall report this information to 
the Committees within 90 days of such data being available and 
provide a briefing to the Committees not later than 180 days 
after enactment of this Act on how the Department is carrying 
out this directive.
    Prematurity and Maternal Mortality.--The Committee notes 
that preterm birth and its complications continue to be the 
leading cause of death for infants in the U.S. and around the 
world. The Committee is aware that the PREEMIE Reauthorization 
Act of 2018 (P.L. 115-328) enables the Secretary to establish 
an interagency working group to improve coordination of 
programs and activities within the Department to prevent 
preterm birth, infant mortality, and related adverse birth 
outcomes. The Committee requests a report within 60 days of 
enactment of this Act regarding its activities to create the 
interagency workgroup and its activities to-date to accomplish 
the duties outlined in the PREEMIE Reauthorization Act of 2018. 
In addition, the Committee recognizes the disparities in 
outcomes by race, ethnicity, geography, and income related to 
maternal mortality and prematurity and appreciates the work of 
many agencies in addressing these disparities. The Committee 
urges the Interagency Workgroup, in collaboration with OMH, 
OWH, NICHD, NIMHD, CDC, CMS, IHS, HRSA, as well as the March of 
Dimes Prematurity Research Centers, to develop a coordinated 
Department-wide strategy and implementation plan to share 
learning and identify and address factors that lead to maternal 
mortality and prematurity, including those socio-economic and 
racial-ethnic factors contributing to disparities in outcomes 
and inequities in health care. The Committee requests a report 
within 180 days of enactment of this Act on the aforementioned 
strategy and a plan for implementation.
    Regional Coordination.--The Committee supports efforts to 
encourage and expand greater regional collaboration in the 
competitive grant process. The Committee encourages the 
Secretary to consider including regional councils and councils 
of governments as eligible entities in competitions for Federal 
funding when permitted by program statute.
    Repatriation.--The Committee directs HHS to review the 
process for Congressional notification during repatriation 
flights of U.S. nationals from countries with developing health 
crises. The Committee directs HHS to provide a report within 
180 days of enactment of this Act outlining a revised plan to 
ensure that members of Congress are notified in a timely manner 
when a repatriation flight could be landing in their district.
    Shortages of Prescription Drugs.--The Committee remains 
concerned about the shortage of prescription drugs, including 
generic drugs, in times of international crisis, disaster, or 
manufacturing shortages. Generic drugs account for 90 percent 
of prescriptions consumed in the U.S. The Committee directs the 
Secretary to conduct a study on increased costs to consumers 
due to shortages of prescription drugs, including generic 
drugs. The study should outline policy options to address cost 
disparity when there are shortages in the generic version of 
life-saving drugs, as well as policy options to ensure 
sufficient supply of generic drugs. In addition, the study 
should evaluate how many Americans have faced shortages of 
their medications, including generic medications. The study 
should be submitted to the Committee within 180 days of 
enactment of this Act.
    Social Determinants Council.--The Committee directs the 
Secretary of Health and Human Services to form an interagency-
intergovernmental Social Determinants Council, which shall be 
responsible for drafting and releasing a report on federal 
cross-agency opportunities to address social determinants of 
health, including the potential benefits of grants to State, 
local, or Tribal jurisdictions to address social determinants 
of health. The Council shall consist of at least one designee 
from the Office of Management and Budget, the Department of 
Agriculture, the Department of Education, the Indian Health 
Service, HUD, the Department of Labor, the Department of 
Transportation, three designees of the Department of Health and 
Human Services--including CMS--and others as deemed 
appropriate. Up to six council designees may be non-federal 
subject matter experts with experience in areas such as 
implementing and evaluating transformative initiatives that 
harness data and conduct evaluations to increase the impact and 
cost-effectiveness of Federal Government Services and represent 
State, local, and Tribal health and human service agencies, 
public housing authorities, budget offices, State Medicaid 
agencies, or national Consumer organizations. The Council shall 
provide technical assistance to State, local, and tribal 
jurisdictions seeking to develop Social Determinants 
Accelerator Plans through a new pilot program under the CDC.
    Social Media and Negative Outcomes.--The Committee supports 
efforts by the Secretary to investigate whether there is a 
relationship between the use of social media and negative 
social and individual outcomes, including clinical and 
undiagnosed depression; self-harm, such as suicide, attempted 
suicide, and suicidal intent; harm to others; cyber bullying; 
chronic anxiety; or social isolation. Such investigation should 
consider the role of content and presentation in social media 
that is linked to negative outcomes, as well as the design of 
algorithms to prioritize user engagement. The Committee 
requests an update on this topic within 180 days of enactment 
of this Act.
    Staffing Reports.--The Committee includes a general 
provision requiring the Department to submit a staffing report 
to the Committee on a biannual basis. 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.
    Sugar Substitutes.--The Committee directs the Secretary to 
conduct a study that reviews the sufficiency of the scientific 
evidence with regard to the safety of children consuming no- 
and low-calorie sugar substitutes in their diet, identifies 
gaps in the available evidence, and makes recommendations 
consistent with protecting the health of children.
    Teen Pregnancy Prevention Evidence Review.--The Committee 
again includes $600,000 for the Assistant Secretary for 
Planning and Evaluation to maintain and continue to update the 
existing Teen Pregnancy Prevention Evidence Review. In 
addition, the Committee directs the agency to report to 
Congress within 30 days of enactment of this Act on steps it 
has taken to use the $600,000 appropriated for fiscal year 2020 
for the Teen Pregnancy Prevention Evidence Review.
    Tribal Set-aside.--The Committee notes that, according to 
the CDC, HIV-positive status among Native Americans is 
increasing and nearly one-in-five HIV-positive Native Americans 
is unaware of their status. In addition, only three-in-five 
receive care and less than half are virally suppressed. To 
increase access to HIV/AIDS, testing, prevention, and 
treatment, the Committee includes $3,000,000 as a Tribal set-
aside within the Minority HIV/AIDS Prevention and Treatment 
program.

Office of the Assistant Secretary for Health

    Access to Diapers.--The Committee recognizes that many low-
income families spend twice as much on diapers for their 
children compared to families who have the means to buy diapers 
in bulk at low price. The Committee is deeply concerned that 
one-in-three families in the U.S. struggles to afford diapers, 
which leads to higher poverty and increased health risks for 
infants and toddlers. The Committee also notes that conditions 
such as diaper dermatitis and urinary tract infection can be 
caused by an insufficient supply of diapers and result in 
costly emergency room visits and doctor appointments. The 
Committee requests HHS submit a report, within 180 days of 
enactment of this Act, estimating the number of emergency room 
visits and medical interventions caused by an insufficient 
supply of diapers, the cost to our healthcare system of these 
preventable conditions, and the number of diapers that would be 
required to prevent many of the conditions from occurring.
    Clinical Psychological Training for Public Health Service 
Corps.--The Committee supports the review by the Surgeon 
General's office to update HHS regulations to permit the 
graduates of the 43 doctoral programs in clinical psychology 
accredited by the Psychological Clinical Science Accreditation 
System (PCSAS) to be employed by the Public Health Service 
Corps. This update is necessary as PCSAS was recognized in 
September 2012 by the Council for Higher Education 
Accreditation (CHEA) and now accredits 43 programs that are 
among the highest ranked clinical psychology program in the 
country. The Veterans Administration, the Association of 
Psychological Postdoctoral and Internship Centers, and others 
have already updated their regulations to permit the employment 
of the graduates of PCSAS accredited programs. The Committee 
urges the Surgeon General's office to finalize and implement 
these changes as soon as possible.
    Embryo Adoption Awareness Campaign.--The Committee includes 
$1,000,000 for the Embryo Adoption Awareness Campaign, the same 
as the fiscal year 2020 enacted level, to educate Americans 
about the existence of frozen human embryos (resulting from in-
vitro fertilization), which may be available for donation/
adoption to help other couples build their families. The 
Committee continues bill language permitting these funds also 
to be used to provide medical and administrative services to 
individuals adopting embryos, deemed necessary for such 
adoptions, consistent with the Code of Federal Regulations.
    Health Care for the Homeless.--The Committee strongly 
encourages the Secretary to study the delivery of health care 
services to homeless persons. The department should then make 
recommendations to Congress as to what should be done to 
improve the availability and delivery of health care services 
for homeless persons.
    Insulin Affordability.--The Committee directs HHS to study 
and submit a report to Congress on the relationship between 
insulin affordability and complications from diabetes. In the 
study, HHS should study the impact of insulin costs on health 
outcomes for individuals with diabetes. The study should also 
quantify the cost to federal health programs of patients who 
are unable to afford their proper insulin doses.
    Obstetrics in Rural Areas.--The Committee directs the 
Government Accountability Office (GAO) to conduct a study on 
access to obstetrics (OB) in rural areas. According to the 
Rural Health Research Gateway, between 2004 and 2014, 179 rural 
counties lost hospital-based OB services. The GAO report should 
include policy recommendations for ways to improve access to OB 
care in rural areas and prevent OB unit hospital closures in 
rural areas.
    Sexually Transmitted Infections.--The Committee is aware of 
the recent statistics regarding the rise in sexually 
transmitted infections (STI) and is pleased that the Assistant 
Secretary for Health is creating a National STI Action Plan to 
address increasing rates in these diseases. Further, the 
Committee requests that the Action Plan be responsive to 
findings included in the National Academy of Public 
Administration report on ``The Impact of Sexually Transmitted 
Diseases in the United States: Still Hidden, Getting Worse, Can 
be Controlled.'' The Committee requests an update within 180 
days of enactment of this Act on progress being made to 
implement the plan.
    Teen Pregnancy Prevention.--The Committee strongly supports 
the Teen Pregnancy Prevention (TPP) Program and the first two 
five-year cycles of grants. The TPP Program has been widely 
cited as a high-quality evidence-based program, including by 
the bipartisan Commission on Evidence-Based Policymaking. Since 
2017, however, there has been a well-established pattern of HHS 
administering the Teen Pregnancy Prevention Program in a manner 
that violates appropriations language and strays from commonly 
understood definitions of terms in appropriations language. The 
Committee intends that TPP Program funds be used to carry out 
medically accurate and age appropriate programs and has adopted 
definitions of those terms and other requirements in bill 
language to carry out the original congressional intent. 
Similarly, The committee has defined a requirement in bill 
language for Tier 2 programs to rigorously test teen pregnancy 
prevention models. The committee directs HHS to submit a report 
within 60 days of enactment of this Act on how the agency is 
administering the TPP Program consistent with the statutory 
requirement ``to fund medically accurate and complete and age 
appropriate (as those terms are defined in 42 U.S.C. 
Sec. 713(e)) programs that reduce teen pregnancy and that do 
not withhold information about the effectiveness and benefits 
of correct and consistent use of condoms and other 
contraceptives and for the Federal costs associated with 
administering and evaluating such contracts and grants, of 
which not more than 10 percent of the available funds shall be 
for training and technical assistance, evaluation, outreach, 
and additional program support activities, and of the remaining 
amount 75 percent shall be for replicating programs that have 
been proven effective through rigorous evaluation to reduce 
teenage pregnancy, behavioral risk factors underlying teenage 
pregnancy, or other associated risk factors, and 25 percent 
shall be available for research and demonstration grants to 
develop, replicate, refine, and rigorously test (defined as 
randomized controlled trial, quasi-experimental design, or 
regression discontinuity design) additional models and 
innovative strategies for preventing teenage pregnancy'', and 
that meet the requirements listed in 42 U.S.C. 713(b)(2)(B)(ii) 
through (vi).
    Teen Pregnancy Prevention Program--Evaluation.--The 
Committee notes that HHS awarded MITRE nearly $30,000,000 in 
fiscal years 2017 and 2018, including approximately $28 million 
in funding appropriated to the TPP Program. The Committee is 
concerned this sole source award violates the appropriations 
language requiring TPP contracts and grants to be awarded 
competitively. The Committee includes bill language to prohibit 
the Department from making TPPP funding available to another 
agency through interagency agreement. The Committee directs HHS 
to report to Congress within 60 days of enactment of this Act 
on the amount of funds that have been obligated to MITRE 
Corporation in fiscal years 2017, 2018, 2019, and 2020; the 
terms of the contract, grant, or other mechanism; from which of 
the congressionally-mandated categories (Tier 1, Tier 2, 
Program Support) the funds were transferred; total expenditures 
by MITRE; the purposes of the expenditures and a justification 
for whether such purposes are consistent with the 
congressionally-mandated categories and uses; and any studies, 
reports, or work products that have been developed with such 
federal funds.

Office of Minority Health

    The Committee includes $65,000,000 for the Office of 
Minority Health (OMH), which is $6,330,000 above the fiscal 
year 2020 enacted level and the fiscal year 2021 budget 
request. The OMH works with U.S. Public Health Service agencies 
and other agencies of the Department to address the health 
status and quality of life for racial and ethnic minority 
populations in the United States. OMH develops and implements 
new policies; partners with States, Tribes, and communities 
through cooperative agreements; supports research, 
demonstration, and evaluation projects; and disseminates 
information.
    Center for Indigenous Innovation and Health Equity.--The 
Committee recognizes the health and socioeconomic disparities 
facing indigenous communities in the United States and the 
resulting need to support the growing movement of indigenous 
innovation to draw on deeply-rooted values and practices 
address such challenges. The Committee directs the Office of 
Minority Health to create a Center for Indigenous Innovation 
and Health Equity to support efforts including research, 
education, service, and policy development related to advancing 
Indigenous solutions. To lead this Center, HHS should consider 
a partnership between two universities, one with a focus on 
Indigenous health research and policy among Native Americans 
and Alaska Natives, and one with a focus on Indigenous health 
policy and innovation among Native Hawaiians/Pacific Islanders. 
The Committee includes not less than $2,000,000 for grants to 
support this partnership. These academic institutions should 
have Indigenous leaders and engaged Indigenous community 
partners in both innovation and health disparities focus areas, 
as well as aligned goals and priorities. The Center should 
disseminate best practices and lessons learned to other 
Indigenous communities, including through Indigenous digital 
storytelling. The Committee requests a written report within 
120 days of enactment of this Act outlining the Department's 
plans for a Center for Indigenous Innovation and Health Equity.
    Health Disparities Education Program.--The Committee 
strongly encourages the Office of Minority Health to establish 
and coordinate a health and health care disparities education 
program. The health and health care disparities education 
program should collaborate with public, private, and nonprofit 
stakeholder organizations on education, outreach, and public 
awareness campaigns targeting the general public and the 
medical community. In addition, the program should disseminate 
scientific evidence for the existence and extent of racial and 
ethnic disparities in health care; new research findings to 
health care providers and patients to assist them in 
understanding, reducing, and eliminating health and health care 
disparities; information about the impact of linguistic and 
cultural barriers on health care quality; and information about 
the importance and legality of data collection and analysis 
according to race, ethnicity, disability status, socioeconomic 
status, sex, gender identity, sexual orientation, and primary 
language.
    Hispanic Serving Institutions.--The Committee urges the 
Office of Minority Health to enter into cooperative agreements 
with Hispanic Serving Institution medical schools in addition 
to existing agreements with Historically Black Colleges and 
Universities medical schools. The Committee urges OMH to 
develop a strategy to improve outreach efforts in soliciting 
these cooperative agreements, with particular focus on 
institutions within impoverished and underserved communities, 
and to report on such efforts within 90 days of enactment of 
this Act.
    Lupus Program.--The Committee includes $2,000,000 to 
support the first year of a new multiyear grant cycle for the 
National Lupus Training, Outreach, and Clinical Trial Program 
(Lupus Program). The purpose of the Lupus Program is to reduce 
lupus-related health disparities among racial and ethnic 
minority populations disproportionately affected by lupus and 
also to increase minority participation in lupus-related 
clinical trials.
    Minority Leadership Fellowship Program.--The Committee 
includes $1,000,000 for the Office of Minority Health to 
establish a Minority Leadership Fellowship grant program. The 
Committee is concerned there is a shortage of minority leaders 
in senior positions within HHS agencies. The purpose of the 
Minority Leadership Fellowship Program is to support a year-
long fellowship program within HHS, including a curriculum of 
health care policy, leadership skill building, lectures, 
panels, case studies, cultural competence, and exchanges with 
national health care leaders who direct Federal health policy 
and programs that impact the health and wellness of minority 
populations.
    Racial and Ethnic Health Inequities.--The Committee 
includes $1,500,000 for the Office of Minority Health to enter 
into an agreement with the National Academies of Sciences, 
Engineering, and Medicine to provide an evidence-based, non-
partisan analysis of Federal policies that contribute to racial 
and ethnic health inequities, as well as potential solutions. 
The study should review current Federal policies that 
contribute to health inequities, including those policies that 
impact the social determinants of health. Based on that review, 
the analysis should identify the most effective or promising 
strategies to eliminate or modify to advance racial and ethnic 
health equity. The analysis should be inclusive of all racial 
and ethnic minority populations in the United States, including 
Black or African American, Hispanic or Latino, American Indian, 
Alaska Native, Asian American, Native Hawaiian, and Pacific 
Islander.
    Social Determinants of Health.--The Committee is aware that 
social determinants of health are critical drivers of health 
outcomes and health care costs. Social determinants of health 
can have impacts on the health outcomes of specific populations 
and impact health disparities in the United States. OMH is 
encouraged to enter into cooperative agreements with academic 
institutions with HBCU, HSI, or Minority-Serving Institution 
status that have expertise in addressing social determinants of 
health to address the impact of social determinants on minority 
populations.
    Underserved Populations Along the U.S.-Mexico Border.--The 
Committee urges the HHS Office of Minority Health to examine 
how it can support health professions schools at Hispanic 
Serving Institutions along the United States-Mexico border, 
including ways to engage community partnerships that utilize 
cancer prevention tools including screening, education, and 
diagnostics to meet the healthcare needs of underserved 
populations along the border. The Committee further encourages 
OMH to work with the CMS Office of Minority Health to support 
these types of cancer prevention activities.

Office on Women's Health

    The Committee includes $36,640,000 for the Office on 
Women's Health, which is $3,000,000 above the fiscal year 2020 
enacted level and the fiscal year 2021 budget request.
    Combatting Violence Against Women.--The Committee includes 
$7,100,000 to combat violence against women through the State 
partnership initiative and to have the Office on Women's Health 
(OWH) work in conjunction with the Family Violence Prevention 
and Services Program office. This is an increase of $3,000,000 
above the fiscal year 2020 enacted level. 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. In addition, the 
Committee recommends OWH create a state-level pilot program to 
incentivize substance use disorder treatment providers to be 
trained on intimate partner violence. The pilot program would 
also include partnerships with domestic and sexual violence 
organizations at the state and local level to address the 
intersections of intimate partner violence and substance use.
    Menstrual Hygiene Products.--The Committee is concerned 
with the affordability and accessibility of menstrual hygiene 
products and information regarding these products, which are 
basic health care necessities. Per the report requested in 
House Report 116-62, the Committee encourages the Office on 
Women's Health to include in the report the number of 
individuals who experience problems with affordability and 
accessibility of menstrual hygiene products by race, 
socioeconomic status, and age. The Committee encourages OWH to 
include in the study an assessment of the availability and 
accessibility of menstrual hygiene products within 
institutions, including public schools, colleges, and 
universities, and provide a price comparison on fair market 
costs of menstrual products.

             OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH

                         INFORMATION TECHNOLOGY

 
 
 
Appropriation, fiscal year 2020.......................       $60,367,000
Budget request, fiscal year 2021......................        50,717,000
Committee Recommendation..............................        60,367,000
    Change from enacted level.........................             - - -
    Change from budget request........................        +9,650,000
 

    The Office of the National Coordinator (ONC) is the 
principal Federal entity charged with coordinating efforts to 
implement and use health information technology and 
electronically exchange health information.
    Assessment of the State of Health Information Technology at 
Hospitals.--The Committee is concerned about the state of 
health information technology at hospitals in the United 
States. The Committee directs the ONC, in consultation with 
State departments of health and other public health entities, 
to submit a report to the Committee within one year of the date 
of enactment of this Act. The report should assess the state of 
electronic medical records at U.S. hospitals and the dependence 
of hospitals and health systems on technology that is outdated 
or debunked, as well as barriers associated with updating 
health information technology, including with respect to 
hardware, software, administrative burden, staff training, and 
associated costs.
    Health Information Technology Surveillance.--The Committee 
understands that ONC is actively coordinating with the Centers 
for Disease Control and Prevention (CDC) on data collection and 
surveillance activities during the ongoing COVID-19 outbreak, 
but that much of the data being shared today are being 
transmitted via paper or PDF files. To better understand agency 
surveillance capacity and future needs, the Committee requests 
a report within 120 days of enactment of this Act on 
coordination activities to date, the extent to which computable 
information is being shared with local, State, and Federal 
authorities, identified barriers to interoperable exchange of 
electronic surveillance data, and strategies that can be put in 
place to improve the surveillance technology infrastructure.
    Interagency Task Force on Health and Human Services 
Information Technology (IT).--The Committee recognizes a 
growing need for the integration and modernization of Federal 
IT systems and notes that increased investment in IT would 
greatly improve employee and recipient interactions with 
Federal health and human service programs while enhancing 
program efficiency, integrity, analytic capability, and network 
security. The Committee urges the Chief Information Office and 
Chief Technology Officer (CTO) of HHS, in collaboration with 
the White House CTO and U.S. Department of Agriculture (USDA), 
as well as the Office of the National Coordinator for Health 
Information Technology (ONC) within HHS, 18F within the General 
Services Administration (GSA), and the Cybersecurity and 
Infrastructure security Agency (CISA) within the U.S. 
Department of Homeland Security, to establish an interagency 
task force that will examine existing IT infrastructure in 
federal health human service programs nationwide and identify 
the barriers to successfully integrating and modernizing health 
and human services IT, and the network security necessary for 
health and human services IT interoperability. The task force 
shall submit to the Committee within 180 days of enactment on 
this Act a report on its progress and on recommendations for 
further Congressional action, which should include estimated 
costs for agencies to make progress on interoperability 
initiatives.
    Interoperability.--The Committee notes that finalization of 
the rule to implement the interoperability provisions of the 
21st Century Cures Act takes significant steps forward to give 
patients greater access to their health data and to improve the 
electronic flow of health information across care settings. The 
Committee expects ONC to keep the Committee informed of any 
delays in implementation.
    Patient Data Matching.--The Committee is concerned that 
there is no consistent and accurate way to link patients to 
their health information across the care continuum and notes 
the serious patient safety concerns that arise when data is 
mismatched or when important data is missing. Although the 
Committee continues to prohibit the use of funds to promulgate 
or adopt any final standard providing for the assignment of a 
unique health identifier for an individual until such activity 
is authorized, the Committee notes that this limitation does 
not prohibit HHS from examining the issues around patient 
matching. The Committee continues to encourage the Secretary to 
provide technical assistance to private-sector-led initiatives 
to develop a coordinated national strategy that will promote 
patient safety by accurately identifying patients to their 
health information.

                      OFFICE OF INSPECTOR GENERAL

 
 
 
Appropriation, fiscal year 2020.......................       $80,000,000
Budget request, fiscal year 2021......................        90,000,000
Committee Recommendation..............................        80,000,000
    Change from enacted level.........................             - - -
    Change from budget request........................      -$10,000,000
 

    The Committee provides $80,000,000 for the Office of 
Inspector General (OIG), which is equal to the fiscal year 2020 
enacted level and $10,000,000 less than the fiscal year 2021 
budget request. The bill includes language making a portion of 
funding available for two years, as requested in the 
Congressional Budget Justification, for the investigation and 
enforcement of information blocking.
    In addition, within the Health Care Fraud and Abuse Control 
(HCFAC) program discretionary appropriations for fiscal year 
2021, the Committee provides the OIG with $98,000,000. 
Mandatory appropriations for this office also are contained in 
the HCFAC program and the Health Insurance Portability and 
Accountability Act of 1996.
    The Committee notes that additional funding was provided to 
the OIG for the purposes of investigations related to the 
Unaccompanied Children program in the Emergency Supplemental 
Appropriations for Humanitarian Assistance and Security at the 
Southern Border Act, 2019 (P.L. 116-26). In addition, the 
Coronavirus Preparedness and Response Supplemental 
Appropriations Act (P.L. 116-123) included $2,000,000; the 
CARES Act (P.L. 116-136) included $4,000,000; and the Paycheck 
Protection Program and Health Care Enhancement Act (P.L. 116-
138) included $6,000,000 for the OIG to conduct oversight and 
investigations of activities funded by emergency supplemental 
appropriations for COVID-19.

                        OFFICE FOR CIVIL RIGHTS

 
 
 
Appropriation, fiscal year 2020.......................       $38,798,000
Budget request, fiscal year 2021......................        30,286,000
Committee Recommendation..............................        38,798,000
    Change from enacted level.........................             - - -
    Change from budget request........................        +8,512,000
 

    The Office for Civil Rights (OCR) is responsible for 
enforcing civil rights statutes that prohibit discrimination in 
health and human services programs. OCR implements the civil 
rights laws through a compliance program designed to generate 
voluntary compliance among all HHS recipients.
    Assisted Suicide Laws and Disabled Americans.--The 
Committee is aware of a recent National Council on Disability 
report entitled ``The Danger of Assisted Suicide Laws,'' which 
raises concern that such laws could lead to a two-tiered system 
that results disproportionately in the deaths of people with 
disabilities. Accordingly, the Committee strongly encourages 
OCR to clarify that all HHS suicide prevention grants and 
services must comply with existing disability rights laws, 
including the ADA, Sections 504 and 508 of the Rehabilitation 
Act, and Section 1557, including the provisions requiring 
accessible communications, so that all videos, documents, and 
other products ensure access to persons with disabilities. The 
Committee further strongly encourages OCR to clarify that 
Sections 504 and 508 of the Rehabilitation Act require 
physicians to provide people with disabilities with information 
on the full array of available clinical treatments and 
available long-term services and supports (LTSS) and to require 
that referrals to such treatments and services be given if 
requested. Finally, the Committee encourages OCR to recommend 
that hospitals create a disability ombudsperson position who is 
authorized to facilitate communication between healthcare 
providers and patients with disabilities or their proxies and 
advocate on the patient s behalf, when required, to ensure that 
all clinical and LTSS options and choices are made available.
    Rehabilitation Act.--The Committee directs the Secretary to 
fully enforce the Rehabilitation Act of 1973 and the Americans 
with Disabilities Act.

     RETIREMENT PAY AND MEDICAL BENEFITS FOR COMMISSIONED OFFICERS

 
 
 
Appropriation, fiscal year 2020.......................      $623,591,000
Budget request, fiscal year 2021......................       653,023,000
Committee Recommendation..............................       653,023,000
    Change from enacted level.........................       +29,432,000
    Change from budget request........................             - - -
 

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

            PUBLIC HEALTH AND SOCIAL SERVICES EMERGENCY FUND

 
 
 
Appropriation, fiscal year 2020.......................    $2,737,458,000
Budget request, fiscal year 2021......................     2,641,465,000
Committee Recommendation..............................     2,827,558,000
    Change from enacted level.........................       +90,000,000
    Change from budget request........................      +185,993,000
 

    This account supports the activities of the Assistant 
Secretary for Preparedness and Response (ASPR) and other 
components within the Office of the Secretary to prevent, 
prepare for, and respond to the health consequences of 
bioterrorism and other public health emergencies, including 
pandemic influenza. It also includes funding for the 
Department's cybersecurity efforts.
    In addition, the Committee provides $4,500,000,000 in 
emergency appropriations for BARDA to address the COVID-19 
pandemic, including emergency appropriations for advanced 
research and development and advanced manufacturing of vaccines 
and therapeutics; enhancements to domestic vaccine facilities; 
and innovation in antibacterial research and development. The 
emergency appropriation is further described under Title VI of 
this committee report.
    Further, the Coronavirus Preparedness and Response 
Supplemental Appropriations Act (P.L. 116-123) included 
$3,000,000,000; the CARES Act (P.L. 116-136) included 
$26,725,500,000; and the Paycheck Protection Program and Health 
Care Enhancement Act (P.L. 116-139) included $1,000,000,000 
through the Public Health and Social Services Emergency Fund 
for advanced research and development of vaccines, 
therapeutics, and diagnostics; healthcare system preparedness; 
medical surge capacity, and procurement and distribution of 
personal protective equipment, ventilators, and other medical 
supplies, to respond to the COVID-19 pandemic.

Office of the Assistant Secretary for Preparedness and Response

    The Committee provides $2,451,128,000 for activities 
administered by ASPR. ASPR is responsible for coordinating 
national policies and plans for medical and public health 
preparedness and for administering a variety of public health 
preparedness programs.
    Mission Zero.--The Committee encourages ASPR to pursue 
partnerships between military and civilian trauma care 
providers to ensure trauma care readiness by integrating 
military trauma care providers into civilian trauma centers. 
The Committee requests an update on such efforts in the fiscal 
year 2022 Congressional Budget Justification.
    Public Health Emergency Medical Countermeasures Enterprise 
Multi-Year Budget.--The Committee encourages ASPR to delineate 
information on emerging infectious diseases, pandemic 
influenza, and antimicrobial resistance investments in its 
annual five-year budget plan for medical countermeasure (MCM) 
development to clarify how ASPR is considering such naturally 
occurring threats in relation to other priority areas of MCM 
development, particularly given their inclusion in the 
Strategic Initiatives section of the Pandemic and All-Hazards 
Preparedness and Advancing Innovation Act (P.L. 116-22).
    Repatriation Flights.--The Committee directs HHS to review 
the process for Congressional notification during repatriation 
flights from countries with developing health crises. Within 
200 days after enactment, the Committee directs HHS to provide 
the Committee with a report detailing a new strategy to ensure 
that members of Congress are notified in a timely manner when a 
repatriation flight is headed, or potentially headed, to their 
district.

Operations

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

Preparedness and Emergency Operations

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

National Disaster Medical System

    The Committee includes $67,404,000, an increase of 
$10,000,000, for the National Disaster Medical System (NDMS). 
NDMS deploys trained medical teams to communities impacted by 
public health and medical emergencies due to natural and man-
made incidents.
    Biocontainment Surge Capacity.--The Committee encourages 
efforts to create biocontainment surge capacity.
    Pediatric Disaster Care.--The Committee includes 
$10,000,000 for pediatric disaster care, as pediatric care 
requires specialized training, equipment, supplies, and 
pharmaceuticals that may not be readily available in an 
emergency. When disaster strikes, minimizing the impacts of 
children's exposure to infectious diseases, trauma, and other 
hazards is a challenge for healthcare facilities and stresses 
the ability of the healthcare system to respond. The Committee 
recognizes that Pediatric Disaster Centers of Excellence are 
working to address appropriate planning and response 
capabilities that support the specific needs of children during 
public health emergencies and disasters, such as mass casualty 
events.
    Regional Coordination.--The Committee supports the 
Department's approach to improve the disaster readiness of the 
Nation by better coordinating the existing assets within a 
State and within regions.

Hospital Preparedness Program

    The Committee includes $300,555,000, an increase of 
$25,000,000, for the Hospital Preparedness Program (HPP). HPP 
supports cooperative agreements with State, local, and 
territorial health departments to build healthcare coalitions 
that improve regional and local hospital preparedness and surge 
capacity in public health emergencies.
    High Consequence, Emerging, Infectious Disease Threats.--
The Committee supports the continuation of the nation's 
preparedness against high consequence, emerging, infectious 
disease threats. The Committee directs no less than $11,000,000 
for the National Emerging Special Pathogen Training and 
Education Center (NETEC) and the ten existing regional Ebola 
and other special pathogen treatment centers.
    Hospital Preparedness Grants.--The Committee includes 
funding for critical support to State, local and regional 
partners to advance health care system preparedness and 
response.

Biomedical Advanced Research and Development Authority

    The Committee includes $561,700,000 for the Biomedical 
Advanced Research and Development Authority (BARDA). In 
addition, the Committee provided significant, multi-year 
resources to BARDA in the COVID-19 supplemental funding bills. 
BARDA's role in supporting the development of diagnostics, 
therapeutics, and vaccines is critical to our nation's 
response. BARDA supports the advanced development of vaccines, 
drugs, and therapeutics for potential serious public health 
threats, including chemical, biological, radiological, and 
nuclear threats, pandemic influenza, and emerging and re-
emerging infectious diseases.
    In addition, the Coronavirus Preparedness and Response 
Supplemental Appropriations Act (P.L. 116-123) included 
$2,000,000,000; the CARES Act (P.L. 116-136) included 
$3,500,000,000; and the Paycheck Protection Program and Health 
Care Enhancement Act (P.L. 116-139) included $1,000,000,000 for 
advanced research and development of vaccines, therapeutics, 
and diagnostics, as well as enhancements to domestic vaccine 
facilities.
    Active Pharmaceutical Ingredients.--The Committee is 
concerned with the national security risk of our increased 
reliance on foreign-based sources of active pharmaceutical 
ingredients, their chemical components, and off-shore drug 
production. The Committee recognizes the importance of domestic 
drug manufacturing and onshore production of medicine, and 
provided supplemental emergency funding in the CARES Act (P.L. 
116-136) to support increased U.S.-based manufacturing 
capabilities. The successful work of BARDA in addressing public 
health vulnerabilities and securing a national stockpile of 
drugs has unique potential to consider program expansion to 
include active at-risk drug ingredients. The Committee strongly 
urges BARDA to engage in public-private partnerships for U.S.-
based advanced manufacturing for active pharmaceutical 
ingredients and their chemical precursors for the Strategic 
National Stockpile.
    Antifungal Resistance.--The Committee understands the CARB-
X program supports development of products targeted to address 
pathogens on the Centers for Disease Control and Prevention 
(CDC) 2013 Antibiotic Resistant Threats. The Committee is aware 
CDC released an updated Antimicrobial Threat Report in 2019, 
which includes several fungal pathogens. Accordingly, the 
Committee urges the Secretary to update the scope of support 
for the CARB-X program to include pathogens listed in the 2019 
CDC Antibiotic Resistant Threats, including products that 
target fungal pathogens.
    Antimicrobial Resistance.--The Committee recognizes 
antimicrobial resistance is an increasingly serious threat to 
America's public health and national security. The antibiotic 
commercial market, especially in the national security space, 
presents challenges as novel products currently may have 
limited commercial markets. ASPR has made great progress over 
the past fifteen plus years in combatting antibiotic resistance 
through supporting the development and availability of novel 
antibiotics but market viability issues have limited commercial 
success. The Committee strongly encourages ASPR to review its 
current program to ensure its focus is on projects that enhance 
the U.S. national security posture against antibiotic-resistant 
threats through novel, broad-spectrum antibiotics for use 
against biothreats or serious, secondary infections that would 
result from other chemical, biological, radiological, or 
nuclear threats or pandemic influenza especially if a 
commercial market does not exist. ASPR is encouraged to explore 
alternative support methods to incubate, test, and refine 
projects aligned toward such national security priorities. 
Furthermore, ASPR is encouraged to explore and enhance the use 
of authorized emergency use, government licensing provisions, 
and other mechanisms to protect its investments aligned to 
national security priorities that do not have viable commercial 
markets.
    Disease X Medical Countermeasures.--The novel coronavirus 
pandemic of 2019 demonstrated that the U.S. urgently needs the 
ability to more rapidly respond to newly emerging or unknown 
pathogens with the potential to cause an epidemic in the U.S. 
The Committee urges HHS to work with the Department of Defense 
to implement a dedicated medical countermeasures program 
focused on developing medical countermeasures in months, not 
years, for previously unknown epidemic pathogens in order to 
enhance our ability to save lives immediately with classes of 
medical countermeasures that are broadly applicable. The 
Committee requests an update in the fiscal year 2022 
Congressional Justification.
    Ebola.--The Committee remains concerned by all global 
health threats, including the ongoing threat of Ebola in the 
Democratic Republic of the Congo and its potential to spread. 
The Committee requests a briefing from ASPR within 60 days of 
enactment of this Act regarding the five-year spend plan for 
Ebola therapeutics, diagnostics and vaccines to counter this 
material threat.
    Novel, Non-Vaccine Approaches to Respiratory Viruses.--The 
Committee urges the Secretary to provide adequate funding to 
support the manufacturing of novel bio-specific immunotherapies 
that show potential for the universal prevention and treatment 
of influenza.
    Strengthening Domestic Medical Manufacturing.--The 
Committee is concerned about the nation's lack of medical 
infrastructure to produce essential products such as medical 
devices, medical equipment, generic pharmaceuticals, and 
personal protective equipment. The coronavirus pandemic 
demonstrated the weaknesses in the U.S. supply chain and the 
dependence of the U.S. healthcare system on other countries. 
The U.S. must invest in our domestic capacity. The Committee 
directs the Secretary to conduct a study on methods to increase 
our domestic medical manufacturing capacity and reduce 
dependence on foreign suppliers. The study should include 
potential incentives and investments necessary for companies to 
increase domestic production of components vital to the U.S. 
healthcare system, and the consideration of maintaining an 
online library of pre-approved design information and usage 
guidance to speed enlistment of non-traditional suppliers. The 
study shall be reported to the Committee no later than 180 days 
after enactment of this Act.
    Tuberculosis.--Drug resistant TB is identified as a serious 
threat level pathogen to the United States by the National 
Strategy for CARB. The Committee remains interested in BARDA's 
investment in new TB diagnostics, drugs, and vaccines all of 
which are urgently needed to address growing drug resistance. 
The Committee requests a report on BARDA's investments in drug 
resistant TB research in the fiscal year 2022 Congressional 
Justification.
    Vaccine Production.--The Committee urges BARDA to support 
vaccines produced through recombinant DNA technology in 
addition to traditionally-produced vaccines to facilitate the 
competitive process for all vaccine manufacturers.

Policy and Planning

    The Committee includes $19,877,000, an increase of 
$5,000,000, for Policy and Planning. The Office of Policy and 
Planning leads HHS' emergency preparedness and response 
strategic direction and policy coordination.
    National Biodefense Strategy.--The Committee includes 
$5,000,000 to support the implementation of the National 
Biodefense Strategy.

Project BioShield Special Reserve Fund

    The Committee includes $735,000,000 for Project BioShield. 
These funds support the acquisition of promising medical 
countermeasures developed through BARDA contracts for the most 
serious public health threats.

Strategic National Stockpile

    The Committee includes $705,000,000 for the Strategic 
National Stockpile (SNS).
    In addition, the Coronavirus Preparedness and Response Act 
(P.L. 116-123) included $500,000,000 and the CARES Act (P.L. 
116-136) included up to $16,000,000,000 for the Strategic 
National Stockpile.
    In response to COVID-19, the SNS was utilized in an 
unprecedented manner in response to the nation-wide need for 
supplies, including personal protective equipment and 
ventilators. While there will be many lessons learned from the 
COVID-19 response, it is blatantly clear that the SNS was not 
prepared for a pandemic response and our nation has very 
limited domestic production of the products in the SNS. The 
Committee continues to expect that CDC will have a significant 
role in providing scientific expertise in decision-making 
related to the procurement of countermeasures, as well as 
maintaining strong relationships with State and local public 
health departments to facilitate efficient deployment of 
countermeasures in public health emergencies.
    Budget Submission.--The Committee directs that a 
professional judgement budget be submitted at the same time as 
the fiscal year 2022 President's Budget with respect to 
expenditures necessary to maintain the minimum level of 
relevant supplies in the Strategic National Stockpile, 
including in case of a significant pandemic, in consultation 
with the working group under section 319F(a) of the Public 
Health Service Act and the Public Health Emergency Medical 
Countermeasures Enterprise established under section 2811-1 of 
such Act.
    Forward Deployment.--The Committee strongly urges HHS to 
use discretion in allowing the forward deployment of SNS 
medication in reasonable quantities in or near high-threat, 
high-density urban jurisdictions that have demonstrated an 
ability to stand up Points of Dispensing faster than SNS 
medications can be delivered to jurisdictions.
    Inventory of Ventilators and Personal Protective 
Equipment.--The Committee directs the Secretary to submit a 
weekly report on the current inventory of ventilators and 
personal protective equipment in the Strategic National 
Stockpile, including the numbers of face shields, gloves, 
goggles and glasses, gowns, head covers, masks, and 
respirators, as well as deployment of ventilators and personal 
protective equipment during the previous week, reported by 
State and other jurisdiction. The Secretary is directed to 
continue to submit weekly reports until the public health 
emergency related to COVID-19 is no longer in effect.
    Medical Center Surge Response Capabilities.--The Committee 
is aware of concerns regarding the lack of medical center surge 
response capabilities. Therefore, the Committee encourages ASPR 
to explore the acquisition of modular temporary containment 
wall systems for deployment during national public health 
emergencies to provide scalable treatment centers and for the 
Strategic National Stockpile for use in future emergencies.
    Revolving Management.--The Committee recognizes that the 
COVID-19 Pandemic was an unprecedented challenge for the SNS. 
Prior to the pandemic, the SNS management system was based on 
large, infrequent purchases. The Committee encourages 
consideration of a revolving method, such as utilized by the 
Defense Logistics Agency.
    Vulnerable Populations.--The Committee is concerned about 
the availability of medical countermeasures for individuals who 
are immunocompromised with common conditions like eczema, HIV, 
and diabetes. Some traditional vaccines contain a live virus 
that can be harmful or even fatal for patients with these 
conditions. Therefore, the Committee encourages HHS to evaluate 
its stockpile of medical countermeasures to ensure appropriate 
supplies are available to protect these vulnerable populations.

Office of the Assistant Secretary for Administration--Cybersecurity

    The Committee provides $57,820,000 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 National Security

    The Committee provides $8,510,000 for the Office of 
National Security to maintain the security of the Department's 
personnel, systems, and critical infrastructure.

Office of Public Health and Science--Medical Reserve Corps

    The Committee includes $6,000,000 for the Medical Reserve 
Corps program, which is a network of local volunteers made up 
of doctors, dentists, nurses, pharmacists, and other community 
members who work to strengthen the public health infrastructure 
and preparedness capabilities of their communities.

Pandemic Influenza Preparedness

    The Committee includes $310,000,000, an increase of 
$50,000,000, for the pandemic influenza preparedness program. 
This funding supports research and development of vaccines and 
the next-generation influenza medical countermeasures, 
preparedness testing and evaluation, and stockpiling.
    Pandemic Response.--The Committee remains concerned about 
our nation's limited ability to satisfy the Federal 
government's goal of delivering vaccines within 12 weeks of a 
declared pandemic with multiple vaccine suppliers. The 
Secretary shall provide a report no later than 180 days after 
enactment of this Act on current flexible manufacturing 
platforms and domestic multi-modal facilities with the 
potential to rapidly respond to emerging infectious diseases 
and pandemics to include influenza. Furthermore, within the 
funds provided for Pandemic Influenza Preparedness, the 
Committee strongly encourages the Department to facilitate 
access to approved adjuvants with priority given to late-stage 
and pre-clinical technologies that have achieved regulatory 
approval or are in advanced-state clinical development.

                           General Provisions

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

                          (TRANSFER OF FUNDS)

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

                          (TRANSFER OF FUNDS)

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

                          (TRANSFER OF FUNDS)

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

                          (TRANSFER OF FUNDS)

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

                          (TRANSFER OF FUNDS)

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

                   PREVENTION AND PUBLIC HEALTH FUND

    The Committee continues a provision that directs the 
transfer of the Prevention and Public Health Fund. In fiscal 
year 2021, the level appropriated for the fund is $895,850,000 
after accounting for sequestration. The Committee includes bill 
language in section 222 of this Act that requires that funds be 
transferred within 45 days of enactment of this Act to the 
following accounts, for the following activities, and in the 
following amounts:

------------------------------------------------------------------------
                                                            FY 2021
             Agency                 Budget Activity        Committee
------------------------------------------------------------------------
ACL.............................  Alzheimer's Disease        $14,700,000
                                   Program.
ACL.............................  Chronic Disease              8,000,000
                                   Self-Management.
ACL.............................  Falls Prevention...          5,000,000
CDC.............................  Breastfeeding                9,000,000
                                   Grants (Hospitals
                                   Promoting
                                   Breastfeeding).
CDC.............................  Diabetes...........         52,275,000
CDC.............................  Epidemiology and            40,000,000
                                   Laboratory
                                   Capacity Grants.
CDC.............................  Healthcare                  12,000,000
                                   Associated
                                   Infections.
CDC.............................  Heart Disease and           57,075,000
                                   Stroke Prevention
                                   Program.
CDC.............................  Million Hearts               4,000,000
                                   Program.
CDC.............................  Preventive Health          160,000,000
                                   and Health
                                   Services Block
                                   Grant.
CDC.............................  Tobacco............        130,500,000
CDC.............................  Section 317                370,300,000
                                   Immunization
                                   Grants.
CDC.............................  Lead Poisoning              17,000,000
                                   Prevention.
CDC.............................  Early Care                   4,000,000
                                   Collaboratives.
SAMHSA..........................  Garrett Lee Smith--         12,000,000
                                   Youth Suicide.
------------------------------------------------------------------------

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

                          (TRANSFER OF FUNDS)

    Sec. 225. The Committee continues a provision permitting 
transfer of funds within NIH, if such funds are related to 
opioid and pain management research.
    Sec. 226. The Committee continues certain Congressional 
notification requirements.
    Sec. 227. The Committee continues a provision related to a 
report on staffing.
    Sec. 228. The Committee continues a provision allowing HHS 
to cover travel expenses when necessary for employees to obtain 
medical care when they are assigned to duty in a location with 
a public health emergency.
    Sec. 229. The Committee continues a provision relating to 
donations for unaccompanied alien children.
    Sec. 230. The Committee modifies a provision prohibiting 
the use of funds to change policy directives related to the 
unaccompanied children program.
    Sec. 231. The Committee includes a new provision 
prohibiting the use of funds to house unaccompanied children in 
facilities that are not State-licensed for the care of 
unaccompanied children.
    Sec. 232. The Committee modifies a provision relating to 
Members of Congress and oversight of facilities responsible for 
the care of unaccompanied alien children.
    Sec. 233. The Committee modifies a provision requiring 
monthly reporting on unaccompanied alien children who were 
separated from their parents or legal guardians and transferred 
to the care of the Office of Refugee Resettlement.
    Sec. 234. The Committee includes a new provision 
prohibiting the use of funds for implementation or enforcement 
of the Memorandum of Agreement between the Office of Refugee 
Resettlement and the Department of Homeland Security regarding 
information sharing of unaccompanied alien children and 
sponsors.
    Sec. 235. The Committee includes a new provision 
prohibiting the use of funds to share information provided by 
unaccompanied children during mental health or therapeutic 
services with the Department of Homeland Security or the 
Department of Justice for the purposes of immigration 
enforcement.
    Sec. 236. The Committee includes a new provision ensuring 
that efforts are taken to place unaccompanied alien children 
who are siblings together.
    Sec. 237. The Committee includes a new provision directing 
the Secretary to report the death of any unaccompanied child in 
HHS custody to the Committee within 24 hours.
    Sec. 238. The Committee includes a new provision requiring 
the Secretary to submit a detailed spend plan outlining 
anticipated uses of funds in the Refugee and Entrant Assistance 
account.
    Sec. 239. The Committee continues a provision related to 
primary and secondary school costs for eligible dependents of 
HHS personnel stationed in the Commonwealth of Puerto Rico, the 
Commonwealth of the Northern Mariana Islands, and the 
possessions of the United States.
    Sec. 240. The Committee includes a new provision related to 
facilities at CDC.
    Sec. 241. The Committee modifies a provision relating to 
the Nonrecurring Expenses Fund.
    Sec. 242. The Committee includes a new provision related to 
the period of availability of multiyear research grants if the 
Director of the NIH determines the project suffered an 
interruption of activities attributable to COVID-19.
    Sec. 243. The Committee includes a new provision requiring 
the Secretary to report on the current inventory of the 
Strategic National Stockpile.
    Sec. 244. The Committee includes a new provision 
prohibiting funds from being used to implement, enforce, or 
give effect to a rule related to conscience rights.
    Sec. 245. The Committee includes a new provision 
prohibiting funds from being used to implement, enforce, or 
otherwise give effect to a rule related to nondiscrimination in 
health and health education programs or activities.
    Sec. 246. The Committee includes a new provision 
prohibiting funds from being used to publish a proposed rule 
relating to a non-emergency medical transportation benefit for 
Medicaid beneficiaries.
    Sec. 247. The Committee includes a new provision 
prohibiting funds from being used to implement, enforce, or 
otherwise give effect to a rule related to reassignment of 
Medicaid provider claims.
    Sec. 248. The Committee includes a new provision 
prohibiting funds for foster care programs from being awarded 
to an organization that excludes an individual based on non-
merit factors such as age, disability, sex, race, color, 
national origin, religion, gender identity, or sexual 
orientation, or that refuses to treat as valid the marriages of 
same-sex couples in accordance with the Supreme Court decisions 
United States v. Windsor and Obergefell v. Hodges.
    Sec. 249. The Committee includes a new provision 
prohibiting CMS from relocating its call center operations 
until the Government Accountability Office has submitted an 
evaluation of relocation options.

                   TITLE III--DEPARTMENT OF EDUCATION


              IMPROVING ELEMENTARY AND SECONDARY EDUCATION

 
 
 
Appropriation, fiscal year 2020...........                         - - -
Budget request, fiscal year 2021..........               $19,363,430,000
Committee Recommendation..................                         - - -
    Change from enacted level.............                         - - -
    Change from budget request............               -19,363,430,000
 

    The Committee rejects the fiscal year 2021 budget request 
for a new Elementary and Secondary Education Block Grant.

                    EDUCATION FOR THE DISADVANTAGED

 
 
 
Appropriation, fiscal year 2020...........               $16,996,790,000
Budget request, fiscal year 2021..........                         - - -
Committee Recommendation..................                17,258,290,000
    Change from enacted level.............                  +261,500,000
    Change from budget request............               +17,258,290,000
 

    This account provides foundational funding to help ensure 
all children receive a fair, equitable and high-quality 
education.
    Of the total amount available, $6,336,990,000 is 
appropriated for fiscal year 2021 for obligation on or after 
July 1, 2022 and $10,841,177,000 is appropriated for fiscal 
year 2021 for obligation on or after October 1, 2022.

Grants to Local Educational Agencies

    For fiscal year 2021, the Committee recommends 
$16,563,802,000 for Title I grants to LEAs, an increase of 
$254,000,000 over the fiscal year 2020 enacted level. The 
fiscal year 2021 budget request proposed to eliminate this 
program. Title I is the cornerstone of federal K-12 education 
programs and critical to the nation's collective efforts to 
ensure that every child has the opportunity to obtain a high-
quality education. The program serves an estimated 25 million 
students in nearly 90 percent of school districts and nearly 60 
percent of all public schools. Providing additional resources 
so that children can succeed in school and in life is one of 
the Committee's highest priorities in the bill.
    Of the amounts provided for Title I programs, 
$6,459,401,000 is available for Basic Grants to Local 
Educational Agencies (LEAs or school districts), which is the 
same as the fiscal year 2020 enacted level. Basic grants are 
awarded to school districts with at least 10 low-income 
children who make up more than two percent of the school-age 
population.
    Within the amount for Title I Basic Grants, up to 
$5,000,000 is made available to the Secretary of Education 
(Secretary) on October 1, 2020, to obtain annually-updated LEA-
level poverty data from the Bureau of the Census.
    The Committee recommends $1,362,301,000 for Title I 
Concentration Grants, which is the same as the fiscal year 2020 
enacted level. Concentration Grants target funds to school 
districts in which the number of low-income children exceeds 
6,500 or 15 percent of the total school-age population.
    The Committee recommends $4,371,050,000 for Title I 
Targeted Grants, which is $127,000,000 above the fiscal year 
2020 enacted level. Targeted Grants provide higher payments to 
school districts with high numbers or percentages of low-income 
students.
    The Committee recommends $4,371,050,000 for Title I 
Education Finance Incentive Grants (EFIGs), which is 
$127,000,000 above the fiscal year 2020 enacted level. EFIGs 
provide payments to States and school districts that 
incorporate equity and effort factors to improve the equity of 
State funding systems.
    The Committee urges that the Department support LEAs' 
development of plans under section 1112(b)(6) of the Elementary 
and Secondary Education Act (ESEA) that describe the amount of 
funds for homeless students reserved under section 
1113(c)(3)(A) of the ESEA, how such amount was determined, and 
the amount of the prior year's reservation that was spent on 
homeless students. The Committee further urges that the 
Department support SEAs' development of plans under section 
1111(g)(1)(F) of the ESEA that describe how the SEA will 
monitor the amount and use of funds reserved for homeless 
students under section 1113(c)(3)(A) and provide technical 
assistance to assist LEAs in effectively using such funds to 
support homeless students.
    The Committee believes that all students should be able to 
access texts that reflect their interests and diverse cultures. 
Unfortunately, too many Black, Latino, Asian-American, and 
Native students are unable to access such books and printed 
materials in their classrooms and school libraries. To address 
this challenge, the Committee supports classroom and school 
libraries that seek to include content that reflects the 
history and diversity of their student populations.
    The Committee supports efforts by State and school district 
leaders to improve student learning environments by 
prioritizing rigorous culturally and linguistically responsive 
education (CLRE). Such efforts not only prioritize an emphasis 
on the experiences of culturally and linguistically diverse 
student populations in academic curricula, but also help 
students confront racism and prejudice in common discussions of 
literature and history. The Committee notes that rigorous CLRE 
and anti-racist education can support critical thinking skills, 
feelings of student belonging, and student social and emotional 
well-being.
    The Committee is concerned with and opposes proposals from 
the Administration that divert public education funding to 
private school voucher programs and that block-grants ESEA 
funds while eliminating vital resources such as Title I grants 
to LEAs.
    The Committee notes that the ESEA recognizes military-
connected students as a distinct subgroup of students. More 
than 80 percent of military-connected children attend public 
schools. Students with parents/guardians who serve full-time in 
the military move and change schools frequently. In addition, 
they may experience trauma resulting from separations from a 
parent/guardian due to their parents' service to the U.S. 
Military. The Military Student Identifier provides educators, 
school leaders, and policymakers with critical information to 
personalize attention and direct resources to better support 
military dependent children. Current law directs the Military 
Student Identifier toward the children of active duty families, 
leaving out the nearly one-half million children of the reserve 
component, both National Guard and Reserves. The Committee 
supports efforts to address the unique needs of children whose 
parents/guardians serve in the National Guard and reserve 
components.
    The Committee encourages the Department to provide 
technical assistance and support to State and local educational 
agencies in implementing evidence-based strategies for 
improving schools identified for comprehensive and targeted 
support and improvement under Title I. In particular, the 
Committee notes the importance of principals and other school 
leaders in bringing about improvements in student achievement 
and other outcomes. Research shows there are virtually no 
documented instances of low-performing schools being turned 
around without intervention by a powerful leader. Demonstrated 
effects of successful leadership are considerably greater in 
schools that are in more difficult circumstances. Additionally, 
research has found that school leadership is second only to 
classroom instruction as an influence on student learning, and 
97 percent of teachers say that the principal is responsible 
for determining if a school can attract and retain great 
teachers. Therefore, the Committee encourages the Department to 
provide technical assistance to States and school districts on 
strengthening school leadership as a mechanism for improving 
results in low-performing schools, particularly those 
identified for comprehensive and targeted support and 
improvement within the State's accountability system. The 
Committee directs the Department to respond to this request in 
the fiscal year 2022 Congressional Budget Justification.
    The CARES Act (P.L. 116-136) included $30,750,000,000 for 
the Education Stabilization Fund (ESF) to prevent, prepare for, 
and respond to the coronavirus, including $153,750,000 for the 
Outlying Areas and $153,750,000 for the Bureau of Indian 
Education. The ESF included $13,500,000,000 in funding for 
elementary and secondary emergency relief and $3,000,000,000 in 
funding to governors for elementary, secondary, and 
postsecondary emergency relief.

Comprehensive Literacy Development Grants

    The Committee recommends $192,000,000 for Comprehensive 
Literacy Development Grants, which is the same as the fiscal 
year 2020 enacted level. The fiscal year 2021 budget request 
proposes to eliminate this program. Funds are awarded to States 
to subgrant to school districts and/or early education programs 
to improve literacy instruction for disadvantaged students.

Innovative Approaches to Literacy

    The Committee recommends $28,500,000 for Innovative 
Approaches to Literacy, which is $1,500,000 above the fiscal 
year 2020 enacted level. The fiscal year 2021 request proposes 
to eliminate this program. Funds support competitive grants to 
school libraries and national not-for-profit organizations to 
provide books and literacy activities to children and families 
in high-need communities.
    The Committee directs the Department to prioritize in the 
fiscal year 2021 competition underserved communities in urban 
school districts in which students from low-income families 
make up at least 50 percent of enrollment.

State Agency Programs: Migrant

    The Committee recommends $378,501,000 for the State Agency 
Program for Migrant Education, which is $3,750,000 above the 
fiscal year 2020 enacted level. The fiscal year 2021 request 
proposes to eliminate this program. This program supports 
special educational and related services for children of 
migrant agricultural workers and fishermen, including: (1) 
supplementary academic education; (2) remedial or compensatory 
instruction; (3) English for limited English proficient 
students; (4) testing; (5) guidance counseling; and (6) other 
activities to promote coordination of services across States 
for migrant children whose education is interrupted by frequent 
moves.

State Agency Programs: Neglected and Delinquent

    For the State Agency Program for Neglected and Delinquent 
Children, the Committee recommends $48,864,000, which is 
$1,250,000 above the fiscal year 2020 enacted level. The fiscal 
year 2021 request proposes to eliminate this program. This 
formula grant program supports educational services for 
children and youth under age 21 in State-run institutions, 
attending community day programs, and in correctional 
facilities. A portion of these funds is provided for projects 
that support the successful re-entry of youth from the criminal 
justice system into postsecondary and vocational programs.

Special Programs for Migrant Students

    The Committee recommends $46,623,000 for the Special 
Programs for Migrant Students, which is $1,000,000 above the 
fiscal year 2020 enacted level. The fiscal year 2021 request 
proposes to eliminate this program. These programs make grants 
to colleges, universities, and nonprofit organizations to 
support educational programs designed for students who are 
engaged in migrant and other seasonal farm work. The High 
School Equivalency Program (HEP) recruits migrant students age 
16 and over and provides academic and support services to help 
those students obtain a high school equivalency certificate and 
subsequently to gain employment or admission to a postsecondary 
institution or training program. The College Assistance Migrant 
Program (CAMP) provides tutoring and counseling services to 
first-year, undergraduate migrant students and assists those 
students in obtaining student financial aid for their remaining 
undergraduate years.

                               IMPACT AID

 
 
 
Appropriation, fiscal year 2020.......................    $1,486,112,000
Budget request, fiscal year 2021......................     1,410,799,000
Committee Recommendation..............................     1,491,112,000
    Change from enacted level.........................        +5,000,000
    Change from budget request........................       +80,313,000
 

    This account supports payments to school districts affected 
by Federal activities, such as those that educate children 
whose families are connected with the military or who live on 
Indian land.

Basic Support Payments

    The Committee recommends $1,345,242,000 for Basic Support 
Payments to LEAs, which is $5,000,000 above the fiscal year 
2020 enacted level and the fiscal year 2021 budget request. 
Basic Support Payments compensate school districts for lost tax 
revenue and are made on behalf of Federally-connected children, 
such as children of members of the uniformed services who live 
on Federal property.
    The reporting method used to calculate the amount of Impact 
Aid a school receives is critical to ensuring accurate data for 
eligible communities. Correct student counts ensure adequate 
resources are provided for students. The Committee requests the 
Department assess any potential challenges with under reporting 
of eligible students and develop recommendations for addressing 
such challenges. The result of such assessment is requested in 
the fiscal year 2022 Congressional Budget Justification.

Payments for Children with Disabilities

    The Committee recommends $48,316,000 for Payments for 
Children with Disabilities, which is the same as both the 
fiscal year 2020 enacted level and the fiscal year 2021 budget 
request. These payments compensate school districts for the 
increased costs of serving Federally-connected children with 
disabilities.

Facilities Maintenance

    The Committee recommends $4,835,000 for Facilities 
Maintenance, which is the same as both the fiscal year 2020 
enacted level and the fiscal year 2021 budget request. These 
capital payments are authorized for maintenance of certain 
facilities owned by the Department.

Construction

    The Committee recommends $17,406,000 for the Construction 
program, which is the same as both the fiscal year 2020 enacted 
level and the fiscal year 2021 budget request. Funding is 
allocated by formula to eligible LEAs for school construction 
activities under section 7007(b) of ESEA.

Payments for Federal Property

    The Committee recommends $75,313,000 for Payments for 
Federal Property, which is the same as the fiscal year 2020 
enacted level. The fiscal year 2021 budget request proposes to 
eliminate this program. Funds are awarded to school districts 
to compensate for lost tax revenue as the result of Federal 
acquisition of real property since 1938.

                      SCHOOL IMPROVEMENT PROGRAMS

 
 
 
Appropriation, fiscal year 2020.......................    $5,404,967,000
Budget request, fiscal year 2021......................       392,374,000
Committee Recommendation..............................     5,453,617,000
    Change from enacted level.........................       +48,650,000
    Change from budget request........................    +5,061,243,000
 

    The Committee recommendation includes $5,453,617,000 for 
the School Improvement Programs account.

Supporting Effective Instruction State Grants

    The Committee recommends $2,154,330,000 for Supporting 
Effective Instruction State Grants (Title II-A), which is 
$22,500,000 above the fiscal year 2020 enacted level. The 
fiscal year 2021 budget request proposes to eliminate the 
program. Title II-A grants provide States and school districts 
with a flexible source of funding to strengthen the skills and 
knowledge of teachers, principals, and administrators to enable 
them to improve student achievement.
    The Committee is supportive of efforts to strengthen school 
leadership through the Title II-A program. Research has 
consistently demonstrated that school leadership is second only 
to classroom instruction as an influence on student learning, 
and 97 percent of teachers say that the principal is 
responsible for determining if a school can attract and retain 
great teachers. The Committee particularly takes note of the 
fact that, under ESEA, States may reserve approximately three 
percent of their Title II-A formula allocations to carry out 
activities for principals and other school leaders and 
encourages States to make use of this optional reservation so 
as to maximize the impact of the Title II-A program. The 
Committee directs the Department to encourage, through guidance 
or technical assistance, SEAs to utilize the school leader 
three percent Title II-A set-aside to better drive school 
improvement efforts.

Supplemental Education Grants

    The Committee recommends $16,699,000 for Supplemental 
Education Grants to the Federated States of Micronesia and the 
Republic of the Marshall Islands, which is the same as both the 
fiscal year 2020 enacted level and the fiscal year 2021 budget 
request. The Compact of Free Association Amendments Act of 2003 
(P.L. 108-188) authorizes these entities to receive funding for 
general education assistance.

Nita M. Lowey 21st Century Community Learning Centers

    The Committee recommends $1,262,673,000 for Nita M. Lowey 
21st Century Community Learning Centers, $13,000,000 more than 
the fiscal year 2021 enacted level. The fiscal year 2021 budget 
request proposes to eliminate this program. Funds are awarded 
by formula to States, which in turn distribute funds on a 
competitive basis to local school districts, nonprofit 
organizations, and other public entities.
    The Committee notes that only one in three 21st Century 
Community Learning Centers grant applications is awarded, 
reflecting substantial unmet demand for these opportunities. 
The $13,000,000 increase over fiscal year 2020 will help 
communities providing afterschool programs serve 15,600 more 
students than in fiscal year 2020.

State Assessments

    The Committee recommends $378,000,000 for State 
Assessments, which is the same as the fiscal year 2020 enacted 
level and $8,900,000 more than the fiscal year 2021 budget 
request. Funds are available to develop and implement academic 
standards and assessments. The program includes a set-aside for 
audits to identify and eliminate low-quality or duplicative 
assessments.

Education for Homeless Children and Youth

    The Committee recommends $102,650,000 for the Education for 
Homeless Children and Youth program, which is $1,150,000 more 
than the fiscal year 2020 enacted level. The 2021 budget 
request proposes to eliminate this program. Grants are 
allocated to States in proportion to the total each State 
receives under the Title I program.

Training and Advisory Services

    The Committee recommends $6,575,000 for Training and 
Advisory Services authorized by Title IV-A of the Civil Rights 
Act, which is the same as both the fiscal year 2020 enacted 
level and the fiscal year 2021 budget request. Title IV-A 
authorizes technical assistance and training services for 
school districts to address problems associated with 
desegregation on the basis of race, sex, or national origin. 
The Department awards three-year grants to regional Equity 
Assistance Centers (EACs) located in each of the 10 Department 
of Education regions. The EACs provide services to school 
districts upon request. Typical activities include 
disseminating information on successful education practices and 
legal requirements related to nondiscrimination on the basis of 
race, sex, and national origin in educational programs.

Education for Native Hawaiians

    The Committee recommends $37,897,000 for the Education for 
Native Hawaiian program, which is $1,000,000 more than the 
fiscal year 2020 enacted level. The fiscal year 2021 budget 
request proposes to eliminate this program. Funds are used to 
provide competitive awards for supplemental education services 
to the Native Hawaiian population.
    The Committee recognizes that teacher shortages and related 
issues of poor recruitment, attrition, and retention 
disproportionately impact rural, impoverished, and urban 
communities, including those regions with a high population of 
Native Hawaiian students. Stronger pathways are needed between 
the K-12 school system and postsecondary institutions to 
support Native Hawaiian education by recruiting more 
underrepresented students to become teachers, increasing 
production of teachers through teacher pre-service programs, 
providing work-related growth and advancement for educators, 
and supporting coordinated mentorship, coaching, and induction 
processes. The Committee encourages the Department to foster 
stronger educational pathways between the K-12 school system 
and postsecondary institutions to improve teacher recruitment, 
training, and retention in the area of Native Hawaiian 
education.

Alaska Native Education Equity

    The Committee recommends $35,953,000 for the Alaska Native 
Education Equity program, which is the same as the fiscal year 
2020 level. The fiscal year 2021 budget request proposes to 
eliminate this program. Funds are used to provide competitive 
awards for supplemental education services to the Alaska Native 
population.

Rural Education

    The Committee recommends $186,840,000 for Rural Education 
programs, which is $1,000,000 more than the fiscal year 2020 
enacted level. The fiscal year 2021 budget request proposes to 
eliminate this program. There are two dedicated programs to 
assist rural school districts with improving teaching and 
learning in their schools: the Small, Rural Schools Achievement 
program, which provides funds to rural districts that serve a 
small number of students; and the Rural and Low-Income Schools 
program, which provides funds to rural districts that serve 
concentrations of poor students, regardless of the number of 
students served by the district. Funds appropriated for Rural 
Education shall be divided equally between these two programs.
    The Committee recognizes that the Rural Education 
Achievement Programs Rural and Low-Income School grant program 
has provided vital funding to rural schools across the country 
to ensure that regardless of geographic location, every child 
can have an effective and comprehensive education. Therefore, 
any changes to the administration of the Rural and Low-Income 
School grant program should give schools losing grant funding 
previously received from the program a sufficient amount of 
time and guidance to pursue supplementary funding not less than 
one year.

Comprehensive Centers

    The Committee recommends $52,000,000 for Comprehensive 
Centers, which is the same as the fiscal year 2020 enacted 
level. The fiscal year 2021 budget request proposes to 
eliminate this program. The Comprehensive Centers program 
includes support for regional centers that provide training, 
technical assistance, and professional development to build 
State capacity to provide high-quality education to all 
students. The Committee notes the critical role Comprehensive 
Centers play in helping States vet evidence and strategies to 
implement ESEA and provide children with a high-quality 
education.

Student Support and Academic Enrichment State Grants

    The Committee recommends $1,220,000,000 for Student Support 
and Academic Enrichment (SSAE) State Grants, which is 
$10,000,000 above the fiscal year 2020 enacted level. The 
fiscal year 2021 budget request proposes to eliminate this 
program. SSAE grants provide SEAs and LEAs with flexible 
resources that provide students with access to a well-rounded 
education, including rigorous coursework, and improve school 
conditions and the use of technology.
    The Committee encourages the Department to work with States 
and school districts that serve diverse youth to explore using 
SSAE funding to support and create youth pipeline programs in 
the arts and entertainment industries. The Committee is aware 
of programs that focus on closing student opportunity gaps by 
bringing filmmakers into Title I schools to partner with 
teachers to expand access to the arts, implement social and 
emotional learning strategies, and support rigorous academic 
curricula. A 2019 evaluation by the Stanford Center for 
Assessment, Learning, and Equity found that such programs 
create a positive environment and learning community, promote 
active and social learning, provide in-depth instruction of 
vocabulary practices, and cultivate social and emotional 
learning competencies.
    The Committee supports efforts by States and LEAs to 
increase diversity in accelerated student learning programs, 
such as advanced placement courses, gifted and talented classes 
and honors programs. The Committee supports the use of ESEA 
funding to create State or local equity offices. Equity offices 
could evaluate current data on the students enrolled in 
accelerated student learning programs and use such data to 
inform recommendations to LEAs on how to improve the diversity 
of those programs. The Committee recognizes that Black, Latino, 
and Native students, students living in poverty, and English 
Learners are historically underrepresented in accelerated 
learning programs. Research shows that developing targeted 
recruitment and outreach plans, as well as universal screening 
for talented and gifted programs help address inequitable 
access that lock students out of opportunities that engage them 
more meaningfully in school and expand their postsecondary 
success.
    The Committee is concerned about the high rates of students 
who are chronically absent from school. The most recent 
statistics show that over seven million students in the 2015-
2016 school year were considered chronically absent. Studies 
have shown that chronic absenteeism hurts students' academic 
achievement and can lead to students dropping out of school. In 
the fiscal year 2022 Congressional Budget Justification, the 
Committee directs the Department to describe State-driven 
efforts to combat chronic absenteeism. The Department's 
description can include relevant analysis such as which factors 
contribute most to student chronic absenteeism, and 
recommendations for Federal, State, and local strategies to 
prevent and address chronic absenteeism. The Committee is 
interested in chronic absenteeism trends by subgroups such as 
by gender, race, ethnicity, homeless, foster, English Learner 
status, and geography. The Committee urges the Department to 
make clear to State and local education agencies that they may 
leverage SSAE funding to address chronic absenteeism.
    The Committee continues to note that SEAs and LEAs can use 
SSAE funds for activities that contribute to a well-rounded 
education, including supports for safe, culturally responsive 
classroom communities. The Committee also notes that SEAs and 
LEAs can use SSAE funds to support and expand school-based 
mental health services including but not limited to providing 
trauma-informed care and mindfulness meditation.
    The Committee notes that States and school districts may 
use funds available under the SSAE grant program to strengthen 
instruction in science, technology, engineering, arts, and 
mathematics (STEAM) fields, including computer science, and 
improve access to Pre-K-12 computer science and STEAM 
programming for underserved students, such as minorities, 
girls, and youth from families living at or below the poverty 
line. The Committee recognizes that supporting education in the 
STEAM fields, particularly computer science, is critical to 
ensuring that our nation continues to lead in innovation. As 
computer science is a basic skill in the 21st century global 
economy, the Committee intends for investments in Title IV-A to 
reduce the computer science enrollment and achievement gaps.
    The explanatory statement accompanying the Department of 
Education Appropriations Act, 2020, directed the Department to 
include in the fiscal year 2021 Congressional Budget 
Justification information about the Department's plans for 
using the two percent set-aside for technical assistance and 
capacity building for supporting SEAs and LEAs in carrying out 
authorized activities under the SSAE program. The Committee 
notes the Department provided limited information in the fiscal 
year 2021 Congressional Budget Justification about some of its 
plans for fiscal year 2019 funds. However, the Department has 
not been fully transparent about its plans, nor has it been 
clear about how technical assistance and capacity building 
funds directly support the technical assistance and capacity 
building needs of SEAs and LEAs. In fact, the Department has 
devoted approximately one-quarter of these funds for a new 
grant competition this year circumventing otherwise applicable 
rules regarding notice and comment procedures to support two to 
four grants to SEAs for course access programs that operate 
outside of LEAs and allow students to choose courses through 
State-identified course providers. Such a program does nothing 
to address the challenges SEAs identified in a study of SSAE 
released by the Department earlier this year but merely 
advances a privatization agenda.
    The Committee directs the Department to include in its 
fiscal year 2022 Congressional Budget Justification and each 
subsequent Congressional Budget Justification information on 
current and planned expenditures for the two percent set-aside 
for technical assistance and capacity building, and include a 
plan for how resources will be spent to build the capacity of 
SEAs and LEAs and provide technical assistance. The plan should 
include how resources will be spent helping SEAs and LEAs vet 
evidence, implement evidence-based interventions, and 
incorporate evidence-based SSAE activities into school 
improvement strategies.
    The Committee is supportive of SEA and LEA efforts to 
expand evidenced-based and scalable integrated student support 
systems by creating partnerships with existing school and 
community resources to deliver and track an individual tailored 
support plan for each student in a high-need school. The 
Committee notes that funds available under the SSAE grant 
program may be used to support such efforts, which can improve 
academic performance and graduation rates for students.

                            INDIAN EDUCATION

 
 
 
Appropriation, fiscal year 2020.......................      $180,739,000
Budget request, fiscal year 2021......................       180,739,000
Committee Recommendation..............................       181,239,000
    Change from enacted level.........................          +500,000
    Change from budget request........................          +500,000
 

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

Grants to Local Educational Agencies

    The Committee recommends $105,381,000 for Grants to Local 
Educational Agencies, which is the same as the fiscal year 2020 
enacted level and the fiscal year 2021 budget request. This 
program provides assistance through formula grants to school 
districts and schools supported or operated by the Bureau of 
Indian Education. The purpose of this program is to improve 
elementary and secondary school programs that serve American 
Indian students, including preschool children. Grantees must 
develop a comprehensive plan and ensure that the programs they 
carry out will help Indian students reach the same challenging 
standards that apply to all students. This program supplements 
the regular school program to help American Indian children 
sharpen their academic skills, bolster their self-confidence, 
and participate in enrichment activities that would otherwise 
be unavailable.
    In addition, the CARES Act (P.L. 116-136) included 
$153,750,000 for the Bureau of Indian Education to address the 
impact of COVID-19 on students.

Special Programs for Indian Children

    The Committee recommends $67,993,000 for Special Programs 
for Indian Children, which is the same as the fiscal year 2021 
enacted level and the fiscal year 2021 budget request. These 
programs make competitive awards to improve the quality of 
education for American Indian students. The program also funds 
the American Indian Teacher Corps and the American Indian 
Administrator Corps to recruit and support American Indians as 
teachers and school administrators.

National Activities

    The Committee recommends $7,858,000 for National 
Activities, which is $500,000 above the fiscal year 2020 
enacted level and the fiscal year 2021 budget request. The 
fiscal year 2021 increase to National Activities is directed to 
support the Department's Native American language immersion 
grant program.
    Within this account, funding is provided for grants to 
Tribes for education administrative planning, development, and 
coordination, grants to support Native language immersion 
schools and programs. Funds under this authority also support 
research, evaluation and data collection to provide information 
about the educational status of Indian students and the 
effectiveness of Indian education programs.

                       INNOVATION AND IMPROVEMENT

 
 
 
Appropriation, fiscal year 2020.......................    $1,103,815,000
Budget request, fiscal year 2021......................             - - -
Committee Recommendation..............................     1,074,815,000
    Change from enacted level.........................       -29,000,000
    Change from budget request........................    +1,074,815,000
 

    The Committee recommends $1,074,815,000 for programs within 
the Innovation and Improvement account.

Education Innovation and Research

    The Committee recommends $195,000,000 for the Education 
Innovation and Research (EIR) program, which is $5,000,000 
above the fiscal year 2020 enacted level. The fiscal year 2021 
budget request proposes to eliminate this program. This program 
makes competitive grants to support the replication and 
scaling-up of evidence-based education innovations.
    Within the total for EIR, the Committee recommendation 
includes $110,000,000 to provide new grants for the initiative 
in social and emotional learning (SEL) interventions and 
provide evidence-based, field-initiated innovations that 
address student social, emotional, and cognitive needs. The 
recently released National Commission on Social, Emotional and 
Academic Development report chronicles decades of research 
showing ``that the social, emotional, and cognitive dimensions 
of learning are deeply linked'' and that educating the whole 
student involves integrating and sustaining these dimensions 
throughout the day. In addition, a recent study by the 
Collaborative for Academic, Social, and Emotional Learning 
found that students who received SEL interventions showed 
lasting positive impacts on variables such as high school 
graduation rates and college attendance and lower likelihoods 
of being arrested or being diagnosed with a clinical mental 
health disorder. Further, RAND Corporation finds that there are 
at least 60 SEL interventions that have been evaluated and that 
meet the Every Student Succeeds Act (ESSA) evidence 
requirements.
    The Committee is encouraged by the robust, growing evidence 
base behind SEL strategies, trauma-informed services, and whole 
child approaches to learning, and makes funding for these 
interventions a top priority. Children across the country have 
been significantly impacted by disruptions related to COVID-19, 
including school closures. The increase to EIR in fiscal year 
2021 is intended to address these concerns and provide 
additional support for the SEL initiative, which can include 
trauma-informed practices and services within schools.
    Within 90 days of enactment of this Act, the Department is 
directed to brief the Committees on Appropriations on plans for 
carrying out the SEL competition. In addition, the Department 
shall provide notice to the Committees at least seven days 
before grantees are announced.
    As part of the SEL initiative, the Committee encourages the 
Department to investigate opportunities to consider previous 
work done by the CDC and the Association for Supervision and 
Curriculum Development who together helped develop an 
integrated model called Whole School, Whole Community, Whole 
Child. The Department is encouraged to consider how cross-
sector research collaboration and evidence-informed practice 
among researchers can provide informed implementation guidance 
relevant to all stakeholders. Nurses, psychologists and 
associated workers can have an important role in supporting 
students' emotional health as well as their physical health in 
school settings, and the Department is encouraged to explore 
supporting opportunities to promote such collaborations.
    In addition, within the total for EIR, the Committee 
recommendation includes $85,000,000 for States, school 
districts, and school-based afterschool programs to provide or 
strengthen instruction in STEAM fields, including computer 
science. In particular, these funds must be used by the 
Secretary to direct additional Pre-K-12 computer science and 
STEAM grants to underrepresented students such as minorities, 
girls, and youth from families living at or below the poverty 
line to help reduce the enrollment and achievement gap. 
Supporting education in the STEAM fields, particularly computer 
science, is critical to ensure that our nation continues to 
lead in innovation. As computer science is a basic skill in the 
21st century global economy, the Committee encourages the 
Department to support Pre-K-12 computer science education in 
schools across the country. Funds should also be used within 
these amounts to increase teacher training, proficiency, and 
knowledge of STEAM and computer science courses, with a 
particular interest in coding.
    Given the significant Federal investment in the EIR program 
(and its predecessor program, Investing in Innovation), the 
Committee directs the Department to take stronger steps to 
publicly release and widely publicize the research findings 
from this critical program. More specifically, the Department 
should post research findings on its own website and issue 
related press releases and Dear Colleague letters. The 
Department should also provide summaries of the research 
findings to the Committees on Appropriations. The Committee 
directs the Secretary to better showcase those programs that 
have demonstrated, through rigorous research as required by the 
ESEA, that their innovations show specific evidence of 
achievement in educational outcomes. The Department should also 
communicate any research findings that demonstrate successful 
outcomes to outside stakeholders, particularly chief State 
school officers and district superintendents. The Committee 
believes that publicizing these research findings will provide 
critical information for State governments, State and local 
education agencies, and others, particularly in unserved and 
underserved communities.
    The Committee is aware that certain criteria for evaluating 
EIR grants, such as the use of randomized control trials, are 
more difficult for rural-based applicants to successfully 
fulfill. The Committee requests that the Department consider 
additional assistance for rural applicants in fulfilling 
evaluation requirements in future grant competitions.
    The Committee is aware that the Department has excluded 
nonprofit institutions of higher education from participation 
in grant opportunities depending on their category of 
eligibility for a tax exemption. The Committee encourages the 
participation of all nonprofit institutions of higher education 
regardless of the category of its tax-exempt designation.
    The Committee strongly opposes the Department's misguided 
efforts to fund EIR grants using its proposed Teacher-Directed 
Professional Learning Experiences priority. So much is already 
asked of our teachers who serve as instructional experts, 
counselors, and confidants for our nation's students. Asking 
teachers to navigate an uncharted, unregulated teacher 
professional development market is unreasonable and unwise. The 
Committee is concerned about the quality of the unvetted 
resources available to teachers online through popular 
websites. Reviewers in a recent Fordham Institute report found 
that most of these available materials are ``mediocre'' or 
``probably not worth using.'' A better approach would be 
providing school districts with resources to invest in high-
quality, evidence-based professional development experiences. 
The EIR program is capable of doing so much more, and the 
Committee is disappointed to learn the Department is wasting 
taxpayer dollars on dubious approaches to teacher development.

Teacher and School Leader Incentive Grants

    The Committee recommends $200,000,000 for the Teacher and 
School Leader Incentive Grants program, which is the same as 
the fiscal year 2020 enacted level. The fiscal year 2021 budget 
request proposes to eliminate this program. This program 
provides grants to States, school districts, and partnerships 
to develop, implement, improve, or expand human capital 
management systems or performance-based compensation systems in 
schools.

American History and Civics Academies

    The Committee recommends $2,315,000 for American History 
and Civics Academies, which is $500,000 more than the fiscal 
year 2020 enacted level. The fiscal year 2021 budget request 
proposes to eliminate this program.

American History and Civics National Activities

    The Committee recommends $3,500,000 for American History 
and Civics National Activities, which is $500,000 more than the 
fiscal year 2020 enacted level. The fiscal year 2021 budget 
request proposes to eliminate this program.
    The Committee supports efforts by school districts that are 
home to populations of Latino students to ensure public schools 
reflect the diversity of their districts, which may extend to 
the naming of schools to highlight the achievements of Latinos.

Supporting Effective Educator Development

    The Committee recommends $80,000,000 for the Supporting 
Effective Educator Development (SEED) grant program, which is 
the same as the fiscal year 2020 level. The fiscal year 2021 
budget request proposes to eliminate this program. SEED 
provides competitive grants to support alternative 
certification and other professional development and enrichment 
activities for teachers, principals, and other school leaders. 
Funds are included to fully support continuation costs for 
grants made in prior years.
    The Committee is supportive of the Department's competitive 
preference priority for SEL in the fiscal year 2020 SEED 
competition and directs the Department to include the 
competitive preference priority in any new SEED competition in 
fiscal year 2021.
    The Committee recognizes the positive impact SEL has on 
academic performance, classroom behavior, and student well-
being. But studies have also shown that SEL school-based 
programs are more effective when they are supported by parent 
and family involvement. The Committee encourages the Department 
to support grantees that develop and implement teacher and 
school leader training programs on family engagement to 
increase the capacity of new and existing teachers and school 
leaders to work with families to collaboratively develop and 
support the social and emotional skills, habits, and mindsets 
of children. Efforts to promote family engagement could provide 
instruction of research-based, social and emotional skills, 
habits, and mindsets through locally relevant materials that 
increase the SEL competencies and capacities of teachers, 
school leaders, and families. Such efforts could also provide 
teacher and school leader training and professional development 
on strategies to engage families and collectively support the 
development of the social and emotional skills, habits, and 
mindsets of families.
    Further, the Committee directs the Department to ensure 
that SEED grants are awarded to a diverse set of eligible 
entities, including national nonprofit organizations 
implementing evidence-based activities (as defined in section 
8101(21)(A)(i) of the ESEA) across a number of sites which can 
help bring to scale evidence-based programs of national 
significance across the country.
    In addition, the Committee encourages the Department, 
through the SEED program, to fund projects that increase the 
number of teachers with computer science certifications with a 
priority to increase the number of such teachers in rural 
public schools and public schools serving high percentages of 
Native students.
    The Committee encourages the Department to ensure that SEED 
grants are awarded to a diverse set of eligible entities, 
including Historically Black Colleges and Universities and 
other Minority Serving Institutions that have a focus on 
improving teacher diversity and educational outcomes in urban 
or underserved communities.
    The Committee recognizes the vital role in preparing 
educators so that all students have access to high-quality STEM 
learning opportunities. The Committee further recognizes the 
value in a diverse STEM teacher pipeline and encourages efforts 
to increase women in STEM teacher positions.
    The Committee supports improving civic education in the 
U.S. to ensure students understand the Declaration of 
Independence, the U.S. Constitution, the Bill of Rights, and 
other founding and foundational documents including the 
Emancipation Proclamation. The Committee is aware that teacher 
subject matter expertise is a factor in student achievement. 
Accordingly, within SEED, the Department is encouraged to 
support evidence-based professional development that helps 
elementary and secondary educators increase civic knowledge of 
principles included in the U.S.'s founding and foundational 
documents.

Charter Schools Grants

    The Committee recommends $400,000,000 for Charter School 
Program (CSP) Grants, which is $40,000,000 below the fiscal 
year 2020 enacted level. The fiscal year 2021 budget request 
proposes to eliminate this program.
    CSP awards grants to SEAs or, if a State's SEA chooses not 
to participate, to charter school developers to support the 
development and initial implementation of public charter 
schools. State Facilities Incentive Grants and Credit 
Enhancement for Charter School Facilities awards help charter 
schools obtain adequate school facilities. These programs work 
in tandem to support the development and operation of charter 
schools.
    The Committee requests GAO to provide a report to the 
Committees on Appropriations on the Department's oversight over 
CSP and whether the program is being implemented effectively 
among grantees and subgrantees. The report should include an 
analysis of CSP grant amounts over time that supported charter 
schools, with a particular focus on schools that eventually 
closed or received funds but never opened; the relationships 
between charter schools supported by CSP grants and charter 
management organizations; and an analysis of enrollment 
patterns at these schools, especially for students with 
disabilities. The report should examine ways to improve the 
Department's oversight of CSP as well as make recommendations 
on potential legislative changes to the program that would 
reduce the potential for mismanagement and ineffective 
operations.
    Further, the Committee supports efforts by the Department's 
Office of Inspector General (OIG) to examine grantee 
administration of Replication and Expansion Grants, including 
charter management organization grantees. The Committee also 
supports the OIG's efforts to evaluate whether the Department 
adequately monitored grantees' performance and uses of funds 
for CSP competitions.

Magnet Schools Assistance

    The Committee recommends $109,000,000 for the Magnet 
Schools Assistance program, which is $2,000,000 more than the 
fiscal year 2020 enacted level. The fiscal year 2021 budget 
request proposes to eliminate this program. This program makes 
competitive grants to support the establishment and operation 
of magnet schools that are a part of a court-ordered or 
Federally-approved voluntary desegregation plan.
    The Committee encourages the Department to prioritize 
Magnet School Assistance applications that are paired with 
Department of Housing and Urban Development Choice 
Neighborhoods planning or implementation grants.
    The Supreme Court's landmark 1954 ruling in Brown v. Board 
of Education declared separate but equal public schools to be 
unconstitutional. Yet, according to a 2016 GAO audit, public 
education is more segregated by race and class than at any time 
since 1960. The Committee is concerned by the resegregation of 
public schools and believes that the 2015 enactment of ESSA 
presents a valuable opportunity to support State and school 
district efforts to improve student diversity as a means of 
achieving equity of educational opportunity. Further, the 
evidence base in support of increasing student diversity as a 
means of school improvement is extensive, which is why the 
Committee continues to support the Magnet School Assistance 
program.
    The Committee recognized a longstanding barrier to the 
implementation of this work in the Department of Education 
Appropriations Act, 2019, when it removed two decades-old 
prohibitions on the use of Federal funds for transportation 
costs to carry out school desegregation efforts. However, the 
Committee recognizes that barriers to this work persist due to 
Section 426 of the General Education Provisions Act. It is 
concerning to the Committee that such legislative language has 
remained in place since 1974 as an obstacle when many school 
districts are working voluntarily to promote racial and 
economic integration for the benefit of their children and 
communities. Therefore, new bill language is included to rid 
the Federal code of this outdated prohibition.

Ready to Learn Programming

    The Committee recommends $30,000,000 for Ready to Learn 
Programming, which is $1,000,000 more than the fiscal year 2020 
enacted level. The fiscal year 2021 budget request proposes to 
eliminate this program. This program supports the development 
and distribution of educational video programming for preschool 
and elementary school children and their parents, caregivers, 
and teachers.

Arts in Education

    The Committee recommends $31,000,000 for Arts in Education, 
which is $1,000,000 more than the fiscal year 2020 level. The 
fiscal year 2021 budget request proposes to eliminate this 
program. This program provides competitive grants to support 
professional development and the development of instructional 
materials and programming that integrate the arts into the 
curricula.

Javits Gifted and Talented Education

    The Committee recommends $14,000,000 for the Javits Gifted 
and Talented Education Program, which is $1,000,000 more than 
the fiscal year 2020 enacted level. The fiscal year 2021 budget 
request proposes to eliminate this program. Funds are awarded 
through grants and contracts to States, schools districts, and 
other organizations to support a coordinated program of 
research, demonstration projects, innovative strategies, and 
other activities to help schools identify gifted and talented 
students and address their unique educational needs.
    The Committee encourages the Department to use funds to 
increase the number of grants that assist schools in the 
identification of, and provision of services to, gifted and 
talented students who may not be identified and served through 
traditional assessment methods, such as children with 
disabilities, English learners, children of color, and 
economically disadvantaged students.

Statewide Family Engagement

    Centers The Committee recommends $10,000,000 for the 
Statewide Family Engagement Centers program, which is the same 
as the fiscal year 2020 enacted level. The fiscal year 2020 
budget request proposes to eliminate the program. Funds are 
awarded through grants to organizations to provide technical 
assistance and training to State and local educational agencies 
in the implementation and enhancement of systemic and effective 
family engagement policies, programs, and activities that lead 
to improvements in student development and academic 
achievement.

                 SAFE SCHOOLS AND CITIZENSHIP EDUCATION

 
 
 
Appropriation, fiscal year 2020.......................      $210,000,000
Budget request, fiscal year 2021......................             - - -
Committee Recommendation..............................       218,000,000
    Change from enacted level.........................        +8,000,000
    Change from budget request........................      +218,000,000
 

    The Committee recommends a total of $218,000,000 for 
activities to promote safe schools, healthy students, and 
citizenship education, which is $8,000,000 more than the fiscal 
year 2020 enacted level and $218,000,000 more than the fiscal 
year 2021 budget request.

Promise Neighborhoods

    The Committee recommends $82,000,000 for Promise 
Neighborhoods, which is $2,000,000 more than the fiscal year 
2020 enacted level. The fiscal year 2021 budget request 
proposes to eliminate this program. Promise Neighborhoods 
supports grants to nonprofit, community-based organizations for 
the development of comprehensive neighborhood programs designed 
to combat the effects of poverty and improve educational 
outcomes for children and youth, from birth through college.

School Safety National Activities

    The Committee recommends $106,000,000 for School Safety 
National Activities, which is $1,000,000 more than the fiscal 
year 2020 enacted level. The fiscal year 2021 budget request 
proposes to eliminate this program. The Committee's 
recommendation provides up to $5,000,000 for the Project School 
Emergency Response to Violence (Project SERV) program.
    In addition, the CARES Act (P.L. 116-136) included 
$100,000,000 for Project SERV to help elementary and secondary 
schools and institutions of higher education respond to the 
immediate needs of COVID-19 and the effect on students.
    Within School Safety National Activities, the Committee 
includes sufficient funding to continue the Mental Health 
Demonstration Grant and the Mental Health Personnel Grant 
competition, first initiated by the Committee in fiscal year 
2020, to increase the number of well-trained school counselors, 
social workers, and psychologists, or other mental health 
professionals qualified to provide school-based mental health 
services.
    The Project SERV program provides counseling and referral 
to mental health services as well as other education-related 
services to LEAs and IHEs in which the learning environment has 
been disrupted by a violent or traumatic crisis. The Committee 
directs the Department to report to the Committees on 
Appropriations within 180 days of enactment of this Act on how 
fiscal years 2017, 2018, 2019 and 2020 grant recipients used 
Project SERV funds; recommendations from grant recipients on 
how the program could be improved; and, information on how 
these funds helped them recover from a violent or traumatic 
crisis.
    The Committee is concerned about the possible mental, 
emotional, and behavioral health effects on students and staff 
resulting from lockdown drills and active shooter drills 
conducted in elementary and secondary schools. In response, the 
Committee provides $1,000,000 for the Department to enter into 
an agreement with the National Academies of Sciences, 
Engineering, and Medicine (National Academies) under which the 
National Academies will conduct a study to assess the science 
on the potential mental, emotional, and behavioral health 
effects of firearm violence prevention activities on students 
and staff in elementary and secondary school settings. The 
study and subsequent report should include an analysis of the 
effects of active shooter simulations, full-scale lockdowns, 
secured-perimeter lockouts, and other school security measures 
(e.g. metal detectors, visibility of police/policing on campus) 
and their mental, emotional and behavioral consequences. The 
assessment should review the potential effects on children and 
youth of different ages and on students with disabilities. The 
National Academies report should identify practices and 
procedures that can minimize any adverse mental, emotional, and 
behavioral health effects on children, youth, and staff in 
elementary and secondary schools resulting from the drills and 
make recommendations where appropriate.
    The Committee encourages the Department to continue to 
operate grants and technical assistance that support LEA and 
school building efforts to promote a safe, supportive, and 
positive school climate. This includes initiatives such as 
implementing effective discipline strategies such as positive 
behavior interventions and supports and restorative practices; 
improving access to comprehensive mental health services; 
fostering positive relationships; and, anti-bullying 
initiatives and efforts to reduce school violence. A positive 
school climate is the cornerstone to a safe and supportive 
school environment, and the Committee encourages the Department 
to continue efforts to promote proactive and evidence-based 
efforts to foster a positive school climate that benefits all 
students, as opposed to simply attempting to stop rare acts of 
school violence.

Full-Service Community Schools

    The Committee recommends $30,000,000 for Full-Service 
Community Schools, which is $5,000,000 more than the fiscal 
year 2020 level. The fiscal year 2021 budget request proposes 
to eliminate this program. This program makes competitive 
grants to support school-based comprehensive services for 
students, families, and communities. The Full-Service Community 
Schools program, which supports evidence-based models to meet 
the holistic needs of children and families, is part of the 
Committee's continued initiative to provide resources for SEL. 
The Committee is also encouraged by research that shows 
comprehensive community schools as a strategy that can improve 
educational quality and equity for students from diverse 
backgrounds. Therefore, the Committee urges the Department to 
provide technical assistance to SEAs and LEAs that are 
interested in leveraging Full-Service Community Schools grants 
to meet local school improvement needs.

                      ENGLISH LANGUAGE ACQUISITION

 
 
 
Appropriation, fiscal year 2020.......................      $787,400,000
Budget request, fiscal year 2021......................             - - -
Committee Recommendation..............................       797,400,000
    Change from enacted level.........................       +10,000,000
    Change from budget request........................      +797,400,000
 

    This program provides formula grants to States to serve 
Limited English Proficient (LEP) students. Grants are based on 
each State's share of the National LEP students and recent 
immigrant student population. Funds under this account also 
support professional development to increase the pool of 
teachers prepared to serve LEP students as well as evaluation 
activities. The bill continues language to calculate all State 
awards based on a three-year average of data from the American 
Community Survey.
    The Committee recommends $797,400,000 for English Language 
Acquisition (ELA) in fiscal year 2021, which is $10,000,000 
above the fiscal year 2020 enacted level. The fiscal year 2021 
budget request proposes to eliminate this program.
    The Committee understands that the nation's English learner 
(EL) student population is rapidly growing and becoming more 
diverse. The Committee is deeply concerned by the academic 
achievement gap that persists between ELs and their peers and 
understands that addressing this challenge has been difficult 
for many States. These States rely on Federal technical 
assistance in crafting and administering their State and local 
plans under Title III of the ESEA, and the Committee recognizes 
the need to provide them with timely, accurate guidance. The 
Office of English Language Acquisition (OELA) already 
disseminates research and resources for teaching ELs and has 
the expertise needed to provide this guidance to States. 
Therefore, the Committee directs all assistance duties required 
under section 6823(f) of the ESEA to be conducted by OELA.
    The Committee is supportive of the Department's ongoing 
activities to study uses of funds for the ELA program, 
effective practices for ELs, professional development for 
teachers of ELs, and how teacher residency programs impact ELs. 
The Committee is also supportive of the Department's efforts to 
publish more detailed outcomes for EL students; however, the 
Committee notes that the Department does not currently collect 
outcome data for EL students by all ethnic and racial 
subgroups. The Committee strongly urges the Department to 
consider collecting disaggregated outcomes data to present a 
more complete picture of academic achievement for diverse ELs.
    The Committee is concerned by the quality and availability 
of data for EL students on State report cards as required under 
ESEA and directs the Department to develop a plan to ensure 
States are clearly presenting required data elements for EL 
students in fiscal year 2021 and subsequent years. The 
Department is directed to share its plan with the Committees on 
Appropriations and provide a briefing within 270 days of 
enactment of this Act. In particular, the Committee is 
concerned about data for former EL students and urges the 
Department to address gaps and collect more complete 
information for this subgroup. The Committee directs the 
Department to report on its progress in responding to this 
request in the fiscal year 2022 Congressional Budget 
Justification.
    The Committee is aware that children and youth who relocate 
from the U.S. territory of Puerto Rico, where Spanish is the 
primary language of instruction, to one of the 50 States or the 
District of Columbia are not counted in the statutory formula 
used to make English Language Acquisition allotments to States, 
set forth in section 3111(c) of the ESEA.

                           SPECIAL EDUCATION

 
 
 
Appropriation, fiscal year 2020.......................   $13,885,228,000
Budget request, fiscal year 2021......................    13,985,228,000
Committee Recommendation..............................    14,092,995,000
    Change from enacted level.........................      +207,767,000
    Change from budget request........................      +107,767,000
 

    Of the total amount available, $4,553,979,000 is available 
for obligation on July1, 2021, and $9,283,383,000 is available 
for obligation on October 1, 2021. These grants help States and 
localities pay for a free, appropriate education for students 
with disabilities aged 3 through 21.

Grants to States

    This program provides formula grants to assist States in 
meeting the costs of providing special education and related 
services to children with disabilities. States generally 
transfer most of the funds to LEAs; however, they can reserve 
some funds for program monitoring, technical assistance, and 
other related activities. In order to be eligible for funds, 
States must make free appropriate public education available to 
all children with disabilities.
    The Committee recommends $12,957,892,000 for Part B Grants 
to States, which is $193,500,000 more than the fiscal year 2020 
enacted level and $93,500,000 above the fiscal year 2021 budget 
request. The Committee is concerned that the Federal share of 
the excess cost of educating students with disabilities has 
declined and notes the critical role increased funding plays in 
helping to reverse this trend.
    The Committee encourages the Department to address the 
unique needs of students who use American Sign Language (ASL). 
The Committee directs the Department to assess the needs of, 
and identify ways to better serve, students who use ASL and to 
share findings with the Committee in the fiscal year 2022 
Congressional Budget Justification.

Preschool Grants

    The Committee recommends $397,620,000 for Preschool Grants, 
which is $3,500,000 more than the fiscal year 2020 enacted 
level and the fiscal year 2021 budget request. These funds 
provide additional assistance to States to help them make free, 
appropriate public education available to children with 
disabilities ages 3 through 5.

Grants for Infants and Families

    The Committee recommends $481,850,000 for Grants for 
Infants and Families, which is $4,850,000 above the fiscal year 
2020 enacted level and the fiscal year 2021 budget request. 
These funds provide additional assistance to States to help 
them make free, appropriate public education available to 
children with disabilities from birth through age 2.
    The Committee recommendation includes new bill language to 
clarify that States may use funds to support subgrants to non-
profit and other organizations for State activity work under 
IDEA Part C.

IDEA National Activities

    The Committee recommends $255,633,000 for the IDEA National 
Activities program, which is $5,917,000 more than the fiscal 
year 2020 enacted level and the fiscal year 2021 budget 
request. The IDEA National Activities programs support State 
efforts to improve early intervention and education results for 
children with disabilities.
    Educational Technology, Media, and Materials.--The 
Committee recommends $29,547,000 for Educational Technology, 
Media, and Materials, which is the same as the fiscal year 2020 
enacted level and the fiscal year 2020 budget request. This 
program makes competitive awards to support the development, 
demonstration, and use of technology and educational media 
activities of educational value to children with disabilities.
    The Committee continues to recognize the ongoing progress 
made with the tools and services provided under this program 
that have allowed more than 620,000 students with disabilities 
free access to more than 700,000 books in digitally accessible 
formats. The Committee strongly encourages continued effort to 
expand this program's reach to K-12 students in underserved 
areas.
    Parent Information Centers.--The Committee recommends 
$27,411,000 for Parent Information Centers, which is the same 
a